Efficacy, safety of and adherence to adjustable compression wraps in the control phase of breast cancer-related lymphedema: A randomized controlled trial.

OBJECTIVE: To evaluate efficacy, safety, and adherence to using adjustable compression wraps (ACWs) for upper limb volume control in women with breast cancer-related lymphedema. DESIGN AND SETTING: Randomized controlled trial at a reference hospital for breast cancer treatment in Brazil. PARTICIPANTS: Women in control phase of the breast cancer-related lymphedema. INTERVENTIONS: Compared use of ACWs versus compressive mesh. MAIN MEASURES: Evaluated before treatment, at 30 days, and 6 months after initiating therapy. The primary outcome was the change in excess limb volume. Secondary outcomes included adherence, incidence of adverse events, functionality, quality of life, and hand grip. Statistical analysis involved calculating the effect size (ES) with a 95% confidence interval. RESULTS: Were included 71 women with mean excess limb volume of 321.79 mL (±194.98). In the 30-day analysis (Time 1), a reduction of 37.6 mL in volume was observed only in the ACW group (p = .041, ES 0.20), with improved functionality (p = .013, ES 0.22). In the six months analysis (Time 2), the compressive mesh group increased by 2.48% in volume (p = .023, ES 0.26) and demonstrated improvement functionality (p = .036, ES 0.27). Mild adverse events and satisfactory adherence were observed. However, in the intergroup comparison, no statistically significant difference was observed for any evaluated outcome-excess volume, incidence of adverse events, adherence, hand grip, quality of life, and functionality between the groups (p > .05) at both times. CONCLUSIONS: Both compression therapies achieved satisfactory adherence, were safe, effective and equivalent for controlling limb volume in breast cancer-related lymphedema.

Assessment of health-related quality of life after mild COVID-19 infection.

INTRODUCTION: Coronavirus disease 19 (COVID-19) affected the health-related quality of life (HRQoL), and its impact on well-being is not sufficiently understood yet. The worsening of HRQoL and symptoms such as fatigue, anxiety, depression, chronic Headache, Myalgia, ageusia, olfactory disorders, and cognitive impairment can be seen in people of different ages and genders after COVID-19 infection, even mild infections without hospitalization. These issues generate a disease burden that can reduce work skills and cause social, psychological, and neuropsychiatric challenges. OBJECTIVE: To evaluate the HRQoL of patients affected by COVID-19, the domains most affected, and their relationship with fatigue, anxiety, depression, chronic Headache and Myalgia, ageusia, olfactory disorders, and cognitive impairment. METHODS: An analytical transverse was conducted with 143 patients after COVID-19 infection. The patient-reported outcomes measures (PROMS) were collected by the 36-item Short Form survey (SF-36), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), Mini-Mental State Examination-2 (MMSE-2), Symbol Digit Modalities Test (SDMT), and a questionnaire regarding symptoms such as chronic Headache, myalgia, and olfactory disorders. Spearman's correlation test was used to correlate the performance of the patients on different PROMS. RESULTS: Fatigue, depression, and anxiety were negatively correlated with all the SF-36 domains, and patients with subjective cognitive complaints had low scores in all SF-36 domains. Furthermore, those with chronic Headaches had low scores in physical functioning, role-physical functioning, and vitality. Regarding myalgia complaints, the worst scores were observed in the physical functioning and vitality domains. Patients with ageusia had low scores in general health perceptions, and those with olfactory dysfunction had low scores in the vitality and mental health domains. CONCLUSIONS: Although the acute phase of COVID-19 has resolved, knowledge about HRQoL after this period is essential since many individual and collective changes have been taking place until today-patients with neuropsychiatric manifestations that persisted after the acute phase showed lower overall quality of life.

Epidemiological profile of neuroendocrine tumors in adults in Brazil.

Objective: Neuroendocrine tumors (NETs) are a set of diseases that originate from neuroendocrine cells, which comprises a diffuse endocrine system present in various organs of the body. These tumors are more frequent in the gastrointestinal tract (70%) and the bronchopulmonary system (20%-30%). A NET incidence rate of 1-5 per 100,000 inhabitants has been estimated for several European countries and the USA employing 20 years of data. However, no comprehensive studies on this rare neoplasm are available in Brazil. In this context, the aim of this study was to characterize the epidemiological NET profile in the country. Materials and methods: This is a retrospective descriptive observational study based on data from Hospital Cancer Records available at the Brazilian National Cancer Institute and the São Paulo Oncocentro Foundation. Demographic, clinical and treatmentrelated variables were analyzed from selected cases employing descriptive statistics. Results and Conclusion: A total of 15,859 cases were identified, most occurring in males (53.4%) and in individuals under 65 years old (63.3%). Small cell carcinoma was the most frequent histological type (46.7%). Bronchopulmonary tumors were the most frequent NETs, followed by pancreatic tumors, with cases mostly concentrated in high complexity centers in the Brazilian Southeast and treated mainly with surgery and chemotherapy, with over half of the patients diagnosed in advanced stages of the disease.

Exploring factors and trends in place of death by cancer: a population-based study in Brazil.

Background: The place of death profoundly affects end-of-life care quality, particularly in cancer. Assisting individuals at home enhances support, privacy, and control, reducing healthcare costs. This study seeks to elucidate factors associated and trends in place of death by cancer in Brazil. Methods: Using data obtained from the National Mortality Information System, this study extracted tumour topography, sociodemographic characteristics, and the place of death (outcome classified into hospital or home death) by cancer in Brazil from 2002 to 2021. Findings: The analysis included 3,677,415 cases, with 82.3% of deaths occurring in hospitals and 17.7% at home. Most participants were male (53.1%), had gastrointestinal tumours (32.2%), and resided in the Southeastern region (48.7%). Home deaths were more frequent in the Northeastern (30.2%) and Northern (24.8%) regions compared to the Southern (17.1%) and Southeastern (12.2%) regions. A strong inverse correlation was found between home deaths and the Human Development Index of the region. Over the years, there was a reduction in home deaths, followed by a recent increase. Individuals with no formal education, indigenous individuals, and patients from the North, Northeast, and Central-West regions had higher rates of home deaths, while patients with haematological malignancies had lower rates compared to those with gastrointestinal tumours. Interpretation: The minority of deaths by cancer in Brazil occur at home, with distinct trends over time. Home death was associated with regional, racial and educational level differences. Funding: No funding.

Compressive taping to prevent postmastectomy seroma: patient adherence and satisfaction.

OBJECTIVE: Evaluate patient adherence and satisfaction concerning postmastectomy compressive taping. METHODS: This comprises a preintervention and postintervention study carried out with women ≥18 years old who underwent taping during the first 7 postoperative days at the Cancer Hospital III/National Cancer Institute. Good adherence was considered as taping maintenance for 7 days. Satisfaction levels were classified as satisfied and dissatisfied. RESULTS: A total of 124 women with a mean age of 56.54 (±11.24) were included in the study. Most lived without a partner (58.1%), had more than 8 years of study (59.7%), referred to themselves as white (68.5%) and considered their health status to be good or very good (69.4%). Regarding treatment adherence, 90.3% patients displayed adherence. Patients with no bullous lesions were more likely to adhere to taping (OR 7.00; 95% CI 1.98 to 24.74; p=0.003). Regarding satisfaction, 78.2% of the patients felt satisfied. The absence of local discomfort (OR 4.51; 95% CI 1.73 to 11.74; p=0.002) and non-existence of self-reported oedema (OR 5.81; 95% CI 1.81 to 18, 66; p=0.003) were associated with greater patient satisfaction. CONCLUSION: Patients exhibited good adherence and felt very satisfied with the use of postmastectomy compressive taping. TRIAL REGISTRATION NUMBER: NCT04471142.

Ethnic disparities in breast cancer patterns in Brazil: examining findings from population-based registries.

PURPOSE: To investigate breast cancer (BC) incidence and mortality rates among specific racial groups in Brazil. METHODS: BC incidence was evaluated from 2010 to 2015, using Brazilian Population-Based Cancer Registries, incorporating crude ratios and annual average percentage change (AAPC). Clinical and sociodemographic data from 2000 to 2019 were obtained from Hospital-Based Cancer Registries. Mortality data from 2000 to 2020 were sourced from the National Mortality Information System, comparing White women and Black women. RESULTS: Across 13 Brazilian registries, 70,896 new BC cases were reported from 2010 to 2015. The median BC incidence rate was notably higher for White women (101.3 per 100,000) compared to Black women (59.7 per 100,000). In the general population, non-significant decrease in annual BC incidence was observed (AAPC = - 1.2; p = 0.474). Black women were more likely to live in underdeveloped areas, have lower education levels, live without a partner, and have higher alcohol consumption as compared to White women. A higher proportion of Black women received advanced-stage diagnoses (60.1% versus 50.6%, p < 0.001). BC-related mortality analysis showed 271,002 recorded deaths, with significant increase in BC-specific mortality rates in both racial groups. Black women displayed an AAPC of 2.3% (p < 0.001), while White women demonstrated a moderately elevated AAPC of 0.6% (p < 0.001). CONCLUSION: This study underscores the need for targeted policies to address disparities in access to early detection and proper treatment, particularly for Black women in underprivileged regions, aiming to improve the survival rates of Brazilian women grappling with BC.

Population-Based Trends in Cervical Cancer Incidence and Mortality in Brazil: Focusing on Black and Indigenous Population Disparities.

OBJECTIVE: This study aimed to explore trends in cervical cancer (CC) incidence and mortality rates according to race/skin color in Brazil focusing on the seriousness of the racial disparity. METHODS: Data from Brazilian Population-Based Cancer Registries (PBCRs) were analyzed for trends in incidence between 2010 and 2015. For mortality, data from the National Mortality Information System were retrieved between 2000 and 2020. A self-declaration on race/skin color was collected following the classification proposed by the Brazilian Institute of Geography and Statistics - white, black, brown/mixed race, yellow, or indigenous. For the analysis, black and brown/mixed race were grouped as black. RESULTS: Between 2010 and 2015, 10,844 new cases of CC were registered in the participating PBCRs, distributed among white women (49.6%), black (48.0%), and other race/skin color (2.3%). Compared with white counterparts, black women had a 44% higher risk of incident CC. As for mortality, between 2000 and 2020, 108,590 deaths from CC occurred nationwide. The mean age-adjusted mortality rates according to race/skin color were 3.7/100,000 for white, 4.2/100,000 for black, 2.8 for yellow, and 6.7 for indigenous women. Taking the mortality rates in white women as a reference, there was a 27% increase in death risk in black women (RR = 1.27) and 82% in indigenous women (RR = 1.82). CONCLUSION: These findings suggest that the higher rates of incidence and mortality from CC in vulnerable populations of black and more impactfully indigenous women in Brazil remain alarming. More efficient HPV vaccination strategies synchronized with well-conducted Pap smear-based screening should be prioritized in these more vulnerable populations.

Epidemiological profile of neuroendocrine tumors in adults in Brazil

ABSTRACT Objective: Neuroendocrine tumors (NETs) are a set of diseases that originate from neuroendocrine cells, which comprises a diffuse endocrine system present in various organs of the body. These tumors are more frequent in the gastrointestinal tract (70%) and the bronchopulmonary system (20%-30%). A NET incidence rate of 1-5 per 100,000 inhabitants has been estimated for several European countries and the USA employing 20 years of data. However, no comprehensive studies on this rare neoplasm are available in Brazil. In this context, the aim of this study was to characterize the epidemiological NET profile in the country. Material and methods: This is a retrospective descriptive observational study based on data from Hospital Cancer Records available at the Brazilian National Cancer Institute and the São Paulo Oncocentro Foundation. Demographic, clinical and treatment-related variables were analyzed from selected cases employing descriptive statistics. Results and Conclusion: A total of 15,859 cases were identified, most occurring in males (53.4%) and in individuals under 65 years old (63.3%). Small cell carcinoma was the most frequent histological type (46.7%). Bronchopulmonary tumors were the most frequent NETs, followed by pancreatic tumors, with cases mostly concentrated in high complexity centers in the Brazilian Southeast and treated mainly with surgery and chemotherapy, with over half of the patients diagnosed in advanced stages of the disease.

Complex physical therapy employing self-adjusting garment (ReadyWrap®) in breast cancer-related lymphedema cases in Brazilian women: a protocol for a randomized controlled trial.

BACKGROUND: Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema. METHODS: This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant. DISCUSSION: This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis. TRIAL REGISTRATION: NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021.

Differential survival of Brazilian patients with diffuse large B-cell lymphoma with and without HIV infection.

OBJECTIVE: Combinatorial antiretroviral therapy provided improvement of HIV patients' immune function and a decrease in the incidence of non-Hodgkin lymphoma (NHL). Diffuse large B-cell lymphoma (DLBCL) is one of the most common NHL forms affecting HIV+ patients. The present study aimed to evaluate the impact of HIV infection on the prognosis of patients treated for DLBCL in a reference cancer treatment center in Brazil. METHODS: A retrospective case-control study was developed with patients followed-up at the Brazilian National Cancer Institute, in which 243 DLBCL patients (91 HIV+ and 152 HIV-) were enrolled. HIV- controls were matched to HIV+ according to date of cancer diagnosis, clinical staging, primary cancer treatment and date of birth. Sociodemographic and cancer treatment data were extracted from medical charts. Kaplan-Meier analyses were carried out to estimate survival, while univariate and multiple Cox regression analyses were used to determine factors associated with mortality. RESULTS: A total of 98 deaths were observed in a 5-year period after cancer diagnosis. A negative association of HIV infection with both overall and disease-specific survival 1 year after cancer diagnosis was observed [hazard ratio (HR) = 1.98 and 1.96, respectively]. The negative association with HIV infection with disease-specific survival remained significant for a 5-year period after cancer diagnosis (HR = 1.53). HIV viral load above 1000 copies/ml at study entry was also associated with shorter overall and cancer-specific survival. CONCLUSIONS: HIV infection negatively impacted prognosis and mortality of DLBCL patients irrespective of cancer-related clinical factors.

Effectiveness of mat pilates on fatigue in women with breast cancer submitted to adjuvant radiotherapy: randomized controlled clinical trial.

PURPOSE: This clinical trial aimed to evaluate the influence of Mat Pilates and time on the change in fatigue scores in women with breast cancer undergoing adjuvant radiotherapy (RT). Additionally, assess the adherence and adverse effects of Mat Pilates sessions and the association of the level of physical activity with severe fatigue symptoms. METHODS: One hundred fifty-six patients with non-metastatic breast cancer were randomized to usual care or supervised Mat Pilates exercise. Fatigue and physical activity level were measured at baseline, end of RT, 30 days, 3 and 6 months after RT. The generalized estimating equation (GEE) with intention to treat was applied. RESULTS: A significant difference in the fatigue mean between the end of RT and the baseline was found in patients of both groups. There was no adverse effect with the practice of Mat Pilates, and it was analyzed the reduction of the symptom pain after the end of RT in women of intervention group compared to the control. There was no significant effect on fatigue between the groups. Patients with severe fatigue after 3 and 6 months of RT reported a significantly lower level of physical activity in the last periods. CONCLUSION: Fatigue levels increased at the end of RT but returned to baseline values after 6 months. A lower level of physical activity was associated with severe fatigue symptoms. Mat Pilates was safe for these women and reduced the symptom pain after treatment, but it did not successfully reduce fatigue during adjuvant RT. REGISTRATION: NCT03333993. November 7, 2017.  https://clinicaltrials.gov/ct2/show/NCT03333993?term=breast+cancer&cond=pilates&draw=2&rank=1 .

Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series.

Axillary dissection is a standard surgical procedure for stage III skin and soft tissue tumors and is usually performed under general anesthesia. This study aimed to investigate the feasibility of performing axillary dissection with Serratus muscle plane block plus intravenous sedation. Fifteen patients undergoing axillary dissection were prospectively recruited. The patients were evaluated during their pre-operative anesthetic appointment, during their procedure, and at post-operative days 1 and 30. The blockade was performed superficial to the Serratus muscle at the level of fourth rib. Sedation was performed using propofol, fentanyl, dexmedetomidine, and S-ketamine. None of the patients required conversion to general anesthesia. Surgeons showed a highly positive response when asked about the anesthetic technique, and most of them found the technique "indistinguishable" from general anesthesia. The median (interquartile range) pain scores at rest over all time frames was 0 (0-0). Furthermore, no patients developed nausea, hemodynamic instability, or any complications associated with the technique. The Serratus plane block associated with intravenous sedation proved feasible for axillary lymphadenectomy, however, further clinical trials should evaluate potential advantages compared to other techniques.

Trends in the incidence of malignant central nervous system tumors in Brazil, 2000-2015.

Background: In Brazil, 5870 new cases of malignant central nervous system tumors (MCNST) were estimated for men and 5220 for women for each year of the 2020-2022 triennium. The objective of this study was to analyze incidence rate trends and compare demographic characteristics of new MCNST cases according to tumor topographies in Brazil from 2000 to 2015. Methods: This study comprises an analytical cross-sectional assessment of secondary databases extracted from the Brazilian National Cancer Institute (INCA) website. Data comprised new neoplasm cases of meninges (C70), brain (C71), spinal cord, cranial nerves, and other central nervous system parts (C72) retrieved from 23 population-based cancer registries. A descriptive analysis was performed. Crude and age-adjusted incidence rates were calculated. Linear trends were calculated using a linear least squares regression for adjusted incidence rates versus time. Results: A total of 24 986 new MCNST cases were recorded. The main topography was the brain (91.5%). Except for meninges tumors, where 62.4% of the cases were observed in women, MCNST cases were more frequent among men concerning the other evaluated topographies. All 3 topographies occurred predominantly in adult patients aged from 40- to 64-year-old. Between 2000 and 2015, incidence rates ranged from 5.12 to 4.95 (a 1.4% increase of per year; 95% CI -4.0 to 6.8; P = .584) in men and from 4.35 to 3.61 (a 3.1% increase per year; 95% CI -1.7 to 8.0; P = .189). Conclusions: The most frequent topography was the brain. Incidence rates of MCNST remained relatively stable over time in both sexes.

Primary diffuse large B-cell lymphoma of the head and neck in a Brazilian single-center study.

OBJECTIVES: Lymphomas represent around 10% of head and neck neoplasms, among which the diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype. In the present study, we characterized demographic parameters, anatomical sites, and survival rates of patients in a Brazilian cancer center. MATERIALS AND METHODS: Single-center retrospective epidemiological study of 243 head and neck DLBCL patients. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) activity, and treatment modality were obtained from electronic medical records. RESULTS: The most common primary head and neck tumor location in patients with DLBCL was Waldeyer's ring. Interestingly, age above 80 years, male gender, high LDH levels, and HIV positivity were significantly associated with shorter overall survival (OS) rates and increased risk of death. We further demonstrated that treatment had a protective effect, improving OS, and reducing risk of death. Notably, we found no benefit of combination of chemotherapy and radiotherapy versus isolated treatment modalities. CONCLUSION: The study showed that primary head and neck DLBCL is more incident in middle age and elderly patients with a small male patients' majority in a Brazilian population. Moreover, we observed a 3-year OS rate of almost 60% and multivariate analysis showed that treatment was the only protective factor.

Epidemiology of tongue squamous cell carcinoma: A retrospective cohort study.

OBJECTIVE: To analyze the epidemiological profile and the specific survival of patients diagnosed with tongue squamous cell carcinoma at the National Cancer Institute (INCA). MATERIALS AND METHODS: Hospital Cancer Registry System Data and Mortality Information from 2007 to 2009 were retrieved in a retrospective cohort study of patients diagnosed with tongue squamous cell carcinoma. Specific survival was estimated using the Kaplan-Meier method. The association between independent variables and the risk of death was explored in a Cox proportional hazards regression model. RESULTS: A total of 346 patients were eligible, mostly male (77.5%), smokers (87.6%), with alcohol consumption (80.9%), with low education (65.6%), advanced staging at the time of diagnosis (71.1%), and presenting a high mortality rate (72.5%). In total, 44.5% of patients underwent a surgical approach alone or associated with another treatment modality, of which 85.1% of patients underwent neck dissection and 90.1% had free surgical margins. Specific survival was 40.6% in two years and 31.2% in five years. CONCLUSION: The 5-year specific survival was considered worse in individuals over 60 years, and who did not undergo surgical treatment or had surgery associated with another treatment, compared to patients undergoing isolated surgery.

Cognitive Complaints Assessment and Neuropsychiatric Disorders After Mild COVID-19 Infection.

OBJECTIVES: This study aimed to analyze cognitive impairment associated with long-term coronavirus disease 2019 (COVID-19) syndrome and its correlation with anxiety, depression, and fatigue in patients infected with severe acute respiratory syndrome coronavirus. METHODS: This was a cross-sectional study of 127 patients with COVID-19. Tests to screen for neuropsychiatric symptoms included the Fatigue Severity Scale, Mini-Mental State Exam 2 (MMSE-2), Symbol Digit Modalities Test (SDMT), and Hospital Anxiety and Depression Scale. RESULTS: In cognitive tests, SDMT was abnormal in 22%, being more sensitive than MMSE-2 to detect cognitive changes. Furthermore, although manifestations such as fatigue, depression, and anxiety were frequent in the post-COVID-19 phase, these 3 conditions, known to contribute to cognitive impairment, were slightly correlated with worse performance on the rapid screening tests. CONCLUSIONS: In patients with mild COVID-19 and cognitive complaints, SDMT helped to confirm disturbances in the attention domain and processing speed.

Influence of Age on Health-Related Quality of Life of Women Diagnosed with Breast Cancer / Influência da Idade na Qualidade de Vida Relacionada à Saúde de Mulheres Diagnosticadas com Câncer de Mama / Influencia de la Edad en la Calidad de Vida Relacionada con la Salud de Mujeres Diagnosticadas con Cáncer de Mama

Introduction: Women with breast cancer may have differences in health-related quality of life (HRQoL) at diagnosis by age. Objective: To analyze the influence of age on the HRQoL of women diagnosed with breast cancer. Method: Cross-sectional study was carried out with women diagnosed with breast cancer. HRQoL assessment was performed before starting cancer treatment, using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its specific breast cancer module (BR-23). Association between age group and HRQoL was determined through multiple linear regression. Results: 961 women were included in the study, with a mean age of 54 (SD±11.7). Women aged ≥50 years displayed better emotional functioning (+7.6 points; p<0.001), and less fatigue (-4.4 points; p=0.014), pain (-4.7 points; p=0.033), nausea and vomiting (-2.3 points; p=0.030) and financial difficulties (-10.3 points; p<0.001) compared to younger women. Concerning the BR-23 module, these women displayed better body image scores (+3.6 points; p=0.029) and future perspective (+12.4 points; p<0.001), and worse sexual functioning (-19.9 points; p<0.001) and sexual enjoyment (-8.9 points; p=0.001), and on the symptom scale, less breast symptoms (-11.6 points; p<0.001) and arm symptoms (-3.5 points; p=0.047). Conclusion: Patients aged ≥50 years exhibited better HRQoL in all QLQ C-30 and BR-23 functioning scales and symptom scales, except for sexual functioning and sexual enjoyment

Introdução: Mulheres com câncer de mama podem apresentar diferenças na qualidade de vida relacionada à saúde (QVRS) ao diagnóstico de acordo com a idade. Objetivo: Analisar a influência da idade na QVRS de mulheres com diagnóstico de câncer de mama. Método: Estudo transversal com mulheres diagnosticadas com câncer de mama. A avaliação da QVRS foi realizada antes do início do tratamento oncológico por meio do questionário European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) e seu módulo específico para o câncer de mama (BR-23). A associação entre faixa etária e QVRS foi determinada por meio da regressão linear múltipla. Resultados: Foram incluídas 961 mulheres com média de idade de 54 anos (DP±11,7). Mulheres com idade ≥50 anos apresentaram melhor função emocional (+7,6 pontos; p<0,001), menos fadiga (-4,4 pontos; p=0,014), dor (-4,7 pontos; p=0,033), náuseas e vômitos (-2,3 pontos; p=0,030) e dificuldade financeira (-10,3 pontos; p<0,001) comparadas às mulheres jovens. Em relação ao BR-23, essas mulheres apresentaram melhor escores de imagem corporal (+3,6 pontos; p=0,029) e de perspectiva futura (+12,4 pontos; p<0,001), e piores função sexual (-19,9 pontos; p<0,001) e satisfação sexual (-8,9 pontos; p=0,001); e, na escala de sintomas, menos sintomas na mama (-11,6 pontos; p<0,001) e sintomas no braço (-3,5 pontos; p=0,047). Conclusão: As pacientes com idade ≥50 anos apresentaram melhor QVRS em todos os domínios das escalas de função e escalas de sintomas do QLQ C-30 e BR-23, exceto no que diz respeito à função sexual e à satisfação sexual

Introducción: Las mujeres con cáncer de mama pueden tener diferencias en la calidad de vida relacionada con la salud (CVRS) al momento del diagnóstico según la edad. Objetivo: Analizar la influencia de la edad en la CVRS de mujeres con diagnóstico de cáncer de mama. Método: Estudio transversal con mujeres diagnosticadas con cáncer de mama. La evaluación de la CVRS se realizó antes de iniciar el tratamiento oncológico mediante el Cuestionario European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) y su módulo específico para el cáncer de mama (BR-23). La asociación entre el grupo de edad y la CVRS se determinó mediante regresión lineal múltiple. Resultados: Se incluyeron 961 mujeres con una edad media de 54 años (DE±11,7). Las mujeres ≥50 años tuvieron mejor funcionamiento emocional (+7,6 puntos; p<0,001), y menos fatiga (-4,4 puntos; p=0,014), dolor (-4,7 puntos; p=0,033), náuseas y vómitos (-2,3 puntos; p=0,030) y dificultades financieras (-10,31 puntos; p<0,001) en comparación con las mujeres jóvenes. Con respecto al BR-23, estas mujeres presentaron mejores puntajes de imagen corporal (+3,6 puntos; p=0,029) y perspectiva de futuro (+12,4 puntos; p<0,001) y peor función sexual (-19,9 puntos; p<0,001) y satisfacción sexual (-8,9 puntos; p=0,001), y en la escala de síntomas, menos síntomas mamarios (-11,6 puntos; p<0,001) y brazos (-3,5 puntos; p=0,047). Conclusión: Las pacientes con edad ≥50 años tuvieron mejor CVRS en todos los dominios de las escalas de función y síntomas del QLQ C-30 y BR-23, excepto función sexual y satisfacción sexual

Serratus plane block with sedation for patients submitted to axillary dissection: a prospective case series / Bloqueio do plano do músculo serrátil guiado por ultrassonografia associado à sedação venosa como técnica anestésica em cirurgia de linfadenectomia axilar: uma série de casos prospectiva

ABSTRACT Axillary dissection is a standard surgical procedure for stage III skin and soft tissue tumors and is usually performed under general anesthesia. This study aimed to investigate the feasibility of performing axillary dissection with Serratus muscle plane block plus intravenous sedation. Fifteen patients undergoing axillary dissection were prospectively recruited. The patients were evaluated during their pre-operative anesthetic appointment, during their procedure, and at post-operative days 1 and 30. The blockade was performed superficial to the Serratus muscle at the level of fourth rib. Sedation was performed using propofol, fentanyl, dexmedetomidine, and S-ketamine. None of the patients required conversion to general anesthesia. Surgeons showed a highly positive response when asked about the anesthetic technique, and most of them found the technique "indistinguishable" from general anesthesia. The median (interquartile range) pain scores at rest over all time frames was 0 (0-0). Furthermore, no patients developed nausea, hemodynamic instability, or any complications associated with the technique. The Serratus plane block associated with intravenous sedation proved feasible for axillary lymphadenectomy, however, further clinical trials should evaluate potential advantages compared to other techniques.

RESUMO A linfadenectomia axilar é um procedimento cirúrgico padrão para tratamento de tumores de pele e partes moles no estádio III e usualmente é realizada sob anestesia geral. A presente serie de casos prospectiva tem por objetivo investigar a viabilidade da realização da linfadenectomia axilar com o uso do bloqueio do plano do músculo serrátil anterior associado a sedação endovenosa. Foram incluídos 15 pacientes no estudo. Os participantes foram recrutados e avaliados durante consulta pré-anestésica ambulatorial, acompanhados durante o dia da cirurgia, no primeiro e no trigésimo dias de pós-operatório. O bloqueio foi realizado anterior ao músculo serrátil anterior ao nível da quarta costela na linha axilar média. A sedação foi realizada com o uso de propofol, fentanil, dexmedetomidina e dextrocetamina. Não houve necessidade de conversão para anestesia geral em nenhum paciente. Os cirurgiões apresentaram resposta altamente positiva quando questionados sobre a técnica anestésica, considerando na maior parte dos casos "indistinguível" da anestesia geral. A mediana (intervalo interquartil) da dor em repouso em todos os momentos avaliados foi 0 (0-0). Além disso, nenhum paciente desenvolveu náuseas, vômitos, instabilidade hemodinâmica ou qualquer complicação relacionada à técnica empregada. O bloqueio do plano do músculo Serrátil anterior associado a sedação venosa se mostrou viável para execução de linfadenectomia axilar, entretanto ensaios clínicos adicionais são necessários para avaliar potenciais vantagens em comparação com outras técnicas.