17-ß Estradiol up-regulates energy metabolic pathways, cellular proliferation and tumor invasiveness in ER+ breast cancer spheroids.

Several biological processes related to cancer malignancy are regulated by 17-ß estradiol (E2) in ER+-breast cancer. To establish the role of E2 on the atypical cancer energy metabolism, a systematic study analyzing transcription factors, proteins, and fluxes associated with energy metabolism was undertaken in multicellular tumor spheroids (MCTS) from human ER+ MCF-7 breast cancer cells. At E2 physiological concentrations (10 and 100 nM for 24 h), both ERα and ERß receptors, and their protein target pS2, increased by 0.6-3.5 times vs. non-treated MCTS, revealing an activated E2/ER axis. E2 also increased by 30-470% the content of several transcription factors associated to mitochondrial biogenesis and oxidative phosphorylation (OxPhos) (p53, PGC1-α) and glycolytic pathways (HIF1-α, c-MYC). Several OxPhos and glycolytic proteins (36-257%) as well as pathway fluxes (48-156%) significantly increased being OxPhos the principal ATP cellular supplier (>75%). As result of energy metabolism stimulation by E2, cancer cell migration and invasion processes and related proteins (SNAIL, FN, MM-9) contents augmented by 24-189% vs. non-treated MCTS. Celecoxib at 10 nM blocked OxPhos (60%) as well as MCTS growth, cell migration and invasiveness (>40%); whereas the glycolytic inhibitor iodoacetate (0.5 µM) and doxorubicin (70 nM) were innocuous. Our results show for the first time using a more physiological tridimensional cancer model, resembling the initial stages of solid tumors, that anti-mitochondrial therapy may be useful to deter hormone-dependent breast carcinomas.

Evaluación de cribado de la calidad de vida en cuidadores primarios informales de pacientes oncológicos / Screening assessment of quality of life in informal primary caregivers of cancer patients

Objetivo: determinar las propiedades psicométricas de un instrumento de CV (CQoLC) y evaluar la calidad de vida (CV) de los cuidadores primarios (CPI) de pacientes con cáncer. Material y método:estudio tres fases: (1) evaluación de CV en CPI con un instrumento validado para población general y de pacientes que requieren atención médica (InCaViSa); (2) adaptación y piloteo del CQoLC y; (3) evaluación de confiabilidad, validez y normas del CQoLC. Se incluyeron 317 CPI de pacientes con diferentes diagnósticos oncológicos. Se realizaron análisis descriptivos de la CV reportada por los CPI. Para piloteo del instrumento se estimó el porcentaje de CPI que tuvieron dificultades para comprender algún reactivo. En la fase de validación se realizó un análisis factorial por ejes principales y la estructura propuesta se sometió a un análisis factorial confirmatorio (AFC). La confiabilidad se obtuvo a través del Alfa de Cronbach y el coeficiente Omega de McDonald’s. Finalmente, se estimaron los parámetros para calificación del CQoLC. Resultados: los CPI obtuvieron puntajes de “baja” a “muy baja” CV en la mayoría de las subescalas del InCaViSa. El CQoLC no mostró dificultades para su comprensión y se obtuvo una versión de nueve reactivos, distribuidos en cuatro indicadores, que explican el 45,62% de la varianza con adecuado ajuste en el AFC y adecuados índices de confiabilidad (Alfas de Cronbach de 0,496 a 0,866 y coeficiente Omega de McDonald’s = 0,868).Conclusiones:la CV de los CPI de pacientes con cáncer se encuentra afectada importantemente. El CQoLC es un instrumento especializado, que demostró ser adecuado como herramienta de cribado en las mediciones de auto-reporte (AU)

Objective: To determine the psychometric properties of a QoL instrument (CQoLC) and to assess the quality of life (QoL) of primary caregivers (PC) of cancer patients. Methods:Three-phase study: (1) assessment of QoL in PC with an instrument validated for general population and patients requiring medical care (InCaViSa); (2) adaptation and piloting of the CQoLC and (3) assessment of reliability, validity, and norms of the CQoLC. A total of 317 PCs of patients with different oncologic diagnoses were included. Descriptive analyses of the QOL reported by the PCs were performed. For piloting the instrument, the percentage of PCs who had difficulties in understanding any item was estimated. Factor analysis by main axes was performed in the validation phase, and the proposed structure was subjected to confirmatory factor analysis (CFA). Reliability was obtained through Cronbach’s Alpha and McDonald’s Omega coefficient. Finally, the parameters for CQoLC scoring were estimated. Results: The PCs obtained “low” to “deficient” QoL scores in most InCaViSa subscales. The CQoLC showed no difficulties in its comprehension, and a version of nine items was obtained, distributed in four indicators, which explain 45,62% of the variance with adequate adjustment in the AFC and adequate reliability indexes (Cronbach’s alphas from 0,496 to 0,866 and McDonald’s Omega coefficient = 0,868). Conclusions: The QoL of the CQoLC of cancer patients is significantly affected. The CQoLC is a specialized instrument, which proved to be adequate as a screening tool in self-report measurements (AU)

Ibero-American Expert Consensus on Squamous Cell Carcinoma of the Head and Neck Treatment in Patients Unable to Receive Cisplatin: Recommendations for Clinical Practice.

Cisplatin is the standard of treatment for squamous cell carcinoma of the head and neck (SCCHN) that has demonstrated efficacy, either in locally advanced disease when combined with radiotherapy at high doses, or in metastatic/recurrent disease when combined with other agents. However, the usual toxicities related to cisplatin, such as neurotoxicity, nephrotoxicity, ototoxicity, and hematologic toxicities, especially when high doses have been administered, have important implications in the patients' quality of life. The decision to administer cisplatin depends on several patient factors, such as age, performance status, weight loss, comorbidities, previous toxicities, chronic viral infection, or even the current SARS-CoV-2 pandemic. In order to establish recommendations for the management of patients with SCCHN, a group of experts in medical and radiation oncology from Spain and Latin-American discussed how to identify patients who are not candidates for cisplatin to offer them the most suitable therapeutic alternative.

Acetate Promotes a Differential Energy Metabolic Response in Human HCT 116 and COLO 205 Colon Cancer Cells Impacting Cancer Cell Growth and Invasiveness.

Under dysbiosis, a gut metabolic disorder, short-chain carboxylic acids (SCCAs) are secreted to the lumen, affecting colorectal cancer (CRC) development. Butyrate and propionate act as CRC growth inhibitors, but they might also serve as carbon source. In turn, the roles of acetate as metabolic fuel and protein acetylation promoter have not been clearly elucidated. To assess whether acetate favors CRC growth through active mitochondrial catabolism, a systematic study evaluating acetate thiokinase (AcK), energy metabolism, cell proliferation, and invasiveness was performed in two CRC cell lines incubated with physiological SCCAs concentrations. In COLO 205, acetate (+glucose) increased the cell density (50%), mitochondrial protein content (3-10 times), 2-OGDH acetylation, and oxidative phosphorylation (OxPhos) flux (36%), whereas glycolysis remained unchanged vs. glucose-cultured cells; the acetate-induced OxPhos activation correlated with a high AcK activity, content, and acetylation (1.5-6-fold). In contrast, acetate showed no effect on HCT116 cell growth, OxPhos, AcK activity, protein content, and acetylation. However, a substantial increment in the HIF-1α content, HIF-1α-glycolytic protein targets (1-2.3 times), and glycolytic flux (64%) was observed. Butyrate and propionate decreased the growth of both CRC cells by impairing OxPhos flux through mitophagy and mitochondrial fragmentation activation. It is described, for the first time, the role of acetate as metabolic fuel for ATP supply in CRC COLO 205 cells to sustain proliferation, aside from its well-known role as protein epigenetic regulator. The level of AcK determined in COLO 205 cells was similar to that found in human CRC biopsies, showing its potential role as metabolic marker.

Patients' quality of life: Validation of the functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) instrument for the Mexican population.

OBJECTIVE: The functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) is a widely used instrument to assess quality of life (QOL) in hematopoietic stem cell transplant (HSCT) patients, but there is little evidence of its validity in Latin American populations. This study evaluated the psychometric properties of the Spanish language version of the FACT-BMT in Mexican patients. METHOD: First, the original version was piloted with 15 HSCT patients to obtain an adequate cultural version, resulting in the adaptation of one item. After that, the new version was completed by 139 HSCT patients. RESULTS: The results showed a FACT factor structure that explains 70.84% of the total variance, a factor structure similar to the original FACT structure, and with a high internal consistency (Cronbach's alpha = 0.867). For the BMT subscale, the best factor structure included 17 items which explain 61.65% of the total variance with an adequate internal consistency (Cronbach's alpha = 0.696). SIGNIFICANCE OF THE RESULTS: The FACT-BMT was found to be a valid and reliable instrument to evaluate QOL in Mexican patients. Our results constitute new FACT-BMT empirical evidence that supports its clinical and research uses.

Heart myxoma develops oncogenic and metastatic phenotype.

PURPOSE: Heart myxomas have been frequently considered as benign lesions associated with Carney's complex. However, after surgical removal, myxomas re-emerge causing dysfunctional heart. METHODS: To identify whether cardiac myxomas may develop a metastatic phenotype as occurs in malignant cancers, a profile of several proteins involved in malignancy such as oncogenes (c-MYC, K-RAS and H-RAS), cancer-associated metabolic transcriptional factors (HIF-1α, p53 and PPAR-γ) and epithelial-mesenchymal transition proteins (fibronectin, vimentin, ß-catenin, SNAIL and MMP-9) were evaluated in seven samples from a cohort of patients with atrial and ventricular myxomas. The analysis was also performed in: (1) cardiac tissue surrounding the area where myxoma was removed; (2) non-cancer heart tissue (NCHT); and (3) malignant triple negative breast cancer biopsies for comparative purposes. RESULTS: Statistical analysis applying univariate (Kruskal-Wallis and Dunn's tests) and multivariate analyses (PCA, principal component analysis) revealed that heart myxomas (7-15 times) and myxoma surrounding tissue (22-99 times) vs. NCHT showed high content of c-MYC, p53, vimentin, and HIF-1α, indicating that both myxoma and its surrounding area express oncogenes and malignancy-related proteins as occurs in triple negative breast cancer. CONCLUSIONS: Based on ROC (receiver operating characteristics) statistical analysis, c-MYC, HIF-1α, p53, and vimentin may be considered potential biomarkers for malignancy detection in myxoma.

Validación de la Escala de Ansiedad Preoperatoria y de Información Ámsterdam (APAIS) en mujeres latinoamericanas con cáncer de mama: Estudio México - Costa Rica / Validation of the Amsterdam Pre-surgery Anxiety and Information Scale in Latino American women with breast cancer: Mexico - Costa Rica research

El tratamiento más frecuente contra el cáncer es la cirugía; sin embargo es un procedimiento invasivo que se ha asociado con la presencia de sintomatología psicológica hasta en el 76% de los pacientes. El estudio de la ansiedad ante la cirugía requiere de herramientas específicas adaptadas a las peculiaridades del constructo; entre ellas se encuentra la Escala de Ansiedad Preoperatoria y de Información Ámsterdam (APAIS) que ha sido validada en pacientes sometidos a diversas cirugías en múltiples países; mostrando consistentemente propiedades psicométricas adecuadas. Objetivo: Obtener la confiabilidad y validez de la APAIS en población oncológica para población latinoamericana. Método: Estudio transversal, no experimental, de análisis psicométrico que incluyó una muestra no probabilística de 117 mujeres con edades entre 25 y 75 años, todas diagnosticadas con cáncer de mama y programadas para cirugía en un hospital público de México (57 mujeres) o Costa Rica (63 mujeres). Resultados: Los seis reactivos de la Escala APAIS mostraron adecuada distribución de las contestaciones de las participantes entre las opciones de respuestas, tener capacidad de discriminación entre grupos extremos y contribuyeron a la consistencia interna del instrumento. El análisis factorial de máxima verosimilitud con rotación varimax mostró una estructura que explicó el 58,58% de la varianza con dos factores, la cual fue confirmada por análisis factorial confirmatorio; la escala total mostró una consistencia interna de α=0,816. Dicha escala mostró adecuada sensibilidad y especificidad con un punto de corte de 14 puntos. Conclusiones: La escala APAIS muestra propiedades psicométricas adecuadas para considerarla válida y confiable para evaluar ansiedad prequirúrgica en mujeres con cáncer de mama

Surgery is the most frequent and efficient treatment for cancer, however, it is an invasive procedure that has been associated with psychological symptoms in up to 76% of patients. Health professional require specific and adapted tools to evaluate anxiety related to surgery, but there are few instruments to evaluate it. An option is the Amsterdam Preoperative Anxiety and Information Scale (APAIS), which has been validated in multiple countries with patients undergoing different surgeries. Validations have shown APAIS has adequate psychometric properties. Aim: To obtain the reliability and validity of APAIS in the oncology population for the Latin American population. Method: Cross-sectional, non-experimental, psychometric analysis study that included a non-probabilistic sample of 117 women aged between 25 and 75 years, all patients have been diagnosed with breast cancer and have been scheduled for surgery in a public hospital in Mexico (57 women) or Costa Rica (63 women). Results: The six items of the APAIS Scale showed an adequate distribution of the responses of the participants among the response options, the ability to discriminate between extreme groups and contributed to the internal consistency of the instrument. The factor analysis of maximum likelihood with varimax rotation showed a structure that explained 58.58% of the variance with two factors, this structure was confirmed by a confirmatory factor analysis. The total scale showed an internal consistency of α = .816. This scale showed adequate sensitivity and specificity with a cut-off point of 14 points. Conclusions: The APAIS scale shows adequate psychometric properties to be considered valid and reliable to evaluate pre-surgical anxiety in patients with cancer

Frequency of BRAF V600E Mutation in the Mexican Population of Patients With Metastatic Melanoma.

PURPOSE: The BRAF V600E mutation has been described in melanomas occurring in the Caucasian, European, and Asian populations. However, in the Mexican population, the status and clinical significance of BRAF mutation has not been researched on a large scale. METHODS: Consecutive BRAF-tested Mexican patients with metastatic melanoma (n = 127) were analyzed for mutations in exon 15 of the BRAF gene in genomic DNA by real-time polymerase chain reaction technology for amplification and detection. The results were correlated with the clinical-pathologic features and the prognosis of the patients. RESULTS: The frequency of somatic mutation V600E within the BRAF gene was 54.6% (43 of 127 patients). Nodular melanoma was the most prevalent subtype in our population, with BRAF mutations in 37.2% (16 of 55 patients). In contrast, superficial spread had a frequency of 18.6% BRAF mutation (eight of 24). Other clinicopathologic features were assessed to correlate with the mutation status. CONCLUSION: This study searched for the most prevalent BRAF V600E mutation type in melanoma in a heterogeneous population from Mexico. Nodular melanoma was found to be the most prevalent in metastatic presentation and the presence of BRAF V600E mutation, perhaps related to the mixed ancestry; in the north, ancestry is predominantly European and in the south, it is predominantly Asian. The outcomes of the mutation correlations were similar to those found in other populations.

Epidemiological Data on the Nutritional Status of Cancer Patients Receiving Treatment with Concomitant Chemoradiotherapy, Radiotherapy or Sequential Chemoradiotherapy to the Abdominopelvic Area.

Cancer patients are particularly susceptible to undernourishment so associated weight loss is frequent. Approximately 15% of patients lose >10% of their usual body weight, 40-80% become undernourished, and about 20% die as a result. Well-nourished patients have a higher survival rate when compared with patients at risk of undernourishment (19.9 vs. 3.7 months); hence, nutritional intervention is pivotal. Undernourishment negatively influences the patient's prognosis, and its prevalence depends on the tumor type and location, disease stage, treatment, and the applied nutritional evaluation tool. During abdominopelvic radiotherapy, up to 90% of patients experience symptoms of varying severity; weight loss during radiotherapy is an early indicator of nutritional deterioration, and he the use of radiation is associated with a higher likelihood of undernourishment. In patients with gynecological malignancies, 12.5-54% are malnourished before receiving oncological treatment, worsening after treatment in 35.8-82% of cases. There is also deterioration of the nutritional status in patients with colorectal cancer once pelvic radiotherapy is initiated, whereby 50% of cases are malnourished at the beginning of treatment, and 66.7% are so when it ends. Although there are notable differences in the impact of radiotherapy on weight according to the radiated region, 88% patients receiving abdominal radiotherapy were found to lose weight compared to 38% of patients whose treatment was limited to the pelvis.

Propiedades psicométricas del cuestionario general del salud de Goldberd - QHQ-28 - en cuidadores primarios informales de pacientes con cáncer / Psychometric properties of Goldberg’s General Health Questionnaire - GHQ-28 - in informal primary caregivers of cancer patients

Objetivo. Determinar las propiedades psicométricas del Cuestionario de Salud General de Goldberg -GHQ-28-, en una muestra de cuidadores primarios informales mexicanos de pacientes con cáncer. Método. Participaron 276 cuidadores de los cuales 205 fueron mujeres (74,3%) y 71 hombres (25,7%). Los participantes contestaron concurrentemente el GHQ-28 y el Inventario de Depresión de Beck BDI. Resultados. La consistencia interna de la escala global mostró un índice satisfactorio (α= 0,91). Las alfas de Cronbach de las sub-escalas tuvieron un valor de α=0,86, a α=0,76 que explicaron el 53,42% de la varianza. La validez concurrente con el BDI mostró resultados significativos (r de Pearson de 0,72 a 0,427, p<0,05). Conclusiones. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a presentar afectaciones en la salud en general a lo largo del proceso de cuidado de los pacientes oncológicos

Objective. To determine the psychometric properties of Goldberg’s General Health Questionnaire -GHQ-28- in a sample of Mexican primary caregivers of cancer patients. Method: Two hundred and seventy six caregivers participated in this protocol, 205 of which were women (74.3%) and 71 were men (25.7%). Participants answered the GHQ-28 and the Beck Depression Inventory (BDI) concurrently. Results. The internal consistency of the overall scale showed a satisfactory index (α =0.91). The Cronbach alphas of the subscale had a value of α =.86, α =.76, explaining the 53.42% of the variance. The correlation validity by BDI showed significant outcomes (Pearson r=0.723 - 0.427, p<0.05). Conclusions. The relevance of the outcomes is that this is a population that can show damages in the overall health throughout the process of care for cancer patients

[Review of pharmacokinetic monitoring of 5-Fluorouracil as a tool to increase efficacy and safety]. / Revisión del monitoreo farmacocinético del 5-fluorouracilo como herramienta para incrementar eficacia y seguridad.

Recent progress in medical knowledge has indicated that both clinical and biological markers will determine the response to different medical treatments: age, gender and genetics will determine the success of treatment. Genetic variability in this respect is fundamental and determines efficiency and safety of drugs, as well as susceptibility and illness' development. Fortunately, personalized medicine now offers individually tailored treatment strategies for each patient's needs. This is of outmost importance in oncology, since treatment is per se toxic and the commonly found low serum drug concentrations result in low treatment efficacy. Personalized medicine will allow a better approach to this, until now, a poorly managed disease. In this review we intent to raise awareness of personalized medicine and of clinical pharmacologic monitoring, with the aim to achieve adequate levels of efficacy and safety in the use of the cytotoxic drug 5-Fluorouracil (5-FU). Additionally, the importance of pharmacogenomics for the use of 5-FU is discussed. We designed this discussion towards medical practitioners challenged with treatment decisions every day, together with their patients.

Los pacientes bajo tratamiento con alopurinol pueden presentar reacciones adversas potencialmente mortales, particularmente al inicio del tratamiento. Las reacciones cutáneas adversas por alopurinol tienen una prevalencia aproximada del 2 %. Presentamos dos casos de síndrome de hipersensibilidad por alopurinol en pacientes mexicanos en quienes la hiperuricemia asintomática fue la indicación para su uso. El médico general y el especialista deben estar alerta ante este síndrome que ocasiona alta morbilidad y mortalidad.

Advanced Squamous Cell Carcinoma of the Head and Neck: The Current Role of Cetuximab.

We review clinical trials of squamous cell carcinoma of the head and neck (SCCHN) to address the current and potential uses of cetuximab (CTX). PubMed was reviewed to identify papers published between 2010 and 2016. The search terms used were "cetuximab" and "head and neck cancer." A total of 634 articles were identified. Phase II or III studies with CTX in patients with advanced SCCHN without treatment or with recurrent/metastatic tumors were selected. Forty-six registries were obtained. Information was critically reviewed and relevant information presented. As definitive treatment of advanced squamous cells carcinomas and as palliative treatment of recurrent/metastatic disease, CTX alone or associated with chemotherapy and/or radiotherapy is an alternative to chemoradiotherapy because of its distinct and favorable toxicity profile.

Escala Hospitalaria de Ansiedad y Depresión (HADS) en cuidadores primarios informales de pacientes con cáncer: propiedades psicométricas / Hospital anxiety and depression scale (hads) in informal primary caregivers of cancer patients: psychometric properties

Introducción: la sintomatología ansiosa y depresiva son parte de los principales problemas de salud mental en cuidadores primarios informales afectando su calidad de vida. A través de instrumentos de tamizaje válidos y confiables como la Escala Hospitalaria de Ansiedad y Depresión (HADS) ha sido posible detectar posibles casos. Sin embargo, hasta ahora no se habían caracterizado las propiedades psicométricas en cuidadores primarios informales de pacientes con cáncer en población mexicana. Objetivo: determinar las propiedades psicométricas de la HADS en una muestra de cuidadores primarios informales. Material y Método: Participaron 200 pacientes del Instituto Nacional de Cancerología, de los cuales 65,5% eran mujeres y 34,5% hombres; la edad promedio fue de 47,4 ± 14,1 años. Los participantes contestaron además del HADS la escala de carga de Zarit. Resultados: El análisis factorial presentó dos factores con los 14 reactivos originales. La consistencia interna de la escala global mostró un índice satisfactorio (α=0,83). Los alfas de Cronbach de cada subescala tuvieron un valor de 0,82 y 0,78 que explican el 42,58% de la varianza. La validez por medio de correlación con las medidas concurrentes mostraron resultados significativos (r de Pearson de 0,41-0,64, p< 0,05). Conclusiones: La HADS en cuidadores primarios de pacientes con cáncer en población mexicana presentó adecuadas características psicométricas. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a requerir atención oportuna en salud mental en diferentes etapas del cuidado de pacientes con cáncer

Introduction: Symptoms of anxiety and depression are some of the major mental health problems in caregivers affecting quality of life. Valid and reliable screening instruments such as the Hospital Anxiety and Depression Scale (HADS) has made possible the detection of possible cases of depression and anxiety. However, the psychometric properties of this instrument have not been documented in caregivers in the Mexican population. Objetives: Determine the psychometric properties of the HADS in a sample of caregivers in the Mexican population. Materials and Methods: 200 caregivers from the National Cancer Institute participated, of which 65.5% were women and 34.5% men, with a mean age of 47.4 ± 14.1 years. Participants completed concurrently the HADS and Zarit Burden Interview. Results: A factor analysis to two factors explained 42.05% of the variance with 14 items on two factors. The internal consistency of the overall scale was satisfactory (alfa=0.83). Cronbach’s alphas for each subscale were .78 and .82. The concurrent validity assessed by way of correlations with concurrent measures showed significant associations (Pearson r=0.41-0.64, p< 0.05). Conclusions: The HADS has adequate construct validity, internal consistency and concurrent validity for use in caregivers of cancer patients from the Mexican population. The relevance of the results is that this is a population that can require mental health care in stages of care for patients with cáncer

Propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión (HADS) en una población de pacientes oncológicos mexicanos / Psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in a Mexican population of cancer patients

ANTECEDENTES: La sintomatología ansiosa y depresiva es parte de los principales problemas de salud mental en pacientes oncológicos, lo cual afecta la calidad de vida y la adhesión al tratamiento, además de que se asocia con mayor número de síntomas y estancia hospitalaria. Mediante instrumentos de tamizaje válidos y confiables, como la Escala hospitalaria de ansiedad y depresión (HADS), ha sido posible detectar posibles casos en pacientes hospitalarios. Sin embargo, hasta ahora no se habían caracterizado las propiedades psicométricas en pacientes oncológicos en población mexicana.OBJETIVO: Determinar las propiedades psicométricas de la HADS en una muestra de pacientes oncológicos.MÉTODO: Participaron 400 pacientes del Instituto Nacional de Cancerología, de los cuales 226 eran mujeres (56.5%) y 174 eran hombres (43.6%); la edad promedio fue de 47.4 ± 14.1 años. Los participantes contestaron, además de la HADS, los siguientes inventarios: depresión de Beck, ansiedad de Beck, termómetro de distrés.RESULTADOS: Un análisis factorial ajustado a dos factores presentó un instrumento con 12 reactivos, similar a la versión original. La consistencia interna de la escala global mostró un índice satisfactorio (a=0.86). Los alfas de Cronbach de cada subescala tuvieron un valor de .79 y .80 que explicaron el 48.04% de la varianza. La validez, por medio de correlación con las medidas concurrentes, mostró resultados significativos (r de Pearson de .51 a .71, p<0.05).DISCUSIÓN Y CONCLUSIÓN: La HADS en pacientes con cáncer en población mexicana presentó adecuadas características psicométricas. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a requerir atención oportuna en salud mental en etapas tempranas de su tratamiento. La detección de sintomatología ansiosa y depresiva por medio de la HADS deriva en beneficios para la población oncológica y en estrategias funcionales de atención adecuada y costo-efectivas.

BACKGROUND: Symptoms of anxiety and depression are among the major mental health problems in cancer patients. These symptoms affect the quality of life and treatment adherence, and are associated with other symptoms and longer hospital stays. Valid and reliable screening instruments such as the Hospital Anxiety and Depression Scale (HADS), have made possible the detection of possible cases of depression and anxiety in medically ill patients. However, the psychometric properties of this instrument have not been documented in different types of cancer diagnoses in the Mexican population.OBJECTIVE: To determine the psychometric properties of the HADS in a sample of patients with cancer from the Mexican population.METHOD: Four hundred patients from the National Cancer Institute participated, of which 226 were women (56.5%) and 174 men (43.6%), with a mean age of 47.4 ±14.1 years. Participants completed concurrently the HADS as well as the following inventories: 1. Beck Depression, 2. Beck Anxiety and 3. Distress Thermometer.RESULTS: A factor analysis adjusted to two factors explained 48.04% of the variance, with 12 items loading on these two factors in a way similar to the original version. The internal consistency of the overall scale was satisfactory (α=0.86). Cronbach's alphas for each subscale were .79 and .80. The concurrent validity assessed by way of correlations with concurrent measures showed significant associations (Pearson r=51-71, p<0.05).DISCUSSION AND CONCLUSION: The HADS has adequate construct validity, internal consistency and concurrent validity for its use in cancer patients from the Mexican population. The relevance of these results is a cost effective tool to provide timely mental health care early in oncological treatment for those in need. Detecting anxiety and depression symptoms through the HADS may benefit cancer patients by ensuring appropriate care that may increase their quality of life and treatment adherence, and reduce their hospital stays.

Propiedades psicométricas del inventario de ansiedad de beck (BAI) en pacientes con cáncer / Psychometric properties of the beck anxiety inventory (bai) for patients with cancer

La sintomatología ansiosa es uno de los principales problemas psicológicos en pacientes oncológicos. La Escala de Ansiedad de Beck (BAI) ha demostrado ser un instrumento válido y confiable. Sin embargo, hasta ahora no se había documentado su comportamiento psicométrico en población oncológica en México. Objetivo: Determinar las propiedades psicométricas de la Escala de Ansiedad de Beck (BAI) en una muestra de pacientes con cáncer. Material y Método: participaron 250 pacientes del Instituto Nacional de Cancerología, de los cuales 138 eran mujeres (55,2%) y 112 eran hombres (44,8%); la edad promedio fue de 46,6 ± 14,3 años. Los participantes contestaron además del BAI, la Subescala de ansiedad de la Escala de Ansiedad y Depresión (HADS-A). Resultados: El análisis factorial varimax con 21 reactivos presentó una estructura con 4 factores: Subjetivo, Neurofisiológico, Autonómico y Síntomas vasomotores que explicaron el 46,38% de la varianza. La consistencia interna de la escala global mostró un índice satisfactorio (α=0,82). La validez por medio de correlación con el HADS-A mostraron resultados significativos (r de Pearson de 0,58, p <0,05) y el ECOG (r de Pearson de -0,36 p <0,05). Conclusiones: el BAI en pacientes con cáncer en población mexicana presentó adecuadas características psicométricas. La detección de sintomatología ansiosa a través del BAI deriva en beneficios para la población oncológica y en estrategias funcionales de atención adecuada y costo-efectivas

Introduction: Depressive symptomatology is a major mental health problem in cancer patients. The Beck Anxiety Scale (BAI) has proven to be a reliable and valid instrument. However, until now has not been documented it’s psychometric properties in Mexican population with cancer. Objetives: Determine the psychometric properties of the Beck Anxiety Scale BAI in a sample of cancer patients. Material and methods: Involved 250 patients from the National Cancer Institute, of which 112 were women (55.2%) were male and 138 (44.82%); the average age was 46.6 ± 14.3 years. Participants answered the BAI, and also the Anxiety Sub-scale of HADS. Results: A varimax factor analysis with 21 items show a structure of 4 factors: Subjective, Neurophysiological, Autonomic and vasomotor symptoms that explain 46.38% of the variance. The internal consistency of the overall scale was satisfactory (α=0.82). The validity through correlations with the HADS-A showed significant associations (Pearson r=0.58, p <0.05) and ECOG (Pearson -0.36, p <0.05). Conclusions: The BAI in Mexican population with cancer showed adequate psychometric characteristics. Detection of anxiety symptoms through BAI provides benefits to the cancer population and facilitates the development of adequate and cost-effective care strategies

Guía de práctica clínica para la atención psico-oncológica del cuidador primario informal de pacientes con cáncer / Clinical practice guideline for psychooncologic diagnosis and treatment of primary caregivers of cancer patients

Introducción: Los cuidadores primarios representan un papel crucial en la atención de los pacientes con cáncer, lo que comúnmente representan tareas complejas de cuidado. Los cuidadores de los pacientes pueden experimentar diversas afectaciones físicas y psicológicas, así como un funcionamiento social deficiente. Objetivo: Proporcionar a los servicios de psicooncología un algoritmo con los elementos suficientes que faciliten el diagnóstico y tratamiento psicosocial de cuidadores primarios de pacientes con cáncer. Método: Se realizó una búsqueda de la literatura en PsycInfo, LatinIndex y Medline en el período de 2005-2014. Resultados: El presente algoritmo se divide en dos momentos clave: 1). Evaluación y 2). Tratamiento del cuidador primario. Los instrumentos más empleados para ansiedad y depresión son: CES-D, BDI, IDARE, HADS y POMS. Para carga el ECCZ y CRA; las intervenciones psico-educativa, capacitación y orientación terapéutica presentan efectos benéficos para esta población. Conclusiones: El algoritmo ofrece un proceso de toma de decisiones para el diagnóstico y tratamiento psicooncológico del cuidador primario informal

Introduction: The primary caregivers play a crucial role in the care of cancer patients, which commonly represent complex care tasks. Caregivers of patients may experience various physical and psychological effects, and poor social functioning. Objective: To provide at psychooncology services of an algorithm with sufficient elements for diagnosis and psychosocial treatment of primary caregivers of patients with cancer elements. Method: A literature search in PsycInfo, Medline LatinIndex in the period of 2005 to 2014. Results: This algorithm is divided into two key points: 1) Evaluation and 2) Treatment of primary caregiver. More used instruments are CES-D, BDI, IDARE, HADS and POMS. For Burden ECCZ and CRA; the psycho-educational interventions, training and therapeutic orientation have beneficial effects for this population. Conclusions: The algorithm provides a process of decision making for the diagnosis and psychooncologic treatment of the primary caregiver

Efectos de intervenciones psicológicas en supervivientes de cáncer: una revisión / Effects of psychological interventions in cancer survivors: a review

Introducción: Durante las últimas décadas la detección temprana y tratamientos eficaces contra el cáncer han producido un aumento en el número de supervivientes de cáncer. Lo que representa un amplio grupo de pacientes susceptibles de presentar afectaciones psicológicas, físicas y sociales posteriores al tratamiento oncológico. Objetivo: Hacer una revisión de la literatura sobre los efectos de las terapias psicológicas en el manejo de aspectos psicológicos y/o síntomas de los supervivientes de cáncer. Método: Se realizó una revisión de la literatura reportada en MEDLINE, PsycINFO, CINAHL, MedicLatina y Psychology and Behavioral Sciences Collection en el periodo de Enero de 2009 a Diciembre de 2013. Resultados: Se identificaron 24 artículos. Solo 22 cumplieron con los criterios de selección, en 2 casos no se tuvo acceso a los artículos completos, por lo que solo se incluyeron 19. Se identificaron efectos estadísticamente significativos en afectaciones del sueño, bienestar emocional, fatiga, calidad de vida, y síntomas post menopáusicos; y tamaños del efecto entre 0,00-1,40. Conclusiones: Los efectos de la mayoría de las intervenciones psicológicas fueron positivos tanto en modalidad única como en combinación con otras modalidades de tratamiento así como las intervenciones telefónicas y modalidades terapéuticas en línea

Introduction: During the past decades early detection and effective cancer treatments have produced an increase in the number of cancer survivors. This represents a large group of patients susceptible to psychological, physical and social impairments after cancer treatment. Objective: To review the literature on the effects of psychological therapies in the management of psychological and / or somatic symptoms of cancer survivors. Method: A review of the literature reported in MEDLINE, PsycINFO, CINAHL, and MedicLatina Psychology and Behavioral Sciences Collection in the period January 2009 to December 2013 was conducted. Results: 24 articles were identified. Only 22 met the selection criteria; in 2 cases no access to the full articles was obtained, so only 19 were included. Statistically significant effects were identified in sleep difficulties, emotional symptoms, fatigue, quality of life, and post menopausal symptoms. Effect sizes were mostly small to moderate ranging from 0.00 - 1.40. Conclusions: The effects of most psychological interventions were positive whether independent or in combination with other treatment modalities. Interventions via telephone and online therapeutic modalities also showed positive results (AU)

Identification of a metabolic and canonical biomarker signature in Mexican HR+/HER2-, triple positive and triple-negative breast cancer patients.

Infiltrating ductal breast cancer (IDC) is the principal tumor associated-malignancy in Mexican women. In IDC, the development of intermittent hypoxia leads to an adaptive response coordinated by the transcriptional factor HIF-1α. In the present pilot, retrospective/cross-sectional study, the HIF-1α expression was analyzed in 102 tru-cut biopsies from female patients (51 ± 12 years) without previous clinical treatment and compared to 31 normal breast biopsies. The 102 IDC samples corresponded to 56% of HER2-/HR+; 8% of HER2+/HR-; 22% of triple positive (HER2+/HR+); and 14% of triple negative (TN, HER2-/HR-) subtypes. To assess HIF-1α functionality, proteomic and kinetic analysis of glycolytic as well as mitochondrial enzymes, were determined. Validation of HIF-1α as cancer biomarker was assessed by determining the contents of the commonly used biomarkers c-MYC, Ki67, and H- and K-RAS, as well as metastatic and autophagy proteins. Proteomic analysis revealed that HIF-1α, c-MYC, HER2 and COXIV contents were significantly increased in all IDC subtypes vs. normal tissue. The contents and activities of glycolytic proteins were similar between normal and IDC samples, except for HER2-/HR+ where a substantial increase of HKII was observed. Significant increase in 2OGDH and E-cadherin was detected for TN samples vs. other IDC subtypes and for normal samples. These results clearly indicated that HIF-1α + COXIV + c-MYC (+ HER2 for HER2+ subtype) may be useful to depict a breast cancer metabolic marker pattern for diagnosis, whereas the contents of HIF-1α + c-MYC + 2OGDH + E-cadherin may be an alternative useful and reliable signature for TN subtype cancer prognosis.

Oxidative phosphorylation as a target to arrest malignant neoplasias.

Since Warburg proposed in 1956 that cancer cells exhibit increased glycolysis due to mitochondrial damage, numerous researchers have assumed that glycolysis is the predominant ATP supplier for cancer cell energy-dependent processes. However, chemotherapeutic strategies using glycolytic inhibitors have been unsuccessful in arresting tumor proliferation indicating that the Warburg hypothesis may not be applicable to all existing neoplasias. This review analyzes recent information on mitochondrial metabolism in several malignant neoplasias emphasizing that, although tumor cells maintain a high glycolytic rate, the principal ATP production may derive from active oxidative phosphorylation. Thus, anti-mitochondrial drug therapy may be an adequate adjuvant strategy to arrest proliferation of oxidative phosphorylation-dependent neoplasias.