Evaluation of Stages, Treatment Protocols and Outcomes of Colorectal Cancer among Palestinian Patients

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سواعد, ابراهيم
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An-Najah National University
Introduction: In Palestine, the first leading cause of death is cardiovascular diseases, and cancer is ranked as the second leading cause of death. Colorectal cancer is ranked as the second type of cancer among Palestinian patients. Cancer care is improving in Palestinian hospitals with time; however, services like palliative care, targeted therapy, bone-marrow transplantation, and individualized therapy are still limited. The study aims to assess the colorectal cancer stages, treatment protocols, and the survival of patients in Palestine. Methodology: This is a retrospective study through data collection from medical records in a hospital specialized in cancer patients' care. Patients with confirmed colorectal cancer (stages I, II, III, IV) undergoing surgical or medical treatment were included in the study. Data collection was standardized by using Data Collection Form to gather information from included medical records. The disease outcomes after treatment were categorized into six categories, namely, Death, Cure, Disease Progression, Disease Recurrence, Under-treatment, or Unknown outcomes. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 21). Results: A sample of 252 patients with colorectal cancer from An-Najah National University Hospital (NNUH) was collected, males were 143 (56.7%), their age was between 27 – 86 years with a mean of 60.64 (±11.4) years. Most of the patients had colon cancer only (183 patient, 72.6%) and (29 patient, 11.5%) had rectal cancer only, while the rest had both rectal and colon cancer (40 patients, 15.9%), most of them were at stage IV (159 patients, 63.1%). Surgery was the most prevailing mode of treatment for colorectal cancer patients (230; 91.3%), on the other hand, in patients who received chemotherapy, FOLFOX (folinic acid, fluorouracil, oxaliplatin) was more prevalent among patients and the physicians tend to choose it compared to FOLFIRI (folinic acid, fluorouracil, irinotecan). The mortality of the disease was high as many patients (41.3%) have died within a short interval between diagnosis and death. Worth mentioning that there was an apparent delay in the diagnosis of the disease as most patients were diagnosed at a later stage which has a poor prognosis. Regression analysis of days between last visit and diagnosis date and the type of treatment received (Chemotherapy, Surgical Treatment, Radiotherapy) (R2 = 0.035) surgical treatment had the longest days between diagnosis and last visit and this was significant (p = 0.033). Surgical treatment had a positive impact on increasing the days of survival and it was significant (p = 0.021). A Chi-square analysis of the stage at diagnosis and the prognosis of CRC patients using existing data revealed that there is a significant difference (p <0.05) between the stage at diagnosis and the disease outcome. On the other hand, Chi-square analysis for the chemotherapy protocol used among patients in comparison with disease outcomes, cure rates were highest with the use of FOLFOX (26.7%), death rates were similar between FOLFIRI and FOLFOX patients. These results were significantly different (p<0.05). Conclusions: A high percentage of patients were diagnosed in advanced disease stages. The modes of treatment generally were adopted from international guidelines, however, the cure rates and good disease prognosis were not high, the disease mortality rate was high. More studies need to be undertaken to investigate the actual application of chemotherapy protocols and involve clinical pharmacists in the chemotherapy protocol choice, dosing, frequency, follow-up. As a result, the present analysis of Palestine's colorectal cancer pattern advocates for a wide range of treatments to lower the disease's burden. These include investments in public awareness campaigns aimed at the general public and primary care professionals, intending to increase understanding of colorectal cancer symptoms and risk factors, as well as the merits of screening, and promotion of healthy lifestyles in order to avoid this serious illness. In order to diagnose the disease much earlier which makes health care providers intervene earlier to promote a better prognosis.