Samy Alsirafy

From 2000 to 2007, 11,793 cancer patients received treatment in Kuwait. Non-Kuwaitis accounted for 6,016 (51%) patients. They came from 68 countries, mainly from the World Health Organization Eastern Mediterranean (59%) and South-East Asian (20%) regions. The majority (69%) was from low- and low-middle income countries. Thirty-seven percent were from non-Arabic speaking countries. To provide culturally-competent care for expatriate patients, there is a need to explore the impact of their ethnic, sociocultural, economic, language diversity, and expatriation-related stressors on different aspects of cancer care.

Neoplastic fever (NF) is a paraneoplastic syndrome that is encountered in a significant proportion of patients with cancer. We present the case of a 37 year old female with matastatic renal transitional cell carcinoma. She was hospitalized with fever, constitutional symptoms, and worsening performance status. There was no identifiable infection source. In the third week of hospitalization, she was started on naproxen, resulting in complete lysis of fever, control of constitutional symptoms and improvement in performance status. She was discharged the next day and died of advanced disease within two months. Workup of NF can lead to unnecessary and prolonged hospitalization in patients near the end of their life, resulting in significant suffering. While it is important to rule out infection, an early trial of naproxen is inexpensive and, in patients who can tolerate NSAIDs, may provide good control for NF.

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Introduction: During this early stage of development of palliative care (PC) in Egypt, research is warranted to identify PC needs of advanced cancer patients and to develop suitable PC models. One of the PC models is the hospital-based inpatient palliative care unit (HB-IPCU). This report describes causes of admission to a new HB-IPCU in an Egyptian cancer center.
Methods: We retrospectively reviewed 70 admissions related to 61 advanced cancer patients admitted to HB-IPCU from June, 2009 to end of January, 2010. Primary end point was determination of main causes of hospital admissions for palliative care, while secondary end points were the principal lines of palliative treatment and average length of hospital stay.
Results: Median age was 50 years (range, 27-76 years). Female admissions constituted 66% of all admissions. Average period from date of first presentation to PC unit till admission was 28 days (range, 0-90 days). Average length of stay was 6 days (range, 1-22 days). Median number of problems listed upon admission was three (range, 1-5). Uncontrolled pain, vomiting, dehydration, fever were the most common problems and constituted 66%, 31%, 23% and 23% respectively. Other problems included severe anaemia, constipation, respiratory distress, venous thrombo-embolism, bleeding, electrolytes disturbances, and renal impairment. In 74% of admissions, opioids were used to control pain. Other lines of treatment included infection management, blood transfusion, anticoag-ulation and parenteral hydration.
Conclusion: Pain was the main cause of admission to HB-IPCU in our setting. In Egypt, many barriers exist to cancer pain control including immediate release morphine unavailability and restrictive regulations. An immediate action is needed to overcome these barriers. Many of the listed problems could be managed at home to avoid unnecessary hospitalization. Our results provide provisional guidance for future PC development in our center and similar settings in Egypt.

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We conducted this study to describe the symptom burden among hospitalized patients with cancer in a Kuwaiti cancer center. Twenty physical symptoms were assessed in 45 patients with cancer. The majority (82%) of patients had an advanced incurable cancer and 42% were receiving best supportive care only. The median number of symptoms per patient was 6.4 ± 2.8. The most common symptoms were pain (82%), weakness/fatigue (80%), anorexia (67%), weight loss (49%), and dyspnea (42%). Pain was the most distressing symptom in 31% of patients, followed by dyspnea (24%) and weakness/fatigue (11%). The high prevalence of advanced disease and the demonstrated high symptom burden mandate the initiation and development of culturally sensitive palliative care models, especially hospital-based ones, to relieve the suffering of patients with cancer in Kuwait.

{This report describes the death place of patients with advanced cancer referred to an Egyptian palliative care program over 1 year. Of 79 patients included, 73% died at home and 27% in hospital or ambulance. Patients who were visited by a palliative care physician at home were significantly more likely to die at home compared to those who did not (92% vs 64%

Hypercalcemia is common in patients with advanced head and neck squamous cell carcinoma (HNSCC). In this study, hypercalcemia was detected in 46 (51%) of 90 eligible patients with HNSCC over 4 years. Compared with nonhypercalcemics, hypercalcemics were more likely to be referred to palliative care, while they were inpatients (P = 0.004). During the last 3 months of follow-up, hypercalcemic patients were more likely than nonhypercalcemics to be hospitalized for ≥ 14 days (P = 0.01) and to visit the emergency room more than once (P = 0.04). The median survival from the first hypercalcemic episode was 74 days (95% CI, 0.234). With data calculated from the date of referral to palliative care, hypercalcemics had a shorter survival than did nonhypercalcemics (43 vs 128 days, respectively; P = 0.046). Early detection and management of hypercalcemia in patients with HNSCC may improve the chance of preventing distressing symptoms and reducing unnecessary frequent emergency room visits and lengthy hospitalization.

The few palliative care programs available to date in Saudi Arabia are largely hospital-based. Subacute palliative care models have not been developed yet. This retrospective review was conducted to assess the patterns and outcomes of hospital-based palliative care unit admissions in the absence of subacute palliative care models. We reviewed 759 eligible palliative care unit admissions related to 629 cancer patients during a 4-year period. Of all admissions, 66% were hospitalized through the emergency room. The average hospital stay was 24 days. The majority (86%) of patients died in-hospital. These results suggest that end-of-life quality indicators are unlikely to improve depending on hospital-based palliative care models only. To improve palliative care services in Saudi Arabia, other subacute models may need to be considered.