ABSTRACT
Purpose: The aim of this study is to evaluate the oncological care during the first state of national emergency due to the COVID-19 pandemic in several public cancer hospitals in Peru. Materials and Methods: A multicentric cross-sectional descriptive study was conducted by interviewing adult cancer patients diagnosed and treated between January 2019 and February 2020 from 18 hospitals. This study was carried out in September 2020, the last month of the first state of national emergency. Demographic and clinical characteristics were evaluated, including COVID-19 status and cancer treatment features. Results: A total of 1472 patients were included; the median age was 55 years (range 19-97). Most patients (85.8%, n = 1263) had solid neoplasia, 13.5% (n = 198) hematologic neoplasia, and 0.7% (n = 11) others. SARS-CoV-2 infection was confirmed in 8.6% (n = 126), 1.2% (n = 18) were probable, 1.6% (n = 24) suspected, and 88.6% (n = 1304) negative cases. Overall, 51.6% of patients (n = 759) had cancer treatment delays, 42.5% (n = 626) changed treatment delivery (endovenous to oral systemic therapy), and 12.6% (n = 185) of cases cancer therapy was discontinued. In total, 10.3% (n = 117) of patients whose disease was controlled or in remission, experienced progression of disease during the state of emergency. A total of 6.7% (n = 98) of patients died, of whom 73.5% (n = 72) died from disease progression; 18.4% (n = 18) from SARS-CoV-2 infection and 8.1% (n = 8) from undetermined causes. Patients with hematological malignancies [hazard ratio (HR): 5.11 (95% confidence interval (CI): 1.99-13.07)] and no response to therapy before the onset of the pandemic [5.01 (1.44-17.42)] had an increased risk of death among COVID-19 infected individuals, whereas advanced clinical stage [5.09 (2.37-10.95)] and discontinuation of treatment [3.66 (1.97-6.78)] were risk factors among non-COVID-19 patients. Conclusion: Our study suggests that the COVID-19 pandemic has an adverse impact on the outcomes of Peruvian cancer patients. In our cohort, cancer mortality was higher than COVID-19 disease mortality.
ABSTRACT
Objectivo: El principal objetivo fue determinar si la bioquimioterapia (tratamiento estándar) para los pacientes con Cáncer Renal de Células Claras Metastásico en el HNERM ofrece mayores respuestas y beneficio en la sobrevida con respecto a las otras modalidades de tratamiento empleadas en la misma institución. Pacientes y métodos. El presente estudio tuvo como población a pacientes con Cáncer Renal de Células Claras Metastásico, quienes fueron diagnosticados y tratados en Hospital Nacional Edgardo Rebagliati Martins - EsSalud, entre 2000 a 2005. Se evaluaron 50 pacientes, quienes fueron sometidos o no a nefrectomía y que posteriormente recibieron algún tipo de tratamiento médico como bioquimioterapia, corticoterapia, hormonoterapia, inmunoterapia y radioterapia, esta última como tratamiento único o en combinación con alguna otra modalidad anteriormente señalada. Estudio observacional. Resultados. La mayoría de los pacientes con Cáncer Renal de Células Claras Metastásico fue mayor de 60 años (68 por ciento) y del sexo masculino (76 por ciento). Los sitios más frecuentes de metástasis fueron a nivel pulmonar y óseo (46 por ciento). De la totalidad de pacientes, el 60 por ciento fue sometido a nefrectomía, el 74 por ciento recibió algún tipo de tratamiento médico y hasta el 22 por ciento pasó a cuidados paliativos por pobre status performance al momento del diagnóstico. Los pacientes recibieron bioquimioterapia hasta en 24 por ciento, corticoterapia en 8 por ciento, hormonoterapia e inmunoterapia, 12 por ciento; y radioterapia en 38 por ciento (en su mayoría combinada con alguna de las anteriores). La mediana de sobrevida libre de progresión y sobrevida global fue de 8.2 m. La sobrevida global de los pacientes nefrectomizados fue de 20.3 m vs. 4 m. de los no nefrectomizados (diferencia estadísticamente significativa), de los nefrectomizados más bioquimioterapia fue 14.2 m. vs. 20.3 m. de los nefrectomizados que recibieron cualquiera de las otras ...
Objectives: The main objective was to determine if the immunochemotherapy (treatment standard) for the patients with renal cancer of cells clear metas-tatic in HNERM offers bigger answers and benefit in the survival with regard to the other treatment modalities used in the same institution. Patient and meto-dos. Patients with renal cancer of cells clear metastatic who were diagnosed and treaties in the HNERM-EsSalud, among 2000 at 2005. 50 patients were evaluated who were subjected or not to nephrectomy and that later on they received some medical treatment type Results. Most of patient with cancer renal of cell clear metastatic was bigger than 60 years (68 per cent) and of the mascu-line (76 per cent) sex. The most frequent places in metastatic went at lung and bone (46 per cent) level. Of the entirety of patient 60 per cent was subjected to nephrectomy 74 per cent received some medical treatment type and until 22 per cent it went to cares palliatives by poor status performance to the moment of the diagnosis. The patients received immunochemotherapy until 24 per cent, corticotherapy 8 per cent, hormonotherapy and immunotherapy, 12 per cent; and radiotherapy 38 per cent (in their majority combined with some of the previous ones). The disease-free survival and median overall survival was of 8.2 m.The overall survival of the patient treated with a nephrectomy was of 20.3 m. vs. 4 m. of the without nephrectomy (differs statistically significant), of the patient treated with a nephrectomy more immunochemotherapy it was 14.2m vs 20.3m of the withoutnephrectomy that they received anyone of the other treatment ( differs not statistically significant) modalities. Conclusions. The immunochemotherapy is the mostly suitable treatment for patient with renal cancer of cells clear metastatic in HNERM; however she was not advantages as for answer and survival regarding the other treatment modalities. Also it was evidenced that the overall survival increases significantly ...