Implementation and evaluation of a remote geriatric assessment and intervention program in Brazil.

BACKGROUND: This study sought to determine the feasibility and acceptability of a remote geriatric assessment (GA) and implementation (GAIN) program in Brazil. The authors also explored the effect of this program on health-related quality of life (HR-QOL) outcomes 3 months after initiating treatment. METHODS: This is a longitudinal study enrolling older adults (65+ years), diagnosed with any type of solid tumor, scheduled to initiate chemotherapy in a networked Brazilian cancer center. The GA was performed through telehealth. We assessed the feasibility of the remote GA, acceptability to patients, and changes in patient-centered outcomes (HR-QOL, mood, function) from baseline to month 3. Linear mixed model analysis was done, adjusting for age, gender, race, income, and disease stage. RESULTS: Fifty-six patients completed all intended assessments. Notably, the threshold of feasibility was 70% and there was 92% complete adherence. Average age was 76 years old (SD = 7.2). Most patients were female (57%), married (59%), and had a college degree (46%). The most common diagnoses were gastrointestinal (39%) and gynecological cancers (18%); most were diagnosed at an advance disease stage (77%). A total of 32 patients were referred to a remote appointment and 86% followed this recommendation(s). Significant improvement in Functional Assessment of Cancer Therapy - General FACT-G (mean difference, 6.04; p < .001), Geriatric Depression Scale (mean difference, -0.86; p = .008), and instrumental activities of daily living ratio (mean difference, 0.17; p < .001) were found. CONCLUSION: Remote GAIN is feasible and acceptable to older adults with cancer receiving treatment in Brazil. The authors also found significant improvement in HR-QOL outcomes over time. Notably, this GAIN program could guide early detection of chemotherapy toxicity and improving patient-reported outcomes in low-resource environments.

Tratamento com radio e quimioterapia do carcinoma epidermóide do canal anal: experiência do hospital Barão de Lucena / Radiochemotherapy for squamous cell carcinoma of the anal canal: Barao de Lucena hospital experience

Objetivos: Apresentar os resultados e analisar as variáveis implicadas no tratamento e prognóstico do carcinoma epidermóide do canal anal tratado através da radio e quimioterapia no Hospital Barão de Lucena-SUS-PE. Metodologia: Análise dos prontuários de pacientes com diagnóstico de câncer do canal anal submetidos a tratamento radioquimioterápico. O período de acompanhamento foi de junho de 1989 a junho de 2005. Foram incluídos os pacientes com diagnóstico histológico de câncer de canal anal, enquadrados nos estadios I, II, IIIa e IIIb, submetidos a dois ciclos de quimioterapia com 5-fluorouracil (5-FU) na dose de 1g/m²/dia em infusão contínua de 96 horas e cisplatino na dose de 100mg/m² administrado em 6 horas no segundo dia de infusão de cada ciclo, administrados na primeira e terceira semanas do esquema de tratamento radioterápico. Resultados: Avaliamos 108 prontuários de pacientes que preencheram os critérios do protocolo. O tempo médio de seguimento foi de 51 meses (1-182 meses). Houve predomínio do gênero feminino (81,5 por cento dos pacientes). A idade variou de 33 a 83 anos (média de 59 anos). O tipo histológico mais freqüente foi o carcinoma de células escamosas (80,6 por cento dos casos). Em 21 pacientes, foi diagnosticado carcinoma basalóide. Quanto ao grau de diferenciação, prevaleceu o tipo moderadamente diferenciado (61 por cento dos pacientes com carcinoma de células escamosas). O índice de resposta inicial completa foi de 89,8 por cento. Onze pacientes persistiram com tumor após o tratamento radio e quimioterápico. O índice de resposta inicial completa foi menor nos estadios IIIa e IIIb em relação aos estadios I e II com significância estatística (p<0,05). 14 pacientes evoluíram com recidiva tumoral, oito com recidiva local (7,4 por cento) e seis (5,5 por cento) com recidiva linfática e à distância. CONCLUSÕES: O tratamento radioquimioterápico exclusivo do carcinoma epidermóide do canal anal, tem índice de resposta completo bastante elevado co...

Objectives: To present the results and analyze the variables involved in the treatment and prognosis of squamous cell carcinoma of the anal canal treated by radiotherapy and chemotherapy at the Hospital Barao de Lucena-SUS-PE. Methodology: Analysis of medical records of patients diagnosed with anal cancer treated by chemoradiation. The monitoring period was from June 1989 to June 2005. We included patients with histologically confirmed cancer of the anal canal, framed in stages I, II, IIIa and IIIb, underwent two cycles of chemotherapy with 5-fluorouracil (5-FU) at a dose of 1g / m² / day continuous infusion 96 hours and cisplatin at a dose of 100 mg / m² administered at 6 hours the second day of infusion of each cycle, administered on the first and third weeks of radiotherapy treatment regimen. Results: We evaluated records of 108 patients who met the criteria of the protocol. The mean follow-up was 51 months (1-182 months). There were more females (81.5 percent of patients). The age ranged from 33 to 83 years (mean 59 years). The most common histological type was squamous cell carcinoma (80.6 percent of cases). In 21 patients, was diagnosed Basaloid carcinoma. Regarding the degree of differentiation, the most prevalent type was moderately differentiated (61 percent of patients with squamous cell carcinoma). The rate of initial complete response was 89.8 percent. Eleven patients had persistent tumor after radiotherapy and chemotherapy. The initial response rate was lower in complete stages IIIa and IIIb compared to stages I and II with statistical significance (p <0.05). 14 patients developed recurrence, eight with local recurrence (7.4 percent) and six (5.5 percent) with lymphatic recurrence and distance. CONCLUSIONS: The chemoradiation treatment of unique cell carcinoma of the anal canal, have complete response rate very high with acceptable morbidity. Surgical treatment still has its value in cases of persistent injury and / or local recurrence, with sati...