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Cancer research in Latin America, 2014-2019, and its disease burden
No full textThere is little available information on cancer research overall in Latin American and Caribbean countries, and on its relationship with the disease burden from cancer, which is increasing as a proportion of the total. We identified cancer research papers in the Web of Science from 2014-19. Outputs of the region on anatomical cancer sites were compared with the relative disease burden from these cancers. Outputs of individual countries were compared with their wealth and their disease burden from cancer. Their usage and impact on other researchers were determined from U2, a new usage indicator, citation counts over three years (C0-2), and the impact factor of the journals in which they were published (JIF). In 2014-19, Brazil, Chile and Uruguay published twice the amounts expected from the Latin American trend-line, but much less than European countries, relative to their Gross Domestic Products (GDPs). Most countries under-researched cancer relative to its burden. Lung, pancreatic and oesophageal cancers were relatively neglected. Less populous countries' research was of high impact, principally due to international collaboration with larger nations. Latin American research funding was dominated by the public sector. Current research orientation and funding is insufficient to combat the growing cancer burden in Latin America. This reflects the lack of research funding overall, relative to the countries' GDPs. The paucity of private-non-profit support needs to be addressed with policies to encourage public donations, and the endowment of foundations. There is also a need to improve the infrastructure for clinical trials.We are grateful to Professor Hernan Chaimovich of the University of São Paulo for his helpful and insightful comments, and to Dr Philip Roe of Evaluametrics Ltd for the provision of the macros (programs) used for the analysis. GO acknowledges funding from CONICYT (FONDAP-1513001), IMII (P09/016-F) and FONDECYT (1180241)
Prevalence of H. pylori Infection in Relatives of Peruvian Patients with Gastric Cancer
No full textbjective:
The aim of this study was to determine the relationship between Helicobacter pylori (H. pylori)
infection in relatives and patients with gastric cancer (GC).
Methods:
H. pylori infection was evaluated by
the breath urease test in 171 relatives and by qPCR technique in gastric tissue of 61 patients (n=45 for GC and
n=16 for non-GC).
Results:
There were included 137 relatives of GC patients and 34 of non-GC. The median
age of the relatives of patients with a gastric tissue sample was 39 years (10-86). Infection was found in 60.2%
(n=103) relatives. There were no higher H. pylori infection rates in relatives of patients with gastric cancer
(62% vs 62.9%, p=0.33), H. pylori infection (60% vs 60%, p=0.96), or metaplasia (58.8% vs 61.8%, p=0.71).
Conclusion:
The prevalence of infection in relatives of GC patients is high in our population but not associated
with H. pylori presence in the paired caseThis work was supported by InnovatePeru (#430-PNICP-PIAP-2014) and CONCYTEC (#197-2015-FONDECYT)
Factores emocionales asociados al automanejo en personas con diagnóstico de cáncer "
No full textIntroducción: Las personas con diagnóstico de cáncer y que reciben tratamiento manifiestan factores estresantes, físicos, emocionales y sociales, que inciden en la salud mental del paciente, por lo tanto, se reconoce la importancia de las prácticas de automanejo para aliviar la carga de estos. factores. Objetivo: Identificar factores emocionales que puedan ser útiles para predecir la práctica de automanejo. Método: Diseño transversal, predictivo, muestreo no probabilístico intencional conformado por 160 personas con diagnóstico de cáncer. Se emplearon los instrumentos: Partners in Health (PIH), Self-rated Health, Escala de depresión del Cuestionario de Salud del Paciente (PHQ-8P), Escala Visual Análoga para valorar el estrés e insomnio. Se aplicó el modelo de regresión lineal múltiple; se calculó el efecto de la diferencia y la potencia estadística utilizando el método de escalado. Resultados: Se identifican dos variables predictoras con significancia estadística (p <.05): problemas para dormir β= -1.310 y trastorno depresivo β= -.440, con una varianza del 10 %, prueba de Durbin-Watson 1,658, tamaño del efecto 0,15 y una potencia de 0,95. Discusión y Conclusiones: Las personas con cáncer presentan una práctica de automanejo deficiente. Se identifican factores emocionales que interfieren en este comportamiento: estrés, trastorno depresivo y problemas para dormir; los dos últimos los factores pueden influir en el automanejo. Se sugiere seguir investigando y profundizar el estudio con el fin de identificar otras barreras asociadas al automanejo, sus diferenciaciones según perfiles sociodemográficos y estadio de la enfermedad
Adaptation of international coronavirus disease 2019 and breast cancer guidelines to local context
No full textBackground: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (a novel coronavirus), which was first identified amid an outbreak of respiratory illness cases in Wuhan, China and declared a global health emergency, is currently considered an additional challenge in the management of patients with breast cancer (BC). Cancer patients are more vulnerable to becoming infected with severe acute respiratory syndrome coronavirus 2 and are more likely to suffer additional complications that can increase mortality. Identifying those BC patients who require more urgent therapy than others in the current situation is essential. These recommendations are based on and have been adapted from those similarly published by international scientific societies for BC management. They are divided mainly by clinical stage (early, advanced), subtype [luminal, human epidermal growth factor receptor 2 (HER2), triple-negative], or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes are similar, whereas in luminal subtype there are various options of management. The objective is to adapt guidelines to local context through relevant decision-makers, avoiding duplication of efforts and optimizing use or resources. We hope that these recommendations will help medical oncologists provide the best quality care to BC patients during the COVID-19 pandemic with information tailored to our healthcare system. Aim: To establish and adapt recommendations from those published by international scientific societies for BC management. Methods: The Peruvian Society of Medical Oncology developed a consensus and propose here a manuscript with recommendations for oncological medical treatment of BC during the COVID-19 pandemic. The Peruvian Society of Medical Oncology invited a panel of experts and opinion leaders on BC working in major health care systems around Peru. Panel experts selected three international clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, Spanish Foundation Research Group in Breast Cancer), considering that these are more representative in COVID-19 management. Also, the panel agreed to include at least one European and American clinical practice guideline.
Results: Recommendations about BC management during the COVID-19 pandemic were divided mainly by clinical stage (early, advanced), subtype (luminal, HER2, triple-negative), or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes were similar between clinical practice guidelines, whereas in luminal subtype there were various options of management. One hundred twelve recommendations were reviewed, adapted, and voted. A consensus was made in order to provide best decisions of management, avoid duplication of efforts, and optimize medical resources, considering health care system reality. These recommendations are not intended to replace clinical judgment.Conclusion: Most of recommendations are similar, mainly in high-risk subtypes (HER2, triple-negative). Certain societies adapt them to deal with different situations involving the best decision in the management of BC patients
PIK3CA mutation in non-metastatic triple-negative breast cancer as a potential biomarker of early relapse: A case report
No full textBackground: Currently, the detection of PIK3CA mutations is of special interest in personalized medicine because it is frequently found in triple-negative breast cancer (TNBC). The PI3KCA mutation is an independent negative prognostic factor for survival in metastatic breast cancer, and its prognostic value in liquid biopsy as a biomarker of treatment and early relapse is under investigation, both for metastatic disease and neoadjuvant scenario with curative intent. Case summary: A 54-year-old female patient with TNBC clinical stage IIIA, who, after receiving neoadjuvant chemotherapy (based on anthracyclines and taxanes), surgery, radiotherapy, and adjuvant capecitabine, was detected with a PI3KCA mutation in tissue and peripheral blood (ctDNA in liquid biopsy). After 10 mo, the patient had disease relapse of left cervical node disease. Conclusion: The detection of PIK3CA mutation in TNBC after neoadjuvant treatment might be associated with early relapse or rapid disease progression
Clinicopathological factors associated with the presence of tumor deposits in resected gastric cancer patients
No full textPurpose: The role of tumor deposits (TDs) in the staging of gastric cancer is currently debatable. TDs are defined as tumoral nodules in perigastric adipose tissue with no evidence of lymphatic, vascular, or neural structures. Clinicopathological factors related to the presence of TDs are not well defined. This study aimed to identify the clinicopathological factors associated with the presence of TDs in resected gastric cancer patients.
Materials and methods: This prospective study included patients diagnosed with gastric cancer and treated with D2 radical gastrectomy from January 2019 to January 2020. Univariate and multivariate analyses were performed to determine the factors related to the presence of TDs.
Results: A total of 111 patients were eligible and TDs were present in 31 of them (28%). In the univariate analysis, male gender (p = 0.027), tumor size ≥ 5cm (p = ≤0.001), serosa and adjacent organs invasion (pT4a and pT4b) (p = ≤0.001), ≥16 metastatic lymph nodes (pN3b) (p = ≤0.001), and TNM stage III tumors (p = ≤0.001) were significantly associated with the presence of TDs. The multivariate analysis showed that a tumors size ≥5 cm (OR = 3.69, 95% CI: 1.17-11.6), serosa and adjacent organs invasion (pT4a and pT4b) (OR = 3.78, 95% CI: 1.31-10.86) and ≥16 metastatic lymph nodes (pN3b) (OR = 3.21, 95%CI:1.06-9.7) were independent risk factors for the presence of TDs.
Conclusions: Larger tumors (tumor size ≥ 5cm), serosa and adjacent organs invasion (pT4 and pT4b), and ≥16 metastatic lymph nodes (pN3b) were independent risk factors for the presence of TDs.
Keywords: Gastric cancer; Pathology; Surgery; Tumor deposits (TDs)
Update on the epidemiology of carbapenemases in Latin America and the Caribbean
No full textIntroduction: Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D. Areas covered: Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean.Expert opinion: Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy
Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer
No full textBackground: Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. Patients and methods: We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. Results: In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). Conclusion: A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC
Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420)
No full textPurpose: COVID-19 has affected cancer care worldwide. Clinical trials are an important alternative for the treatment of oncologic patients, especially in Latin America, where trials can be the only opportunity for some of them to access novel and, sometimes, standard treatments.Methods: This was a cross-sectional study, in which a 22-question survey regarding the impact of the COVID-19 pandemic on oncology clinical trials was sent to 350 representatives of research programs in selected Latin American institutions, members of the Latin American Cooperative Oncology Group.Results: There were 90 research centers participating in the survey, with 70 of them from Brazil. The majority were partly private or fully private (n = 77; 85.6%) and had confirmed COVID-19 cases at the institution (n = 57; 63.3%). Accruals were suspended at least for some studies in 80% (n = 72) of the responses, mostly because of sponsors' decision. Clinical trials' routine was affected by medical visits cancelation, reduction of patients' attendance, reduction of other specialties' availability, and/or alterations on follow-up processes. Formal COVID-19 mitigation policies were adopted in 96.7% of the centers, including remote monitoring and remote site initiation visits, telemedicine visits, reduction of research team workdays or home office, special consent procedures, shipment of oral drugs directly to patients' home, and increase in outpatient diagnostic studies. Importantly, some of these changes were suggested to be part of future oncology clinical trials' routine, particularly the ones regarding remote methods, such as telemedicine. Conclusion: To our knowledge, this was the first survey to evaluate the impact of COVID-19 on Latin American oncology clinical trials. The results are consistent with surveys from other world regions. These findings may endorse improvements in clinical trials' processes and management in the postpandemic period
Preoperative Predictors for 90-Day Mortality after Pancreaticoduodenectomy in Patients with Adenocarcinoma of the Ampulla of Vater: A Single-Centre Retrospective Cohort Study
No full textBackground: The standard treatment for ampullary adenocarcinoma is pancreaticoduodenectomy. Identification of preoperative risk factors might help the clinician to select patients fit for resection and potentially decrease morbidity and mortality after PD. We conducted a cohort study to determine the preoperative factors related to 90-day severe morbidity and mortality after PD.Methods: We conducted a retrospective cohort study in patients with a diagnosis of ampullary adenocarcinoma who underwent an open PD between January 2010 and December 2019 at our tertiary centre.Results: Independent preoperative predictors of mortality were the albumin-bilirubin (ALBI) grade 3 (OR: 21.7; CI 95: 2.1-226.9; p=0.01) and the estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 (OR: 17.7; CI 95: 1.8-172.6; p=0.013). The eGFR <90 mL/min/1.73 m2 (OR = 6.6; CI 95: 1.9-23.4; p=0.003) and prothrombin time (OR = 1.5; CI 95; 1.1-2.1; p=0.005) were independent predictors for severe morbidity. Conclusion: These findings suggest that baseline renal function measured by the eGFR and liver function categorized with the ALBI grading are predictors of severe morbidity and mortality. Thus, they should be considered when selecting patients for PD or the use of neoadjuvant treatments. Further research is warranted