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INTRODUCTION: Breast cancer is still one of the main causes of cancer mortality in women worldwide, and death rates are even greater in vulnerable populations. A delay in diagnosis usually comes with advanced-stage disease, which impacts patient survival. The aim of this study was to evaluate the time for first medical consultation among women with breast cancer attending the Magdalena V. de Martínez Hospital and to determine the causes that may influence patient delay and its impact on cancer stage at diagnosis. MATERIALS AND METHODS: Three hundred and six breast cancer patients were interviewed using a self-report questionnaire, and socioeconomic and demographic variables, namely, highest education level completed, employment status and breast cancer awareness, were collected. The answers were associated with patient clinical records, such as clinical staging and tumor size. RESULTS: Forty-nine percent of the patients were diagnosed with advanced-stage disease. These women had either a deficiency in breast cancer awareness, did not visit a gynecologist after age 40 or, were unemployed, while those patients diagnosed with early-stage breast cancer had nonpalpable tumors, declared a sufficient household income or delayed less than four weeks in seeking medical attention. Moreover, the delay in the first medical visit was more than one month in 78% of the patients, being disregard the most common cause of postponement. Additionally, patient delays were associated with larger tumors and with incomplete education. DISCUSSION: These results indicate that early detection efforts should be made to reduce the disease stage at diagnosis, which may impact on overall survival.

Introducción: El cáncer de mama (CM) es una de las principales causas de mortalidad por cáncer en mujeres, y las tasas de mortalidad son aún mayores en poblaciones vulnerables. Un retraso en el diagnóstico suele acompañarse con estadios avanzados de la enfermedad, lo que impacta en la supervivencia del paciente. El objetivo fue evaluar el tiempo transcurrido para la primera consulta médica entre mujeres con CM que asisten al Hospital Magdalena V. de Martínez y determinar las causas que pueden influir en la demora del paciente y su impacto en el estadio al momento del diagnóstico. Materiales y métodos: Se entrevistaron 306 pacientes con CM utilizando un cuestionario autoinformado, y se recopilaron variables socioeconómicas y demográficas, entre ellas, nivel educativo más alto completado, situación laboral y conocimiento sobre el CM. Las respuestas se asociaron con los registros clínicos de las pacientes. Resultados: El 49% de las pacientes fueron diagnosticadas con enfermedad en estadios avanzados. Estas mujeres tenían deficiencias en el conocimiento sobre el CM, no consultó al ginecólogo después de los 40 años o estaba desempleada, mientras que aquellas diagnosticadas con CM en estadios tempranos tenían tumores no palpables, declaraban un ingreso familiar suficiente o demoraban menos de cuatro semanas en buscar atención médica. Además, la demora en la primera visita médica fue de más de un mes en el 78% de las pacientes, siendo el desinterés la causa más común de postergación. Asimismo, las demoras estaban asociadas con tumores más grandes y con una educación incompleta. Discusión: Este estudio sugiere la necesidad de desarrollar estrategias de sensibilización y educación sobre el CM, así como de políticas para mejorar el acceso a la atención médica, especialmente para poblaciones vulnerables, con el fin de reducir el retraso en el diagnóstico y mejorar la salud de las pacientes con CM.

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INTRODUCTION: The BV-AVD (Brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) combination for first-line treatment of advanced stage Hodgkin's lymphoma has been approved by regulatory authorities and included in international guidelines. However, several factors influence its incorporation as standard of care. MATERIALS AND METHODS: A group of experts from different institutions was identified and, using the Delphi method, an analysis of the results of the ECHELON 1 trial for the indication of BV-AVD over ABVD (doxorubicin hydrochloride, bleomycin sulfate, vinblastine sulfate, dacarbazine) in patients with Hodgkin's lymphoma Stages III and IV in Argentina was done. The clinical and academic experience of the authors and the context of the Argentine healthcare system were considered. RESULTS AND DISCUSSION: Seven statements on general aspects of the management of Hodgkin's lymphoma and nine on specific aspects related to the use of BV-AVD over ABVD reached a consensus of agreement. There was a strong expert consensus in favor of indicating BV-AVD in the presence of extranodal disease or pulmonary disease. Moderate to severe neuropathy, pregnancy and drug allergy were considered absolute contraindications to prescribe BV. CONCLUSIONS: The authors agreed that BV-AVD could be considered a new treatment option in high-risk patients. However health system-dependent factors (such as high cost, lack of availability, reimbursement difficulties, irregular delivery, and issues with granulocyte-colony stimulating factor availability) could pose limitations for this prescription. While awaiting new data from clinical trials and real-world studies, these recommendations can represent a useful tool for hematologists in different parts of the world.

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Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

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Existem poucos dados na literatura sobre os resultados obstétricos e oncológicos de adolescentes com tumores borderline de ovário em estádio avançado trata- das com cirurgia preservadora da fertilidade. Uma adolescente de 15 anos com diagnóstico de tumor borderline de ovário estádio IIIc foi inicialmente tratada com tumorectomia ovariana bilateral e quimioterapia adjuvante com esquema de platina/taxano (seis ciclos). Durante o seguimento, foi submetida a outras três tumorectomias devido a tumor borderline de ovário (duas vezes) e cistadenoma ovariano (uma vez). Outra recidiva de tumor borderline de ovário ocorreu seis anos após o diagnóstico inicial, quando ela estava grávida; foi tratada com tumorecto- mia realizada durante a cesariana. Em sua última consulta ambulatorial, a mulher de 27 anos não apresentava evidência da doença e tinha um filho saudável. Mesmo em estádio avançado, a cirurgia de preservação da fertilidade foi segura e factível nessa paciente com tumor borderline de ovário.

There are few data in the literature regarding obstetric and oncological outcomes of adolescents with advanced-stage borderline ovarian tumors treated with fertility spa- ring surgery. A 15 years old adolescent who was diagnosed with a stage IIIc borderline ovarian tumor, was treated with bilateral ovarian tumorectomies and adjuvant chemotherapy with platinum/taxane regimen (six cycles). During follow up she was submitted to other three tumorectomies due to borderline ovarian tumor(twice) and ovarian cysta- denoma (once). Another borderline ovarian tumorrecurren- ce occurred six years after initial diagnosis, when she was pregnant; treated with tumorectomy performed during ce- sarean section. At her last outpatient visit, the 27-year-old woman had no evidence of disease and a had healthy child. Even at an advanced stage, fertility sparing surgery was safe and feasible in this patient with borderline ovarian tumor.

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Retinoblastoma is highly curable, with event-free survival (EFS) of greater than 95% in high-income countries. However, in lower middle-income countries, outcomes of EFS are 30%-60% due to delayed diagnosis and lack of resources resulting in extra-ocular disease. We report the toxicity profile and outcomes of intensified therapy for advanced retinoblastoma: vincristine, etoposide, carboplatin (VEC) alternating with vincristine, doxorubicin, and cyclophosphamide (VDoCx) in Guatemala. Compared to VEC alone, similar rates of neutropenia, anemia, and thrombocytopenia were seen, with no toxic deaths. Although survival was not a primary objective, a modest survival benefit supports further investigation of VEC+VDoCx for advanced retinoblastoma.

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BACKGROUND: Advanced stage and high mortality are characteristics of cervical cancer in developing countries. Comprehension of the diagnosis itinerary is one of the main strategies to control the disease impact. OBJECTIVES: To identify reasons for the delay in diagnosing symptomatic cervical cancer according to the patient's perspectives reported in qualitative studies. We searched four databases (PubMed, Embase, CINAHL, and Web of Science). SELECTION CRITERIA: We included qualitative studies of women with advanced cervical cancer that explored their experiences before treatment. We excluded unoriginal, non-qualitative, and duplicated studies. DATA COLLECTION AND ANALYSIS: We selected 39 articles for a full-text reading and included 15 in the present review. We chose the Consolidated Criteria for Reporting Qualitative Research (COREQ) for quality assessment and The Model of Pathways to Treatment to guide the codifying process. MAIN RESULTS: Four main themes emerged from the synthesis: (1) Health-seeking motivators; (2) Obstacles to seeking medical care; (3) Diagnosis delay; and (4) Coping with the disease. These themes were derived from patients' personal knowledge and beliefs, social relationships, socioeconomic status, and healthcare system characteristics. CONCLUSIONS: Individual behavior, social factors, and healthcare organization contribute to the delay in diagnosing advanced cervical cancer.

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BACKGROUND: Lung cancer is still a prevalent and fatal neoplasm in developing countries. In the last decades, chemotherapy (CHT) maintenance occupied an important role in the treatment, as well as targeted therapies. We aimed to evaluate the survival impact of targeted therapy in advanced lung cancer at a private Peruvian institution (Oncosalud - AUNA). METHODS: We reviewed retrospectively medical records of patients with advanced-stage non-small cell lung cancer (NSCLS) (clinical stage III-IV) who received CHT and maintenance treatment with target therapy (TT) or CHT. The impact was assessed by progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method, and comparisons of survival curves were performed using log-rank or Breslow test and Cox model. RESULTS: The median age of the patients was 65 years. Clinical characteristics, as well as the treatment type, showed no significant difference between the two groups. The maintenance schedule in those receiving CHT was generally pemetrexed (70%) and in those receiving TT was erlotinib (60.7%). In patients receiving TT, the median PFS was 13 months compared to 7 months in those receiving CHT; likewise, the median OS was 45 and 17 months, respectively. The PFS and OS curves showed significant differences (P < .05), achieving a better survival in subjects treated with TT. CONCLUSION: Progression-Free Survival and OS were superior in patients who received targeted therapy than those treated only with CHT, the 2 years rate of PFS and OS was nearly double to those who received only CHT-based treatments.

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RESUMEN Introducción: La conducta ante el glaucoma avanzado es polémica entre los oftalmólogos por sus posibles consecuencias visuales. Objetivo: Evaluar el resultado de la trabeculectomía en el tratamiento de pacientes con glaucoma avanzado. Método: En el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el periodo de 2015-2018, se realizó un estudio observacional, descriptivo, longitudinal, de una serie de casos. El universo fue conformado por 57 ojos con glaucoma avanzado operados con la citada técnica. Se describen las variables: edad, sexo, variables en el periodo preoperatorio y posoperatorio (cantidad de fármacos para el control del glaucoma, agudeza visual mejor corregida, campo visual, medición de la presión intraocular, complicaciones posoperatorias). Resultados: La edad promedio fue de 65,4 años, el 55,8 % eran hombres. La agudeza visual posoperatoria fue la misma que la preoperatoria en 54 ojos (96,5 %). La medicación antiglaucoma disminuyó a un valor medio de 1,6 fármacos y la presión intraocular posoperatoria a los 2 años fue de 16,5 mmHg. El índice total de éxito fue del 93,0 %. Conclusiones: La trabeculectomía permite un índice de éxito satisfactorio en el tratamiento del glaucoma avanzado en los pacientes estudiados.

ABSTRACT Introduction: Behavior in advanced stage glaucoma has brought controversies among specialists in ophthalmology due to its possible visual consequences. Objective: To evaluate the outcome of trabeculectomy surgery in patient treated with glaucoma in advanced stage. Method: An observational, descriptive, and longitudinal study of several cases was conducted at the Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" in Santiago de Cuba, from 2015 through 2018. It was involved as total and selected 57 eyes with glaucoma in advanced stage and associated with a trabeculectomy surgery. Variables used were: age, sex, preoperative and postoperative variables used (number of drugs used for glaucoma management, best corrected visual acuity, visual field, measurement of intraocular pressure, and postoperative complications). Results: Average age was 65.4% and 55.8% were male. Preoperative and postoperative visual acuity in 54 eyes (96.5%) was the same. Antiglaucoma medication decreased to a median value of 1.6 drugs and the postoperative intraocular pressure, 2 years after surgery, was 16.5 mmHg. The overall success rate was 93.0%. Conclusions: Trabeculectomy had a satisfactory success rate in the patients with glaucoma in advanced stage treated.

RESUMO Introdução: O comportamento no glaucoma avançado é controverso entre os oftalmologistas devido às suas possíveis consequências visuais. Objetivo: Avaliar o resultado da trabeculectomia no tratamento de pacientes com glaucoma avançado. Método: No Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante o período 2015-2018, foi realizado um estudo observacional, descritivo e longitudinal de uma série de casos. O universo era formado por 57 olhos com glaucoma avançado operados pela técnica citada. As variáveis são descritas: idade, sexo, variáveis no período pré e pós-operatório (quantidade de medicamentos para controle do glaucoma, acuidade visual melhor corrigida, campo visual, medida da pressão intra-ocular, complicações pós-operatórias). Resultados: A média de idade foi de 65,4 anos, 55,8% eram homens. A acuidade visual pós-operatória foi igual à pré-operatória em 54 olhos (96,5%). A medicação antiglaucoma diminuiu para um valor médio de 1,6 medicamentos e a pressão intra-ocular pós-operatória em 2 anos foi de 16,5 mmHg. A taxa de sucesso total foi de 93,0%. Conclusões: A trabeculectomia permite uma taxa de sucesso satisfatória no tratamento do glaucoma avançado nos pacientes estudados.

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PURPOSE: Lung cancer is the leading cause of cancer death in Spain. The objective of our study was to evaluate the characteristics of patients diagnosed with stages I-III non-small-cell lung cancer, as well as the impact that epidemiological changes, diagnostic improvements and surgical therapeutic innovations have had on survival in the past 20 years. METHODS: Retrospective analysis of patients diagnosed with early and locally advanced non-small-cell lung cancer between years 2000 and 2017 in our institution. RESULTS: A total of 859 patients were included. An increase in the percentage of women diagnosed over time was observed. Statistically significant differences were observed in the mean age at diagnosis, with a progressive increase in the different periods. The percentage of current or former smokers was similar in all periods. Adenocarcinoma was the most frequent histologic type with a progressive increase in its frequency. The percentage of patients diagnosed in early stages has been increasing over the years. In stages I-II, there was a significant increase in the median survival (29.7 months: 2000-2004, 68.73 months: 2010-2014) that could be seen in stage III as well (14.7 months: 2000-2004, 30.63 months: 2015-2017). CONCLUSIONS: A variation of clinical characteristics of lung cancer in Spain has been observed in recent years, as well as an improvement in survival in early and locally advanced stages, due not only to the treatments, but also to a more accurate detection of these tumors. Little progress has been made in tobacco habit with high stable percentages over the years.

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BACKGROUND: Optimal upfront treatment of patients with advanced ovarian cancer is complex and requires the adequate function of a multidisciplinary team. Specific standard of quality of care needs to be taken into consideration. METHODS: A literature search in PubMed was performed using the following criteria: ("ovarian neoplasms"[MeSH Terms] OR ("ovarian"[All Fields] AND "neoplasms"[All Fields]) OR "ovarian neoplasms"[All Fields] OR ("ovarian"[All Fields] AND "cancer"[All Fields]) OR "ovarian cancer"[All Fields])"[Date - Publication]: "2018/01/14"[Date - Publication]). RESULTS: This article describes how to optimize the surgical management of advanced ovarian cancer, to achieve the best results in terms of survival and quality of life. For this purpose, this document will cover aspects related to pre-, intra- and postoperative care of newly diagnosed advanced ovarian cancer patients. CONCLUSION: Optimizing upfront treatment of patients with advanced ovarian cancer is complex and requires a structured quality management program including the wise judgment of a multidisciplinary team. Surgeries performed by gynecologic oncologists with formal training in cytoreductive techniques at referral centers are crucial factors to obtain better clinical and oncological outcomes. However, other factors such as the patient's clinical status, the hospital infrastructure and equipment, as well as the tumor biology of each individual patient should also be taken into account before deciding on an initial therapeutic strategy for advanced-stage ovarian cancer to offer patients the best quality of care.

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Resumen El alivio del sufrimiento existencial en los pacientes oncológicos en estadio avanzado es un objetivo terapéutico de primer orden. En el presente trabajo se sugieren una serie de ejes sobre los cuales podría pivotar la intervención psicoterapéutica, con el fin de propiciar: 1) la experiencia de que a pesar del "ya" de la situación límite, la vida "todavía" tiene sentido; 2) experiencias emocionales positivas que promuevan el bienestar y la calidad de vida; 3) el afrontamiento de la experiencia de enfermedad grave y de muerte esperada más o menos inminente, mediante el desarrollo de una actitud serena, reconciliada con la vida e integradora con uno mismo y con los demás, a la par que abierta a la trascendencia.

Abstract The relief of existential suffering in the patients with adavanced cancer is a first-order therapeutic goal. The present work suggests some axis on which psychotherapeutic intervention could be developed, in order to facilitate in these patients: 1) The experience of: In spite of the "existing" limited situation, one's life "still" has meaning, 2) Positive emotional experiences that promote well-being and quality of life, and 3) Face the serious illness that will cause one's almost imminent death, through the development of a serene, reconciled attitude with life and integrating with oneself and the others.

Resumo O alívio do sofrimento existencial em pacientes oncológicos em estágio avançado é um objetivo terapêutico de primeira ordem. No presente trabalho, sugerimos uma série de eixos nos quais a intervenção psicoterapêutica poderia girar, a fim de promover: 1) a experiência de que, apesar do "já" da situação limite, a vida "ainda" faz sentido; 2) experiências emocionais positivas, que promovam bem-estar e qualidade de vida; 3) enfrentar a experiência de doença grave e morte esperada mais ou menos iminente, através do desenvolvimento de uma atitude serena, conciliada com a vida e integrando-se consigo mesmo e com os outros, ao mesmo tempo que aberta à transcendência.

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BACKGROUND: Breast cancer is commonly diagnosed at an advanced stage in Brazil. AIM: Analyze the determinants of advanced staging in Brazilian women with breast cancer. METHODS: Crosssectional study, including women diagnosed with breast cancer in Brazil, between 2000 and 2009. RESULTS: A total of 59,317 women were included, 53.5% being classified as advanced stage (≥IIB). Younger age (18 to 49 years old) (OR=1.61 95% CI 1.51 to 1.72) or between 40 and 49 years old (OR=1.08 95% CI 1.03 to 1.14), having low educational level (OR=1.53 95% CI 1.48 to 1.58), living in less developed geographical regions (OR=1.27 95% CI 1.21 to 1.33), having invasive ductal carcinoma (OR=2.70 95% CI 2.56 to 2.84) and invasive lobular carcinoma (OR=2.63 95% CI 2.42 to 2.86) were associated with advanced breast cancer. CONCLUSION: We conclude that future interventions should focus on these high risk groups.

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La valoración del sufrimiento humano al final de la vida resulta relevante para la Psicología del Dolor y Paliativa, en la medida que permite determinar qué factores emocionales, sociales y espirituales agravan el dolor y el sufrimiento; y cuáles lo alivian, orientando de este modo la intervención. Asimismo, contar con un instrumento simple, de fácil aplicación y comprensión enriquece la comunicación y el trabajo de equipo. El estudio tuvo por objetivo valorar el sufrimiento humano a causa del dolor y la enfermedad oncológica avanzada en el Policlínico Alivio del Dolor y Cuidados Paliativos del Complejo Hospitalario San José. Se utilizó el modelo de Dolor Total, acuñado por Saunders y piedra angular del Programa Nacional Alivio del Dolor por Cáncer Avanzado y Cuidados Paliativos de nuestro país. Fueron entrevistados 211 pacientes entre enero y diciembre de 2010 en el contexto de su ingreso al Policlínico con diagnóstico de cáncer avanzado y derivados a la Unidad para el manejo de Dolor y Cuidados Paliativos. Las entrevistas realizadas por Psicología utilizaron el instrumento Valoración de Dolor Total (VDT), diseñado y ajustado a la ficha clínica de ingreso, tuvieron una duración promedio de 45 minutos y a las cuales asistieron también los cuidadores principales. El instrumento permitió el registro y análisis de variables sociodemográficas, clínicas, de apoyo psicosocial y de Dolor Total pertinentes a este estudio. Los datos fueron analizados a nivel descriptivo con el programa Stata 10.0, mediante medidas de tendencia central y de dispersión. Los resultados más importantes permiten concluir que el sufrimiento humano a causa del dolor y la enfermedad oncológica avanzada se caracteriza en este grupo de pacientes por la angustia de separación (85,1 por ciento), el cansancio (78,75 por ciento),la tristeza (71,71 por ciento) y por los sentimientos de inutilidad (63,59 por ciento).Se discuten las limitaciones y proyecciones del estudio.

For Pain and Palliative Psychology, evaluating human suffering at the end of Life is a most relevant matter as it allows determining the emotional, social and spiritual elements that intensify pain and suffering and those that relieve both, orienting specialists towards intervention. Likewise, having a simple, easy to use and understand instrument enriches team communication and work. The object of this study was to valuate human suffering caused by pain and advanced stage cancer at the Pain Relief and Palliative Care Clinic at Complejo Hospitalario San José. We used Sanuders’ Total Pain model, which is the cornerstone of the Advanced Cancer Pain Relief and Palliative Care National Program.A total of 211 advanced cancer diagnosed patients were interviewed from January through December 2010 when first admitted to the Clinic and were transferred to the Pain Management and Palliative Care Unit. The interviews of the Psychology department used a Total Pain Valuation (TPV) tool that was designed and adjusted to the admittance clinical chart. Interviews lasted 45 minutes in average and were witnessed by main caretakers. This instrument allowed for recording and analyzing sociodemographic, clinical, psychosocial, and Total Pain variables. Data was analyzed at descriptive level using Stata 10.0 program with central and dispersion trend measurements. Based on the most relevant results we may conclude that for this group of patients, pain and advanced stage cancer caused human suffering mostly expressed as separation anxiety feelings (85.1 per cent), tiredness (78.75 per cent), sadness (71.71 per cent), and feelings of uselessness (63.59 per cent).There have been discussions about the limitations and projections of this study and the TPV has been proposed as a useful and efficient tool to valuate and accompany relief of Total Pain caused by advanced stage cancer.

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