Change in therapeutic management after the EndoPredict assay in a prospective decision impact study of Mexican premenopausal breast cancer patients.

OBJECTIVE: To evaluate the change in adjuvant therapeutic decision in a cohort of young women with breast cancer discussed by a multidisciplinary team, before and after EndoPredict testing. PATIENTS AND METHODS: 99 premenopausal women with hormone receptor-positive, HER2-negative, T1-T2, and N0-N1 breast cancer were included. Clinicopathological characteristics were recorded and cases were presented in a multidisciplinary tumor board. Consensual therapeutic decisions before and after EndoPredict results were registered. Medical records were reviewed at six-month follow-up to determine physicians' adherence to therapeutic recommendations. Pearson chi-square and McNemar's tests were used to analyze differences between groups and changes in treatment recommendations, respectively. RESULTS: Median age at diagnosis was 43 years. The most frequent tumor size was pT2 (53.5%) and 27% of patients had 1-3 positive lymph nodes. 46% of patients had a low-risk EPclin result. Nodal status and tumor grade were significantly associated with EPclin result (p < .00001 and p = .0110, respectively), while Ki67 levels and age ≤40 years were not. A change in chemotherapy decision was registered in 19.2% of patients (p = .066), with the greatest impact in de-escalation (9% net reduction). A change in chemotherapy or endocrine therapy regimen was suggested in 19% and 20% of cases, respectively, after EPclin results were available. A significant difference was found in the median EPclin score between patients with a low- vs. high-intensity chemotherapy and endocrine therapy regimen recommendation (p = 0.049 and p = 0.0001, respectively). Tumor board treatment recommendation adherence with the EndoPredict result was 95% and final treatment adherence to EPclin result was 93%. CONCLUSIONS: The EndoPredict test successfully assisted the clinical decision-making process in premenopausal patients, with a clinically significant change in overall decision-making, with the greatest impact seen in chemotherapy reduction, and a high rate of therapeutic adherence.

Incremento de síndrome de burnout en estudiantes de Medicina tras su primer mes de rotación clínica / Increase in burnout syndrome in medical students during their first month of clinical rotation

INTRODUCCIÓN: Se ha demostrado que el desarrollo de burnout en los médicos se inicia desde su formación académica y puede repercutir en su vida personal. OBJETIVO: Evaluar la prevalencia de burnout al inicio y tras un mes de rotación clínica. MATERIAL Y MÉTODOS: Se empleó el Maslach Burnout Inventory-Human Services Survey de 22 reactivos. Se evaluaron al inicio de la rotación, después de un período vacacional, y después de un mes de rotación clínica. Se estableció la prevalencia y las diferencias entre las 2 mediciones. RESULTADOS: Veintiún (12,3%) alumnos presentaban síntomas de severidad al inicio del trimestre y 34 (19,8%) después del primer mes (p = 0,059). Tras eliminar la realización personal, 54 (31,6%) y 76 (44,2%) alumnos presentaron severidad en el resto de las dimensiones (p = 0,016), respectivamente. CONCLUSIÓN: Después de un mes de exposición clínica se presentó un incremento significativo en la presencia de cansancio emocional, despersonalización y burnout

INTRODUCTION: It has been demonstrated that the development of burnout in physicians begins during their academic training and it can affect their personal life. OBJECTIVE: To evaluate the prevalence of burnout in medical students at the beginning, and after one month of clinical rotation. MATERIALS AND METHODS: We evaluated students at the beginning of surgical clinical rotation and one month after using the Maslach Burnout Inventory-Human Services Survey. The prevalence and differences between the 2 measurements were calculated. RESULTS: Twenty-one (12.3%) students showed symptoms of severity at the beginning, and 34 (19.8%) after the first month (P = .059). After eliminating the personal accomplishment scale, 54 (31.6%) and 76 (44.2%) students had severity of symptoms in the rest of the dimensions at the beginning and after one month, respectively (P = .016). CONCLUSION: Medical students showed an increase in the presence of severe burnout, as well as emotional exhaustion and depersonalisation after one month of clinical rotation

Locally advanced breast cancer in young women in Latin America.

The purpose of this review is to organise, summarise and critically assess existing knowledge on locally advanced breast cancer (LABC) among young women in Latin America. We discuss the most relevant findings in six sections: 1) epidemiology of breast cancer in young women in Latin America; 2) being young as a factor for worse prognosis; 3) LABC in young women in the region; 4) aggressive tumour behaviour among young women; 5) delays in diagnosis and treatment and 6) burden of advanced disease. We point out the need to dedicate resources to enhance earlier diagnosis and prompt referrals of young women with breast cancer; promote research regarding prevalence, biologic characteristics, outcomes and reasons for diagnosis and treatment delays for this age group; and finally, implement supportive care programmes as a means of improving patients and their families' well-being. The recognition of the current standpoint of breast cancer in young patients across the continent should shed some light on the importance of this pressing matter.