Antecedentes: La enfermedad por coronavirus 2019 (COVID-19) en pacientes oncológicos parece inducir mayor severidad y mortalidad. Objetivo: Describir las características clínicas, severidad y ...mortalidad en adultos con cáncer y COVID-19. Material y métodos: Revisión de la literatura del 1 de enero al 31 de mayo del 2020 y análisis combinado de datos individuales. Resultados: Veintiséis estudios analizados, 3,700 casos y 718 defunciones (19.4%); los hombres representaron el 51.6%. Hipertensión arterial sistémica en el 34.9%, diabetes mellitus en el 16.6% y obesidad en el 18%. Predominó el cáncer mamario (23.7%), gastrointestinal (14.4%) y pulmonar (11.5%). El 40.6% tuvo tratamiento oncológico en los 30 días previos. Síntomas frecuentes: fiebre (65.1%), tos (46.8%), disnea (40.1%), fatiga (25%) y diarrea (9.5%). La infección fue severa en el 27.8% y crítica en el 11.8%. El 63.3% requirió hospitalización y el 11.3% cuidados intensivos. El 61.1% requirió oxígeno, el 17.2% ventilación no invasiva y el 9.1% intubación orotraqueal. No fue posible identificar factores asociados a la severidad y mortalidad. Conclusiones: La COVID-19 en adultos con cáncer fue severa o crítica en el 40% de los casos; además, el 30% requirió hospitalización y soporte ventilatorio. La tasa de mortalidad fue del 19.4%.
Cancer is the second cause of death in Mexico, most cases are detected at advanced stages and the use of chemotherapy is frequent. At present, more than 300 types of complementary and/or alternative ...medicine (CAM) treatments are known that offer different therapeutic objectives. Many patients use this type of treatments.
To determine the characteristics of the patients that use CAM, to identify the aim of these treatments, the source of information and the potential benefits obtained by the patient.
A questionnaire was applied from February 20 to March 5, 2004 to non-selected patients with cancer in private consultation to determine age, sex, education level, work, use of CAM, type and number of used therapies, potential benefits and monthly cost. Two groups were formed, A for users and B for non-users of CAM. Results between groups were compared and the mentioned variables were correlated with the use of alternative medicine.
Group A included 37 patients and group B included 38, with no difference regarding age, education level, work and oncological diagnosis, p > 0.05; a significant trend was found as regards the feminine sex, p = 0.07, neoplasm different from breast cancer, p = 0.08 and evident association with neoplasm advanced stages, p = 0.02. Most patients used between 1 and 3 types of therapies, 97.2%. The most common types of therapies were nutritional and spiritual, 54% and 48.6%, respectively. The source was the patient's family in 56.4% and the physician in 24.3%. Complementary and alternative therapy was considered a success in 57.1%; most of the users mentioned benefits (78.6%) deemed as tranquility (46.4%) or improvement of the physical condition (46.4%). The average monthly cost was $ 345.5 dollars, with a range of $ 13.6 to $ 2,545.5 dollars.
The use of complementary and/or alternative therapy is frequent among young women with advanced cancer and high level of education. The family participates in the decision of using these methods; most users noticed a benefit in their general condition and reported tranquility; these patients may be prone to higher incidence of depression and anxiety. The effectiveness and safety of this type of treatments remain to be determined, as well as the possible interactions with conventional therapy.
Antecedentes: El cáncer de células pequeñas (CPCP) representa el 13-15% del total de neoplasias primarias de pulmón. Se caracteriza por su rapidez en la tasa de crecimiento y en el desarrollo de ...metástasis a distancia. Objetivos: Orientar y estandarizar el tratamiento del CPCP, enfermedad limitada, en México, basado en evidencia clínica nacional e internacional. Material y métodos: Este documento se desarrolló como una colaboración entre el Instituto Nacional de Cancerología y la Sociedad Mexicana de Oncología en cumplimiento con estándares internacionales. Se integró un grupo conformado por oncólogos médicos, cirujanos oncólogos, cirujanos de tórax, radio-oncólogos y metodólogos con experiencia en revisiones sistemáticas de la literatura y guías de práctica clínica. Resultados: Se consensuaron, por el método Delphi y en reuniones a distancia, las recomendaciones en CPCP enfermedad limitada, producto de las preguntas de trabajo. Se identificó y evaluó críticamente la evidencia científica que responde a cada una de dichas preguntas clínicas, antes de incorporarla a la guía. Conclusión: Esta guía proporciona recomendaciones clínicas para el manejo de la enfermedad limitada del CPCP y durante el proceso de toma de decisiones de los clínicos involucrados con su manejo en nuestro país para mejorar la calidad de la atención clínica en estos pacientes.
Adjuvant chemotherapy (ACT) reduces recurrence and mortality in breast cancer (BC); however, not all patients require ACT. Oncotype Dx® (ODX) explores the expression of 21 genes and the risk of ...recurrence BC.
To determine the clinicopathologic characteristics, prognosis, and the prescription for ACT in early BC according to ODX risk groups.
36 patients with resected stage I-IIA BC, axillary lymph node-negative or 1-3+, hormonal receptor (HR)-positive, HER2 negative. Three groups were designed by ODX: low (LG), medium (MG) and high-risk groups (HG).
LG 23 patients (63.9%), MG eight (22.2%) and HG five (13.9%). We detected high expression of Ki-67 in MG and HG in relation to LG, 21.1 and 32.5 versus 10.1%, respectively (p = 0.007) and lower ER-positive, 85.3, 85.4 and 56.9%, respectively (p = 0.005). Recurrence score: LG 12 (0-18), MG 23 (19-27) and HG 47 (36-57); p < 0.000. Pre-ODX, we planned ACT in 21/36 patients (58.3%) and post-ODX only 9/36 patients (25%) received it. No recurrences or deaths were observed in all groups.
In early BC, 64% have low recurrence risk. High-risk cases presented elevated Ki-67 and lower ER expression. ODX modifies the therapeutic recommendation in 57.2% of cases.
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