RESUMO
AIMS: To prove if there is clinical inertia in the identification and treatment of episodes of breakthrough cancer pain (BTcP), comparing actual results from clinical practice with clinical oncologists' prior perception. DESIGN: Observational and descriptive study, using information collected by practising medical oncologists, at three moments: (a) questionnaire regarding their professional judgement of the handling of patients with BTcP in their practice, (b) cross-sectional clinical screening, to detect possible existing cases of BTcP in a representative sample of their patients, (c) retrospective self-audit of clinical case histories of patients diagnosed with BTcP to find out about how it has been handled. PARTICIPANTS AND STUDY PERIOD: A random sample on a state level of 108 specialists in medical oncology. 540 patients who suffer some type of cancer pain on the designated study date for each specialist (July-December 2016). RESULTS: The global prevalence of BTcP in the study sample covered 91.3% of the patients who were suffering some type of cancer pain. Barely 2% of the doctors surveyed suspected figures around this mark. 40.9% of the cases had not been previously detected as BTcP by their doctors. Although 90% of the patients who had previously been diagnosed with BTcP received a specific analgesic treatment for the symptoms, 42% of those patients with known BTcP were not able to control their episodes of pain. CONCLUSIONS: Clinical inertia is a serious problem in the handling of BTcP in medical oncology services, where it is the subject of a significantly low level of detection and treatment, despite the contrasting perception of specialists.
Assuntos
Dor Irruptiva/diagnóstico , Dor Irruptiva/epidemiologia , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Oncologia/estatística & dados numéricos , Idoso , Dor do Câncer/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e QuestionáriosRESUMO
PURPOSE: Management of metastatic disease in oncology includes monitoring of therapy response principally by imaging techniques like CT scan. In addition to some limitations, the irruption of liquid biopsy and its application in personalized medicine has encouraged the development of more efficient technologies for prognosis and follow-up of patients in advanced disease. METHODS: PrediCTC constitutes a panel of genes for the assessment of circulating tumor cells (CTC) in metastatic colorectal cancer patients, with demonstrated improved efficiency compared to CT scan for the evaluation of early therapy response in a multicenter prospective study. In this work, we designed and developed a technology transfer strategy to define the market opportunity for an eventual implementation of PrediCTC in the clinical practice. RESULTS: This included the definition of the regulatory framework, the analysis of the regulatory roadmap needed for CE mark, a benchmarking study, the design of a product development strategy, a revision of intellectual property, a cost-effectiveness study and an expert panel consultation. CONCLUSION: The definition and analysis of an appropriate technology transfer strategy and the correct balance among regulatory, financial and technical determinants are critical for the transformation of a promising technology into a viable technology, and for the decision of implementing liquid biopsy in the monitoring of therapy response in advanced disease.
Assuntos
Neoplasias Colorretais/patologia , Oncologia/métodos , Células Neoplásicas Circulantes/patologia , Medicina de Precisão/métodos , Neoplasias Colorretais/sangue , Humanos , Biópsia Líquida , Espanha , Transferência de TecnologiaRESUMO
PURPOSE: Breakthrough cancer pain (BTcP) has been shown to be a prevalent and poor prognostic factor for oncologic patients, which remain under diagnosed and undertreated. In 2012, the Spanish Society of Medical Oncology (SEOM) published a clinical practice guideline (CPG) for the treatment of cancer pain which specifically addressed the management of BTcP. METHODS: Fundación ECO designed a qualitative study using an Internet-based survey to investigate the attitudes toward, compliance with, and use of SEOM Guideline. RESULTS: A total of 83 oncologists with a mean experience of 13 years responded. Overall, 82% were aware of different guidelines to manage BTcP. Notably, attitudes toward guidelines were highly positive and there was nearly unanimous agreement that CPG provided the best scientific evidence available (99%), on the minimum information to be gathered for the medical history (100%), on the need for a specific treatment for BTcP (100%), and fentanyl as the first-choice drug (99%). Interestingly, there were discrepancies between what oncologists agreed with and what they do in clinical practice. In fact, 87.6% declare full compliance with SEOM guideline, although adherence to registration of BTcP data in medical records ranged from 30.1 to 91.6% (mean 64.5%); therapeutic management compliance was higher ranging from 75.9 to 91.6%. Main barriers identified were time pressure together with vague statements and limited dissemination of the guidelines. CONCLUSION: Despite oncologist's clinical practice is increasingly guided by GPC, it suffers from limited compliance, at least in part due to suboptimal statements. Improved dissemination and education are needed to enhance guideline implementation.
Assuntos
Dor Irruptiva/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Manejo da Dor/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Oncologistas , Espanha , Inquéritos e QuestionáriosRESUMO
Chemotherapy-induced nausea and vomiting is one of the most worrisome adverse effects of chemotherapy for cancer patients. It can cause severe discomfort and affect the quality of life. In recent years, the incorporation of new drugs has increased the efficacy of antiemetic treatments in the control of emesis associated with chemotherapy. This guideline, in which we give some treatment recommendations with level of evidence and grade of recommendation, provides an update of the previously published guideline of the Spanish Society of Medical Oncology and represents our continued commitment to improving supportive care in cancer patients.
Assuntos
Antineoplásicos/efeitos adversos , Náusea/induzido quimicamente , Náusea/prevenção & controle , Guias de Prática Clínica como Assunto , Vômito/induzido quimicamente , Vômito/prevenção & controle , Humanos , Neoplasias/tratamento farmacológico , Qualidade de Vida , EspanhaRESUMO
PURPOSE: In high risk gastric and gastroesophageal adenocarcinoma, adjuvant radiochemotherapy with 5-fluorouracil bolus became a standard adjuvant treatment, showing significant improvement in overall survival after surgery, although with substantial toxicity. We explored the efficacy and toxicity of a modified 5-fluorouracil continuous infusion scheme. METHODS: We conducted an observational retrospective study in our centre. Gastric/gastroesophageal junction adenocarcinoma patients were treated with a schedule consisting in four infusions of bolus 5-fluorouracil 400 mg/m(2) iv with leucovorin 200 mg/m(2) iv and 1200 mg/m(2) in 46-hour infusion of 5-fluorouracil (D'Gramont scheme), followed by concomitant radiochemotherapy (45 Gy in 25 fractions of 1.8 Gy) with 5-fluorouracil continuously infusion 225 mg/m(2)/day and four additional infusions of chemotherapy one month after complete radiochemotherapy. RESULTS: Between January 2007 and December 2013, 55 patients received a mean of 3.16 bi-weekly adjuvant infusions followed by 4.6 weeks of continuous treatment concurrent with radiotherapy and 3.72 bi-weekly infusions after radiotherapy treatment. During adjuvant treatment, grade III toxicity was mostly haematologic, while gastrointestinal and cutaneous toxicity was predominant during concurrent treatment. There were no grade IV- or treatment-related deaths during this study. Disease-free survival (DFS) was 79.2 months (56.3-102.1 months), and the 3-year survival rates were 52.7 %. CONCLUSIONS: This 5-fluorouracil infusional scheme has an excellent tolerability profile and favourable efficacy results.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/administração & dosagem , Quimioterapia Adjuvante/métodos , Fluoruracila/administração & dosagem , Neoplasias Gástricas/tratamento farmacológico , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Quimioterapia Adjuvante/efeitos adversos , Intervalo Livre de Doença , Junção Esofagogástrica/patologia , Feminino , Fluoruracila/efeitos adversos , Humanos , Infusões Intravenosas , Estimativa de Kaplan-Meier , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/mortalidadeRESUMO
PURPOSE: The economic situation showed that the resources devoted to health spending are limited, making rationalisation of their consumption necessary. The relevance of pharmacoeconomic analyses is becoming crucial. The ECO Foundation, promoting the quality of oncology care, set out to analyse the consensus on the new therapeutic targets inclusion and the integration of pharmacoeconomics when evaluating their effectiveness. METHODS: Study about pharmacoeconomic estimations was performed during the first ECO-Seminar (2010). It was developed using a modified Delphi method, in four stages: (1) committee coordinator establishment, (2) expert-panel selection, (3) preparation and submission of survey (1 question) by email, and (4) analysis of the degree of consensus reached. RESULTS: Results were obtained from surveys completed by 35 experts. Regarding the tolerable annual cost for the approval of new drugs, 68.8 % of the respondents considered a cost per quality-adjusted life year (QALY) gained between 30,000 and 100,000 acceptable (34.4 % 30,000-60,000; 34.4 % 60,000-100,000), 21.9 % of the respondents found costs between 100,000-150,000/QALY and 9.3 % of the respondents found costs above 150,000/QALY acceptable. CONCLUSIONS: The costs of new drugs are higher than traditional treatments, making it a priority to identify subgroups of patients with specific molecular profiles as candidates for higher-efficiency-targeted therapies. The allocation of the available resources to the most effective interventions, to achieve the best clinical outcomes with lower costs and best subjective profile possible, allows expenditure to be rationalised. Pharmacoeconomic studies are a basic tool for obtaining better health outcomes according to the available resources, while also considering the other needs of the population.
Assuntos
Atitude do Pessoal de Saúde , Custos de Medicamentos , Oncologia , Neoplasias/economia , Anos de Vida Ajustados por Qualidade de Vida , Análise Custo-Benefício , Técnica Delphi , Descoberta de Drogas , Farmacoeconomia , Humanos , Neoplasias/tratamento farmacológico , Valores Sociais , EspanhaRESUMO
Brain metastases of prostate adenocarcinoma are rare. We report a case of brain metastases from prostate adenocarcinoma 15 months after the diagnosis of the primary tumour. The patient had headache and one solitary metastasis upon magnetic resonance imaging (MRI). The biopsy performed showed metastatic prostate adenocarcinoma. He was treated with surgery and cranial irradiation.
Assuntos
Adenocarcinoma/secundário , Neoplasias Encefálicas/secundário , Neoplasias da Próstata/patologia , Adenocarcinoma/complicações , Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/terapia , Cardiomiopatias/complicações , Terapia Combinada , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Próstata/complicações , Neoplasias da Próstata/terapia , Radioterapia , Procedimentos Cirúrgicos UrológicosRESUMO
The concomitant occurrence of cancer during pregnancy is a rare event. The cancers most frequently detected during pregnancy are breast, cervical, melanoma, ovarian, leukaemia and lymphoma, however the diagnosis of lung cancer during pregnancy is particularly exceptional. In this case, we report on a pregnant woman who was diagnosed with non-small-cell lung cancer and received therapy with paclitaxel and cisplatin.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Cisplatino/administração & dosagem , Feminino , Humanos , Paclitaxel/administração & dosagem , Gravidez , Resultado da GravidezRESUMO
OBJECTIVE: Considering that chronic diseases such as diabetes mellitus (DM) may determine premature ovarian failure by various mechanisms, we studied the age at menopause in women without diabetes and in women with type 2 DM. DESIGN: We studied 409 women without diabetes and 404 patients with type 2 DM, selected from 45 to 55 years of age, for analysis with the status quo method. The age at menopause was calculated with a logistic regression on the proportions of menopausal women for each age group. RESULTS: In the groups, 172 women without diabetes and 207 women with diabetes had menopause. The regression procedure gave a median age of 49.7 +/- SD 1.7 years for the whole group, 49.6 +/- 1.6 years for the nondiabetic group, and 49.8 +/- 1.7 years for women with diabetes. Women without diabetes were 1.4 years younger, but this factor did not have an influence on the results. Smoking habits, vegetarianism, and somatometric variables were similar in both groups, except for waist/hip and abdomen/hip ratios, larger in the group of women with diabetes. The mean for years since diagnosis in patients < 45 years of age was 4.9 years. For older patients, the figure increased to 8.9 years. CONCLUSIONS: No difference for age at menopause was found between women without diabetes and women with type 2 diabetes who were 5 to 8 years since the diagnosis was made.