|Year : 2022 | Volume
| Issue : 3 | Page : 254-261
Detailed demographics and the prevalence of comorbidities in ovarian cancer patients in Western Region of Saudi Arabia
Syed Sameer Aga1, Refal Jaha2, Rawaa Khan2, Dhiyaa Junaydi2, Alqassem Y Hakami1, Muhammad Anwar Khan3, Hashem Alsaab2
1 Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Centre, National Guard Health Affairs, King Abdulaziz Medical City; King Abdullah International Medical Research Centre, Research Summer School 12, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
2 King Abdullah International Medical Research Centre, Research Summer School 12, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
3 Department of Medical Education, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, King Abdullah International Medical Research Centre, National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
|Date of Submission||19-Dec-2021|
|Date of Decision||29-Mar-2022|
|Date of Acceptance||18-Apr-2022|
|Date of Web Publication||08-Jul-2022|
Syed Sameer Aga
Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Affairs (NGHA), King Abdulaziz Medical City (KAMC), Jeddah
Source of Support: None, Conflict of Interest: None
Objectives: The study was carried out to report the descriptive demographics, comorbidities, and adverse effects in women with ovarian cancer attending the King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. Materials and Methods: The current retrospective study was conducted at King Saud Bin Abdulaziz University for Health Sciences between the months of July and August 2021. The study sample included all the patients that had been admitted in the Princess Noorah Oncology Center in KAMC and fulfilling the two inclusion criteria (a) age not <18 and (b) confirmed histological or cytological diagnosis as per the International Federation of Gynecology and Obstetrics guidelines. A comprehensive review of the charts was conducted by a team of researchers for the extraction of data which included detailed demographics, tumor characteristics, comorbidities, and adverse effects. Results: A total of 119 ovarian cancer patients were identified, out of which 90 were included in the analysis. Most of the patients were aged above 40 years. A total of 67 of 90 (74.44%) tumors were of higher stage (II+IV) and 54 of 90 (60.0%) were located bilaterally. Among the comorbidities, we found that diabetes mellitus, hypertension, dyslipidemia, asthma, and hypothyroidism were the top five ones. Furthermore, most of the patients (82.1%) underwent a surgical intervention for the primary treatment of the tumor. The top adverse effect of the chemotherapy was the gastrointestinal ones (40.3%), followed by renal and metabolic disorders. Conclusions: Patients with ovarian cancer were of higher age and with advanced stage of the disease contrary to the reported trends in world literature. Almost all reported with one of more of the comorbidities and majority had surgical intervention as first line of treatment.
Keywords: Adverse effects, comorbidities, genetics, ovarian cancer, risk factors, Saudi Arabia
|How to cite this article:|
Aga SS, Jaha R, Khan R, Junaydi D, Hakami AY, Khan MA, Alsaab H. Detailed demographics and the prevalence of comorbidities in ovarian cancer patients in Western Region of Saudi Arabia. J Nat Sci Med 2022;5:254-61
|How to cite this URL:|
Aga SS, Jaha R, Khan R, Junaydi D, Hakami AY, Khan MA, Alsaab H. Detailed demographics and the prevalence of comorbidities in ovarian cancer patients in Western Region of Saudi Arabia. J Nat Sci Med [serial online] 2022 [cited 2022 Aug 17];5:254-61. Available from: https://www.jnsmonline.org/text.asp?2022/5/3/254/350298
| Introduction|| |
Cancer is the one disease which has become a sole key barrier to the increasing life expectancy in the world. It is one of the leading causes of death worldwide, surpassing other chronic diseases such as coronary heart diseases and stroke. Ovarian cancer (OC) ranks as the eighth common cancer in females in incidence accounting for about 3.4% of the new diagnosed cases in females and 2.1% of the new deaths recorded worldwide. Furthermore, there is a geographical variation in OC incidences;, for instance, in countries with High Human Development Index (HDI), the incidence of OC is higher (7.1) versus the low HDI countries (5.8)., OC is usually diagnosed at an advanced stage making its prognosis very poor; hence, it is regarded as the most lethal gynecological malignancy.
In Saudi Arabia, according to the National Cancer Registry, ovarian cancer is the seventh most common cancer representing 3.3% of the total cancers affecting women. As per the latest data by the International Agency for Research on Cancer, OC ranks as the 10th most lethal cancer, with the age-standardized incidence rate and the age-standardized mortality rate for OC in Saudi Arabia in 2020 being 3.8/100,000 women and 2.7/100,000 women, respectively. In 2020, Saudi Arabia reported a total 444 new OC cases constituting 1.6% of the new cancer cases and 281 deaths.
Among the various risk factors for OC, age (>50), history of endometriosis, delayed childbearing age, early onset of menarche, and late onset of menopause, family history of cancers, and mutations in BRCA1 and BRCA2 gene are considered the main risk factors for the disease., However, to the best of our knowledge, the descriptive data about the demographics, risk factors, comorbidities, and clinical modalities about the OC in Saudi women are not well established, even though numerous publications are present in literature both from this region, and globally that address the different aspects of this malignancy.,,,,
Therefore, the aim of this descriptive study is to enlist the detailed demographics and investigate the prevalence of comorbidities and adverse events (AEs) in ovarian cancer patients at King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia.
| Materials and Methods|| |
The current retrospective study was conducted at King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS). The chart review of medical records from the patient care system (BEST Care) at National Guard Health Affairs in Jeddah, Saudi Arabia, was performed between the months of July and August 2021.
Consent and ethical approval
The study was carried out in line with the Helsinki protocol, and an ethical approval from the Institutional Review Board of King Abdullah International Medical Research Centre, KSAU-HS, Jeddah, was duly acquired prior to conducting this study (RSS21J-008-06J; dated: July 8, 2021). None of the names and IDs were collected from the participants, and the data were stored within 64-bit encrypted software on the work PC of the PI that was not prone to be breached by nonauthorized persons.
The study sample included all the patients that had been admitted in the Princess Noorah Oncology Center in NGHA, KAMC, between the years of 2015 and 2021. Patients were identified from the medical records databases by using the International Classification of Diseases-9 codes for ovarian cancer (C56). Two inclusion criteria were applied: (a) age not less than 18 and (b) confirmed histological or cytological diagnosis as per the International Federation of Gynecology and Obstetrics guidelines.
A comprehensive review of the charts was conducted by a team of researchers for the extraction of data which included demographics, time of diagnosis, reproductive history, and personal/family history of cancers. Information about the tumor characteristics, including histology, grade, and type, was also recorded. Treatment modalities were also reviewed and recorded in the data collection sheet, which included the surgery performed, type, and duration of chemotherapy. Information about comorbidities and adverse effects were also recorded for each patient.
Data and statistical analysis
Data were entered in MS Excel, and before the analysis by SPSS Software IBM Statistic SPSS (SPSS Inc., Chicago, IL, USA) version 20.0., the dataset was prepared and checked for any missing data. Chi-square test was performed on the data. Descriptive statistics (e.g., mean and standard deviation [SD]) were used to describe continuous variables while categorical variables were presented in frequencies and percentages. Independent sample t-test was used to determine the mean score differences. The confidence was set at 95%, and statistical significance was determined at P ≤ 0.05.
| Results|| |
Demographic profile of ovarian cancer patients
The study comprised a total of 119 ovarian cancer patients of whose charts were reviewed for data collection phase. The mean age of the patients was 58.59 (±15.17 SD), and most of the patients were aged above 40 years, with 106 of 119 (89.1%) being ≥40 years of age.
In addition, 29 cases were excluded from the correlation analysis due to incomplete data. A total of 67 of 90 (74.44%) tumors were of higher stage (II + IV) and 54 of 90 (60.0%) were located bilaterally. Recurrence of the diseases was reported in 33 of 90 (36.67%) patients. [Table 1] summarizes the 119 patients' demographics and tumor characteristics in details.
Among the comorbidities, we found that diabetes mellitus (DM), hypertension (HTN), dyslipidemia, asthma, and hypothyroidism were the top five ones. All reported comorbidities are enlisted in [Table 2].
|Table 2: Documented comorbidities of the ovarian cancer patients at the time of admission|
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In this study, we found that most of the patients (82.1%) underwent a surgical intervention for the primary treatment and resection of the tumor tissue, while only 23.5% had debulking surgery and 10.1% were treated with laparotomy. All treatment options used are enlisted in [Table 3].
In this study, we found that most of the adverse effects of the chemotherapy were the gastrointestinal ones (40.3%), followed by renal and metabolic disorders. [Table 4] enlists all reported and documented adverse reactions in the patients based on the organ systems involved.
|Table 4: Reported adverse effects in the ovarian cancer patients as documented during or after chemotherapy|
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Statistical analyses showed no significant association between the comorbidities and adverse effects with age, tumor stage, or recurrence. Only two statistically significant associations (P < 0.05) were found: one of respiratory and thoracic disorders with higher stage of cancer and others of recurrence of cancer with blood and lymphatic comorbidities. [Table 5],[Table 6],[Table 7],[Table 8] represent the statistical analyses of various demographic characteristics with multiple factors.
|Table 7: Association of comorbidities with the stage and recurrence of cancers|
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|Table 8: Association of adverse effects of chemotherapy with the stage and recurrence of cancers|
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In this study, we found only four documented cases of BReast CAncer gene (BRCA) mutation among all 119 cases of ovarian cancer.
| Discussion|| |
In this study, we included a total of 119 ovarian cancer patients who visited KAMC, Jeddah, of whose charts were reviewed for data curation and detailing the demographics and comorbidities. Statistical analyses revealed that most of the patients (89.1%) belonged to ≥40 years' age group with a mean age of 58.59 ± 15 years. This outcome was projected due to the rarity of this disease in the Saudi population and globally as well (SHC-NHIC-SCR, 2015). Al-Badawi et al. also reported similar findings in their study where the mean age of patients was reported to be 55 ± 15 years.
In addition, we found that most of the patients had an advanced stage of the disease, with 51 of 90 (56.7%) patients having Stage III and 16 (17.8%) having Stage IV. Importantly, this finding is in similar context with other reports from the region where most of the OC patients reported to have advanced stage.,, One of the main reasons for such observation is the lack of awareness among the general population about the gynecological cancers as well as the limited access to the medical care and screening procedures.,,
Furthermore, in our study, almost 89% of the ovarian cancers were of epithelial type and only 9% were in sex cord; however, all ovarian cancer patients had a malignant type of cancers. Two studies from Saudi Arabia had previously reported quite contrary results with regard to the malignant nature of the ovarian cancers. In one of the sentinel retrospective studies from King Abdulaziz University, Jeddah, authors reported that benign neoplasms were more common (72.8%) than malignant ones (22%) across all age groups. Furthermore, they also reported that the most common benign neoplasm was serous cystadenoma (44.6%) and the most common malignant type was serous cystadenocarcinoma (33.3%). Moreover, this latter study reported that the most common ovarian neoplasm below the age of 20 years was reported to be surface epithelial tumors followed by germ cell tumor. Another study from Saudi Arabia also reported that benign cystic nonneoplastic lesions were more frequent (47.5%) in comparison to neoplastic lesions (29.7%).
With regard to the treatment modalities that were used for the initial management of the disease, we found that most of the patients (82.1%) underwent a surgical intervention for the primary treatment and resection of the tumor tissue, while only 23.5% had debulking and 10.1% were treated with laparotomy. These results were in similar line to that reported by Al-Badawi et al., who reported that 67.8% of the patients underwent surgery followed by chemotherapy and 22.2% has a debulking surgery only.
In this study, we identified the top five comorbidities in the ovarian cancer patients to be DM, HTN, dyslipidemia, asthma, and hypothyroidism. DM, HTN, and hypothyroidism have been reported to be independent risk factors for ovarian cancers by various researchers, in addition to family history, genetic factors like BRCA mutations, high body mass index (BMI), smoking, and alcohol.,,,,
A study by Le Saux et al. was conducted on French ovarian cancer patients reported that nutrition, vascular, and metabolic disorders such as DM and HTN are the most common comorbidities. With regard to the AEs, our study reported that gastrointestinal disorders (48%) are the most common followed by renal/urinary disorders (15.1%), metabolic disorder/imbalance (14.3%), and fever and nervous system disorders both (9.2%), and the least AEs were cardiorespiratory symptoms (8.4%). These results are in contrast with those reported by Le Saux et al. in which they reported that the most common AEs were anemia (16.5%), hematologic events (12.6%), taste change (11.8%), and headache (7.1%).
However, contrary to our expectations, we found only two correlations between various demographics with any of the recorded comorbidities, as shown in [Table 7] (P < 0.05). These results were in contrary to what other studies had reported previously.,,
- This study was carried out in only one oncology center in Jeddah, Saudi Arabia, and hence does not necessarily reflect the general population data
- The study with its retrospective nature has inherent inability to determine if there are regional variations in the incidence of ovarian cancer
- Twenty-nine patients had to be excluded from the majority of the analysis because of the missing data in their charts, which might affect the outcome.
| Conclusions|| |
This study showed that majority of the OC patients in our center were older than 40 years and most of them reported with an advanced-stage malignancy. In addition, most of them had an underlining comorbidity and majority had surgical intervention as first line of treatment.
The author would like to express his deep gratitude to all students of the KSAU-HS, Jeddah Campus, who proactively participated in this study.
This study was approved by the Institutional Review Board of King Abdullah International Medical Research Centre, a research wing of KSAU-HS, Jeddah (Reference No: RSS21J/008/06; dated: July 8, 2021).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]