ABSTRACT
Choosing Wisely is an initiative by the American Board of Internal Medicine (ABIM) and ABIM Foundation to deter unnecessary medical treatments and procedures. Faced with the burden of modern technologies and treatments, it is crucial to identify practices lacking value in daily care. The Latin American and Caribbean Society (SLACOM), comprising cancer control experts, deems it vital to tailor this initiative for enhancing cancer care in the region. Through a modified DELPHI methodology involving two rounds of electronic questionnaires and a hybrid meeting to discuss key points of contention, ten essential recommendations were identified and prioritised to avoid harmful oncology procedures in our region. These consensus-based recommendations, contextualised for Latin America, have been compiled and shared to benefit patients. The Scientific Committee, consisting of prominent oncologists and health experts, collaborates remotely to drive this project forward.
ABSTRACT
INTRODUCTION: The world is living through an outbreak of an acute respiratory syndrome caused by a new betacoronavirus known as coronavirus 2 (SARS CoV-2), which has been declared an international public health emergency by the World Health Organisation. Cancer patients are a very special population in this setting since they are more susceptible to viral infections than the general population. Several recommendations have been made on this issue, most of them based on expert opinion and institutional experience. It is essential to gather the evidence available for decision making. OBJECTIVE: To review the evidence available in order to create a multi-institutional position from the perspective of scientific societies in Argentina involved in the management of cancer patients. METHODOLOGY: The review included two phases: 1) search and systematic revision of the medical literature; 2) consensus and revision of the document drafted by national scientific societies involved in the management and care of cancer patients using the modified Delphi method. The final results were presented at a videoconference with all the participants. Also, additional comment and recommendations were discussed. The final document was revised and approved for publication by the members of the panel. RESULTS: The consensus panel included 18 representatives from scientific societies from Argentina who assessed the evidence and then made recommendations for the management of cancer patients in our country. International guidelines (CDC; ASCO, NCCN and ESMO) were considered as a background for analysis, as well as institutional guidelines and an open ad hoc survey administered to 114 healthcare professionals from the scientific societies involved in this study.The recommendations are grouped as follows: 1) general care interventions-training of the personnel, cleaning and disinfection of the hospital premises and patient scheduling; 2) treatment decisions-patient care, surgeries, immunosuppressive therapy, radiotherapy and screening; 3) ethical considerations-optimisation of resources, end-of-life care for critically-ill patients; 4) management of hospitalised patients; and 5) wellbeing of the healthcare team.The general recommendation arising from the study is that the management of cancer patients must adapt to the exceptional pandemic status quo without disregarding treatment or cure options. Moreover, healthcare professional accompaniment of all patients should not be neglected. All healthcare professionals must make a significant joint effort to create multidisciplinary teams to discuss the most appropriate measures for each particular situation. CONCLUSIONS: The scientific evidence available on this topic worldwide is in progress. This together with the epidemiologically shifting scenario poses unprecedented challenges in the management of cancer amidst this global pandemic. Furthermore, the key role of the healthcare structural organisation appears evident, such as the drafting of clear guidelines for all the stakeholders, adaptability to constant change and an interdisciplinary shared vision through consensus to provide adequate care to our cancer patients in the light of uncertainty and fast-paced change.
ABSTRACT
Numerosos estudios mencionan que la sobre-expresión de la proteína p16, un marcador biológico que permite identificar lesiones pre-neoplásicas del epitelio exocervical, tendría una alta asociación con el Papiloma Virus Humano (HPV) de alto riesgo oncogénico. Es un estudio descriptivo correlacional cuyo objeti-vo fue establecer asociación de las Neoplasias Intraepiteliales Cervicales grado I (NIC I), HPV positivos, con la expresión del p16.Materiales, métodos y resultados: Es un estudio correlacional que se realizó en el período de noviembre de 2009 a noviembre de 2010; se presentaron 256 casos de NIC I de los cua-les, 72 fueron HPV positivos; se practicó técni-ca de p16. La edad promedio de las mujeres fue de 41 años. Se encontró positividad para el p16 en 40 casos (55.6%) y fueron negativos 32 (44.4%). De los casos positivos para p16, los tipos virales más frecuentes fueron los de alto riesgo: 33 (82.5%). El p16 fue valorado en cuantía, distribución e intensidad, estableciéndose relación entre la intensidad del p16 con los virus de alto riesgo (p=0.038). Cuan-do se analizó la edad y el tipo viral, pacientes entre 20 y 40 años (36 casos, 90%) presenta-ron genoma de HPV de alto riesgo.Conclusiones: Existió correlación entre la intensidad del p16 con la presencia de HPV de alto riesgo, ayudando a seleccionar grupos con tendencia a la progresión de la enfermedad.
Numerous studies report that overexpression of p16 protein that is a biomarker to identify premalignant exocervical epithelium lesions would have a high association with human papillomavirus (HPV) with high oncogenic risk. It is a descriptive correlational study whose objective was to establish association of Cer-vical Intraepithelial Neoplasia grade I (CIN I), HPV positive, with the p16 expression.Materials, methods and results: It is a corre-lational study conducted from November 2009 to November 2010; about 256 cases of CIN I were presented, 72 were positive HPV; also p16 technique was performed. The wo-men average age was 41 years. There were 40 (55.6%) positive cases for p16, and only 32 (44.4%) were negative. From the positive ca-ses for p16, the most common viral types were high-risk patients: 33 (82.5%). The p16 was va-lued in amount, distribution and intensity, es-tablishing a relationship between the intensity of p16 with high-risk virus (p = 0.038). When the age and viral type were analyzed, patients between 20 and 40 years (36 cases, 90%) pre-sented HPV genome with high risk.Conclusions: There is correlation between the intensity of p16 with the presence of HPV high risk, helping select groups prone to disease progression.
Subject(s)
Humans , Female , Adult , Uterine Cervical Dysplasia , Diagnosis , Human papillomavirus 16 , Carcinoma in Situ , Risk FactorsABSTRACT
Los autores presentan 15 pacientes con diagnóstico histológico de Cáncer de poulmón de células pequeñas (l3 hombres y 2 mujeres). Diez pacientes fueron tratados con VAC alternante con carboplatino + etopósido. Cinco pacientes recibieron solamente carboplatino + etopósido. No obtuvieron ningna RC. Los pacientes que presentaron una RP > del 50 por ciento eran portadores de enfermedad localizada y tuvieron una sobrevida mayor. La toxicidad fue elevada con una muerte imputable a la terapéutica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Carcinoma, Small Cell , Drug Therapy, Combination , Lung Neoplasms/drug therapy , Neoplasm Metastasis , Antineoplastic Combined Chemotherapy Protocols/toxicity , Carboplatin , Etoposide , Smoking , Superior Vena Cava SyndromeABSTRACT
Los autores presentan 15 pacientes con diagnóstico histológico de Cáncer de poulmón de células pequeñas (l3 hombres y 2 mujeres). Diez pacientes fueron tratados con VAC alternante con carboplatino + etopósido. Cinco pacientes recibieron solamente carboplatino + etopósido. No obtuvieron ningna RC. Los pacientes que presentaron una RP > del 50 por ciento eran portadores de enfermedad localizada y tuvieron una sobrevida mayor. La toxicidad fue elevada con una muerte imputable a la terapéutica
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Lung Neoplasms/drug therapy , Carcinoma, Small Cell , Drug Therapy, Combination , Neoplasm Metastasis , Carboplatin , Etoposide , Tobacco Use Disorder , Superior Vena Cava Syndrome , Antineoplastic Combined Chemotherapy Protocols/toxicityABSTRACT
Se trataron 57 pacientes portadores de carcinoma de pulmón de células pequeñas: 26 con quimioterapía y 31 con terapías de sostén clínico. En el primer grupo hubo 19,2 por ciento de respuestas objetivas con 80,8 por ciento de mortalidad. Entre los tratados con sostén clínico falleció el 96,7 por ciento. La sobrevida media fue de 8,1 mes y 5,0 meses respectivamente
Subject(s)
Humans , Male , Female , Carcinoma, Small Cell/therapy , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Lung Neoplasms/therapy , Risk Factors , Smoking , Carcinoma, Squamous Cell , Drug Therapy , Neoplasm Metastasis , Neoplasm StagingABSTRACT
Se trataron 57 pacientes portadores de carcinoma de pulmón de células pequeñas: 26 con quimioterapía y 31 con terapías de sostén clínico. En el primer grupo hubo 19,2 por ciento de respuestas objetivas con 80,8 por ciento de mortalidad. Entre los tratados con sostén clínico falleció el 96,7 por ciento. La sobrevida media fue de 8,1 mes y 5,0 meses respectivamente
