Fasting in Cancer Patients: A Challenge for Caregivers

Background: Muslim cancer patients and healthcare professionals face several challenges about the necessity of fasting and its possible side effects during the holy month of Ramadan. We aimed to study the prevalence of fasting among cancer patients during Ramadan and opinions of health care professionals about fasting among cancer patients in Iran. Methods: We conducted a cross-sectional survey during the Ramadan (July-August) in 2013. Participants were 620 cancer patients and, 187 healthcare professionals in several cancer clinics from different provinces of Iran. We used self-administered questionnaires and collected data from patients, and healthcare professionals to collect data. We performed descriptive analysis by using Stata statistical software. Results: Out of 620 patients who participated in this study, 428 (69%) were women. 76 (13%) of patients had fasted for at least a day during Ramadan and, from which 41 (7%) had fasted whole months because of their religious belief. Among patients who had refrained from fasting, the reasons were lack of sufficient physical strength (403, 65%), excessive thirst (141, 23%). 275 (44%) of participants had consulted with their physician about fasting. We found that more than 50% of physicians advised against fasting for patients following surgery, pre-operation, recent hospitalization, and consumption of oral or intravenous chemotherapy. Most of the healthcare professionals (68%) believed that cancer survivors could not fast even if they have no signs or symptoms or side-effects after the treatment.Conclusion: Although most of the cancer patients refrain from fasting, some cancer patients practice fasting and face challenges during the holy month of Ramadan in Iran. Most patients consult about fasting in Ramadan with their doctor who has variable opinions about this issue. Development of guidelines for healthcare professional and cancer patients regarding Ramadan fasting is needed.  

Background: We studied the number of lymph nodes (LN) assessed in gastric cancer, and evaluated the association between different factors and a lower number of LN assessed.Methods: We conducted a retrospective study in three hospitals in Tehran city, I.R. Of Iran. We used patient medical and pathological reports and obtained personal and clinical information. We studied the association of being on the N3 stage with the number of assessed lymph nodes (NALN), gender, tumor size, T stage, hospital, tumor site, histopathological diagnosis, tumor grade and age at diagnosis. In addition, we estimated the association between NALN and different clinical variables. A logistic regression model estimated the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI).Results: The average number of NALN was 10.48 (±6.9). We found that the probability of being diagnosed as stage N3 was significantly lower in patients who had less than 15 LN assessed compared to those who had more than 15 LN assessed in their pathology reports (OR=0.2; 95% CI 0.1-0.4). The hospital, tumor sizes were significantly associated with NALN.Conclusion: Lower NALN led to stage migration and underestimation of the real tumor stage in GC patients. The LN assessments were lower than recommended by the American Joint Cancer Clinician Association in all the three hospitals included in this study. Developing national guidelines, training surgeons and pathologists, conducting regular monitoring and evaluation of the data is necessary to increase NALN and thus improve the staging of GC patients.

Background: Colorectal cancer is one of the mostly diagnosed malignancies worldwide. The main risk factors for colorectal cancer include the mutation of tumor suppressor genes or proto-oncogenes and unhealthy lifestyle. Vegetable and fruit consumption with multiple anticancer agents can reduce the risk of colon cancer. Resveratrol is a natural polyphenolic product that inhibits proliferation and induces apoptosis through several pathways. In this study the effects of resveratrol on β-catenin (CTNNB1) and GSK-3β expression in the Wnt-signaling pathway were examined and, morphology changes were analyzed in colon cancer cells with high levels of β-catenin such as HCT-116.Methods: HCT-116 cells were seeded into 6-well plates, and the cells were treated with various concentrations of resveratrol (25, 50 and 100 μM) for 24, 48 and 72 hours respectively. Quantitative Real-time PCR examined β-catenin and GSK-3β expression and morphology changes were analyzed.Results: The results showed that, in 25 and 50 μM concentrations, resveratrol reduced β-catenin and GSK-3β expression in 24 h (p-value; 0.001). Gene expressions were found to increase in 48 h and 72 h treatment with resveratrol in the concentrations of 50 and 100 μM respectively (p-value; 0.001).Conclusion: considering our data, it can be concluded that low doses of resveratrol could reduce β-catenin expression, which can affect the Wnt-signaling pathway. High doses can increase the GSK-3β expression, playing a role in the destruction of β-catenin, inhibition of its accumulation in the cytoplasm and nuclear, apoptosis induction and cellular proliferation inhibition while low doses of resveratrol can decrease GSK-3β expression and suppress proliferation.Abbreviations: LEF/TCF, lymphoid enhancing factor/T-cell factor; APC, adenomatous polyposis coli; GSK-3β, glycogen synthase kinase 3B; CK, casein kinase 1; RSV, resveratrol; DMSO, dimethyl sulfoxide; DMEM-F12, Dulbecco's Modified Eagle's Medium F-12; FBS, fetal bovine serum; CIN, chromosomal instability; PI3K, phosphatidylinositol-3-kinase; TGF-β, transforming growth factor-β; GFR, Growth Factor Receptor; KRAS, Kirsten rat sarcoma viral oncogene homolog; PTEN, Phosphatase and tensin homolog; COX, Cytochrome c oxidase; IGF-1R, insulin-like growth factor 1 (IGF-1) receptor; Akt, Protein kinase B (PKB);

Diagnosis of the tumors' tissues in the liver and distinguishing the malignant tumorsfrom benign is a critical issue in medicine. In this regard, so many methods have beenproposed to make the accurate tumor detection and classification algorithms usingMachine Learning and Computer Vision techniques. In this study, first we analyzedthe liver’s MR images using Discrete Wavelet Transform techniques for dimensionality reduction and feature extraction, and then Principal Component Analysis techniquehas been employed to select the essential features for classification, and finally the selected features were used to train Support Vector Machine algorithm. In classification,we used the different kernels for SVM and the result of each classifier was compared.The outcome of the algorithm indicates the high performance of our method whenthere are few training data available

Background: aging of population, high incidence of cancer and chronic diseases have led to the focus of medical care on managing symptoms of the disease, raising the ability of patients, quality of life and helping patients and their families cope with threatening illnesses. The comprehensive management of cancer patients in the palliative care system is not possible except through interdisciplinary and multidisciplinary approaches. In these approaches, the focus is on the patient and the family as well as the best care for the patient. This study aims at investigating and introducing a team approach as the basis of palliative care as well as its advantages and its implementation barriers.Methods: This paper was a literature review using a detailed search in the databases: Science Direct, Scopus, SID, PubMed, Magiran as well as reviewing articles and clinical trials between 2000 and 2017.Results: Teamwork approach is a process in which a group of health professionals cooperate with one another to promote health, prevent and treat diseases and provide other health services. Increasing patients’ satisfaction and survival, providing coordinated care, helping patients to make decisions and be engaged in their own treatment, reducing the cost of treatment, and using evidence-based guidelines in managing the symptoms are the advantages of teamwork to the patient providing the proper environment for learning and increasing the knowledge and skills of members, leading to creativity and problem solving in group members. Financial problems, lack of workforce, inadequate time, and poor communication skills are among the barriers for implementation of this approach.Conclusion: In spite of the obstacles and challenges faced in the implementation of teamwork, attempts have been made to eliminate the barriers in order to institutionalize and implement this approach for palliative care, having advantages for both patients and the organization.