Resources and Costs Associated with the Treatment of Advanced and Metastatic Gastric Cancer in the Mexican Public Sector: A Patient Chart Review.

BACKGROUND: Little evidence is available on the management and cost of treating patients with advanced or metastatic gastric cancer (GC). This study evaluates patient characteristics, treatment patterns, and resource utilization for these patients in Mexico. METHODS: Data were collected from three centers of investigation (tertiary level). Patients were ≥18 years of age, diagnosed between 1 January 2009 and 1 January 2015, had advanced or metastatic GC, received first-line fluoropyrimidine/platinum, and had ≥3 months follow-up after discontinuing first-line treatment. Data were summarized using descriptive statistics. RESULTS: The study sample totaled 180. Patients' mean age was 57.2 years (±12.4) and 57.0% were male; 151 (83.9%) patients received second-line chemotherapy. A total of 16 and 19 regimens were identified in first- and second-line therapy. Of the sample, 51 (28.3%) received third-line therapy, and <10% received more than three lines of active chemotherapy. Supportive care received in first- and second-line chemotherapy, included pain interventions (12.2 and 7.9%), nutritional support (3.3 and 1.3%), radiotherapy (6.1 and 16.6%), and transfusions (13.3 and 10.6%), respectively. Using Mexican Institute of Social Security (IMSS) tariffs, the average total cost per patient-month in first- and second-line therapy was US$1230 [95% confidence interval (CI) 1034-1425] and US$1192 (95% CI 913-1471), respectively. Administration and acquisition of chemotherapy comprised the majority of costs. CONCLUSIONS: This study shows considerable variation in first- and second-line chemotherapy regimens of patients with advanced or metastatic GC. Understanding GC treatment patterns in Mexico will help address unmet needs.

Modifying cancer patients' attitudes towards medical care received in the oncology service.

BACKGROUND: Attitude changing involves a holistic change on individual biopsychosocial structure. That attitude is understood by behaviors, thoughts, feelings and higher mental processes involved with behavior. This attitude will be considered in two ways: favorable or unfavorable, through a part of the environment. If unfavorable, the most common way to change it is through teaching and learning processes. The aim of this study was to evaluate the impact of a program directed to modify cancer patients' attitudes. METHODS: This study was performed in three stages from February to September 2009 in the Medical Oncology Area of the UMAE Oncology Hospital, Instituto Mexicano del Seguro Social (IMSS), according to a before and after quasi-experimental design to evaluate the effect of the intervention. The first stage was to diagnose through semantic networks using the results to create and validate a survey. The second stage was the educative intervention focused on providing general information to patients in the area of medical oncology. Finally, the initial survey was used in order to measure the impact of the intervention, which had been previously implemented and validated. The cumulative total of patients during the three stages was 4,200. RESULTS: Patients attitudes were modified with a specific favorable tendency on the instrument from 51% to 94% (p = 0.05) of total instrument perceptions. CONCLUSIONS: This intervention significantly changed patients' attitudes related to the medical oncology area.

[Treatment patterns in advanced breast cancer with anthracycline and taxanes and their costs in three public hospitals of Mexico]. / Patrones de tratamiento y costo de atención del cáncer de mama avanzado con falla a antraciclinas y taxanos en 3 hospitales públicos de México.

OBJECTIVES: In Mexico, breast cancer is the second leading cause of cancer mortality among females. For patients with advanced breast cancer (ABC) resistant to anthracyclines and taxanes (AT), there are limited treatment options. There is a scarcity of data regarding clinical management of this population and treatment costs at this stage of the disease. The objective of this study was to describe the treatment patterns of care for metastatic breast cancer after AT and the associated cost from the point-of-view of the Mexican Public Health Care Sector. METHODS: Between January 1, 2004 and December 31, 2007, a retrospective cohort of adult female ABC patients resistant to AT was developed by reviewing and extracting key data from medical charts. We conducted a retrospective, transversal and descriptive analysis of the patient data. Target population data files were obtained from 414 patients from 3 public hospitals in México. RESULTS: Capecitabine, vinorelbine and cyclophosphamide were the most commonly prescribed agents, however clinical drug therapy management of the disease was different within and among the three hospitals included in the study. This difference translated into a disparity of prescription costs, ranging from an average of $122.22 pesos/patient/month (cyclophosphamide, IC 95% $94.43-$150.01) to $37,835.53 pesos/patient/month (capecitabine+trastuzumab IC 95% $34,953.18-$40,717.88) for the first treatment after AT. CONCLUSIONS: The results highlight a lack of standardized care for patients and suggest that differences in treatment patterns are not only a reflection of scarcity of scientific data and diversity of prescription preferences among physicians but also of economic restrictions. Ultimately, there is a clear unmet medical need to be addressed through evidence-based medicine alternatives that support efficacy and cost effectiveness treatments.

[Concomitant treatment with gemcitabine and radiotherapy in patients with advanced stages of epidermoid carcinoma originating in the head and neck. A phase II sutdy]. / Tratamiento concomitante con gemcitabina y radioterapia en pacientes con carcinoma epidermoide locorregionalmente avanzado de cabeza y cuello. Estudio fase II.

BACKGROUND: Surgery, radiotherapy or radiotherapy alone (RTA) constitute conventional treatment regimes for advanced stages of squamous cell carcinoma originating in the head and neck mucosa. Nevertheless, the results in advanced regional carcinoma (ARC) are disappointing. The chemotherapy-radiotherapy (CHT-RT) association has shown to be superior to RTA in irresectable disease and in resectable disease it could substitute initial surgery as a rescue alternative. OBJECTIVE: Our objective is to report the response rate and toxicity of concurrent treatment with Gemcitabine and Radiotherapy (GRT) in patients with ARC. In a prospective design, patients with ARC received concurrent GRT; the global, complete and partial response rate as well as toxicity were assessed. MATERIAL AND METHODS: 15 patients were included, 5 women and 10 men, 73% in stage IVa; 13/15 showed a global response (87%), a complete response was observed in 9 cases (60%) (RC) and 2 showed progress. RESULTS: All patients included showed toxicity, the most frequent one was level 4 mucositis in 46%, of this 40% required nutritional support by catheter or gastrostomy. One patient in RC died due to sepsis. None of them suspended treatment. CONCLUSION: The GRT association offers a complete response rate of 60%; nevertheless morbidity was not insignificant; randomized studies with a larger number of patients will be required to allow us to outline the optimal therapeutic scheme.

Tratamiento concomitante con gemcitabina y radioterapia en pacientes con carcinoma epidermoide locorregionalmente avanzado de cabeza y cuello: estudio fase II / Concomitant treatment with gemcitabine and radiotherapy in patients with advanced stages of epidermoid carcinoma originating in the head and neck: a phase II sutdy

Antecedentes: En casos avanzados el tratamiento clásico del carcinoma epidermoide originado en mucosas de cabeza y cuello es cirugíaradioterapia o radioterapia sola (RTS). Sin embargo los resultados en carcinoma localmente avanzado (CLA) son decepcionantes. La asociación quimioterapia-radioterapia (QT-RT) ha demostrado ser superior a RTS en enfermedad irresecable y, en enfermedad resecable podría sustituir a la cirugía inicial y dejarla como rescate. Objetivo: El objetivo de este estudio es conocer la tasa de respuesta y la toxicidad del tratamiento concomitante Gemcitabina-Radioterapia (GRT) en pacientes con CLA. Material y métodos: Estudio prospectivo en el que pacientes con CLA recibieron GRT concomitante; se evaluó la tasa de respuesta global, completa, parcial y la toxicidad. Se incluyeron 15 pacientes, 5 mujeres y 10 hombres, 73% en etapa IVa. Resultados: Trece de 15 pacientes tuvieron respuesta global (87%), en 9(60%) fue completa (RC) y 2 tuvieron progresión. Todos tuvieron toxicidad, la más frecuente fue mucositis grado 4 en 46%; de éstos 40% requirió apoyo nutricio por sonda o gastrostomía. Un paciente en RC murió por sepsis. Ninguno abandonó el tratamiento. Conclusiones: La asociación GRT ofrece tasa de respuesta completa en 60%; sin embargo, la morbilidad no es despreciable; se requieren estudios aleatorizados con mayor número de pacientes que permitan definir el mejor esquema terapéutico.

BACKGROUND: Surgery, radiotherapy or radiotherapy alone (RTA) constitute conventional treatment regimes for advanced stages of squamous cell carcinoma originating in the head and neck mucosa. Nevertheless, the results in advanced regional carcinoma (ARC) are disappointing. The chemotherapy-radiotherapy (CHT-RT) association has shown to be superior to RTA in irresectable disease and in resectable disease it could substitute initial surgery as a rescue alternative. OBJECTIVE: Our objective is to report the response rate and toxicity of concurrent treatment with Gemcitabine and Radiotherapy (GRT) in patients with ARC. In a prospective design, patients with ARC received concurrent GRT; the global, complete and partial response rate as well as toxicity were assessed. MATERIAL AND METHODS: 15 patients were included, 5 women and 10 men, 73% in stage IVa; 13/15 showed a global response (87%), a complete response was observed in 9 cases (60%) (RC) and 2 showed progress. RESULTS: All patients included showed toxicity, the most frequent one was level 4 mucositis in 46%, of this 40% required nutritional support by catheter or gastrostomy. One patient in RC died due to sepsis. None of them suspended treatment. CONCLUSION: The GRT association offers a complete response rate of 60%; nevertheless morbidity was not insignificant; randomized studies with a larger number of patients will be required to allow us to outline the optimal therapeutic scheme.

Frecuencia de asociación del factor reumatoide en pacientes con cáncer de mama / Frequency of association of rheumatoid factor and breast cancer

Antecedentes: existen reportes de que algunos pacientes con cáncer sufren fenómenos autoinmunes, por autoanticuerpos, lo que ha sugerido una relación entre autoinmunidad y cáncer. Nuestro interés fue determinar la frecuencia de asociación del factor reumatoide y el cáncer de mama. Material y método: se estudiaron 50 pacientes, 31 en estadio III y 19 con estadio IV, a las cuales se determinó el factor reumatoide, se utilizó método de ELISA para la determinación sérica de los autoanticuerpos. Se hizo una revisión del expediente clínico del paciente para determinar la existencia de metástasis (ósea, pulmonar, SNC y hepática) así como el tipo histológico del cáncer y correlacionar la expresión del factor reumatoide con el estado clínico del paciente. Resultados: de las 31 pacientes estudiadas, del estadio III, cuatro mostraron FR (+) una asociación del 12.9 por ciento, y nueve de las 19 pacientes del estadio IV fueron positivas al FR (+) (47.3 por ciento); el promedio de edad de las pacientes en estadio III y FR (+) fue de 48 años y de estadio IV de 53 años. En las pacientes del estadio III y FR (+) sólo hubo metástasis locorregional, mientras que en las pacientes de estadio IV y FR (+) hubo metástasis a distancia. El tipo histológico predominante en ambos estadios fue el adenocarcinoma. Conclusiones: en este estudio se muestra cómo los estadios más avanzados del cáncer de mama tienen mayor expresión del FR y, a su vez, mayor deterioro clínico a mayor expresión. El llegar a proponer a los autoanticuerpos como predictores de gravedad en cáncer requiere mayor estudio y aplicación en varios tipos de cáncer.