Exercise in cancer patients: assistance levels and referral pathways-a position statement from the Spanish Society of Medical Oncology.

There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient's needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients.

Boosting self-efficacy and improving practices for smoking prevention and cessation among South American cancer care providers with a web-based algorithm.

BACKGROUND: Digital technologies have positively impacted the availability and usability of clinical algorithms through the advancement in mobile health. Therefore, this study aimed to determine if a web-based algorithm designed to support the decision-making process of cancer care providers (CCPs) differentially impacted their self-reported self-efficacy and practices for providing smoking prevention and cessation services in Peru and Colombia. METHODS: A simple decision-making tree algorithm was built in REDCap using information from an extensive review of the currently available smoking prevention and cessation resources. We employed a pre-post study design with a mixed-methods approach among 53 CCPs in Peru and Colombia for pilot-testing the web-based algorithm during a 3-month period. Wilcoxon signed-rank test was used to compare the CCPs' self-efficacy and practices before and after using the web-based algorithm. The usability of the web-based algorithm was quantitatively measured with the system usability scale (SUS), as well as qualitatively through the analysis of four focus groups conducted among the participating CCPs. RESULTS: The pre-post assessments indicated that the CCPs significantly improved their self-efficacy and practices toward smoking prevention and cessation services after using the web-based algorithm. The overall average SUS score obtained among study participants was 82.9 (± 9.33) [Peru 81.5; Colombia 84.1]. After completing the qualitative analysis of the focus groups transcripts, four themes emerged: limited resources currently available for smoking prevention and cessation in oncology settings, merits of the web-based algorithm, challenges with the web-based algorithm, and suggestions for improving this web-based decision-making tool. CONCLUSION: The web-based algorithm showed high usability and was well-received by the CCPs in Colombia and Peru, promoting a preliminary improvement in their smoking prevention and cessation self-efficacy and practices.

Socioeconomic disparities and health literacy: Unraveling the impact on diagnostic and cancer care in Uruguay.

BACKGROUND: Disparities in the timely diagnosis and care of cancer patients, particularly concerning geographical, racial/ethnic, and economic factors, remain a global health challenge. This study explores the multifaceted interplay between socioeconomic status, health literacy, and specific patient perceptions regarding care access and treatment options that impact cancer care in Uruguay. METHODS: Using the Cancer Health Literacy Test, Spanish Version (CHLT-30-DKspa), and a highly comprehensive questionnaire, we dissected the factors influencing the pathway to diagnosis and route of cancer care. This was done to identify delays by analyzing diverse socioeconomic and sex subgroups across multiple healthcare settings. RESULTS: Patients with lower income took longer to get an appointment after showing symptoms (p = 0.02) and longer to get a diagnosis after having an appointment (p = 0.037). Race/ethnicity also had a significant impact on the length of time from symptoms to first appointment (p =0.019), whereas employment status had a significant impact on patients being susceptible to diagnostic delays beyond the advocated 14-day window (p = 0.02). Higher educational levels were positively associated with increased cancer health literacy scores (p = 0.043), revealing the potential to mitigate delays through health literacy-boosting initiatives. Women had significantly higher self-reported symptom duration before seeking an intervention (p = 0.022). We also found many other significant factors effecting treatment delays and cancer health literacy. CONCLUSIONS: While affirming the global pertinence of socioeconomic- and literacy-focused interventions in enhancing cancer care, the findings underscore a complex, gendered, and perceptually influenced healthcare navigation journey. The results highlight the urgent necessity for strategically crafted, globally relevant interventions that transcend equitable access to integrate literacy, gender sensitivity, and patient-perception alignments in pursuit of optimized global cancer care outcomes.

Children with cancer at the end of life in a middle-income country: integrated pediatric palliative care improves outcomes.

BACKGROUND: In 2020, the Global Cancer Observatory reported 280,000 cases of childhood cancer worldwide, with a higher burden of disease and mortality rates in low- and middle-income countries. In 2022, the National Institute of Health reported 1708 new cases of childhood cancer in Colombia and an overall survival rate of approximately 55%. The aim of this study is to compare outcomes in children with cancer in the hospital setting during the last 72 h of life who received concurrent Pediatric Palliative Care (PPC) versus oncology care alone. METHODS: An observational descriptive study was conducted between January 2013 and June 2022 in a center for pediatric patients with oncological diagnoses. In 2017, the PPC team was created. Patients between 28 days and 17 years of age who were hospitalized at least 72 h before death were included. A retrospective review of the medical records of patients in the last 72 h of life was performed. Two cohorts were established: oncology-alone group received exclusive management by oncology, and oncology and PPC received concurrent oncology and PPC management since the diagnosis. RESULTS: We evaluated 257 medical records of deceased pediatric patients with cancer diagnoses. For the first cohort (2013-2017), 136 patients were included; for the second cohort (2018 and 2022), 121 patients were evaluated. The most frequent diagnosis was leukemia [47.1% (n = 121)]. No significant difference was found in either group between dyspnea, pain, and seizures. Dyspnea was the most frequent symptom in both groups. Agitation and anxiety were reported more frequently in children from the oncology-alone group (22.1% and 13.2%, respectively). The oncology and PPC group received more psychology and social work consultation (94.2% and 70.2% vs. 84.6 and 54.4% in the oncology alone group) and had a higher percentage of advance care planning (79.3% vs. 62.5% in the oncology alone group). CONCLUSIONS: This retrospective study highlights that PPC at the end of life (EoL) offers a holistic approach to the physical and psychosocial symptoms experienced by children with cancer; these patients received more comfort through symptom management and less aggressive treatment at the EoL. The availability of a PPC team may contribute to improvements in the quality of end-of-life care. TRIAL REGISTRATION: retrospectively registered.

Barreras y facilitadores de la atención en salud de personas con cáncer en una comuna del norte de Chile: reporte cualitativo

Introducción: Los pacientes oncológicos constituyen un grupo vulnerable de la población por la fragilidad que les provoca la enfermedad. Consultada la literatura se describen problemas en el acceso a la atención en salud Objetivo: Analizar las barreras y facilitadores de acceso que afectan a personas con cáncer en una comunidad del norte de Chile Metodología: Se abordó desde el paradigma interpretativo, metodología cualitativa y enfoque análisis de contenido según Bardin. La muestra fue intencionada y consideró cuatro pacientes con cáncer y cuatro familiares cuidadores. Se realizaron entrevistas en profundidad y se utilizó una parrilla de preguntas orientadoras. Se contó con autorización de un comité de ética de investigación acreditado Resultados: Se identificaron barreras de a) disponibilidad, b) accesibilidad, c) psicosociales y d) burocráticas, y facilitadores en e) redes de apoyo y f) estrategias de prevención Conclusiones: Las barreras de disponibilidad son especialmente importantes para los pacientes, ya que se asocian a un déficit de oferta de servicios oncológicos oportunos. Destacan las redes de grupos de autoayuda como facilitador del proceso terapéutico. La identificación de barreras y facilitadores contribuye a mejorar las estrategias de acción, para una mejor atención de pacientes oncológicos

Introdução: Os pacientes oncológicos constituem um grupo vulnerável da população devido à fragilidade causada pela doença. Após consulta à literatura, são descritos problemas no acesso aos cuidados de saúde Objetivo: Analisar as barreiras e os facilitadores de acesso que afetam as pessoas com câncer em uma comuna no norte do Chile Metodologia: Foi abordado a partir do paradigma interpretativo, metodologia qualitativa enfocada em análise de conteúdo segundo Bardin. A amostra foi intencional e considerou quatro pacientes com câncer e quatro cuidadores familiares. Foram realizadas entrevistas em profundidade e utilizada uma grade de perguntas orientadoras. Foi obtida autorização de um comitê de ética em pesquisa credenciado Resultados: Foram identificadas barreiras de a) disponibilidade, b) acessibilidade, c) psicossociais e d) burocráticas, e facilitadores em e) redes de apoio e f) estratégias de prevenção Conclusões: As barreiras de disponibilidade são especialmente importantes para os pacientes, uma vez que estão associadas a um déficit na oferta de serviços oncológicos oportunos. As redes de grupos de autoajuda destacam-se como facilitadores do processo terapêutico. A identificação de barreiras e facilitadores contribui para aprimorar estratégias de ação para um melhor atendimento aos pacientes oncológicos

Introduction: Cancer patients constitute a vulnerable group of the population due to the fragility caused by the disease. After consulting the literature, problems in access to health care are described. Objective: Analyze the access barriers and facilitators that affect people with cancer in a commune in northern Chile. Methodology: It was approached from the interpretive paradigm, qualitative methodology, and content analysis approach according to Bardin. The sample was intentional and considered four patients with cancer and four family caregivers. In-depth interviews were conducted, and a grid of guiding questions was used. Authorization was obtained from an accredited research ethics committee Results: There were identified a) availability, b) accessibility, c) psychosocial and d) bureaucratic barriers, and facilitators in e) support networks and f) prevention strategies. Conclusions: Availability barriers are especially important for patients since they are associated with a deficit in the supply of timely oncological services. Networks of self-help groups stand out as facilitators of the therapeutic process. The identification of barriers and facilitators contributes to improving action strategies for better care of cancer patients

Quality of emergency oncological surgery: time for advanced oncological life support

SUMMARY In the emergency care of cancer patients, in addition to cancer-related factors, two aspects influence the outcome: (1) where the patient is treated and (2) who will perform the surgery. In Brazil, a significant proportion of patients with surgical oncological emergencies will be operated on in general hospitals by surgeons without training in oncological surgery. OBJECTIVE: The objective was to discuss quality indicators and propose the creation of an urgent oncological surgery advanced life support course. METHODS: Review of articles on the topic. RESULTS: Generally, nonelective resections are associated with higher rates of morbidity and mortality, as well as lower rates of cancer-specific survival. In comparison to elective procedures, the reduced number of harvested lymph nodes and the higher rate of positive margins suggest a compromised degree of radicality in the emergency scenario. CONCLUSION: Among modifiable factors is the training of the emergency surgeon. Enhancing the practice of oncological surgery in emergency settings constitutes a formidable undertaking that entails collaboration across various medical specialties and warrants endorsement and support from medical societies and educational institutions. It is time to establish a national registry encompassing oncological emergencies, develop quality indicators tailored to the national context, and foster the establishment of specialized training programs aimed at enhancing the proficiency of physicians serving in emergency services catering to cancer patients.

Mathematical Modeling for the Assessment of Public Policies in the Cancer Health-Care System Implemented for the Colombian Case.

The incidence of cancer has been constantly growing worldwide, placing pressure on health systems and increasing the costs associated with the treatment of cancer. In particular, low- and middle-income countries are expected to face serious challenges related to caring for the majority of the world's new cancer cases in the next 10 years. In this study, we propose a mathematical model that allows for the simulation of different strategies focused on public policies by combining spending and epidemiological indicators. In this way, strategies aimed at efficient spending management with better epidemiological indicators can be determined. For validation and calibration of the model, we use data from Colombia-which, according to the World Bank, is an upper-middle-income country. The results of the simulations using the proposed model, calibrated and validated for Colombia, indicate that the most effective strategy for reducing mortality and financial burden consists of a combination of early detection and greater efficiency of treatment in the early stages of cancer. This approach is found to present a 38% reduction in mortality rate and a 20% reduction in costs (% GDP) when compared to the baseline scenario. Hence, Colombia should prioritize comprehensive care models that focus on patient-centered care, prevention, and early detection.

Caracterización de los pacientes oncológicos que ingresan por comorbilidades en el Hospital Universitario «Dr. Celestino Hernández Robau» / Characterization of cancer patients admitted for comorbidities at "Dr. Celestino Hernández Robau" University Hospital

Introducción Según datos de la Organización Mundial de Salud (OMS), el cáncer se ha convertido en una de las primeras causas de muerte a nivel mundial debido al aumento progresivo, si no existe control de su propagación. La valoración conjunta del paciente por parte de distintos especialistas que asumen su abordaje desde diferentes perspectivas, siempre mejora la atención de los mismos y en el caso del paciente oncológico no es una excepción. Objetivo: Caracterizar los pacientes oncológicos que ingresaron por comorbilidades en el Hospital Universitario «Dr. Celestino Hernández Robau» de la provincia Villa Clara. Métodos: Se realizó un estudio descriptivo de corte transversal, en el Hospital Universitario «Dr. Celestino Hernández Robau», de enero a diciembre del 2020, mediante la revisión documental de las historias clínicas al egreso. Resultados: En el sexo femenino, en pacientes de 60 años y más, predominaron los tumores de pulmón, mama y colorrectal, y en el sexo masculino, de pulmón, próstata y hemolinfopoyético El tumor de pulmón fue la localización más frecuente, predominó entre las comorbilidades, las neumonías en pacientes del sexo femenino, mayores de 60 años. Los pacientes ingresados por Diabetes Mellitus, presentaban una enfermedad estable, seguidos por los que se encontraban en progresión, los que ingresaron con insuficiencia cardiaca, presentaban tumor en pulmón o laringe. Conclusiones: Los pacientes que ingresaron por tener tumor de pulmón se asociaron a mayor número de complicaciones y egresos fallecidos. Recomendamos perfeccionar la atención integral de estos pacientes por oncólogos e internistas.

ABTRACT Introduction: according to data from the World Health Organization (WHO), cancer has become one of the leading causes of death worldwide due to its progressive increase, if there is no control of its spread. The joint assessment of the patients by different specialists who assume their approach from different perspectives always improves their care and in the case of cancer patients this is not an exception. Objective: to characterize cancer patients admitted for comorbidities at "Dr. Celestino Hernández Robau" University Hospital in Villa Clara province. Methods: a descriptive cross-sectional study was carried out at "Dr. Celestino Hernández Robau" University Hospital from January to December 2020, through documentary review of the medical records at discharge. Results: females aged 60 years and over predominated; lung, breast, and colorectal tumours predominated in this gender, as well as lung, prostate, and hemolymphopoietic tumours in males. Lung tumour was the most frequent location; pneumonia prevailed among the comorbidities, in females older than 60 years. Patients admitted for diabetes mellitus had a stable disease, followed by those who were in progression; those who were admitted with heart failure had a lung or larynx tumour. Conclusions: patients admitted for having a lung tumour were associated with a greater number of complications and deaths at discharge. We recommend improving a comprehensive care of these patients by oncologists and internists.

The STOP Program: a Hybrid Smoking Prevention and Cessation Training for Cancer Care Providers in Colombia and Peru.

We designed and tested the feasibility of the Smoking Cessation Training Program for Oncology Practice (STOP), a hybrid (face-to-face plus web-based) educational intervention to enhance Spanish-speaking cancer care professionals' (CCPs') ability to provide brief smoking prevention and cessation counseling to cancer patients and survivors. Changes in the CCPs' competencies (knowledge, attitude, self-efficacy, and practices toward smoking and smoking cessation services) were assessed post-training. Sixty CCPs from one major cancer center in Colombia (n = 30) and Peru (n = 30) were invited to participate in a 4-module hybrid training program on smoking prevention and cessation. Demographic and pre- and post-test evaluation data were collected. The training's acceptability was measured after each module. Bivariate analysis was conducted using Wilcoxon signed-rank test to compare the CCPs' competencies before and after the delivery of the STOP Program. Effect sizes were computed over time to assess the sustainability of the acquired competencies. Twenty-nine CCPs in Colombia and 24 CCPs in Peru completed the STOP Program (96.6% and 80.0% retention rates, respectively). In both countries, 98.2% of the CCPs reported that the overall structure and organization of the program provided an excellent learning experience. The pre-post-test evaluations indicated that the CCPs significantly improved their knowledge, attitude, self-efficacy, and practices toward smoking, smoking prevention, and cessation services. We found that the CCPs' self-efficacy and practices increased over time (1-, 3-, and 6-month assessments after completing the 4 educational modules). The STOP Program was effective and well-received, demonstrating remarkable changes in CCPs' competencies in providing smoking prevention and cessation services to cancer patients.

Health professionals' preferences with the use of pegfilgrastim on-body injector at oncology centers in 8 cities in Colombia.

BACKGROUND: Febrile neutropenia associated with some chemotherapy regimens can lead to potentially fatal complications and high health care costs. Administration of pegfilgrastim using an On-Body Injector (OBI) may be more convenient for cancer patients and physicians in countries with limited access to high-complexity healthcare. This study aims to describe physician and nurse preferences regarding different options for administration of pegfilgrastim at cancer centers, the chemotherapy schemes for which pegfilgrastim is most frequently prescribed and how healthcare providers prioritize certain administration schemes according to patients' access to healthcare services. METHODS: Observational, descriptive, cross-sectional study and survey, conducted between 2019 and 2020, to describe physician and nurse preferences regarding options for administration of pegfilgrastim at cancer centers, the demographics of the study population and characteristics of participating cancer centers. It included 60 healthcare professionals practicing at oncology centers from 8 cities in Colombia who were contacted and surveyed via telephone. Quantitative continuous variables were summarized using central tendency and dispersion measures. RESULTS: It was found that 35% of participants are haemato-oncologists, oncologists or hematologists, 30% are general practitioners, and 35% are other healthcare professionals (i.e., nurse, oncology nurse and head nurse). Our study shows that 48% of physicians prefer the use of OBI, particularly in the scheme of 24 h after myelosuppressive chemotherapy administrations. Regardless of patient frailty and travel time to the clinic, over 90% of healthcare providers (HCPs) prefer to prioritize preventing the patient from having to return to the clinic for pegfilgrastim administration as well as to increase healthcare staff availability through the use of OBI. CONCLUSIONS: The present study is the first one in Colombia that sought the reasons behind HCPs' choice to use OBI pegfilgrastim. Our results indicate that most professionals prefer to avoid the patient having to re-enter the care center for pegfilgrastim administration to facilitate access to healthcare for patients; patient characteristics and ease of transport are determining factors for respondents when choosing an option for drug administration. We found OBI is the preferred alternative by most HCPs and a good resource optimization strategy in the context of cancer patients' health care in Colombia.

'More stressful than cancer': Treatment Experiences Lived During Hurricane Maria among Breast and Colorectal Cancer Patients in Puerto Rico.

Background: This study explored experiences in cancer care and disruption after Hurricanes Irma and Maria's aftermath in Puerto Rico (PR). Methods: A total of three focus groups were conducted among breast and colorectal cancer patients diagnosed six months before the disaster. Results: The most prevalent themes were (a) barriers related to their cancer treatment, (b) facilitators related to their cancer treatment, and (c) treatment experiences during the hurricane. Participants discussed struggles regarding their experience with treatment and access to care during and after Hurricanes Irma and Maria and how household limitations due to lack of electricity and water deter their intention to continue their treatment. Moreover, stressors directly linked with the disaster were the most challenging to cope with. Conclusions: Our study identifies the hardships experienced by cancer patients living during a disaster. Similarly, our study highlights the impending need to address in future emergency plans the individual and system needs of cancer patients in active treatment to minimize the delay in continuing cancer care.

Cancer stage and time from cancer diagnosis to first treatment during the COVID-19 pandemic.

The 2019 coronavirus disease (COVID-19) pandemic has impacted cancer care and the diagnosis of new cases of cancer. We analyzed the impact of the COVID-19 pandemic on patients with cancer by comparing the number of newly diagnosed cases, cancer stage, and time to treatment in 2020 with those in 2018, 2019, and 2021. A retrospective cohort of all cancer cases treated at A.C. Camargo Cancer Center in 2018-2021, identified from the Hospital Cancer Registry, was studied. We analyzed single and multiple primary cancer case and patient characteristics-by year and by clinical stage (early v advanced). Times from diagnosis to treatment were compared according to the most frequent tumor sites between 2020 and the other study years. Between 2018 and 2021, a total of 29,796 new cases were treated at the center including 24,891 with a single tumor and 4,905 with multiple tumors, including nonmelanoma skin cancer. The number of new cases decreased by 25% between 2018 and 2020 and 22% between 2019 and 2020, followed by an increase of about 22% in 2021. Clinical stages differed across years, with the number of new advanced cases decreasing from 17.8% in 2018 to 15.2% in 2020. Diagnoses of advanced-stage for lung and kidney cancer decreased between 2018 and 2020, while the number of thyroid and prostate cancer cases diagnosed in advanced-stages increased from 2019 to 2020. The time from diagnosis to treatment decreased between 2018 and 2020 for breast (55.5 v 48 days), prostate (87 v 64 days), cervical/uterine (78 v 55 days) and oropharyngeal (50 v 28 days) cancers. The COVID-19 pandemic affected the numbers of single and multiple cancers diagnosed in 2020. An increase in the number of advanced-stage cases diagnosed was observed only for thyroid and prostate cancer. This pattern may change in coming years due to the possibility that a significant number of cases went undiagnosed in 2020.

Status of breast cancer in Latin American: Results of the breast cancer revealed initiative.

The Breast Cancer Revealed initiative was designed and conducted to know the status of breast cancer at each point of breast cancer care, through i) prevention, ii) detection, iii) diagnosis, iv) treatment, and iv) the capacity of our health systems. The expert panel from 11 Latin American countries identified several strategies and proposed high impact priorities, including implementation of prevention policies, improve primary healthcare capacity for breast cancer screening, have adequate infrastructure to make effective and timely diagnoses, have a multidisciplinary team in the treatment process, access to a variety of treatments for all types of patients, have a coordinated and articulated system from primary care to specialized hospital. In a region with limited resources, prioritization in high-impact strategies for breast cancer control could lead to improved clinical outcomes and quality of life for our patients.

Humanization in oncology care: A necessary change.

Developments in cancer care, automation of care, rationing of time and fragmentation of the work process for institutional imperatives can often lead to the dehumanization of care. Although, it is indisputable that these interventions have significantly improved outcomes in oncology, they may have caused the emotional needs of patients, families, and health professionals to be considered secondary concerns. Therefore, humanized care can help dispel the negative emotions associated with cancer diagnosis and treatment and may even contribute to improve patient outcomes. This empathetic and respectful approach to patients leads to increase patient expectations of recovery, accountability, control over their own health, satisfaction, safer care, patient happiness and healthcare professional resilience, resulting in time and cost savings. The humanization of care has emerged as a response to the needs and concerns of patients and their families that go beyond the biological.

Global Breast Cancer Initiative: A platform to address the psycho-oncology of cancer in low- and middle-income countries for improving global breast cancer outcomes.

BACKGROUND: Psycho-oncology is a clinical specialty in which the humanistic aspects of cancer diagnoses and treatment are addressed to reduce the psychological burden for patients and their caregivers to optimize patient participation, cancer outcomes and quality-of-life, which is especially critical in cultures where cancer is perceived as invariably fatal. Psycho-oncology programs face multiple barriers in low- and middle-income countries, including limited resource allocation and lack of training, both of which have been impediments to psycho-oncology programs becoming recognized as core competencies in cancer management and part of a standard medical curriculum. PURPOSE: This paper discusses the role of the Global Breast Cancer Initiative (GBCI) in helping to overcome inequities in breast cancer care and improve clinical outcomes from a psycho-oncology perspective as a model for improved cancer care in limited resource settings. FINDINGS: GBCI applies a comprehensive framework encompassing all phases of cancer care (defined through three pillars spanning the continuum of cancer management) and includes addressing the physical, psychological, and social needs of women throughout the life-course. Efforts to promote policies that increase access to early detection and treatment programs and improve health literacy among the public are important strategies to mitigate the most common emotional and physical challenges reported by people with cancer accessing care. CONCLUSIONS: Future efforts will focus on the integration of culturally appropriate guidance to promote early cancer detection and treatment completion through training programs for clinicians to establish core competencies in psycho-oncology. Emerging advocacy efforts in the oncology arena may help guide the integration of psycho-oncology services into routine care in countries where these services are not already integrated into the standard curriculum.

Reseña histórica de la revista ONCOLOGÍA (Ecuador) / Historical review of the journal ONCOLOGÍA (Ecuador)

La revista Oncología (Ecuador) es una revista médica de acceso abierto que se publica cuatrimestralmente por la Sociedad de Lucha contra el Cáncer del Ecuador (SOLCA). La revista fue fundada en 1993 y publica artículos originales, revisiones bibliográficas, artículos especiales, casos clínicos y cartas al editor en el campo de la oncología.La revista Oncología (Ecuador) está indexada en las siguientes bases de datos: Latindex, LILACS, DOAJ, tiene un comité editorial internacional que está compuesto por expertos en oncología de todo el mundo. Los manuscritos enviados a la revista son revisados por pares.La revista Oncología (Ecuador) es una importante fuente de información para los profesionales de la salud que trabajan en el campo de la oncología.

The journal Oncología (Ecuador) is an open-accessmedical journal published quarterly by the Society for the Fight against Cancer of Ecuador (SOLCA). The journal was founded in 1993 and publishes original articles, literature reviews, special articles, clinical cases,and letters to the editor in the field of oncology.The journal Oncología (Ecuador) is indexed in the following databases: Latindex, LILACS, and DOAJ, which havean international editorial board that is made up of oncology experts from around the world. Manuscripts submitted to the Journal are peer-reviewed.The JpurnalOncología (Ecuador) is an essentialsource of information for health professionals working in oncology

Critical assessment of resource waste in staging and follow-up of breast cancer

SUMMARY BACKGROUND: Breast cancer is a public health problem with both high incidence and cure rates. After treatment, patients are monitored for long periods of time due to the risk of recurrence. Thus, staging and follow-up strategies should consider not only the best results for the patient but also its costs for the public health system. OBJECTIVE: The objective of this study was to quantify the waste of resources on breast cancer follow-up and evaluate its impact on the public health system. METHODS: This is a retrospective analysis of consecutive medical records to identify the intervals between consultations and tests used for staging and during the first 2 years of follow-up of patients with breast cancer treated at a public hospital in Brazil. Data were compared with the guidelines of the main international consensus. RESULTS: Medical records of 60 consecutive patients treated in 2018 were selected, of whom 52 had 2 or more years of follow-up, and 8 had only 1 year of complete follow-up. A total of 34 patients (56.67%) underwent excessive examinations for stating. During follow-up, 125 surplus consultations were performed (33.6%). In this phase, 111 surplus exams were also performed, representing an increase of 100.9%. A total of 423 laboratory tests were performed for 18 patients in the first year and 229 tests for 14 patients in the second year. CONCLUSION: Excessive tests and consultations significantly burdened the Unified Health System without any benefit to patients. Better adherence to staging and follow-up recommendations could reduce costs and optimize the limited resources used in the public health system.

Respuesta en la atención del cáncer durante la pandemia por COVID-19 en Colombia: gestión en clínicas y hospitales / Cancer Care Response During the COVID-19 Pandemic in Colombia: Management in Clinics and Hospitals / Resposta no atendimento ao câncer durante a pandemia de COVID-19 na Colômbia: gestão em clínicas e hospitais

Introducción. El principal reto en la atención del cáncer durante la pandemia causada por la COVID-19 fue asegurar la oportunidad en el diagnóstico y tratamiento a cerca de 100,000 casos nuevos de cáncer al año en Colombia. El objetivo de esta investigación fue conocer la respuesta de las Instituciones Prestadoras de Servicios de Salud sobre su gestión en los servicios para la atención de la patología oncológica en el primer semestre del año 2020. Metodología. Estudio descriptivo y transversal tipo encuesta sobre la caracterización de los pacientes oncológicos con COVID-19, la capacidad instalada, la atención integral del cáncer, la implementación de telesalud/telemedicina y el apoyo institucional durante la pandemia. Participaron veinticinco prestadores con servicio de cirugía oncológica y quimioterapia o radioterapia. Resultados. El 56% de prestadores reportó pacientes oncológicos con COVID-19. Todos reportaron cambios de gestión en la capacidad resolutiva ante la pandemia: el 76% acondicionó infraestructura y dispositivos, el 84% adoptó la telesalud/telemedicina y el 92% recibió asistencia en planes de acción. El 48% de las instituciones prestadoras evidenciaron una disminución en el tamizaje de cáncer. Discusión. Este estudio evidencia que la emergencia de la pandemia obligó a apresurar los esfuerzos de infraestructura y recursos en las entidades oncológicas de Colombia. Los resultados obtenidos en la disminución de tamización de cáncer a nivel nacional se equiparán con los datos reportados por distintos países, incluyendo la región de las Américas. Conclusión. Los hallazgos evidencian la necesidad de mejorar la capacidad de respuesta del sistema de salud en escenarios de emergencia sanitaria que eviten el retraso en la atención y las acciones en salud pública del cáncer.

Introduction. The main challenge in cancer care during the COVID-19 pandemic was to ensure the timelines of diagnosis and treatment of nearly 100,000 new cancer cases per year in Colombia. The objective of this research was to know the response of the Health Service Provider Institutions on their management of services for cancer care in the first semester of the year 2020. Methodology. Descriptive, cross-sectional, survey-type study on the characterization of cancer patients with COVID-19, installed capacity, comprehensive cancer care, telehealth/telemedicine implementation, and institutional support during the pandemic. Twenty-five providers with oncological surgery and chemotherapy or radiotherapy services participated. Results. Fifty-six percent of providers reported cancer patients with COVID-19. Everyone reported management changes in pandemic response capacity: 76% upgraded infrastructure and devices, 84% adopted telehealth/telemedicine and 92% received assistance in action plans. Forty-eight percent of the provider institutions showed a decrease in cancer screening. Discussion. This study shows that the emergency of the pandemic forced to rush the efforts of infrastructure and resources in the oncological entities of Colombia. The results obtained in the decrease of cancer screening nationally will be equated with the data reported by different countries, including the Americas region. Conclusion. The findings show the need to improve the response capacity of the health care system in health emergency scenarios to avoid delays in cancer care and public health actions.

Introdução. O principal desafio no tratamento do câncer durante a pandemia causada pelo COVID-19 foi garantir oportunidade no diagnóstico e tratamento de quase 100,000 novos casos de câncer por ano na Colômbia. O objetivo desta pesquisa foi conhecer a resposta das Instituições Prestadoras de Serviços de Saúde sobre sua gestão nos serviços para atendimento de patologia oncológica no primeiro semestre do ano de 2020. Metodologia. Estudo descritivo e transversal do tipo enquete sobre caracterização de pacientes oncológicos com COVID-19, capacidade instalada, atenção integral ao câncer, implantação de telessaúde/telemedicina e apoio institucional durante a pandemia. Participaram vinte e cinco prestadores de serviços de cirurgia oncológica e quimioterapia ou radioterapia. Resultados. 56% dos provedores relataram pacientes oncológicos com COVID-19. Todos relataram mudanças de gestão na capacidade de resposta diante da pandemia: 76% adaptaram infraestrutura e dispositivos, 84% adotaram telessaúde/telemedicina e 92% receberam assistência em planos de ação. 48% das instituições prestadoras apresentaram uma diminuição no rastreamento do câncer. Discussão. Este estudo mostra que a emergência da pandemia obrigou a acelerar os esforços de infraestrutura e recursos nas entidades oncológicas da Colômbia. Os resultados obtidos na redução do rastreamento do câncer em nível nacional são equivalentes com os dados relatados por diferentes países, incluindo a região das Américas. Conclusão. Os achados mostram a necessidade de melhorar a capacidade de resposta do sistema de saúde em cenários de emergência sanitária que evitem atrasos no atendimento e nas ações de saúde pública para o câncer.

The impact of telemedicine on cancer care: real-world experience from a Peruvian institute during the COVID-19 pandemic.

Background: The COVID-19 pandemic caused discontinuities in cancer care (CC) in most countries. Here, the authors describe the real-world impacts of implementing a contingency plan employing telemedicine for CC. Methods: A retrospective study of patients who received CC through telemedicine at the Instituto Nacional de Enfermedades Neoplasicas, Peru, from March 2020 to February 2021 was conducted. Impacts were measured by comparing the amount of CC administered during the pandemic versus the prior year. Results: A total of 16,456 telemedicine visits were carried out. An annual comparative analysis showed a gap of 23% and telemedicine accounted for 27.6% of the total CC administered during the pandemic. A high (4.50/5) level of patient satisfaction with telemedicine was reported. Conclusion: Telemedicine is an important tool to facilitate the continuity of CC.

Oncological Care During First Peruvian National Emergency COVID-19 Pandemic: A Multicentric Descriptive Study.

Purpose: The aim of this study is to evaluate the oncological care during the first state of national emergency due to the COVID-19 pandemic in several public cancer hospitals in Peru. Materials and Methods: A multicentric cross-sectional descriptive study was conducted by interviewing adult cancer patients diagnosed and treated between January 2019 and February 2020 from 18 hospitals. This study was carried out in September 2020, the last month of the first state of national emergency. Demographic and clinical characteristics were evaluated, including COVID-19 status and cancer treatment features. Results: A total of 1472 patients were included; the median age was 55 years (range 19-97). Most patients (85.8%, n = 1263) had solid neoplasia, 13.5% (n = 198) hematologic neoplasia, and 0.7% (n = 11) others. SARS-CoV-2 infection was confirmed in 8.6% (n = 126), 1.2% (n = 18) were probable, 1.6% (n = 24) suspected, and 88.6% (n = 1304) negative cases. Overall, 51.6% of patients (n = 759) had cancer treatment delays, 42.5% (n = 626) changed treatment delivery (endovenous to oral systemic therapy), and 12.6% (n = 185) of cases cancer therapy was discontinued. In total, 10.3% (n = 117) of patients whose disease was controlled or in remission, experienced progression of disease during the state of emergency. A total of 6.7% (n = 98) of patients died, of whom 73.5% (n = 72) died from disease progression; 18.4% (n = 18) from SARS-CoV-2 infection and 8.1% (n = 8) from undetermined causes. Patients with hematological malignancies [hazard ratio (HR): 5.11 (95% confidence interval (CI): 1.99-13.07)] and no response to therapy before the onset of the pandemic [5.01 (1.44-17.42)] had an increased risk of death among COVID-19 infected individuals, whereas advanced clinical stage [5.09 (2.37-10.95)] and discontinuation of treatment [3.66 (1.97-6.78)] were risk factors among non-COVID-19 patients. Conclusion: Our study suggests that the COVID-19 pandemic has an adverse impact on the outcomes of Peruvian cancer patients. In our cohort, cancer mortality was higher than COVID-19 disease mortality.