Disfunção sexual nos doentes oncológicos: a importância de uma abordagem especializada / Sexual dysfunction among oncological patients: The importance of a specialized approach

OBJETIVOS: Determinação do impacto oncológico a nível afetivo/sexual assim como do grau de satisfação dos doentes quanto à informação recebida. Pretende‐se, adicionalmente, avaliar a importância da existência de uma abordagem especializada em sexologia durante o tratamento e seguimento oncológico. MÉTODOS: Estudo transversal que incluiu doentes oncológicos admitidos para consulta num serviço de radioterapia. Aplicação de um questionário e aferição de dados clínicos através do processo clínico. RESULTADOS: Amostra de 104 doentes, com uma média de 64,7 anos, em que a maioria (60,6%) refere ter disfunção sexual após o tratamento oncológico. Relativamente ao grau de informação, 62,5% encontram‐se satisfeitos quanto à informação fornecida pelos profissionais de saúde. Cerca de 2/3 dos doentes (66,4%) recorreriam a uma consulta de oncossexologia caso fossem referenciados pelo médico assistente. Não foram observadas diferenças estatisticamente significativas entre os subgrupos analisados relativamente ao impacto oncológico na sexualidade nem quanto à necessidade de uma abordagem especializada em sexologia. DISCUSSÃO: A abordagem da sexualidade nos doentes oncológicos engloba tanto o esclarecimento dos doentes como o tratamento das disfunções sexuais inerentes aos tratamentos. A existência de consultas de oncosexologia é uma forma de abordagem especializada, é do interesse da maioria dos nossos doentes. CONCLUSÕES: A sexualidade deve ser abordada com o doente oncológico desde o início da doença. Os cuidados especializados de oncossexologia são importantes ao constituírem uma via de redução do impacto oncológico na qualidade de vida

OBJECTIVES: Determination of the emotional and sexual impact after oncologic disease and patient's satisfaction regarding information provided by healthcare professionals. We also aim to evaluate the importance of sexology care during cancer treatment and follow‐up. METHODS: This is a cross‐sectional study including patients admitted for radiation therapy. A questionnaire and an assessment of clinical data were assessed. RESULTS: The study sample was composed by 104 patients. 60.6% had a negative impact on their sexual life after treatment and 62.5% were satisfied about the information given by healthcare professionals. About two thirds of the patients would accept sexology care during cancer treatment and/or follow‐up. After a sub‐group analysis, there were no statistically significant differences between groups regarding the prevalence of sexual dysfunction or needs for sexual care. DISCUSSION: There is a well‐known impact of cancer on sexuality since its diagnosis. Our patients feel themselves well informed about this by health professionals. Most of them would accept being referred to an oncosexology appointment. CONCLUSIONS: Sexuality must be discussed with cancer patients since their diagnosis. Oncosexuality care is necessary and desired by most patients as a mean for reduction of the cancer impact in their life quality

Adjuvant radiotherapy in the treatment of dedifferentiated liposarcoma of the spermatic cord: a rare entity.

Dedifferentiated liposarcoma (DDL) of the spermatic cord is a very rare entity in which management is remarkably controversial due to scarce literature. Although the actual standard of care is surgery via radical inguinal orchiectomy, adjuvant therapies like radiotherapy have demonstrated improved local control, particularly in cases with higher risk for local recurrence and worse prognosis. The role of adjuvant chemotherapy remains questionable in this subset of patients. On literature review, the most important prognostic factors for survival outcomes were surgical margin status, histological grade and the presence of metastases prior to the initial surgery. In this report, we discuss the case of a 59-year-old man with DDL of the spermatic cord that was treated with surgery followed by adjuvant radiotherapy. We also provide a comprehensive literature review about the management of this entity.

[Sexual dysfunction among oncological patients: The importance of a specialized approach]. / Disfunção sexual nos doentes oncológicos: a importância de uma abordagem especializada.

OBJECTIVES: Determination of the emotional and sexual impact after oncologic disease and patient's satisfaction regarding information provided by healthcare professionals. We also aim to evaluate the importance of sexology care during cancer treatment and follow-up. METHODS: This is a cross-sectional study including patients admitted for radiation therapy. A questionnaire and an assessment of clinical data were assessed. RESULTS: The study sample was composed by 104 patients. 60.6% had a negative impact on their sexual life after treatment and 62.5% were satisfied about the information given by healthcare professionals. About two thirds of the patients would accept sexology care during cancer treatment and/or follow-up. After a sub-group analysis, there were no statistically significant differences between groups regarding the prevalence of sexual dysfunction or needs for sexual care. DISCUSSION: There is a well-known impact of cancer on sexuality since its diagnosis. Our patients feel themselves well informed about this by health professionals. Most of them would accept being referred to an oncosexology appointment. CONCLUSIONS: Sexuality must be discussed with cancer patients since their diagnosis. Oncosexuality care is necessary and desired by most patients as a mean for reduction of the cancer impact in their life quality.

ACE-27 as a prognostic tool of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy: a real-world, prospective, observational study.

PURPOSE: To evaluate the association between comorbidities as assessed by the "Adult Comorbidity Evaluation 27" (ACE-27) and the development of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy. METHODS: Prospective, single-center cohort of patients with head and neck cancer treated with chemoradiotherapy (cisplatin 100 mg/m2 on days 1, 22, and 43; intensity-modulated radiotherapy 60 to 69.96 gray, in 30 to 33 fractions,) between June 2018 and December 2019. ACE-27 was assessed before the start of treatment. Patients were divided in two groups based on ACE-27 grading (none to mild versus moderate to severe comorbidities). Differences in incidence of severe acute toxicity and change in treatment plan between groups were examined. RESULTS: A total of 101 patients were included: 90.1% were male, and median age was 57 years. ACE-27 grading was none in 6.9% of patients, mild in 52.5%, moderate in 29.7%, and severe in 10.9%. Severe acute toxicities occurred more frequently in patients with moderate to severe comorbidities (75.6% versus 48.3%), with a statically significant difference (p = 0.006, OR 3.314, 95%-CI (1.382-7.944)). In the group with moderate to severe comorbidities, omission of at least one cisplatin cycle (75.6% versus 60.0%) and premature ending of radiotherapy (12.2% versus 5.0%) also occurred more frequently (p ≥ 0.05). CONCLUSION: In patients with head and neck cancer treated with chemoradiotherapy, the presence of moderate to severe comorbidities seems to correlate with higher incidences of severe acute toxicities. ACE-27 may identify patients at higher risk of major toxicities and assist decisions regarding treatment.

Neoadjuvant radiotherapy in the approach of locally advanced breast cancer.

BACKGROUND: Approximately 4% of European patients are diagnosed with locally advanced breast cancer (LABC), a clinical condition commonly associated with poorer prognosis. Systemic therapy is the recommended initial treatment and when inoperability criteria prevails, radiotherapy (RT) should be used for tumour downstaging. This study intends to evaluate the impact of neoadjuvant radiotherapy (NART) in the treatment of inoperable LABC. METHODS: A retrospective study of female patients, submitted to the NART between January 2014 and December 2018 at our institution. The evaluation of pathological response (pR) was made based on Pinder criteria. Primary endpoint: pR. Secondary endpoints: overall survival (OS) and progression-free survival (PFS). OS and PFS were calculated using the Kaplan-Meier method. Differences between groups were compared using Student's t-test, ANOVA (Analysis of variance) and χ2 test. The statistical analyses were performed using Stata (V.13). RESULTS: A total of 76 patients were included, 18% with breast complete response. The 5 years OS was 54% and PFS was 61%. Subgroup analysis showed that pR >90% is correlated with a better OS (p=0.004). Basal-like intrinsic subtype is correlated with worse OS and PFS (p<0.05). No relation was found between response and age, intrinsic subtype, treatment performed and clinical T stage. CONCLUSION: Our study confirms that NART is an effective downsizing treatment in inoperable LABC, allowing for a surgical resection regardless of the systemic treatment performed. Response to NART is independent of the intrinsic subtype and pR >90% is correlated with a better OS. Prospective studies to explore predictive response biomarkers are necessary in order to improve patient selection and optimisation of the treatment.