Repositorio Institucional INEN
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Epidemiology and natural history of penile cancer
No full textAn extensive literature search was performed using the key words squamous cell carcinoma of the penis, phimosis, circumcision, chronic balanitis, cigarette smoking, genital warts and human papillomavirus (HPV) infection. All selected studies were classified according to the level of evidence (LE). The final grades of recommendation were assigned after discussion by the full panel of the International Consultation on Penile Cancer in November 2008. The factors positively associated with invasive penile cancers include the presence of phimosis (LE 3a), tobacco smoking (LE 3a-4), chewing tobacco (LE 3a), injury to the penis (LE 3a), balanitis (LE 3a), genital warts (LE 3a), and high-risk HPV infection (LE 3a-4)
Cancer incidence and mortality trends in young adults in Metropolitan Lima young adults, 1990-2012
No full textObjectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.Design, setting, and participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main outcomes and measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs
Sarcoma European and Latin American Network (SELNET) Recommendations on Prioritization in Sarcoma Care During the COVID-19 Pandemic
No full textBackground: The COVID‐19 outbreak has resulted in collision between patients infected with SARS‐CoV‐2 and those with cancer on different fronts. Patients with cancer have been impacted by deferral, modification, and even cessation of therapy. Adaptive measures to minimize hospital exposure, following the precautionary principle, have been proposed for cancer care during COVID‐19 era. We present here a consensus on prioritizing recommendations across the continuum of sarcoma patient care. Material and Methods: A total of 125 recommendations were proposed in soft‐tissue, bone, and visceral sarcoma care. Recommendations were assigned as higher or lower priority if they cannot or can be postponed at least 2–3 months, respectively. The consensus level for each recommendation was classified as “strongly recommended” (SR) if more than 90% of experts agreed, “recommended” (R) if 75%–90% of experts agreed and “no consensus” (NC) if fewer than 75% agreed. Sarcoma experts from 11 countries within the Sarcoma European‐Latin American Network (SELNET) consortium participated, including countries in the Americas and Europe. The European Society for Medical Oncology‐Magnitude of clinical benefit scale was applied to systemic‐treatment recommendations to support prioritization. Results: There were 80 SRs, 35 Rs, and 10 NCs among the 125 recommendations issued and completed by 31 multidisciplinary sarcoma experts. The consensus was higher among the 75 higher‐priority recommendations (85%, 12%, and 3% for SR, R, and NC, respectively) than in the 50 lower‐priority recommendations (32%, 52%, and 16% for SR, R, and NC, respectively). Conclusion: The consensus on 115 of 125 recommendations indicates a high‐level of convergence among experts. The SELNET consensus provides a tool for sarcoma multidisciplinary treatment committees during the COVID‐19 outbreak
Global Retinoblastoma Presentation and Analysis by National Income Level
No full textImportance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale
Prognostic impact of diagnostic and treatment delays in children with osteosarcoma
No full textBackground: The aim of this study is to evaluate the relationship between the latency to diagnosis (LD) and the time to completion of chemotherapy (TCC) with clinical outcomes in children with osteosarcoma.Methods: We performed a retrospective analysis of all patients who received treatment for osteosarcoma in two tertiary centers in Peru from 2008 to 2015. All causes of delayed LD or TCC were evaluated. Overall survival (OS) and event-free-survival (EFS) were estimated and compared according to LD, TCC, and established clinical prognostic factors. Results: One hundred and thirteen patients were included in the study. The median LD was 13.5 weeks (interquartile range, 10-18.5 weeks). No association was observed among clinical stage, tumor size, and LD. Delayed LD was not associated with a worse clinical outcome. Multivariate analysis confirmed that OS and EFS were significantly worse in cases of a delayed TCC (≥4 weeks), with hazard ratios of 2.70 (1.11-6.76, P = 0.003) and 1.13 (1.00-1.26, P = 0.016), respectively. Most delays in TCC (85%) were due to extramedical reasons (e.g., lack of available hospital beds). Conclusion: The LD did not seem to influence the EFS and OS in pediatric patients with osteosarcoma. However, a delay in TCC from any cause is independently associated with poor outcome in pediatric patients with osteosarcoma. Based on these results, further efforts may be needed to avoid treatment delays in patients with osteosarcoma in middle-income countries
Health Education by Nurses: Self-Care of Patients with Chemotherapy from a Specialized Cancer Institute in Lima-Peru
No full textObjective: To determine self-care in patients with chemotherapy in a pre-post educational intervention test performed by nurses from a specialized oncology institute. Methodology: Quantitative, quasi-experimental, longitudinal. Population of 90 patients with chemotherapy treatment, who were given 3 educational sessions with a pre and post test evaluation; in addition, a questionnaire with 4 dimensions was applied: nutrition, hygiene, infection prevention and avoidance of complications, with 20 items, a Likert scale validated by experts and a reliability of 0.8. Results: In the pre-test, self-care levels were 60% low, 22.2% high and 17.8% medium. In the post-test, self-care levels were 96.7% high and 3.3% medium. In relation to the dimensions of self-care in the pre-test, levels were found to be in Food: 52.2% low and 26.7% high; Hygiene: 42.2% low and 17.8% high; Infection prevention: 36% high and 30% low; and avoidance of complications: 55.6% low and 8.9% high. Finally, in the post-test, levels of: Feeding 94.4% high and 5.6% medium; Prevention of infections: 91.1% high and 8.9% medium. Dimensions: Hygiene and avoidance of complications, obtained 100% high level. Conclusion: It was demonstrated that nurses who promote education on self-care and incorporate the delivery of educational materials, increase knowledge and practices of self-care in their daily lives, which favor the welfare and ensure a quality of life in the patient
Health education by nurses: self-care of patients with chemotherapy from a specialized cáncer Institute in Lima -Perú
No full textObjective: To determine self-care in patients with chemotherapy in a pre-post educational intervention test performed by nurses from a specialized oncology institute. Methodology: Quantitative, quasi-experimental, longitudinal. Population of 90 patients with chemotherapy treatment, who were given 3 educational sessions with a pre and post test evaluation; in addition, a questionnaire with 4 dimensions was applied: nutrition, hygiene, infection prevention and avoidance of complications, with 20 items, a Likert scale validated by experts and a reliability of 0.8. Results: In the pre-test, self-care levels were 60% low, 22.2% high and 17.8% medium. In the post-test, self-care levels were 96.7% high and 3.3% medium. In relation to the dimensions of self-care in the pre-test, levels were found to be in Food: 52.2% low and 26.7% high; Hygiene: 42.2% low and 17.8% high; Infection prevention: 36% high and 30% low; and avoidance of complications: 55.6% low and 8.9% high. Finally, in the post-test, levels of: Feeding 94.4% high and 5.6% medium; Prevention of infections: 91.1% high and 8.9% medium. Dimensions: Hygiene and avoidance of complications, obtained 100% high level. Conclusion: It was demonstrated that nurses who promote education on self-care and incorporate the delivery of educational materials, increase knowledge and practices of self-care in their daily lives, which favor the welfare and ensure a quality of life in the patient
A phased approach to implementing the Breast Imaging Reporting and Data System (BI-RADS) in low-income and middle-income countries
No full textBackground: Successful breast cancer detection programs rely on standardized reporting and interpreting systems, such as the Breast Imaging Reporting and Data System (BI-RADS), to improve system performance. In low-income and middle-income countries, evolving diagnostic programs have insufficient resources to either fully implement BI-RADS or to periodically evaluate the program's performance, which is a necessary component of BI-RADS. This leads to inconsistent breast ultrasound interpretation and a failure to improve performance. Methods: The authors applied the Breast Health Global Initiative's phased implementation strategy to implement diagnostic ultrasound and BI-RADS within the context of a limited-resource setting. Results: The authors recommended starting with triage ultrasound to distinguish suspicious masses from normal breast tissue and benign masses such as cysts because the majority of health workers performing ultrasounds at this level have minimal breast imaging experience. Transitioning to full diagnostic ultrasound with condensed or full BI-RADS should occur after performance and quality metrics have been met. Conclusions: Transitioning through these phases across facilities likely will occur at different times, particularly in rural versus urban settings
Breast Cancer Early Detection: A Phased Approach to Implementation
No full textWhen breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered
Interventional cytopathology and cancer in Peru: how to act during COVID-19?
No full textThe worldwide health crisis due to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has affected all healthcare systems. Low- and middle-income countries have needed to establish health strategies to combat the pandemic, many of which have collaterally affected the diagnosis and treatment of other illnesses. One of these other illnesses is cancer, which in Peru represents the primary cause of mortality. In recent decades, interventional cytopathology with fine-needle biopsy techniques has emerged as a minimally invasive, rapid, economical and effective procedure for diagnosing and staging cancer. However, in the current health context, it is confronted by the challenge of continuing to function in spite of the pandemic. This article reviews the existing literature on interventional cytopathology, the risk of infection from SARS-CoV-2 and biosafety and provides recommendations for carrying out said procedures for the benefit of the patient and the safety of healthcare staff