1
|
Abdul-Sater Z, Mukherji D, Adib SM, Shamseddine A, Abu-Sitta G, Fadhil I, Sullivan R, Omari AA, Saleh S, Taher A. Cancer registration in the Middle East, North Africa, and Turkey (MENAT) region: A tale of conflict, challenges, and opportunities. Front Oncol 2022; 12:1050168. [PMID: 36505790 PMCID: PMC9730320 DOI: 10.3389/fonc.2022.1050168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Cancer registration is a core component of national and regional cancer control strategies. In the Middle East, North-Africa and Turkey (MENAT) region, capacity and resources for cancer registration is variable and shaped by multiple contextual challenges. This viewpoint maps out practical recommendations around cancer registration, in an attempt to inform cancer control planning, policy, and implementation. The recommendations laid out in this viewpoint are informed by the discussions held at the Initiative for Cancer Registration in the MENAT (ICRIM) virtual workshop, which convened registry managers, policy makers, and international agencies from 19 countries in the MENAT region. The discussions were distilled in four categories of recommendations, revolving around cancer registration procedures, collaborative governance, putting cancer registration on the map, and capacity building. This viewpoint provides a much-needed mapping of practical recommendations around cancer registration, informed by direct key stakeholders in the region. These practical recommendations offer a road map for policy making, cancer control planning, and future regional capacity strengthening initiatives.
Collapse
Affiliation(s)
- Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Hematology/Oncology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Salim M. Adib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Hematology/Oncology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Ghassan Abu-Sitta
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | - Richard Sullivan
- Institute of Cancer Policy & Conflict & Health Research Group, King’s College London, London, United Kingdom
| | - Amal Al Omari
- King Hussein Cancer Center, Office of Scientific Affairs and Research (OSAR), Amman, Jordan
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ali Taher
- Department of Hematology/Oncology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon,*Correspondence: Ali Taher,
| |
Collapse
|
2
|
Al Omari A, Abdelkhaleq H, Al-Hussaini M, Turfa R, Awad N, Hassan MM, Alfaqih MA, Garrett CR. Validation of the Survival Benefits of Metformin in Middle Eastern Patients With Type II Diabetes Mellitus and Colorectal Cancer. J Glob Oncol 2019; 4:1-10. [PMID: 30084749 PMCID: PMC6223523 DOI: 10.1200/jgo.18.00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Epidemiologic data from several populations suggest that metformin may decrease cancer risk and mortality in patients with colorectal cancer (CRC) and type II diabetes mellitus (DM). Although type II DM and CRC are major health problems in the Middle East, no investigations have been performed to test the effect metformin has on the outcome of patients with type II DM and CRC who are also treated with metformin. Materials and Methods We retrospectively reviewed the medical records of 1,902 patients diagnosed with CRC at King Hussein Cancer Center between January 2004 and December 2012, and identified 349 patients (18%) with type II DM; we censored the data of 28 patients because their antidiabetic medications were unknown. We then categorized these 321 patients into two groups: 192 patients treated with metformin (group A) and 129 patients treated with other antidiabetic medications (group B). Results Group A patients had significantly longer overall survival (89 months; 95% CI, 66 to 112 months) and progression-free survival (47 months; 95% CI, 15 to 79 months) than group B patients (overall survival: 36 months; 95% CI, 24 to 48 months; P ≤ .001; progression-free survival: 21 months; 95% CI, 13 to 29 months; P = .016). After adjustment for age, sex, body mass index, aspirin use, anticholesterol treatment, and CRC stage, group A patients had a 40% reduction in mortality (hazard ratio, 0.58; 95% CI, 0.4% to 0.85%; P = .005). Conclusion Our results support findings from other populations that patients with diabetes and CRC who are also treated with metformin have better outcomes than those treated with other antidiabetic medications.
Collapse
Affiliation(s)
- Amal Al Omari
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hadeel Abdelkhaleq
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Maysa Al-Hussaini
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rim Turfa
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nour Awad
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manal M Hassan
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mahmoud A Alfaqih
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R Garrett
- Amal Al Omari, Hadeel Abdelkhaleq, Maysa Al-Hussaini, Rim Turfa, and Nour Awad, King Hussein Cancer Center, Amman; Mahmoud A. Alfaqih, Jordan University of Science and Technology, Irbid, Jordan; and Manal M. Hassan and Christopher R. Garrett, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
3
|
Al Omari A, Abdelkaleq H, Al-Hussaini M, Turfa R, Awad N, Hassan M, Garrett CR. The metformin effect on survival in Middle Eastern patients (pts) with type II diabetes (DM) and colorectal cancer (CRC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Rim Turfa
- King Hussein Cancer Center, Amman, Jordan
| | - Nour Awad
- King Hussein Cancer Center, Amman, Jordan
| | - Manal Hassan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | |
Collapse
|
4
|
Al Omari A, Abdelkaleq H, Al-Hussaini M, Turfa R, Awad N, Al Mutar SS, Hassabo HM, Sahin IH, Hassan M, Garrett CR. Retrospective evaluation of Middle Eastern patients (pts) with type II diabetes mellitus (DM) and colorectal cancer (CRC): Validation of metformin effect on overall survival (OS). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.478] [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: 11/20/2022] Open
Abstract
478 Background: Epidemiologic data suggest that anti-DM medications may impact OS in CRC pts who have type 2 DM. Although type 2 DM and CRC are major health problems in the Middle East, little data exists on pts with both conditions from this region. Methods: Medical records from 1,835 CRC pts seen at King Hussein Cancer Center between 1/1/2004 and 12/31/2012 were evaluated for prevalence of type 2 DM; those with both conditions were evaluated for anti-diabetic therapy and treatment outcomes (OS and progression-free survival [PFS]). Results: 285 type 2 DM CRC patients were identified (prevalence 15.5%); 19 pts were censored as their anti-DM medications were not known. Median age of 266 pts analyzed was 62.1 years (± 8.9), M: F ratio 1.6:1, non-metformin (n = 109, 41%), metformin only (n = 43, 16%), metformin + insulin (n = 11, 4%), metformin + another oral agent (n = 104, 39%). Metformin use increased over time (19% in 2004 to 71% in 2012). Adjusting for age, gender, body mass index, and stage, type 2 DM pts treated with metformin had a 40% improvement in OS (hazard ratio 0.624, 95% confidence interval 0.44-0.97). Conclusions: These data support previous findings that metformin use in CRC pts with type 2 DM is associated with a superior PFS and OS. Contrary to previously published data there was a statistically significant OS benefit in stage IV pts, while the trend toward OS benefit in stage I-III pts was not statistically significant (see Table). This study was supported by the King Hussein Cancer Center/MD Anderson Sister Institution Network Fund. [Table: see text]
Collapse
Affiliation(s)
| | | | | | - Rim Turfa
- King Hussein Cancer Center, Amman, Jordan
| | - Nour Awad
- King Hussein Cancer Center, Amman, Jordan
| | | | | | | | - Manal Hassan
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | |
Collapse
|
5
|
Abstract
BACKGROUND Artemether-lumefantrine is being recommended by the World Health Organization for treating uncomplicated malaria. It is expensive. We sought evidence of its superiority over existing treatment regimens. OBJECTIVES To compare artemether-lumefantrine with other antimalarial drugs for treating uncomplicated falciparum malaria. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group specialized trials register (February 2003), the Cochrane Controlled Trials Register (Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to February 2003), conference proceedings, and reference lists of articles. We contacted experts in malaria research and the pharmaceutical company that manufactures artemether-lumefantrine. SELECTION CRITERIA Randomized and quasi-randomized trials comparing artemether-lumefantrine administered orally with standard treatment regimens (single drug or combination). DATA COLLECTION AND ANALYSIS Two reviewers independently applied inclusion criteria to potentially relevant trials, assessed trial quality, and extracted data. Parasitaemia on day 28 (day 42 for sulfadoxine-pyrimethamine and day 63 for mefloquine) was the primary outcome. Adverse event information was collected from the studies. MAIN RESULTS Six trials (1698 participants) tested a four dose regimen. Failure rates for artemether-lumefantrine tended to be higher (comparisons included sulfadoxine-pyrimethamine, halofantrine, and mefloquine; difference statistically significant for mefloquine). When compared with chloroquine, artemether-lumefantrine was better in two studies, but the failure rate for chloroquine at these sites was over 50%. Two trials (419 participants) tested a six dose regimen against mefloquine plus artesunate. Artemether-lumefantrine was associated with higher failure rates but the studies were small. REVIEWER'S CONCLUSIONS The four dose regimen of artemether-lumefantrine seems to be less effective than most other current antimalarial regimens. The six dose regimen is largely untested.
Collapse
Affiliation(s)
- A A Omari
- International Health Research Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK, L3 5QA.
| | | | | |
Collapse
|