Current state and future perspectives for palliative care in Latin America with a special focus on Peru.

The evolution of palliative care in Latin America has been slow compared with other parts of the world, especially developed countries. Current data show inequality in the development of palliative care in the region and those differences are also evident within countries between urban and rural populations. Peru is situated in the low-ranking group in terms of palliative care services in Latin America. The main reasons are a lack of education and funding and misconceptions about palliative care. Limited access to the use of opioids and regulatory barriers are also common features. The development of more palliative care units in Peru, as well as in other Latin American countries, is needed to ensure access to adequate and timely treatment for patients receiving palliative care.

Sobrevida de un paciente adulto mayor con cáncer de pulmón, tratado con quimioterapia de primera línea

RESUMEN Introducción: El cáncer de pulmón está afectando cada vez más a la población de adultos mayores, a medida que la expectativa de vida aumenta. Sin embargo, es difícil establecer la eficacia de la quimioterapia y el pronóstico de estos pacientes es grave. Objetivo: Presentar un caso de paciente adulto mayor con cáncer de pulmón avanzado de células no pequeñas, con una prolongada sobrevida que recibió solamente quimioterapia de primera línea. Caso clínico: Paciente no fumador, de 71 años, diagnosticado con cáncer de pulmón de células no pequeñas avanzado, del subtipo adenocarcinoma, con compromiso pleural. Inició tratamiento con carboplatino 5 AUC y gemcitabina 1,1 g. En el noveno ciclo, se encontró reducción de los nódulos pulmonares, pero también metástasis en el nivel D6-D7. Inició la segunda línea de tratamiento con carboplatino 5,4 AUC, paclitaxel 200 mg y ácido zolendrónico en dosis de 4,0 mg. Debido a eventos adversos, el tratamiento fue cambiado a vinorelbina 2,5 g y ácido zolendrónico 4,0 mg. Tras dos ciclos, el paciente fallece, alcanzando 21 meses de sobrevida global, solo con quimioterapia. Conclusión: El tratamiento del paciente adulto mayor con cáncer de pulmón es complejo. En el presente esquema de quimioterapia, el paciente pudo alcanzar 21 meses de sobrevida global, a pesar de que no fue caracterizado molecularmente.

ABSTRACT Introduction: Lung cancer is taking an increasing toll on the older population as life expectancy increases. However, the efficacy of chemotherapy is difficult to establish and the prognosis of these patients is severe. Objective: Report a case of an older adult patient with advanced non-small cell lung cancer with prolonged survival who received only first-line chemotherapy. Case report: A 71-year-old non-smoker patient diagnosed with advanced non-small cell lung cancer, adenocarcinoma subtype, with pleural involvement. He started treatment with carboplatin 5 AUC and gemcitabine 1,1 g. In the ninth cycle, reduction of pulmonary nodules was found, but he also had metastases at the D6-D7 level. He started the second line of treatment with carboplatin 5,4 AUC, paclitaxel 200 mg and zolendronic acid at a dose of 4,0 mg. Due to adverse events, the treatment was changed to vinorelbine 2,5 g and zolendronic acid 4.0 mg. After two cycles, the patient died, reaching 21 months of overall survival, only with chemotherapy. Conclusion: The treatment of the older adult patient with lung cancer is challenging. In the present chemotherapy treatment, the patient was able to achieve 21 months of overall survival, despite the fact that he was not molecularly characterized.