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Öğe The access rate to diagnosis and treatment modalities in breast cancer patients in Turkey; Multicenter observational study(Imprimatur Publications, 2011) Saip, P.; Keskin, S.; Ozkan, M.; Kaplan, M. A.; Aydogan, F.; Demirag, G. Gonullu; Uzunoglu, S.Purpose: To determine the time elapsed between the first notification of the disease and the access to the diagnosis and treatment modalities and the associated factors in female patients with breast cancer in Turkey. Methods: Data was acquired from a questionnaire involving 535 patients who applied to 14 various oncology clinics in Turkey between 1st and 28th of February 2010. Analyses were performed by the participating clinics and were divided into 3 groups: centers located in metropolitan areas formed group I (n=161), those located in Marmara and central Anatolia region formed group 2 (n=189), and centers located in Karadeniz and East-Southeast Anatolia region formed group 3 (n=185). The groups of these centers were formed according to the socioeconomic development of the provinces. Results: The median patient age was 48 years, 56.1% of patients were less than 50 years of age. Eighty-five percent of the patients detected a mass in their breast by self examination and 27% of the patients older than 50 years never had breast imaging until the definite diagnosis was established. The median time elapsed between disease noticed by the patient and application to a health care center was 10 days, between application and biopsy 19 days, between biopsy and surgery 10 days, and between surgery and systemic therapy 31 days. The median time elapsed between patients applying for surgery in groups I and 2 centers was 11 and 21 days, respectively (p=0.01). The median time elapsed between biopsy and surgery in groups 1,2 and 3 centers was 14,1.5, and 12 days, respectively (p<0.05). Conclusion: A high level of awareness regarding breast cancer in our country is related with the time that is defined as 10 days between disease recognition and medical application. The time elapsed between the application and biopsy, surgery and systemic therapy was longer compared with the corresponding figures in developed countries.Öğe Depression and socio-economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG)(Wiley, 2016) Tanriverdi, O.; Yavuzsen, T.; Turhal, S.; Kilic, D.; Yalcin, S.; Ozkan, A.; Uzunoglu, S.In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n=476) among all subjects (n=968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.Öğe MOBILISING FINANCIAL RESOURCES FOR SUSTAINABLE TOURISM INDUSTRY ON THE BALKANS(Scibulcom Ltd, 2008) Apak, S.; Uzunoglu, S.; Acikgoz, A. F.The purpose of the tourism industry on the Balkans for the coming years will be the free movement of people among the countries. The countries try to adopt the rules so that the natural environment is protected. The competitive advantage of the rational use for the financial resources needs to be analysed by the effective investments of the hotels. Therefore, the tourism target should be divided into conference, rural, sport and cultural heritage. The support of these projects will come from the World Bank, the EU and other international project supporters. Thus, the investment incentives for green-field investments and other management possibilities such as BOT models should be encouraged. The optimal use of tourists spending is resulted from the cost effectiveness analysis among countries. The main tourism potential developments for the success of these policies are to remove price distortions, decrease subsidies and effective tourist trafficking. The strategic plan among the Balkan countries' tourism establishments should come to use for new investments and tourist spending. The environment will favour from this outcome through benefiting climate change, biodiversity loss, ozone depletion, and the degradation of international waters. The aim of the Study is to construct a strategic plan model for each tourism investment in order to protect the environment and have the tourists use their spending potential optimally.Öğe The most important prognostic factor in elderly patients with glioblastoma multiforme: diameter of residual tumor(Elsevier Ireland Ltd, 2015) Turkkan, G.; Yurut-Caloglu, V.; Caloglu, M.; Uzunoglu, S.; Kilic-Durankus, N.; Cakir-Nurlu, D.[Abstract Not Available]Öğe Prognostic nutritional index is an independent prognostic factor for treatment response, survival and drug choice in metastatic castration-resistant prostate cancer treated with abiraterone acetate or enzalutamide(Elsevier Espana, 2022) Kucukarda, A.; Gokyer, A.; Gokmen, I; Ozcan, E.; Hacioglu, M. B.; Erdogan, B.; Uzunoglu, S.Purpose: We designed this study to identify the prognostic value of baseline prognostic nutritional index (PNI) in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate or enzalutamide. Methods: One hundred one mCRPC patients were included. PNI was calculated using formula 10 x serum albumin value (g/dl) + .005 x total lymphocyte count (per mm(3)). ROC analysis was used for determining prognostic PNI value. Results: The statistically significant cut-off value for PNI was 46.62. Initial PSA response and PSA kinetics (early PSA response and 30-50%-90% PSA response at any time) were much better in PNI>46.62 group than the PNI <= 46.62 group (P<.01). In multivariate analysis, baseline PNI level >46.62 was an independent predictor of PSA-PFS (HR: .42; P<.01), radiologic PFS (HR: .53; P<.01), and OS (HR: .42; P<.01). In the PNI <= 46.62 group, median OS was 7.4 months (95% CI: 4.1-10.7) for the abiraterone acetate subgroup vs. 17.6 months (95% CI: 10.1-25.1) for enzalutamide subgroups (P<.01). Conclusion: PNI is a useful, independent prognostic marker for mCRPC patients treated with either abiraterone acetate or enzalutamide. Using pre-treatment PNI may help clinicians in the prediction of survival and decision making based on abiraterone acetate or enzalutamide. (C) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.Öğe Relation between sarcopenia and dose-limiting toxicity in patients with metastatic colorectal cancer who received regorafenib(Springer Int Publ Ag, 2019) Gokyer, A.; Kucukarda, A.; Kostek, O.; Hacioglu, M. B.; Sunal, B. S.; Demircan, N. C.; Uzunoglu, S.BackgroundSarcopenia is related to poor prognosis and drug toxicities in solid tumors. The aim of our study is to investigate the predisposition of patients with metastatic colorectal carcinoma who started regorafenib treatment to sarcopenia and prolonged survival.MethodsPatients with metastatic colorectal carcinoma who receives regorafenib were search retrospectively. Dose-limiting toxicity was defined as dose reduction or toxicity requiring drug withdrawal. Sarcopenia evaluation was made with computed tomography performed within a month before treatment. Progression-free survival and overall survival were estimated.ResultsThirty-six patients were found as suitable for the study. 63.9% of patients were found as basally sarcopenic. Dose-limiting toxicity occured 13 of 23 patients (56.5%) with basal sarcopenia, whereas only 1 of 13 patients (7.6%) with no sarcopenia exhibited dose-limiting toxicity (p=0.005). Three patients suffered from grade 3-4 toxicity. Hand-foot syndrome, hypertension, and mucosal rash were the most seen side effects. Mean regorafenib treatment duration was 3.36 months. There was no significant difference in the progression-free survival (PFS) and the overall survival (OS) between sarcopenic patients and patients with no sarcopenia. Durations were as OS 24.2 weeks in patients with sarcopenia (95% CI 16.7-31.7), 28.1 weeks in patients with no sarcopenia (95% CI 20.5-35.7) (p=0.36), and as PFS 14.2 weeks in patients with sarcopenia (95% CI 12.1-16.4), 14.8 weeks in patients with no sarcopenia (95% CI 9.7-20.1) (p=0.65).ConclusionDose-limiting toxicity was significantly higher in basally sarcopenic patients who were started regorafenib as treatment of metastatic colorectal carcinoma. There was no significant relationship between overall survival and progression-free survival with sarcopenia.
