Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high-risk, early breast cancer.

BACKGROUND: The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS: One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS: With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION: With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.

Review of concepts in therapeutic decision-making in HER2-negative luminal metastatic breast cancer.

PURPOSE: Hormone receptor (HR)-positive, Human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) requires a therapeutic approach that takes into account multiple factors, with treatment being based on anti-estrogen hormone therapy (HT). As consensus documents are valuable tools that assist in the decision-making process for establishing clinical strategies and optimize the delivery of health services, this consensus document has been created with the aim of developing recommendations on cretiera for hormone sensitivity and resistance in HER2-negative luminal MBC and facilitating clinical decision-making. METHODS: This consensus document was generated using a modification of the RAND/UCLA methodology, which included the definition of the project and identification of issues of interest, a non-exhaustive systematic review of the literature, an analysis and synthesis of the scientific evidence, preparation of recommendations, and external evaluation with a panel of 64 medical oncologists specializing in breast cancer. RESULTS: A Spanish panel of experts reached consensus on 32 of the 32 recommendations/conclusions presented in the first round and were accepted with an approval rate of 100% about definition of metastatic disease not susceptible to local curative treatment, definition of hormone sensitivity and hormone resistance in metastatic luminal disease and therapeutic decision-making. CONCLUSION: We have developed a consensus document with recommendations on the treatment of patients with HER2-negative luminal MBC that will help to improve therapeutic benefits.

SEOM clinical guidelines in advanced and recurrent breast cancer (2018).

Although the metastasic breast cancer is still an incurable disease, recent advances have increased significantly the time to progression and the overall survival. However, too much information has been produced in the last 2 years, so a well-based guideline is a valuable document in treatment decision making. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with advanced and recurrent breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference.

SEOM clinical guidelines in advanced and recurrent breast cancer (2018)

Although the metastasic breast cancer is still an incurable disease, recent advances have increased significantly the time to progression and the overall survival. However, too much information has been produced in the last 2 years, so a well-based guideline is a valuable document in treatment decision making. The SEOM guidelines are intended to make evidence-based recommendations on how to manage patients with advanced and recurrent breast cancer to achieve the best patient outcomes based on a rational use of the currently available therapies. To assign a level of certainty and a grade of recommendation the United States Preventive Services Task Force guidelines methodology was selected as reference

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Preclinical and clinical development of palbociclib and future perspectives

Cyclin-dependent kinases (CDKs) play a key role in cell cycle regulation, which makes them a clear therapeutic target to interfere with cell division and proliferation in cancer patients. Palbociclib, a specific inhibitor of CDK4/6 with outstanding clinical efficacy data and limited toxicity, has been recently approved for the treatment of hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer, either in combination with an aromatase inhibitor or in combination with fulvestrant in women who have received prior endocrine therapy. This review describes the mechanism of action, preclinical experiences and clinical data of palbociclib, with a special focus on integrating this data with the positioning of palbociclib in the current clinical guidelines for advanced HR-positive/HER2-negative breast cancer. Aspects of the ongoing major studies are also presented, as well as future prospects in the development of palbociclib

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Safety of everolimus plus exemestane in patients with hormone-receptor-positive, HER2-negative locally advanced or metastatic breast cancer: results of phase IIIb BALLET trial in Spain

Background: Everolimus with exemestane has shown promising activity in patients with hormone-receptor (HR)-positive HER2-negative endocrine-resistant advanced breast cancer. It is necessary, therefore, to characterize the safety profile of this new combination in the real-world clinical setting and in the broadest possible population. Patients and methods: Post-menopausal women with HR-positive HER2-negative advanced breast cancer progressing after prior non-steroidal aromatase inhibitors (NSAIs) were included. The objectives of this analysis were to evaluate the safety profile of this combination in a subset of Spanish patients in the BALLET trial and to characterize grade 3 and 4 adverse events (AEs) in routine clinical practice in Spain. Results: Between September 2012 and July 2013, 429 patients (20% of the overall study population) were included in the BALLET study in 52 hospitals in Spain, of whom 100 (23%) were ≥ 70 years. The median treatment duration was 3.14 and 3.03 months for exemestane and everolimus, respectively. The most common reasons for discontinuation of treatment were local reimbursement of everolimus (43%), followed by disease progression (31%) and the incidence of AEs (15%). The most frequent AEs causing permanent discontinuation were pneumonitis (4%), asthenia (2%) and stomatitis (2%). Overall, 87% of patients experienced at least one AE of any grade, 30% of patients at least one grade 3 AE and 2% of patients a grade 4 AE. Conclusion: The safety profile in Spanish patients of the BALLET trial is consistent with the results obtained in the overall population of the trial, as well as in previous clinical trials

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Preclinical and clinical development of palbociclib and future perspectives.

Cyclin-dependent kinases (CDKs) play a key role in cell cycle regulation, which makes them a clear therapeutic target to interfere with cell division and proliferation in cancer patients. Palbociclib, a specific inhibitor of CDK4/6 with outstanding clinical efficacy data and limited toxicity, has been recently approved for the treatment of hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer, either in combination with an aromatase inhibitor or in combination with fulvestrant in women who have received prior endocrine therapy. This review describes the mechanism of action, preclinical experiences and clinical data of palbociclib, with a special focus on integrating this data with the positioning of palbociclib in the current clinical guidelines for advanced HR-positive/HER2-negative breast cancer. Aspects of the ongoing major studies are also presented, as well as future prospects in the development of palbociclib.

Safety of everolimus plus exemestane in patients with hormone-receptor-positive, HER2-negative locally advanced or metastatic breast cancer: results of phase IIIb BALLET trial in Spain.

BACKGROUND: Everolimus with exemestane has shown promising activity in patients with hormone-receptor (HR)-positive HER2-negative endocrine-resistant advanced breast cancer. It is necessary, therefore, to characterize the safety profile of this new combination in the real-world clinical setting and in the broadest possible population. PATIENTS AND METHODS: Post-menopausal women with HR-positive HER2-negative advanced breast cancer progressing after prior non-steroidal aromatase inhibitors (NSAIs) were included. The objectives of this analysis were to evaluate the safety profile of this combination in a subset of Spanish patients in the BALLET trial and to characterize grade 3 and 4 adverse events (AEs) in routine clinical practice in Spain. RESULTS: Between September 2012 and July 2013, 429 patients (20% of the overall study population) were included in the BALLET study in 52 hospitals in Spain, of whom 100 (23%) were ≥ 70 years. The median treatment duration was 3.14 and 3.03 months for exemestane and everolimus, respectively. The most common reasons for discontinuation of treatment were local reimbursement of everolimus (43%), followed by disease progression (31%) and the incidence of AEs (15%). The most frequent AEs causing permanent discontinuation were pneumonitis (4%), asthenia (2%) and stomatitis (2%). Overall, 87% of patients experienced at least one AE of any grade, 30% of patients at least one grade 3 AE and 2% of patients a grade 4 AE. CONCLUSION: The safety profile in Spanish patients of the BALLET trial is consistent with the results obtained in the overall population of the trial, as well as in previous clinical trials.

Defining the optimal sequence for the systemic treatment of metastatic breast cancer.

Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.

Evaluación de los indicadores de calidad asistencial de la Asociación Española de Urología en un programa de trasplante renal / Evaluation of the Spanish Urological Association quality care indicators in a kidney transplantation programme

Introducción: Los indicadores muestran la presencia de un fenómeno y su intensidad. Evalúan el nivel de calidad asistencial, identificando situaciones de mejora potencial. Nuestro objetivo es evaluar los indicadores de calidad asistencial de 2013 y 2014 del área de trasplante renal de nuestro servicio. Material y método: Revisamos 88 y 106 trasplantes renales, y 47 y 66 extracciones realizados durante 2013 y 2014. Evaluamos los indicadores de calidad asistencial elaborados por la Asociación Española de Urología, analizando los resultados con el programa SPSS v 21.0. Resultados: Tiempo de isquemia fría (TIF) medio 14,96h en 2013 y 18,07h en 2014; TIF≤18h en 53% y 56% de riñones de donante cadáver. Tasa de fístula urinaria precoz relevante de 1,14% y 2,83% cada año; tasa de trasplantectomía precoz por complicación vascular 3,41% y 2,83%. Supervivencia global del paciente al primer año del 100% para ambos periodos; supervivencia de injerto al primer año del 95% y 94,34%. Porcentaje de trasplante de donante vivo del 14,77% y 17,92%, siendo laparoscópicas el 92,31% de extracciones de vivo en 2013 y 68,42% en 2014. Médicos en formación (MIR) como primer cirujano en el 6,67% y 12,64% de trasplantes, y en el 55,88% y 19,14% de extracciones de cadáver. Conclusiones: Durante el periodo evaluado se cumplieron todos los estándares de calidad asistencial en trasplante renal, salvo el TIF en ambos años y participación de MIR en implante renal únicamente en 2013. Este análisis promociona mejoras en la calidad asistencial, pudiendo trabajar sobre puntos débiles detectados

Introduction: Indicators show the presence of a phenomenon and its intensity. They assess the level of quality care and identify potential situations for improvement. Our objective is to assess the 2013 and 2014 quality care indicators of our department's kidney transplantation area. Material and method: For 2013 and 2014, we reviewed 88 and 106 kidney transplants and 47 and 66 extractions. We evaluated the quality care indicators developed by the Spanish Urological Association, analysing the results with the SPSS v 21.0 programme. Results: The mean cold ischaemia time (CIT) was 14.96hours in 2013 and 18.07hours in 2014. The CIT was ≤18h in 53% and 56% of cadaveric donor kidneys in 2013 and 2014, respectively. The rate of relevant early onset urinary fistulae was 1.14% and 2.83% for each year. The rate of early transplantectomy due to a vascular complication was 3.41% and 2.83% for 2013 and 2014, respectively. Overall patient survival at 1 year was 100% for both periods, and graft survival at 1 year was 95% and 94.34% for 2013 and 2014, respectively. The rate of living-donor transplantation was 14.77% and 17.92%, and 92.31% and 68.42% of the living-donor extractions were laparoscopic for 2013 and 2014, respectively. Resident medical interns were the first surgeon in 6.67% and 12.64% of the transplantations and in 55.88% and 19.14% of the cadaveric extractions during 2013 and 2014, respectively. Conclusions: During the evaluated period, all quality care standards in kidney transplantation were met, except for CIT in both years and resident medical intern participation in kidney implantation in 2013. This analysis promotes improvements in quality care, highlighting weak spots that need work

Evaluation of the Spanish Urological Association quality care indicators in a kidney transplantation programme. / Evaluación de los indicadores de calidad asistencial de la Asociación Española de Urología en un programa de trasplante renal.

INTRODUCTION: Indicators show the presence of a phenomenon and its intensity. They assess the level of quality care and identify potential situations for improvement. Our objective is to assess the 2013 and 2014 quality care indicators of our department's kidney transplantation area. MATERIAL AND METHOD: For 2013 and 2014, we reviewed 88 and 106 kidney transplants and 47 and 66 extractions. We evaluated the quality care indicators developed by the Spanish Urological Association, analysing the results with the SPSS v 21.0 programme. RESULTS: The mean cold ischaemia time (CIT) was 14.96hours in 2013 and 18.07hours in 2014. The CIT was ≤18h in 53% and 56% of cadaveric donor kidneys in 2013 and 2014, respectively. The rate of relevant early onset urinary fistulae was 1.14% and 2.83% for each year. The rate of early transplantectomy due to a vascular complication was 3.41% and 2.83% for 2013 and 2014, respectively. Overall patient survival at 1 year was 100% for both periods, and graft survival at 1 year was 95% and 94.34% for 2013 and 2014, respectively. The rate of living-donor transplantation was 14.77% and 17.92%, and 92.31% and 68.42% of the living-donor extractions were laparoscopic for 2013 and 2014, respectively. Resident medical interns were the first surgeon in 6.67% and 12.64% of the transplantations and in 55.88% and 19.14% of the cadaveric extractions during 2013 and 2014, respectively. CONCLUSIONS: During the evaluated period, all quality care standards in kidney transplantation were met, except for CIT in both years and resident medical intern participation in kidney implantation in 2013. This analysis promotes improvements in quality care, highlighting weak spots that need work.

Tratamiento conservador del carcinoma renal de novo sobre injerto renal / Conservative treatment of de novo renal carcinoma on kidney graft

Introducción: El carcinoma renal de novo en el trasplante renal es una situación poco frecuente pero no excepcional, de mucha trascendencia por la potencial mortalidad del receptor o pérdida del injerto. El objetivo de nuestro trabajo es conocer el manejo y evolución de estos tumores en nuestra unidad de trasplante renal. Material y métodos: Analizamos los casos de tumor renal de novo entre los trasplantados de los últimos 17 años en nuestra unidad de trasplante renal, detectando 3 casos de carcinoma de células claras y uno de carcinoma papilar sobre el injerto. Se realizó seguimiento desde el punto de vista oncológico y de función renal, y se analizó la respuesta a cambios en la inmunosupresión. Resultados: En todos los casos se practicó tumorectomía, precisándose en el paciente con carcinoma papilar trasplantectomía posteriormente. En ningún caso hubo complicaciones quirúrgicas relevantes. Además, se realizó conversión a un inhibidor de señales de proliferación o inhibidor de la mTOR y retirada completa de anticalcineurínicos. Con un seguimiento medio de 43,5 meses (15-61) los 3 pacientes con carcinoma de células claras sobreviven con buena función del injerto y sin datos de recidiva tumoral. El paciente con carcinoma papilar realiza seguimiento en otro centro hospitalario. Conclusiones: La cirugía conservadora, junto con la conversión a un inhibidor de señales de proliferación, parecen ser una opción segura para el tratamiento de tumores primarios en injerto renal, ofreciendo buenos resultados oncológicos y en cuanto a función renal a corto y medio plazo

Background: De novo renal carcinoma in kidney transplants is an uncommon but not exceptional condition and is of significant importance due to the potential for recipient mortality and graft loss. The aim of our study was to determine the management and outcome of these tumors in our Kidney Transplantation Unit. Material and methods: We analyzed cases of de novo kidney tumors among patients who underwent transplantation in the last 17 years in our Kidney Transplantation Unit. We detected 3 cases of clear cell carcinoma and 1 case of papillary carcinoma on the graft. We conducted follow-up on the tumor and renal function and analyzed patient responses to changes in immunosuppression. Results: Tumorectomy was performed in all cases, and subsequent transplantectomy was required for patients with papillary carcinoma. None of the patients had relevant surgical complications. We also changed the patients’ regimen to a proliferation signal inhibitor or mTOR inhibitor and completely withdrew all anticalcineurin agents. With a mean follow-up of 43.5 months (15-61), the 3 patients with clear cell carcinoma survived with good graft function and with no evidence of tumor recurrence. The patient with papillary carcinoma underwent follow-up at another hospital center. Conclusions: Conservative surgery along with conversion to a proliferation signal inhibitor appears to be a safe option for treating primary tumors in kidney grafts and offers good oncological and renal function results in the short and medium term

Conservative treatment of de novo renal carcinoma on kidney graft.

BACKGROUND: De novo renal carcinoma in kidney transplants is an uncommon but not exceptional condition and is of significant importance due to the potential for recipient mortality and graft loss. The aim of our study was to determine the management and outcome of these tumors in our Kidney Transplantation Unit. MATERIAL AND METHODS: We analyzed cases of de novo kidney tumors among patients who underwent transplantation in the last 17 years in our Kidney Transplantation Unit. We detected 3 cases of clear cell carcinoma and 1 case of papillary carcinoma on the graft. We conducted follow-up on the tumor and renal function and analyzed patient responses to changes in immunosuppression. RESULTS: Tumorectomy was performed in all cases, and subsequent transplantectomy was required for patients with papillary carcinoma. None of the patients had relevant surgical complications. We also changed the patients' regimen to a proliferation signal inhibitor or mTOR inhibitor and completely withdrew all anticalcineurin agents. With a mean follow-up of 43.5 months (15-61), the 3 patients with clear cell carcinoma survived with good graft function and with no evidence of tumor recurrence. The patient with papillary carcinoma underwent follow-up at another hospital center. CONCLUSIONS: Conservative surgery along with conversion to a proliferation signal inhibitor appears to be a safe option for treating primary tumors in kidney grafts and offers good oncological and renal function results in the short and medium term.

Pairs of kidneys transplanted from the same donor: is there any difference?

OBJECTIVES: The aim of this study was to compare the evolution of the first kidney in relation to the second kidney transplanted from the same donor, focusing on the impact that a longer cold ischemia time may have as an independent variable. MATERIAL AND METHODS: The study included 44 pairs of kidneys transplanted from the same donor between February 2008 and October 2010, divided into Groups 1 and 2 according to the graft placement order. The variables analyzed were age, sex, comorbidities, number of transfusions, length of hospital stay, maximum peak PRA, immunologic incompatibility, ischemia time, delayed graft function (DGF), presence of rejection, creatinine clearance at first week, at 3 months and at 1 year, and vascular and tract complications in each group. RESULTS: The mean cold ischemia time was 15.6 hours in Group 1 and 20.1 hours in Group 2 (P < .001). The average recipient age was 52.79 years in Group 1 and 54.52 years in Group 2, with an equal sex ratio in the two groups; an average of 2.06 PRC were transfused prior to transplantation in Group 1 and 0.93 PRC in Group 2; the average length of stay was similar in the two groups. Major DR incompatibility was only found in Group 2 (P < .03). Creatinine clearance at first week, DGF and acute rejection showed worse results in Group 2, but these differences were not significant. Vascular complications were present in 4.5% and 2.3% of Groups 1 and 2, respectively, and tract complications were 6.8% and 11.4%. CONCLUSIONS: A greater tendency to DGF, early rejection and tract complications were found in the group with longer ischemia time, although the difference was not statistically significant. Larger series will be necessary to confirm our results.

In vitro activity of ceftobiprole and seven other antimicrobial agents against invasive Streptococcus pneumoniae isolates in Spain.

The in vitro activity of ceftobiprole was compared with that of seven antimicrobial agents against invasive Streptococcus pneumoniae isolated from adult patients (>15 years old). Characterization of erythromycin-resistant strains and serotype distribution of all pneumococci were also evaluated. Seventy invasive S. pneumoniae strains were isolated from December 2007 to January 2009. Serotyping was carried out by Quellung reaction. Antibiotic susceptibility was tested by broth microdilution (CLSI guidelines). The comparator agents were penicillin, cefotaxime, erythromycin, clindamycin, telithromycin, tetracycline and moxifloxacin. Phenotypic characterization of macrolide resistance was performed by the double disk method. Macrolide resistance genes [erm(B) and mef(A/E)] and the promoter of erm(B) were detected by PCR. Twenty-five different serotypes were detected of which 87% were non-PCV7 types. The percentages of resistance to erythromycin, clindamycin and tetracycline were 20%, 8.6% and 16%, respectively. A penicillin MIC ≥0.12 mg/L was observed in 14 of the 70 invasive pneumococci strains. The cefotaxime and ceftobiprole MIC(50)/MIC(90) of these 14 strains were 1/4 and 0.03/1 mg/L, respectively. Ceftobiprole showed higher in vitro activity than penicillin and cefotaxime with all isolates being inhibited by ≤1 mg/L. Its high in vitro activity should make ceftobiprole a very promising drug for the treatment of pneumococcal infections.

Congreso ASCO 2006. Aportaciones sobre el cáncer de mama / ASCO Conference 2006. Contributions about breast cancer

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Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms.

OBJECTIVES: To assess the efficacy of posterior tibial nerve stimulation for treatment of lower urinary tract irritative symptoms (urgency, frequency, urge incontinence and pelvic pain). PATIENTS AND METHODS: 51 female patients with a mean age of 55 years were enrolled in the study. The patients presented with the following symptoms: Frequency/urgency 26 patients (50.98%), urge incontinence 22 (43.13%) and interstitial cystitis 3 patients (5.88%). The technique consists in administering low voltage electric stimulation via a 3-5cm needle placed above the tibial malleolus. Patients received weekly stimulations of 30 minutes for a 10-week period. Quality of life questionnaires and voiding diaries before and after treatment were completed. Moreover, the results were evaluated by patients. The variables analysed include: daytime and nighttime voiding frequency, daytime and nighttime voiding volume, daytime and nighttime leakage episodes and hypogastric pain. RESULTS: A statistically significant improvement was seen in all variables, especially remarkable in relation to frequency/urgency, impact on women quality of life and hypogastric pain, being less marked in relation to leakage episodes and voiding volume. CONCLUSIONS: Afferent nerve stimulation offers an alternative treatment for managing lower urinary tract irritative symptoms. However, it would be advisable to confirm the results obtained by means of long-term randomized, follow-up studies.

La petición de pruebas complementarias en somatizadores en Atención Primaria: un estudio cualitativo

Objetivo. Determinar la razón para la petición de pruebas complementarias en pacientes somatizadores de atención primaria. Métodología. Estudio cualitativo basado en entrevistas en profundidad individuales y en grupos focales. Se estudió a treinta y siete somatizadores pertenecientes a diez consultas de atención primaria de Zaragoza, España. Resultados. Fueron identificados cuatro subgrupos de pacientes en dependencia de sus características personales, experiencias previas negativas con médicos, confianza en la tecnología o papel activo en las cuestiones sobre la salud. Estos grupos eran: 1. Pacientes que tienden a confiar en la explicación somática de los síntomas, 2. Pacientes marcados por experiencias médicas negativas, 3. Buscadores de seguridad y 4. Buscadores de tecnología. Además existe un pequeño grupo de pacientes que no encajan con ninguno de estos modelos. Conclusiones. Hay varios modelos que explican el comportamiento de un alto porcentaje de pacientes. En un individuo en particular, este modelo parece estable en el tiempo y predecible, por lo que se podría diseñar un tratamiento específico. Sin embargo, un cierto porcentaje de somatizadores no se ajusta a ningún modelo, su comportamiento parece cambiar a lo largo del tiempo y no es fácil desarrollar un tipo de tratamiento específico (AU)