Smoking, mortality, access to diagnosis, and treatment of lung cancer in Brazil.

INTRODUCTION: Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD: Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS: There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION: This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.

Endoscopic Retrograde Cholangiopancreatography on Pediatric Patients: Experience of a Portuguese Adult Gastroenterology Department.

Introduction: Experience with endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population is limited. Few medical centers have experts specifically trained in pediatric therapeutic endoscopy. As a result, patients are generally referred to adult endoscopists with high experience in the procedure. The aim of this study was to characterize the experience of an adult endoscopy unit with ERCP on pediatric patients, with a special focus on very young patients. Methods: We retrospectively analyzed indications, technical success rate, final clinical diagnosis, and complications of ERCPs in children <18 years at our tertiary referral hospital center between January 1994 and June 2022. Results: Sixty-five ERCPs were performed on 57 children with a median age of 13 years (range 1-17 years). Eleven ERCPs were performed on 9 patients up to 5 years old. Indications for ERCP were as follows: biliary obstruction (n = 40), mainly due to choledocholithiasis, lithiasic acute pancreatitis (n = 19), recurrent pancreatitis (n = 3), stent extraction (n = 2), and post-operative biliary fistula (n = 1). The cannulation success rate was 95.1%. Therapeutic interventions were performed in 79% of ERCP. All patients were followed up as inpatients. Complications were recorded in two procedures (3.1%), and no procedure-related mortality occurred. Conclusion: In our experience, ERCP in children can be safely performed with high success rates by advanced adult-trained expert endoscopists at a high-volume center.

Introdução: Existe pouca experiência na realização de colangiopancreatografia retrógrada endoscópica (CPRE) na população pediátrica. A maioria dos centros carece de especialistas especificamente treinados em endoscopia terapêutica pediátrica, sendo os doentes geralmente referenciados para Gastroenterologistas de adultos com elevada experiência na técnica. O objectivo deste estudo foi caracterizar a experiência de um departamento de Gastrenterologia de adultos em CPRE pediátrica, com destaque particular nos doentes muito novos. Métodos: Foram analisadas retrospectivamente as indicações, sucesso técnico, diagnósticos e complicações das colangiopancreatografias retrógradas endoscópicas (CPREs) realizadas no nosso hospital terciário em crianças <18 anos, entre Janeiro de 1994 e Junho de 2022. Resultados: Foram realizadas 65 CPREs em 57 crianças com idade mediana 13 anos (1­17 anos). Doze procedimentos foram realizados em 9 crianças com idade até 5 anos. As indicações para CPRE foram: obstrução biliar (n = 40), sobretudo devido a coledocolitíase, pancreatite aguda litiásica (n = 19), pancreatite recorrente (n = 3), extracção de prótese (n = 2) e fístula biliar pós cirurgia (n = 1). A taxa de sucesso de canulação foi 95.4%. Foram realizados procedimentos terapêuticos em 80.0% das CPREs. Todos os doentes foram vigiados em regime de internamento, tendo-se registado complicações em dois exames (3.1%). Não existiram mortes relacionadas com a técnica. Discussão/ Conclusão: A CPRE pode ser realizada na população pediátrica com segurança e elevada taxa de sucesso por Gastrenterologistas de adultos com experiência na técnica, num centro com elevado volume de exames.

Smoking, mortality, access to diagnosis, and treatment of lung cancer in Brazil / Tabagismo, mortalidade, acesso ao diagnóstico e tratamento de câncer de pulmão no Brasil

ABSTRACT INTRODUCTION Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.

RESUMO INTRODUÇÃO O câncer de pulmão (CP) é um relevante problema de saúde pública no Brasil e no mundo, dada sua alta incidência e mortalidade. Assim, objetiva-se analisar a distribuição do tabagismo e da carga tabágica segundo características sociodemográficas e disparidades no acesso, no tratamento e na mortalidade por CP no Brasil, em 2013 e 2019. MÉTODO Estudo retrospectivo de triangulação de fontes de dados de abrangência nacional: a) análise da distribuição do tabagismo, baseada na Pesquisa Nacional de Saúde (PNS); b) investigação dos registros de CP, via Registros Hospitalares de Câncer (RHC); e c) distribuição da mortalidade por CP, no Sistema de Informação sobre Mortalidade (SIM). RESULTADOS Verificou-se redução do percentual de pessoas que nunca fumaram de 2013 (68,5%) para 2019 (60,2%), assim como da carga tabágica (anos-maço). Esta foi observada maior em homens em pessoas de faixas etárias mais avançadas e de menor escolaridade. Em relação aos pacientes registrados no RHC, a entrada no serviço de saúde se dá a partir de 50 anos, e apenas 19% nunca fumaram. Ao passo que os fumantes na população são majoritariamente pardos, os pacientes no RHC são em maioria brancos. Quanto ao estadiamento inicial (I e II), é mais frequente em pessoas brancas e que nunca fumaram. A taxa de mortalidade apresentou variação de 1,00, para pessoas com ensino superior, a 3,36, entre pessoas sem instrução, assim como pessoas brancas têm uma taxa de mortalidade três vezes maior que a de pessoas negras e pardas. CONCLUSÃO Este artigo apontou relevantes disparidades sociodemográficas no acesso ao diagnóstico, tratamento e mortalidade do CP. Assim, recomenda-se: fortalecer o Registro de Câncer de Base Populacional; desenvolver e implementar estratégia de screening de CP no Brasil, uma vez que a realização de estratégias de prevenção e diagnóstico precoce combinadas funcionam melhor no controle da mortalidade pela doença; e investimento contínuo nas políticas de prevenção e controle do tabagismo.

Lung Cancer Screening in Brazil Comparing the 2013 and 2021 USPSTF Guidelines.

Importance: It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. Objective: To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. Design, Setting, and Participants: This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. Exposures: Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with ≥30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 pack-years and <15 years since cessation). Main Outcomes and Measures: The primary outcomes were the numbers of individuals eligible for LCS, the 5-year preventable deaths attributable to LC, and the number of YLGs if death due to LC was averted by LCS. Results: In Brazil, the eligible population for LCS was 27 280 920 ever-smokers aged 50 to 80 years (13 387 552 female [49.1%]; 13 249 531 [48.6%] aged 50-60 years; 394 994 Asian or Indigenous [1.4%]; 3 111 676 Black [11.4%]; 10 942 640 Pardo [40.1%]; 12 830 904 White [47.0%]; 12 428 536 [45.6%] with an incomplete middle school education; and 12 860 132 [47.1%] living in the Southeast region); 5 144 322 individuals met the USPSTF 2013 criteria for LCS (2 090 636 female [40.6%]; 2 290 219 [44.5%] aged 61-70 years; 66 430 Asian or Indigenous [1.3%]; 491 527 Black [9.6%]; 2 073 836 Pardo [40.3%]; 2 512 529 [48.8%] White; 2 436 221 [47.4%] with an incomplete middle school education; and 2 577 300 [50.1%] living in the Southeast region), and 8 380 279 individuals met the USPSTF 2021 LCS criteria (3 507 760 female [41.9%]; 4 352 740 [51.9%] aged 50-60 years; 119 925 Asian or Indigenous [1.4%]; 839 171 Black [10.0%]; 3 330 497 Pardo [39.7%]; 4 090 687 [48.8%] White; 4 022 784 [48.0%] with an incomplete middle school education; and 4 162 070 [49.7%] living in the Southeast region). The number needed to screen to prevent 1 death was 177 individuals according to the USPSTF 2013 criteria and 242 individuals according to the USPSTF 2021 criteria. The YLG was 23 for all ever-smokers, 19 for the USPSTF 2013 criteria, and 21 for the USPSTF 2021 criteria. Being Black, having less than a high school education, and living in the North and Northeast regions were associated with increased 5-year risk of LC death. Conclusions and Relevance: In this comparative effectiveness study, USPSTF 2021 criteria were better than USPSTF 2013 in reducing disparities in LC death rates. Nonetheless, the risk of LC death remained unequal, and these results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.

Factors associated with late-stage diagnosis and overall survival for lung cancer: An analysis of patients treated in a Brazilian hospital and a US-hospital from 2009 to 2019.

BACKGROUND: Lung cancer is a major public health problem due to its high incidence and mortality rates worldwide. Histology, socioeconomic conditions, access, quality of healthcare, and regional aspects are associated with lung cancer stages at diagnosis and survival outcomes. This paper aims to examine and contrast the factors associated with late-stage diagnosis of lung cancer and overall survival rates in two different settings: a Brazilian hospital and a US hospital, spanning from 2009 to 2019. METHODS: This is a retrospective cohort study of the incidence of lung cancer cases at the institution's cancer registry from a Brazilian and a US-based cohort. Descriptive analyses are presented using either the mean and standard deviation or the median and interquartile interval. Frequency is used to present categorical variables. Factors associated with late-stage lung cancer diagnosis were identified through bivariate and multivariable forward stepwise logistic regression. One-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. RESULTS: Between January 2009 and December 2019, a total of 5286 individuals were diagnosed with LC in the Brazilian cohort, and out of these cases, 85.6% were diagnosed with late-stage disease. The US-cohort consisted of 3594 individuals, of whom 60.3% were diagnosed with late-stage disease in lung cancer. The one-year overall survival was 8.6 months for the US cohort and 6.4 months for the Brazilian cohort. In both cohorts, late-stage diagnosis emerged as the most significant factor influencing overall survival. However, the factors associated with late-stage diagnosis differed between the US and Brazilian cohorts. In the Brazilian cohort, being male and belonging to black or brown ethnic groups, along with having a lower education level, were linked to late-stage diagnosis. On the other hand, in the US-based cohort, the factors related to late-stage diagnosis were being male, having been diagnosed before 2015, and possessing private insurance coverage. CONCLUSION: Late-stage diagnosis was associated with the worst survival in both the US and Brazilian cohorts. This study provides valuable information on inequities and barriers to access for lung patients with cancer from upper-middle-income and high-income countries.

First use of antineoplastic agents in women with breast cancer in the state of Rio de Janeiro, Brazil.

Context: Breast cancer is the most common cancer, except for non-melanoma skin cancer, among women in Brazil and worldwide. Breast cancer treatment involves surgery, radiotherapy and chemotherapy, which is used in 70% of patients. This study analyzes the utilization of antineoplastic agents among women undergoing their first round of chemotherapy in Brazil's public health system (SUS) in the state of Rio de Janeiro. Methods: Data from the SUS Outpatient Information System's authorizations for high-complexity outpatient procedures (APACs) billed between January 2013 and December 2019 were extracted, and three datasets were created: all type 1 and type 2 APACs (including all chemotherapy procedures performed); all type 1 APACs; and first type 1 APACs (containing data only for the first round of breast cancer chemotherapy). Names of antineoplastic agents were standardized to enable the subsequent classification of therapy regimens, mitigating limitations related to data quality. Absolute and relative frequencies were used to describe sociodemographic, clinical and treatment characteristics, therapy regimen and supportive drugs. Results: We analyzed 23,232 records of women undergoing their first round of chemotherapy. There was a progressive increase in the number of procedures over time. Women were predominantly white, lived in the capital and close to the treatment center. Most had stage 3 cancer at diagnosis (50.51%) and a significant proportion had regional lymph node invasion (37.9%). The most commonly used chemotherapy regimens were TAC (docetaxel, doxorubicine, cyclophosphamide) (21.05%) and and cyclophosphamide (17.71%), followed by tamoxifen (15.65%) and anastrozole (12.94%). Supportive drugs were prescribed to 386 women and zoledronic acid was predominant (59.58%). Conclusion: The findings point to important bottlenecks and possible inequities in access to treatment and medicine utilization for breast cancer patients in Brazil. Efforts to improve breast cancer treatment and prevention should not only focus on interventions at the individual level but address the disease as a public health problem. The study focused on women undergoing their first round of treatment, providing valuable insight into patient and treatment characteristics to inform policy decisions.

Quimioterapia para Câncer de Mama no Estado do Rio de Janeiro durante a Pandemia da Covid-19: Análise de Séries Temporais / Chemotherapy for Breast Cancer in the State of Rio de Janeiro during the COVID-19 Pandemic: Time Series Analysi / Quimioterapia para el Cáncer de Mama en el Estado de Río de Janeiro durante a la Pandemia de Covid-19: Análisis de Series de Tiempo

Introdução: O câncer é uma das principais causas de morte no Brasil e no mundo. Estimam-se 483 mil novos casos no país, para cada ano do triênio 2023-2025, excetuando-se o câncer de pele não melanoma, sendo o câncer de mama o mais incidente em mulheres, com 74 mil novos casos. Após a declaração da pandemia da covid-19 pela Organização Mundial da Saúde, vários Estados brasileiros estabeleceram medidas restritivas, visando à redução da contaminação, e os centros de referência em diagnóstico do câncer foram impactados. Objetivo: Analisar séries temporais das quantidades de procedimentos aprovados de quimioterapia para câncer de mama antes e durante a pandemia da covid-19 nos estabelecimentos habilitados para alta complexidade em oncologia no Estado do Rio de Janeiro. Método: Estudo descritivo com análises de séries temporais e ecológica, usando dados públicos de procedimentos de quimioterapia autorizados pelo Sistema Único de Saúde entre março de 2018 e fevereiro de 2021. Resultados: Foram identificados 394.926 procedimentos, representando um aumento de 47% com tendência linear crescente (R2 =0,5203) no período. Verificou-se um aumento de procedimentos para câncer de mama receptor hormonal positivo (46%) e carcinoma de mama HER-2 positivo (900%). Conclusão: Observou-se um aumento nos procedimentos de quimioterapia, assim como uma diminuição do deslocamento de tratamento dos grandes centros. Os resultados apontam para uma possível resposta efetiva da rede de atendimento e fortalecimento da regionalização durante o primeiro ano da pandemia.

Introduction: Cancer is one of the main causes of death in Brazil and worldwide. For each year of the triennium 2023-2025, 483,000 new cases are estimated for the country, except non-melanoma skin cancer, breast cancer being the most incident in women with 74,000 new cases. After the declaration of the COVID-19 pandemic by the World Health Organization, several Brazilian states determined restrictive measures to reduce the contamination and cancer diagnosis reference centers were impacted. Objective: To analyze the number of approved breast cancer chemotherapy procedures before and during the COVID-19 pandemic in SUS-affiliated cancer-care facilities in the State of Rio de Janeiro, Brazil. Method: Descriptive design, with time series and ecological analyses using publicly available data of chemotherapy procedures authorized by SUS between March 2018 and February 2021. Results: A total of 394,926 procedures were identified, an increase of 47% with a rising linear trend (R2 =0,5203) during the period. Increases in hormonal receptor-positive cancer (46%) and in HER-2 positive carcinoma (900%) were observed. The patients travelled smaller distances for chemotherapy procedures. Conclusion: Results point out a possible effective response by the cancer care network and strengthening of the regionalization during the first pandemic year.

Introducción: El cáncer es una de las principales causas de muerte en el Brasil y en el mundo. Se estiman 483 000 nuevos casos en el país, para cada año del trienio 2023-2025, excluyendo el cáncer de piel no melanoma, siendo el cáncer de mama el más incidente en mujeres, con 74 000 nuevos casos. Luego de la declaración de la pandemia de covid-19 por la Organización Mundial de la Salud, varios Estados del Brasil establecieron medidas restrictivas con el objetivo de reducir la contaminación y los centros de referencia para el diagnóstico del cáncer fueron impactados. Objetivo: Analizar series de tiempo de las cantidades de procedimientos de quimioterapia aprobados para el cáncer de mama, antes y durante la pandemia de covid-19, en los establecimientos calificados para la alta complejidad en oncología en el Estado de Rio de Janeiro, Brasil. Método: Diseño descriptivo con análisis de series de tiempo y ecológico, utilizando datos públicos de procedimientos de quimioterapia aprobados por el Sistema Único de Salud entre marzo de 2018 y febrero de 2021. Resultados: Fueran identificados 394 926 procedimientos, representando un aumento de 47% con una tendencia lineal creciente (R2 =0,5203) en el periodo. Fueron observados aumentos de procedimientos para cáncer de mama receptor hormonal positivo (46%) y carcinoma de mama HER-2 positivo (900%). Conclusión: Los resultados apuntan hacia una posible respuesta efectiva de la red de atención y fortalecimiento de la regionalización durante el primer año pandémico.

Aspectos Éticos Priorizados pela Revista Brasileira de Cancerologia / Ethical Aspects Prioritized by Revista Brasileira de Cancerologia / Aspectos Éticos Priorizados por la Revista Brasileira de Cancerologia

A Revista Brasileira de Cancerologia (RBC) preza pela integridade na pesquisa, estimulando a publicação de artigos desenvolvidos de forma respeitosa, honesta, rigorosa, transparente e aberta, além de envolver cuidado e respeito com os envolvidos. A revista viabiliza as correções em manuscritos sempre que estes afetarem substancialmente o significado ou a interpretação dos dados, mas que não comprometam os resultados ou conclusões gerais do artigo. Além disso, disponibiliza as retratações de um manuscrito indicadas por diversas razões, incluindo publicação duplicada, plágio, práticas de investigação não éticas. Sendo um periódico financiado pelo governo federal, a RBC não reproduz nem divulga anúncios publicitários em seus artigos ou em seu website, concentrando sua atuação na divulgação do conhecimento científico, com vistas ao aprimoramento dos serviços oferecidos pelo Sistema Único de Saúde (SUS) e por outros sistemas nacionais de saúde. Dentro de rígidos princípios éticos, a RBC segue crescendo tanto na publicação como no alcance nacional e internacional de seus artigos, expandindo pela ciência aberta a geração de novas práticas destinadas à prevenção e ao controle do câncer no cenário brasileiro e no contexto global.

Registros Hospitalares de Câncer: Proposta Metodológica para Correção do Estadiamento de Câncer de Pulmão / Hospital-Based Cancer Registry: Methodological Proposal for Correction of Lung Cancer Staging / Registros Hospitalarios de Cáncer: Propuesta Metodológica para la Corrección de la Estadificación del Cáncer de Pulmón

Introdução: Um grande desafio para a utilização de registros e bases de dados secundárias é a qualidade do registro e o percentual de perdas em variáveis estratégicas e necessárias à plena utilização do banco. Objetivo: Propor um método de correção para a variável de estadiamento no âmbito dos Registros Hospitalares de Câncer (RHC), a fim de aprimorar sua completude e qualidade. Método: Estudo descritivo, abrangendo as Unidades da Federação, utilizando-se como fonte de informação o RHC, de janeiro de 2013 a dezembro de 2019. O câncer de pulmão foi escolhido como caso para a correção do banco, em razão da sua alta taxa de mortalidade no Brasil e no mundo. As análises foram realizadas com o software de análises estatísticas SAS Studio e a base de dados organizada em Excel. Resultados: O total de casos registrados no RHC foi de 86.026, e a variável de interesse, o estadiamento, teve um total de 32,0% de perda. Ao final de todas as etapas de correção, a perda foi de 9,8%, correspondendo a 22,2% de recuperação. Conclusão: A metodologia proposta representa um avanço na correção do banco do RHC, possibilitando a utilização dos dados de base secundária, com melhor representatividade das diferentes Regiões do país, sobre o tratamento de câncer de pulmão, com possibilidade de expansão de seu uso para outras topografias

Introduction: A major challenge to utilize the registries and secondary databases is the quality of the data and the percentage of losses in strategic and necessary variables for better effectiveness of the database. Objective: To propose a correction method for the cancer staging variable of the HospitalBased Cancer Registry (HBCR), to improve its completeness and quality. Method: HBCR-based descriptive analysis covering Brazil's Federation Units from January 2013 to December 2019. Due to its high mortality in Brazil and worldwide, lung cancer was selected as case for database correction. The analyzes were performed with the software SAS Studio for statistical analyzes and the data were organized in Excel. Results: The total number of cases registered at the HBCR was 86,026, and 32% the variable of interest, staging, were missed. At the end of the correction process, the missed data reached 9.8%, corresponding to a recovery of 22.2%. Conclusion: The proposed methodology is an advance for the correction of the HBCR database on the treatment of lung cancer, allowing a more extensive use, with better representativeness of different country regions, and potential utilization in other topographies

Introducción: Un gran desafío para el uso de registros y bases de datos secundarias es la calidad del registro en sí, el porcentaje de pérdidas en variables estratégicas y necesarias para el pleno uso de la base de datos. Objetivo: Proponer un método de corrección de la variable estadificación en el ámbito de los Registros Hospitalarios de Cáncer (RHC), con el fin de mejorar su exhaustividad y calidad. Método: Análisis descriptivo, abarcando las Unidades de la Federación. Se utilizó el RHC como fuente de información, de enero de 2013 a diciembre de 2019. El cáncer de pulmón fue elegido como caso para la corrección de la base de datos, debido a su alta tasa de mortalidad en el Brasil y en el mundo. Los análisis se realizaron con el software de análisis estadístico SAS Studio y los datos se organizaron en Excel. Resultados: El total de casos registrados en el RHC fue de 86.026, y la variable de interés, la estadificación, tuvo una pérdida total del 32,0% Al final de todas las etapas esta fue de 9,8%, es decir el 22,2% de recuperación. Conclusión: La metodología propuesta representa un avance en la corrección del RHC, permitiendo una mejor utilización de la base de datos, con una mejor representatividad de las diferentes regiones del país, sobre el tratamiento del cáncer de pulmón, con la posibilidad de expandir su uso a otras topografías

Effect of municipal and state regulation on access and outcomes for cervical cancer patients in Rio de Janeiro, Brazil: An interrupted time series analysis.

BACKGROUND: Cervical cancer (CC) is one of Brazil's most prevalent neoplasms, and organizing health care flows that guarantee adequate and timely referral is a challenge. This paper analyzes the effect of municipal and state regulation on access and outcomes for CC patients treated in Rio de Janeiro. METHODS: Retrospective, quasi-experimental study, applying interrupted time series, using data from Cancer Registry from January-2012 to December-2017. We analyzed the implementation of the municipal (August-2013) and state (June-2015) regulation systems for the treatment of CC. The primary outcomes were 1. Time from diagnosis to the first Specialist Visit (TSV); 2. Time from a specialist visit to Treatment Initiation (TSV-TTI); 3. Time from diagnosis to treatment initiation (DTTI); 4. Percentage of patients with adequate Time to Treatment Initiation (PATTI); 5. Percentage of patients with a positive outcome (PPO). RESULTS: were included 4119 women. 71.04 % were between 30 and 59 years old, 55.57 % were black or brown, and 50.52 % had completed elementary school. The monthly average TSV was 43 days in 2012. After the first intervention, TSV increased by seven days, with a decreasing trend of 1 day per month until December-2017. Similarly, after June-2015, DTTI increased to 63 days, decreasing by one day per month until December-2017. After both interventions, there was an increase of 11.98 % in PATTI, with an increasing monthly trend of 0.18 %. PPO remained stable throughout the analyzed period. CONCLUSION: the results suggest that regulation organized access flow for specialized care. However, other relevant issues must be addressed, such as an internal backlog at the institutions, which compromises a timely start of treatment. POLICY SUMMARY: To improve access to the diagnosis and treatment of CC in its early stages, it is necessary to invest in health policies to adjust the supply to the required demand and thus reduce mortality from this pathology.

Efeitos da judicialização de medicamentos antineoplásicos nos serviços farmacêuticos em oncologia / Judicialization effects of antineoplastic drugs in a public cancer care facility / Efectos de la judicialización de los fármacos antineoplásicos en un servicio público de atención oncológica

Objetivo: analisar como os efeitos das demandas judiciais quanto aos aspectos regulatório, técnico, logístico e clínico impactam os serviços farmacêuticos em oncologia. Metodologia: estudo descritivo e exploratório, utilizando dados de processos judiciais recebidos pelo Instituto Nacional do Câncer (INCA), entre janeiro de 2009 e dezembro de 2018, e que resultaram no fornecimento de antineoplásicos. As variáveis foram analisadas nas dimensões médico-sanitária e político-administrativa, e correlacionadas aos seus efeitos nos serviços farmacêuticos em oncologia, nas perspectivas regulatória, logística, técnica e clínica. Resultados: foram identificados 41 processos judiciais que demandaram 14 antineoplásicos diferentes no período. Todos os medicamentos possuíam registro válido na Agência Nacional de Vigilância Sanitária; os anticorpos monoclonais foram os mais demandados; e o gasto total no período ultrapassou R$ 3 milhões. O descumprimento de aspectos normativos; as implicações técnicas e logísticas para preparo de antineoplásicos adquiridos pelos pacientes com recursos advindos de demandas judiciais; e a insuficiência de evidências científicas que suportem a adequada tomada de decisão foram alguns dos efeitos da judicialização para os serviços farmacêuticos em oncologia. Conclusão: os resultados permitiram ampliar o debate sobre os efeitos da judicialização da saúde, considerando aspectos basilares da assistência farmacêutica imbricados na rotina dos serviços de saúde.

Objective: to analyze the effects of lawsuits regarding the regulatory, technical, logistical and clinical aspects that impact the pharmaceutical services. Methods: descriptive and exploratory study using data from lawsuits received by a reference cancer care facility between January 2009 and December 2018, and which resulted in the supply of antineoplastic drugs. The variables were analyzed in the clinical-sanitary and regulatory-institutional dimensions and correlated to its effects on pharmaceutical services in oncology, from regulatory, logistical, technical, and clinical perspectives. Results: a total of 41 lawsuits demanded 14 different antineoplastic drugs in the period. All medicines had a valid Brazilian National Health Surveillance Agency registration, monoclonal antibodies were the most demanded and the total expenditure in the period exceeded R$ 3 million. Non-compliance with normative aspects, technical and logistical implications for the preparation of antineoplastic drugs purchased by patients with resources from lawsuits and lack of scientific evidence to support adequate decision-making were discussed as some of the judicialization effects for pharmaceutical services. Conclusion: the results made it possible to broaden the debate on the effects of health judicialization considering the basic aspects of pharmaceutical care imbricated in the routine of health services.

Objetivo: analizar los efectos de los juicios sobre los aspectos regulatorios, técnicos, logísticos y clínicos que impactan los servicios farmacéuticos. Metodología: estudio descriptivo y exploratorio con datos de los juicios recibidos por un centro oncológico de referencia entre enero de 2009 y diciembre de 2018 y que resultaron en el suministro de fármacos antineoplásicos. Las variables fueron analizadas en las dimensiones médico-sanitaria y político-administrativa, y correlacionado con sus efectos sobre los servicios farmacéuticos en oncología, desde las perspectivas regulatoria, logística, técnica y clínica. Resultados: un total de 41 demandas demandaron 14 antineoplásicos diferentes en el período. Todos los medicamentos tenían un registro válido de la Agencia Nacional de Vigilancia Sanitaria de Brasil, los anticuerpos monoclonales fueron los más demandados y el gasto total en el período superó los R$ 3 millones. El incumplimiento de aspectos normativos, las implicaciones técnicas y logísticas para la preparación de fármacos antineoplásicos adquiridos por pacientes con recursos de litigios y la falta de evidencia científica que sustente una adecuada toma de decisiones se discutieron como algunos de los efectos de judicialización para los servicios farmacéuticos. Conclusión: los resultados permitieron ampliar el debate sobre los efectos de la judicialización de la salud, considerando los aspectos básicos de la atención farmacéutica imbricados en la rutina de los servicios de salud.

[Strategies adopted to ensure the rights of people with cancer in the Brazilian Unified Health System (SUS)]. / Estratégias adotadas para a garantia dos direitos da pessoa com câncer no âmbito Sistema Único de Saúde (SUS).

This study was based on Giddens' Structuration Theory and aimed to analyze strategies adopted to ensure the rights of people with cancer in five Brazilian municipalities, anchored on the experience of managers and health professionals within the Brazilian Unified Health System (SUS). A multiple-case study design was conducted. The municipality was the unit of analysis and oncology care-certified facilities were established as analytical sub-units. We analyzed the strategic behavior of ten managers and 15 health professionals from interviews. The results were systematized according to care, legal and social dimensions. The relevant elements expressed were the need to expand and organize the diagnostic and therapeutic cancer care network; the concern with the large number of lawsuits, both in light of economic sustainability of the health system and because of the promotion of inequalities; and the low resoluteness of social benefits, as they do not meet all people's needs. The adopted measures are considered insufficient to ensure the rights of people with cancer in the Brazilian Unified Health System.

Este estudo, fundamentado na Teoria da Estruturação de Giddens, buscou analisar as estratégias adotadas para garantir os direitos das pessoas com câncer em cinco municípios brasileiros, a partir da experiência de gestores e profissionais de saúde no contexto do Sistema Único de Saúde. Foi conduzido um estudo de casos múltiplos. A unidade de análise foi o município e a subunidade foi a unidade habilitada de atenção oncológica. Foi realizada a análise de conduta estratégica de dez gestores e 15 profissionais de saúde, a partir de entrevistas. Os resultados foram sistematizados em três dimensões: assistencial, judicial e social. Destacaram-se: a necessidade de expansão e organização da rede assistencial diagnóstica e terapêutica; a preocupação com o grande número de demandas judiciais, tanto pela sustentabilidade econômica do sistema de saúde, quanto pela promoção de iniquidades; a pouca resolutividade dos benefícios sociais, uma vez que não atendem a todos aqueles que necessitam. A percepção é de que as medidas adotadas são insuficientes para garantir os direitos da pessoa com câncer no sistema de saúde brasileiro.

Estratégias adotadas para a garantia dos direitos da pessoa com câncer no âmbito Sistema Único de Saúde (SUS) / Strategies adopted to ensure the rights of people with cancer in the Brazilian Unified Health System (SUS)

Resumo Este estudo, fundamentado na Teoria da Estruturação de Giddens, buscou analisar as estratégias adotadas para garantir os direitos das pessoas com câncer em cinco municípios brasileiros, a partir da experiência de gestores e profissionais de saúde no contexto do Sistema Único de Saúde. Foi conduzido um estudo de casos múltiplos. A unidade de análise foi o município e a subunidade foi a unidade habilitada de atenção oncológica. Foi realizada a análise de conduta estratégica de dez gestores e 15 profissionais de saúde, a partir de entrevistas. Os resultados foram sistematizados em três dimensões: assistencial, judicial e social. Destacaram-se: a necessidade de expansão e organização da rede assistencial diagnóstica e terapêutica; a preocupação com o grande número de demandas judiciais, tanto pela sustentabilidade econômica do sistema de saúde, quanto pela promoção de iniquidades; a pouca resolutividade dos benefícios sociais, uma vez que não atendem a todos aqueles que necessitam. A percepção é de que as medidas adotadas são insuficientes para garantir os direitos da pessoa com câncer no sistema de saúde brasileiro.

Abstract This study was based on Giddens' Structuration Theory and aimed to analyze strategies adopted to ensure the rights of people with cancer in five Brazilian municipalities, anchored on the experience of managers and health professionals within the Brazilian Unified Health System (SUS). A multiple-case study design was conducted. The municipality was the unit of analysis and oncology care-certified facilities were established as analytical sub-units. We analyzed the strategic behavior of ten managers and 15 health professionals from interviews. The results were systematized according to care, legal and social dimensions. The relevant elements expressed were the need to expand and organize the diagnostic and therapeutic cancer care network; the concern with the large number of lawsuits, both in light of economic sustainability of the health system and because of the promotion of inequalities; and the low resoluteness of social benefits, as they do not meet all people's needs. The adopted measures are considered insufficient to ensure the rights of people with cancer in the Brazilian Unified Health System.

Gynecological history to diagnosis and pregnancy outcomes in diagnosed Wilson's disease patients under therapy - A bicentric matched-control cohort study.

INTRODUCTION: most studies narrowly focus on pregnancy outcome comparisons between Wilson's disease (WD) patients on and off treatment. We aimed to identify menses irregularities in untreated WD, and to evaluate pregnancy outcomes in treated WD patients as compared to matched controls (with and without liver disease). METHODS: females with WD, hepatitis C (liver disease controls), and other gastrointestinal conditions (controls without liver disease) were identified at two tertiary hospital gastroenterology departments. Gynecological and obstetric data were retrospectively collected. A comparison of gynecological and obstetric outcomes was performed between the groups, and regression models were used to further assess obstetric outcomes. RESULTS: a total of 18 females with WD were identified, comprising 19 pregnancies under treatment in 11 patients, and 20 females were included in each control group. Age and liver disease stage were adjusted between groups. The incidence of menses irregularities was higher for WD (late menarche, 83 % vs. 10 % vs. 10 %, p < 0.01; irregular cycles, 100 % vs. 20 % vs. 20 %, p < 0.01; amenorrhea, 67 % vs. 10 % vs. 5 %, p < 0.01). Logistic regression models identified WD as a predictor of miscarriage and low birth weight (OR: 6.0; CI: 1.1-33.3; p < 0.05) but not of birth defects. Neither therapies (D-penicillamine 300 mg or zinc acetate 150 mg) nor disease presentation (hepatic and/or neurological) were associated with obstetric complications in WD subjects. CONCLUSION: there was a higher incidence of menses irregularities in untreated females with WD. In addition, our data suggest that treated WD still carries a higher risk of spontaneous abortion and low birth weight when compared to matched control groups with and without liver disease.

Potential interactions between antineoplastic agents and medicines used to treat Covid-19.

INTRODUCTION: Cancer patients with Covid-19 are exposed to treatment combinations that can potentially result in interactions that adversely affect patient outcomes. This study aimed to identify potential drug-drug interactions between antineoplastic agents and medicines used to treat Covid-19. METHODS: We conducted a search for potential interactions between 201 antineoplastic agents and 26 medicines used to treat Covid-19 on the Lexicomp® and Micromedex® databases. The following data were extracted: interaction severity ("major" and "contraindicated") and interaction effects (pharmacokinetic and pharmacodynamic). We also sought to identify the therapeutic indication of the antineoplastic drugs involved in the potential drug-drug interactions. RESULTS: A total of 388 "major" or "contraindicated" drug-drug interactions were detected. Eight drugs or combinations (baricitinib, lopinavir/ritonavir, atazanavir, darunavir, azithromycin, chloroquine, hydroxychloroquine, and sirolimus) accounted for 91.5% of these interactions. The class of antineoplastic agents with the greatest potential for interaction was tyrosine kinase inhibitors (accounting for 46.4% of all interactions). The findings show that atazanavir, baricitinib, and lopinavir/ritonavir can affect the treatment of all common types of cancer. The most common pharmacokinetic effect of the potential drug-drug interactions was increased plasma concentration of the antineoplastic medicine (39.4%). CONCLUSIONS: Covid-19 is a recent disease and pharmacological interventions are undergoing constant modification. This study identified a considerable number of potential drug-drug interactions. In view of the vulnerability of patients with cancer, it is vital that health professionals carefully assess the risks and benefits of drug combinations.

Os 75 Anos da RBC e o Desafio da Ciência Aberta / The 75 Years of RBC and the Challenge of Open Science / Los 75 Años de RBC y el Desafío de la Ciencia Abierta

A Revista Brasileira de Cancerologia (RBC) representa um marco na editoração científica nas áreas do controle do câncer no Brasil. Sua história teve início em 1941, quando o Decreto-Lei n.º 3.643, de 23 de setembro de 19411, instituiu, no então Departamento Nacional de Saúde do Ministério da Educação e Saúde, o Serviço Nacional de Câncer e criou uma revista científica de cancerologia. No entanto, somente em setembro de 1947, foi publicado o seu primeiro número na intenção de divulgar, à comunidade acadêmica, conhecimentos no campo da cancerologia. Nas publicações da época, a RBC apresentava não somente artigos científicos e relatos de casos clínicos, mas também notícias relacionadas ao tema, material de divulgação de congressos e seminários, sessão de "perguntas e respostas", discursos completos do ministro da Saúde em eventos da área de câncer e saúde pública, além de anúncios de auxílios financeiros em pesquisa. Com o tempo, a RBC teve a sua importância e manutenção ainda mais valorizadas, e, em agosto de 1968, foi criado o Corpo Editorial, visando ao direcionamento e à indicação de pautas das futuras publicações. Até então, a revista trabalhava somente com redatores permanentes. Em 1982, buscando mais visibilidade, a revista foi indexada na base de dados denominada Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Apesar do aperfeiçoamento do seu projeto editorial, e de ter se tornado um grande veículo de comunicação científica na área da cancerologia no país, poucos avanços aconteceram em busca de uma maior internacionalização e indexação em outras bases de dados, até 2017

The Revista Brasileira de Cancerologia (RBC) is a milestone in scientific editing in the area of cancer control in Brazil. Its history started in 1941 after the issue of Decree-Law number 3,643, dated September 23, 19411 , which created the National Cancer Service and a cancerology scientific journal at the former National Department of Health of the Ministry of Education and Health. Nevertheless, only in 1947 the first edition came to light with the purpose of divulging knowledge in cancerology to the scholar community. Of the journals published at that time, RBC issued not only scientific articles and case reports but also theme-related news, press material for congresses and seminaries, Q&A (questions and answers) sections, complete addresses of the Ministry of Health in events on cancer and public health, further to notices about financial funding of researches2 . As time went by, RBC grew in importance and worth and the Editorial Board was created in August 1968 to put together guidelines and agenda of the upcoming editions. Until then, the journal counted only with permanent writers. In 1982, for more visibility, the journal was indexed at the database Latin American and Caribbean in Health Sciences (LILACS). Notwithstanding its editorial betterment and having stepped up to be a great vehicle of scientific communication in cancerology in the country, few advances in attempting a wider internationalization and indexation occurred at other databases until 2017

Novos Rumos da Política de Controle do Câncer no Brasil / New Trends of the Cancer Control Policy in Brazil / Nuevas Direcciones de la Política de Control del Cáncer en Brasil

As últimas estimativas mundiais de incidência e mortalidade relacionadas ao câncer apontam para a necessidade de adoção de medidas sustentáveis de prevenção e controle do câncer, especialmente nos países com baixo nível de desenvolvimento econômico e naqueles em desenvolvimento, onde se inclui o Brasil1. Essas estratégias perpassam, necessariamente, pela adoção e fortalecimento de políticas públicas que apoiem o planejamento e a priorização de medidas de controle do câncer

Sustainable measures for cancer prevention and control are deemed necessary as the recent world estimates of cancer-related incidence and mortality indicate, mostly for low economic income countries and in development as Brazil1. Necessarily, these strategies beget the adoption and strengthening of supportive public policies for planning and prioritization of cancer control

Association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma.

BACKGROUND: This study aimed to evaluate the association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma. METHODS: We enrolled, in a retrospective cohort, 239 women treated with carboplatin and paclitaxel between 2008 and 2017. Pretreatment computed tomography scans were used to quantify skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and subcutaneous adipose tissue index (SATI). Chemotherapy doses, related toxicities, potential drug-drug interactions (DDI), and clinical variables were collected from medical records. Outcomes were the number of adverse events ≥ grade 3 toxicity, toxicity-induced modification of treatment (TIMT), and three-year survival. RESULTS: Average age was 56.3 years and 35.1% had myopenia. Almost 33% had TIMT and 51.3% presented any grade 3 toxicity. Potential severe DDI occurred in 48.1% of the patients and 65.1% died three years after the first treatment. The SMD and SATI below the median were independent predictors for the number of adverse events ≥ grade 3 and TIMT. Also, SMD was the only body composition parameter able to predict reduced three-year survival. The SMI was not associated with any of the outcomes. CONCLUSION: Fewer amounts of SATI and low SMD were associated with the occurrence of toxicity to chemotherapy, and the low SMD increased the risk of death in the three years after oncologic treatment.