ABSTRACT
Background: The combination of doxorubicin (DOX) with paclitaxel (PTX) effectively treats breast cancer (BC). However, DOX-associated cardiotoxicity (CTX) is aggravated by the use of PTX. Consensus is lacking about which drug sequence involves the most CTX. Objectives: To evaluate whether DOX followed by PXT or the reverse sequence has the greatest cardiotoxic potential in the treatment of BC. Methods: Prospective study of women with primary BC who received four cycles of DOX and 12 infusions of PTX. Participants were divided into Group 1 (G1; PXT before DOX) and Group 2 (G2; DOX before PXT) at the discretion of the oncologist. CTX was defined as an absolute reduction in left ventricular ejection fraction (LVEF) > 10% to a value <53%. Patients underwentclinical evaluations and echocardiography before treatment (Phase 1) and one year after treatment (Phase 2). Results: Sixty-nine women were evaluated: 19 in G1 and 50 in G2. The groups had similar clinical characteristics. The doses of radiation, DOX, and PTX used were similar. Eight (11.6%) patients developed CTX: two (10.5%) in G1 and six (12.0%) in G2 (p=0.62). The mean LVEF was similar between groups in Phase 1 (G1=65.1±3.5%; G2=65.2±3.9%; p=0.96), with a significant reduction noted after one year in both groups: G1=61.4±8.1% (p=0.021) and G2=60.8±7.6% (p<0,001). Although lower, mean LVEF remained similar between groups after Phase 2 (p=0.79). Conclusions: In women with BC who underwent chemotherapy, the incidence of CTX at the end of the first year of treatment was similar regardless of whether DOX was used before or after PTX. (AU)
Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/drug therapy , Breast Neoplasms/therapy , Cardiotoxins/radiation effects , Cardiotoxins/toxicity , Stroke Volume/drug effects , Echocardiography/methods , Doxorubicin/toxicity , Paclitaxel/toxicityABSTRACT
Resumo Fundamento Ainda não temos informações acerca do impacto da pandemia da COVID-19 sobre a atividade médica assistencial no Brasil. Objetivo Descrever as repercussões da pandemia da COVID-19 na rotina de atendimentos em um hospital terciário, referência regional em cardiologia e oncologia. Métodos Estudo de corte transversal. Foi realizado levantamento dos atendimentos no período de 23/03/2020 (fechamento do comércio local) até 23/04/2020 (P20) e comparado com o mesmo período em 2019 (P19).Resultados: Detectamos redução no número de consultas cardiológicas, teste ergométrico, Holter, monitorização ambulatorial da pressão arterial, eletrocardiograma e ecocardiograma (90%, 84%, 94%, 92%, 94% e 81%, respectivamente). Em relação à cirurgia cardíaca e cateterismo cardíaco, houve redução de 48% e 60%, respectivamente. Aumento no número de angioplastia transluminal coronária (33%) e de implante de marca-passo definitivo (29%). Houve 97 internamentos na UTI em P19, contra 78 em P20, redução de 20%. Diminuição dos atendimentos no pronto-socorro cardiológico (45%) e nos internamentos na enfermaria de cardiologia (36%). Houve diminuição nas consultas oncológicas de 30%. Sessões de quimioterapia reduziram de 1.944 para 1.066 (45%). Sessões de radioterapia diminuíram 19%. Conclusão A COVID-19 provocou redução considerável no número de consultas nos ambulatórios de cardiologia, oncologia e demais especialidades. Houve uma preocupante diminuição no número de cirurgias cardíacas e nas sessões de quimioterapia e radioterapia nas semanas iniciais da pandemia. A procura por atendimento no pronto-socorro cardiológico, assim como as internações na UTI e enfermaria cardiológicas, também reduziram, gerando preocupação acerca da evolução e prognóstico destes pacientes portadores de outras patologias, que não a COVID-19, nestes tempos de pandemia. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Abstract Background We still do not have information regarding the impact of the COVID-19 pandemic on medical care activity in Brazil. Objective To describe the repercussions of the COVID-19 pandemic on the care routine of a tertiary hospital, which is a regional reference in cardiology and oncology. Methods Cross-sectional cohort study. We conducted a survey of medical visits from March 23, 2020 (when local commerce was closed) to April 23, 2020 (P20), in comparison with the same period in 2019 (P19). Results We found decreases in the number of cardiology consultations, exercise tests, Holter, ambulatory blood pressure monitoring, electrocardiogram, and echocardiogram (90%, 84%, 94%, 92%, 94%, and 81%, respectively). In relation to cardiac surgery and cardiac catheterization, there were 48% and 60% decreases, respectively. There was an increase in the number of percutaneous transluminal coronary angioplasties (33%) and definitive pacemaker implantations (29%). There were 97 admissions to the ICU during P19, in contrast with 78 during P20, a 20% decrease. Visits to the cardiac emergency room (45%) and admissions to the cardiology ward (36%) also decreased. The decrease in oncology consultations was 30%. Chemotherapy sessions decreased from 1,944 to 1,066 (45%), and radiotherapy sessions decreased by 19%. Conclusion COVID-19 has led to a considerable decrease in the number of consultations in outpatient clinics for cardiology, oncology, and other specialties. There was a concerning decrease in the number of cardiac surgeries, chemotherapy sessions, and radiotherapy sessions during the initial weeks of the pandemic. The number of people seeking care in the cardiac emergency room and the number of admissions to the cardiology ward and ICU also decreased, generating concern regarding the evolution and prognosis of these patients with pathologies other than COVID-19 during this pandemic time. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)