Effectiveness and safety of neoadjuvant therapy in triple-negative breast cancer in a real-world population. / [Artículo traducido] Efectividad y seguridad del tratamiento neoadyuvante del cáncer de mama triple negativo en la vida real.

OBJECTIVE: Triple-negative breast cancer is a subtype of aggressive breast cancer. Our aim is to evaluate the effectiveness and safety of neoadjuvant treatment in early-stage triple-negative breast cancer and to identify predictors of pathological complete response. METHODS: This is a single-center, retrospective study involving 79 patients with triple-negative breast cancer who initiated neoadjuvant treatment between January 2017 and October 2022. Descriptive analyses were performed as appropriate. Statistical analysis utilized bivariate logistic regression to explore the presence of factors related to pathological complete response, and the Kaplan-Meier method was employed for survival analysis. RESULTS: In the overall population, 27 patients (n = 78; 34.6%) achieved pathological complete response in the breast and axillary lymph nodes, and 31 (n = 73; 42.5%) achieved a grade 5 pathological complete response in the breast, according to the Miller and Payne classification. The addition of platinum to standard therapy improved both breast and axillary lymph node pathological complete response rates. Age less than 40 years was identified as a predictor of pathological complete response in our study population through bivariate analysis, while Ki67 levels lower than 70% were associated with a lower pathological complete response rate. Adverse events were reported in 72 patients (91.1%), with grade 3-5 adverse events observed in 33 (41.8%). There was a particularly notable increase in gastrointestinal and hematological adverse events when platinum was added. CONCLUSIONS: In this population, we observed moderate rates of pathological complete response with acceptable chemotherapy tolerance. Platinum-based chemotherapy appears to enhance the likelihood of achieving pathological complete response, albeit with a less favorable safety profile. Therefore, evaluating the benefit-risk balance is crucial when selecting the optimal chemotherapy regimen for individual patients.

Treatment adherence to oral chemotherapy in patients with locally advanced or metastatic non-small cell lung cancer: Protocol for a hospital pharmacy-based real-world study.

OBJECTIVE: This article describes a study protocol for evaluating adherence to oral chemotherapy (OCT) in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) in Spain. METHODS: This multicenter, observational, prospective study will be conducted by 6 hospital pharmacists from 6 Spanish hospitals. The study will include men and women aged 18 years or older with a diagnosis of locally advanced or metastatic NSCLC who are being treated or have been prescribed OCT. Once included, the patient will be active and prospectively followed up for 3 months, including 4 study visits to record information on sociodemographic variables, antineoplastic treatment and adherence, pharmaceutical care, clinical variables, and patient-reported outcomes (PRO) (the 3-level version of EQ-5D, the EORTC Core Quality of Life Questionnaire, the Brief Illness Perception Questionnaire, the Treatment Satisfaction with Medicines Questionnaire, and the PRO version of Common Terminology Criteria for Adverse Events). Twelve months after patient inclusion, we will record information on the disease progression status and dispensed prescriptions. The primary outcome is the percentage of treatment adherence that will be calculated based on the pill count as follows: the difference between the number of pills dispensed minus the number of unused pills will be divided by the number of days of treatment multiplied by the number of pills/day prescribed by the oncologist; this quotient will be multiplied by 100 to obtain the percentage of adherence. Based on the that pill count reconciliation, those with a percentage adherence >80% will be primarily categorized as adherent. Secondarily, treatment adherence will be also calculated based on the proportion of days covered and the 4-items Morisky Green Levine Medication Adherence Scale. To analyze the impact of patients' and treatment characteristics on adherence, bivariate analyses will be performed using different adherence cut-off points. To evaluate the impact of adherence on treatment efficacy as evaluated by progression-free survival, we will be using the Kaplan-Meier method and compare it with the log-rank test and univariate Cox regression analysis. CONCLUSIONS: We expect that our study will provide initial information on key aspects of adherence to OCT (i.e., measurement, facilitators, and barriers) and its relationship with patients' and clinically relevant outcomes in the setting of NSCLC, and that this information will help in designing pharmaceutical interventions to improve adherence.

Effectiveness and safety of neoadjuvant therapy in triple-negative breast cancer in a real-world population.

OBJECTIVE: Triple-negative breast cancer is a subtype of aggressive breast cancer. Our aim is to evaluate the effectiveness and safety of neoadjuvant treatment in early-stage triple-negative breast cancer and to identify predictors of pathological complete response. METHODS: This is a single-center, retrospective study involving 79 patients with triple-negative breast cancer who initiated neoadjuvant treatment between January 2017 and October 2022. Descriptive analyses were performed as appropriate. Statistical analysis utilized bivariate logistic regression to explore the presence of factors related to pathological complete response, and the Kaplan-Meier method was employed for survival analysis. RESULTS: In the overall population, 27 patients (n=78; 34.6%) achieved pathological complete response in the breast and axillary lymph nodes, and 31 (n=73; 42.5%) achieved a grade 5 pathological complete response in the breast, according to the Miller and Payne classification. The addition of platinum to standard therapy improved both breast and axillary lymph node pathological complete response rates. Age less than 40 years was identified as a predictor of pathological complete response in our study population through bivariate analysis, while Ki67 levels lower than 70% were associated with a lower pathological complete response rate. Adverse events were reported in 72 patients (91.1%), with grade 3-5 adverse events observed in 33 (41.8%). There was a particularly notable increase in gastrointestinal and hematological adverse events when platinum was added. CONCLUSIONS: In this population, we observed moderate rates of pathological complete response with acceptable chemotherapy tolerance. Platinum-based chemotherapy appears to enhance the likelihood of achieving pathological complete response, albeit with a less favorable safety profile. Therefore, evaluating the benefit-risk balance is crucial when selecting the optimal chemotherapy regimen for individual patients.

Childhood cancer survivors: current challenges.

Rates of childhood cancer survival in developed countries have risen to over 80-85 %. In consequence, the population of childhood cancer survivors (CCS) has grown considerably. Nevertheless, CCS present a high morbidity and mortality due to cancer or its treatment, with an increased risk of premature mortality, second primary tumors and late side effects, both physical and psychosocial, all of which decrease the quality of life. Long-term follow-up (LTFU) of CCS is recommended to prevent, detect and treat those health problems. Despite the advances achieved, the management of CCS is still not optimal. Among the areas for improvement discussed in this manuscript are: (1) Quantifying the real burden of morbimortality, by implementing new frequency measures (mean cumulative count and cumulative burden), to obtain more accurate assessments, and using simulation models, to determine individual risks; (2) Assessing the impact of risk factors for late side effects, related to the patient, tumor type, treatments, lifestyle, comorbidities, genetics and ageing; (3) Considering the impact of the international harmonisation of long-term follow-up guidelines, to generate homogeneous, evidence-based recommendations and an individualized LTFU and, (4) Challenges to LTFU implementation, considering models of care adapted to patient risk and needs, with special attention to the transition to adult-care follow-up. Finally, we comment on the situation of CCS in Spain and consider future prospects for improving the health and quality of life of this population.

CLINICAL PROTOCOLS ADOPTED BY NURSES IN THE EXTRAVASATION OF ANTINEOPLASTIC DRUGS: AN INTEGRATIVE REVIEW / PROTOCOLOS CLÍNICOS ADOPTADOS POR ENFERMERÍA EN LA EXTRAVASACIÓN DE FÁRMACOS ANTINEOPLÁSICOS: UNA REVISIÓN INTEGRADORA / PROTOCOLOS CLÍNICOS ADOTADOS PELOS ENFERMEIROS NO EXTRAVASAMENTO DE ANTINEOPLÁSICOS: UMA REVISÃO INTEGRATIVA

Objective: To identify the patient safety measures and clinical protocols adopted by nurses in the case of antineoplastic extravasation. Methodology: The research approach was based on an integrative literature review that used the PICo strategy to structure the research question. Bibliographic surveys were carried out using the MEDLINE, Lilacs, BDENF, SciELO and PubMed databases using the following terms according to DeCS: "Clinical Protocols", " Extravasation of Therapeutic and Diagnostic Materials", "Oncology Nursing", "Patient Safety", "Antineoplastics". After applying the inclusion and exclusion criteria, 25 articles were selected, read in full, classified and organized according to the theme, and critically analyzed. Results: From the analysis of the studies, it was possible to delimit the main actions and knowledge of nurses in the management and guarantee of patient safety in the face of antineoplastic extravasation, as well as promising new managements in the prevention and treatment of this aggravation. Conclusion: Nurses' knowledge of specific measures for antineoplastic drug leakage is incipient, and there is a clear need for research to minimize the gaps in innovative knowledge in nursing practice with the aim of preventing extravasation.

Objetivo: Identificar las medidas de seguridad del paciente y los protocolos clínicos adoptados por el personal de enfermería en el caso de extravasación de antineoplásicos. Metodología: El abordaje de la investigación se basó en una revisión bibliográfica integradora que utilizó la estrategia PICo para estructurar la pregunta de investigación. Las pesquisas bibliográficas fueron realizadas en las bases de datos MEDLINE, Lilacs, BDENF, SciELO y PubMed, utilizando los siguientes términos de acuerdo con el DeCS: "Protocolos clínicos", " Extravasación de material terapéutico y de diagnóstico", "Enfermería oncológica", "Seguridad del paciente", "Antineoplásicos". Tras aplicar los criterios de inclusión y exclusión, se seleccionaron 25 artículos, que fueron leídos en su totalidad, clasificados y organizados según el tema, y analizados críticamente. Resultados: A partir del análisis de los estudios, fue posible delinear las principales acciones y conocimientos de las enfermeras en el manejo y garantía de la seguridad del paciente ante la extravasación de antineoplásicos, así como nuevos manejos promisorios en la prevención y tratamiento de este agravamiento. Conclusión: El conocimiento de las enfermeras sobre las medidas específicas para la fuga de fármacos antineoplásicos es incipiente, existiendo una clara necesidad de investigación para minimizar las lagunas de conocimiento innovador en la práctica enfermera con el objetivo de prevenir la extravasación.

Objetivo: Identificar quais são as medidas de segurança do paciente e protocolos clínicos adotados pelos enfermeiros no extravasamento de antineoplásicos. Metodologia: A abordagem da pesquisa se deu a partir de uma revisão integrativa da literatura que se utilizou da estratégia PICo para estruturar a questão de pesquisa. Foram realizados levantamentos bibliográficos utilizando as bases de dados MEDLINE, Lilacs, BDENF, SciELO e PubMed utilizando os termos segundo o DeCS: "Protocolos Clínicos", "Extravasamento de Materiais Terapêuticos e Diagnósticos", "Enfermagem Oncológica", "Segurança do paciente", "Antineoplásicos". Após a aplicação dos critérios de inclusão e exclusão, foram selecionados 25 artigos lidos na íntegra, classificados e organizados conforme a temática, e analisados criticamente. Resultados: A partir da análise dos estudos, foi possível delimitar as principais ações e conhecimentos dos enfermeiros no manejo e garantia da segurança do paciente diante do extravasamento de antineoplásicos, assim como novos manejos promissores na prevenção e tratamento deste agravo. Conclusão: Incipiente é o conhecimento dos enfermeiros sobre as medidas específicas diante do extravasamento de antineoplásicos, com evidente necessidade de pesquisas que minimizem as lacunas no conhecimento inovador na prática da enfermagem com desígnio de prevenir  o extravasamento.

Is trimodal therapy the current standard for muscle-invasive bladder cancer?

OBJECTIVE: The aim of this review is to summarize the current evidence and future perspectives of bladder-sparing treatment for MIBC. METHODS: A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords "bladder cancer", "bladder-sparing", "trimodal therapy", "chemoradiation", "biomarkers", "immunotherapy", "neoadjuvant chemotherapy", "radiotherapy". RESULTS: Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to preserve their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly oriented toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes. Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation. CONCLUSIONS: Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.

Efectos secundarios oculares de las terapias oncológicas. Revisión / Ocular side effects of oncological therapies: Review

Con el avance de la terapia contra el cáncer en los últimos años, ha aumentado el conocimiento de los mecanismos involucrados en esta enfermedad, lo que ha supuesto un aumento de la calidad de vida y de la supervivencia de los pacientes con afecciones tumorales anteriormente consideradas incurables o refractarias al tratamiento. El número de fármacos utilizados ha sufrido un aumento exponencial, y a pesar de que la toxicidad implícita es menor que la de la terapia antineoplásica convencional, conllevan la aparición de nuevos efectos adversos asociados, que el oftalmólogo debe reconocer y manejar.(AU)

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.(AU)

Terapia de conversión en cáncer gástrico: experiencia del Instituto Nacional de Cancerología de Colombia / Conversion therapy in gastric cancer: experience at Instituto Nacional de Cancerología de Colombia

RESUMEN Antecedentes: el cáncer gástrico (CG) representa un problema de salud pública en Colombia y el mundo. Dado que la mayoría de los pacientes se encuentran en estadios avanzados en el momento del diagnóstico. desarrollar estrategias de manejo. como la terapia de conversión (TC). es una necesidad cada vez mayor en su tratamiento. Objetivo: estimar los resultados con la TC en el tratamiento de pacientes con CG avanzado en el Instituto Nacional de Cancerología de Colombia (INC). Material y métodos: serie de casos de pacientes con adenocarcinoma gástrico incurable llevados a quimioterapia de inducción y cirugía con intención curativa. entre los años 2010 y 2021. Se revisaron de forma retrospectiva los datos clínico-patológicos y de supervivencia. La supervivencia global (SG) se calculó desde la fecha de la primera quimioterapia hasta la muerte. Las funciones de supervivencia se estimaron con tablas de vida y por el método de Kaplan-Meier y se realizaron curvas de supervivencia a 3 y 5 años. Resultados: se analizaron los datos de 23 pacientes con edad promedio de 56 años. 17 (74%) fueron varones. El criterio de irresecabilidad más frecuente fue un tumor T4b en 13 casos (56.5%). Todos recibieron TC. La mediana de seguimiento fue de 28 meses. Se documentaron 11 recurrencias (52%). La mediana de supervivencia fue de 41.2 meses y la SG a 3 y 5 años de 57.7% y 38.5%. respectivamente. Conclusiones: la TC permitió obtener una SG aceptable de pacientes seleccionados con CG avanzado incurable. Esta estrategia requiere una cuidadosa selección y manejo multidisciplinario en centros oncológicos de referencia.

ABSTRACT Background: Gastric cancer (GC) represents a public health problem in Colombia and worldwide. Since most patients are at advanced stages at the time of diagnosis. it is necessary to develop management strategies as conversion therapy (CT). Objective: The aim of this study was to estimate the results of CT for treating patients with advanced and GC at Instituto Nacional de Cancerología de Colombia (INC). Material and methods: We included patients with incurable gastric cancer who underwent induction chemotherapy and intended curative surgery between 2010 and 2021. The clinical and pathological data and survival of the patients included were retrospectively reviewed. Overall survival (OS) was calculated from the time of initiation of chemotherapy until the date of death. Survival functions were estimated using the life table and Kaplan-Meier methods. and survival curves at 3 and 5 years were constructed. Results: 23 patients were analyzed; mean age was 56 years. and 17 (74%) were men. The most common criterion indicating unresectability was a T4b tumor in 13 cases (56.5%). All the patients underwent CT. Median follow-up was 28 months. Eleven patients developed disease recurrence (52%). Median survival was 41.2 months. and 3- and 5-year OS was 57.7% and 38.5%. respectively. Conclusions: CT provided an acceptable OS rate for selected patients with incurable advanced GC. This strategy requires an adequate selection of patients and multidisciplinary management in reference oncology centers.

Intra and peritumoral PET radiomics analysis to predict the pathological response in breast cancer patients receiving neoadjuvant chemotherapy.

OBJECTIVE: The aim of our study was to evaluate the contribution of 18Fluorine-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) radiomic data obtained from both the tumoral and peritumoral area in predicting pathological complete response (pCR) in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC). METHODS: Female patients with a diagnosis of invasive ductal carcinoma who received NAC were evaluated retrospectively. The volume of interest (VOI) of the primary tumor (VOI-T) was manually segmented, then a voxel-thick VOI was added around VOI-T to define the peritumoral area (VOI-PT). Morphological, intensity-based, histogram and texture parameters were obtained from VOIs. The patients were divided into two groups as pCR and non-complete pathological response (npCR). A "radiomic model" was created with only radiomic features, and a "patho-radiomic model" was created using radiomic features and immunohistochemical data. RESULTS: Of the 66 patients included in the study, 21 were in the pCR group. The only statistically significant feature from the primary tumor among patients with pCR and npCR was Morphological_Compacity-T (AUC: 0.666). Between response groups, a significant difference was detected in 2 morphological, 1 intensity, 4 texture features from VOI-PT; no correlation was found between Morphological_Compacity-PT and NGTDM_contrast-PT. The obtained radiomic model's sensitivity and accuracy values were calculated as 61.9% and 75.8%, respectively (AUC: 0.786). When HER2 status was added, sensitivity and accuracy values of the patho-radiomic model increased to 85.7% and 81.8%, respectively (AUC: 0.903). CONCLUSIONS: Evaluation of PET peritumoral radiomic features together with the primary tumor, rather than just the primary tumor, provides a better prediction of the pCR to NAC in patients with breast cancer.

Levels of depression and self-esteem in women with cancer of the endometrium and cervix receiving chemotherapy treatment in Türkiye.

OBJECTIVE: Endometrium and cervical cancer is a common and important health problem that affects women in many physical, emotional and psychological aspects. This study aimed to determine the levels of depression and self-esteem in women with endometrial and cervical cancer receiving chemotherapy, determine the factors affecting them, and examine the relationship between the levels of depression and self-esteem. METHODS: This descriptive and cross-sectional study was conducted with 158 women who came to the gynecology-oncology policlinic and chemotherapy unit of a training and research hospital in Izmir, western Türkiye, between April 2022 and April 2023. Data were collected with the "Descriptive Information Form", "Beck Depression Inventory" and "Rosenberg Self-Esteem Scale". Descriptive and inferential statistics were performed to analyse the association between the study variables. RESULTS: In this study, 52.5% of women were diagnosed with endometrial cancer and 47.5% with cervical cancer. Beck Depression Inventory mean total score was 11.28 ±â€¯6.35, and 20.3% of them were at risk of depression (BDI ≥ 17). Rosenberg Self-Esteem Scale mean total score was 21.06 ±â€¯3.85, and 97.5% of them had high self-esteem. There was a statistically significant and strong negative correlation between the mean total scores of the Beck Depression Inventory and Rosenberg Self-Esteem Scale (r = 0.723; p < 0.05). It was determined that an increase in the Rosenberg Self-Esteem Scale mean total score by 1 unit decreased the Beck Depression Inventory mean total score by 1.2 units and was responsible for 52% of the variance (B = -1.192; R2 = 0.523). CONCLUSION: It was determined that one-fifth of women experienced moderate/severe depression and the majority of them had high self-esteem. The increase in women's depression levels decreased their self-esteem. Health professionals and oncology nurses should perform screenings to determine the depression and self-esteem levels of women with endometrial and cervical cancer and provide necessary education, counseling, and care to women.

Ocular side effects of oncological therapies: Review.

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.

Estudo dos indivíduos e suas variáveis clínico-histopatológicas relacionadas ao aumento do risco de reação hansênica durante poliquimioterapia em área endêmica do nordeste do Brasil / Study of individuals and their clinical-histopathological variables related to the increased risk of leprosy reaction during multidrug therapy in endemic area of the northeast of Brazil / Estudio de individuos y sus variables clínico-histopatológicas relacionadas con el aumento del riesgo de reacción a la lepra durante el tratamiento multimedicamentoso en una zona endémica del noreste de Brasil

Introdução: a hanseníase apresenta potencial incapacitante secundário às reações hansênicas. Existe considerável número de indivíduos com episódios recorrentes de reação durante o tratamento. Objetivo: identificar características clínicas e histopatológicas que diferenciem pacientes com reação hansênica ou não. Método: estudo prospectivo de julho/2015 a dezembro/2016, com avaliação de indivíduos com diagnóstico novo de hanseníase atendidos no serviço de dermatologia do Complexo Hospitalar Clementino Fraga, na cidade de João Pessoa, Paraíba, Brasil. Os sujeitos foram classificados segundo os critérios de Ridley-Jopling/Madrid e por classificação operacional. Realizaram exame histopatológico no momento do diagnóstico e após 12 meses, e reavaliados após 6 e 12 meses do diagnóstico. Resultados: o grupo sem reação apresentou maior número de lesões com nítida delimitação. Observou-se predomínio das formas multibacilares entre indivíduos com reação. Quanto ao grau de incapacidade, o grupo com reação apresentou maior número de indivíduos com grau de incapacidade maior que zero. No grupo sem reação, encontrou-se menor frequência de fatores predisponentes. Notou-se correlação positiva do índice baciloscópico de biópsia cutânea com a ocorrência de reações. Discussão: a ausência de delimitação periférica das lesões pode se correlacionar com o surgimento de reação hansênica. O predomínio de reação entre os indivíduos que apresentavam grau de incapacidade maior que zero sugere associação de deficiência física e doença multibacilar. A ausência de fatores predisponentes aponta menor risco de reação hansênica. Observou-se correlação positiva do índice baciloscópico da biópsia com a ocorrência das reações. Conclusão: a significativa prevalência de reações graves enfatizam a importância do estudo contínuo da hanseníase e a necessidade de identificar precocemente as características clínicas sugestivas de reações hansênicas.(AU)

Introduction: leprosy reactions have the potential to cause disabilities. Many individuals experience recurrent episodes of reaction during treatment. Objective:to identify clinical and histopathological characteristics that differentiate patients with leprosy reactions from those without leprosy reactions. Method: this is a prospective study conducted from July 2015 to December 2016, evaluating individuals newly diagnosed with leprosy and treated at the dermatology service of the Clementino Fraga Hospital Complex in João Pessoa, Paraíba, Brazil. The subjects were classified according to the Ridley-Jopling/Madrid criteria and operational classification. They underwent a histopathological examination at the time of diagnosis and 12 months later, and were reassessed 6 and 12 months after the diagnosis. Results: the group without a reaction had a greater number of lesions with clear delimitation. Individuals with a reaction showed a predominance of multibacillary forms. The group with a reaction had a greater number of individuals with a degree of disability greater than zero. A positive correlation was observed between the bacilloscopic index and the occurrence of reactions. Discussion: the lack of clear boundaries around the lesions may be linked to the onset of a leprosy reaction. The higher incidence of reactions in individuals with some degree of physical disability indicates a correlation between disability and multibacillary disease. Additionally, a positive correlation was found between the bacilloscopic index of the biopsy and the occurrence of reactions. Conclusion: the high incidence of severe reactions underscores the need for ongoing studies on leprosy and the identification of early clinical characteristics that suggest leprosy reactions.(AU)

Complicaciones gastrointestinales asociadas a quimioterapia de acondicionamiento para trasplante autólogo en pacientes con mieloma múltiple / Gastrointestinal complications associated with conditioning chemotherapy for autologous transplantation in patients with multiple mieloma

Objetivo: Determinar la prevalencia de mucositis oral (MO) y su gravedad en pacientes con mieloma múltiple (MM) sometidos a trasplante antólogo de sangre periférica (TASP) en nuestro centro. Otros objetivos son describir la duración de MO, utilización de Nutrición Parenteral Total (NPT) y analgesia, posibles infecciones y determinar la prevalencia de efectos adversos gastrointestinales (EA GI). Métodología: Estudio observacional, retrospectivo y longitudinal en pacientes con MM, sometidos a TASP acondicionado con melfalán a altas dosis. La variable principal estudiada fue la presencia de MO y su gravedad. Las variables secundarias fueron: duración de la MO, enfermedad peridontal previa (EPP), el tratamiento con NPT y con analgésicos y la presencia de infecciones. Resultados: Se incluyeron 34 pacientes en el estudio. El 71% (24/34) del total presentó MO y, de estos, el 42% (10/24) MO grave. El 38% (13/34) del total requirió de NPT, lo cual fue significativamente superior en el grupo de pacientes con MO grave (p<0,05). De los pacientes con MO, el 96% (23/24) requirió tratamiento analgésico sistémico. El 88% (30/34) y el 76% (26/34) del total, presentaron diarrea y náuseas y vómitos (N/V) respectivamente. Conclusiones: La MO tiene una alta prevalencia en los pacientes tratados con melfalán a dosis mieloablativas como acondicionamiento para TASP en nuestro hospital. La única variable que se relacionó con la presencia de MO fue la EPP. Otros EA GI que también tienen una alta prevalencia son la diarrea y N/V.(AU)

Objective: To determine the prevalence of oral mucositis (OM) and its severity in patients of multiple myeloma (MM) who had a procedure of autologous transplant of hematopoietic cells in our center. Other objectives are to describe the duration of MO, the use of Total Parenteral Nutrition (TPN) and analgesia, possible infections and determine the prevalence of gastrointestinal adverse effects (GI AE).Methodology: Observational, retrospective, and linear study of patients with multiple myeloma that went through conditioning myeloablative therapy and, after that, an autologous transplant of hematopoietic cells. Main variable was made the presence of OM and its duration. Secondary variables were OM degree, previous periodontal disease (PPD) parenteral nutrition and analgesic treatments and whether or not there was presence of infections. Results: 34 patients were included in the study. 71% (24/34) had OM and, among those, in 42% of cases (10/24) OM was severe. 38% (13/34) needed parenteral nutrition, with numbers significantly higher when it came to the ones affected by severe OM (p<0.05). 96% (23/24) of OM patients needed systemic analgesic therapy. 88% (30/34) and 76% (26/34) of all patients presented diarrhea and nausea and vomits, respectively. Conclusions: OM has a high prevalence in patients treated with Melphalan in myeloablative doses as a preparation for an autologous transplant of hematopoietic cells in our hospital. The only variable related to the presence of OM was previous mouth disease. More IG AE with high prevalence are diarrhea and nausea and vomits.(AU)

Resting energy expenditure changes after antineoplastic treatment in gynecological cancer: a prospective pilot study / Cambios en el gasto energético en reposo tras el tratamiento antineoplásico en cáncer ginecológico: estudio piloto prospectivo

Introduction: energy metabolism in cancer patients is influenced by different factors. However, the effect of antineoplastic treatment is not clear, especially in women. Objective: to evaluate resting energy expenditure (REE) by indirect calorimetry (IC) before (T0) and after (T1) first cycle period of antineoplastic therapy: radiotherapy (RT), chemotherapy (CT), and concomitant chemoradiation therapy (CRT), quality of life (QoL) and accuracy of REE were compared with international guidelines recommendations per kilogram (European Society for Clinical Nutrition and Metabolism [ESPEN]). Methods: an observational, longitudinal study was conducted in women with gynecological cancer diagnosis undergoing antineoplastic treatment: RT, CT and CRT. Weight loss, actual body weight and height were measured. REE was evaluated in T0-T1 and compared with ESPEN recommendations. Kruskal-Wallis test and Bland-Alman analysis were used to determine the agreement (± 10 % of energy predicted) of REE adjusted by physical activity (TEE) compared with ESPEN recommendations, respectively. Results: fifty-four women with cancer were included: 31.5 % (n = 17) for RT group, 31.5 % (n = 17) for CT group and 37 % (n = 20) for CRT group. REE showed statistical differences between T0 and T1 in the total population (p = 0.018), but these were not associated with anticancer therapy groups (p > 0.05). QoL had no significant changes after treatment (p > 0.05). Accuracy of 25 and 30 kcal/kg compared to TEE was less than 30 %. Conclusion: REE in women with gynecological cancer decreased after antineoplastic treatments but this is not associated with a particular antineoplastic therapy. It is needed to develop research to determine the accuracy of ESPEN recommendations with TEE estimated by IC and clinical factors in women with cancer. (AU)

Antecedentes: el metabolismo energético en pacientes con cáncer está influenciado por diferentes factores. Sin embargo, el efecto sobre el tratamiento antineoplásico no es claro, especialmente en mujeres. Objetivo: evaluar el gasto energético en reposo (GER) mediante calorimetría indirecta (CI) antes (T0) y después (T1) del primer ciclo del tratamiento antineoplásico: radioterapia (RT), quimioterapia (QT) y quimio-radioterapia concomitante (QRT), calidad de vida (CdV) y precisión del GER con las con las recomendaciones internacionales por kilogramo de peso (European Society for Clinical Nutrition and Metabolism [ESPEN]). Métodos: se realizó un estudio longitudinal, observacional en mujeres con diagnóstico de cáncer ginecológico en tratamiento antineoplásico. Se evaluó el GER en T0 y T1. Se midieron la pérdida de peso, el peso corporal y la talla. Se usaron las pruebas de Kruskal-Wallis y el análisis Bland-Altman para determinar la concordancia (± 10 % de GER) del REE ajustado por actividad física (TEE) en comparación con las recomendaciones de ESPEN. Resultados: se incluyeron 54 mujeres con cáncer; 31,5 % (n = 17) en el grupo RT, 31,5 % (n = 17) en el de QT y 37 % (n = 20) en el de QRT. GER mostró diferencias estadísticas entre T0 y T1 en la población total (p = 0,018); no se asoció con la terapia contra el cáncer (p > 0,05). La calidad de vida no tuvo cambios significativos después del tratamiento (p > 0,05). La precisión de 25 y 30 kcal/kg en comparación con TEE fue inferior al 30 %. Conclusión: el GER en mujeres con cáncer ginecológico disminuyó después del tratamiento antineoplásico, pero no se asoció a una terapia antineoplásica en particular. Es fundamental desarrollar más investigaciones que compare las recomendaciones de ESPEN y con los valores de la CI comparando más factores clínicos para ofrecer una intervención nutricional precisa (AU)

Programa integral de apoyo a personas con cáncer de mama en tratamiento con quimioterapia para mejorar resultados en salud y calidad de vida, con perspectiva de autocuidado / Comprehensive support program for people with breast cancer undergoing chemotherapy treatment to improve health outcomes and quality of life, with a self-care perspective

El rol de la Enfermería de Práctica Avanzada (EPA) se incorpora a los equipos de salud en la década de los 60 en Estados Unidos y su contribución se expande a otros países. En Chile es un rol incipiente. El rol de EPA contribuye a implementar un modelo de atención centrado en la persona, que brinda atención integral y atiende necesidades específicas y relevantes a diversos grupos de población. OBJETIVO: Diseñar una intervención dirigida a personas en tratamiento con quimioterapia (QT) por un profesional de enfermería con formación avanzada. PROPUESTA: Como parte del diseño, se buscó evidencia para respaldo de la intervención. Se utilizaron las palabras claves: cáncer de mama, quimioterapia, enfermera de practica avanzada, enfermera practicante, sobreviviente; en las bases de datos Pubmed, Web of Science, ProQuest, Epistemonikos, Elsevier, Scielo. Un componente fundamental del programa propuesto es el seguimiento proactivo realizado por una EPA y dirigido a las mujeres con cáncer de mama en QT. Este permitirá: a) potenciar las habilidades de autocuidado, b) mejorar la tolerancia al tratamiento, c) hacer entrega de cuidado experto e individualizado, planificado de acuerdo a las necesidades de cada persona, promoviendo la recuperación de la autonomía y el bienestar. CONCLUSIONES: Como resultados complementarios se espera impactar en la satisfacción usuaria, y asimismo aportar a la implementación del nuevo rol EPA al promover el reconocimiento por el paciente y el equipo de salud como profesional experto en cuidado avanzado.

The Advanced Practice Nurse (APN) joined health teams in the 1960s in the United States and her contribution spread to other countries. In Chile it is an incipient role. APN's role contributes to implementing a person-centered care model that provides comprehensive care and attends to specific and relevant needs of various population groups. OBJECTIVE: To design an intervention aimed at people undergoing chemotherapy treatment (CT) by a nursing professional with advanced training. PROPOSAL: As part of the design, evidence was sought to support the intervention. The keywords were used: breast cancer or neoplasm cancer, chemotherapy, advanced practice nurse or nurse practitioner. Survivorship in the Pubmed, Web of Science, ProQuest, Epistemonikos, Elsevier, Scielo databases. A fundamental component of the proposed program is the proactive follow-up carried out by an APN and aimed at women with breast cancer in QT. This will allow: a) to enhance self-care skills, b) to improve tolerance to treatment, c) to deliver expert and individualized care, planned according to the needs of each person, promoting the recovery of autonomy and well-being. CONCLUSIONS: As complementary results, it is expected to impact user satisfaction, and also contribute to the implementation of the new APN role by promoting recognition by the patient and the health team as an expert professional in advanced care.

Fatores associados à punção venosa periférica difícil em adultos submetidos à quimioterapia antineoplásica / Factors associated with difficult peripheral venipuncture in adults undergoing antineoplastic chemotherapy / Factores asociados a la venopunción periférica difícil en adultos sometidos a quimioterapia antineoplásica

Objetivo: identificar os fatores associados à punção venosa periférica difícil em adultos submetidos à quimioterapia antineoplásica. Método: estudo transversal, observacional, analítico e quantitativo realizado em uma Unidade de Alta Complexidade em Oncologia (UNACON) da região amazônica brasileira. Os dados foram analisados por meio de estatística descritiva e inferencial, onde a razão de possibilidades foi calculada. Resultados: a maioria dos participantes foi do sexo feminino (64,6%), autodeclarados como pardos (51,2%). Em relação à localização do câncer, a maioria possuía a doença no aparelho digestório (46,4%) ou reprodutor (45,2%). Pacientes que tinham histórico de punção venosa difícil, veias não visíveis ou não palpáveis apresentaram mais chance de apresentar a punção venosa difícil (OR 1,6, 1,5 e 1,3, respetivamente). Conclusão: os preditores encontrados relacionados à punção venosa periférica difícil em pacientes adultos submetidos à quimioterapia antineoplásica foram: histórico de punção difícil e veias não visíveis ou não palpáveis(AU)

Objective: to identify factors associated with difficult peripheral venipuncture in adults undergoing antineoplastic chemotherapy. Method: cross-sectional, observational, analytical, and quantitative study carried out in a High Complexity Oncology Unit (UNACON) in the Brazilian Amazon region. Data were analyzed using descriptive and inferential statistics, where the odds ratio was calculated. Results: majority of participants were female (64.6%), self-declared as brown (51.2%). Regarding the location of the cancer, the majority had the disease in the digestive (46.4%) or reproductive (45.2%) systems. Patients who had a history of difficult venipuncture, non-visible or non-palpable veins were more likely to have difficult venipuncture (OR 1.6, 1.5 and 1.3, respectively). Conclusion: found predictors related to difficult peripheral venipuncture in adult patients undergoing antineoplastic chemotherapy were: history of difficult puncture and non-visible or non-palpable veins(AU)

Objetivo: identificar los factores asociados a la dificultad de la venopunción periférica en adultos sometidos a la quimioterapia antineoplásica. Método: estudio transversal, observacional, analítico y cuantitativo realizado en una Unidad de Oncología de Alta Complejidad (UNACON) en la Amazonía brasileña. Se analizaron los datos mediante estadística descriptiva e inferencial, donde se calculó el odds ratio. Resultados: la mayoría de los participantes era del sexo femenino (64,6%), se auto declaró morena (51,2%). En cuanto a la ubicación del cáncer, la mayoría tenía la enfermedad en el sistema digestivo (46,4%) o reproductivo (45,2%). Los pacientes que tenían antecedentes de venopunción difícil, venas no visibles o no palpables tenían más probabilidades de tener venopunción difícil (OR 1,6, 1,5 y 1,3, respectivamente). Conclusión: Los predictores encontrados relacionados con la punción venosa periférica difícil en pacientes adultos sometidos a quimioterapia antineoplásica fueron antecedente de punción difícil y venas no visibles o no palpables(AU)

Características epidemiológicas y microbiológicas de los episodios de Neutropenia Febril (NF) en niños con cáncer en el Hospital del Niño - Dr. José Renán Esquivel (HNJRE)

Introducción: La neutropenia febril (NF) constituye una complicación frecuente, considerada una urgencia infectológica en los pacientes con cáncer que reciben tratamiento mielosupresor. Metodología: Se realizó un estudio retrospectivo descriptivo a través de la revisión de los expedientes de todos los episodios de NF secundarios a quimioterapia ingresados en el Hospital del Niño - Dr. José Renán Esquivel durante el periodo de enero a diciembre de 2017. Resultados: El estudio consistió en la evaluación de características epidemiológicas e identificación de agentes infecciosos en 49 casos de NF, y 104 eventos febriles. Se observó que el 51% de los casos eran varones, con una edad promedio de 7 años, y recuperación de NF en los primeros 7 días del 68%. La mayoría de las hospitalizaciones (53,8%) duraron de 1 a 7 días, con una relación directa con los días de fiebre y la presencia de neutropenia. La letalidad registrada fue de 6.1%. Los agentes etiológicos más frecuentes fueron la Pseudomonas aeruginosa, los Estafilococos coagulasa negativos y Staphylococcus aureus meticilino sensible. Conclusión: Los hallazgos permiten conocer la epidemiología actual de los pacientes con NF que se admiten al hospital, con el fin de optimizar el tratamiento para reducir la tasa de letalidad. (provisto por Infomedic International)

Introduction: Febrile neutropenia (NF) constitutes a frequent complication, considered an infectious emergency in cancer patients receiving myelosuppressive treatment. Methodology: A descriptive retrospective study was conducted by reviewing the records of all episodes of NF secondary to chemotherapy admitted to the Hospital del Niño - Dr. José Renán Esquivel during the period from January to December 2017. Results: The study consisted of the evaluation of epidemiological characteristics and identification of infectious agents in 49 cases of NF, and 104 febrile events. It was observed that 51% of the cases were male, with a mean age of 7 years, and recovery from NF in the first 7 days of 68%. Most hospitalizations (53.8%) lasted from 1 to 7 days, with a direct relationship with the number of days of fever and the presence of neutropenia. The case fatality rate was 6.1%. The most frequent etiological agents were Pseudomonas aeruginosa, coagulase-negative Staphylococci and methicillin-sensitive Staphylococcus aureus. Conclusion: The findings provide insight into the current epidemiology of patients with NF admitted to the hospital, in order to optimize treatment to reduce the case-fatality rate. (provided by Infomedic International)

Factores relacionados a flebitis química en personas con quimioterapia, revisión sistemática de la literatura / Factors related to chemical phlebitis in patients treated with chemotherapy, a systematic literature review

Objetivo: Describir los factores asociados a la flebitis química en personas con diagnóstico de cáncer que reciben quimioterapia, evidenciados en la literatura. Metodología: Se realizó una revisión sistemática de la literatura, según recomendaciones de Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Resultados: Los factores que aumentaron el riesgo de flebitis química hallados en la evidencia fueron la edad mayor de 57 años, sexo femenino, antecedentes de cáncer, enfermedad metastásica, hipertensión arterial, neutropenia, tabaquismo, vaciamiento ganglionar, hipoalbuminemia, uso de medicamentos citotóxicos, epirrubicina, fosaprepitant, antraciclina y vinorelbina, presentación premezclada de los fármacos, dilución en 50 cc de solución salina normal, tiempo de administración mayor a 60 minutos, catéteres de calibres grandes como 18 G o 20 G y ubicación anatómica del catéter en antebrazo o fosa antecubital. Conclusión: los factores relacionados a la flebitis química hallados en la literatura fueron principalmente elementos inherentes al paciente y a su tratamiento, algunos de estos no son modificables.

Objective: To describe the factors related to chemical phlebitis in patients diagnosed with cancer undergoing chemotherapeutic treatment. Methodology: A systematic review of the literature was carried out, according to recommendations of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results: The factors that increase the risk of chemical phlebitis were: age older than 57 years, female sex, history of cancer, metastatic disease, arterial hypertension, neutropenia, smoking, lymph node emptying, hypoalbuminemia, use of cytotoxic drugs, epirubicin, fosaprepitant, anthracycline and vinorelbine, premixed presentation, dilution in 50 cc of Normal Saline Solution, administration time greater than 60 minutes, catheters of large gauges such as 18 G or 20 G and anatomical location of the catheter in the forearm or antecubital fossa. Conclusion: Factors related to chemical phlebitis found in the literature were features inherent to the patient and their treatment. Therefore, some of these are not modifiable.

Resting energy expenditure changes after antineoplastic treatment in gynecological cancer: a prospective pilot study.

Introduction: Introduction: energy metabolism in cancer patients is influenced by different factors. However, the effect of antineoplastic treatment is not clear, especially in women. Objective: to evaluate resting energy expenditure (REE) by indirect calorimetry (IC) before (T0) and after (T1) first cycle period of antineoplastic therapy: radiotherapy (RT), chemotherapy (CT), and concomitant chemoradiation therapy (CRT), quality of life (QoL) and accuracy of REE were compared with international guidelines recommendations per kilogram (European Society for Clinical Nutrition and Metabolism [ESPEN]). Methods: an observational, longitudinal study was conducted in women with gynecological cancer diagnosis undergoing antineoplastic treatment: RT, CT and CRT. Weight loss, actual body weight and height were measured. REE was evaluated in T0-T1 and compared with ESPEN recommendations. Kruskal-Wallis test and Bland-Alman analysis were used to determine the agreement (± 10 % of energy predicted) of REE adjusted by physical activity (TEE) compared with ESPEN recommendations, respectively. Results: fifty-four women with cancer were included: 31.5 % (n = 17) for RT group, 31.5 % (n = 17) for CT group and 37 % (n = 20) for CRT group. REE showed statistical differences between T0 and T1 in the total population (p = 0.018), but these were not associated with anticancer therapy groups (p > 0.05). QoL had no significant changes after treatment (p > 0.05). Accuracy of 25 and 30 kcal/kg compared to TEE was less than 30 %. Conclusion: REE in women with gynecological cancer decreased after antineoplastic treatments but this is not associated with a particular antineoplastic therapy. It is needed to develop research to determine the accuracy of ESPEN recommendations with TEE estimated by IC and clinical factors in women with cancer.

Introducción: Antecedentes: el metabolismo energético en pacientes con cáncer está influenciado por diferentes factores. Sin embargo, el efecto sobre el tratamiento antineoplásico no es claro, especialmente en mujeres. Objetivo: evaluar el gasto energético en reposo (GER) mediante calorimetría indirecta (CI) antes (T0) y después (T1) del primer ciclo del tratamiento antineoplásico: radioterapia (RT), quimioterapia (QT) y quimio-radioterapia concomitante (QRT), calidad de vida (CdV) y precisión del GER con las con las recomendaciones internacionales por kilogramo de peso (European Society for Clinical Nutrition and Metabolism [ESPEN]). Métodos: se realizó un estudio longitudinal, observacional en mujeres con diagnóstico de cáncer ginecológico en tratamiento antineoplásico. Se evaluó el GER en T0 y T1. Se midieron la pérdida de peso, el peso corporal y la talla. Se usaron las pruebas de Kruskal-Wallis y el análisis Bland-Altman para determinar la concordancia (± 10 % de GER) del REE ajustado por actividad física (TEE) en comparación con las recomendaciones de ESPEN. Resultados: se incluyeron 54 mujeres con cáncer; 31,5 % (n = 17) en el grupo RT, 31,5 % (n = 17) en el de QT y 37 % (n = 20) en el de QRT. GER mostró diferencias estadísticas entre T0 y T1 en la población total (p = 0,018); no se asoció con la terapia contra el cáncer (p > 0,05). La calidad de vida no tuvo cambios significativos después del tratamiento (p > 0,05). La precisión de 25 y 30 kcal/kg en comparación con TEE fue inferior al 30 %. Conclusión: el GER en mujeres con cáncer ginecológico disminuyó después del tratamiento antineoplásico, pero no se asoció a una terapia antineoplásica en particular. Es fundamental desarrollar más investigaciones que compare las recomendaciones de ESPEN y con los valores de la CI comparando más factores clínicos para ofrecer una intervención nutricional precisa.

Three-Year Survival in a Cohort of Women with Breast Cancer from an Insurance Company in Cali, 2017-2020 / SUPERVIVENCIA A TRES AÑOS EN UNA COHORTE DE MUJERES CON CÁNCER DE MAMA DE UNA ASEGURADORA EN CALI 2017-2020

INTRODUCTION: Breast cancer, in particular, is a significant concern in public health due to its high mortality rate. This research focuses on understanding the factors related to the 3-year survival of women with breast cancer in Cali, contributing to addressing this health challenge. OBJECTIVE: To determine the socio-demographic, clinical, and healthcare-related factors associated with the 3-year survival of women with breast cancer affiliated with an insurance provider in Cali from 2017 to 2020. This study aims to generate scientific evidence for decision-making within the insurance provider and the region. METHODOLOGY: A study was conducted in women with breast cancer in Cali to identify factors linked to 3-year survival. Data from a cohort of women with breast cancer affiliated with an insurance provider were analyzed, applying inclusion and exclusion criteria. Socio-demographic, clinical, and healthcare-related factors were assessed. Data were collected from secondary sources and analyzed to determine variables associated with survival. Ethical and confidentiality considerations were adhered to throughout the process. RESULTS: The most significant finding of our study, based on a three-year follow-up of 140 women with breast cancer, is the alarming mortality rate of 21.4%. We emphasize the importance of diagnosing the disease at its early stages, which can make a difference in the survival and prognosis of patients. CONCLUSION: The study highlights the high vulnerability of the cohort of women with breast cancer affiliated with the insurance provider. Although a longer survival time was observed in certain groups, the mortality rate remains significant.

INTRODUCCIÓN: El cáncer de mama, en particular, es una preocupación significativa en la salud pública debido a su alta mortalidad. Esta investigación se centra en comprender los factores relacionados con la supervivencia a 3 años de mujeres con cáncer de mama en Cali, contribuyendo a abordar este desafío de salud. OBJETIVO: determinar los factores socio demográficos, clínicos y de atención en salud asociados a la supervivencia a 3 años de mujeres con cáncer de mama afiliadas a una aseguradora en Cali 2017-2020, generando evidencia científica para la toma de decisiones tanto en la aseguradora como en la región. METODOLOGIA: Se realizó un estudio en mujeres con cáncer de mama en Cali para identificar factores vinculados a la supervivencia a 3 años. Se analizaron datos de una cohorte de mujeres con cáncer de mama afiliadas a una aseguradora, aplicando criterios de inclusión y exclusión. Se evaluaron factores sociodemográficos, clínicos y de atención en salud. Los datos se recopilaron de fuentes secundarias y se analizaron para determinar las variables relacionadas con la supervivencia. Se cumplieron consideraciones éticas y de confidencialidad en el proceso. RESULTADOS: El hallazgo más significativo de nuestro estudio, basado en un seguimiento de tres años a 140 mujeres con cáncer de mama, es la alarmante tasa de mortalidad del 21.4%. Destacamos la importancia de diagnosticar la enfermedad en sus estadios iniciales, lo que puede marcar la diferencia en la supervivencia y el pronóstico de las pacientes. CONCLUSION: Estudio destaca la alta vulnerabilidad de la cohorte de mujeres con cáncer de mama afiliadas a la EAPB. Aunque se observó un mayor tiempo de supervivencia en ciertos grupos, la tasa de mortalidad sigue siendo significativa.