RESUMO
Non-small cell lung cancer (NSCLC) is still diagnosed at late stages in Brazil. The availability of newer treatment options has changed patient management, however, few real-world data have been published since then. This is a population-based retrospective cohort study that aims to evaluate the characteristics of stage III/IV NSCLC patients and their journey in the Brazilian private healthcare system. Patients aged ≥18 years, residing in Brazil who had their first medical appointment between 2016 and 2018 were included in the study. The sociodemographic and clinical characteristics of the patients and time intervals of interest were described. A total of 10,394 patients were analyzed. The majority of the patients were male (58.5%) with a median age of 64.0 (IQR = 58.0 - 71.0) years. In relation to characteristics of the disease, most of the tumors were characterized as adenocarcinomas (52.3%) and diagnosed at stage IV (72.2%). Most patients arrived at the hospital with an established NSCLC diagnosis, while 45.7% were diagnosed at the first medical appointment in the hospital or later. For patients who were diagnosed at the first medical appointment or later, a median interval of 15.0 (IQR = 6.0 - 33.0) days was observed between the first medical appointment and the diagnosis. The first treatment was given after a median of 25.0 (IQR = 6.0 - 49.0) days after diagnosis for patients without a prior diagnosis, and 57.0 (IQR: 33.0 - 98.0) days for patients with a prior diagnosis. The most common treatments were chemotherapy alone (33.8%), chemotherapy combined with radiotherapy (21.5%), radiotherapy alone (13.1%), adjuvant or neoadjuvant treatment (9.3%), surgery (3.3%), and immunotherapy (0.7%; alone or combined). At the end of follow-up (September, 2020), 52.3% of the patients had died. Despite having more treatment options in the private sector, data show that there is a need to improve access to technologies.
RESUMO
Anemia é uma complicação quase universal nos pacientes em estágios avançados de doença renal crônica (DRC). Ela está associada com maior número de internações hospitalares, maior mortalidade e pior qualidade de vida dos pacientes. Ela tem várias causas, sendo deficiência de eritropoetina e ferro as duas principais causas. A condição inflamatória presente na DRC interfere com a ação da eritropoetina e com a absorção intestinal de ferro e mobilização de ferro dos estoques, devido ao aumento de hepcidina. A correção parcial (não completa) da anemia promove melhores resultados nos pacientes com DRC.
Anemia is an almost universal complication of patients in advanced stages of chronic kidney disease (CKD). It is associated with more hospitalizations, increased mortality and worse quality of life. Although there are several causes, erythropoietin and iron deficiency are the most common. The inflammatory condition present in CKD interferes with the action of erythropoietin, intestinal iron absorption and iron mobilization from deposits, due to increased hepcidin concentrations. Partial but incomplete correction of anemia promotes better outcomes in patients with CKD.
Assuntos
Humanos , Anemia , NeoplasiasRESUMO
The use of adjuvant chemotherapy following resection for all patients with stage III colon cancer is now part of the standard of care around the world. Recent trials have led to changes in the standard regimens, which now include the use of oxaliplatin (Eloxatin) for most patients with stage III colon cancer. The addition of oxaliplatin has resulted in a 23% reduction in the risk of recurrence compared with fluorouracil/leucovorin alone, with a small but statistically significant survival benefit. Unfortunately, no adequately powered trial has determined whether adjuvant chemotherapy is beneficial for stage II patients, and its use is much more controversial. Most investigators agree that adjuvant chemotherapy has some activity against stage II disease. However, its impact on progression-free and overall survival remains highly controversial. Despite the lack of data, there is growing acceptance of an informal classification system, which stratifies stage II patients by risk on the basis of clinical data, as a guide for deciding whether to use adjuvant therapy. The only phase III clinical trial for stage II patients currently ongoing in the United States uses molecular classification as the basis for patient randomization.
