Cancer and how the patients see it; prevalence and perception of risk factors: a cross-sectional survey from a tertiary care centre of Karachi, Pakistan

Cancer-Related Stigmatization, Quality of Life, and Fear of Death Among Newly Diagnosed Cancer Patients

The purpose of the study is to investigate the gender differences among newly diagnosed cancer patients from the cultural perspective of Pakistan. The data comprised two equal groups: men (50%) and women (50%). Most participants were 31-45 years old, and the duration of the cancer diagnosis was less than 6 months (74.6%). The data was collected on the following scales: the discrimination and stigma scale, the internalized stigma scale, the WHO-quality of life scale, and the fear of death scale. Data was analyzed using SPSS v.25; descriptive statistics, an independent sample t-test, and simple linear regression were applied to the data. The results revealed that men and women are both experiencing cancer-related stigmatization in Pakistan. However, women face a higher level of stigmatization, lower quality of life, and higher fear of death than men. Furthermore, the regression analysis result confirms that the cancer-related stigma faced by the diagnosed patients decreases the patient's quality of life and induces the fear of death.

Factors Influencing Breast Cancer Knowledge and Attitudes of Women in Abbottabad, Pakistan

BACKGROUND Breast cancer (BC) is a significant health issue in Pakistan, leading to higher mortality rates compared to other countries. Therefore, this questionnaire-based study aimed to assess knowledge, awareness, and beliefs about BC in 300 women in Abbottabad, Pakistan, between January and April 2019. MATERIAL AND METHODS A cross-sectional study was conducted among healthy adult female residents of Abbottabad between January and April 2019 using structured, pre-validated questionnaires. Data collection was conducted through face-to-face interviews. The questionnaire was divided into 3 sections with 17 items, including demographic information, knowledge about BC, and beliefs about BC. Data were analyzed using the SPSS version 25. A total of 300 women responded to the study invitation. RESULTS Of 300 respondents, 87.3% (n=262) were aware of BC. Among them, only 37 (14.1%) had good knowledge, 90 (34.4%) had average knowledge, and 135 (51.5%) had poor knowledge about BC. The majority of respondents exhibited positive beliefs (74%). Knowledge was significantly higher among single (6.77±2.87) and widowed (6.00±3.65) women compared to married women (p=0.001). Similarly, knowledge and beliefs about BC were higher among women with higher education (6.79±2.93; p=0.001; 6.76±2.12; p=0.025) compared to those with lower education. Women living in urban areas had greater knowledge (5.89±2.75) than those in rural areas (4.58±2.78), suggesting a significant difference. A weak positive correlation between knowledge and beliefs (r=0.336, p=0.001) was identified. CONCLUSIONS Study participants had low knowledge about BC but generally positive beliefs, highlighting the need for targeted education and awareness programs to improve knowledge about BC among women in Abbottabad.

Cancer care and outreach in South Asian Association for Regional Cooperation (SAARC) countries: from epidemiology and the National Cancer Control Programme to screening, diagnosis, and treatment

South Asian Association for Regional Collaboration (SAARC) countries, home to 24% of the world's population, are facing the double burden of disease (ie, where a population experiences both an increasing incidence of cancers typically associated with affluence and a sustained or rising burden of cancers linked to infections and poverty) with non-communicable diseases (NCDs) attributing to 47% of the global burden of disease and to about 60% of all deaths. In 2022, cancer in this region accounted for approximately 9·3% of incidence worldwide and 12% of global mortality. Cancer is one of the major NCDs affecting South Asia, accounting for a large proportion of disability-adjusted life-years lost in this region. The most common cancers are lung, head and neck, and gastrointestinal cancers in both sexes, and cervix and breast cancers in females. The cancer burden is high in SAARC countries, although there are differences among countries and within urban and rural regions of each country, depending on the level of available resources, development, and epidemiological shift. Here we discuss various cancer care issues and challenges throughout the cancer care continuum in the SAARC region. We make an urgent call for regional collaboration to develop, modify, and implement a holistic cancer control plan and formulate a systematic approach directed to address the growing burden of cancer in this region. It is crucial to establish strong political will and commitment to take forward the recommended actions outlined in this Series to overcome and address the cancer crisis in the SAARC region, aligning with Sustainable Development Goal 2030 targets.

Prevalence and Risk Factors of Oral Cancer Among Dental Students From Two Private Colleges in Pakistan: A Comparative Study

BACKGROUND

Globally, oral cancer is still a major public health concern, with different lifestyle and socioeconomic variables influencing its occurrence.

OBJECTIVE

This study compared the prevalence and risk factors of oral cancer among students from private colleges in Pakistan, identifying patterns and variations in risk profiles within this group.

METHODOLOGY

This six-month cross-sectional research was carried out at Azra Naheed Dental College and Rahbar College of Dentistry, two private dental institutions in Lahore, Pakistan. Four hundred and thirty students between the ages of 18 and 30 who were split evenly between the two schools made up the sample. A well-structured questionnaire including lifestyle variables, oral cancer awareness, and demographic information was used to gather data. Dental practitioners with training conducted clinical oral exams to look for any indications of oral lesions. The demographic variables were summed up using descriptive statistics, and the relationships between risk factors and the prevalence of oral cancer were assessed using multivariate logistic regression analysis. A p-value of less than 0.05 was used to define statistical significance.

RESULTS

Among the 430 students, 215 were from Azra Naheed Dental College and 215 were from Rahbar College of Dentistry; 12 students (5.58%) at Azra Naheed and 19 students (8.84%) at Rahbar College were found to have oral lesions. Regarding lifestyle factors, 69 students (32.22%) at Azra Naheed and 62 students (28.89%) at Rahbar College reported current tobacco use. Regular betel quid chewing was observed in 93 students (43.33%) at Azra Naheed compared to 77 students (35.56%) at Rahbar College. Dietary habits showed that 148 students (68.89%) at Azra Naheed and 138 students (64.44%) at Rahbar College consumed a diet high in processed foods. The multivariate logistic regression analysis identified significant risk factors for oral cancer, including current tobacco use (odds ratio (OR) = 2.15, p = 0.001), regular betel quid chewing (OR = 2.87, p < 0.001), and a diet high in processed foods (OR = 1.62, p = 0.021).

CONCLUSION

The research identifies important risk factors for oral cancer among dentistry college students, pointing to the need for focused preventative and educational initiatives to address lifestyle-related concerns.

miR-4716-3p and the target AKT2 Gene/rs2304186 SNP are associated with blood cancer pathogenesis in Pakistani population

AKT2 is crucial for cancer cells' invasion, metastasis, and survival. It is a possible downstream gene target of cancer glycolysis-related microRNAs. The study investigated the role of miRNA-4716-3p, rs2304186, and the AKT2 gene in blood cancer pathogenesis. RT-qPCR was used to analyze AKT2 gene mRNA and miRNA-4716-3p expression in 200 blood cancer samples and 200 healthy controls. Furthermore, Tetra-ARMS PCR was used to examine the rs2304186 AKT2 SNP in 300 patients and 290 control samples. miRNA-4716-3p was shown to be significantly downregulated (p = 0.0294), whereas mRNA expression of the AKT2 gene was found to be significantly upregulated (p = 0.0034) in blood cancer patients compared to healthy individuals. miRNA-4716-3p downregulation (p = 0.0466) was more pronounced, while AKT2 upregulation was non-significant (p = 0.1661) in untreated patients compared to chemotherapy-treated patients. Blood cancer risk was significantly associated with the rs2304186 GT genotype (p = 0.0432), TT genotype (p = 0.0502), and mutant allele (T) frequency (p = 0.0008). Polymorphism rs2304186 was associated with an increased risk of blood cancer in dominant (p = 0.0011), recessive (p = 0.0502), and additive (p = 0.0008) genetic models. The results suggested that the rs2304186 and the deregulated expression of miRNA-4716-3p and AKT2 gene at the mRNA level may significantly increase the incidence of blood cancer, particularly in the Pakistani population. Therefore, these may function as suitable biomarkers for blood cancer diagnosis and prognosis. Additional, larger-scale investigations may be required to affirm these results.

A Computational Predictor for Accurate Identification of Tumor Homing Peptides by Integrating Sequential and Deep BiLSTM Features

Cancer remains a severe illness, and current research indicates that tumor homing peptides (THPs) play an important part in cancer therapy. The identification of THPs can provide crucial insights for drug-discovery and pharmaceutical industries as they allow for tailored medication delivery towards cancer cells. These peptides have a high affinity enabling particular receptors present upon tumor surfaces, allowing for the creation of precision medications that reduce off-target consequences and enhance cancer patient treatment results. Wet-lab techniques are considered essential tools for studying THPs; however, they're labor-extensive and time-consuming, therefore making prediction of THPs a challenging task for the researchers. Computational-techniques, on the other hand, are considered significant tools in identifying THPs according to the sequence data. Despite many strategies have been presented to predict new THP, there is still a need to develop a robust method with higher rates of success. In this paper, we developed a novel framework, THP-DF, for accurately identifying THPs on a large-scale. Firstly, the peptide sequences are encoded through various sequential features. Secondly, each feature is passed to BiLSTM and attention layers to extract simplified deep features. Finally, an ensemble-framework is formed via integrating sequential- and deep features which are fed to a support vector machine which with 10-fold cross-validation to carry to validate the efficiency. The experimental results showed that THP-DF worked better on both [Formula: see text] and [Formula: see text] datasets by achieving accuracy of > 95% which are higher than existing predictors both datasets. This indicates that the proposed predictor could be a beneficial tool to precisely and rapidly identify THPs and will contribute to the cutting-edge cancer treatment strategies and pharmaceuticals.

Heated tobacco products- well known or well understood? A national cross-sectional study on knowledge, attitudes and usage in Pakistan

BACKGROUND

Heated tobacco products (HTPs) are reshaping the tobacco industry and just recently, a plan was sought to regularize HTPs in Pakistan. Pakistan provides an intriguing case study in this context, as tobacco use is deeply ingrained in public use. To ensure that future evidence-based policy recommendations are grounded in the public's knowledge, attitudes, and usage of HTPs, a nationwide survey must be conducted.

METHODS

A cross-sectional study was conducted using an online-based questionnaire nationwide in Pakistan. The questionnaire was validated and distributed through convenience sampling. The questionnaire assessed participants' knowledge, attitudes, and usage of HTPs. Descriptive statistics was used to describe participants' response and linear regression was performed at a p-value of < 0.05 using SPSS version 26.

RESULTS

In our sample of 1195 respondents (mean age of 33 years, 41.8% males and 58.2% females), 54.7% had previously heard about HTPs and 16.9% reported using HTPs at least once. Additionally, 38.24% were unsure of the legality of HTP use. Those with monthly household incomes of PKR 100,000 to 500,000, were more likely to have higher knowledge scores (OR:1.80[1.07-3.04]). On the other hand, males (OR:0.70 [0.55-0.89]) and respondents from Balochistan (OR:0.40 [0.22-0.71]) were more likely to have lower knowledge scores. The strongest motivators were the enjoyability of HTPs (55.73%) and usage as a cigarette alternative (54.64%), while the strongest deterrents were the negative health effects (82.68%) and potential for addiction (81.01%).

CONCLUSION

Our study underscores the need for awareness campaigns and interventions concerning HTPs, given prevalent preconceived notions and mixed attitudes among respondents. It was found that women and households with higher incomes scored higher on knowledge. Subjective enjoyment and a substitute for cigarettes were important motivators, but the most mentioned deterrents were the possibility of addiction and the detrimental effects on health. These insights form the basis for informed policy making for non-cigarette tobacco products.

Revolutionizing ocular cancer management: a narrative review on exploring the potential role of ChatGPT

This paper pioneers the exploration of ocular cancer, and its management with the help of Artificial Intelligence (AI) technology. Existing literature presents a significant increase in new eye cancer cases in 2023, experiencing a higher incidence rate. Extensive research was conducted using online databases such as PubMed, ACM Digital Library, ScienceDirect, and Springer. To conduct this review, Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines are used. Of the collected 62 studies, only 20 documents met the inclusion criteria. The review study identifies seven ocular cancer types. Important challenges associated with ocular cancer are highlighted, including limited awareness about eye cancer, restricted healthcare access, financial barriers, and insufficient infrastructure support. Financial barriers is one of the widely examined ocular cancer challenges in the literature. The potential role and limitations of ChatGPT are discussed, emphasizing its usefulness in providing general information to physicians, noting its inability to deliver up-to-date information. The paper concludes by presenting the potential future applications of ChatGPT to advance research on ocular cancer globally.

Decoding the significant diagnostic and prognostic importance of maternal embryonic leucine zipper kinase in human cancers through deep integrative analyses

BACKGROUND

Cancer is a multifactorial disease and the second leading cause of human deaths worldwide. So far, the underlying mechanisms of cancer have not been yet fully elucidated.

METHODS

By using TCGA expression data, we determine the pathogenic roles of the maternal embryonic leucine zipper kinase (MELK) gene in various human cancers in this study. For this purpose, different online databases and tools (UALCAN, Kaplan-Meier (KM) plotter, TNMplot, GENT2, GEPIA, HPA, cBioPortal, STRING, Enrichr, TIMER, Cytoscape, DAVID, MuTarget, and CTD) were used.

RESULTS

MELK gene expression was analyzed in a total of 24 human cancers and was found notably up-regulated in all the 24 analyzed tumor tissues relative to controls. Moreover, across a few specific cancers, including kidney renal clear cell carcinoma (KIRC), stomach adenocarcinoma (STAD), lung adenocarcinoma (LUAD), and liver hepatocellular carcinoma (LIHC) patients, MELK up-regulation was observed to be correlated with the shorter survival duration and metastasis. This valuable information highlighted that MELK plays a significant role in the development and progression of these four cancers. Based on clinical variables, MELK higher expression was also found in KIRC, STAD, LUAD, and LIHC patients with different clinical variables. Gene ontology and pathway analysis outcomes showed that MELK-associated genes notably co-expressed with MELK and belongs to a variety of diverse biological processes, molecular functions, and pathways. MELK expression was also correlated with promoter methylation levels, genetic alterations, other mutant genes, tumor purity, CD8+ T, and CD+4 T immune cells infiltrations in KIRC, STAD, LUAD, and LIHC.

CONCLUSION

This pan-cancer study revealed the diagnostic and prognostic roles of MELK across four different cancers.

Perceptions of Cancer in Parents of Adolescent Daughters in Northwest Cameroon

BACKGROUND

Cancer is a rapidly rising cause of morbidity and mortality in sub-Saharan Africa. Cervical cancer, in particular, is still one of the leading causes of mortality for women in this setting. The uptake of healthcare services is in part influenced by patients' belief systems. We sought to better understand the perception of cancer in the Kom tribe of Northwest Cameroon.

METHODS

A qualitative research study was completed using a semi-structured interview guide and one-on-one interviews with 45 parents of girls aged 9-14 years. These girls were candidates for free HPV vaccination to prevent cervical cancer. The interviews were recorded, transcribed, and analyzed using ATLAS.ti 9.

RESULTS

Thirty-five mothers and ten fathers with a median age of 42 yo were interviewed from Mbingo, Belo, Njinikom, and Fundong. Half of the parents were farmers, with three being herbalists or traditional medicine doctors. Seventy-seven percent had either no or only primary school education. None had had cancer. All knew at least one person with cancer. The most common word for cancer in the Kom language is "ngoissu". It can refer to a bad infection or cancer. The occurrence of ngoissu is the result of either a curse placed on you, ancestral retribution, or transgressing the ngoulatta (snail shell spoken over and usually placed in a garden). The implications are that treatment of ngoissu must involve the traditional doctor who determines the spiritual issue and prescribes a remedy (like a herb or tea) and/or an incantation. Within the context of cancer, this can lead to a delay in diagnosis until the disease is no longer curable by conventional therapies.

CONCLUSION

Ways to bridge biomedical healthcare services and traditional medicine are needed, especially in tribal contexts where the latter is an integral part of daily life.

Myths and Misconceptions of Breast Cancer in the Pakistani Population

Background Breast cancer is one of the most prevalent types of cancer in the female population. The cultural diversity, religious beliefs, myths, and misinformation regarding the disease contribute to diagnostic delays and enhanced burden on the healthcare system. This study aimed to ascertain the extent of knowledge and prevalence of erroneous beliefs and misconceptions regarding breast cancer among Pakistani women belonging to diverse socioeconomic and educational backgrounds. Methodology This cross-sectional study was performed in a tertiary care hospital in Karachi, Pakistan. A total of 350 women were enrolled in the study as a representative female population, and 300 participants were included who met the inclusion criteria. Participants were conveniently interviewed using a pre-piloted questionnaire designed to assess the prevalent myths and misconceptions about breast cancer. The data were analyzed by SPSS version 23 (IBM Corp., Armonk, NY, USA) using descriptive statistics. Results The study findings point to a significant prevalence of erroneous beliefs and a lack of accurate information on breast cancer. The mean age of the participants was 20.8 ± 10.4 years. The majority of the participants belonged to a middle socioeconomic status (70%) and were undergraduates (61.4%). The participants' friends and family members were the most frequent sources of information regarding breast cancer. The most common myth was "breast-feeding offers immunity to breast cancer completely" (76.6%), followed by "breast cancer spreads after biopsy" (63.8%). Participants also believed that breast tissue biopsy can lead to the spread of cancer (63.4%) and that faith healers and alternative medicine can cure breast cancer (47.5%). One-third (33.3%) of the participants considered all lumps to be breast cancer; however, approximately half (41.6%) of the participants thought that only painful lumps were associated with breast cancer. A significant number of participants believed breast cancer to be a result of God's curse (31.4%) or evil eye (38.7%). Conclusions The findings suggest a critical need for community-based breast health education initiatives that take into account Pakistani women's distinctive cultural and societal attitudes and work to dispel common misconceptions about the condition.

Exploring the Burden of Cancer in Pakistan: An Analysis of 2019 Data

Cancer has become a growing burden in Pakistan in recent times, posing a significant cause for concern. The World Health Organization has reported a steady increase in the incidence of cancer in Pakistan. According to the present study, breast cancer (24.1%), oral cavity (9.6%), colorectum (4.9%), esophagus (4.2%), and liver cancer (3.9%) were the five most prevalent cancers. Males were more likely to have oral cavity cancer (14.9%), colorectum cancer (6.8%), liver cancer (6.4%), prostate cancer (6.0%), and lung cancer (6.0%). In women (41.6%), breast (6.9%), oral cavity (5.5%), cervix (4.7%), and uterus cancer (4.1%) were the most common cancers. Middle-aged people (43.0%) were most likely to develop cancer, followed by seniors (30.0%) and adults (20.0%). Children and adolescents were most likely to develop cancers of the central nervous system (CNS), leukemia (18.7%), and Hodgkin (17.3%), followed by breast, oral cavity, colorectum, and prostate at other ages. Most patients were from Punjab (40.4%) and Sindh (32.2%). Approximately 30.0% of patients were diagnosed at stage III and stage IV. In terms of registered cases, breast cancer, oral cavity cancer, colon cancer, esophagus cancer, and liver cancer are among the highest. In the future, this information may prove useful for assessing the effectiveness of interventions.

Identifying barriers to resilience from the perspective of young and middle-aged patients with lymphoma: A qualitative exploration

PURPOSE

This study aimed to understand and identify barriers to resilience in young and middle-aged patients with lymphoma in the context of Chinese culture.

METHODS

A qualitative descriptive study was employed. Face-to-face, semi-structured, and in-depth individual interviews were conducted between May and July 2022. Purposive and differential sampling was used to select eligible participants. Conventional content analysis was used to analyze qualitative data and identify categories and subcategories. This study followed the COREQ checklist.

RESULTS

Twenty patients aged 28-59 years completed the interviews. Three categories involving thirteen subcategories were identified from the interview data: (1) internal barriers-derived from individual cognitive, emotional, behavioral, spiritual, and physical distress, resulting in internal negative constructs, and reducing the motivation to overcome adversity; (2) unbalanced family functioning-families threatened by disease are incapable of maintaining normal functioning and fail to act effectively when facing crises; and (3) absent social support-insufficient or unavailable shielding protection from social support further inhibits resilience among patients with lymphoma.

CONCLUSIONS

This study identified various barriers to the resilience of young and middle-aged patients with lymphoma in the context of Chinese culture. In addition to the patient's internal barriers of resilience, specific family and socio-cultural barriers should also be emphasized by healthcare professionals. Multidisciplinary and family-centered resilience intervention should be developed to help such patients cope with, adapt to the disease, and achieve good psychosocial returns.

Strengthening Breast Cancer Screening Mammography Services in Pakistan Using Islamabad Capital Territory as a Pilot Public Health Intervention

Late diagnosis of treatable breast cancer is the reason for higher breast cancer mortality. Until now, no public breast cancer facility has been established in the Islamabad Capital Territory. First, a Federal Breast Screening Center (FBSC) was established. Afterward, awareness campaigns about breast cancer were organized among the public. Subsequently, women above 40 years of age were provided with mammography screenings. Data were analyzed in SPSS version 22.0. An intervention was performed using a six tier approach to strengthening the health system. Utilizing the offices of the FBSC and the national breast cancer screening campaign, breast cancer awareness has become a national cause and is being advocated by the highest offices of the country. The number of females undergoing mammography has increased each year, starting from 39 in 2015 to 1403 in 2019. Most of the cases were BI-RAD I (n = 2201, 50.74%) followed by BI-RAD II (n = 864, 19.92%), BI-RAD III (n = 516, 11.89%), BI-RAD IV (n = 384, 8.85%), BI-RAD V (n = 161, 3.71%), and BI-RVAD VI (n = 60, 1.38%). The current study has theoretical and practical implications for the contemplation of policymakers. The FBSC can serve as a model center for the establishment of centers in other parts of the country, thereby promoting nationwide screening coverage.

A Descriptive Cross-Sectional Study on Awareness and Belief of People About Cancer in Southern Ethiopia: Special Focus on Breast and Cervical Cancers

BACKGROUND

The general population's lack of awareness, limited knowledge, myths and misconceptions about breast and cervical cancers (CCs) is considered as a serious public health problem.

OBJECTIVE

This study was intended to assess the status of awareness and beliefs of people about cancer and breast and CCs in particular.

METHODS

A descriptive community-based cross-sectional survey was conducted on 345 study participants in Southern Ethiopia. A pretested, structured questionnaire that contained demographics and questions on the variables of exposure to biological and chemical carcinogenic agents, lifestyle and personal behavior was administered. Frequency distribution and proportions were used to describe the study population in relation to major variables.

RESULTS

The mean age of study participants was 25.19 (Range 15-58). More than a third of the study participants heard about cancer from Mass Media followed by schools (28.5%) and treating physicians (6.7%). The proportion of study participants that knew about the association between smoking, alcohol intake and cancer development was 38.6% and 51.5%, respectively. Only 48% and 24.2% of the study participants heard about breast and CCs, respectively. The fact that 69.4% of the study participants had limited knowledge about the mode of transmission of the causative agents of CCs indicates that the study groups are at risk of acquiring the agent. Additionally, only 4.7% of the study participants were screened for CC and have poor breast self-examination experiences, indicating poor awareness and knowledge about the importance of screening programs.

CONCLUSION

Comprehensive awareness and knowledge about cancer in general and breast and CCs in particular is lacking in southern Ethiopia. Early sexual debut, limited knowledge about the diseases and unfavorable lifestyle are the risk factors to be addressed in public health education.