Have acute appendicitis complications increased in children as a result of SARS-CoV-2? / ¿Han aumentado las complicaciones de las apendicitis agudas en niños por el impacto del SARS-CoV-2?

INTRODUCTION: The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis. MATERIALS AND METHODS: A retrospective cohort study was carried out. It included acute appendicitis patients under 15 years of age treated from January 1, 2019 to December 31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February 2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicated appendicitis (catarrhal/phlegmonous/gangrenous). Demographic data, progression time, and postoperative complications were analyzed. RESULTS: A total of 309 patients were included, 193 (62.5%) in Group B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and 9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and 1.43 days (p>0.05) in Groups B and D, respectively, with ≥ 3 days representing 15.5% of cases in Group B, and 16.4% of cases in Group D (p = 0.84). The proportion of complicated appendicitis was 23.3% in Group B vs. 21.6% in Group D (p>0.05). Postoperative complications were observed in 11.4% of patients in Group B, and in 13.8% of patients in Group D (p>0.05), with intra-abdominal abscess being the most frequent complication in both groups (54.5% of the total complications in Group B vs. 65.5% in Group D; p>0.05). CONCLUSIONS: The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2 pandemic or the safety measures enforced.

INTRODUCCION: Se ha descrito el impacto de la pandemia del SARS-CoV-2 en la atención sanitaria, al suponer un aumento del retraso diagnóstico y morbilidad. Nuestro objetivo es evaluar su influencia en el desarrollo de complicaciones en las apendicitis agudas en niños. METODOLOGIA: Estudio retrospectivo de cohortes, incluyendo los pacientes menores de 15 años tratados por apendicitis aguda desde 01/01/2019 hasta 31/12/2020. Se distribuyeron según su fecha de diagnóstico en: antes de la pandemia (A) (enero/2019-febrero/2020) y durante la pandemia (P) (marzo-diciembre/2020). Según los hallazgos quirúrgicos se clasificaron en: apendicitis complicadas (perforadas/abscesos/plastrones/peritonitis) y no complicadas (catarrales/flemonosas/gangrenosas). Se analizaron datos demográficos, tiempo de evolución y complicaciones postoperatorias. RESULTADOS: Se incluyeron un total de 309 pacientes, 193 pacientes (62,5%) en el grupo A y 116 (37,5%) en el P, con edades de 9,2 ± 0,4 y 9,4 ± 0,6 años respectivamente (IC = 95%). Los días al diagnóstico fueron 1,35 y 1,43 (p>0,05) en A y P respectivamente, siendo ≥ 3 días en 15,5% de A y 16,4% en P (p = 0,84). La proporción de apendicitis complicada fue un 23,3% en A vs. 21,6% en P; con p>0,05. Se observaron complicaciones postoperatorias en 11,4% de A y 13,8% de P (p>0,05), siendo la más frecuente el absceso intraabdominal en ambos grupos (54,5% del total de complicaciones vs 65,5%; en A y P respectivamente; p>0,05). CONCLUSIONES: La atención sanitaria de la apendicitis aguda y sus complicaciones en pacientes pediátricos no se ha visto modificada por la pandemia del SARS-CoV-2 o las medidas de seguridad adoptadas durante la misma.

¿Han aumentado las complicaciones de las apendicitisagudas en niños por el impacto del SARS-CoV-2? / Have acute appendicitis complications increased in children as a result of SARS-CoV-2?

Introducción: Se ha descrito el impacto de la pandemia del SARS-CoV-2 en la atención sanitaria, al suponer un aumento del retraso diagnóstico y de la morbilidad. Nuestro objetivo es evaluar su influenciaen el desarrollo de complicaciones en las apendicitis agudas en niños. Metodología: Estudio retrospectivo de cohortes, incluyendo lospacientes menores de 15 años tratados por apendicitis aguda desde01/01/2019 hasta 31/12/2020. Se distribuyeron según su fecha dediagnóstico en: antes de la pandemia (A) (enero/2019-febrero/2020) ydurante la pandemia (P) (marzo-diciembre/2020). Según los hallazgosquirúrgicos se clasificaron en: apendicitis complicadas (perforadas/abscesos/plastrones/peritonitis) y no complicadas (catarrales/flemonosas/gangrenosas). Se analizaron datos demográficos, tiempo de evolucióny complicaciones postoperatorias. Resultados: Se incluyeron un total de 309 pacientes, 193 pacientes(62,5%) en el grupo A y 116 (37,5%) en el P, con edades de 9,2 ± 0,4y 9,4 ± 0,6 años respectivamente (IC = 95%). Los días al diagnósticofueron 1,35 y 1,43 (p > 0,05) en A y P respectivamente, siendo ≥ 3 díasen el 15,5% de A y el 16,4% en P (p = 0,84). La proporción de apendicitis complicada fue un 23,3% en A vs. un 21,6% en P; con p > 0,05.Se observaron complicaciones postoperatorias en un 11,4% de A y un 13,8% de P (p > 0,05), siendo la más frecuente el absceso intraabdominalen ambos grupos (54,5% del total de complicaciones vs. 65,5%, en Ay P respectivamente; p > 0,05). Conclusiones: La atención sanitaria de la apendicitis aguda y suscomplicaciones en pacientes pediátricos no se ha visto modificada por la pandemia del SARS-CoV-2 o las medidas de seguridad adoptadasdurante la misma.(AU)

Introduction: The impact of the SARS-CoV-2 pandemic on health-care has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis. Materials and methods: A retrospective cohort study was carriedout. It included acute appendicitis patients under 15 years of age treatedfrom January 1, 2019 to December 31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicatedappendicitis (catarrhal/phlegmonous/gangrenous). Demographic data,progression time, and postoperative complications were analyzed. Results: A total of 309 patients were included, 193 (62.5%) inGroup B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and1.43 days (p > 0.05) in Groups B and D, respectively, with ≥ 3 daysrepresenting 15.5% of cases in Group B, and 16.4% of cases in GroupD (p = 0.84). The proportion of complicated appendicitis was 23.3% inGroup B vs. 21.6% in Group D (p > 0.05). Postoperative complicationswere observed in 11.4% of patients in Group B, and in 13.8% of patientsin Group D (p > 0.05), with intrabdominal abscess being the mostfrequent complication in both groups (54.5% of the total complicationsin Group B vs. 65.5% in Group D; p > 0.05). Conclusions: The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2pandemic or the safety measures enforced.(AU)

Pandemic's impact on inguinal hernia management in infants. / Impacto de la pandemia en el manejo de la hernia inguinal en lactantes.

INTRODUCTION: The SARS-CoV-2 pandemic brought about a reduction in surgical activity. The objective of this work was to analyze its impact on inguinal hernia morbidity. MATERIAL AND METHODS: A retrospective study of cases and controls was carried out. Patients under 18 months of age undergoing inguinal hernia surgery from January 1, 2019 to August 31, 2020 were included. They were divided into two groups: patients undergoing surgery before (group A) or after (group D) the state of alarm was declared in Spain. Primary variables: episodes of incarceration and postoperative complications. Secondary variable: urgent or scheduled surgery. Demographic variables: sex, gestational age (GA), previous pathologies, age at diagnosis (AD), and age at surgery (AS) (months). RESULTS: 64 patients were included - 43 in group A and 21 in group D. In group A, median GA was 37+3, 90.5% of patients were male, median AD was 2.33, and median AS was 3.27. In group D, median GA was 31+2, 72.1% of patients were male, median AD was 3, and median AS was 3.63. There were no statistically significant differences. However, differences in terms of previous pathologies were significant (16.3% for Group A vs. 38.1% for group D) (p = 0.05). Regarding the primary variable, 25.6% of patients in group A had incarcerations vs. 33.3% of patients in group D (p = 0.51), whereas 9.3% of patients in group A had postoperative morbidity vs. 14.3% of patients in group D (p = 0.41). Regarding the secondary variable, 88.4% of surgeries in group A were scheduled vs. 90.5% of surgeries in group D (p = 0.583). CONCLUSION: In spite of reduced surgical activity, inguinal hernia morbidity did not surge in our environment. An increase in patients with previous pathologies was noted, which means severe patients should be prioritized.

INTRODUCCION: La pandemia del SARS-CoV-2 supuso una reducción de las jornadas quirúrgicas. Analizamos el efecto en la morbilidad de la hernia inguinal. MATERIAL Y METODOS: Estudio retrospectivo de casos y controles. Incluimos menores de 18 meses intervenidos de hernia inguinal desde 01/01/2019 hasta 31/08/2020, divididos en 2 grupos: intervenidos antes (grupo A) o después (grupo D) de la declaración del estado de alarma. Variables principales: episodios de incarceraciones y complicaciones postoperatorias. Variable secundaria: intervención urgente o programada. Variables poblacionales: sexo, edad gestacional (EG), patología previa, edad al diagnóstico(ED) y a la intervención (EI) (meses). RESULTADOS: Incluimos 64 pacientes, 43 grupo A y 21 grupo D. En el grupo A la mediana de EG fue 37+3, el 90,5% fueron varones, la mediana ED fue 2,33 y EI 3,27. En el grupo B la mediana de EG fue 31+2, el 72,1% fueron varones, la mediana ED fue 3 y EI 3,63. No hubo diferencias estadísticamente significativas. Si fueron significativas las diferencias en patología previa 16,3% A y 38,1% D (p = 0,05). Sobre la variable principal: 25,6% del A sufrieron incarceraciones frente a 33,3% del D (p = 0,51) y un 9,3% tuvieron morbilidad postoperatoria en A frente a 14,3% en D (p = 0,41). Respecto a la variable secundaria un 88,4% se realizaron de forma programada en el grupo A y un 90,5% en el grupo D (p = 0,583). CONCLUSION: Pese a la reducción de jornadas quirúrgicas no ha aumentado la morbilidad de la hernia inguinal en nuestro medio. Hemos observado un aumento de pacientes con patología previa, implicando la priorización de los pacientes más graves.

Impacto de la pandemia en el manejo de la hernia inguinal en lactantes / Pandemic’s impact on inguinal hernia management in infants

Introducción: La pandemia del SARS-CoV-2 supuso una reducciónde las jornadas quirúrgicas. Analizamos el efecto en la morbilidad dela hernia inguinal.Material y método: Estudio retrospectivo de casos y controles.Incluimos menores de 18 meses intervenidos de hernia inguinal desde01/01/2019 hasta 31/08/2020, divididos en dos grupos: intervenidos an-tes (grupo A) o después (grupo D) de la declaración del estado de alarma.Variables principales: episodios de incarceraciones y complicacionespostoperatorias. Variable secundaria: intervención urgente o programada.Variables poblacionales: sexo, edad gestacional (EG), patología previa,edad al diagnóstico (ED) y a la intervención (EI) (meses).Resultados: Incluimos 64 pacientes, 43 grupo A y 21 grupo D. En el grupo A la mediana de EG fue 37+3, el 90,5% fueron varones, la mediana ED fue 2,33 y EI 3,27. En el grupo B la mediana de EG fue 31+2, el 72,1% fueron varones, la mediana ED fue 3 y EI 3,63. No hubo diferencias estadísticamente significativas. Sí fueron significativas las diferencias en patología previa: 16,3% A y 38,1% D (p = 0,05). Sobre la variable principal, 25,6%, del A sufrieron incarceraciones frente a 33,3% del D (p = 0,51) y un 9,3% tuvieron morbilidad postoperatoriaen A frente al 14,3% en D (p = 0,41). Respecto a la variable secundaria, un 88,4% se realizaron de forma programada en el grupo A y un 90,5% en el grupo D (p = 0,583). Conclusión: Pese a la reducción de jornadas quirúrgicas, no ha aumentado la morbilidad de la hernia inguinal en nuestro medio. Hemos observado un aumento de pacientes con patología previa, implicando la priorización de los pacientes más graves.

Introduction: The SARS-CoV-2 pandemic brought about a reduction in surgical activity. The objective of this work was to analyze its impact on inguinal hernia morbidity.Materials and methods: A retrospective study of cases and controls was carried out. Patients under 18 months of age undergoing inguinal hernia surgery from January 1, 2019 to August 31, 2020 were included. They were divided into two groups: patients undergoing surgery before (group A) or after (group D) the state of alarm was declared in Spain.Primary variables: episodes of incarceration and postoperative complications. Secondary variable: urgent or scheduled surgery. Demographic variables: sex, gestational age (GA), previous pathologies, age at diagnosis (AD), and age at surgery (AS) (months).Results: 64 patients were included – 43 in group A and 21 in group D. In group A, median GA was 37+3, 90.5% of patients were male, median AD was 2.33, and median AS was 3.27. In group D, median GA was 31+2, 72.1% of patients were male, median AD was 3, and medianAS was 3.63. There were no statistically significant differences. However, differences in terms of previous pathologies were significant (16.3% for Group A vs. 38.1% for group D) (p = 0.05). Regarding the primary variable, 25.6% of patients in group A had incarcerations vs. 33.3% ofpatients in group D (p = 0.51), whereas 9.3% of patients in group A had postoperative morbidity vs. 14.3% of patients in group D (p = 0.41). Regarding the secondary variable, 88.4% of surgeries in group A were scheduled vs. 90.5% of surgeries in group D (p = 0.583).Conclusion. In spite of reduced surgical activity, inguinal hernia morbidity did not surge in our environment. An increase in patients with previous pathologies was noted, which means severe patients should be prioritized.

Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society).

PURPOSE: To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. RESULTS: Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5-128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. CONCLUSIONS: In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.

Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society).

OBJECTIVES: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND METHODS: A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). RESULTS: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT. CONCLUSION: The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.

Análisis descriptivo del tratamiento quirúrgico del cáncer de pulmón en los centros del sistema sanitario público de Andalucía. Proyecto vara II / Descriptive analysis of the surgical treatment of lung cancer at Public Health Hospitals in Andalusia: VARA Project II

Introducción: El cáncer de pulmón es el responsable de unas 3000 muertes cada año en Andalucía y, aunque la cirugía es el tratamiento de elección en estadios iniciales, menos del 20-25% son intervenidos. La Dirección del Plan Integral de Oncología de Andalucía (PIOA) realizó un estudio (Proyecto VARA I) sobre variabilidad y accesibilidad al tratamiento de radioterapia en 2003, observando una infrautilización manifiesta de este recurso en cáncer de pulmón. Esto motivó la puesta en marcha de un 2º estudio (VARA II) para evaluar el tratamiento locorregional, radioterapia y cirugía, del cáncer de pulmón en esta Comunidad. Material y métodos: Se evaluaron retrospectivamente las historias clínicas de los pacientes intervenidos en 2007 por cáncer de pulmón en los Hospitales Públicos de Andalucía. Se realizaron análisis descriptivos y de variabilidad entre los distintos equipos quirúrgicos. Resultados: Se evaluaron 418 pacientes, de los que 303 ofrecieron datos suficientes para el análisis. La edad media fue de 64 años (94% varones) con la siguiente distribución por estadios: I (60%), II (13%), III (21%), IV (6%). Se practicó tomografía de emisión de positrones (PET) en el 75% y mediastinoscopia en el 5%. La tasa de cirugía fue del 17% del total de casos esperados de cáncer de pulmón no células pequeñas. En el 97% de los casos se practicó linfadenectomía, la mayoría de ellas (72%) con un número de (..) (AU)

Introduction: Lung cancer is responsible of 3000 deaths every year in Andalusia. Although surgery is the elective treatment in early stages, less than 20-25% are operated on. The Direction of the Comprehensive Cancer Plan of Andalusia (PIOA) performed a study (VARA I Project) about variability and accessibility to radiation therapy in Andalusia in 2003, finding a clear infra utilisation in lung cancer. This motivated a second study (VARA II) to evaluate the locoregional treatment, both radiotherapy and surgery, of lung cancer in this region. Material and methods: Medical Records of patients operated in 2007 for lung cancer in Andalusian Public Hospitals were retrospectively evaluated. Descriptive analysis and studies of variability between surgical teams were performed. Results: Medical records of 418 patients were evaluated, 303 of them showing sufficient data for the analysis. Mean age was 64 (94% males), with the following stage distribution: I (60%), II (13%), III (21%), IV (6%). A PET was realized in 75% and mediastinoscopy in 5%. Surgery rate was 17% of the total expected cases of non small cell lung cancer. A lymphadenectomy was performed in 97%, the majority of them (72%) with less than 10 nodes resected. A good clinical and pathological concordance was demonstrated and low values of perioperative mortality (6%). Inter-hospitals variability study showed significant differences on histology, PET use, number of mediastinal nodes resected and reintervention rate. Discussion: The estimated surgical rate is similar to the published by other authors, although with a larger percentage of advanced stages III-IV. An important variability in patterns of care is demonstrated. Last, a low use of diagnostic mediastinoscopy is highlighted, while the use of PET for preoperative mediastinal evaluation is increasing, especially when the hospital owns the technique (AU)

Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant Online en pacientes con cáncer de mama / Experience with a simplified format of decision making tool adjuvant Online in breast cancer patients

Fundamento. Adjuvant. Online calcula el riesgo de recidiva y muerte a 10 años y proporciona estimaciones del beneficio del tratamiento adyuvante en pacientes con cáncer de mama. Testamos su aplicabilidad y analizamos únicamente estimaciones de mortalidad. Método. Presentamos las estimaciones de 66 pacientes intervenidas de cáncer de mama unilateral y unicéntrico, sin enfermedad residual ni metástasis. Las variables analizadas fueron edad, comorbilidad, receptores de estrógenos, grado histológico, tamaño tumoral, ganglios metastásicos, tipo de tratamiento hormonal y de quimioterapia. Resultados. La estimación de la mediana de supervivencia fue del 77%, de mortalidad por cáncer fue del 18% y por otras causas fue del 5%. La media de reducción absoluta del riesgo (RAR) de mortalidad con tratamiento hormonal fue del 4%, con quimioterapia fue del 4,5% y con tratamiento combinado fue del 7%. Resultados. Todas las pacientes con algún beneficio decidieron recibir tratamiento hormonal. Cuarenta y tres pacientes (65%) decidieron recibir quimioterapia y 23 pacientes (35%) decidieron no recibirla. La media de reducción del riesgo con quimioterapia fue del 2% en quien decidió no recibir quimioterapia y fue del 8% en quien decidió recibirla. Existe asociación entre la decisión de quimioterapia y la estimación del riesgo de mortalidad por cáncer (p=0,0001), del riesgo de mortalidad por otras causas (p=0,038) y de la RAR (p=0,0001). El 6% de las pacientes con RAR del 1%, el 50% de las que tenían RAR entre el 2–5%, y el 61,8% con RAR entre el 6–10% eligieron la quimioterapia. Conclusiones. Todas las mujeres optan por el tratamiento hormonal independientemente del beneficio. Las razones para elegir la quimioterapia fueron el propio pronóstico vital y la magnitud del beneficio. Algunas pacientes deciden elegir quimioterapia con beneficios mínimos(AU)

Background. Adjuvant. Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. Method. We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. Results. Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. Results. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2–5% and 61.8% between 6–10%, who chose chemotherapy. Conclusions. All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal(AU)

[Experience with a simplified format of decision making tool adjuvant! Online in breast cancer patients]. / Experiencia con un formato simplificado de la herramienta de ayuda en la toma de decisiones Adjuvant! Online en pacientes con cáncer de mama.

BACKGROUND: Adjuvant! Online estimates 10-year recurrence and mortality outcomes for breast cancer patients and predicts the effect of each type of treatment. Our purpose was to test the applicability by only analysing mortality estimations. METHOD: We present estimations of 66 women with definitive surgery and axillary staging for unilateral, unicentric, invasive adenocarcinoma, without metastatic or residual disease. Age, co-morbidity, estrogen receptor status, histological grade, tumor size, number of positive nodes, and hormone therapy or chemotherapy option, were the variables required. RESULTS: Median of survival estimations was 77%, cancer mortality 18% and mortality for other reasons 5%. The average of absolute risk reduction (ARR) with hormone therapy was 4%, with chemotherapy 4.5% and with combined treatment 7%. All the patients with some benefit decided to receive hormone therapy. Forty-three patients (65%) decided to receive chemotherapy and 23 (35%) did not. The average risk reduction with chemotherapy was 2% in those who decided not to receive chemotherapy and 8% in those who decided to receive it. There was an association between a chemotherapy decision and the estimation of the risk of breast cancer mortality (P=0.0001), risk of mortality for other reasons (P=0.038), and the ARR (P=0.0001). There were 6% of the patients with an ARR of 1%, 50% between 2-5% and 61.8% between 6-10%, who chose chemotherapy. CONCLUSIONS: All women opted for hormone therapy regardless of benefit. The reasons for choosing chemotherapy were the prognosis itself and the magnitude of benefit. Some patients decided to choose chemotherapy even when the benefit was minimal.