Evaluation of Current Antiemetic Therapy Response in Patients Undergoing MEC or HEC Regimens in Portugal.

Chemotherapy-induced nausea and vomiting (CINV) negatively impact cancer patients' quality of life and treatment outcomes. This study evaluated the achievement of complete response to CINV prophylaxis during the first five days after chemotherapy in adult outpatient cancer clinics with solid malignant tumours receiving Moderate or Highly Emetogenic Chemotherapy (MEC or HEC) in Portugal. During the study, patients completed three evaluations, and nausea severity and CINV impact on patients' daily life was assessed. A complete response (no emetic episodes, no use of rescue antiemetic medication, and no more than mild nausea) was observed in 72% of the cycles (N = 161) throughout the five days after chemotherapy. Amongst the patient population, 25% classified their CINV episodes as severe. Though more than half of the patients achieved a complete response, suggesting that a therapeutic effort is being made to minimise this side effect, the overall scenario is barely optimistic. Significantly, new CINV-control measures in MEC/HEC patients should be adopted, specifically avoiding the single use of dexamethasone and 5-HT3 and raising awareness of using NK1-RAs. Thus, it is critical to improve CINV prophylactic treatment and implement practical international antiemetic guidelines in Portuguese clinical practice, envisaging the improvement of supportive care for cancer patients.

The Impact of COVID-19 Pandemic in Portuguese Cancer Patients: A Retrospective Study.

Literature reports that SARS-CoV-2 infection in cancer patients may be associated with higher severity and mortality, nevertheless the knowledge is limited. We aimed to describe patients' demographic characteristics and COVID-19 disease outcomes in Portuguese cancer patients. We conducted a retrospective study in a cohort of cancer patients diagnosed with COVID-19. A total of 127 individuals were included: 46.5% males and 53.5% females, with a median age of 72 years. Clinicopathological characteristics were used in univariate and multivariable logistic regression analyses to estimate odds ratios for each variable with outcomes adjusting for potential confounders. Our cohort revealed that 84.3% of patients had more than one risk factor for severe disease rather than cancer. In total, 36.2% of patients were admitted to the Department of Internal Medicine, 14.2% developed severe disease, 1.6% required Intensive Care Unit, and mortality was observed in 11.8%. Severe COVID-19 disease was associated with unfit (ECOG PS > 2) patients (p = 0.009; OR = 6.39; 95% CI: 1.60-25.59), chronic kidney disease (p = 0.004; OR = 20.7; 95% CI: 2.64-162.8), immunosuppression (p < 0.001; OR = 10.3; 95% CI: 2.58-41.2), and presence of respiratory symptoms at diagnosis (p = 0.033; OR = 5.05; 95% CI: 1.14-22.4). Increased risk for mortality was associated with unfit patients (p = 0.036; OR = 4.22; 95% CI: 1.10-16.3), cardiac disease (p = 0.003; OR = 8.26; 95% CI: 2.03-33.6) and immunosuppression (p = 0.022; OR = 5.06; 95% CI: 1.27-20.18). Our results demonstrated that unfit and immunosuppressed patients, with chronic kidney disease and cardiac disease, have, respectively, an increased risk for severe disease and mortality related to COVID-19. Hence, this study provides important information on risk factors for severe COVID-19 disease and associated mortality in a Portuguese cancer population.

Efficacy of complex decongestive therapy for lymphedema of the lower limbs: a systematic review.

Lymphedema is a chronic condition that negatively affects function and quality of life. There is currently no definitive treatment. However, some options have been proposed to mitigate its consequences. Complex Decongestive Therapy (CDT) stands out as one of the main treatment methods of choice. This systematic review aimed to evaluate the effectiveness of this technique for treating lower extremity lymphedema. The results revealed that CDT was effective in reducing the volume of affected limbs. However, some questions have not yet been answered, such as: How long do patients benefit from using CDT? and How to maintain the gains obtained? It was not possible to perform a meta-analysis because of heterogeneity, unsatisfactory methodological quality of the available studies, and the lack of a gold-standard protocol for administration of the technique. Further studies are needed to advance lymphedema research and therapy.

Eficácia da terapia complexa descongestiva para linfedema nos membros inferiores: revisão sistemática / Efficacy of complex decongestive therapy for lymphedema of the lower limbs: a systematic review

Resumo O linfedema é uma condição crônica que afeta negativamente a função e a qualidade de vida. Atualmente, não existe tratamento definitivo. Todavia, algumas opções foram propostas para amenizar suas consequências. Entre elas, destaca-se a terapia complexa descongestiva (TCD), que se configura como um dos principais métodos de escolha de tratamento. Esta revisão sistemática teve por objetivo avaliar a eficácia dessa técnica no tratamento de linfedemas nos membros inferiores. Os resultados revelaram que a TCD foi eficaz na redução do volume das extremidades afetadas. No entanto, algumas questões ainda não foram elucidadas, tais como: por quanto tempo os pacientes se beneficiam com o uso da TCD? Como manter os ganhos obtidos? Diante da heterogeneidade, da insatisfatória qualidade metodológica dos trabalhos disponíveis e da inexistência de protocolo padrão para aplicação da técnica, não foi possível realizar a metanálise, o que demonstra que há muito a se avançar na investigação e na terapêutica do linfedema.

Abstract Lymphedema is a chronic condition that negatively affects function and quality of life. There is currently no definitive treatment. However, some options have been proposed to mitigate its consequences. Complex Decongestive Therapy (CDT) stands out as one of the main treatment methods of choice. This systematic review aimed to evaluate the effectiveness of this technique for treating lower extremity lymphedema. The results revealed that CDT was effective in reducing the volume of affected limbs. However, some questions have not yet been answered, such as: How long do patients benefit from using CDT? and How to maintain the gains obtained? It was not possible to perform a meta-analysis because of heterogeneity, unsatisfactory methodological quality of the available studies, and the lack of a gold-standard protocol for administration of the technique. Further studies are needed to advance lymphedema research and therapy.

Management of tumour lysis syndrome during first-line palliative chemotherapy for high-volume colorectal cancer.

Tumour lysis syndrome (TLS) is a rare oncological emergency in solid tumours. Because it is associated with bad short-term prognosis, early recognition and treatment are mandatory. This case refers to a middle-aged woman who presented with stage IV colon cancer, with massive hepatic involvement. After three cycles of first-line FOLFOX (folinic acid, 5-fluorouracil and oxaliplatin), she developed acute kidney injury and hyperkalaemia that did not respond to standard measures. High suspicion of TLS prompted further corroborating investigations and early intensive care unit admission. With vigorous hydration and allopurinol, TLS completely resolved and the patient was discharged. Prophylaxis of subsequent TLS recurrence was complicated by biopsy-proven neutrophilic vasculitis secondary to allopurinol. Prevention of TLS with hydration and rasburicase was performed prior to each subsequent cycle of chemotherapy. This case report is intended to highlight risk factors for TLS in solid tumours and focus on treatment and secondary prophylaxis of TLS.

Automedicação em Indivíduos com Osteoartrose Atendidos em uma Unidade Básica de Saúde / Self-Medication in Individuals with Osteoarthritis Assisted in a Primary Care Facility

Osteoartrose (OA) é uma das perturbaçõesmusculoesqueléticas com o maior complexo sintomatológico. Osindivíduos acometidos utilizam a automedicação como método maisacessível e prático para os sintomas, porém esse ato pode promovergastos desnecessários, atraso no diagnóstico e na terapêutica.Objetivo: verificar a prevalência da automedicação em portadores deOA, além de comparar entre os indivíduos que fazem ou não aautomedicação, características pessoais, da patologia e daautomedicação. Material e métodos: 58 indivíduos com OA foramdivididos em dois grupos de acordo com a automedicação. Voluntáriosresponderam um questionário para caracterização da população, dapatologia e hábito da automedicação. Foram avaliados peso, estatura,circunferência de abdômen, cintura e quadril. Estatística descritiva,teste de Goodman e teste t de Student foram utilizados para análiseestatísticas com p<0,05. Resultados: 60,4% dos voluntários seautomedicam. Nessa população o diagnóstico de OA foi relatado emmais de uma articulação (48,7%), maior presença de dor constante enoturna. Não houve diferenças entre os grupos para locais anatômicos,medicamentos utilizados, valores da escala visual analógica (EVA) eclasse socioeconômica. Voluntários que se automedicam apresentammenores valores de peso, estatura e circunferência abdominal. Nãoforam encontradas associações entre os grupos e os valores de EVAe classe socioeconômica. Conclusão: existe alta prevalência deautomedicação. Aqueles que se automedicam apresentam níveis dedor entre 6 e 8, e os analgésicos e antinflamátórios são os maisutilizados, seguidos de variadas técnicas para controle da dor. Não háassociação entre utilização da automedicação e os valores de escalade dor e as classes socioeconômicas...

Osteoarthritis is considered one of the mostsymptomatically complex musculoskeletal disorders. Affectedindividuals often use self-medication as a more accessible and practicalmethod to alleviate their symptoms. However, this act can promoteunnecessary spending, as well as delay in diagnosis and treatment.Objective: To verify the prevalence of self-medication in patients withosteoarthritis, and perform a comparative analysis between theseindividuals and those who do not self-medicate. The analysis addressedtopics concerning personal features, pathology and self-medicationprofile. Material and Methods: A total of 58 individuals with osteoarthritiswere divided into two groups according to self-medication. Volunteersanswered a questionnaire addressing the study population profile,characteristics of the disease and self-medication habits. Weight,height, abdominal circumference, waist circumference and hipcircumference were evaluated. Descriptive statistics, Goodman testand Student’s t test were used for statistical analysis, with p <0.05.Results: 60.4% of the volunteers reported the habit of self-medication.In this population, osteoarthritis was diagnosed in more than one joint(48.7%), with greater constant, nocturnal pain. There were nodifferences between groups concerning anatomical sites, used drugs,visual analogic scale (VAS) values and socioeconomic profile. Thevolunteers who self-medicate showed lower weight, height and waistcircumference measurements. There were no associations betweenthe groups and the VAS values and socioeconomic class. Conclusions:A high prevalence of self-medication was found. The individuals whoself-medicate showed pain levels between 6 and 8. They usually takeanalgesics and anti-inflammatory drugs, followed by various techniquesfor pain control. There was no association between self-medicationand the pain scale values and socioeconomic class...

Evolution of costs of cancer drugs in a Portuguese hospital.

AIM: To analyze the costs of cancer drugs administered in a Portuguese Hospital compared with the Karolinska Institute study. METHODS: To evaluate spending on cancer drugs, we retrospectively analyzed data on the overall costs of cancer drugs, obtained at the Department of Medical Oncology of the Centro Hospitalar de Entre Douro e Vouga, between 2004 and 2010. In this comparative study we selected only drugs belonging to the following groups: chemotherapy, targeted therapy, immunotherapy and endocrine therapy. The selected drugs were further grouped according to their market placement year: ≤ 1998, 1999 to 2002, 2003 to 2005, and 2006 to 2010. Drugs used as supportive therapy and bisphosphonates were excluded. RESULTS: The overall costs of cancer drugs increased gradually between 2004 and 2008 (from €1911947 to €3666284), with an increase in the number of patients treated during this period. The expenditure decreased in 2009 (€3438155) and increased again in 2010 (€3673116), but the costs increment was not the same as in previous years. Chemotherapy and targeted therapy were responsible for most of the expenditure. Drugs placed on the national market before 1999 accounted for more than 50% of the expenditure up to 2007. From 2008, these drugs represented less than 50% of the total expenditure. Cancer drugs placed between 1999 and 2002 accounted for 25%-35% of the costs in all the years studied, while drugs placed between 2003 and 2005 accounted for less than 30%. Drugs placed between 2006 and 2010 were responsible for less than 10% of the expenditure. CONCLUSION: In this study, older drugs were responsible for most of the expenditure up to 2007, which is in agreement with the Karolinska study.

Bacillary prostatitis after intravesical immunotherapy: a rare adverse effect.

Nowadays, the most efficient form of intravesical immunotherapy for superficial transitional cell carcinoma of the urinary bladder is the instillation of bacillus Calmette-Guérin (BCG), proceeding from an attenuated strain of Mycobacterium bovis. In up to 40% of cases, its instillation is associated with significantly elevated prostate-specific antigen (PSA) levels. In these cases, prostate biopsy should be withheld for 3 months and PSA should be monitored. Bacillary prostatitis is a rare occurrence in patients treated with intravesical BCG immunotherapy. Although symptomatic bacillary prostatitis is even rarer, it is the worst type of this condition. The aims of this study are to report a case of bacillary prostatitis as a rare adverse effect of intravesical BCG immunotherapy and to make a theoretical review about how to manage this complication. A 58-year-old man, former smoker, underwent a transurethral resection of the bladder in February 2004 because of a papillary transitional cell carcinoma of the bladder (pT1G2N0M0). After surgery, BCG instillation therapy was given in a total of 15 instillations, the last one in March 2007. In the last 3 months of therapy, until May 2007, a progressive increase in his PSA level was registered, and he underwent a prostate biopsy revealing granulomatous prostatitis of bacillary etiology. The semen culture was positive for M. bovis. After 3 months of a two-drug (isoniazid and rifampin) antituberculous regimen, the semen culture became negative and the PSA level decreased. The early identification of intravesical BCG immunotherapy complications allows their effective treatment. However, when a histological diagnosis of asymptomatic granulomatous prostatitis is made, the execution and type of treatment are controversial.

Metastatic renal cell carcinoma: the importance of immunohistochemistry in differential diagnosis.

INTRODUCTION: Clear cell carcinoma accounts for 75% of all types of renal neoplasms. Approximately one third presents with metastatic disease at diagnosis. Immunohistochemical studies play a significant diagnostic role. CASE REPORT: We report the case of a 48-year-old heavy smoker who presented with productive cough and progressive dyspnea. The study revealed a renal mass and lung alterations compatible with primary tumor of the lung. The patient underwent a right complete nephrectomy. The anatomopathological exam showed clear cell renal carcinoma (pT1bN0Mx). After transthoracic needle aspiration biopsy, the clinical diagnosis was stage IV adenocarcinoma of the lung. Initially, the patient received one cycle of chemotherapy (cisplatin/pemetrexed). Two weeks later, the immunohistochemistry tests revealed a secondary lesion with probable renal origin. Chemotherapy was stopped and the patient was started on sunitinib treatment. After two cycles the disease progressed. A second-line treatment with everolimus was proposed; however, the patient died 2 weeks later due to terminal respiratory insufficiency. DISCUSSION: Clear cell renal cell carcinoma remains one of the great mimickers in pathology. Immunohistochemistry is a valuable tool in the differential diagnosis of lung carcinomas. With the help of thyroid transcription factor 1, it is possible to distinguish a primary lung tumor from a metastasis with a reasonable degree of certainty. The present case report illustrates the challenge of making a definitive and adequate diagnosis. The immunohistochemistry added information that changed the whole treatment strategy. For the best treatment approach, it is fundamental that clinicians await all possible test results, before establishing a treatment plan.

Modest reductions in dose intensity and drug-induced neutropenia have no major impact on survival of patients with non-small cell lung cancer treated with platinum-doublet chemotherapy.

BACKGROUND: Previous studies investigating the effect of increased dose intensity and chemotherapy-induced neutropenia in patients with advanced non-small cell lung cancer (NSCLC) have not consistently shown significant survival benefits. METHODS: This retrospective analysis reviewed the outcome of patients receiving palliative chemotherapy for advanced NSCLC (stages III-IV) at the Royal Marsden Hospital. Regimens included cisplatin or carboplatin with either vinorelbine or gemcitabine on days 1 and 8, every 21 days. Patients who received at least four cycles of chemotherapy were classified into groups based on dose intensity, dose reductions, and worst grade of neutropenia for a landmark analysis. Comparisons between these groups for time to progression and overall survival were made by standard univariate and multivariate methods. RESULTS: One hundred sixty-nine of a total of 190 patients who received more than four cycles of chemotherapy during the period between November 1998 and December 2008 were included. One hundred twenty-five (73.9%) patients received four chemotherapy cycles with the remaining receiving up to six cycles. The median relative dose intensity for platinum was 93.9% (62.1-102%) and for vinorelbine/gemcitabine was 91.7% (37.8-105%). Dose reductions were recorded in 64 patients (37.8%), and 65 patients (38.5%) had grades 3 to 4 neutropenia. There were no statistically significant differences in time to progression and overall survival between any of the subgroups. CONCLUSIONS: This retrospective analysis demonstrates no significant relationship between survival and dose intensity (<90%), modest dose reductions (<20%), or chemotherapy-induced neutropenia in patients receiving standard doublet platinum containing chemotherapy in NSCLC.

Topotecan in second-line treatment of small-cell lung cancer--how it works in our daily clinical practice?

Lung cancer is one of the most commonly diagnosed malignancies and it causes more than 1 million deaths each year worldwide. Small-cell lung cancer (SCLC) accounts for about 15 to 20% of all lung cancers and it is an extremely aggressive cancer, having a response rate of 60-80% with the standard first-line chemotherapy (CT). Topotecan is a topoisomerase I inhibitor currently approved for relapsed SCLC. The authors reviewed the clinical files of SCLC's patients (pts) of a single institution, the Portuguese Institute of Oncology-Porto Centre, in a five year period. The end-points were to evaluate response rates (RR), time to progression (TTP), overall survival (OS) and toxicity profile of topotecan as a second-line treatment of SCLC. From January of 2002 to December of 2006, it was diagnosed 146 pts with SCLC, 32 were submitted to second-line treatment and 23 with topotecan. The RR was 17.4%, median TTP and median survival after topotecan were 2.8 months and 6.3 months, respectively, and median OS was 17.5 months. The incidence of grade 3 and 4 adverse events was 16.6 and 2.6%, respectively. Topotecan showed clinical activity in our unselected daily patients with relapsed SCLC, with acceptable toxicity, in accordance with the published literature.