Terapia de conversión en cáncer gástrico: experiencia del Instituto Nacional de Cancerología de Colombia / Conversion therapy in gastric cancer: experience at Instituto Nacional de Cancerología de Colombia

RESUMEN Antecedentes: el cáncer gástrico (CG) representa un problema de salud pública en Colombia y el mundo. Dado que la mayoría de los pacientes se encuentran en estadios avanzados en el momento del diagnóstico. desarrollar estrategias de manejo. como la terapia de conversión (TC). es una necesidad cada vez mayor en su tratamiento. Objetivo: estimar los resultados con la TC en el tratamiento de pacientes con CG avanzado en el Instituto Nacional de Cancerología de Colombia (INC). Material y métodos: serie de casos de pacientes con adenocarcinoma gástrico incurable llevados a quimioterapia de inducción y cirugía con intención curativa. entre los años 2010 y 2021. Se revisaron de forma retrospectiva los datos clínico-patológicos y de supervivencia. La supervivencia global (SG) se calculó desde la fecha de la primera quimioterapia hasta la muerte. Las funciones de supervivencia se estimaron con tablas de vida y por el método de Kaplan-Meier y se realizaron curvas de supervivencia a 3 y 5 años. Resultados: se analizaron los datos de 23 pacientes con edad promedio de 56 años. 17 (74%) fueron varones. El criterio de irresecabilidad más frecuente fue un tumor T4b en 13 casos (56.5%). Todos recibieron TC. La mediana de seguimiento fue de 28 meses. Se documentaron 11 recurrencias (52%). La mediana de supervivencia fue de 41.2 meses y la SG a 3 y 5 años de 57.7% y 38.5%. respectivamente. Conclusiones: la TC permitió obtener una SG aceptable de pacientes seleccionados con CG avanzado incurable. Esta estrategia requiere una cuidadosa selección y manejo multidisciplinario en centros oncológicos de referencia.

ABSTRACT Background: Gastric cancer (GC) represents a public health problem in Colombia and worldwide. Since most patients are at advanced stages at the time of diagnosis. it is necessary to develop management strategies as conversion therapy (CT). Objective: The aim of this study was to estimate the results of CT for treating patients with advanced and GC at Instituto Nacional de Cancerología de Colombia (INC). Material and methods: We included patients with incurable gastric cancer who underwent induction chemotherapy and intended curative surgery between 2010 and 2021. The clinical and pathological data and survival of the patients included were retrospectively reviewed. Overall survival (OS) was calculated from the time of initiation of chemotherapy until the date of death. Survival functions were estimated using the life table and Kaplan-Meier methods. and survival curves at 3 and 5 years were constructed. Results: 23 patients were analyzed; mean age was 56 years. and 17 (74%) were men. The most common criterion indicating unresectability was a T4b tumor in 13 cases (56.5%). All the patients underwent CT. Median follow-up was 28 months. Eleven patients developed disease recurrence (52%). Median survival was 41.2 months. and 3- and 5-year OS was 57.7% and 38.5%. respectively. Conclusions: CT provided an acceptable OS rate for selected patients with incurable advanced GC. This strategy requires an adequate selection of patients and multidisciplinary management in reference oncology centers.

From conservatism to support for gay conversion therapy: the role of prejudice and beliefs about same-sex sexuality.

Support for Gay Conversion Therapy may be motivated by homophobic prejudice driven by conservative groups. We propose that Support for Gay Conversion Therapy (SGCT) is motivated by conservatism and that this relationship is mediated by prejudice against gay individuals. We tested these hypotheses in three studies. In Study 1 (N = 249), we found that conservative values predict SGCT, and that this effect is partly mediated by prejudice. In Study 2 (N = 247), we replicated this mediation and found that ethical-religious and psychological essentialist beliefs differently moderated it. Study 3 (N = 210) went further by experimentally showing the political consequences of SGCT. We showed that more conservative individuals tend to absolve psychologists who practice sexual conversion, and that both prejudice and conservative-motivated SGCT mediated this effect. We discussed these results by emphasizing the psychosocial process that motivates SGCT.

Sexual Orientation and Gender Identity Change Efforts and Suicide Morbidity Among Sexual and Gender Minority Adults in Colombia.

Purpose: We assessed the association between sexual orientation and gender identity change efforts (SOGICE) experiences and lifetime suicide morbidity among sexual and gender minority (SGM) groups in Colombia. Methods: A sample of 4160 SGM Colombian adults responded to an online cross-sectional survey. We used binary logistic regression to assess the relationship between SOGICE and suicide morbidity for the overall sample and stratified by SGM group. Results: We found a high prevalence of suicidal ideation (56%), suicide planning (54%), suicide attempt (25%), and SOGICE experiences (22%). There were significant differences in the prevalence of suicide morbidity and SOGICE experiences across SGM groups, with transgender men and gender nonbinary participants being generally most at risk. SOGICE experiences were associated with 69% increased odds of suicidal ideation, 55% increased odds of suicide planning, and 76% increased odds of suicide attempt. Stratified analyses by SGM group showed that the association of SOGICE experiences with suicide morbidity varied by SGM group, and it was particularly detrimental for cisgender sexual minority men. Conclusions: Suicide morbidity among SGM adults in Colombia is high, with rates that are 8-22 times higher than in the general population. SOGICE experiences further exacerbate suicide risk. The study findings highlight the need to design and implement policies affirming diverse sexual orientation and gender identities in Colombia and to ban SOGICE practices. These findings also highlight the importance of recognizing the variability within SGM groups and the need to examine these groups separately rather than treating them as a monolithic group.

Characterizing Experiences of Conversion Therapy Among Middle-Aged and Older Men Who Have Sex with Men from the Multicenter AIDS Cohort Study (MACS).

Conversion therapies are practices that attempt to change an individuals' same-sex attractions through psychotherapeutic and aversive therapeutic techniques. Conversion therapies were developed based on homophobic beliefs that same-sex attractions are a mental illness. We sought to describe the prevalence and characteristics of conversion therapy experienced among middle-aged and older men who have sex with men in the United States. Given associations of homophobic stigma and HIV risk, we hypothesized that HIV-positive men would report higher odds of conversion therapy compared to HIV-negative men. We analyzed data from 1,237 middle-aged and older MSM enrolled in the Multicenter AIDS Cohort Study. Among participants, 17.7% reported lifetime conversion therapy, of which the average start of therapy age was 22.67 (sd = 10.56) years, 25.8% reported therapy durations of 6+ months, 37.7% reported session frequencies 1+ session per week, and 35.9% indicated that undergoing therapy was either a little or not at all their decision. We observed no statistically significant association between reporting lifetime conversion therapy and HIV status. Future efforts should continue to assess the magnitude of harm conversion therapies impose on MSM's health across the life course as well as test potential, indirect associations that may link these practices to HIV.