The Performance of Colorectal Cancer Screening in Brazil: The First Two Years of the Implementation Program in Barretos Cancer Hospital.

Colorectal cancer is the second most common cancer in Brazil. Yet, a nationally organized colorectal screening program is not implemented. Barretos Cancer Hospital (BCH) is one of the largest Brazilian institution that cares for underserved patients. BCH developed a fecal immunochemical test (FIT)-based organized colorectal cancer screening program to improve colorectal cancer outcomes.This study aims to present the quality/performance measures of the first 2 years of the FIT-based colorectal cancer screening program and its impact on the colorectal cancer disease stage. Between 2015 and 2017, a total of 6,737 individuals attending the Outpatient Department of Prevention or the Mobile Unit of BCH, which visits 18 cities of Barretos county, ages 50 to 65 years, were personally invited by a health agent/nurse practitioner. Exclusion criteria were personal history of colorectal cancer, adenomatous polyps, inflammatory bowel disease, and colonoscopy, or flexible sigmoidoscopy performed in the past 5 years. European Union (EU) guidelines for colorectal cancer screening programs were evaluated. Overall, 92.8% returned the FIT, with an inadequate examination rate of 1.5%. Among the 6,253 adequately tested, 12.5% had a positive result. The colonoscopy compliance and completion rates were 84.6 and 98.2%, respectively. The PPVs were 60.0%, 16.5%, and 5.6% for adenoma, advanced adenoma, and cancer, respectively. Stage distribution of screen-detected cancers shows earlier stages than clinically diagnosed colorectal cancer cancers reported at BCH and Brazilian cancer registries. Our colorectal cancer screening program achieved desirable quality metrics, aligned with the EU guidelines. The observed shift toward earlier colorectal cancer stages suggests an exciting opportunity to improve colorectal cancer-related cancers in Brazil.

Tendências de mortalidade por câncer segundo a Diretoria Regional de Saúde XV de São José do Rio Preto, São Paulo, Brasil / Trends of mortality by cancer according to the Regional Directorate of Health XV of São José do Rio Preto, São Paulo, Brazil / Tendencias de mortalidad por cáncer según la Delegación Regional de Salud XV de São José do Rio Preto, São Paulo, Brasil

Introdução: Pesquisas sobre as taxas de mortalidade dos diferentes tipos de cânceres são elementos-chave para o alcance da meta de redução. Objetivo: Avaliar a tendência da mortalidade por câncer na região de São José do Rio Preto (DRS-XV) no período de 2000 a 2015. Material e Método: Estudo populacional de séries temporais. As referências de população dos municípios pertencentes à DRS-XV bem como as respectivas estimativas intercensitárias foram obtidas no sítio eletrônico do DATASUS e as informações sobre a mortalidade obtidas de dados oficiais do MS...(AU)

Quimioterapia neoadjuvante e resposta patológica: coorte retrospectiva / Neoadjuvant chemotherapy and pathologic response: a retrospective cohort

OBJETIVO: Avaliar a taxa de resposta patológica completa atingida pelas pacientes com diagnóstico de câncer de mama localmente avançado submetidas à quimioterapia neoadjuvante baseada no esquema doxorrubicina/ciclofosfamida seguido de paclitaxel. MÉTODOS: Coorte retrospectiva de pacientes admitidas no Hospital de Câncer de Barretos com câncer de mama localmente avançado entre 2006 e 2008 submetidas ao protocolo de doxorrubicina/ciclofosfamida seguido de paclitaxel (4 ciclos de doxorrubicina 60mg/m² e ciclofosfamida 600mg/m² a cada 21 dias; 4 ciclos de paclitaxel 175mg/m² a cada 21 dias). As seguintes variáveis foram avaliadas: idade, menopausa, performance status, estadiamento clínico inicial, dados antropométricos, quimioterapia (dose - duração), perfil de toxicidade, estadiamento clínico pós-tratamento, cirurgia, resposta patológica completa, sobrevida livre de doença e características anatomopatológicas (tipo e grau histológico, perfil hormonal e comprometimento linfonodal). A análise estatística foi realizada considerando-se o nível de significância de 5%. RESULTADOS: Das 434 pacientes avaliadas, 136 foram excluídas por erro no estadiamento ou por terem recebido outro tipo de quimioterapia. A mediana de idade foi 50 anos, todas com performance status 0-1. A mediana do tamanho clínico inicial do tumor foi 65mm e a mediana do tamanho clínico final do tumor foi 22mm. Apresentaram resposta patológica completa 51 (17,1%) pacientes. Aquelas que apresentavam perfil hormonal negativo ou que eram triplo-negativas (Her-2 e perfil hormonal negativos) tiveram impacto favorável na resposta patológica completa. CONCLUSÃO: Quimioterapia neoadjuvante com doxorrubicina/ciclofosfamida seguidas de paclitaxel ofereceu taxa de resposta patológica completa na população estudada de acordo com a literatura. Pacientes triplo-negativas tiveram maior chance de atingir essa resposta.

OBJECTIVE: To evaluate the complete pathologic response attained by patients diagnosed with locally advanced breast cancer submitted to neoadjuvant chemotherapy based on the doxorubicin/cyclophosphamide regimen followed by paclitaxel. METHODS: A retrospective cohort of patients with locally advanced breast cancer, admitted to the Hospital de Câncer de Barretos between 2006 and 2008 submitted to the doxorubicin/cyclophosphamide protocol followed by paclitaxel (4 cycles of doxorubicin 60mg/m² and cyclophosphamide 600mg/m² every 21 days; 4 cycles of paclitaxel 175mg/m² every 21 days). The following variables were assessed: age, menopause, performance status, initial clinical staging, anthropometric data, chemotherapy (dose - duration), toxicity profile, post-treatment staging, surgery, pathologic complete response rate, disease-free survival, and pathological characteristics (type and histological degree, hormonal profile and lymph node involvement). Statistical analysis was performed using a 5% level of significance. RESULTS: Of the 434 patients evaluated, 136 were excluded due to error in staging or because they had received another type of chemotherapy. Median age was 50 years, all with performance status 0-1. Median initial clinical size of tumor was 65mm and the median final clinical size of the tumor was 22mm. Fifty-one (17.1%) patients experienced a pathologic complete response. Those with a negative hormonal profile or who were triple-negative (negative Her-2 and hormonal profile) experienced a favorable impact on the pathologic complete response. CONCLUSION: Neoadjuvant chemotherapy with doxorubicin/cyclophosphamide followed by paclitaxel provided a pathologic complete response in the population studied in accordance with that observed in the literature. Triple-negative patients had a greater chance of attaining this response.

Neoadjuvant chemotherapy and pathologic response: a retrospective cohort.

OBJECTIVE: To evaluate the complete pathologic response attained by patients diagnosed with locally advanced breast cancer submitted to neoadjuvant chemotherapy based on the doxorubicin/cyclophosphamide regimen followed by paclitaxel. METHODS: A retrospective cohort of patients with locally advanced breast cancer, admitted to the Hospital de Câncer de Barretos between 2006 and 2008 submitted to the doxorubicin/cyclophosphamide protocol followed by paclitaxel (4 cycles of doxorubicin 60mg/m² and cyclophosphamide 600mg/m² every 21 days; 4 cycles of paclitaxel 175mg/m² every 21 days). The following variables were assessed: age, menopause, performance status, initial clinical staging, anthropometric data, chemotherapy (dose - duration), toxicity profile, post-treatment staging, surgery, pathologic complete response rate, disease-free survival, and pathological characteristics (type and histological degree, hormonal profile and lymph node involvement). Statistical analysis was performed using a 5% level of significance. RESULTS: Of the 434 patients evaluated, 136 were excluded due to error in staging or because they had received another type of chemotherapy. Median age was 50 years, all with performance status 0-1. Median initial clinical size of tumor was 65mm and the median final clinical size of the tumor was 22mm. Fifty-one (17.1%) patients experienced a pathologic complete response. Those with a negative hormonal profile or who were triple-negative (negative Her-2 and hormonal profile) experienced a favorable impact on the pathologic complete response. CONCLUSION: Neoadjuvant chemotherapy with doxorubicin/cyclophosphamide followed by paclitaxel provided a pathologic complete response in the population studied in accordance with that observed in the literature. Triple-negative patients had a greater chance of attaining this response.

Avaliação de um instrumento para classificação de pacientes pediátricos oncológicos / The evaluation of an instrument for pediatric oncology patient classification / Evaluación de un instrumento para clasificación de pacientes pediátricos oncológicos

Este estudo teve como objetivos avaliar a reprodutibilidade interavaliadores do instrumento para a classificação de pacientes pediátricos portadores de câncer; verificar se o instrumento de classificação de pacientes é adequado a pacientes pediátricos portadores de câncer e elaborar uma proposta de modificação do instrumento, permitindo a adaptação para pacientes pediátricos oncológicos. Foram avaliados, na unidade de internação pediátrica de um Hospital de câncer, 34 pacientes pelas equipes de médicos, enfermeiros e técnicos de enfermagem. Para a avaliação do grau de concordância entre os escores obtidos pelos avaliadores foi utilizado o coeficiente Kappa, que revelou um valor intermediário/alto nas classificações objetivas, e um valor baixo nas subjetivas. Conclui-se que o instrumento é confiável e reprodutível, porém, para classificação do paciente pediátrico oncológico, sugere-se a complementação de itens para atingir um resultado mais compatível com a realidade dessa população.

The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.

Estudio que objetivó estimar la reproductibilidad inter-evaluadores del instrumento para la clasificación de pacientes pediátricos portadores de cáncer; verificar si el instrumento de clasificación de pacientes es adecuado para pacientes pediátricos portadores de cáncer y elaborar una propuesta de modificación del instrumento, permitiendo su adaptación para pacientes pediátricos oncológicos. Fueron evaluados 34 pacientes en la unidad de internación pediátrica de un Hospital oncológico por parte de los equipos de médicos, enfermeros y técnicos de enfermería. Para estimar el grado de concordancia entre los puntajes obtenidos por los evaluadores, se utilizó el coeficiente Kappa, que expresó un valor entre intermedio y alto en las clasificaciones objetivas, y un valor bajo en las subjetivas. Se concluye en que el instrumento es confiable y reproducible, aunque para la clasificación del paciente pediátrico oncológico se sugiere la implementación de ítems para alcanzar un resultado más compatible con la realidad de éste población.

Barreiras relacionadas à adesão ao exame de mamografia em rastreamento mamográfico na DRS-5 do estado de São Paulo / Barriers related to the non-adherence to the mammography screening program in DRS-5 of the state of São Paulo

Introdução: A mamografia constitui o método populacional mais eficaz na redução da mortalidade por câncer de mama, visto a elevação do diagnóstico de lesões precoces. Há inúmeras barreiras relacionadas à não realização do exame de mamografia, podendo estar relacionadas ao sistema de saúde, à educação e à adesão da paciente. Iniciou-se, em 2003, na DRS-5 rastreamento mamográfico, controlando as variáveis relacionadas ao sistema de saúde e educação. Objetivo: Avaliar, após a cobertura de 50,3% da população, as características das mulheres refratárias ao exame de mamografia. Métodos: Foram entrevistadas 550 mulheres, provenientes de 19 cidades que tinham conhecimento do rastreamento mamográfico da DRS-5 e que nunca haviam realizado o exame de mamografia previamente, sendo aplicado questionário para avaliar o conhecimento sobre o exame clínico da mama, a importância da mamografia, bem como estratégias para identificação dessa população refratária ao exame. Resultados: As principais características dessa população foram a baixa escolaridade (84,7%), a baixa classe socioeconômica (66,8%) e a faixa etária entre 42 e 49 anos (43,8%). As mulheres relataram que o autoexame da mama é pouco indicado por parte dos médicos (14,9%), sendo poucas as mulheres que o realizavam de maneira adequada (25,8%). O exame de mamografia também é pouco oferecido pelos médicos (23,6%), porém as mulheres sabem de sua importância e não o realizam, principalmente, por causa de ausência de sintomas (60,4%), medo da dor (25,1%) ou do câncer (20,5%). Para identificação dessa população, o Programa de Saúde da Família (PSF) foi de fundamental importância (90,0%), visto que apenas 71,8% dessas mulheres aderiram à realização do exame de mamografia. Conclusões: A identificação de subgrupos refratários ao exame de mamografia mostra a necessidade de aprimoramento no rastreamento, sendo o PSF importante instrumento de intervenção.

Introduction: Mammography is the best method to reduce the mortality from breast cancer, related to increase in early diagnosis. There are barriers related to low adherence to mammography, and the main reasons are related to health system, education and adherence to guidelines. In 2003 began in DRS-5 a mammography screening controlling the factors related to health system and knowledge. Objective: When we done mammography in 50.3% of DRS- 5 women, we find the characteristics of women that although having the knowledge of breast screening hadn't done mammography yet. Methods: We interview 550 women from 19 cities with questions related to the knowledge about breast clinical examination or reasons related to non adherence to mammography, and the strategy used to find these women. Results: The women had low years of school (84.7%), low income (66.8%) and were 42-49 years old (43.8%). The clinical frequently doesn't realize breast examination (14.9%), and low women know how to do this exam (25.8%). Besides the clinical doesn't infirm about the importance of mammography (23.6%), women don't realize this exam because the absent of health symptoms (60.4%), afraid of pain (25.1%) or afraid of cancer (20.5%). The "Programa de Saúde da Família" (PSF) had a fundamental importance to identify these women (90.0%), and just 71.8% of the interview women realize mammography. Conclusions: The identification of sub-group non adherent to mammography screening shows us the importance to improve the screening, and the PSF is a good way to promote heath intervention.