Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews.

BACKGROUND: Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. METHODS: We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. RESULTS: We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. CONCLUSIONS: The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. TRIAL REGISTRATION: Open Science Framework, https://doi.org/10.17605/OSF.IO/7CHX6 .

Cancer-related fatigue and its determinants in a cohort of women with breast cancer: the DAMA Cohort.

Cancer-related fatigue (CRF) is one of the most prolonged discomforts suffered by people who have had cancer. Seventy-eight to ninety-six percent of cancer patients experience fatigue, especially while undergoing treatment. CRF is related to insomnia, anxiety, depression, and also varies depending on age. However, little is known about the factors contributing to CRF and better understanding of determinants of CRF makes it easier to identify early patients at risk and in designing intervention planning. The aim of this study was to assess the influence of precipitating factors (diagnosis of breast cancer and other clinical aspects) and perpetuating factors (social network, quality of life, mental disorders) on the presence of chronic fatigue in women from our cultural context, by social class each other determinants. METHODS: It was carried out a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were data from the Brief Fatigue Inventory questionnaire and hospital medical records. The dependent variable was fatigue and the independent variables were age, social class, time since diagnoses, cohabitation, comorbidity, relapse, body mass index, mental health (anxiety and depression), social network, social support, and quality of life. RESULTS: Seventy-two percent of the women in the DAMA cohort reported moderate to severe fatigue. Risk of suffering from severe fatigue was greatest among individuals with low social class, those aged under 50 years, those with chronic disorders who had relapsed, and those with symptoms of anxiety and depression. In our study, CRF did not appear to be related to the stage of the cancer at diagnosis, or to the time since diagnosis. CONCLUSIONS: CRF is an element that the professionals responsible for the control and monitoring of women should take into account as another element to be taken into consideration.

Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening.

BACKGROUND: Our aim was to assess the cumulative risk of false-positive screening results, screen-detected cancer, and interval breast cancer in mammography screening among women with and without a previous benign breast disease and a family history of breast cancer. METHODS: The cohort included 42 928 women first screened at the age of 50-51 years at three areas of the Spanish Screening Programme (Girona, and two areas in Barcelona) between 1996 and 2011, and followed up until December 2012. We used discrete-time survival models to estimate the cumulative risk of each screening outcome over 10 biennial screening exams. RESULTS: The cumulative risk of false-positive results, screen-detected breast cancer, and interval cancer was 36.6, 5.3, and 1.4 for women with a previous benign breast disease, 24.1, 6.8, and 1.6% for women with a family history of breast cancer, 37.9, 9.0, and 3.2%; for women with both a previous benign breast disease and a family history, and 23.1, 3.2, and 0.9% for women without either of these antecedents, respectively. CONCLUSIONS: Women with a benign breast disease or a family history of breast cancer had an increased cumulative risk of favourable and unfavourable screening outcomes than women without these characteristics. A family history of breast cancer did not increase the cumulative risk of false-positive results. Identifying different risk profiles among screening participants provides useful information to stratify women according to their individualised risk when personalised screening strategies are discussed.

Efficacy of erlotinib in patients with relapsed gliobastoma multiforme who expressed EGFRVIII and PTEN determined by immunohistochemistry.

Epidermal growth factor receptor gene (EGFR) alteration is a common feature in most of glioblastoma multiforme (GBM). Robust response of anti-EGFR treatments has been mostly associated with the EGFR deletion mutant variant III (EGFRvIII) and expression of PTEN. We have performed a prospective trial in order to confirm the efficacy of erlotinib treatment in patients with relapsed GBM who expressed EGFRvIII and PTEN. All patients included in the trial were required to be PTEN (+++), EGFR (+++) and EGFRvIII (+++) positives by immunohistochemistry. This new phase II trial enrolled 40 patients and was design to be stopped in case of fewer than two responses in the first 13 patients. Patient eligibility included histopathology criteria, radiological progression, more than 18 years old, Karnofsky performed status, KPS > 50, and adequate bone marrow and organ function. There was no limit to the number of prior treatments for relapses. No enzyme-inducing antiepileptic drugs were allowed. The primary endpoints were response and progression-free survival at 6 months (PFS6). Thirteen patients (6 men, 7 women) with recurrent GBM received erlotinib 150 mg/day. Median age was 53 years, median KPS was 80, and median prior treatments for relapses were 2. There was one partial response and three stable diseases (one at 18 months). PFS at 6 months was 20 %. Dose reduction for toxicity was not needed in any patient. Dermatitis was the main treatment-related toxicity, grade 1 in 8 patients and grade 2 in 5 patients. No grade 3 toxicity was observed. Median survival was 7 months (95 % IC 1.41-4.7). As conclusion, monotherapy with erlotinib in GBM relapses patients with high protein expression for PTEN (+++), EGFR (+++), and EGFRvlII (+++) showed low toxicity but minimal efficacy and the trial stopped.

The role of vegetable and fruit consumption and other habits on survival following the diagnosis of oral cancer: a prospective study in Spain.

The authors carried out a hospital-based prospective study to evaluate the role of behavioral and clinical risk factors, occurring before and after diagnosis, on the prognosis of 146 patients with newly diagnosed oral cancer using Cox models. High weekly intake of vegetables before and after diagnosis were both associated with lower recurrence rates, longer overall survival and longer oral cancer survival. Diagnostic delay was associated with an increased risk of recurrence and oral cancer mortality. Patients presenting with pharyngeal pain or a mucosal lesion had a longer oral cancer survival than patients presenting with other symptoms. Quitting tobacco and alcohol consumption before and after diagnosis were both associated with a lower recurrence and/or better survival, but the effects were not statistically significant. This study suggests that high consumption of vegetables before and after diagnosis of oral cancer may reduce the risk of recurrence, overall mortality and cancer mortality in oral cancer patients.

Socio-economic impact on women diagnosed and treated for breast cancer: a cross-sectional study.

INTRODUCTION: The increase in breast cancer survival poses a challenge for patients to be able to rejoin their professional and social life in very similar conditions to those before diagnosis. The aim of this study is to assess short- and medium-term social, economic and professional impact of BC among women diagnosed with it. METHODS: A cross-sectional descriptive study using QLQ-C30, QLQ-BR23, and MOS-SSS instruments and a semi-structured interview in women diagnosed in years 2011, 2014, and 2016 in Hospital de la Santa Creu i Sant Pau in Barcelona (Spain). RESULTS: 175 patients were included with a mean age of 55. About 62.8% were married or coupled, 76% were living with their family unit, and 52.6% denied changes in their living situation. The mean Support Global Index was 74.7% and 78.8% before and after diagnosis, respectively. The mean global quality of life (QOL) was 67.3%, outstanding insomnia as the main symptom (X > 30%) and sexual function as the most affected dimension. At the moment of diagnosis, two-thirds of patients were working. After diagnosis, 87.5% stopped working, 39.4% were off work for 7-12 months, and only 50% returned to work. Multivariate analysis identified working as the most associated variable with a good QOL. CONCLUSIONS: QOL among women diagnosed with breast cancer is quite high and stable. Nevertheless, there are some very relevant aspects to QOL that need to be considered whilst caring for patients with BC to achieve rehabilitation as complete and comprehensive as possible.

Anxiety and depression in women with breast cancer: Social and clinical determinants and influence of the social network and social support (DAMA cohort).

BACKGROUND: Anxiety and depression are the most prevalent mental health pathologies among women with breast cancer. Social, clinical and contextual variables may influence emotional stress among women with breast cancer. The aim of this work is to study anxiety and depression in a cohort of women diagnosed with breast cancer between 2003 and 2013 in Barcelona. We evaluate social and clinical determinants. METHODS: We performed a mixed cohort study (prospective and retrospective) using a convenience sample of women diagnosed with breast cancer. The information sources were the Hospital Anxiety and Depression questionnaire and hospital medical records. Dependent variables were anxiety and depression; independent variables were social class, age, employment status, tumour stage at diagnosis, time since diagnosis, social network and social support. We performed a descriptive analysis, a bivariate analysis, and a multivariate logistic regression analysis. RESULTS: A total of 1086 (48.6%) women had some degree of anxiety-related problem. As for depression. In the case of depression, 225 (15%) women had some degree of depression-related problem. Low emotional support and social isolation were clear risk factors for having more anxiety and depression. Low social class was also a risk factor, and age also played a role. DISCUSSION: Our results show that women long period of cancer survival have high prevalences of anxiety than depression, and this prevalence of anxiety is higher than the general population. In addition, we found inequalities between social classes and the isolation and social support are worse too in low social class.

Oral and oropharyngeal cancer in Spain: influence of dietary patterns.

Cancer of the oral cavity and oropharynx is a major public health problem in Spain. Tobacco and alcohol have been identified as the two major risk factors for oral cancer in most western populations. Other risk factors include diets low in fruits and vegetables, but the impact of dietary habits on the risk of these cancers has never been assessed in Spain. The objective of this study was to elucidate the role of dietary habits in oral and oropharyngeal cancer, a multicentric case-control study was conducted in three areas of Spain (Barcelona, Granada and Sevilla) between 1996 and 1999. Cases were 375 patients (71 women), with incident, histologically confirmed cancer of the oral cavity or oropharynx, and controls were 375 subjects (71 women) admitted to hospitals for conditions unrelated to smoking or alcohol drinking. Data were analysed using multivariate logistic regression procedures. After allowance for education, tobacco and alcohol use, a significant inverse association with the risk of oral and oropharyngeal cancer was found for total consumption of total green vegetables (OR 0.54, 95% CI = 0.34-0.87) and total fruit (OR 0.52, 95% CI = 0.34-0.79) with significant trends in risk. We found that the protective effect of each of these food items was consistently larger among current smokers and among heavy alcohol drinkers, following a multiplicative effect model. In conclusion, this study provides further support to the beneficial effect of high intake of vegetables and fruits on the risk of developing cancers of the oral cavity and oropharynx in Spain, particularly among current smokers and heavy alcohol drinkers.

[Human papillomavirus and human immunodeficiency virus infections as risk factors for cervix cancer in women prisoners]. / Infección por los virus del papiloma humano y de la inmunodeficiencia humana como factores de riesgo para el cáncer de cuello uterino en mujeres reclusas.

BACKGROUND: The identification of high risk groups for genital human papillomavirus (HPV) infection may contribute to cervical cancer prevention. The study was designed to estimate the prevalence of HPV infection and the related risk of cervical cancer among imprisoned women. PATIENTS AND METHODS: 157 women were visited at the Medical Office of a prison in Barcelona, Spain. Women underwent a structured interview, determination of HIV serostatus and detection of HPV cervical infection by means of PCR. RESULTS: The prevalence of HPV infection was 46%. Prostitution was reported by 38.2% and intravenous drug use by 64.3%. HIV infection was detected in 56.1%. Cervical cytology revealed 19 women with ASCUS and 28 with squamous intraepithelial lesions (SIL) (all grades). HPV infection was associated with an increased risk of intravenous drug use for more than 10 years (prevalence odds ratio [POR] = 2.9) and seropositivity to HIV (POR = 4.7). The increase in risk for SIL related to HIV was explained by the presence of HPV. HIV positive women with low CD4 counts may increase the risk for SIL independently of HPV. CONCLUSION: HIV positive women are at high risk for HPV infection and as a consequence, for developing SIL. HIV positive women should be closely monitored for cervical cancer.

[Evaluation of the complications of the use of enteral diet with fiber in critical patients]. / Valoración de las complicaciones del uso de dieta enteral con fibra en pacientes críticos.

Our proposal consisted of analyzing whether the use of diets with fibre in the enteral nutrition (EN) of critical patients had an effect on the incidence of diarrhoea and vomiting, which are frequent complications in EN via nasogastric tube. For this purpose, in 1990 we followed a uniform EN protocol in our polyvalent I.C.U. A prospective analysis was made of a group of patients on a fibre diet (n = 30). The results were compared with those obtained in a previous group on a non-fibre diet (n = 42). Both groups were homogeneous with regard to age, date of initiation of the EN, duration of the diet and reason for ceasing the diet. We observed an incidence of diarrhoea (8/22 in the fibre group, compared to 5/37 in the non-fibre group, P + NS) and an increase in gastric residue (8/22 compared to 8/34, p = NS) which was similar in both groups. Incidence of vomiting was higher in the fibre group (7/23 compared to 0/42, P less than 0.01), perhaps due to a higher volume administered in the fibre group (1,001.7 +/- 176 compared to 679.2 +/- 210, P less than 0.001), although there were no cases of clinically significant bronchoaspiration. In conclusion, we can say that incidence of diarrhoea was similar in both groups, as well as the increase in gastric residue, despite a considerably higher volume administered in the fibre group. Incidence of vomiting was higher in the fibre group, with no cases of clinically significant bronchoaspiration.(ABSTRACT TRUNCATED AT 250 WORDS)

The Spanish external quality assessment scheme for mercury in urine.

In 1986 the Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT), established the "Programa interlaboratorios de control de calidad de mercurio en orina (PICC-HgU)". The operation of this scheme is explained, criteria for evaluation of laboratory performance are defined and some results obtained are reviewed. Since the scheme started, an improvement in the overall performance of laboratories has been observed. The differences in the analytical methods used by laboratories do not seem to have a clear influence on the results.

[Multiple radicular tumors in von Recklinghausen disease assessed by magnetic resonance]. / Tumores radiculares múltiples en la enfermedad de Von Recklinghausen. Valoración mediante resonancia magnética.

We present a case of multiple neurofibromata at lumbar nerve root level in a patient diagnosed as having Von Reckling-hausen's disease or type 1 neurofibromatosis (NF 1), studied using magnetic resonance (MR). We also observed in the same study the presence of dural ectasis, something likewise related to NF 1. We assessed MR possibilities in the study of this type of pathology and its relative advantages with respect to other types of image-forming techniques. MR is nowadays considered as the technique of choice when studying medullar and radicular pathology in patients suffering Von Recklinghausen's disease.

Smoking and drinking cessation and risk of esophageal cancer (Spain).

OBJECTIVES: To explore the effectiveness of alcohol drinking and tobacco smoking cessation in reducing esophageal cancer risk, taking into account the key characteristics of each habit and the simultaneous exposure to both habits. METHODS: Data from a series of five hospital-based case-control studies of incident squamous-cell carcinoma of the esophagus conducted by the International Agency for Research on Cancer (IARC, Lyon, France) in high-risk areas in South America were combined and analyzed by multivariate logistic regression procedures. A total of 2063 men (655 case patients and 1408 control subjects) were included in the pooled analysis. RESULTS: For either habit, the risk of esophageal cancer decreased rapidly, strongly and significantly with longer periods of abstention. The risk reduction was statistically significant regardless of the intensity and duration of each habit and the type of tobacco or alcoholic drink consumed. For subjects exposed to both risk factors, the protective effect of quitting both habits appeared to be synergistic, reaching, after only five to nine years of simultaneous cessation of both exposures, a 70% risk reduction, a reduction that clearly overlapped with the risk intervals of both never-smokers and never-drinkers. The risk benefit of merely quitting alcohol drinking was delayed (>10 years of cessation) unless it was also accompanied by a few years of smoking cessation. CONCLUSIONS: Our findings solidly demonstrate for the first time the effectiveness of smoking and drinking cessation in reducing esophageal cancer risk. For the large proportion of subjects in the general population exposed to both risk factors, our results further emphasize the importance of smoking cessation to effectively reduce cancer risk.

Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women.

To estimate the independent and joint effects of tobacco smoking and alcohol drinking, we analyzed data from a series of 5 hospital-based case-control studies of squamous-cell carcinoma of the esophagus conducted in high-risk areas in South America. A total of 830 case subjects and 1779 control subjects were included in the pooled analysis. All exposure characteristics of amount, duration, cessation and type of alcohol and tobacco consumed were strongly related to esophageal-cancer risk in both sexes. Women had the same exposure profile as men, but the magnitudes of the associations were lower than were those among men. Black-tobacco smoking was associated with a 2-fold increased risk as compared with the smoking of blond or mixed tobacco. Quitting either of the 2 habits significantly reduced esophageal-cancer risk. Alcohol and tobacco alone were strongly related to the risk of esophageal cancer, even in the absence of the other exposure. A history of simultaneous exposure to cigarette smoking and alcohol drinking had a strong multiplicative effect on risk. Concomitant exposure to heavy alcohol drinking and black-tobacco smoking identified the group with the highest risk for developing esophageal cancer (odds ratio = 107). A synergistic interaction was found between the 2 habits, particularly in women and in moderately exposed men. Moderate cigarette smoking without drinking and moderate alcohol drinking without smoking had a negligible effect on esophageal-cancer risk. However, simultaneous exposure to the same moderate amounts increased the risk 12- to 19-fold in men and in women respectively. The overall public-health implications of these findings are obvious for a tumor that depends on preventive strategies for its control.

[Intrahospital transportation of critical patients]. / Transporte intrahospitalario en pacientes críticos.

Critically ill patients often need to be transferred for a short period of time for diagnostical or therapeutical reasons to other areas outside the intensive care unit which are less safe than their own unit and suppose a potential risk of deterioration in the patient's status. We analyse prospectively the intrahospitalary transfer in 50 patients and study the hemodynamic, ventilatory and neurological variations before and after the transfer. 93.7% of our patients were transferred for diagnostical reasons, basically to the radiodiagnosis service (85.4% for TAC performance), only 6.25% were transferred for therapeutical reasons, all of them to the operating theatre. All the patients included in the study were subjected to: -mechanic ventilation, electrocardiographic monitoring (ECG), invasive arterial monitoring (TA), monitoring of arterial saturation of O2 using pulsioximetry, drugs infusion through volumetric bombs and intracraneal pressure monitoring through intra-ventricular catheter (in 18 cases). The intrahospitalary transfer was performed with: -Portable ventilator, ECG monitoring, TA, PIC and pulsioximetry. Before and after the transfer different parameters were registered: -Inspiratory fraction of O2 (FiO2), TA, cardiac frequency, PIC, arterial gasometry (pH, PAO2, PACO2). There were no complications in any of the cases, the gasometric alterations were due to the change of respiratory parameters for the transfer (increase of the FiO2 and prophylactic ventilation in all the cases). We recommend: -Use of the portable ventilator, volumetric bombs, hemodynamic monitoring and uninterrupted pulsioximetry and the presence of qualified staff (doctor and ICU nurse) during the transfer.

Cytokines clearance during venovenous hemofiltration in the trauma patient.

The objective of the study was to investigate whether continuous venovenous hemofiltration (CVVH) would facilitate removal of substantial amounts of tumor necrosis factor (TNF) and interleukin-6 (IL-6) from the circulation in traumatized critically ill patients with multiple organ dysfunction syndrome. The study design was a prospective, nonblind, randomized controlled trial that was set in the trauma intensive care unit of a tertiary university referral hospital. Thirty consecutive critically ill, mechanically ventilated trauma patients with multiple organ dysfunction syndrome (without renal failure) were included in the study. Patients were randomized to either CVVH or conventional treatment. Blood and ultrafiltrate samples were collected from each patient before the initiation of CVVH and after 24, 72, and 168 hours of therapy. In the control group, blood samples were collected during the same periods. In the 30 patients studied, 15 had hemofiltration and 15 did not. Both groups were similar with regard to age (36+/-18 years v 36+/-14 years) and severity scores (injury severity score, 32+/-16 v 30+/-11; APACHE II score, 22+/-7 v 21+/-6; Goris score, 5.2+/-1.7 v 5.2+/-1.8). Before CVVH, TNF and IL-6 could be detected in the serum of all patients. The mean concentration of TNF was 17+/-22 pg/mL in patients and 22+/-20 pg/mL in control subjects (P = NS). The mean concentration of IL-6 was 2,153+/-2,824 pg/mL in patients and 1,774+/-1,637 pg/mL in control subjects (P = NS). We found a TNF and IL-6 substantial elimination with CVVH (excretion of TNF [microg/d] at 24, 48, and 168 hours: 112.6+/-161.2, 105.2+/-149.4, and 143.1+/-170.0; excretion of IL-6 [microg/d]: 1,655+/-719, 3,091+/-489, and 2,420+/-366). However, no significant difference was found in serum cytokines concentration between groups during the study: mean serum TNF concentration decreased from the pretreatment level to a mean level of 12+/-9.6 pg/mL in patients and 21+/-27 pg/mL in control subjects. Similar results were found with IL-6 concentration that decreased from the pretreatment level to a mean of 554+/-731 pg/mL in patients and 382 +/-568 pg/mL in control subjects. In conclusion, CVVH is associated with removal of substantial amounts of TNF and IL-6 from the circulation in traumatized critically ill patients, but the profile of these mediators is similar to that of controls, suggesting a nonclinically relevant elimination. Further prospective, randomized, clinical trials are needed to support our results.

Lifetime body mass index and risk of oral cavity and oropharyngeal cancer by smoking and drinking habits.

The influence of body mass index (BMI) on oral cancer risk was evaluated in 375 incident cases and 375 age-gender-matched hospital-based controls. Low BMIs at diagnosis and 2 years before diagnosis were associated with significantly elevated odds ratios (OR for BMI < or =22 vs >26 kg m(-2); 3.64; 95% confidence interval, CI: 2.27-5.82 and 3.31; 95% CI: 2.04-5.39, respectively). The association with low BMI, however, tended to be weaker and nonsignificant among never smokers and never drinkers.