Correction to: SEOM Clinical Guideline update for the prevention of chemotherapy-induced nausea and vomiting (2021)

In this article the title was incorrectly given as “SEOM clinical guideline emesis (2021)” but should have been “SEOM Clinical Guideline update for the prevention of chemotherapy-induced nausea and vomiting (2021).”The original article has been corrected.

SEOM clinical guideline emesis (2021).

Among the side effects of anticancer treatment, chemotherapy-induced nausea and vomiting (CINV) is one of the most feared given its high prevalence, affecting up to 40% of patients. It can impair patient's quality of life and provoke low adherence to cancer treatment or chemotherapy dose reductions that can comprise treatment efficacy. Suffering CINV depends on factors related to the intrinsic emetogenicity of antineoplastic drugs and on patient characteristics. CINV can appear at different times regarding the administration of antitumor treatment and the variability of risk according to the different antitumor regimens has, as a consequence, the need for a different and adapted antiemetic treatment prophylaxis to achieve the desired objective of complete protection of the patient in the acute phase, in the late phase and in the global phase of emesis. As a basis for the recommendations, the level of emetogenicity of anticancer treatment is considered and they are classified as high, moderate, low and minimal emetogenicity and these recommendations are based on the use of antiemetic drugs with a high therapeutic index: anti 5-HT, anti-NK and steroids. Despite having highly effective treatments, clinical reality shows that they are not applied enough, so evidence-based recommendations are needed to show the best options and help in decision-making. To cover all the antiemetic prophylaxis options, we have also included recommendations for oral treatments, multiday regimens and radiation-induced emesis prevention.

Prospective Study Comparing Clinicians' and Cancer Patients' Estimates of Risk of Relapse and Toxicity with Adjuvant Chemotherapy.

The aim of this study was to compare physicians' and patients' estimates of risk of relapse and toxicity. A prospective, cross-sectional, multicenter study including 735 patients with cancer and 29 oncologists. Physicians' appraisals of risk of relapse with and without chemotherapy (27.5% and 43.1%) and risk of severe toxicity (12.2%) were more realistic than those of patients (34.6%, 78.5%, and 57.4%, respectively). The greater the risk of recurrence and risk of toxicity estimated, the less physicians expressed satisfaction with SDM. Estimations of risk of relapse and toxicity are important in diagnostic and therapeutic decision-making and can help patients face their situation.

The Effects of Abdominal Hypopressive Training on Postural Control and Deep Trunk Muscle Activation: A Randomized Controlled Trial.

BACKGROUND: Abdominal Hypopressive Training (AHT) provides postural improvement, and enhances deep trunk muscle activation. However, until recently, there was a lack of scientific literature supporting these statements. The major purpose of this study was to investigate the effect of AHT on posture control and deep trunk muscle function. METHODS: 125 female participants aged 18-60 were randomly allocated to the Experimental Group (EG), consisting of two sessions of 30 min per week for 8 weeks of AHT, or the Control Group (CG), who did not receive any treatment. Postural control was measured with a stabilometric platform to assess the static balance and the activation of deep trunk muscles (specifically the Transverse Abdominal muscle (TrA)), which was measured by real-time ultrasound imaging. RESULTS: The groups were homogeneous at baseline. Statistical differences were identified between both groups after intervention in the Surface of the Center of Pressure (CoP) Open-Eyes (S-OE) (p = 0.001, Cohen's d = 0.60) and the Velocity of CoP under both conditions; Open-Eyes (V-OE) (p = 0.001, Cohen´s d = 0.63) and Close-Eyes (V-CE) (p = 0.016, Cohen´s d = 0.016), with the EG achieving substantial improvements. Likewise, there were statistically significant differences between measurements over time for the EG on S-OE (p < 0.001, Cohen´s d = 0.99); V-OE (p = 0.038, Cohen´s d = 0.27); V-CE (p = 0.006, Cohen´s d = 0.39), anteroposterior movements of CoP with Open-Eyes (RMSY-OE) (p = 0.038, Cohen´s d = 0.60) and activity of TrA under contraction conditions (p < 0.001, Cohen´s d = 0.53). CONCLUSIONS: The application of eight weeks of AHT leads to positive outcomes in posture control, as well as an improvement in the deep trunk muscle contraction in the female population.

Prediction of Unplanned Hospitalizations in Older Patients Treated with Chemotherapy.

PURPOSE: To determine the incidence of unplanned hospitalization (UH) and to identify risk factors for UH in elderly patients with cancer who start chemotherapy. METHODS: In all, 493 patients over 70 years starting new chemotherapy regimens were prospectively included. A pre-chemotherapy geriatric assessment was performed, and tumor and treatment variables were collected. The association between these factors and UH was examined by using multivariable logistic regression. Score points were assigned to each risk factor. RESULTS: During the first 6 months of treatment, 37% of patients had at least one episode of UH. Risk factors were the use of combination chemotherapy at standard doses, a MAX2 index ≥1, a Charlson comorbidity score ≥2, albumin level <3.5 g/dL, falls in the past 6 months ≥1, and weight loss >5%. Three risk groups for UH were established according to the score in all patients: 0-1: 17.5%; 2: 34%; and 3-7: 57% (p < 0.001). The area under receiver operation characteristic (ROC) curve was 0.72 (95% CI: 0.67-0.77). CONCLUSION: This simple tool can help to reduce the incidence of UH in elderly patients with cancer who are scheduled to initiate chemotherapy treatment.

Development and Validation of an Early Mortality Risk Score for Older Patients Treated with Chemotherapy for Cancer.

Background: Estimation of life expectancy in older patients is relevant to select the best treatment strategy. We aimed to develop and validate a score to predict early mortality in older patients with cancer. Patients and Methods: A total of 749 patients over 70 years starting new chemotherapy regimens were prospectively included. A prechemotherapy assessment that included sociodemographic variables, tumor/treatment variables, and geriatric assessment variables was performed. Association between these factors and early death was examined using multivariable logistic regression. Score points were assigned to each risk factor. External validation was performed on an independent cohort. Results: In the training cohort, the independent predictors of 6-month mortality were metastatic stage (OR 4.8, 95% CI [2.4-9.6]), ECOG-PS 2 (OR 2.3, 95% CI [1.1-5.2]), ADL ≤ 5 (OR 1.7, 95% CI [1.1-3.5]), serum albumin levels ≤ 3.5 g/dL (OR 3.4, 95% CI [1.7-6.6]), BMI < 23 kg/m2 (OR 2.5, 95% CI [1.3-4.9]), and hemoglobin levels < 11 g/dL (OR 2.4, 95% CI (1.2-4.7)). With these results, we built a prognostic score. The area under the ROC curve was 0.78 (95% CI, 0.73 to 0.84), and in the validation set, it was 0.73 (95% CI: 0.67-0.79). Conclusions: This simple and highly accurate tool can help physicians making decisions in elderly patients with cancer who are planned to initiate chemotherapy treatment.

Undertreatment and overtreatment in older patients treated with chemotherapy.

BACKGROUND: Inconsistent doses and schemes are commonly used in older patients receiving cancer chemotherapy. We performed this study in patients with cancer and age ≥ 70 years to determine the frequency of undertreatment and overtreatment as well as factors influencing the decision to modify chemotherapy doses. PATIENTS AND METHODS: Patients aged ≥70 years starting new chemotherapy regimens were prospectively included in a multicentre study. The schedule and drug doses were determined by the treating oncologist. Pre-chemotherapy assessment included sociodemographics, treatment details and geriatric assessment (GA) variables. Association between these factors and undertreatment (use of less intensive cancer treatment [LICT] in a fit patient) or overtreatment (use of standard cancer treatment in an unfit older patient) were examined by multivariate logistic regression. RESULTS: Three- hundred ninety-seven patients were included, 43% of whom received LICT. If not adjusted for GA, toxicity did not differ between those receiving LICT (38%) or standard doses of chemotherapy (37%). If the dose of chemotherapy was analyzed according to the results of GA 61 (15%) patients had been undertreated and 133 (34%) had been overtreated. Undertreatment was related with increasing age and decreased renal function. Factors related with overtreatment were younger age, curative intention of treatment, prescription of G-CSF as primary prophylaxis and adequate cognitive status. Overtreated patients had more grade 3-4 toxicity than those receiving treatment adapted to fragility (42% vs 31%; p < 0.05). CONCLUSIONS: The use of chemotherapy without considering GA leads to overtreatment more commonly than undertreatment in older patients with cancer. Oncologists should take into account the results of GA to stratify patients and to avoid under or overtreatment.

MiR-195 enhances cardiomyogenic differentiation of the proepicardium/septum transversum by Smurf1 and Foxp1 modulation.

Cardiovascular development is a complex developmental process in which multiple cell lineages are involved, namely the deployment of first and second heart fields. Beside the contribution of these cardiogenic fields, extracardiac inputs to the developing heart are provided by the migrating cardiac neural crest cells and the proepicardial derived cells. The proepicardium (PE) is a transitory cauliflower-like structure located between the cardiac and hepatic primordia. The PE is constituted by an internal mesenchymal component surrounded by an external epithelial lining. With development, cells derived from the proepicardium migrate to the neighboring embryonic heart and progressive cover the most external surface, leading to the formation of the embryonic epicardium. Experimental evidence in chicken have nicely demonstrated that epicardial derived cells can distinctly contribute to fibroblasts, endothelial and smooth muscle cells. Surprisingly, isolation of the developing PE anlage and ex vivo culturing spontaneously lead to differentiation into beating cardiomyocytes, a process that is enhanced by Bmp but halted by Fgf administration. In this study we provide a comprehensive characterization of the developmental expression profile of multiple microRNAs during epicardial development in chicken. Subsequently, we identified that miR-125, miR-146, miR-195 and miR-223 selectively enhance cardiomyogenesis both in the PE/ST explants as well as in the embryonic epicardium, a Smurf1- and Foxp1-driven process. In addition we identified three novel long non-coding RNAs with enhanced expression in the PE/ST, that are complementary regulated by Bmp and Fgf administration and well as by microRNAs that selectively promote cardiomyogenesis, supporting a pivotal role of these long non coding RNAs in microRNA-mediated cardiomyogenesis of the PE/ST cells.

Differences in coping strategies among young adults and the elderly with cancer.

BACKGROUND: Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer. METHODS: Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions). RESULTS: Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment. CONCLUSION: Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.

The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients.

OBJECTIVE: The objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer. METHOD: A total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp's mediating role between psychological distress and mental adjustment. RESULTS: A clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance. CONCLUSIONS: The Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.

Psychometric properties of Liverpool Stoicism Scale (LSS) in a cohort of patients with resected cancer in adjuvant treatment / Propiedades psicométricas de la Liverpool Stoicism Scale (LSS) en una cohorte de pacientes con cáncer resecado en tratamiento adyuvante

Stoicism has been used to describe a wide range of behaviors in the face of disease that go from silence, resistance to the adversity, or ‘to make the best of a bad disease’. This study pursued two objectives: 1) analyze the psychometric properties of the Spanish version of the LSS; 2) assess the relation between stoicism and gender, age, and the five-factor personality model. NEOcoping is a prospective, multicenter, observational, non-interventionist study. Patients were recruited consecutively at thirteen Spanish teaching hospitals. The following scales were administered: Liverpool Stoicism Scale (LSS) and Big Five Inventory (BFI-10). A total of 443 patients (250 females) with a mean age of 59.8 years (SD =12.3) were enrolled. Colon cancer was the most common, followed by breast cancer. At the total-scale level, mean LSS was lower than the originally reported British sample. The four-factor structure fitted the data well, had a clear interpretation, and the derived scales showed acceptable reliabilities. The personality trait of introversion predicted 4.1% of the variance of stoicism (p<001). Even though it needs to be improved, the LSS scale demonstrates acceptable psychometric properties to appraise stoicism in the Spanish population with resected cancer (AU)

El estoicismo se ha utilizado para describir una amplia gama de comportamientos frente a la enfermedad que van desde el silencio a la resistencia a la adversidad. Este estudio tiene dos objetivos: 1) analizar las propiedades psicométricas de la versión española del LSS; 2) evaluar la relación entre estoicismo, género, edad y el modelo de los cinco grandes factores de personalidad. NEOcoping es un estudio prospectivo, multicéntrico, observacional, no-intervencionista. Los pacientes fueron reclutados consecutivamente en 13 hospitales universitarios de España. Se aplicó la Liverpool Stoicism Scale (LSS) y el Big Five Inventory (BFI-10). Participaron 443 pacientes (250 mujeres) con una edad media de 59,8 años (SD =12,3). El cáncer de colon y mama fueron los más frecuentes. A nivel de escala total, la puntuación media de la LSS fue inferior a la muestra Británica. La estructura propuesta en cuatro factores proporciona un buen ajuste a los datos, y las puntuaciones en las escalas derivadas presentan fiabilidades aceptables. El rasgo de personalidad de introversión fue capaz de predecir el 4,1% de la variancia de estoicismo (p<001). Aunque debe ser mejorada, la LSS presenta globalmente unas propiedades psicométricas aceptables para evaluar el estoicismo en pacientes españoles con cáncer resecado (AU)

Síndrome de Mayer-Rokitansky-Küster-Hauser (MRKH): enfoque diagnóstico y terapéutico de un cuadro poco frecuente / Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: diagnostic and therapeutic approach of a rare disease

Introduccion: El síndrome de Mayer-Rokitansky-Küster-Hauser se caracteriza por la agenesia de vagina y útero en unamujer con desarrollo normal de caracteres sexuales y amenorrea primaria.Objetivo: Evaluación diagnóstica y posibilidades terapéuticas de un síndrome poco frecuente.Material y método: Presentamos un caso de síndrome de Rokitansky.Resultados: La paciente tuvo un desarrollo normal de caracteres sexuales secundarios. La analítica mostró normofunciónhormonal y cariotipo 46 XX. Ante la sospecha clínica se solicitó resonancia magnética nuclear pélvica, siendo informadala ausencia de útero. El tratamiento fue diferido hasta la asimilación del diagnóstico por parte de la paciente y la familia.Conclusiones: La sospecha diagnóstica es clave. La exploración, junto con la analítica y las pruebas de imagen debenconfirmar el síndrome. La laparoscopia es la vía terapéutica de elección.

Evaluación de la astenia en pacientes oncológicos avanzados y una propuesta de protocolo de intervención psicológica / No disponible

La astenia es un síntoma con una elevada incidencia en pacientes con cáncer. Es un fenómeno multifactorial que deteriora la calidad de vida del paciente, con repercusiones físicas, psicológicas, sociales y laborales. Es uno de los síntomas que más preocupan al enfermo, incluso más que el dolor, y al que se le presta poca atención. Por tanto se infravalora su importancia y no se aplican los medios diagnósticos necesarios para identificar sus causas y poder disminuirlas en la medida de lo posibl (AU)

Fatigue is a symptom with a high incidence in patients with cancer. It is a multifactorial phenomenon, which deteriorates the quality of life of patients, from physical, psychological, social and working points of view. It is one of the symptoms that most concern the patient, even more than pain, medically it is paid little attention, therefore underestimating its importance and not applying the diagnostic tools necessary to identify its causes and to reduce it as far as possible. The aim of this paper is to assess the subjective perception of fatigue in advanced cancer patients, the subjective distress that produces the situation they are living and to assess whether they use strategies to minimize the feeling of tiredness. We consider it necessary to establish a consensus on the measuring instruments used to compare results.We have developed a psychological intervention guideline for management fatigue by promoting the adaptation and adjustment of advanced cancer patients to illness and therefore increase sense of well being and quality of life (AU)

Intelligent client for integrating bioinformatics services.

MOTIVATION: In addition to existing bioinformatics software, a lot of new tools are being developed world wide to supply services for an ever growing, widely dispersed and heterogeneous collection of biological data. The integration of these resources under a common platform is a challenging task. To this end, several groups are developing integration technologies, in which services are usually registered in some sort of catalogue to allow novel discovering and accessing mechanisms to be implemented. However, each service demands specific interfaces to accommodate their parameters and it is a complicated task linking the different service inputs and outputs to solve a biological problem. RESULTS: In this work we address the design and implementation of a versatile web client to access BioMOBY compatible services (a system by which a client can interact with multiple sources of biological data regardless of the underlying format or schema) using the service description stored in the BioMOBY catalogue. The automatic interface generator significantly reduces developing time and produces uniform service access mechanisms. The design and proof of concept (for such a client) including the generic interface generator have been developed and implemented in the National Institute for Bioinformatics in Spain. AVAILABILITY: The INB (National Institute for Bioinformatics, Spain) platform is available at www.inab.org/MOWServ

Demanda de antibióticos orales sin receta médica en una farmacia comunitaria / The demand for oral antibiotics without a medical precription in a community pharmacy

Objetivos: Describir y analizar las demandas de antibióticos orales sin receta médica en una farmacia comunitaria. Métodos: Estudio observacional prospectivo. El estudio tuvo lugar en una farmacia comunitaria de Benalmádena (Málaga). Durante 7 meses a todos los pacientes que solicitaban un antibiótico sin receta médica se le hacían una serie de preguntas para recoger los siguientes datos: edad, sexo, antibiótico solicitado, a quién va destinado el antibiótico, quién aconsejó el antibiótico y motivo de solicitud (problema de salud). Resultados: Se registraron un total de 397 solicitudes de antibióticos orales sin receta médica. El grupo de edad que más antibióticos solicita es el de 31 a 45 años (39,5%), tanto en hombres como en mujeres. El 47,3% de las solicitudes no las realiza el consumidor final del antibiótico. La automedicación supuso un 57,5% de los antibióticos solicitados y la recomendación médica sin receta fue de un 42,5%. La demanda total de antibióticos por grupo terapéutico, en orden de mayor a menor, fueron penicilinas (57,3%), macrólidos (18,3%), quinolonas y antiinfecciosos urinarios (4,6%), cefalosporinas (4,0%), tetraciclinas (3,6%) y sulfamidas (2,8%). Los principales motivos de solicitud fueron problemas de garganta (29,0%) y problemas dentales (23,4%). Conclusiones: La automedicación con antibióticos en nuestro entorno es un problema importante por lo que es necesario poner en marcha actuaciones de educación sanitaria para eliminar la automedicación y conseguir un uso racional de antibióticos (AU)

Objectives: to describe and analyze the demand for oral antibiotics without a medical prescription in a Community Pharmacy. Methods: prospective observational study. The study took place in a community pharmacy in Benalmádena (Málaga). A series of questions were made to all the patients who asked for an antibiotic without a medical prescription during a period of seven months so as to obtain the following data: age, sex, antibiotic demanded, who is the antibiotic for, who recommended the antibiotic, and the motive for the request (Health Problem). Results: a total of 397 requests for oral antibiotics without a medical prescription were registered. The 31 to 45 age group is one that requested the mast oral antibiotics in both men and women (39.5%). 47.3% of the requests are not made by the person who finally takes the antibiotic. Auto-medication supposed 57.5% of the requested antibiotics and medical recommendation without a prescription was 42.5%. The total demand for antibiotics per therapeutic group highest to least, were penicillins (5 7.3%), macrolides (18.3%), quinolones and urine antiinfectives (4.6%), cephalosporins (4.0%), tetracyclines (3.6%) and sulphamides (2.8%).The main motives for the requests were throat problems (29.0%) and dental problems (234%). Conclusions: Selfmedication with antibiotics in our environment is a serious problem and therefore health education strategies should be begun to eliminate selfmedication and to obtain a rational use of antibiotics (AU)

Angiolipoma espinal: descripción de dos casos y revisión de la bibliografía / Angiolipoma involving the spine: a report of two cases and a review of the literature

El angiolipoma espinal es una lesión compuesta por adipocitos maduros con vasos sanguíneos anormales. Hay descritos unos 60 casos, la mayoría en el espacio extradural con predilección por el área dorsal. En nuestro hospital hemos encontrado dos casos documentados con radiología convencional, TC y RM, objeto de esta publicación. Tras revisar la bibliografía y los hallazgos en los diferentes métodos de imagen señalamos la importante aportación de la RM, en especial las técnicas con supresión de la grasa, en el diagnóstico preoperatorio de estas lesiones. En general, presentan alta intensidad de señal en secuencias potenciadas en T1 con algunas áreas de iso/hiposeñal en su interior, que lo diferencia de la lipomatosis que presenta alta intensidad de señal en secuencias ponderadas en T1 pero homogénea. Existe realce tras la administración de contraste paramagnético, menos evidente en las lesiones con muy alta intensidad de señal en secuencias potenciales en T1. En secuencias ponderadas en T2 pueden presentar intensidad de señal variable o alta. Las secuencias con supresión de la grasa aportan especificidad al realzar el componente no lipomatoso (angiomatoso) de la lesión. La asociación de estos hallazgos en RM junto a alteraciones en el esqueleto adyacente en un contexto clínico de compresión medular progresiva debe hacernos pensar en esta lesión, infrecuente y con favorable respuesta al tratamiento quirúrgico. (AU)