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Educational intervention: Self-care in Ostomised patients
No full textObjective: To determine the level of knowledge before and after educational intervention on self-care in ostomized patients attending the Ostomal and Wound Therapy Unit at the National Institute of Neoplastic Diseases. Methodology: Quantitative study, pre-experimental longitudinal design. Population: a sample of 122 patients. A questionnaire was used on self-care knowledge in patients with the following dimensions: ostomy knowledge, ostomy management, feeding, ostomy complications, and products used for ostomy care. The results obtained in the pretest, 61.5% of patients know the ostomy, 60.7% have ostomy care, 31.1% have fed, and after the educational intervention, they achieved 100% knowledge. In the case of knowledge of complications and materials 18% and 23.0% were found, respectively, after the nursing educational intervention they obtained 96.7% of cognitive ability. Conclusions: The educational intervention should be permanent to guarantee the importance of the care given by the nurse of the service, empowering the nurse as an educator
Personal and institucional factors associated with the quality of nursing notes recording in hospitalized oncology patients
No full textObjective: To determine whether personal and institutional factors are associated with the quality of the nursing notes register in hospitalized patients at the National Institute of Neoplastic Diseases. Methodology: A quantitative, basic, descriptive-correlational, non-experimental, cross-sectional study. The population consisted of a total of 129 nursing professionals working in the hospitalization area who prepared nursing notes. Two instruments were used to evaluate the personal and institutional factors and the quality of the nursing notes register, which was validated by expert judgment and with a reliability of Cronbach's alpha 0.8 and KR of 0.86. The results obtained show a moderate correlation (0.695) between the personal and institutional factors and the quality of nursing notes. Likewise, the personal and institutional factors and the content of nursing notes have a moderate correlation (0.492 and 0.483), while the personal and institutional factors and the structure of nursing notes have a moderate correlation (0.471 and 0.445). It is concluded that it is necessary to continue with the training of nurses to strengthen competencies and skills to adequately develop the content and structure of nursing notes
The impact of telemedicine on cancer care: real-world experience from a Peruvian institute during the COVID-19 pandemic
No full textBackground: 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
Primary intracranial spindle cell sarcoma with rhabdomyosarcoma-like features share a highly distinct methylation profile and DICER1 mutations
No full textPatients with DICER1 predisposition syndrome have an increased risk to develop pleuropulmonary blastoma, cystic nephroma, embryonal rhabdomyosarcoma, and several other rare tumor entities. In this study, we identified 22 primary intracranial sarcomas, including 18 in pediatric patients, with a distinct methylation signature detected by array-based DNA-methylation profiling. In addition, two uterine rhabdomyosarcomas sharing identical features were identified. Gene panel sequencing of the 22 intracranial sarcomas revealed the almost unifying feature of DICER1 hotspot mutations (21/22; 95%) and a high frequency of co-occurring TP53 mutations (12/22; 55%). In addition, 17/22 (77%) sarcomas exhibited alterations in the mitogen-activated protein kinase pathway, most frequently affecting the mutational hotspots of KRAS (8/22; 36%) and mutations or deletions of NF1 (7/22; 32%), followed by mutations of FGFR4 (2/22; 9%), NRAS (2/22; 9%), and amplification of EGFR (1/22; 5%). A germline DICER1 mutation was detected in two of five cases with constitutional DNA available. Notably, none of the patients showed evidence of a cancer-related syndrome at the time of diagnosis. In contrast to the genetic findings, the morphological features of these tumors were less distinctive, although rhabdomyoblasts or rhabdomyoblast-like cells could retrospectively be detected in all cases. The identified combination of genetic events indicates a relationship between the intracranial tumors analyzed and DICER1 predisposition syndrome-associated sarcomas such as embryonal rhabdomyosarcoma or the recently described group of anaplastic sarcomas of the kidney. However, the intracranial tumors in our series were initially interpreted to represent various tumor types, but rhabdomyosarcoma was not among the typical differential diagnoses considered. Given the rarity of intracranial sarcomas, this molecularly clearly defined group comprises a considerable fraction thereof. We therefore propose the designation "spindle cell sarcoma with rhabdomyosarcoma-like features, DICER1 mutant" for this intriguing group
Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings
No full textImportance: Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settingshowever, there may be barriers to implementation. Objective: To evaluate stakeholder-reported barriers and enablers to PEWS implementation in resource-limited hospitals. Design, Setting, and Participants: In this qualitative study, semistructured stakeholder interviews were conducted at 5 resource-limited pediatric oncology centers in 4 countries in Latin America. Hospitals participating in a multicenter collaborative to implement PEWS were purposefully sampled based on time required for implementation (fast vs slow), and stakeholders interviewed included physicians, nurses, and administrators, involved in PEWS implementation. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted virtually in Spanish, audiorecorded, and professionally transcribed and translated into English. A codebook was developed a priori using the CFIR and supplemented with codes inductively derived from transcript review. Two coders independently analyzed all transcripts, achieving a κ of 0.8 to 0.9. The study was conducted from June 1 to August 31, 2020. Main Outcomes and Measures: Thematic analysis was conducted based on CFIR domains (inner setting, characteristics of individuals, outer setting, intervention characteristics, and implementation process) to identify barriers and enablers to PEWS implementation. Results: Seventy-one staff involved in PEWS implementation were interviewed, including 32 physicians (45%), 32 nurses (45%), and 7 administrators (10%). Of these, 50 were women (70%). Components of the 5 CFIR domains were mentioned by participants as barriers and enablers to PEWS implementation at both fast- and slow-implementing centers. Participants emphasized barriers at the level of the clinical staff, hospital, external factors, and PEWS intervention. These barriers included staff resistance to change, inadequate resources, components of health systems, and the perceived origin and complexity of PEWS. At all centers, most barriers were successfully converted to enablers during the implementation process through targeted strategies, such as early stakeholder engagement and adaptation, including adapting PEWS to better fit the local context and changing the hospital setting to support ongoing use of PEWS. Conclusions and Relevance: To date, this is the first multicenter, multinational study describing barriers and enablers to PEWS implementation in resource-limited settings. Findings suggest that many barriers are not immutable and can be converted to enablers during the implementation process. This work can serve as a guide for clinicians looking to implement evidence-based interventions to reduce global disparities in patient outcomes. © 2020 Armand Colin. All rights reserved
Sex, immunity, and cancer
No full textThe composition of the tumor microenvironment is the complex result of the interaction between tumoral and host factors. Since there are several differences in the regulation of gene circuits between sexes, mainly influenced by sex hormones, the tumor-host interaction presents some differences, leading tumors to evolve under different conditions. Nowadays, it is well known the existence of sexual dimorphism in the regulation of the immune system, where women present an improved immunity to various infectious agents and, on the other hand, a higher incidence of autoimmune diseases than men. In oncology, differences in cancer susceptibility, response to treatment, and clinical outcomes between men and women patients are well known. Recently, sex-specific differences have also been reported in mutations in driver genes and the prognostic value of several biomarkers. Sex has been a widely forgotten biomarker in cancer therapy, but it has recently acquired great relevance due to the different results seen in immunotherapy treatment. © 2021 Elsevier B.V
Open versus minimally invasive sphincter-sparing surgery for rectal cancer: a single-center retrospective cohort study in Peru
No full textOBJECTIVE: The study aimed to describe and compare minimally invasive surgery (MIS) and open surgery for rectal cancer in Peru. MATERIAL AND METHODS: A retrospective single-center analysis was performed for all patients who underwent sphinctersparing surgery for non-metastatic rectal cancer at Instituto Nacional de Enfermedades Neoplásicas in Peru between January 2016 and December 2020. Clinical, perioperative, pathological, and survival outcomes were compared between both groups. A propensity score matching method was used to minimize bias. RESULTS: 162 patients were included in the final analysis. 124 had open surgery and 38 had MIS. Patients, clinical tumour, pathological characteristics, and perioperative were similar between groups after matching. Similar circumferential resection margin (CRM) with optimal quality of the mesorectum (p=1.000) but higher number of lymph nodes resected in open surgery group (p=0.741) was described. The leakage rate was slightly higher in the MIS group (p=0.358) with 10.5%, while the postoperative hospital stay was longer in the open surgery group after matching (p=0.001 OR 95% 5.2 CI: 1.8-15.6). The estimated recurrence-free survival (RFS) and overall survival (OS) at 3 years in open surgery and MIS was 71.8% (95% CI 0.58-0.89) and 70% (95% CI 0.56-0.88) (p=0.431) and 77.7% (95% CI 0.64-0.94) and 88.9% (95% CI 0.79-0.99) (p=0.5), respectively. CONCLUSIONS: Shorter postoperative hospital stay in the minimally invasive surgery group was reported. RFS, OS, and recurrence rates were similar between both groups. This approach is for non-metastatic rectal cancer in referral centers in Peru
Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope
No full textPurpose: To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3–1.0 Gy) radiotherapy to the lungs. Materials and Methods: PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. Results: Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover ∼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were −0.1% (range −3% to +4%) for the PA treatment and 0.3% (range −10.3% to +15.2%) for the 4-field treatment. Conclusion: A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs
Percepción del apoyo social y calidad de vida en pacientes oncológicos con tuberculosis que acuden a consultorios externos inen
No full textObjective: To determine the perception of social support and quality of life in cancer patients with tuberculosis attending outpatient clinics of the national institute of neoplastic diseases in 2021. Methodology: The study had a quantitative, correlational, cross-sectional, non-experimental design. The population consisted of approximately 80 oncology patients with tuberculosis attending the INEN tuberculosis prevention and control program. Two instruments were used; the MOS questionnaire of Social Support in Primary Care (De la Revilla et al., 2005), to measure social support with 4 dimensions: Emotional, positive social interaction, instrumental and affective with 14 items and the WHOQOL-BREF quality of life scale, which evaluates 4 dimensions: physical health, psychological health, social relationships and environment, with 26 items both instruments with a Likert scale that were validated by expert judgment and a pilot test was performed to obtain Cronbach's alpha. The results obtained were that there is a Spearman correlation indicating that there is a moderate relationship between perception social support and the quality of life in oncology patients with tuberculosis (Rho= ,582), which means that both variables are significant (p= ,000 < ,05)
Pain prevalence and chronicity in a developing country in Latin America: a population-based survey in Lima, Peru
No full textBackground: No population-based epidemiological studies have estimated pain prevalence and its characteristics in Peru. Patients & methods: A representative sample of adults aged over 18 years (n = 502) living in metropolitan Lima, Peru was enrolled. We analyzed prevalence data of pain in the last 3 months and other pain-related characteristics. Results: Pain prevalence was 65.3% (95% CI: 57.7-70.4%). Chronic pain prevalence was 38.5% (95% CI: 33.5-44.0%) and acute pain prevalence was 24.8% (95% CI: 20.7-29.0%). In participants with chronic pain, almost half (55.7%) reported having not used any medication. Conclusion: Pain is prevalent in this population and our results suggest high undertreatment rates. © 2022 The Authors. Plain language summary Although pain is a very important health problem, little is known in Peru about how many people it affects and what its characteristics are. This study aimed to determine the frequency of pain and other related characteristics such as type and location. A sample of inhabitants of metropolitan Lima were surveyed in their homes and were asked about their pain experience in the last 3 months. We found that about seven out of ten had experienced pain in the last 3 months. More than one-third of the participants had pain that lasted more than 3 months (chronic pain). Nearly one-half of the participants with chronic pain had not used any medication to manage their pain. In conclusion, pain is prevalent in the Peruvian population and the results suggest that a large proportion of these people did not receive adequate medical treatment