Decision making in the end-of-life care of patients who are terminally ill with cancer - a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers.

BACKGROUND: In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients. METHODS: Qualitative descriptive-exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. RESULTS: When making decisions regarding end-of-life care, professionals consider: 1. Patient's clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare. CONCLUSIONS: To improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers' perspectives are needed to complement physicians' perceptions and practices.

Comparison of Luminex xTAG® RVP fast assay and real time RT-PCR for the detection of respiratory viruses in adults with community-acquired pneumonia.

Community-acquired pneumonia (CAP) is the third cause of death worldwide. Viruses are frequently detected in adult CAP. Highly sensitive diagnostic techniques should be used due to poor viral shedding. Different sampling methods can affect viral detection, being necessary to establish the optimal type of sample for identifying respiratory viruses in adults. The detection rates of respiratory viruses by Luminex xTAG® RVP fast assay, real time RT-PCR (rtRT-PCR) (Sacace®), and immunofluorescence assay (IFA) in adult CAP were performed in nasopharyngeal swabs (NPS) and aspirates (NPA) from 179 hospitalized adults. Positivity was 47.5% for Luminex®, 42.5% for rtRT-PCR (P = 0.3), and 2.7% for IFA (2.7%) (P < 0.0). The sensitivity, specificity, and kappa coefficient of xTAG® RVP compared with rtRT-PCR were 84.2%, 79.6%, and 0.62%, respectively. Luminex® and rtRT-PCR detected 65 (58.0%) and 57 (50.9%) viruses in 112 NPA and 35 (34.3%) and 31 (30.4%) in 102 NPS, respectively (P < 0.01). xTAG® RVP is appropriate for detecting respiratory viruses in CAP adults. Both molecular techniques yielded better results with nasopharyngeal aspirate than swabs.

Tratamiento sistémico para el cáncer de mama HER2 positivo avanzado. Revisión de la evidencia y abordaje terapéutico en el Instituto Nacional de Cancerología - Colombia / Systemic treatment for advanced HER2 positive breast cancer. Review of the evidence and therapeutic approach at the Instituto Nacional de Cancerología - Colombia

El cáncer de mama es la neoplasia más frecuente y de mayor mortalidad en las mujeres en todo el mundo. El receptor 2 del factor de crecimiento epidérmico humano (HER2) se sobreexpresa en aproximadamente el 20% de las pacientes con cáncer de mama y se asocia a mayor riesgo de recidiva tumoral y mortalidad. Antes del desarrollo de los anticuerpos monoclonales dirigidos contra HER2, el cáncer de mama HER2 positivo estaba asociado con un pronóstico desfavorable. El uso de las terapias dirigidas anti HER2 ha mejorado significativamente las tasas de supervivencia global tanto en el escenario adyuvante como en la enfermedad metastásica. En los últimos años han surgido nuevos medicamentos que bloquean esta vía de señalización, lo cual ha permitido establecer varias líneas de tratamiento con terapia anti HER2 en las pacientes con enfermedad metastásica. Por esta razón, las unidades funcionales de Oncología Clínica/Seno y Tejidos Blandos tomaron la decisión de realizar una revisión de la evidencia científica disponible a octubre de 2021, para establecer las recomendaciones en el abordaje terapéutico de las pacientes con cáncer de mama metastásico HER2 positivo en el Instituto Nacional de Cancerología (INC).

Breast cancer is the most common neoplasm and the one with the highest mortality in women worldwide. Human epidermal growth factor receptor 2 (HER2) is overexpressed in approximately 20% of breast cancer patients and is associated with an increased risk of tumor recurrence and mortality. Before the development of monoclonal antibodies directed against HER2, HER2-positive breast cancer was associated with a poor prognosis. The use of anti-HER2 targeted therapies has significantly improved overall survival rates both in the adjuvant setting and in metastatic disease. In recent years, new drugs have emerged that block this signaling pathway, which has made it possible to establish several lines of treatment with anti-HER2 therapy in patients with metastatic disease. For this reason, the clinical oncology/breast and soft tissue functional units made the decision to conduct a review of the available scientific evidence as of October 2021 to establish recommendations for the therapeutic approach to patients with HER2-positive metastatic breast cancer in the National Cancer Institute (INC).

Calidad de vida de la persona adulta mayor perteneciente al Programa Gerontológico Social de dos provincias de Ica, Perú 2017 / Quality of life of the older adult belonging to the Social Gerontological Program of two provinces of Ica, Peru 2017

Resumen Objetivo: Determinar el nivel de calidad de vida de la persona adulta mayor perteneciente al Programa Gerontológico Social de dos provincias de Ica, Perú, en el año 2017. Metodología: El estudio es de tipo no experimental, descriptivo y de corte transversal. La población estuvo constituida por adultos mayores pertenecientes al Programa Gerontológico Social de las provincias de Palpa (n=65) y Nasca (n=30), en el departamento de Ica, Perú. La unidad de análisis fue la persona adulta mayor participante del Programa Gerontológico Social. La calidad de vida se evaluó con el Cuestionario de Salud SF-36. Resultados: El 90 % de los adultos mayores pertenecientes al Programa Gerontológico Social de la provincia de Nasca posee alta calidad de vida según salud mental; mientras el 60 % posee regular calidad de vida según vitalidad. Se encontró que el 81.5 % de las personas adultas mayores pertenecientes al Programa Gerontológico Social de la provincia de Palpa tienen alta calidad de vida según salud mental, pero baja calidad de vida según rol físico (63.1 %). Conclusión: El nivel de calidad de vida de la persona adulta mayor perteneciente al Programa Gerontológico Social de Nasca es mejor que el nivel de calidad de vida de quienes pertenecen al Programa Gerontológico de Palpa.

Abstract: Objective: To determine the level of quality of life of the older adult belonging to the Social Gerontological Program of two provinces of Ica, Peru, 2017. Methods: The study is non-experimental, descriptive and cross-sectional. The population was older adults belonging to the Social Gerontological Program of the provinces of Palpa (n=65) and Nasca (n=30), Ica, Peru. The unit of analysis was the older adult belonging to the Social Gerontological Program. Quality of life was evaluated by the Health Survey SF-36. Results: 90% of older adults belonging to the Social Gerontological Program of the province of Nasca, have high quality of life according to mental health; while 60% have a regular quality of life according to vitality. It was found that 81.5% of the older adults belonging to the Social Gerontological Program of the province of Palpa have high quality of life according to mental health, but low quality of life according to physical role (63.1%). Conclusion: Quality of life of the older adult belonging to the Social Gerontological Program of the province of Nasca is better than quality of life of those belonging to the Social Gerontological Program of the province of Palpa.

Tumor renal benigno versus carcinoma renal: reporte de caso y revisión de la literatura / Benign Kidney Tumor versus Renal Carcinoma: Case Report and Literature Review

Introducción El cáncer renal representa 2,4% de los casos diagnosticados de cáncer en la población general, es más común en hombres que en mujeres, y se presenta con más frecuencia entre la 6ta y la 8ta décadas de vida. Se estima que el 16% de los pacientes se diagnostican como enfermedad metastásica. Objetivo Se presenta el caso de un paciente cuyo diagnóstico de carcinoma renal se confundió inicialmente con un tumor benigno. Métodos A un hombre de 56 años de edad se le realizó hace 3 años ese diagnóstico en un estadio avanzado de la enfermedad, a pesar del hallazgo incidental de una masa, que se consideró benigna durante 5 años. Resultados Al momento del diagnóstico de carcinoma de células claras, el tumor era Estadio IV, con metástasis a pulmón. Recibió primera línea de tratamiento con sunitinib, pero fue suspendido por toxicidad; segunda línea con pazopanib durante 1 año, después presentó progresión de la enfermedad, por lo cual se cambió a tratamiento con axitinib con respuesta parcial, sin embargo, se suspendió por toxicidad cardiaca, entre otras. Al momento el paciente ha recibido 5 ciclos de bevacizumab con adecuada tolerancia. Conclusiones Es necesario resaltar la indicación de diagnóstico adecuado y manejo quirúrgico en masas renales sospechosas.

Introduction Kidney cancer represents 2.4% of diagnosed cases of cancer in the general population; it is more common in men than in women, and occurs more frequently between the 6th and 8th decades of life. It is estimated that 16% of patients are diagnosed as metastatic disease. Objective To report the case of a male patient whose diagnosis of renal carcinoma was initially misdiagnosed as a benign tumor. Methods We present a 56-year-old male diagnosed three years back with malignancy at an advanced stage of the disease, despite the incidental finding of a tumor that for 5 years was considered benign. Results At the time of diagnosis of clear cell carcinoma, the tumor was Stage IV, with lung metastasis. He received first line treatment with sunitinib, which was discontinued due to toxicity. Subsequently, a second line with pazotinib for 1 year, then presented progression of the disease, so treatment was changed to axitinib with partial response., It was discontinued, however, due to cardiac toxicity, among others. At the time of writing, the patient has received 5 cycles of bevacizumab with adequate tolerance. Conclusions It is necessary to highlight the need for adequate diagnosis and surgical management in suspicious renal masses.

Metástasis duodenogástrica por cáncer de mama: reporte de caso / A Case Report of Duodenogastric Metastasis from Breast Cancer

Resumen Se presenta el caso de una mujer de 82 años con cáncer de mama diagnosticado en 2011 tratado con cirugía y adyuvancia hormonal con tamoxifeno. En 2015 fue hospitalizada por obstrucción intestinal alta y se descartó compromiso tumoral. Sin embargo, se realizó videotoracoscopia por presencia de derrame pleural y se documentaron lesiones pleurales correspondientes a metástasis. Se inició terapia hormonal con adecuada respuesta. Un año después, se realizó gastroduodenoscopia de control en la que se evidenció edema y eritema bulboduodenal. La biopsia corroboró compromiso metastásico por cáncer de mama.

Abstract We present the case of an 82 year old woman who was diagnosed with breast cancer in 2011 and who underwent surgery and adjuvant treatment with tamoxifen. In 2015 she was hospitalized for an upper intestinal obstruction. Involvement of a tumor was ruled out, but video-assisted thoracoscopy showed the presence of pleural effusion and pleural lesions corresponding to metastases. Hormone therapy was initiated, and the patient responded adequately. One year later, a gastroduodenoscopy showed edema and erythema of the duodenal bulb. The biopsy corroborated metastasis from breast cancer.