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2022
Abdel-Hafeez A, Abdel-Aziz HI, Hassan A, et al. "Diagnosis Disclosure Preferences of Cancer Patients in Egypt: A Multi-Institutional Cross-Sectional Study." American Journal of Hospice and Palliative Medicine®. 2022;39:779-784. AbstractWebsite

Background:Although diagnosis disclosure to cancer patients has important roles in cancer care, it is not a routine practice in countries like Egypt. Respecting patients’ autonomy and responding to their preferences are among the factors that should guide the practice of cancer diagnosis disclosure.Objectives:To assess the preferences of Egyptian cancer patients regarding the disclosure of cancer diagnosis and to determine factors that may affect their preferences.Methods:The study included 295 patients aware of their cancer diagnosis from 3 cancer care facilities in Egypt. Patients were asked if they would have preferred to be informed of the diagnosis or not, whom they would have preferred to receive the diagnosis information from, and if they would have preferred to tell their families or not.Results:The vast majority (91%) of the included patients preferred to be informed about their diagnosis, 59% preferred to disclose the diagnosis to their families and 66% preferred to receive the diagnosis information from a physician. In univariate analysis, male gender, higher education level and employment were significantly associated with the preference for disclosure. None of the studied variables associated significantly with the preferences in multivariate analysis.Conclusion:The majority of Egyptian cancer patients in our study preferred to be informed about their diagnosis, which should be respected. The results may help in changing the diagnosis disclosure practice of health care professionals and refuting the misconception of family caregivers about cancer diagnosis disclosure in Egypt and countries with similar culture.

Alsirafy SA, Abdel-Aziz HI, Abd El-Aal HH, El-Sherief WA, Farag DE. "Not Telling Patients Their Cancer Diagnosis in Egypt: Is It Associated With Less Anxiety and Depression and Better Quality of Life?" JCO Global Oncology. 2022:e2200080. AbstractWebsite

{ PURPOSEIn many countries, including Egypt, it is still believed that not telling patients their cancer diagnosis is associated with less psychological morbidity. This study was conducted to explore whether not telling Egyptian patients their cancer diagnosis is associated with less anxiety and depression and better quality-of-life (QoL) or not.METHODSA cross-sectional observational study was conducted in two Egyptian cancer care facilities and included 292 adult patients with cancer of whom 197 (67%) were aware of their diagnosis and 95 (33%) were unaware. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression and the Functional Assessment of Cancer Therapy-General 7 questionnaire to assess QoL.RESULTSPatients unaware of their cancer diagnosis were significantly more likely to be less educated, with no family history of cancer, interviewed within 6 months of cancer diagnosis, diagnosed with a cancer other than breast and colorectal cancer, in a poorer performance status, and with no history of anticancer treatment. There was no significant difference between unaware and aware patients in the scores of HADS-Anxiety (median [interquartile range (IQR)] = 6 [3-11] and 7 [4-11]

2021
Alsirafy SA, Nagy R, Hassan AD, et al. "Caregiver burden among family caregivers of incurable cancer patients in two eastern Mediterranean countries." BMC Palliat Care. 2021;20(1):163. Abstract

BACKGROUND: Although family caregivers (FCs) play an important role in the care provided to incurable cancer patients in our region, little is known about the burden they experience. This study was conducted to determine the prevalence of caregiver burden (CB) among FCs of incurable cancer patients in two Eastern Mediterranean countries and to identify factors that may be associated with significant CB.

METHODS: The study included 218 FCs, 165 from Egypt and 53 from Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess caregiver burden CB. Significant CB was defined as a ZBI-22 score ≥ 21. The assistance with basic ADLs was classified into 3 levels according to FCs' assistance with early/middle/late-loss basic ADLs. The relationship between CB and the assistance with ADLs and other factors was studied.

RESULTS: The mean (SD) ZBI-22 score among FCs was 23.4 (9.3) and the majority (128/218, 59%) had significant CB. Eighty-nine percent of FCs assisted with at least one basic ADL. Assistance with late-loss basic ADLs, best supportive care treatment plan and poorer performance status were associated with higher CB (p < 0.0001, =0.018 and = 0.005). However, in logistic regression analysis, only assistance with late-loss ADLs was independently associated with significant CB (OR = 3.4 [95%CI:1.2-9.7], p = 0.024).

CONCLUSION: A substantial proportion of FCs of incurable cancer patients in our region experience significant CB. Family caregivers assisting with late-loss basic ADLs are at risk of significant CB and should be routinely screened for CB.

Hunter CN, Abd El-Aal HH, Elsherief WA, Farag DE, Riad NM, Alsirafy SA. "Mirtazapine in cancer-associated anorexia and cachexia: A double-blind placebo-controlled randomized trial." Journal of Pain and Symptom Management. 2021. AbstractWebsite

CONTEXT: Few pharmacological interventions are available for cancer-associated anorexia and cachexia. Mirtazapine has been suggested for use in cancer-associated anorexia and cachexia.

OBJECTIVES: This study was conducted to assess the efficacy and tolerability of mirtazapine in cancer-associated anorexia and cachexia.

METHODS: A double-blind placebo-controlled randomized trial. The study included 120 incurable solid tumour patients with anorexia (appetite loss ≥4 on 0-10 scale, 10= maximum appetite loss), cachexia (>5% body weight loss over 6 months or >2% plus body mass index <20) and depression score ≤3 on 0-6 scale (6= extreme feelings of depression). Patients were 1:1 randomized to receive mirtazapine 15mg daily at night for 8 weeks or placebo. The primary endpoint was change in appetite from baseline to day 28. Other outcomes included changes in quality-of-life, fatigue, depressive symptoms, body weight, lean body mass, handgrip strength, inflammatory markers, adverse events and survival.

RESULTS: 48 (80%) patients in the mirtazapine arm and 52 (87%) in the placebo were assessable for the 1ry endpoint. Appetite score increased significantly with mirtazapine as well as with placebo (p<0.0001 each). The increase in appetite score did not differ significantly between the two arms in the per-protocol and intention-to-treat analysis (p=0.472 and 0.462, respectively). Mirtazapine was associated with significantly less increase in depressive symptoms and higher prevalence of somnolence. The change in other outcomes did not differ significantly between mirtazapine and placebo.

CONCLUSION: Mirtazapine 15mg at night for 28 days is no better than placebo in improving the appetite of incurable solid tumor patients with cancer-associated anorexia and cachexia.

2020
Saleh MA, Kassem L, Atteya H, Mousa M, Alsirafy S. "Changes in Perceived Social Support after Starting Treatment in Egyptian Patients with Operable Breast Cancer: A Longitudinal Observational Study." Tumori Journal. 2020;106:28. AbstractWebsite

Background:Social support (SS) has been proven to be associated with improved outcome of early breast cancer. Little is known about the magnitude of social support available for Egyptian breast cancer patient and much less is known about the changes that occur in such support after the diagnosis of breast cancer and starting treatment.

Methods:We designed a longitudinal questionnaire based prospective cohort study using the six item form of the Medical Outcomes Study- Social Support Survey (MOS-SSS) questionnaire and included patients with pathologically proven non-metastatic breast cancer 18-70 years of age. Patients completed the self administered questionnaire at 2 time points: at first diagnosis of breast cancer and after 3-6 months of starting treatment. Comparison of the pre and post treatment questionnaires was done using paired sample T test.

Results:A total of 48 patients completed the 2 questionnaires. Median age was 48 years (range: 24-65 years). Seventy percent of our patients were married, 67% had more than 2 children and 77.8% were housewives. Around half of the patients (45.2%) had monthly income below 1200 EGP. Patients who had higher education level (p=0.002) and those who were living in Cairo (p=0.033) reported higher SS at baseline. Mean MOS-SSS score at baseline was 64.4 (±24.8) while after treatment was 76.4 (±22.3); p<0.001. The increase in SS was consistent in most of the patient subgroups but was more prominent in illiterate patients compared to educated (p=0.033), those who work a handy job compared to housewife (p=0.04), and those who lived in Upper Egypt compared to Cairo residents (p=0.029).

Conclusion:The majority of Egyptian breast cancer patients had a supportive environment after the diagnosis of breast cancer. A special attention should be paid to the at-risk groups with no sufficient SS during that period.

Abdelhafeez AAM, Makady NF, Hafez O, Atallah CN, Alsirafy SA. "Reliability and validity of the Arabic translation of the palliative performance scale." Palliative & Supportive Care. 2020;18(5):575-579. AbstractWebsite

OBJECTIVE: The aim of this study was to translate the Palliative Performance Scale (PPSv2) into Arabic and to test the reliability and validity of the PPS Arabic translation (PPS-Arabic).

METHOD: The PPSv2 was translated into Modern Standard Arabic using a forward-backward method. Inter-rater and intra-rater reliabilities were tested in a pilot study that included 20 patients. The validation study included 150 cancer patients. Patients were divided according to their treatment plan into three groups (in-remission, palliative chemotherapy, and best supportive care) to perform hypothesis-testing construct validity. Validity was further evaluated by correlating PPS-Arabic with the Karnofsky Performance Scale (KPS), the Eastern Cooperative Oncology Group (ECOG) scale, and Physical Functioning (PF2) and Role Functioning (RF2) scales of the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30).

RESULTS: The intraclass correlation coefficients for the intra-rater and inter-rater reliability were 0.935 (95% CI: 0.88-0.965; p < 0.001) and 0.965 (95% CI: 0.934-0.981; p < 0.001), respectively. The PPS-Arabic internal consistency Cronbach's alpha was 0.986. The average PPS-Arabic score differed significantly (p < 0.001) between the three groups of patients being 89 for in-remission, 58 for palliative chemotherapy, and 38 for best supportive care. The PPS-Arabic score correlated significantly (p < 0.001) with the KPS, ECOG performance scale, and the EORTC QLQ-C30 PF2 and RF2 scales.

CONCLUSION: The PPS-Arabic is a reliable and valid tool for the assessment of performance status of cancer patients.

2019
Tawfik E, Abou El Kheir S, Alhassanin S, Gohar S, Harhash D, Alsirafy S. "The relation between the symptom burden of hospitalized patients with incurable cancer and the quality-of-life of their family caregivers." Annals of Oncology. 2019;30(Suppl 5):v661. AbstractWebsite

Background: Family caregivers (FCs) play important roles in the care provided to patients with incurable cancer. These patients experience a wide range of distressing symptoms. This symptom burden may add to the burden of FCs and consequently may have a negative impact on their quality of life (QoL).
Methods: This study was conducted to determine the relationship between the symptom burden in a cohort of patients with incurable cancer and the QoL of their FCs.The study included 94 dyads of hospitalized incurable cancer patients and one of their FCs. The symptom burden among patients was assessed using the revised Edmonton Symptom Assessment System (ESAS-r) and the QoL of their FCs was measured using the Medical Outcomes Study 36-Item Short-Form (MOS SF-36) questionnaire.
Results: Nausea was the most common symptom to associate with poorer QoL scores. There was a significant negative correlation between nausea and the following MOS SF-36 scales: physical functioning (r=-0.219, p = 0.034), role limitations due to physical health (r =-0.0228, p = 0.027), pain (r=-0.404, p \< 0.001), general health (r =-0.222, p = 0.031) and health change (r=-0.317, p = 0.002). Other symptoms that correlated significantly with at least one of the MOS SF-36 scales were weakness, drowsiness, lack of appetite, shortness of breath, depression and wellbeing. The total ESAS-r score correlated significantly with poorer scores on the pain (r=-0.248, p = 0.016) and health change (r=-0.311, p = 0.002) scales of MOS SF-36. In addition; older FCs age, hours of care per day, total period of care, FCs employment and inadequate income correlated significantly with poorer scores of at least one of the MOS SF-36 scales.
Conclusion: The high symptom burden experienced by patients with incurable cancer may have a negative impact on the QoL of their FCs, especially the physical aspect.

Hunter CN, Faheem DEED, El-Sherief WA, Abdel Aal HH, Alsirafy S. "{LBA86Mirtazapine in cancer-associated anorexia cachexia: A randomised, double-blind, placebo-controlled trial}." Annals of Oncology. 2019;30(Suppl 5):v923. AbstractWebsite

{The available options to manage cancer-associated anorexia-cachexia syndrome (CACS) are limited. At standard doses, the tetracyclic antidepressant mirtazapine causes appetite stimulation and weight gain. Based on limited evidence, it is used in cancer-associated anorexia. This trial was conducted to assess the efficacy and safety of mirtazapine in patients with CACS.A double-blind randomized placebo-controlled trial. Included patients were adults with advanced solid tumors, weight loss ≥5\%, appetite loss score ≥ 4 on 0 to 10 scale (10 = maximum appetite loss), and depression ≤3 on 0 to 6 scale (6 = extreme feelings of depression). Patients were randomized to receive mirtazapine 15 mg /day or placebo. The primary end-point was the change in appetite on a 0 to 10 appetite scale (where 10 is the best appetite possible) at week 4. Other assessed outcomes included changes in body weight, lean body mass, handgrip strength, depression (measured by the Hospital Anxiety and Depression Scale [HADS]), and quality of life (measured by Functional Assessment of Anorexia/Cachexia Therapy [FAACT] questionnaire).From 120 allocated patients, 100 completed 4 weeks treatment (48 in the mirtazapine arm and 52 in the placebo). After 4 weeks of treatment there was no significant difference between the two arms in the change from baseline in appetite or other outcome measures (Table 1). The change in the HADS depression score differed significantly in favour of mirtazapine. Sleepiness was significantly more prevalent in the mirtazapine arm (p = 0.01) and only one patient discontinued treatment due to excess sleepiness. Table: LBA86Change in outcome measures from baseline to day 28MirtazapinePlacebopMedian (Interquartile range)Appetite score2 (0-2)2 (0-2)0.401Body weight (kg)-0.8 (-1.5 – 0.9)-0.6 (-1.4 – 0.2)0.94Lean body mass (kg)-0.16 (-1.1 – 1.1)-0.37 (-1 – 0.4)0.411Handgrip strength (kg)-0.76 (-1.5 – 0.8)0 (-1 – 0.8)0.376FAACT Anorexia-cachexia scale4 (1 – 5.8)4 (0 – 6)0.997HADS Depression score1 (0.3 – 2)2 (1 – 2)0.022Compared to placebo, mirtazapine 15mg at night did not improve appetite, body weight, hand-grip strength or quality of life in advanced cancer patients with anorexia cachexia.NCT03254173.The authors.Cairo University.All authors have declared no conflicts of interest.}

Alsirafy SA, Hammad AM, Ibrahim NY, Farag DE, Zaki O. "Preferred Place of Death for Patients With Incurable Cancer and Their Family Caregivers in Egypt." American Journal of Hospice and Palliative Medicine. 2019;36(5):423-428. AbstractWebsite

Abstract
Background:
Little is known about the place of death of patients with cancer in Eastern Mediterranean countries including Egypt, where palliative care is underdeveloped. Identifying the preferred place of death (PPoD) is important for the development of appropriate palliative care models in these countries.

Objectives:
To know the PPoD of Egyptian patients with incurable cancer and their family caregivers (FCGs) and to determine the factors that may impact their preferences.

Methods:
An observational cross-sectional study that included 301 dyads of patients with incurable cancer and one of their FCGs. A questionnaire was designed to collect data about the characteristics of patients and FCGs as well as their preferences.

Results:
The majority of dyads (272/301, 90.4%) answered the PPoD question. Home was the PPoD in 93% of patients and 90.1% of FCGs (P = .218). The congruence between patients’ and FCGs’ PPoD was 92.7% (κ = 0.526). In multivariate analysis, poorer performance status (Eastern Cooperative Oncology Group 3 or 4) and full employment of FCGs associated significantly with patients’ preference to die in hospital (odds ratio [OR] = 3.015 [95% confidence interval [CI]: 1.004-9.054], P = .049 and OR = 4.402 [95% CI: 1.561-12.417], P = .005, respectively), while poorer performance status and nonreferral to the palliative medicine unit were associated with FCGs’ preference of hospital death (OR = 2.705 [95% CI: 1.105-6.626], P = .029 and OR = 2.537 [95% CI: 1.082-5.948], P = .032, respectively).

Conclusions:
The results of the current study suggest that home is the PPoD for the vast majority of Egyptian patients with incurable cancer and their FCGs. Palliative care interventions that promote home death of patients with incurable cancer are needed in Egypt.

Rezk-Allah SS, Elshafi HMA, Farid RJ, Hassan MAE, Alsirafy SA. "Effect of Low-Level Laser Therapy in Treatment of Chemotherapy Induced Oral Mucositis." Journal of Lasers in Medical Sciences. 2019;10:125-130. AbstractWebsite

Introduction: Oral mucositis (OM) is an unavoidable condition of the oral cavity that accompanies chemotherapy for various malignant cases. Chemotherapy-induced oral Mucositis (COM) is a frequent complication due to mucotoxic drugs and is known to deteriorate the general health significantly, while negatively affecting the quality of life (QOL). Studies have reported that low-level laser therapy (LLLT) promotes the tissue healing. The objective of the present study was to explore the efficacy of gallium-arsenide (GaAs) laser in treating COM and its impact on inflammatory cytokine levels in patients receiving chemotherapy for various malignancies.
Methods: A total of 80 patients with COM received LLLT 6 days/week. OM was graded according to the World Health Organization (WHO) grading scale. The outcome parameters were the serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) measured before, during and after administration of LLLT.
Results: After LLLT, a significant decrease was found in the mean values of mucositis grade from 2.35 ± 0.695 to 1.13 ± 0.333 after (P < 0.001). A significant reduction in the level of TNF-α was found after LLLT among breast cancer patients (P = 0.0045), but not in head and neck cancer and lymphoma patients. A significant reduction was also found in IL-6 level after treatment among head and neck and breast cancer patients (P = 0.0307 and 0.019, respectively).
Conclusion: The use of GaAs LLLT in treating COM in patients with various malignancies is well tolerated by patients, it results in improvement of mucositis, however; mechanism of action does not seem to be completely linked to the change of pro or anti-inflammatory cytokines.

Fawzy R, Abdel-Malek R, Metwaly M, Aziz AO, Alsirafy S, Seleem A. "Evaluation of target volume margins in prostate dose escalated VMAT by fiducial markers’ technique." Radiotherapy & Oncology. 2019;133(Suppl 1):S818.
Ahmed RFS, AbdelMalek RR, Metwaly M, Abdelaziz O, Alsirafy S, Seleem A. The impact of simultaneous dose escalation VMAT to the focal lesion micro boost of localized prostate cancer. . Chicago (IL), United States: Journal of Clinical Oncology; 2019.
ElBatrawi MA, May Gaber, Mekheimar SI, Alsirafy SA. "Pattern of referral to a consultation-liaison psychiatry service in an Egyptian cancer center." Egyptian Journal of Psychiatry. 2019;40(2):123-126.
Alsirafy S, Abdelhafeez A, Azab R. The pattern of tramadol use for cancer pain control in the absence of oral morphine in a lower-income setting.. Berlin, Germany: Palliative Medicine; 2019.
Hany RH, Saad E, Alsirafy S, Kader YA, Aly MAH, Abdelhady E. Quality of life assessment in dose escalating head and neck radiation therapy.. Chicago (IL), United States: Journal of Clinical Oncology; 2019.
Atallah C, Aal AH, El-Sherif W, Farag D, Abdelhafeez A, Alsirafy S. Should patients recruited in mirtazapine for anorexia trials be screened for depression?. Berlin, Germany: Palliative Medicine; 2019.
Alsirafy SA, Alabdullateef SH, Elyamany AM, Hassan AD, Almashiakhi M. "Transdermal fentanyl to parenteral morphine route switch and drug rotation in refractory cancer cachexia." BMJ supportive & palliative care. 2019. Abstract

It is recommended not to use transdermal fentanyl (Fe) patches (TFP) in cancer cachexia but TFP may be the only available option for pain. Limited evidence suggests lower Fe absorption from TFP in cachexia. We describe a case of metastatic breast cancer with refractory cachexia. Her pain was uncontrolled on TFP and was route switched and drug rotated to intravenous morphine (M). We were conservative and did not use the 1:100 TFP to oral M conversion ratio. Assuming opioid needs were similar before and after switch/rotation, the suitable conversion ratio in this case was about 1:25. Absent clear guidelines on converting from TFP in cachexia, it is better to avoid TFP. When essential to use TFP in cachexia, caution should be taken when switching from TFP to avoid overdose.

2018
Zayed HS, Amin A, Alsirafy S, et al. "Psychiatric and functional neuroimaging abnormalities in chronic hepatitis C virus patients: Is vasculitis a contributing factor?" Arab J Gastroenterol. 2018;19(2):71-75. Abstract

BACKGROUND AND STUDY AIMS: Central nervous system (CNS) involvement in hepatitis C virus (HCV) infection has different facets such as anxiety, depression, cognitive impairment and vasculitis. We were interested in detecting subclinical CNS involvement in chronic HCV infected subjects with and without systemic vasculitis.

PATIENTS AND METHODS: Nineteen patients (15 females and 4 males) with chronic HCV infection (mean age 46.5 ± 7 and mean duration since diagnosis of HCV infection 4.7 ± 4 years, including 6 (32%) Child-Pugh class A cirrhotic patients) and 30 age, sex and education matched healthy control subjects were studied. Thirteen patients had associated vasculitis. Patients and control subjects were assessed using the block design and comprehension subtests of Wechsler Bellevue Adult Intelligence Scale, Wechsler Memory scale (WMS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Brain HMPAO Single Photon Emission Computed Tomography (SPECT) was performed for HCV patients.

RESULTS: Patients with HCV had lower scores on the block design test compared to control subjects (8.37 ± 1.89 versus 10.37 ± 1.47, p < 0.001), lower total WMS scores (43.15 ± 10.49 versus 60.27 ± 8.08, p < 0.001) and higher anxiety and depression scores (16.94 ± 10.46 and 37.17 ± 10.38 versus 10.3 ± 4.67 and 28.9 ± 5.99, p = 0.004 and 0.001, respectively). Total WMS were lower in HCV patients with vasculitis compared to those without vasculitis (39.14 ± 9.3 versus 51.17 ± 8.3, p = 0.019) while the block design and comprehension tests, BAI and BDI were not significantly different between both groups. The block design and comprehension tests, WMS, BAI and BDI were not significantly different between cirrhotic and non-cirrhotic patients. Seven patients had different patterns of cerebral hypoperfusion on SPECT, and all of them had associated vasculitis. Abnormal SPECT was associated with lower total WMS scores (35.87 ± 10.8 versus 46.79 ± 8.6 in those with normal SPECT, p = 0.049).

CONCLUSIONS: Vasculitis may contribute to the development of neuropsychiatric involvement in HCV patients.

Centeno C, Sitte T, de Lima L, et al. "Documento de Posición Oficial sobre la Promoción Global de Cuidados Paliativos. Recomendaciones del Grupo Internacional Asesor PAL-LIFE de la Academia Pontificia de la Vida, Ciudad del Vaticano." Journal of Palliative Medicine. 2018;21(10):1398-1407. AbstractWebsite

Resumen Contexto: La Academia Pontificia de la Vida (PAV) es una institución académica de la Santa Sede (Vaticano) cuyo objetivo es promover una visión católica de la ética biomédica. La PAV invitó a una serie de expertos en Cuidados Paliativos (CP) de todo el mundo, de todas las creencias, a desarrollar recomendaciones estratégicas para el desarrollo global de CP (“Grupo PAL-LIFE”). Diseño: Trece expertos internacionales reconocidos por su actividad promotora global de CP participaron en un estudio Delphi on-line. En un proceso de cuatro rondas, se pidió a los participantes que identificasen los grupos de interés o instituciones claves para la promoción de CP y que propusieran, para cada uno de ellos, recomendaciones estratégicas para el desarrollo de CP. Cada ronda incorporaba los comentarios de las rondas previas hasta lograr el consenso en las recomendaciones más importantes. En una última fase, al grupo de expertos se le solicitó la jerarquización por importancia de los grupos clave en una escala de 1 a 13. También se solicitaron sugerencias concretas para la implementación de las recomendaciones. Mediante análisis clúster se ordenaron los grupos de interés en dos niveles de importancia para el desarrollo de CP. Resultados: Trece recomendaciones fueron seleccionadas como las más importantes (una por cada grupo clave). Las recomendaciones para los grupos mejor puntuados fueron: (1) Responsables Políticos: garantizar el acceso universal a los CP; (2) Academia: ofrecer cursos obligatorios de CP en el pregrado; (3) Profesionales sanitarios: promover una certificación adecuada; (4) Hospitales e Instituciones sanitarias: asegurar el acceso a medicamentos de CP; y (5) Asociaciones de CP: ser promotoras eficaces y trabajar con los gobiernos en la implementación de las recomendaciones internacionales sobre CP. También se presentan recomendaciones para los ocho grupos clave restantes. Discusión: Este documento representa la posición oficial de la PAV en lo que respecta a estrategias de promoción para el desarrollo de los CP en el mundo.

Sinzabakira F, Alsirafy SA. "The Obesity Epidemic and Cancer in Africa." Research in Oncology. 2018;14(1):2-5. Abstract2018_sinzabakira_res_oncol_obesity_cancer_africa.pdf

Overweight and obesity have increased since the 1980s. It reached 37% for men and 38% for women in 2013. The situation worsened for children and adolescents in developed countries. Recent reports showed that African and other developing nations are not immune from the devastating obesity epidemic.
Many studies revealed a relevant strong relationship between obesity and cancers such as esophageal, postmenopausal breast, colorectal and endometrial cancers. Obesity-related cancers have increased exceptionally in adolescents and young adults but decreased in more advanced ages.
Currently, cancer care services in Africa are still limited despite the rising demand; therefore, access to them is relatively
difficult for many cancer patients with low income. Considering the fact that some cancers may be preventable, we reviewed articles about obesity and cancer to highlight the magnitude of the problem and raise awareness among African leadership on the importance of cancer prevention measures targeting obesity.

El-Sayed N, El-Sawy W, El-Azony A, Noshy E, Alsirafy S. "The Relation between the Severity of Pain and Common Symptoms in Patients with Metastatic Cancer." Research in Oncology. 2018;14(1):43-46. Abstract2018_el-sayed_res_oncol_metastatic_cancer_pain_common_symptoms.pdfWebsite

Background: There is a relation between the severity of pain and common symptoms in patients with metastatic cancer.Aim: This study was done to explore this relation among Egyptian patients with advanced cancer.Methods: The study included 120 adult metastatic cancer patients with pain from two cancer centers in Cairo and Sharkia,Egypt. Pain and other common symptoms were assessed using the Arabic version of the Edmonton Symptom AssessmentSystem (ESAS). The Eastern Cooperative Oncology Group (ECOG) performance scale was used to assess performancestatus. Results: The prevalence of ESAS symptoms was high among patients with cancer pain (tiredness, 94%; drowsiness, 63%; nausea, 60%; lack of appetite, 77%; shortness of breath, 53%; depression, 88%; anxiety, 83%; poor wellbeing, 96%). The ECOG performance scale was 1 in 21 (17.5%) patients, 2 in 57 (47.5%), 3 in 38 (31.7%) and 4 in 4 (3.3%). The average ESAS score was 33.9 ± 13.8, 48.9 ± 14.7, 58 ± 15.4 and 70 ± 5.5 among patients with ECOG score 1, 2, 3 and 4; respectively (p < 0.001). There was no significant difference in the average score of any of the ESAS items according to the site of metastases. There was a significant positive correlation between the pain score and the scores of tiredness (p<0.001), nausea (p=0.037), lack of appetite (p<0.001), shortness of breath (p=0.001), depression (p<0.001), anxiety (p<0.001) and poor wellbeing (p<0.001). Conclusion: Egyptian patients with cancer pain experience high symptom burden. The severity of pain strongly correlates with the presence and severity of other ESAS symptoms. Systematic assessment of other symptoms is indispensable in patients with cancer pain for proper control of symptoms and improving quality of life. 

Masoud HF, Abdelmoneim S, Ismael MF, Alsirafy SA. "Understandability of the Standard Arabic Translation of the EORTC QLQ-C15-PAL Questionnaire by Egyptian Patients with Incurable Cancer." Annals of Oncology. 2018;29(Suppl 8):viii553-viii554.Website
Alsirafy SA, Mohamed AA, Salem M. "Unmet Information Needs of Family Caregivers of Egyptian Patients with Advanced Cancer. ." Palliative Medicine. 2018;32(Suppl 1):271.
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