Background: Hypofractionated radiotherapy in early breast cancer yields equivalent or better outcome in terms of efficacy, toxicity, cosmesis and cost-effectiveness. However, its role in node-positive breast cancer is less clear. Aim: To compare between adjuvant conventional and hypofractionated radiotherapy in node-positive breast cancer. Methods: Prospective pilot study of 66 node-positive breast cancer patients recruited over 1 year in a single institution. Patients were randomized to receive adjuvant conventional radiotherapy 200 cGy x 25 fractions with 200 cGy x 5 fractions boost to the tumor bed in case of breast conservation (control arm) or hypofractionated radiotherapy 266 cGy x 16 fractions with 266 cGy x 4 fractions boost to the tumor bed in case of breast conservation (intervention arm). The end points were disease-free survival, cosmetic outcome, ipsilateral arm lymphedema and acute skin reactions. Results: Disease-free survival did not differ significantly between the two treatment arms (p = 0.6) and the 2-year diseasefree survival rate was 87% and 89% in the hypofractionated and conventional arms. The rate of excellent/good cosmetic score was higher in the hypofractionated arm than the conventional as rated by patients (71% vs. 46%, p = 0.182) and physicians (29% vs. 8%, p = 0.32). Hypofractionation, when compared to conventional fractionation, was associated with less arm lymphedema (22% vs. 40%, p = 0.149), dry desquamation (28% vs. 53%, p = 0.04), skin darkness (0% vs. 15%, p = 0.054) and wet desquamation (16% vs. 21%, p = 0.601). Conclusion: Hypofractionated adjuvant radiotherapy in node-positive breast cancer patients is equivalent to conventional fractionation as regards disease-free survival, cosmetic outcome and arm lymphedema with less early skin reactions.

Introduction: Breast cancer is one of the most common cancers among Egyptian women. Health-related quality of life (QOL) and reduction of side-effects play an important role for the treatment of cancer patients. The purpose of this prospective study was to determine if pharmacist's intervention could improve clinical outcomes of patient with breast cancer. Patients and methods: This study was a single-center interventional prospective study carried out on a group of 60 breast cancer patients at Clinical Oncology Department, Ain Shams University Hospitals from June 2017 to May 2018 patients were subjected to a thorough history taking, assessment of treatment-related adverse events before each cycle and at the end of the treatment. In addition, assessment of QOL was done at the baseline and at the end of treatment to evaluate the effect of the pharmacist's interventions. Results: The present study has shown that the clinical pharmacist interventions were associated with significant decrease of toxicity grades of patients, for example, anemia where the percentage of patients of grade 2 decreased from 17% to 1.7%; moreover, 5% of patients had grade 4 nausea/vomiting, while after pharmacist intervention, it became 0%. Regarding patients’ QOL, results of the present study showed improvement of mean ± standard deviation of most of the QOL scales such as systematic therapy side-effects decreased from 80.8 ± 19.53 to 42.8 ± 16.8, all with P < 0.001. Conclusions: Most treatments for breast cancer despite beneficial result in toxicities, primarily anemia, neutropenia, nausea, and pain. These side-effects adversely impact patient QOL and can lead to treatment discontinuation. Clinical pharmacist intervention resulted in beneficial clinical outcomes in patients with breast cancer such as the reduction of treatment-related side-effects and the improvement of patients’ QOL.

The planning fallacy posits that humans tend to underestimate the amount of time needed to complete a project and that greater complexity results in a larger difference in that estimation. If this phenomenon is present in the orthopedic operating room, it could lead to negative impacts on patients, their families, and physicians themselves. Nine fellowship-trained orthopedic surgeons at one institution were asked to give an estimate of their operative and total room times over the course of three months. Over 759 cases, the surgeons underestimated the total room times by 17.3% (p = 0.034) but did not underestimate their operative times (p = 0.590). The surgeons improved estimation of their operative time for all cases from 13.6 to 10.9 minutes of their actual time (p = 0.031) by comparing the absolute difference for the surgeons’ first 25% to the last 25% of cases. Procedures performed at the hospital underestimated operative and total room times by 8.9% and 7.4% compared to the ambulatory center, which overestimated operative times by 6.0% and underestimated total room times by 3.8% (p < 0.001). We found that the planning fallacy does exist in certain situations within the orthopedic operating room.

Background Lung cancer is the most commonly diagnosed cancer worldwide for both sexes. There are 1.8 million new cases in 2012 (12.9% of the total), 58% of which occurred in the less developed regions. The disease remains the most common cancer in men worldwide (1.2 million, 16.7% of the total) and the most common causes of cancer deaths worldwide for both sexes, estimated to be responsible for nearly one in five (1.59 million deaths, 19.4% of the total) Aim of the Work are to evaluate the effect of platinum-based chemotherapy combinations as a first line treatment on health related quality of life (HRQOL) in advanced NSCLC Egyptian patients and to assess tumor’s response to treatment and treatment toxicity. Patients and Methods A prospective, single arm clinical study, to evaluate the effect of palliative chemotherapy on advanced NSCLC patient’s health related quality of life before starting chemotherapy and after 3 cycles of treatment, patient’s response to treatment and toxicity related to treatment. Results 61 patients completed the EORTC QLQ-C30 and the QLQ-LC13 for the evaluation of HRQoL before the 1st cycle of chemotherapy. Started with 70 patients, 9 were excluded during the study (because of a change in the chemotherapy protocol or because of treatment discontinuation during the following cycles of chemotherapy. Conclusion The present study explored self-reported quality of life in advanced NSCLC patients receiving chemotherapy, Aiming for a better understanding of how chemotherapy influences HRQoL. The importance of patient perception of their own health regarding the complexity of cancer, which is a disease that affects every dimension of life and the way in which individuals perceive the environment, the diagnosis, and the therapy. Therefore, the combination of periodic quality of life assessments and clinical practice should be more extensively.

Background: Recently, there is a great attention, about the clinicopathological differences between right and left colon cancer, and how much these differences will affect the outcomes of colon cancer patients. Many epidemiological studies have demonstrated, that tumor at the right and left colon, respectively, occur with different incidence in diverse region of the world. Differences in clinical presentation, patient's demographics, and tumor biology between right-and left-sided colon cancers have long been reported in the literatures. Methods: The current study was conducted in Clinical Oncology and Nuclear medicine department, Ain Shams University Hospitals, during the period from January 2011 to December 2015, data on all patients histologically confirmed with colon cancer, were evaluated right-and left-sided cancers were compared with regard to epidemiological, clinical and pathological parameters as well as survival data. Results: The study showed that, there was 129 patients, 70(54.2%) patients had left-sided colon cancers and 59(45.7%) patients had right-sided colon cancers, most of the cases were aged above 50 years 61.2%. Histopathological type was mainly adenocarcinoma 72.09%, moderately differentiated 79.8%, the mucinous carcinoma was more in right sided colon 56.25%. Comparison of progression free survival in stage IV, showed higher progression rate (58.3%) in right sided patients, than left sided patients (41.6%), this difference was not statistically significant. We also found that patients with right-sided colon cancer had a statistically significantly worse overall survival (OS) P value=0.019, than patients with left-sided colon cancer. We demonstrated that the differences in OS were significant only in patients with stage IV colon cancer. Conclusion: In conclusion, our results support evidence that there are differences in the biology and outcomes for right-and left-sided colon cancers. Significantly better survival is seen for metastatic colon cancer with a left-sided, and this was confirmed by multivariate analysis. This might have been due to several environmental and lifestyle factors, which contributed to this anatomical shift. The differences in genetic and molecular pathologic profiles in each side of the colon were observed. Stratification based on the primary site should be considered in the future for trials assessing survival for colon cancer.