Abstract:

Background: Lynch syndrome is caused by germline mutation of genes involved in the mismatch repair pathway that leads to an increased susceptibility to colon and extra-colonic cancers. The most important tumor characteristic of this syndrome is microsatellite instability. Based on some studies, these patients do not respond to 5-fluorouracil-based chemotherapy. These individuals can be easily identified using microsatellite instability testing. In this thesis, BAT34c4 and BAT26 mononucleotide markers were evaluated to launch an indigenous panel based on Iranian population genetic and cost-effectiveness, compared to the standard Promega
kit.

Patients and Methods: Of about 685 patients with colorectal cancer in Isfahan city, 37 patients who met the Amsterdam II criteria were selected. Microsatellite instability status of DNA extracted from normal and tumor tissues of these patients were determined using BAT34c4 and BAT26 markers as well as 5 markers of Promega kit by fragment analysis. Output data were analyzed using GeneMarker software. The results of both methods were compared.

Results: In total, 10 patients (27%) of 37 studied patients showed microsatellite instability with both methods. Based on the results of Promega kit as the gold standard, the sensitivity and specificity of the BAT34c4 and BAT26 markers were assessed at 100% for microsatellite instability detection.
Conclusion: The results of this study showed that the sensitivity and specificity of BAT34c4 and BAT26 markers are comparable to Promega kit in microsatellite instability detection. This method is more cost-effective and can be done in less time.

Key words:

lynch Syndrome, Microsatellite Instability, HNPCC, MMR.

Abstract

Introduction: Breast cancer is the most common malignancy in women worldwide. Diagnosis and treatment of breast cancer can have an impact on sexual dysfunction in women. Sexual function is one of the most important aspects of quality of life, therefore, paying attention to it is of utmost importance. This study was aimed to investigate the effect of cognitive-behavioral counseling on sexual function in women with breast cancer.
Methods: The research method is pretest- posttest design with control group. Fifty women with breast cancer referrring to the Ala Cancer Prevention and Control Center (Macsa) were randomly divided into two groups of counseling and control. Cognitive-behavioral counseling was performed in 10 one-hour, weekly sessions for the cognitive-behavioral counseling group. The control group received routine care. Demographic characteristics questionnaire and FSFI questionnaire were completed once before the intervention and once one month after by both groups. Data analysis was performed using SPSS software version 20 and independent t test, paired t-test, and chi-square. Significance level was considered P <0.05.
Findings: The mean scores of sexual functions in the group counseling group were statistically significant in the control group after the intervention (P = 0.001) as compared to that before the intervention (p = 0.876). The mean scores of sexual functions did not show a statistically significant difference between the two groups of counseling and control before the intervention (p = 0.22). However, after the intervention, the difference between the two groups was statistically significant (p = 0.001). The mean scores of vaginal moisture and sexual pain before and after the intervention in the cognitive-behavioral counseling group were, respectively, (p = 0.129), (p = 0.89) which did not show a significant difference.
Conclusion: The results of this study showed that cognitive-behavioral counseling has a positive effect on sexual function in women with breast cancer. Therefore, it is highly recommended to use this treatment method in centers providing services to patients with breast cancer.

Keyword:

cognitive behavioral therapy, cognitive behavioral therapy, Sexual function, Breast Cancer

Abstract:
Background: Cancer is one of the main causes of death. Incidence rate and case fatality of gastric cancer is high. Registry cancer statistics indicates an upward trend of gastric cancer in Iran. Regarding the incidence, gastric cancer is the fourth most common cancer and the second leading cause of cancer death in the world. Hereditary diffuse gastric cancer (HDGC) is a hereditary form of cancer with late-onset features and very aggressive and poor prognosis. CDH1 gene mutation is the most common genetic changes observed in hereditary diffuse gastric cancer (HDGC) and sporadic diffuse gastric cancer (DGC). Apart from the CDH1 gene, CTNNA1 (gene encoding the alpha-E-catenin) is the only gene involved in HDGC.
Methods: The present study carry out in the Isfahan city of Iran country. The samples obtained from the formalin fixed paraffin-embedded tissues and peripheral blood of diffuse gastric cancer patient’s referred to the Al-Zahra hospital, a referral hospital in Isfahan province, central Iran, and Alaa cancer control center, a charity-based foundation for cancer patients in Isfahan from January 2011 to April 2016. Eventually, after the gained family history and the pedigree of patients, 28 cases with sporadic diffuse gastric cancer (SDGC) and 17 cases with hereditary diffuse gastric cancer (HDGC) has been selected and all the patients or their families signed informed consent forms.
Results: In this study, 45 patients were evaluation with SDGC and hereditary HDGC. In HDGC patients, 2 exonic one-nocleotide deletions, 2 non synonymous substitutions, 3 synonymous substitutions, one large deletion in exon 1 and 9 intronic alterations in CDH1 gene were detected. In SDGC patients, 3 synonymous substitutions, one duplication in exon 9, one large deletion in exon 2 and 13 intronic alterations in CDH1 gene were identified. In addition, two samples base on positive family history and histopathatological criteria selected for exome sequencing and their results revealed one-inframe deletion in LMTK3 gene and missense mutations in BRCA2, ATM, PIK3CA and LMTK3 genes.
Conclusion: The results can be used in the population for screening of suspect individuals. The mutations carriers recommended for surveillance utility such as annual endoscopic or biopsy of stomach for the early diagnosis and prevention the fatal effect of diffuse gastric cancer.

Keywords:

Candidate genes, Diffuse gastric cancer, CDH1, Mutation

Abstract:
The aim of the current study is to determine the Structural Pattern of Death Attitude based on quality of Attachment in In teens with Cancer: mediator of Emotional Repression and Anxiety Sensitivity. In this regard, from teens with cancer of Isfahan city statistical community, 150 people (85 female & 65 male) were chosen using available sampling method. Then, they were evaluated by using the following measures: Hazan & Shaver attachment style in adult inventory of, Wong Death Attitude Inventory, Weinberger Emotional Repression Inventory, Anxiety Sensitivity (AS) Inventory. The data were analyzed using IBM SPSS 22 and LISREL 8.85. The result indicated that attachment quality has a direct meaningful relationship with the attitude toward death in adolescents with cancer. Also, attachment quality through mediating role of emotional suppression and anxiety sensitivity have significant relationships with the attitude toward death in adolescents with cancer. Based on these findings, we could state that the attachment quality, both directly and through the mediating role of emotional suppression and anxiety sensitivity, plays an important role in the death attitude in adolescents with cancer.

Keywords:

Cancer, Quality of Attachment, Emotional Repression, Anxiety Sensitivity, Death attitude

Abstract:

The purpose of this study was to investigate the effect of acceptance and commitment therapy, on body image, sexual desire and cognitive behavioral avoidance in women with breast cancer after mastectomy surgery. The research method was semi- experimental and control group with pre- test and post- test. The statistical population included women with breast cancer in the Isfahan province who had come to Alla charity center 2017. A sapmle of 16 female cancers with ber were selected for inclusion in the study through targeted sampling and assigned two groups with eight subjects. The experimental group received acceptance and commitment therapy in 8 sessions, 40 minutes, and the control group remained on the waiting list until the end of the study. Measurement tools were multidimensional questionnaire on personal body image (MBSRQ), Young’s Empirical Avoidance Questionnaire and Sexuality Index Questionnaire (Apt & Halbert, 1998). In order to compare the efficacy of the treatment, both the experimental and control groups were tested. The findings were analyzed using covariance analysis method. The results showed that the treatment was effectine on admission and attachment to body image (p<0.05), sexual orientation (p<0.05) and cognitive-behavioral avoidance (p<0.001), in oueral, the ACT seems to be effective in patients with breast canscer.

Key words:

Acceptance and Commitment Therapy, Sexual Orientation, Body Image, Cognitive- Behavioral Avoidance, Breast Cancer, Mastectomy Surgery.

Abstract:
Introduction: Cancer prevalence and increase in its medical care service costs especially in the end stage of the disease in addition the necessity of optimal allocation of scarce healthcare resources entails the development and practicing of low-cost and high effective treatments. this study aimed to evaluate cost-effectiveness of home-based palliative care for end-stage cancer patients.
Methods: The cost of care and outcomes for two groups of end-stage cancer patients are compared: (1) Intervention group that consists of 94 patients who received home-based palliative care including medical ،nursing and psycho-social care; (2) Control group consists of 113 patients who were not supported by the home care services and referred to hospitals and cancer out-patient clinics to receive palliative care. The aforementioned groups where matched in terms of type and stage of cancer and patient’s age and gender. The cost of care included all inpatient and outpatient clinical/para-clinical services and the effectiveness was measured as length of stay in the hospital (LOS) and percentage of death occurred at home. A time horizon of 6 months was considered.
Results: More death occurred at home among the intervention group compared with the control group (45. 74% VS 23. 89%; p=0. 001) .The reported length of stay (LOS) in hospital was lower for the intervention group compared to the control group (14. 75 Day VS 20. 45 Day; p=0. 052) .Regarding the cost ،the mean total costs were lower for intervention group ($3 ،714 VS $5 ،521; P=0. 019) .This resulted in an incremental costeffectiveness ratio (ICER1) of $316. 60 per LOS  and an incremental costeffectiveness ratio (ICER2) of $ -82. 70 per percentage of death in home. Our findings indicated that home-based palliative care was a dominant strategy.
Conclusion: Home-based palliative care appeared to be a dominant strategy for caring end stage cancer patients. As it decreased the cost of care and increased the death at home at one hand and the length of stay at hospital on the other hand. So this type of care could be considered for including in benefit package to meet needs of end-stage cancer patients.

Keywords:

Cost-effectiveness analysis ،Palliative care ،Home care services ، Hospice,
End of life care ،Neoplasm

Title:
In diagnosing cancer, the main question that can be asked is about their lifespan: “How long will I live?” Or “What is the chance of success of any treatment option?” Many physicians provide patients with cancer survival data only based on the location of the tumor and its stage. Common information includes a 5-year survival rate and survival time. For instance, a physician can tell a patient with early-stage lung cancer that his or her chance of survival is 50%, which means that half of the community with this type  of cancer had lived for more than five years. In fact, estimating the survival rate of cancer patients is based on the average survival of patients at the same stage of cancer.
These estimates are inaccurate since they do not include patient-specific information such as age, gender, and other general conditions. Predicting the lifetime of cancer patients in advanced stages is an important issue. This prediction helps planners make more confident decisions about resource allocation and treatment choices. Most studies have predicted life expectancy of patients with more than five years survival. In this thesis, short-term prediction of life expectancy in cancer patients is investigated. After reviewing the literature, the
factors affecting the life span of cancer patients are studied.
For short-term prediction, the data set was first divided into three groups by expert opinion. These three groups included patients with survival less than three months, six months, and one year. After classifying the data using five nearest-neighbor methods, logistic regression, Bayesian classifier, decision tree and support vector machine were calculated for accuracy, sensitivity and area under the characteristic curve in each method.
Finally, these values were compared to select the best classification algorithm. The results show the successful performance of the support vector machine algorithm in classifying and predicting short-term life expectancy of patients.

Key Words:

Lifetime prediction, cancer, nearest neighbor, logistic regression, Bayes simple classifier, decision tree and support vector machine

Abstract:

Cancer is one of the leading causes of death worldwide and after cardiovascular disease is the second most common in developed countries. Breast Cancer is one of the most common cancers among women, and its incidence and the mortality is rising. This paper examines the relationship between alexithymia and the personality dimensions in patients with breast cancer and healthy and to be compared. The NEO Five-Factor Personality Inventory and Toronto alexithymia questionnaires were distributed in 90 patients with breast cancer of Isfahan’s Entekhab Cancer Control Center who were selected by multi-steps cluster, as well as 90 healthy individuals. The answers were analyzed using descriptive and inferential statistics (t single group, t-test, Pearson correlation and multiple  egression analysis). The results showed that in patients with breast cancer there was a significant positive correlation between neuroticism factor and alexithymia, a negative relationship between the factors of extraversion, agreeableness and conscientiousness and alexithymia. In healthy women, there was a significant positive correlation between neuroticism factor and alexithymia, and a significant negative relationship between extraversion and conscientiousness factors and alexithymia. Also, between the breast cancer patients and healthy women, significant difference in personality dimensions wasn’t found, while difficulty identifying feelings subscale of alexithymia had significantly different between these two groups.
Key Words:
Personality Traits, Personality Dimension, Neuroticism, Alexithymia, Breast Cancer

Abstract:

The present study was conducted aiming to determine the effectiveness of compassionfocused therapy on perceived stress, body image anxiety, valuing body and psychologic distress in the women suffering from breast cancer. The statistical population of the presentstudy included women with breast cancer referring to Ala’ cancer prevention and control center in Isfahan in spring and summer of 2018. Research method was quasi-experimental with pretest, posttest, control group and 45-day follow-up. The independent variable is compassion-focused therapy and dependent variables are perceived stress, body image anxiety, valuing the body and psychological distress in the women with breast cancer. The sample size was 30 women with breast cancer who were selected from those referring to Ala’ cancer prevention and control center through convenient method and were randomly replaced into experimental and control groups (15 patients in the experimental group and 15 patients in the control groups). The experimental group received eight ninety-minute sessions of compassion-focused therapy during two-and-a-half months once a week while the control group didn’t receive any intervention during the study. Then the people in both groups took the posttest. Follow-up stage was administered after 45 days. The applied instruments included valuing body questionnaire (Ghoddoosi, et.al, 2011), perceived stress questionnaire (Cohen, et.al, 2005), psychological distress questionnaire (Kesler, et.al. (2003), body image anxiety questionnaire (Litelton, et.al, 2005). After collecting questionnaires and extracting raw data, data analysis of the study was done via SPSS23 through descriptive statistics and repeated measurement ANOVA. The results of data analysis showed that compassion-focused therapy has significantly influenced perceived stress, body image anxiety, valuing body and psychological distress in the women with breast cancer at the posttest and follow-up stage (p<0001).

Key Words:

Perceived stress, Valuing body, Psychological distress, Compassion-focused therapy, Breast cancer, Body image anxiety

Abstract:

Squamous cell carcinoma (SCC) in the breast is a rare disease and not detectable with current tests. Therefore, identifying molecular factors involved in the development of this type of cancer can help to find specific biomarkers for early diagnosis and targeted treatment of the disease. In this study, a family with familial SCCs with the aim of identifying pathogenic variants has been investigated.

This is a case study of a laboratory type. At first, the family under investigation with three patients with SCC in the breast, esophagus and skin was selected from the database of patients at the Cancer Prevention and Control Center (MACSA) in Isfahan. After genetic counseling and peripheral blood sampling from family proband, the genomic DNA was extracted and after quantitative and qualitative examinations, it was examined by the whole exon sequencing method. Using OMIM and Gene Cards databases and also by bioinformatics analysis software including VarElect and VarAFT, the resulting VCF file from WES was studied and the analysis and prioritization steps of variants was performed. A total of 7176 probably pathogenic variants in 256 genes and 2 variants with unknown function in two genes were reported. After analyzing the data and verifying the findings using Sanger sequencing, two gene variants EP300 (c.3143-4delT) and RECQL4 (c.3104-3105insA) were introduced as pathogenic variants. Given that EP300 gene plays a role in controlling the growth and division of the cells and RECQL4 gene in DNA repair and replication, it seems that mutations in these two genes can cause the onset of inherited cases of SCC cancer. Further studies on familial cases of this disease in different populations can lead to the identification of similar genetic factors and possibly the introduction of new syndromes of hereditary cancer.

Key Word:

Squamous cell carcinoma, Whole exon sequencing, genetic variants, Sanger  sequencing