Publications by authors named "Mamak Tahmasebi"

16 Publications

  • Page 1 of 1

The Impact of COVID-19 on Cancer Care in the Post Pandemic World: Five Major Lessons Learnt from Challenges and Countermeasures of Major Asian Cancer Centres.

Asian Pac J Cancer Prev 2021 Mar 1;22(3):681-690. Epub 2021 Mar 1.

National Cancer Centre, Singapore.

Objective: The COVID-19 pandemic has dramatically affected healthcare services around Asia. The Asian National Cancer Centres Alliance and the Asia-Pacific Organisation for Cancer Prevention collaborated to assess the mid- and long- term impact of COVID-19 to cancer care in Asia.

Methods: The two entities organised a combined symposium and post-meeting interactions among representatives of major cancer centres from seventeen Asian countries to outlining major challenges and countermeasures.

Results: Participating stakeholders distilled five big questions. 1) "Will there be an explosion of late-stage cancers after the pandemic?" To address and recover from perceived delayed prevention, screening, treatment and care challenges, collaboration of key stakeholders in the region and alignment in cancer care management, policy intervention and cancer registry initiatives would be of essential value. 2) "Operations and Finance" The pandemic has resulted in significant material and financial casualties. Flagged acute challenges (shortages of supplies, imposition of lockdown) as well as longer-standing reduction of financial revenue, manpower, international collaboration, and training should also be addressed. 3) "Will telemedicine and technological innovations revolutionize cancer care?" Deploying and implementing telemedicine such as teleconsultation and virtual tumour boards were considered invaluable. These innovations could become a new regular practice, leading to expansion of tele-collaboration through collaboration of institutions in the region. 4) "Will virtual conferences continue after the pandemic?" Virtual conferences during the pandemic have opened new doors for knowledge sharing, especially for representatives of low- and middle-income countries in the region, while saving time and costs of travel. 5) "How do we prepare for the next pandemic or international emergency?" Roadmaps for action to improve access to appropriate patient care and research were identified and scrutinised.

Conclusion: Through addressing these five big questions, focused collaboration among members and with international organisations such as City Cancer Challenge will allow enhanced preparedness for future international emergencies.
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http://dx.doi.org/10.31557/APJCP.2021.22.3.681DOI Listing
March 2021

Frequency of Polypharmacy in Advanced Cancer Patients Consulted with the Palliative Service of Imam Khomeini Hospital (Tehran), Iran, 2017

Asian Pac J Cancer Prev 2019 Jan 25;20(1):131-134. Epub 2019 Jan 25.

Department of Palliative Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Email:

Background: Polypharmacy is defined as the concurrent use of more than four or five medications by an individual. The prevalence of this condition has increased due to the ageing population and the related illnesses. Use of multiple medications would increase the risk of side-effects, drug interactions, and medical costs. The present study aimed to determine the frequency of polypharmacy in the advanced cancer patients. Methods: In this cross-sectional study, 92 patients with advanced cancer were selected through convenience sampling from the inpatients and outpatients who referred to the Palliative Care Unit of Imam Khomeini Hospital (Tehran) in 2017. An examining physician completed a researcher-made checklist for all the subjects based on the patients’ biography and medical records. Statistical analysis was performed by using SPSS software (version 19.0) through descriptive and analytical tests at the significance level of p<0.05. Results: The participants’ mean age was 55.5±16.2 years. A minimum of one comorbid disease was seen in 81.5% of the patients (n=75), the most prevalent of which were psychiatric disorders. Eighty-eight percent of the patients (n=81) were on at least 5 or more medications. Opioids and antacids were the most common medications used by these patients. Conclusion: The frequency of polypharmacy and average number of consumed medications were high in patients with advanced cancer. Studying the effectiveness of these medications can highly help the physicians stop or continue prescribing such medications, and guide the focus of attention towards the drugs that can improve the patients’ quality of life in the final days.
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http://dx.doi.org/10.31557/APJCP.2019.20.1.131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485550PMC
January 2019

Long-Lasting Orthostatic Hypotension and Constipation After Celiac Plexus Block; A Case Report.

Anesth Pain Med 2018 Feb 21;8(1):e63221. Epub 2018 Feb 21.

Cancer Research Centre, Cancer Research Institute, Palliative Medicine Unit, Tehran University of Medical Sciences, Tehran, Iran.

This case report presents a 55 years old man, presented with abdominal pain and diagnosed with a metastatic pancreatic tumor, who developed long lasting orthostatic hypotension and constipation following a celiac plexus block.
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http://dx.doi.org/10.5812/aapm.63221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970361PMC
February 2018

Pediatric Palliative Care in Iran: Applying Regionalization of Health Care Systems

Asian Pac J Cancer Prev 2018 May 26;19(5):1303-1311. Epub 2018 May 26.

Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email:

Background: Establishing palliative care services is a priority in the health system of Iran. Considering the necessity of integrating these services into the health system, this study aimed to explore the stakeholders’ perceptions about the provision of a conceptual framework for palliative care services for children with cancer according to the health system in of Iran. Methods: The present qualitative study was conducted through in-depth semi-structured interviews held with 29 participants including palliative care specialists, policy-makers, health care providers, the parents of children with cancer selected through purposive sampling, between August 2016 and February 2017. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed using MAXQDA10 software. Results: The codes extracted from interviews produced the main theme “ classes of palliative care services” with the two main categories “comprehensive care” including, strengthening family shelter, maintaining the child in a familiar environment, achieving stability and “establishing social justice” including, easy access to services, financial relief and quality care. Conclusion: Presenting a framework based on level of palliative care services, the findings of this study paves the way for integrating these services into Iranian health system.
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http://dx.doi.org/10.22034/APJCP.2018.19.5.1303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031829PMC
May 2018

Palliative Nursing for Cancer Patients as an Abstract Concept: A Hermeneutic Study.

J Nurs Res 2018 Aug;26(4):260-265

MD, Consultant in Palliative Medicine, and Associate Professor, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Understanding the outcomes of palliative care (PC) that is provided to patients with cancer is necessary.

Purpose: The aim of this study was to explore the lived experiences of Iranian nurses with regard to PC outcomes in cancer patients.

Methods: This hermeneutic study interviewed 14 nurses to understand their lived experiences with regard to PC outcomes in cancer patients. A seven-stage process of data analysis was employed.

Results: One constitutive pattern "palliative nursing for cancer patients is an abstractive concept" and the two associated themes of "providing excellent PC" and "PC as an alarm" were identified. Providing excellent PC had two subthemes: being a unique nurse and experiencing the humanistic approach to caring. PC as an alarm also had two subthemes: caring-related concerns and challenging issues caused by caring.

Conclusions: The findings provide a deeper understanding of the nursing experience with regard to PC outcomes in cancer patients.
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http://dx.doi.org/10.1097/jnr.0000000000000232DOI Listing
August 2018

Cost-Effectiveness of Different Cervical Screening Strategies in Islamic Republic of Iran: A Middle-Income Country with a Low Incidence Rate of Cervical Cancer.

PLoS One 2016 8;11(6):e0156705. Epub 2016 Jun 8.

Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, I. R. Iran.

Objective: Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC.

Methods: We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results.

Results: We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran.

Conclusion: We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156705PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898767PMC
July 2017

Assessment of a Hospital Palliative Care Unit (HPCU) for Cancer Patients; A Conceptual Framework.

Indian J Palliat Care 2015 Sep-Dec;21(3):317-27

Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support).

Materials And Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed.

Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps.

Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended.
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http://dx.doi.org/10.4103/0973-1075.164901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617040PMC
November 2015

End-of-life care ethical decision-making: Shiite scholars' views.

J Med Ethics Hist Med 2014 14;7. Epub 2014 Jan 14.

Professor, Medical Ethics and History of Medicine Research Center, and Endocrinology and Metabolism Research Centre,Tehran University of Medical Sciences, Tehran, Iran.

Recent advances in life-sustaining treatments and technologies, have given rise to newly-emerged, critical and sometimes, controversial questions regarding different aspects of end-of-life decision-making and care. Since religious values are among the most influential factors in these decisions, the present study aimed to examine the Islamic scholars' views on end-of-life care. A structured interview based on six main questions on ethical decision-making in end-of-life care was conducted with eight Shiite experts in Islamic studies, and was analyzed through deductive content analysis. Analysis revealed certain points in Islamic views on the definition of death and the persons making decisions about end-of-life care. According to the participants, in addition to conventional criteria ('urf) such as absence of heartbeat and respiration, the irreversible cessation of human voluntary acts (as a sign that the soul has control over the body and the faculty of thinking) are considered to be the criteria in establishing death. The participants also recognized physicians as the main authorities in verifying signs of death. Furthermore, it was emphasized that life preservation and continuation of care must be sensible, and the patient can request not to have death-prolonging procedures started or continued. In the view of participants, patient's autonomy cannot be the sole basis for all measures, but Islamic ethical and jurisprudential principles should be relied upon to make correct and sensible decisions whether to continue or stop terminal patients' care. Final decisions should be made by a team of experts, and physicians must be at the center of such a team. Finally, we suggest that a guideline in keeping with Islamic norms on human life and death, purpose of life, God's will, boundaries of man's authority, and the physician's ethical duties and obligations should be developed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263386PMC
December 2014

Human relationships in palliative care of cancer patient: lived experiences of Iranian nurses.

Mater Sociomed 2014 Feb 20;26(1):35-8. Epub 2014 Feb 20.

Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: cancer patients require palliative care.

Aim: the purpose of this study was to explore the experiences of nurses, who provide palliative care for cancer patients, within the context of Iranian culture.

Methods: we conducted a hermeneutic phenomenological study. Semi structured in-depth interviews with 10 nurses were audio taped and transcribed. The transcriptions were then analyzed by Van Manen's method.

Results: one of the most important themes that emerged was "human relationships", which also contained the subthemes of "comprehensive acceptance" and "psychological support".

Conclusions: the results provide deep understanding of human relationships in palliative care of cancer patients in Iran.
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http://dx.doi.org/10.5455/msm.2014.26.35-38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990400PMC
February 2014

Iranian nurses' perceptions of palliative care for patients with cancer pain.

Int J Palliat Nurs 2014 Feb;20(2):69-74

Assistant Professor of Gynecology, Department of Medicine, and Consultant in Palliative Medicine, Cancer Institute, Tehran University of Medical Sciences, Tehran University of Medical Sciences, East Nosrat Street, Tohid Square, Tehran, Iran.

Aim: The purpose of this study was to identify Iranian nurses' perceptions of palliative care for patients with cancer pain.

Methods: The study took a qualitative approach. Semi-structured interviews were held with 15 nurses with Bachelor's degrees working in three teaching hospitals in Iran. Transcripts of the interviews underwent content analysis, and categories were extracted from the material.

Findings: The findings came under two main categories: management of physical pain and psychological empowerment. Management of physical pain had two subcategories: the importance of communication, and pain palliation using drugs. Psychological empowerment also had two subcategories: supportive behaviour and distress reduction.

Conclusion: The sample felt that palliative care for patients with cancer pain must include psychological empowerment, support, and communication as well as physical pain relief.
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http://dx.doi.org/10.12968/ijpn.2014.20.2.69DOI Listing
February 2014

Perception of Iranian nurses regarding ethics-based palliative care in cancer patients.

J Med Ethics Hist Med 2013 18;6:12. Epub 2013 Dec 18.

Assistant Professor, Cancer Institute Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Palliative care is still a topic under discussion in the Iranian healthcare system, and cancer patients require palliative care. Moreover, nursing ethics has an important role in caring for these patients. The purpose of this study was to identify the perception of Iranian nurses regarding ethics-based palliative care in cancer patients. This study was done with a qualitative approach and by using content analysis. In this study, 14 nurses were selected through purposive sampling, and a face-to-face semi structured interview was conducted with each of them. After data collection, all interviews were transcribed and reviewed, and categories were extracted. At first, similarities in meaning were reviewed and based on centralization arranged in sub-categories. Then, relevant sub-categories were arranged in a category after a second review. In general, original categories in the ethics-based palliative care in cancer patients encompass the following: "human dignity", "professional truthfulness" and "altruism". Human dignity has 3 sub-categories consisting of 'respecting patients', 'paying attention to patient values' and 'empathizing'. Professional truthfulness has 2 sub-categories consisting of 'truthful speech' and 'truthful action'. Lastly, altruism has 3 sub-categories consisting of 'complete and multi-dimensional patient acceptance', 'supportive behavior' and 'responsibility'. Content analysis of ethics-based palliative care in cancer patients revealed the required conditions for this type of care based on the perception of nurses. The results of this study suggest that in nurses' point of view, human dignity, professional truthfulness and altruism all have important roles in ethics-based palliative care in cancer. The findings of this study will give nurses a greater knowledge about ethics-based palliative care in cancer patients, leading to a better understanding of the ethical needs of these patients, and may ultimately help improve the nursing practice.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885223PMC
January 2014

Ethical issues in the end of life care for cancer patients in iran.

Iran J Public Health 2013 1;42(2):188-96. Epub 2013 Feb 1.

Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran ; Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: In the recent years, advances in medical technologies for end stage cancer patients' care have affected the end-of-life decision-making in clinical practice and exposed oncologists to serious ethical dilemmas. But little is known about oncologists' viewpoints in our country regarding their ethical problems in this mention. We aimed to clarify the ethical dilemmas which Iranian oncologists may face in our health care setting and to determine factors influencing decision-making process.

Methods: In this qualitative study, a phenomenological approach was used. We interviewed 8 cancer specialists in teaching hospitals in Iran and used content analysis to identify codes and categorize themes in the data.

Results: DURING THE PROCESS OF ANALYSIS, THREE MAIN THEMES EMERGED ABOUT ETHICAL DILEMMAS IN END OF LIFE CARE FOR ADVANCED CANCER PATIENTS: illness factors, socio-cultural context and patient-physician relationship. Cancer specialists identified ethical problems on several main issues, the most important of which were telling the truth in Iranian cultural context, uncertainty in end stage definition, multidisciplinary team working and cost consideration in Iranian health care system.

Conclusion: Health care and insurance system in Iran face to end of life care challenges; therefore, health care providers and policy makers need to allocate appropriate resources and programs to improve quality of care in terminal stages. Appropriate physicians' communication skills training, multidisciplinary team working and supplementary insurance services that provide essential health care can improve the quality of care of patients with end stages of cancer. The findings of this study can help us to provide ethical policies for decision-making in end-of-life care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595644PMC
March 2013

How to break bad news: physicians' and nurses' attitudes.

Iran J Psychiatry 2010 ;5(4):128-33

Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Bad news disclosure is one of the most complex tasks of physicians. Recent evidences indicate that patients' and physicians' attitude toward breaking bad news has been changed since few years ago. The evidence of breaking bad news is different across cultures. The aim of this study is to evaluate the attitude of medical staff toward breaking bad news to provide a clinical guideline in Iran.

Methods: A descriptive study was conducted during 2008-2009 on a sample of 100 medical staff (50 physicians and 50 nurses) at Cancer Institute of Imam Khomeini hospital. The subjects' demographic characteristics and their attitudes toward the manner of revealing the diagnosis were registered in a questionnaire.

Results: The majority of the physicians (86%, n=43) and nurses (74%, n=37), mostly the older and more experienced, tended to reveal the diagnosis to patients. Only a few physicians (8%, n=4) had been trained how to disclose bad news, which discloused diagnosis more than non trained ones. Physicians and nurses preferred to inform the patients about the diagnosis when either the patients were alone or in the presence of their spouse respectively. Only a few physicians (14%) and nurses (24%) agreed to explain life expectancy to patients.

Conclusion: Compared to past, physicians and nurses are more willing to share cancer diagnosis with patients. However, lack of adequate communication skills in caregivers, and their concerns about managing patients' emotional reactions reduce their tendency to disclose bad news to the patients. Therefore, training physicians and nurses to expose bad news to the patients seems to be necessary.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395928PMC
September 2012

Quality of life in gynecologic cancer patients.

Asian Pac J Cancer Prev 2007 Oct-Dec;8(4):591-2

Dept of Palliative Medicine, Cancer Institute, Tehran University, Tehran, Iran.

Objective: A descriptive study for evaluating the variables which influence the quality of life was performed in women with gynecologic cancer undergoing various kinds of treatment.

Methods: The study was based on a chart review of 104 women with gynecologic cancer and analyses of their compiled FACT-G (V4); (Functional Assessment of Cancer Therapy-General) questionnaires. Patients were assessed before and 3 months after treatment.The relationship of a number of biomedical variables with quality of life outcomes was tested.

Results: The mean age of patients was 50.13 years. The most involved organ was ovary (42.3%).The mean of socio-familial, emotional, functional well-being and overall quality of life 3 months after the treatment were greater than previously. The mean of physical well-being after 3 months of treatment was lower than before that (p<0.05). There were no statistical difference between the mean of overall quality of life before treatment and that 3 months after treatment for variables such as marital status, qualification, job, parity, co-morbidity diseases, organ involved, and stage of cancer (p>0.05).

Conclusions: More studies must utilize quality of life as a primary endpoint. As gynecologic cancers are usually discovered in late stages, strategies for supportive care need to focus on symptom management.
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January 2009

Knowledge and attitudes of physicians in Iran with regard to chronic cancer pain.

Asian Pac J Cancer Prev 2007 Jul-Sep;8(3):383-6

Tehran University of Medical Sciences, Cardiovascular Surgery And Heart Transplantation Center, Shariaty Hospital, Tehran, Iran.

Background And Aim: The knowledge and attitudes of health care professionals with regard to pain and its impact on the patient are among identified barriers that prevent health care professionals from providing effective treatment for pain. The purpose of the present study was to evaluate knowledge about and attitudes towards cancer pain and its management in Iranian physicians with patient care responsibilities.

Methods: We surveyed 122 physicians in six university hospitals in Tehran. Fifty-five (45.1%) questionnaires were completed.

Results: The majority of physicians (76%) recognized the importance of pain management priority and about one half of the physicians acknowledged the problem of inadequate pain management in their settings. Most cited inability to access professionals who practice specialized methods in this field, and inadequate staff knowledge of pain management as barriers to good pain management. A large majority of them expressed dissatisfaction with their training for pain management in medical school and in residency. Furthermore a considerable widespread knowledge deficit among all medical subspecialties and all levels of experience was noted which was significantly more profound in the non-oncologists group and only correlated poorly with number of total treated patients in past 6 months.

Conclusion: The most significant barrier to the effective management of pain in cancer patients in Iran is deficit in knowledge as identified in this survey. A combination of an active continuing education program on both the international guidelines with routine professional education and dissemination of guidelines is needed to bring about significant improvement in cancer pain control.
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June 2008