Efficacy and safety of induction chemotherapy in oral cavity cancer: An eight-year experience at a Portuguese reference center.

BACKGROUND: Induction chemotherapy has been described as an option in locally advanced oral cavity squamous cell carcinoma when the surgical morbidity is expected to be high. This work aimed to evaluate the outcome and safety of induction chemotherapy in this setting. METHODS: We performed a retrospective and observational study including patients with oral cavity squamous cell carcinoma, treated with induction chemotherapy between January 2010 and December 2018. Outcomes included induction chemotherapy toxicity, treatment response, disease-free survival and overall survival. RESULTS: A total of 108 oral cavity squamous cell carcinoma patients were included. Ninety-six (88.9%) had stage IV disease, while 12 (11.1%) had stage III. Eighty-four patients (80.8%) achieved at least a partial response to induction chemotherapy at clinical evaluation, and 75 (72.1%) at radiological evaluation. Seventy-eight patients have been proposed for subsequent definitive treatments, with no differences obtained in prognosis, when comparing surgical to non-surgical approaches. In patients treated with definitive treatments, improved five-year disease-free survival was obtained if at least a clinical (56.3%; p=0.001) or radiological (52.9%; p=0.001) partial response was achieved after induction chemotherapy. Similarly, superior five-year overall survival was verified for those achieving at least clinical (51.1%; p<0.0001) or radiological (52.6%; p=0.001) partial response. Also, accomplishing a pathologic complete response (n=22.6%) significantly improved disease-free survival (p=0.039) and overall survival (p=0.005). Grade 3 and 4 toxicities were observed in 52 patients (41.8%). CONCLUSION: Responses to induction chemotherapy predicted prognosis in our population, however important toxicities were observed. Further studies are necessary to identify induction chemotherapy response predictors and subgroups who may benefit from this approach.

Head and neck cancer patient journey's health literacy: a multidisciplinary team perspective. VOICE study.

PURPOSE: Health literacy is a current Public Health priority in Portugal. The participation of well-informed patients in their care and shared decision making are essential, especially in chronic aggressive and debilitating pathologies such as recurrent or metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC). AIMS: This study aimed to characterize R/M HNSCC patients' and caregivers' information needs identified by healthcare professionals (HCPs). METHODS: Two online Focus Groups, one with only medical doctors and the other with other HCPs involved in the treatment of R/M HNSCC patients, were conducted, using a modified Metaplan, Lean or adapted PDCA methodology. The discussions were audio recorded in full and content analysis was performed using ATLAS.ti qualitative data analysis software. RESULTS: Topics addressed were diagnosis, treatment, quality of life, and global evaluation. In general, all experts agreed that only essential information should be cautiously given, according to patients' and caregivers' wishes. It was consensual that patients are given the necessary information to adhere to treatment. Two main barriers were identified: one barrier was associated with verbal communication due to the lack of health literacy of these patients, and the other barrier regarded healthcare access. It was also considered important to remind patients of the daily and social activities that they could and should maintain, as well as providing sufficient social resources and problem-solving training to caregivers. CONCLUSIONS: This qualitative study highlights the complexity of R/M HNSCC patients' care. Immediate availability of psychologists and psychiatrists should be implemented in all centers that treat HNSCC patients. The differences found between the physicians' Focus Group and other HCPs' Focus Group in some of the addressed topics emphasize the importance of a multidisciplinary and holistic approach, in a biomedical model integrated with a biopsychosocial model.

Inibidores BTK e BCL-2 no Tratamento de Primeira Linha da Leucemia Linfocítica Crônica em Pacientes de Alto Risco: Revisão Sistemática e Meta-Análise em Rede / BTK and BCL-2 Inhibitors in the First-Line Treatment of Chronic Lymphocytic Leukemia in High-Risk Patients: Systematic Review and Network Meta-Analysis / Inhibidores de BTK Y BCL-2 en el Tratamiento de Primera Línea de la Leucemia Linfocítica Crónica en Pacientes de Alto Riesgo: Revisión Sistemática y un Metaanálisis en Red

Introdução: Pacientes com leucemia linfocítica crônica (LLC) com alto risco têm menores taxas de resposta, curso clínico mais agressivo e resistência à quimioterapia padrão, representando um desafio para o tratamento. Os inibidores da tirosina quinase de Bruton (BTK ­ ibrutinibe e acalabrutinibe) e o inibidor BCL-2 (venetoclax) podem ser utilizados nesses casos. Objetivo: Identificar e avaliar a eficácia e a segurança do uso de ibrutinibe, acalabrutinibe e venetoclax no tratamento de primeira linha em pacientes com LLC de alto risco. Método: Revisão sistemática de ensaios clínicos randomizados que avaliaram pacientes adultos com LLC, portadores de deleção 17p ou mutação TP53 e sem tratamento prévio. Foram pesquisadas as bases PubMed, EMBASE, LILACS e Cochrane Library, e realizadas avaliação do risco de viés pela ferramenta RoB 2 da Cochrane e avaliação da qualidade da evidência pelo GRADE. Resultados: Na meta-análise em rede para sobrevida livre de progressão (SLP), venetoclax + obinutuzumabe (RR: 0,62; IC 95% 0,41-0,95; p = 0,027) e acalabrutinibe + obinutuzumabe (RR: 0,74; IC 95% 0,55-0,99; p = 0,043) apresentaram menor risco de progressão ou óbito, com significância considerada limítrofe. Ibrutinibe + obinutuzumabe (RR: 0,93; IC 95% 0,86-1,00; p = 0,054) não apresentou diferença significativa na SLP para pacientes com LLC de alto risco. Conclusão: O tratamento de primeira linha com inibidores de BTK (ibrutinibe e acalabrutinibe) e o inibidor BCL-2 (venetoclax), associados a agentes monoclonais anti-CD20 ­ especialmente o obinutuzumabe ­, tem sido proposto como padrão para a maioria dos pacientes com LLC. Entretanto, pelos resultados desta revisão com meta-análise em rede, não foi possível confirmar essa recomendação.

Introduction: Patients with high-risk chronic lymphocytic leukemia (CLL) have lower response rates, a more aggressive clinical course, and resistance to standard chemotherapy, representing a treatment challenge. Bruton's tyrosine kinase inhibitors (BTK ­ ibrutinib and acalabrutinib) and the BCL-2 inhibitor (venetoclax) can be used in these cases. Objective: To identify and evaluate studies on the efficacy and safety of the use of ibrutinib, acalabrutinib and venetoclax in first-line treatment in patients with high-risk CLL. Method:Systematic review of randomized clinical trials that evaluated adult patients with CLL, carriers of 17p deletion or TP53 mutation and without prior treatment. The PubMed, EMBASE, LILACS and Cochrane Library databases were searched, and the risk of bias was assessed using the Cochrane RoB 2 tool and the quality of evidence was assessed with GRADE. Results: In the network meta-analysis for progression-free survival (PFS) venetoclax + obinutuzumab (RR: 0.62; 95%CI 0.41-0.95; p value 0.027) and acalabrutinib + obinutuzumab (RR: 0. 74; 95% CI 0.55-0.99; p value 0.043) presented a lower risk of progression or death, with significance considered borderline. Ibrutinib + obinutuzumab (RR: 0.93; 95% CI 0.86-1.00; p value 0.054) did not show a significant difference in PFS for patients with high-risk CLL. Conclusion: First-line treatment with BTK inhibitors (ibrutinib and acalabrutinib) and the BCL-2 inhibitor (venetoclax) associated with anti-CD20 monoclonal agents ­ especially obinutuzumab ­ have been proposed as the standard for most patients with CLL. However, based on the results of this review with network meta-analysis, it was not possible to confirm this recommendation.

Introducción: Los pacientes con leucemia linfocítica crónica (LLC) de alto riesgo tienen tasas de respuesta más bajas, un curso clínico más agresivo y resistencia a la quimioterapia estándar, lo que representa un desafío para el tratamiento. En estos casos se pueden utilizar los inhibidores de la tirosina quinasa de Bruton (BTK - ibrutinib y acalabrutinib) y el inhibidor de BCL-2 (venetoclax). Objetivo:Identificar y evaluar estudios sobre la eficacia y seguridad del uso de ibrutinib, acalabrutinib y venetoclax en el tratamiento de primera línea en pacientes con LLC de alto riesgo. Método: Revisión sistemática de ensayos clínicos aleatorios que evaluaron pacientes adultos con LLC, portadores de deleción 17p o mutación TP53 y sin tratamiento previo. Se realizaron búsquedas en las bases de datos PubMed, EMBASE, LILACS y Cochrane Library y se evaluó el riesgo de sesgo mediante la herramienta Cochrane RoB 2 y la calidad de la evidencia se evaluó mediante GRADE. Resultados: En el metaanálisis en red para la supervivencia libre de progresión (SSP) venetoclax + obinutuzumab (RR: 0,62; IC 95% 0,41-0,95; valor de p 0,027) y acalabrutinib + obinutuzumab (RR: 0,74; IC 95%). 0,55-0,99; valor de p 0,043) presentaron un menor riesgo de progresión o muerte, con una significación considerada límite. Ibrutinib + obinutuzumab (RR: 0,93; IC del 95 %: 0,86-1,00; valor de p 0,054) no mostró una diferencia significativa en la SSP para pacientes con LLC de alto riesgo. Conclusión: El tratamiento de primera línea con inhibidores de BTK (ibrutinib y acalabrutinib) y el inhibidor de BCL-2 (venetoclax), asociados con agentes monoclonales anti-CD20, especialmente obinutuzumab, se ha propuesto como estándar para la mayoría de los pacientes con LLC. Sin embargo, según los resultados de esta revisión con metaanálisis en red, no fue posible confirmar esta recomendación

Portuguese consensus on the prevention and treatment of nausea and vomiting induced by cancer treatments.

Chemotherapy-induced nausea and vomiting (CINV) and radiotherapy-induced nausea and vomiting (RINV) strongly affect the quality of life of patients with cancer. Inadequate antiemetic control leads to the decline of patients' quality of life, increases rescue interventions, and may even compromise adherence to cancer treatment. Although there are international recommendations for controlling CINV and RINV, these recommendations focus mainly on pharmacological management, with scarce information on additional measures that patients may adopt. Moreover, the prophylaxis and management of CINV/RINV are not always applied. Thus, we identified the need to systematize the strategies for preventing and managing CINV/RINV and the associated risk factors to implement and promote effective prophylactic antiemetic regimens therapy in patients with cancer. This review sought to create a set of practical recommendations for managing and controlling CINV/RINV, according to the current international recommendations for antiemetic therapy and the main risk factors. Conclusively, we intended to produce a patient-centered guidance document for health care professionals focused on the awareness, monitoring, and treatment of CINV/RINV.

A New Era in Salivary Gland Carcinoma Treatment: A Case Report.

Salivary gland cancers are rare and heterogenous malignancies which makes it hard to standardize treatments with good evidence levels. The localized disease approach is well established, with surgery to the primary site and adjuvant radiation therapy in patients with high-risk features. Treatment of advanced disease should be multidisciplinary. Local approaches, which include radiation therapy, surgery, and thermoablation, among others, have the potential to achieve durable disease control with low toxicity. Chemotherapy has shown disappointing results, so systemic treatment should be guided by actionable genetic alterations, which in salivary gland cancers rely on the histologic type. When directed molecular tests are not useful, a multigene panel should be performed. This case is a good example of how to integrate all these possible tretaments in clinical practice, including molecular testing and target treatment.

Health outcomes and budget impact projection of anti-PD-(L)1s in cancer care in Portugal.

Introduction: PD-[L]1 inhibitors revolutionized cancer treatment but challenge the affordability of health systems. This policy-focused model aimed to estimate the health and budget impact of anti-PD-(L)1s in Portugal and inform current discussions. Materials and methods: The Health Impact Projection (HIP) model estimates clinical (life years, progression-free survival [PFS] years, and quality-adjusted life years [QALY] gained and adverse events [AEs] incurred) and economic (direct and indirect costs) outcomes in a world where cancer patients are initiating treatment with standard-of-care (SOC) versus SOC plus anti-PD-(L)1s over a 3-year time horizon. Indications included adjuvant and metastatic melanoma, non-small cell lung cancer (first and second line), metastatic triple-negative breast cancer, head and neck cancer, urothelial carcinoma, and renal cell carcinoma. Model inputs were based on publicly available literature data and expert opinion. Results: The model estimated that, over 3 years, 7,773 patients would be treated with anti-PD-(L)1s, realizing a gain of 4,787 life years, 6,901 PFS years, and 4,214 QALYs and avoiding 399 AEs. The introduction of anti-PD-(L)1s had a projected average annual impact of ≈ €108 million and a share of 20% of total cancer medicines expenditure and 0.6% of total healthcare expenditure in 2021. Although higher disease management costs are expected for patients living longer with anti-PD-(L)1s and drug acquisition costs are considerable, that is partially offset by a reduction in end-of-life costs (€611,092/year) and costs associated with patient productivity lost to cancer (€9,128,142/year). Discussion: This model highlights the significant survival and QoL benefit of anti-PD-(L)1s for cancer patients in Portugal, with a relatively low increased cost in total healthcare expenditure.

Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies.

OBJECTIVES: Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. METHODS: This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. RESULTS: According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. CONCLUSION: At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.

Pertuzumab in Combination with Trastuzumab and Docetaxel in the Neoadjuvant Treatment for HER2-Positive Breast Cancer.

Introduction: This study aims to assess safety and effectiveness of pertuzumab in combination with trastuzumab and docetaxel in the neoadjuvant treatment (NeoT) of HER2-positive breast cancer. Methods: Two consecutive retrospective cohorts (n = 94, 2012-2015 and 2015-2017) of adult women with HER2-positive breast cancer, receiving NeoT at the breast clinic in Portugal (IPO-Porto), were followed. All patients had surgery and received trastuzumab as adjuvant therapy. The 2012-2015 cohort received doxorubicin, cyclophosphamide, docetaxel plus trastuzumab, whereas the 2015-2017 cohort was treated with the same protocol plus pertuzumab. Results: The 2012-2015 cohort was older (median 53 years), with locally advanced tumors (48.1%), mostly hormone receptor positive (59.3%). The 2015-2017 cohort was younger (median 43 years) with 60% operable tumors. Pathologic complete response (pCR) improved in the second cohort, while maintaining a good safety profile and tolerability. Clinical staging (p = 0.001) and hormone receptor (p = 0.003) were significant predictors of pCR, but not treatment regimen (p = 0.304). Conclusion: Further research with larger samples and longer follow-up is needed to understand the clinical differences. Clinical effectiveness of treatment should also be measured through overall and progression-free survival.

Cuidado domiciliar pós alta do prematuro durante a pandemia Covid-19 / Atención domiciliaria tras el alta de bebés prematuros durante la pandemia de Covid-19 / Post-discharge home care of preterm infants during the Covid-19 pandemic

Objetivo: entender como mães vivenciaram o cuidado com seus filhos prematuros em casa em meio à pandemia da COVID-19. Método: estudo qualitativo, descritivo, desenvolvido entre janeiro e dezembro de 2021, mediante entrevistas remotas com 25 mães de prematuros, após um mês da alta hospitalar, com Análise de Conteúdo temática. Resultados: desvelaram-se preocupações maternas referentes ao cuidado com o filho na pandemia, além de influências do período pandêmico na rotina familiar; acompanhamento do seguimento das crianças nos serviços de saúde descontinuado; sobrecarga e medo. Esses aspectos podem expor o bebê a maior risco de alterações do seu desenvolvimento, bem como afetar a autoeficácia materna, uma vez que o receio das complicações decorrentes do nascimento pré-termo associou-se à angústia de possível contaminação pelo coronavírus. Conclusão: a prematuridade vivenciada em meio à pandemia COVID-19 repercutiu negativamente tanto no cotidiano da vida familiar como no acompanhamento de saúde do prematuro.

Objective: to understand how mothers experienced the care of their preterm infants at home in the midst of the COVID-19 pandemic. Method: qualitative, descriptive study, developed between January and December 2021, through remote interviews with 25 mothers of preterm infants, one month after hospital discharge, with thematic Content Analysis. Results: maternal reoccupations related to child care in the pandemic were revealed, as well as influences of the pandemic period on family routine; monitoring of children in discontinued health services; overload and fear. These aspects may expose the baby to a greater risk of developmental alterations, as well as affect maternal self-efficacy, since the fear of complications resulting from preterm birth was associated with the anguish of possible contamination by the coronavirus. Conclusion: the prematurity experienced in the midst of the COVID-19 pandemic had a negative impact both on the daily life of the family and on the health monitoring of preterm infants.

Objetivo: comprender cómo vivieron las madres el cuidado de sus hijos prematuros en el hogar en medio de la pandemia de COVID-19. Método: estudio cualitativo, descriptivo, desarrollado entre enero y diciembre de 2021, mediante entrevistas remotas a 25 madres de bebés prematuros, un mes después del alta hospitalaria, con Análisis de Contenido temático. Resultados: se revelaron preocupaciones maternas respecto al cuidado de los hijos durante la pandemia, además de las influencias del período pandémico en la rutina familiar; descontinuado el seguimiento de los niños en los servicios de salud; sobrecarga y miedo. Estos aspectos pueden exponer al bebé a un mayor riesgo de cambios en su desarrollo, así como afectar la autoeficacia materna, ya que el miedo a las complicaciones derivadas del parto prematuro se asocia a la angustia de una posible contaminación por el coronavirus. Conclusión: la prematuridad vivida en medio de la pandemia de COVID-19 tuvo un impacto negativo tanto en la vida familiar diaria como en el seguimiento de la salud de los bebés prematuros.

O ensino da língua brasileira de sinais (Libras) sob a ótica de um professor surdo e de uma professora ouvinte / Teaching Brazilian Sign Language (Libras) as per the perspective of a deaf teacher and a hearing teacher: the place of Libras in the curriculum / La enseñanza de la lengua brasileña de Signos (Libras) desde la perspectiva de un maestro sordo y un maestro oyente: el lugar de Libras en el currículo

A Libras é reconhecida como língua da Comunidade Surda brasileira desde abril do ano de 2002, esse reconhecimento se deu graças a uma intensa mobilização da Comunidade Surda. Embora algumas pessoas afirmem que ela é a segunda língua oficial do Brasil, na verdade é uma língua reconhecida como "língua das comunidades surdas brasileiras (Brasil, 2002)" e esse reconhecimento se deu a partir da Lei 10436/02. Após o reconhecimento da língua o Decreto 5626/05 trouxe a obrigatoriedade do seu ensino para os cursos de licenciaturas. Podemos dizer que esse primeiro contato dos licenciandos com a realidade da trajetória dos surdos por educação e da complexidade da Libras é extremamente importante para que os processos de desenvolvimento da Comunidade sejam garantidos e principalmente para que a Língua de Sinais não seja banalizada, simplificada ou fique subordinada à Língua Portuguesa. Neste trabalho, trazemos um pouco da experiência como professores da disciplina em universidades federais, um surdo e uma ouvinte. Além disso, trazemos alguns dados produzidos em um projeto de formação com professores surdos de uma instituição escolar bilíngue para surdos. A partir dos discursos trazidos por esses atores, analisamos os dados com base nos princípios da PCCol - Pesquisa Crítica de Colaboração, Magalhães (2006), que destaca como uma perspectiva teórico-metodológica que favorece a co(construção) dos participantes da pesquisa, assim como a uma construção coletiva de escola e Universidade. Trata-se de um quadro que revela nosso compromisso como professor/a-pesquisador/a, que perseguem a ideia de que ensinar e aprender compõem um caminho de mão dupla. (AU)

Brazilian Sign Language ­ Libras ­ has been recognize as the language of the Brazilian Deaf Community since April 2002, and this recognition occurred as the result of intense activism from the Deaf Community. Although some people may state that Libras is the second official language in Brazil, it is, in actual fact, recognized as the language of Brazilian deaf communities, and this recognition took place as of the publication of Act 10436/02. Following this recognition, the Decree number 5626/05 made it compulsory for Libras to be taught in teaching undergraduate programs. We can say that this first contact for undergraduate students taking their teaching degrees with the paths tread by the deaf in pursue of education, as well as a first understanding of the complexity of Libras is extremely important for the developmental processes of the Community to the guaranteed. It is even more important as a means to prevent the Sign Language from being taken for granted, simplified or considered as a inferior to the Portuguese Language. In this paper, we - a deaf and a hearing professors - discuss some elements of the experience of teaching the language in Federal Universities. We also discuss some data that were produced in a bilingual school, working in teacher education with deaf teachers. By looking at the discourses that the participants present, we analyze the data as per the canons of the Critical Collaborative Research (PCCol), Magalhães, 2006, that was the theoretical-methodological bases for the investigation/teacher education project, and that is a perspective that favors co-construction within the context and school-university collective construction as well. This framework is what allows us to focus on and reveal our commitment as teachers researchers within the belief that teaching and learning compose the same two-way path. (AU)

Libras es reconocida como la lengua de la Comunidad Sorda Brasileña desde abril de 2002, este reconocimiento se debió a una intensa movilización de la Comunidad Sorda. Aunque algunas personas afirman que es el segundo idioma oficial de Brasil, en realidad es un idioma reconocido como "el idioma de las comunidades sordas brasileñas (Brasil, 2002)" y este reconocimiento provino de la Ley 10436/02. Luego del reconocimiento de la lengua, el Decreto 5626/05 hizo obligatoria su enseñanza para los cursos de formación docente. Podemos decir que este primer contacto de los estudiantes de estos cursos con la realidad de la trayectoria de los sordos a través de la educación y la complejidad de Libras es sumamente importante para que se garanticen los procesos de desarrollo comunitario y sobre todo para que la Lengua de Señas no sea banalizada, simplificada o subordinada. a la lengua portuguesa. En este trabajo aportamos un poco de la experiencia como profesores de la disciplina en universidades federales, una persona sorda y una oyente. Además, traemos algunos datos producidos en un proyecto de formación con profesores sordos de una institución escolar bilingüe para sordos. A partir de los discursos traídos por estos actores, analizamos los datos con base en los principios de PCCol - Critical Collaboration Research, Magalhães (2006), que destaca como una perspectiva teórico-metodológica que favorece la co(construcción) de los participantes de la investigación, así como como una construcción colectiva de escuela y universidad. Es un marco que revela nuestro compromiso como docente/investigador, que perseguimos la idea de que la enseñanza y el aprendizaje forman un camino de dos vías. (AU)

Systemic treatment for hormone receptor-positive/HER2-negative advanced/metastatic breast cancer: A review of European real-world evidence studies.

This review examined patterns of systemic anticancer treatment in patients with HR+ /HER2- metastatic breast cancer in real-world clinical practice in Europe since 2016 to assess whether they reflect clinical guidelines and recent changes in available treatment options. We identified 30 publications for inclusion. In studies evaluating patients up to the end of 2017, endocrine therapy predominated, with endocrine monotherapy typically used in 45-65 % of patients. More recent studies suggested that use of cyclin-dependent kinase 4/6 inhibitor therapy has gained ground since European approval in late 2016, with two studies reporting first-line use in over 55 % of patients. Chemotherapy was typically used first line in 25-45 % of patients, although current guidelines recommend endocrine therapy in the absence of a visceral crisis. In conclusion, our review suggests that the most recent treatment developments for patients with HR+ /HER2 - metastatic breast cancer are being reflected in the changing treatment patterns seen in real-world practice.

Centro de Convivência Virtual: potencialidades e desafios para a promoção da saúde e redes de afeto em tempos de pandemia / Virtual Coexistence Center: potentialities and challenges for health promotion and networks of affection in times of pandemic / Centro de Convivencia Virtual: potencialidades y desafíos para la promoción de la salud y las redes de afecto en tiempos de pandemia

A pesquisa apresentada neste artigo foi realizada com o objetivo de estudar as potencialidades e os desafios encontrados na convivência virtual para a continuidade do trabalho dos Centros de Convivência e Cultura (CECOs), que são pontos da rede de atenção psicossocial do SUS. O estudo se caracteriza como uma pesquisa-intervenção por meio da qual se investigou como a Agenda ConViver, através das 28 oficinas por ela ofertadas, pôde servir como uma ferramenta para promoção da saúde e o fortalecimento das redes de afeto no período da pandemia de covid-19 estudado. O método usado foi o grupo focal online com gestores, usuários e usuárias, oficineiros e a equipe de comunicação. Os resultados apontaram que a convivência virtual não substitui a convivência presencial, mas que, quando balizados por uma ética afetiva e relacional, é possível reduzir os danos do isolamento social e promover saúde por meio do uso da tecnologia da informação e comunicação (TIC)

The research presented in this article was carried out with the aim of studying the potentialities and challenges encountered in virtual coexistence for the continuity of the work developed by the Centros de Convivência e Cultura (CECOs), which are points of the Unified Health System (SUS) psychosocial care networking. The study is characterized as an intervention-research by means of which it was examined how the ConViver Agenda through the 28 workshops produced by it could serve as a tool for health promotion and strengthening of affection networks during the studied period of the covid-19 pandemic. The method used was the online focus group with managers, users, participants in workshops and the communication team. The results showed that the virtual coexistence cannot replace the face-to-face coexistence but that when it is guided by an affective and relational ethic it is possible to reduce the damage of social isolation and promoting health through the use of information and communication technology (ICT).

La investigación presentada en este artículo ha sido realizada con el objetivo de estudiar las potencialidades y los desafíos encontrados en la convivencia virtual para la continuidad del trabajo de los Centros de Convivência e Cultura (CECOs), que son puntos de la red de atención psicosocial del Sistema Único de Salud (SUS). El estudio se caracteriza como unainvestigación-intervención por medio de la cual se ha examinado como la Agenda ConViver a través de los 28 grupos de actividadesproducidos por ella ha podido servir como herramienta para la promoción de la salud y el fortalecimiento de las redes de afecto durante el periodo de la pandemia de covid-19 estudiado. El método utilizado fue un grupo focal online con gestores, usuarios y usuarias, participantes de los grupos de actividades, y el equipo de comunicación. Los resultados mostraron que la convivencia virtual no puede reemplazar la convivencia presencial, pero que cuando se guía por una ética afectiva y relacional es posible reducir los daños del aislamiento social y promover la salud mediante el uso de las tecnologías de la información y la comunicación (TIC)

Social Media Listening to Understand the Lived Experience of Individuals in Europe With Metastatic Breast Cancer: A Systematic Search and Content Analysis Study.

Background: Despite a wealth of real-world data on metastatic breast cancer (mBC), insights into the lived experience are lacking. This study aimed to explore how the lived experience of mBC is described on social media. Methods: A predefined search string identified posts relevant to the lived experience of mBC from Twitter, patient forums, and blogs across 14 European countries. The final data set was analyzed using content analysis. Results: A total of 76,456 conversations were identified between November 1, 2018, and November 30, 2020. Twitter was the most commonly used social media platform across all 76,456 conversations from the raw data set (n = 61,165; 80%). Automated and manual relevancy checks followed by a final random sampling filter identified 820 conversations for content analysis. The majority of data from the raw data set was generated from the United Kingdom (n = 31,346; 41%). From this final data set, 61% of posts were authored by patients, 15% by friends and/or family members of patients, and 14% by caregivers. A total of 686 conversations described the patient journey (n = 686/820; 84%); 64% of these (n = 439) concerned breast cancer treatment, with approximately 40% of discussions regarding diagnosis and tests (n = 274/686) and less than 20% of discussions surrounding disease management (n = 123/686; 18%). Key themes relating to a lack of effective treatment, prolonged survival and associated quality of life, debilitating consequences of side effects, and the social impacts of living with mBC were identified. Conclusions: The findings from this study provided an insight into the lived experience of mBC. While retrospective data collection inherently limits the amount of demographic or clinical information that can be obtained from the population sample, social media listening studies offer training to healthcare professionals in communication, the importance of quality of life, organization of healthcare, and even the design of clinical trials. As new targeted therapies are gradually incorporated into clinical practice, innovative technologies, such as social media listening, have the potential to support regulatory procedures and drug toxicity monitoring, as well as provide the patient voice in the regulation of new and existing medicines.

Underreporting of work accidents associated with blood-borne risk factors.

BACKGROUND: Work accidents (WA) due to percutaneous or mucocutaneous injury are extremely frequent among health professionals. The notification of these accidents ensures not only the compliance with legal requirements, but it also enables health institutions to develop, implement and evaluate strategies to prevent them. This study aimed to estimate the proportion of underreporting of work accidents caused by percutaneous and mucocutaneous lesions in a hospital setting, as well as its determinants. METHODS: A self-administered questionnaire was made available to all hospital employees. Age, gender, professional category and type of service adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed by multivariate logistic regression models. RESULTS: Underreporting of WA associated with biological risk factors was high, particularly in accidents by mucocutaneous injury (80.9%). Physicians were the professional category that least reported this type of work accidents (OR=4.64; 95%CI 2.20-9.78). The main determinants of underreporting were the underestimation of the risk of transmission and the excessive bureaucracy. CONCLUSIONS: The underreporting of work accidents associated with biological risk factors was considerable and it contributes to a high degree of uncertainty on accidents' characterization.

Health in School Program in the view of managers in five towns of the Western Paraná, Brazil / Programa Saúde na Escola na visão de gestores, em cinco municípios do Oeste Paranaense, Brasil

INTRODUCTION: In school, education and health should be related to promoting health and turning the Health in School Program (HSP) into an effective cross-sector policy. The managers' view about the implementation of the Program in towns of the 10th Health Regional Office of Paraná, Brazil, and the Regional Education Center from the city of Cascavel was questioned. OBJECTIVE: To analyze the managers' understanding of the implementation and development of the Health in School Program. METHODS: This is an exploratory study of a qualitative approach, with data from interviews with managers of five towns in the Western Parana region from the 10th Health Region and the Regional Education Center of Cascavel. These towns have implemented the Program by 2012. Fifteen managers (eight from the health area and seven fromthe education area) participated in the interviews conducted in July, August, and September 2015. The data were systematized and based on thematic content analysis. RESULTS: The theme "The managers' perception about the implementation of the HSP" was systematized and unfolded into the subthemes: motivations for participation, planning, evaluation and monitoring, developed actions, the cross-sector policies, and financial resources. CONCLUSION: The HSP was implemented in the studied towns, however, in differentiated stages, although the developing actions aimed at its integration. The cross-sector policy has become an important strategy for the development of health and education. The program needs to improve actions for health promotion and training of the subjects involved.

INTRODUÇÃO: Na escola, a educação e a saúde devem se relacionar para implementar ações favoráveis à promoção da saúde, de forma que o Programa Saúde na Escola (PSE) efetiva-se como política intersetorial. Questiona-se a respeito da visão de gestores em relação à implantação do Programa em municípios da 10ª Regional de Saúde/PR e do NRE de Cascavel/PR. OBJETIVO: Analisar a compreensão dos gestores acerca da implantação e desenvolvimento do Programa Saúde na Escola. Métodos: Trata-se de estudo exploratório de abordagem qualitativa, com dados extraídos de entrevistas com gestores de cinco municípios da região Oeste Paranaense, que integram a 10ª Regional de Saúde e o Núcleo Regional de Educação de Cascavel/PR; que fizeram adesão ao Programa Saúde na Escola e o implantaram até o ano de 2012. Participaram quinze gestores (oito da área da saúde e sete da educação), entrevistados nos meses de julho, agosto e setembro de 2015. Os dados foram sistematizados e fundamentados conforme a análise de conteúdo temática. RESULTADOS: Sistematizou-se a temática "A percepção dos gestores acerca da implantação do PSE", que se desdobrou nas subtemáticas: motivações para adesão, planejamento, avaliação e monitoramento, ações desenvolvidas, intersetorialidade observada e recursos financeiros. CONCLUSÃO: O PSE está implantado nos municípios estudados, porém, com estágios diferenciados, mas desenvolvendo ações que visam à sua integralidade. A intersetorialidade tornou-se estratégia importante para o desenvolvimento de ações pertinentes à saúde e educação. O programa carece de fortalecer as ações de promoção da saúde e formação dos sujeitos envolvidos.

Genetic Polymorphisms as Predictors of Survival in Breast Cancer: Future Lessons in Historical Data.

Introduction Breast cancer is the most common cancer among women worldwide and one of the main causes of death in the female sex. Genetic polymorphisms in the mu-opioid receptor (OPRM1) and catechol-o-methyltransferase (COMT) genes have been shown to increase breast cancer risk. Variants in these genes may carry a prognostic impact in breast cancer. Long follow-up intervals are critical to adequately analyze prognosis in diseases with prolonged survival times and late relapses. Objective To analyze the impact of genetic polymorphisms on the survival of a cohort of breast cancer patients with very long follow-up. Methods This was a retrospective study of patients treated at Portuguese Oncology Institute of Porto (IPO Porto), a Portuguese comprehensive cancer center, with invasive carcinoma of the breast with very long follow-up, with analysis of genetic polymorphisms OPMR1 rs1799971 (AA vs. G allele) and COMT rs4680 (CC vs T allele) on biological samples. Statistical analysis of survival was performed using the Kaplan-Meier method, log-rank test, and Cox regression method. Results A total of 143 patients with invasive breast cancer were included, with a median follow-up of 21.5 years. There was a statistically significant difference in overall survival (OS) at 30 years according to the OPMR1 polymorphism, with lower survival in patients with the AA genotype (p<0.05). The difference in OS according to the COMT polymorphism was also statistically significant, with worse survival in patients with genotype T allele (p<0.05). The genetic variants were not associated with patient age, stage at diagnosis, or tumor grade. Discussion The genetic polymorphisms of OPRM1 and COMT affected the overall survival of breast cancer patients, in concordance with previous research. Further investigation is needed in order to clarify the prognostic impact of these genetic alterations on breast cancer.

Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies.

BACKGROUND: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. OBJECTIVE: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. METHODS: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. RESULTS: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). CONCLUSIONS: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.

The addition of neoadjuvant pertuzumab for the treatment of HER2+ breast cancer: a cost estimate with real-world data.

BACKGROUND: Breast cancer (BC) is largely prevalent worldwide. HER2-positive BC account for roughly 20-25% of all BC cases and has an overall survival lower than other BC. Innovation on BC therapeutics is a constant, but novel therapies have higher costs. Therefore, cost-effectiveness research is essential to provide healthcare decision-makers with solid foundations for a resource allocation. This study aims to estimate the average direct medical costs/patient and cost-effectiveness of adding pertuzumab in neoadjuvant treatment (NeoT) for HER2-positive breast cancer (BC). METHODS: Two retrospective real-world consecutive cohorts of ≥18yo female patients diagnosed with HER2-positive BC treated with NeoT at the Breast Clinic of IPO-Porto were studied. The AC-DH regimen (2012-2015) comprised 8 cycles of neoadjuvant therapy (4 cycles of doxorubicin + cyclosphosphamide followed by 4 cycles ofdocetaxel + trastuzumab), while the AC-DHP regimen (2015-2017) included also pertuzumab as NeoT. NeoT was followed by surgery and adjuvant trastuzumab. Micro-costing technique and a bottom-up approach was used comprising all medical direct costs from the hospital perspective. Unit costs were obtained from government official prices or from IPO-Porto costing system. Costs were adjusted to 2017 and are expressed in euros. Multivariable logistic regression models were used for effectiveness assessment, while generalized linear models with gamma distribution were used for costs. ICER was calculated using the pathological complete response (pCR) as the preferential measure of effectiveness. Sensitivity analysis was also performed. RESULTS: AC-DHP (n = 40) and AC-DH (n = 54) cohorts had heterogenous patient profiles (median age 43y/53y; 67.5%/59.3% positive HR; 60.0%/27.8% operable; 25.0%/24.1% inflammatory, respectively). The AC-DHP average total cost/patient was 56,375€, with pertuzumab accounting for 13,978€ (24.79%) and increasing in 15,982€ the average cost/patient (p < 0.001). Clinical staging and hormone receptors (HR) were significantly associated with pCR. ICER was 1.370€ per percentage point of pCR. CONCLUSIONS: ICER was more favourable in stage III HR negative BC patients compared to other patient profiles. Innovative treatments access is critical to deliver high-quality healthcare, but sustainability must be considered. These results suggest the importance of establishing a cost-effectiveness profile of Pertuzumab in NeoT for HER2-positive BC.