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El-Azony A, Basha MAA, Almalki YE, Abdelmaksoud B, Hefzi N, Alnagar AA, Mahdey S, Ali IM, Nasr I, Abdalla AAEHM, Yousef HY, Zaitoun MMA, Elsayed SB, Nada MG, Amin MI, Hassan RM, Ali SA, Dawoud TM, Aly SA, Algazzar YH, Abdelhamed H. The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma. Eur Radiol 2024; 34:2500-2511. [PMID: 37812294 DOI: 10.1007/s00330-023-10150-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase 18F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. PATIENTS AND METHODS This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase 18F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed. RESULTS The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively). CONCLUSION Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients. CLINICAL RELEVANCE STATEMENT Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. KEY POINTS • Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients. • High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS). • RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.
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Affiliation(s)
- Ahmed El-Azony
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Abd Alkhalik Basha
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt.
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | - Bader Abdelmaksoud
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nabila Hefzi
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A Alnagar
- Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sheren Mahdey
- Department of Nuclear Medicine, Nasser Institute, Health Ministry, Cairo, Egypt
| | - Ismail Mohamed Ali
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ibrahim Nasr
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A El-Hamid M Abdalla
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hala Y Yousef
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamad Gamal Nada
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Amin
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Mostafa Hassan
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Susan Adil Ali
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Mahmoud Dawoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Heba Abdelhamed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Alnagar AA, Hagrassy HMA, Abdullah RM, Shabrawy RME, Salah H. Brain and Acute Leukemia, Cytoplasmic Gene Overexpression as a Prognostic Factor in Egyptian De novo Adult Acute Myeloid Leukemia Patients. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_215_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Brain and acute leukemia, cytoplasmic (BAALC) gene is identified on chromosome 8q22.3 and implicated in normal hematopoiesis. BAALC gene overexpression is associated with poor outcome. Methods: We aimed to evaluate BAALC expression in de novo Egyptian acute myeloid leukemia (AML) cases and determine its prognostic value. We recruited 70 patients with de novo AML diagnosed and treated at clinical pathology and medical oncology departments, fulfilling inclusion criteria in our prospective study and evaluated BAALC expression level. Patients received induction therapy. The Institutional Review Board approved our study. Results: The mean age was 39.2 years ± 11.87, (18–60) with a male/female ratio of 3/2. The cutoff value of BAALC as a prognostic factor was 2.11 with sensitivity (86.1%), specificity (80%), positive predictive value (88.6%), and negative predictive value (76.2%.) (P < 0.001), 43 (61.4%) patients had high BAALC expression. Seventy-two percent of patients in the low BAALC group achieved complete remission (CR) compared to 42.1% in high BAALC expression group (P = 0.03). Patients with low BAALC (123.1 ± 4.9) had longer mean survival time than high BAALC group (45.85 ± 5.1) (P = 0.000). Conclusion: High-BAALC expression is an adverse prognostic factor, with a higher risk of relapse, lower CR rates, and lower survival in Egyptian de novo AML patients.
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Affiliation(s)
- Ahmed A Alnagar
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hesham M Al Hagrassy
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania M Abdullah
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham M El Shabrawy
- Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hossam Salah
- Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Elwan A, Abdelrahman AE, Alnagar AA, Abdelhamid MI, Nawar N. Clinicopathological Features and Treatment Challenges in Triple Negative Breast Cancer Patients: A Retrospective Cohort Study. Turk Patoloji Derg 2021; 37:121-129. [PMID: 33432555 PMCID: PMC10512684 DOI: 10.5146/tjpath.2020.01516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE As the genetic and molecular profiles of triple negative breast carcinoma (TNBC) are elucidated, multiple therapeutic targets have been produced. TNBC with less than 1% androgen receptor (AR) expression may respond to enzalutamide with greater response association in higher levels. A metronomic dose of capecitabine and docetaxel are effective developed drugs for angiogenic process inhibition. We aimed to demonstrate the treatment outcome of triple-negative breast cancer patients in correlation to their clinicopathological features. MATERIALS AND METHODS A retrospective cohort study of 80 TNBC patients was conducted. The patients underwent proper observation with the reporting of their treatment and follow-up data. Patients with a metastatic disease, neoadjuvant chemotherapy, follow-up drop or data shortage were excluded from the survival analysis. RESULTS The study results revealed a significant association between negative androgen expression and younger age ≤35 years, premenopausal status, higher grade, extracapsular extension, lymphovascular invasion, Ki 67, and CA15-3 (p=0.003, 0.02, < 0.001, 0.001, 0.027, 0.005, 0.009 respectively). The three-year overall survival (OS) in patients who received bicalutamide was better than those patients who received capecitabine or docetaxel but of no significance (p=0.46). The three-year disease free survival (DFS) was significantly better in the bicalutamide arm versus the other two groups (p=0.012). CONCLUSIONS We concluded that extended adjuvant antiandrogen such as bicalutamide and metronomic capecitabine are well tolerated with accepted compliance and affordability compared to docetaxel and are warranted for problem-solving and better DFS and OS in some TNBC patients.
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Affiliation(s)
- Amira Elwan
- Department of Clinical Oncology and Nuclear Medicine, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Aziza E. Abdelrahman
- Department of Pathology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Ahmed A. Alnagar
- Department of Medical Oncology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed I Abdelhamid
- Department of General Surgery, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Nashwa Nawar
- Department of Clinical Oncology and Nuclear Medicine, Zagazig University, Faculty of Medicine, Zagazig, Egypt
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Hanafy AS, Mohamed MS, Alnagar AA. Ascitic Calprotectin as an early predictor of hepatocellular carcinoma in patients with cirrhotic ascites. J Cancer Res Clin Oncol 2020; 146:3207-3214. [PMID: 32851478 DOI: 10.1007/s00432-020-03363-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Calprotectin is a heterodimer formed by S100A8 and S100A9 proteins which are enhanced during hepatic carcinogenesis and the increased expression of both proteins promotes malignant progression of hepatocellular carcinoma. The potential correlation between ascitic Calprotectin and HCC was not studied. METHODS 100 patients were stratified into a case group which enrolled 50 patients with cirrhotic ascites and documented HCC and a control group consisted of 50 patients with cirrhotic ascites without HCC. They were evaluated by liver function tests, abdominal ultrasound and routine ascitic fluid examination including ascetic Calprotectin and results were validated in another group (n = 100). RESULTS Calprotectin level was significantly higher in the HCC group with insignificant difference regarding total cell count, PNLs, ascitic albumin, LDH, CEA and SAAG. It correlated with serum creatinine (r = 0.245, p = 0.014) and number of focal hepatic lesions (r = 0.309, p = 0.002). In the validation group, 28 patients had elevated ascitic Calprotectin of which 21 patients had developed HCC (75%) after a mean period of 3.8 ± 1.54 months. A cut of value 126 ng/ml was accurate to predict HCC in liver cirrhosis with ascites with a sensitivity of 93.3% specificity 94%, AUC 0.950, Youden's J value = 0.873, p = 0.0001. CONCLUSION Ascitic Calprotectin may offer an easy, affordable marker that can predict the early occurrence of HCC.
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Affiliation(s)
- Amr Shaaban Hanafy
- Internal Medicine Department, Hepatogastroenterology Division, Zagazig University, Zagazig, 40 Mostafa Fouad street, 44519, Egypt.
| | - Mohamed Sorour Mohamed
- Internal Medicine Department, Hepatogastroenterology Division, Zagazig University, Zagazig, 40 Mostafa Fouad street, 44519, Egypt
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Abdelrahman AE, Ibrahim DA, El-Azony A, Alnagar AA, Ibrahim A. ERCC1, PARP-1, and AQP1 as predictive biomarkers in colon cancer patients receiving adjuvant chemotherapy. Cancer Biomark 2020; 27:251-264. [PMID: 31903985 DOI: 10.3233/cbm-190994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The recognition of high-risk colon cancer patients prone to chemoresistant and recurrent disease is a challenge. OBJECTIVES We aimed to assess the immunohistochemical expression of ERCC1, PARP-1, and AQP1 in 60 cases of stage II and III colon cancer who underwent curative resection and adjuvant chemotherapy. Their predictive role of tumor progression and disease-free survival (DFS) was analyzed. METHODS The immunohistochemical expression of ERCC1, PARP-1, and AQP1 in 60 cases of stage II and III colon cancer who underwent curative resection and adjuvant chemotherapy was studied. The collected data on the overall survival (OS), disease-free survival (DFS), and the response to the chemotherapy were analyzed. RESULTS Positive nuclear ERCC1 expression was identified in 58.3% of the patients, ERCC1 expression was significantly associated with left-sided tumors (P< 0.01). Moreover, its expression was significantly associated with the aggressive tumor characteristics including high grade, lymph node metastasis and advanced tumor stage (P< 0.001 for each). High nuclear PARP-1 expression was observed in 63.3% of the cases, and its expression was significantly associated with tumor grade and lymph node metastasis (P= 0.003 for each). Positive membranous AQP1 expression was identified in 41.7% of patients, and it was associated with high grade, lymph node metastasis and advanced tumor stage (P< 0.001 for each). During the follow-up period, 23 patients (38.3%) exhibited a tumor progression; this was significantly associated with positive ERCC1, high PARP-1, and negative AQP1 expression. Statistics of the survival data revealed that shorter DFS was significantly associated with positive ERCC1, high PARP-1, and positive AQP1 expression (P= 0.005, 0.016, 0.002, respectively). CONCLUSIONS ERCC1, PARP1, and AQP1 are adverse prognostic biomarkers in stage II-III colon cancer. Moreover, adjuvant chemotherapy may not be beneficial for patients with positive ERCC1, high PARP1, and AQP1-negative tumors. Therefore, we recommend that ERCC1, PARP-1, and AQP1 should be assessed during the selection of the treatment strategy for stage II-III colon cancer patients.
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Affiliation(s)
- Aziza E Abdelrahman
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed El-Azony
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A Alnagar
- Medical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amr Ibrahim
- General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Alnagar AA, Mahmoud AA, El Gammal MM, Hamdy N, Samra MA. Outcome of Core Binding Factor Acute Myeloid Leukemia by Receptor Tyrosine Kinase Mutation. Clin Lymphoma Myeloma Leuk 2020; 20:459-467. [PMID: 32229198 DOI: 10.1016/j.clml.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/01/2020] [Accepted: 02/04/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Core binding factor acute myeloid leukemia (CBF-AML) encodes 2 recurrent cytogenetic abnormalities, t(8;21) and inv(16), which carries an overall good prognosis. However, some patients will develop a relapse. We sought define the unfavorable group of CBF-AML by analysis of (c-KIT and FLT3-ITD) and to correlate them with treatment outcome. PATIENTS AND METHODS We performed a prospective study of 70 patients with CBF-AML diagnosed and managed at the medical oncology department of the (National Cancer Institute), Cairo University, with analysis of c-KIT and FLT3 mutations. All patients had received "3 + 7" induction, followed by 3 to 4 courses of high-dose cytarabine consolidation. The institutional review board approved the present study. RESULTS The median patient age was 31 years (range, 18-60 years), with a male/female ratio of 4:3. Of the 70 patients, 42 (60%) had t(8;21) and 28 had inv(16) (40%). c-KIT mutations (exons 8 and 17) were detected in 10 of 52 tested patients, and FLT3-ITD was detected in 3 of 70 patients. Patients with inv(16) experienced more lymphadenopathy and splenomegaly, had a higher median initial leukocyte count. Hepatitis C antibody positivity (8 of 42) was exclusively present in patients with t(8;21). The median overall survival (OS) was 19.5 months, and the median disease-free survival (DFS) was not reached. Patients with inv(16) had near-significant (P = .07) better DFS than patients with t(8;21). c-KIT mutations had no significant effect on OS or DFS. However, reverse tyrosine kinase mutations had a negative effect on DFS but not OS (P = .04). CONCLUSION CBF-AML with reverse tyrosine kinase mutation conveys a worse prognosis. Hepatitis C virus antibody positivity might be associated with t(8;21) AML and inv(16) with more extramedullary disease.
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Affiliation(s)
- Ahmed A Alnagar
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Asmaa A Mahmoud
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mosaad M El Gammal
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Naera Hamdy
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed A Samra
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Harb OA, Sallam AM, Habib FM, Gertallah LM, Alnagar AA, Ahmed RZ, Balata SA, El Shafaay BS. Multi-focal superficial basal cell carcinoma of nipple and areola of 60 years female: A case report and a mini review. Human Pathology: Case Reports 2018. [DOI: 10.1016/j.ehpc.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Labib HA, Elantouny NG, Ibrahim NF, Alnagar AA. Upregulation of microRNA-21 is a poor prognostic marker in patients with childhood B cell acute lymphoblastic leukemia. Hematology 2017; 22:392-397. [DOI: 10.1080/10245332.2017.1292204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
| | - Neveen G. Elantouny
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nevin F. Ibrahim
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A. Alnagar
- Medical Oncology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Alsirafy SA, Saleh RN, Fawzy R, Alnagar AA, Hammad AM, El-Sherief W, Farag DE, Radwan RH. The fear of using tramadol for pain control (tramadolophobia) among Egyptian patients with cancer. J Opioid Manag 2015; 11:474-480. [PMID: 26728644 DOI: 10.5055/jom.2015.0300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The fear of using tramadol for pain control (tramadolophobia) by Egyptian patients with cancer is a frequent problem in our practice. This study was conducted to explore the prevalence of and the reasons behind tramadolophobia among Egyptian patients with cancer. METHODS A structured interview including open-ended and closed questions. The study included 178 adult patients with cancer from two cancer centers in Cairo and Sharkia, Egypt. RESULTS The source of information about tramadol was a non-healthcare-related source in 168 (94 percent) patients, mainly the media (50 percent). The believed uses of tramadol were abuse related in 94 (53 percent) patients, stimulant (physical, sexual, and to boost alertness) in 59 (33 percent), and analgesic in 55 (31 percent). Twenty-six (15 percent) patients gave history of tramadol use, largely (69 percent) as a stimulant. In case tramadol was prescribed for pain control, 90 (51 percent) patients refused to take it, 59 (33 percent) patients agreed to take it with concern about addiction, and only 29 (16 percent) patients agreed without concerns. Among those who refused taking tramadol for pain, the mentioned reason of refusal was addiction-related fears in 57 percent. CONCLUSIONS The stigmatization and misconceptions about tramadol may have resulted in tramadolophobia among the majority of Egyptian patients with cancer. This further complicates the barriers to cancer pain control in Egypt. Being the only available World Health Organization step-II analgesic in Egypt, interventions to overcome tramadolophobia should be taken.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Radfan N Saleh
- Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt; Aden Refinery Company Hospital, Aden, Yemen
| | - Radwa Fawzy
- Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Alnagar
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Ahmed M Hammad
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wessam El-Sherief
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt; Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dina E Farag
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Riham H Radwan
- Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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