Resultados del tratamiento del cáncer de mama, Programa Nacional de Cáncer del Adulto / Impact of the Chilean Explicit Guaranties Health System (GES) on breast cancer treatment

Background Breast cancer is the most common malignant tumor in women in the world. In 2005, it was incorporated to the Explicit Guaranties Health System (GES) in Chile. Aim To describe the demographic and clinical characteristics of breast cancer patients and to determine the effect of incorporating these women to GES. Material and Methods Medical records of 5,119 women with breast cancer aged 59 ± 14 years, attended at six public hospitals between 2000 and 2010 were reviewed. Median follow up was 87 months (range 1-182). Mortality was assessed using death certificates obtained at the National Identification Registry. Results Sixty six percent of women were in stage I-II, 29% in stage III and 5% in stage IV. Surgery was performed in 4023/5119 cases (79%), adyuvant radiotherapy in 3627/4517 cases (80%), chemotherapy in 3,204/3,424 cases (94%) and hormone therapy in 1,695/2,375 cases (71%). Between 2000 and 2010, there was a significant increase in the proportion of cases in stage I, from 8% to 25%, (p < 0.01). Overall survival (OS) increased 1% per year, since the beginning of GES system (p = 0.024). Five year OS was 75.1%. The figures for Stage I, II, III and IV were 93, 84, 62 and 27% respectively (p < 0.01). Patients without lymph node involvement and who were not triple negative, had a significantly better OS. Conclusions There was a significant increase in stage I cases, and a 1% per year OS improvement after GES system started, compared with the previous period.

Tropisetrón en la prevención de náuseas y vómitos por quimioterapia: estudio clínico multicéntrico / Tropisetron in the prevention of nausea and vomiting due to chemotherapy: multicentric clinical study

The antiemetic effect of tropisetron was studied in 97 cancer patients (67 men, 30 women) receiving cisplatin in doses of 75 mg/m² or higher. On 279 chemotherapy cycles studied (max 6 per patient) 5 mg of tropisetron was admonistered once a day i.v. on day 1 and p.o. on day 2 to 6. Efficacy preventing vomiting and nausea was measured in 24 hour period as: complete control 0 episodes, major control 1 to 2 episodes, minor control 3 to 4 episodes and no control 5 or more episodes. Satisfactory vomiting control (complete and major) was 69 percent, 63 percent, 82 percent,88 percent, 96 percent and 96 percent in days 1 to 6 of cycle 1. Satisfactory nausea control (complete and major) for the same day was 70, 66, 72, 85 92 and 97 percent. Similar data was obtained for the subsequeny cycles. Complete vomiting control was obtained in 47, 35, 56, 72, 81 and 84 percent and for nausea in 42, 39, 48, 64, 81 and 87 percent. 19 patients presented adverse effects (19,6 percent). Only 2 headache episodes had a definitive relation with antiemetic drug. 12 patients discontinued the medication; 6 due to drug inefficacy, 2 to illness unrelated to the drug, 1 to lack of collaboration, and 3 due to other reasons. We conclude that tropisetron allows satisfactory control of acute and delayed vomiting in a high percentage of patients treated with high doses of cisplatin. The drug does not have significant secondary effects. Tropisetron administration in only 1 daily dose implies an evident advantage and a treatment cost reduction