Factors associated with common mental disorders and use of psychiatric drugs in cancer outpatients.

BACKGROUND: Considering the high incidence of cancer in Brazil and worldwide, the high prevalence and relevance of Common Mental Disorders (CMD) in the treatment of cancer patients, and the use of psychiatric drugs without reliably proven effectiveness, studies that contemplate this topic are needed to understand and provide rationale for the treatment of CMD in these individuals. OBJECTIVES: This study identified prevalence and factors associated with Common Mental Disorders (CMD) and psychotropic use in cancer outpatients. METHOD: This is a cross-sectional study with descriptive correlational design. It was developed in the chemotherapy sector of a hospital specialized in cancer. The tools used were: Self Reporting Questionnaire (SRQ-20) and structured questionnaires. FINDINGS: Among 403 respondents, CMD prevalence was 31.5% and psychotropic use was 25.8%. CMD were associated with gender, education, family income, psychotropic use and cancer surgery. Psychotropic use was associated with gender, employment status, cancer surgery, treatment period and other physical health conditions. Logistic regressions showed CMD were associated with gender and other physical health conditions; psychotropic use was associated with gender, employment status and other conditions.

Retrospective analysis of breast cancer prognosis among young and older women in a Brazilian cohort of 738 patients, 1985-2002.

Invasive breast cancer (BC) is infrequent among women aged ≤40 years, however, the disease outlook in these younger patients is generally worse than among older women. The present study aimed to compare socio-demographic, clinical and pathological characteristics, and their association with long-term survival, between two random cohorts of young (≤40 years) and older (50-69 years) Brazilian patients with BC. The cohort comprised of 738 randomly selected women who were diagnosed with BC at Barretos Cancer Hospital, Pio XII Foundation (Barretos, Brazil) between January 1985 and December 2002; the patients included young women (n=376) and older women (n=362). The current analysis suggested that BC in young women is associated with numerous pathological features of aggressiveness. Second cancer and bilateral BC were independent predictors of a poor outcome in the younger group. Furthermore, C-erB-2 was positively correlated with poor outcome in the older group, whereas estrogen receptor status and TNM stage were associated with disease prognosis in both groups. The overall survival rates of the two age groups were similar except when analyzed according the treatment period (1997-2002). Although patients aged ≤40 years harbored tumors with more aggressive clinicopathological characteristics, these characteristics were not independent predictors of overall survival. The present study indicates that medical advances associated with prevention of breast cancer may improve screening programs, which may therefore increase early diagnosis and subsequently lower mortality rates.

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil.

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.

Melanoma characteristics in Brazil: demographics, treatment, and survival analysis.

BACKGROUND: The incidence of melanoma, one of the most aggressive of the skin cancers, has been increasing worldwide in the last few decades. Data from Latin America and Brazil remain scarce. We aimed to describe the demographic, clinical, and histopathological data; therapy characteristics; and survival rates of the Brazilian melanoma patient population. RESULTS: We collected and analysed retrospective data from 15 years at a tertiary cancer centre. We describe patient characteristics and treatment. We calculated survival, and identified the main prognostic factors through univariate and multivariate analysis. We analysed a total of 1073 patients, with a mean age of 56.7 years. Men and women experienced similar prevalence, and 91.2% of patients had white skin. The most prevalent subtype was superficial spreading, and the most prevalent anatomic location was the trunk (32.2%), followed by the lower extremities (28%). Of all cases, 567 (52.9%) were assigned to clinical stages I and II, while 382 (32.6%) were stages III and IV. Surgery was the main treatment. Sentinel node biopsy was performed in 373 patients, with 23.8% positivity. Overall actuarial 5-year survival was 67.6%. Multivariate analysis showed that gender, serum lactate dehydrogenase (LDH) levels at diagnosis; anatomic location, TNM stage, and local recurrence were significant prognostic factors. CONCLUSIONS: Overall survival was lower than worldwide rates. The main factors influencing survival were similar to those in other populations. Local recurrence was independently associated with lower survival rates. The high prevalence of advanced cases reinforces the importance of strategies to diagnose melanomas in the early stages. There is a need for future multi-institutional prospective studies to attain a better understanding of possible socioeconomic and other influences on survival among melanoma populations in Brazil and Latin America.

Digital photography in skin cancer screening by mobile units in remote areas of Brazil.

BACKGROUND: Non-melanoma skin cancer (NMSC) is one of the most common neoplasms in the world. Despite the low mortality rates, NMSC can still cause severe sequelae when diagnosed at advanced stages. Malignant melanoma, the third most common type of skin cancer, has more aggressive behavior and a worse prognosis. Teledermatology provides a new tool for monitoring skin cancer, especially in countries with a large area and unequal population distribution. This study sought to evaluate the performance of digital photography in skin cancer diagnosis in remote areas of Brazil. METHODS: A physician in a Mobile Prevention Unit (MPU) took four hundred sixteen digital images of suspicious lesions between April 2010 and July 2011. All of the photographs were electronically sent to two oncologists at Barretos Cancer Hospital who blindly evaluated the images and provided a diagnosis (benign or malignant). The absolute agreement rates between the diagnoses made by direct visual inspection (by the MPU physician) and through the use of digital imaging (by the two oncologists) were calculated. The oncologists' accuracy in predicting skin cancer using digital imaging was assessed by means of overall accuracy (correct classification rate), sensitivity, specificity and predictive value (positive and negative). A skin biopsy was considered the gold standard. RESULTS: Oncologist #1 classified 59 lesions as benign with the digital images, while oncologist #2 classified 27 lesions as benign using the same images. The absolute agreement rates with direct visual inspection were 85.8% for oncologist #1 (95% CI: 77.1-95.2) and 93.5% for oncologist #2 (95% CI: 84.5-100.0). The overall accuracy of the two oncologists did not differ significantly. CONCLUSIONS: Given the high sensitivity and PPV, Teledermatology seems to be a suitable tool for skin cancer screening by MPU in remote areas of Brazil.

Implementation of a clinical quality control program in a mammography screening service of Brazil.

AIM: To evaluate the effect of a clinical quality control program on the final quality of a mammography screening service. MATERIALS AND METHODS: We conducted retrospective assessment of the clinical quality of 5,000 mammograms taken in a Mammography Screening Program between November 2010 and September 2011, following the implementation of a Clinical Quality Control Program based on the European Guidelines. RESULTS: Among the 105,000 evaluated quality items, there were 8,588 failures (8.2%) - 1.7 failures per examination. Altogether, 89% of the failures were associated with positioning. The recall rate due to a technical error reached a maximum of 0.5% in the early phase of the observation period and subsequently stabilized (0.09%). CONCLUSION: The ongoing education and monitoring combined with personalized training increased the critical thinking of the involved professionals, reducing the technical failures and unnecessary exposure of patients to radiation, with substantial improvement in the final quality of mammography.

Clinical signs of impending death in cancer patients.

BACKGROUND: The physical signs of impending death have not been well characterized in cancer patients. A better understanding of these signs may improve the ability of clinicians to diagnose impending death. We examined the frequency and onset of 10 bedside physical signs and their diagnostic performance for impending death. METHODS: We systematically documented 10 physical signs every 12 hours from admission to death or discharge in 357 consecutive patients with advanced cancer admitted to two acute palliative care units. We examined the frequency and median onset of each sign from death backward and calculated their likelihood ratios (LRs) associated with death within 3 days. RESULTS: In total, 203 of 357 patients (52 of 151 in the U.S., 151 of 206 in Brazil) died. Decreased level of consciousness, Palliative Performance Scale ≤20%, and dysphagia of liquids appeared at high frequency and >3 days before death and had low specificity (<90%) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (>95%) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95% confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95% CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95% CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95% CI: 10.8-13.9), and death rattle (positive LR: 9; 95% CI: 8.1-9.8). CONCLUSION: We identified highly specific physical signs associated with death within 3 days among cancer patients.

Longitudinal temporal and probabilistic prediction of survival in a cohort of patients with advanced cancer.

CONTEXT: Survival prognostication is important during the end of life. The accuracy of clinician prediction of survival (CPS) over time has not been well characterized. OBJECTIVES: The aims of the study were to examine changes in prognostication accuracy during the last 14 days of life in a cohort of patients with advanced cancer admitted to two acute palliative care units and to compare the accuracy between the temporal and probabilistic approaches. METHODS: Physicians and nurses prognosticated survival daily for cancer patients in two hospitals until death/discharge using two prognostic approaches: temporal and probabilistic. We assessed accuracy for each method daily during the last 14 days of life comparing accuracy at Day -14 (baseline) with accuracy at each time point using a test of proportions. RESULTS: A total of 6718 temporal and 6621 probabilistic estimations were provided by physicians and nurses for 311 patients, respectively. Median (interquartile range) survival was 8 days (4-20 days). Temporal CPS had low accuracy (10%-40%) and did not change over time. In contrast, probabilistic CPS was significantly more accurate (P < .05 at each time point) but decreased close to death. CONCLUSION: Probabilistic CPS was consistently more accurate than temporal CPS over the last 14 days of life; however, its accuracy decreased as patients approached death. Our findings suggest that better tools to predict impending death are necessary.

The impact of breast cancer screening among younger women in the Barretos Region, Brazil.

AIM: To verify the impact of breast cancer screening in women aged 40-49 years in one region of Brazil. PATIENTS AND METHODS: This is a cross-sectional study, targeted to asymptomatic women aged 40-69 years who had breast cancer screening mammography performed between January 2003 and December 2007. Logistic regression was used to estimate the risk of breast cancer by age groups (40-49, 50-59, 60-69 years). RESULTS: Of the 27,133 screened women, 51.9% (14,082) were aged between 40-49 years. The odds ratio (OR) of breast cancer among the 45-49 year age cohort was not significantly different from that of 60 to 69-year-old women (OR=0.64; 95% Confidence Interval 0.39 to 1.03). CONCLUSION: The risk of breast cancer among women aged 45 to 49 years is equivalent to that of women aged 60 to 69 years, indicating that breast cancer screening in this region of Brazil should start at the age of 45 years or immediately thereafter.

Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. The use of mobile mammography units to offer screening to women living in remote areas is a rational strategy to increase the number of women examined. This study aimed to evaluate results from the first 2 years of a government-organized mammography screening program implemented with a mobile unit (MU) and a fixed unit (FU) in a rural county in Brazil. The program offered breast cancer screening to women living in Barretos and the surrounding area. METHODS: Based on epidemiologic data, 54 238 women, aged 40 to 69 years, were eligible for breast cancer screening. The study included women examined from April 1, 2003 to March 31, 2005. The chi-square test and Bonferroni correction analyses were used to evaluate the frequencies of tumors and the importance of clinical parameters and tumor characteristics. Significance was set at p < 0.05. RESULTS: Overall, 17 964 women underwent mammography. This represented 33.1% of eligible women in the area. A mean of 18.6 and 26.3 women per day were examined in the FU and MU, respectively. Seventy six patients were diagnosed with breast cancer (41 (54%) in the MU). This represented 4.2 cases of breast cancer per 1000 examinations. The number of cancers detected was significantly higher in women aged 60 to 69 years than in those aged 50 to 59 years (p < 0.001) or 40 to 49 years (p < 0.001). No difference was observed between women aged 40 to 49 years and those aged 50 to 59 years (p = 0.164). The proportion of tumors in the early (EC 0 and EC I) and advanced (CS III and CS IV) stages of development were 43.4% and 15.8%, respectively. CONCLUSIONS: Preliminary results indicate that this mammography screening program is feasible for implementation in a rural Brazilian territory and favor program continuation.

Co-expression of monocarboxylate transporter 1 (MCT1) and its chaperone (CD147) is associated with low survival in patients with gastrointestinal stromal tumors (GISTs).

Monocarboxylate transporters (MCTs) have been described to play an important role in cancer, but to date there are no reports on the significance of MCT expression in gastrointestinal stromal tumors (GISTs). The aim of the present work was to assess the value of MCT expression, as well as co-expression with the MCT chaperone CD147 in GISTs and evaluate their clinical-pathological significance. We analyzed the immunohistochemical expression of MCT1, MCT2, MCT4 and CD147 in a series of 64 GISTs molecularly characterized for KIT, PDGFRA and BRAF mutations. MCT1, MCT2 and MCT4 were highly expressed in GISTs. CD147 expression was associated with mutated KIT (p = 0.039), as well as a progressive increase in Fletcher's Risk of Malignancy (p = 0.020). Importantly, co-expression of MCT1 with CD147 was associated with low patient's overall survival (p = 0.037). These findings suggest that co-expression of MCT1 with its chaperone CD147 is involved in GISTs aggressiveness, pointing to a contribution of cancer cell metabolic adaptations in GIST development and/or progression.

Lymphangiogenic VEGF-C and VEGFR-3 expression in genetically characterised gastrointestinal stromal tumours.

This study aimed to assess the distribution of VEGF-C and VEGFR-3 expression in gastrointestinal stromal tumours (GISTs), and to analyse the value of lymphatic vessel density (LVD) in a tumour that is believed to preferentially metastasize through blood vessel conduits. A panel of immunohistochemical antibodies was used to evaluate 51 cases of genetically characterised GISTs: VEGF-C, VEGFR-3, D2-40 (for LVD assessment) and CD31 (for blood vessel density--BDV--assessment). The results were correlated with the clinical-pathological data. The large majority of cases (86.2%; 44/51) showed a mutation of the KIT gene, most of them (72.5%; 37/51) revealing mutations in exon 11. VEGFR-3 was predominantly expressed in KIT mutated GISTs (p=0.019). High LVD was correlated with the absence of metastasis (p=0.010) and high BVD showed a positive correlation with the occurrence of metastasis (p=0.049). The strong expression of VEGF-C and VEGFR-3 in GIST's cells was not correlated with the clinical parameters of aggressiveness, nor with high LVD.

Analysis of Survival Rates of Patients Diagnosed With Incipient Esophagic Cancer.

BACKGROUND: Esophagic cancer incidence is extremely variable worldwide. Also, the global survival rate has not oscillated significantly since last decade. Most of the worse prognoses are found among patients with advanced stages. Despite that, around 10% of cases occur in patients with initial stage, which strongly associate these patients with unfavorable prognosis. We sought to analyze the impact of time free of disease and global survival rates of patients with initial stage of esophagic cancer. METHODS: We studied 18 patients with initial stage of esophagic cancer (stage 0 and I), examined and treated at Hospital de Cancer de Barretos between 1990 and 2005. RESULTS: The vast majority of patients were male (83.3%) with age up to 49 yarest old (77.8%), squamous cell carcinoma (SCC) (88.9%) and stage I (83.3%). Most of them were smoker (60.0%) and etilist (62.5%). There were 38.9% of the patients with comorbities like dysphagia and epigastralgia correlated to other pathological conditions. We found free disease rates of 100% and 82.5%, respectively for 12 and 36 months. The significant prognostic evidence was the age, epigastralgia symptoms and chemotherapy. From 18 patients, 6 passed away during the period of 36 months follow up due to cancer consequences. The probabilities of global survival were 76.7% and 64.4% after 12 and 36 months, respectively, and none of the analyzed variables influenced in theses rates. CONCLUSIONS: Our data ratifies those from previous reported. The global survival rates were worse than reported by literature, maybe in consequence of the poor clinical condition of many patients which limited the option for more aggressive therapy.

Barreiras relacionadas à adesão ao exame de mamografia em rastreamento mamográfico na DRS-5 do estado de São Paulo / Barriers related to the non-adherence to the mammography screening program in DRS-5 of the state of São Paulo

Introdução: A mamografia constitui o método populacional mais eficaz na redução da mortalidade por câncer de mama, visto a elevação do diagnóstico de lesões precoces. Há inúmeras barreiras relacionadas à não realização do exame de mamografia, podendo estar relacionadas ao sistema de saúde, à educação e à adesão da paciente. Iniciou-se, em 2003, na DRS-5 rastreamento mamográfico, controlando as variáveis relacionadas ao sistema de saúde e educação. Objetivo: Avaliar, após a cobertura de 50,3% da população, as características das mulheres refratárias ao exame de mamografia. Métodos: Foram entrevistadas 550 mulheres, provenientes de 19 cidades que tinham conhecimento do rastreamento mamográfico da DRS-5 e que nunca haviam realizado o exame de mamografia previamente, sendo aplicado questionário para avaliar o conhecimento sobre o exame clínico da mama, a importância da mamografia, bem como estratégias para identificação dessa população refratária ao exame. Resultados: As principais características dessa população foram a baixa escolaridade (84,7%), a baixa classe socioeconômica (66,8%) e a faixa etária entre 42 e 49 anos (43,8%). As mulheres relataram que o autoexame da mama é pouco indicado por parte dos médicos (14,9%), sendo poucas as mulheres que o realizavam de maneira adequada (25,8%). O exame de mamografia também é pouco oferecido pelos médicos (23,6%), porém as mulheres sabem de sua importância e não o realizam, principalmente, por causa de ausência de sintomas (60,4%), medo da dor (25,1%) ou do câncer (20,5%). Para identificação dessa população, o Programa de Saúde da Família (PSF) foi de fundamental importância (90,0%), visto que apenas 71,8% dessas mulheres aderiram à realização do exame de mamografia. Conclusões: A identificação de subgrupos refratários ao exame de mamografia mostra a necessidade de aprimoramento no rastreamento, sendo o PSF importante instrumento de intervenção.

Introduction: Mammography is the best method to reduce the mortality from breast cancer, related to increase in early diagnosis. There are barriers related to low adherence to mammography, and the main reasons are related to health system, education and adherence to guidelines. In 2003 began in DRS-5 a mammography screening controlling the factors related to health system and knowledge. Objective: When we done mammography in 50.3% of DRS- 5 women, we find the characteristics of women that although having the knowledge of breast screening hadn't done mammography yet. Methods: We interview 550 women from 19 cities with questions related to the knowledge about breast clinical examination or reasons related to non adherence to mammography, and the strategy used to find these women. Results: The women had low years of school (84.7%), low income (66.8%) and were 42-49 years old (43.8%). The clinical frequently doesn't realize breast examination (14.9%), and low women know how to do this exam (25.8%). Besides the clinical doesn't infirm about the importance of mammography (23.6%), women don't realize this exam because the absent of health symptoms (60.4%), afraid of pain (25.1%) or afraid of cancer (20.5%). The "Programa de Saúde da Família" (PSF) had a fundamental importance to identify these women (90.0%), and just 71.8% of the interview women realize mammography. Conclusions: The identification of sub-group non adherent to mammography screening shows us the importance to improve the screening, and the PSF is a good way to promote heath intervention.

In silico analysis of polymorphic microsatellites in penaeid shrimp and construction of a free-access database

We performed an in silico analysis of all microsatellites so far described for penaeid shrimp and for which the polymorphic behavior has previously been analyzed. The objective of the study was to evaluate the structural characteristics of these microsatellites and identifying patterns which allow the characterization of the nature of these sequences in the penaeid genome. All data were compiled in a free-access database specially constructed for this study. Three hundred non-mononucleotide polymorphic microsatellite loci described for 12 shrimp species belonging to the family Penaeidae were analyzed and simple and compound microsatellites with di-, tri-, tetra-, penta- and hexanucleotide motifs were found. Dinucleotides and trinucleotides were the most frequent motifs among both the simple and the compound microsatellites. Although a certain bias related to different microsatellite isolation methodology could not be discarded, it is possible that part of this microsatellite abundance reflects some degree of conservation of microsatellite motifs among the different species. There was a pronounced motif variability within and between species, indicating high differentiation dynamism of these repetitions in this animal group. This study not only sheds light on the structure of the microsatellites present in the penaeid shrimp genome but also resulted in the free-access Penaeid Shrimp Microsatellite Database (available at http://www.shrimp.ufscar.br) which may be very useful for optimizing the use of these microsatellites.

Preliminary data on the feeding habits of the freshwater stingrays Potamotrygon falkneri and Potamotrygon motoro (Potamotrygonidae) from the Upper Paraná River basin, Brazil / Dados preliminares sobre o hábito alimentar das raias de água doce Potamotrygon falkneri e Potamotrygon motoro (Potamotrygonidae), na Bacia do Alto Rio Paraná, Brasil

Stingrays of the Potamotrygonidae family are a singular group of Neotropical ichthyofauna. Although ancient reports exist about the group, there are still many questions that need to be clarified, such as the biology of the species that occur in the Paraná-Paraguay River system. In the present work, the diet of Potamotrygon falkneri and Potamotrygon motoro, captured in the Upper Paraná River, downstream from the Engenheiro Souza Dias Hydroelectric Power Station (UHE Jupiá), was analyzed. Both species showed a diversified diet, consisting of 14 food items, including Mollusca, Crustacea, Insecta and fish, with the predominance in diversity and abundance of aquatic insects. Only one individual of each species ingested fish. Potamotrygon motoro consumed mainly Ephemeroptera, while P. falkneri consumed mainly Mollusca, Hemiptera and Trichoptera. The data apparently indicate a more specialized diet for P. motoro, consuming more Ephemeroptera (Baetidae), and a more generalized diet for P. falkneri. The analysis of individuals captured in three microhabitats that differ in function of the substrate type and presence of marginal vegetation, suggests differences in the food items consumed.

As raias da família Potamotrygonidae representam um grupo singular da ictiofauna Neotropical. Apesar de serem antigos os relatos sobre o grupo, ainda são muitas as questões que permanecem sem resposta, sobretudo no que diz respeito à biologia das espécies que ocorrem na Bacia do Paraná-Paraguai. No presente trabalho foi analisada a dieta de Potamotrygon falkneri e Potamotrygon motoro, capturadas no Alto Rio Paraná, a jusante da Usina Hidrelétrica Engenheiro Souza Dias (UHE Jupiá). As duas espécies de raias apresentaram dieta diversificada, ingerindo 14 itens, entre moluscos, crustáceos, insetos e peixes, porém com predominância de insetos aquáticos em diversidade e abundância. Somente um indivíduo de cada espécie ingeriu peixe. Potamotrygon motoro consumiu principalmente Ephemeroptera, enquanto P. falkneri, principalmente Mollusca, Hemiptera e Trichoptera. Os dados aparentemente indicam uma dieta mais especializada de P. motoro, com maior consumo de Ephemeroptera (Baetidae), e uma dieta mais generalizada de P. falkneri. A análise dos indivíduos capturados em três micro-hábitats, que diferem quanto ao tipo de substrato e presença de vegetação marginal, sugere diferenças nos tipos de alimentos consumidos.