Public Perceptions of the Role of Lifestyle Factors in Cancer Development: Results from the Spanish Onco-Barometer 2020.

The European Code against Cancer recommends not to smoke, to avoid alcohol consumption, to eat a healthy diet, and maintain a healthy weight to prevent cancer. To what extent is the public aware of the influence of these lifestyle factors on cancer development? The goal of the current study was to describe the perceived influence of four lifestyle factors (tobacco, alcohol, diet, and weight) on cancer development in the general population and identify factors related to low perceptions of influence. We analyzed data from the 2020 Onco-barometer (n = 4769), a representative population-based survey conducted in Spain. With the exception of smoking, lifestyle factors were among those with the least perceived influence, more so among the demographic groups at higher risk from cancer including men and older individuals (65+ years). Individuals from lower socio-economic groups were more likely to report not knowing what influence lifestyle factors have on cancer. Lower perceived influence was also consistently related to perceiving very low risk from cancer. Overall, although there is variation in perceptions regarding the different lifestyle factors, low perceived influence clusters among those at higher risk for cancer. These results signal the need for public health campaigns and messages informing the public about the preventive potential of lifestyle factors beyond avoiding tobacco consumption.

Physical Comorbidities and Depression in Recent and Long-Term Adult Cancer Survivors: NHANES 2007-2018.

Many adult cancer patients present one or more physical comorbidities. Besides interfering with treatment and prognosis, physical comorbidities could also increase the already heightened psychological risk of cancer patients. To test this possibility, we investigated the relationship between physical comorbidities with depression symptoms in a sample of 2073 adult cancer survivors drawn from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2007-2018) in the U.S. Based on information regarding 16 chronic conditions, the number of comorbidities diagnosed before and after the cancer diagnosis was calculated. The number of comorbidities present at the moment of cancer diagnosis was significantly related to depression risk in recent but not in long-term survivors. Recent survivors who suffered multimorbidity had 3.48 (95% CI 1.26-9.55) times the odds of reporting significant depressive symptoms up to 5 years after the cancer diagnosis. The effect of comorbidities was strongest among survivors of breast cancer. The comorbidities with strongest influence on depression risk were stroke, kidney disease, hypertension, obesity, asthma, and arthritis. Information about comorbidities is usually readily available and could be useful in streamlining depression screening or targeting prevention efforts in cancer patients and survivors. A multidimensional model of the interaction between cancer and other physical comorbidities on mental health is proposed.

Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain.

Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28-0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46-0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16-0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55-72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival.

[Physicians' awareness and assessment of shared decision making in oncology practice.] / onocimiento y evaluación de la toma de decisiones compartidas en la práctica oncológica desde el punto de vista médico.

OBJECTIVE: Implementation of Shared Decision Making (SDM) in oncology is limited. The objective of the study was to determine the extent of physicians' awareness of Shared Decision Making (SDM) in their treatment of cancer patients, the usefulness that they assign to SDM, the role they play, their assessment of SDM, and perceptions of the main barriers and facilitators to its use. METHODS: A questionnaire was completed by medical oncologists, radiation oncologists and general surgeons working in Andalusia (Spain). Sociodemographic, clinical-care and aspects of SDM variables were collected. SDM was evaluated using the SDM-Q-Doc questionnaire. Non-parametric contrasts were used to determine the possible differences between medical specialties. RESULTS: The questionnaire was sent to 351 physicians. The response rate was 37.04%, 63 women and 67 men, with an average age of 45.6 years and 18.04 years' experience. Of these, 33.08% were medical oncologists, 34.61% radiation oncologists and 29.23% general surgeons. A total of 82.3% stated they had received no training in SDM, whereas 33.8% said they knew a lot about SDM and applied it in practice; 80% considered it to be very useful. In addition, 60% of respondents said they were mainly the ones who made the decisions on treatment. An evaluation of SDM on the SDM-Q-Doc scale showed that all the specialities scored more than 80/100. The main barriers to applying SDM were the difficulty patients experienced in understanding what they needed to know, the lack of decision aids and time. CONCLUSIONS: Some 82% of physicians have no training in SDM and 66% don´t use it in practice, with decisions on treatment taken mainly by the physicians themselves. Strategies to increase training in SDM and to implement it into clinical practice are important.

OBJETIVO: La implementación de la Toma de Decisiones Compartidas (TDC) en oncología es escasa. El objetivo del estudio fue determinar el conocimiento de la TDC que tienen los médicos que tratan a pacientes con cáncer, la utilidad que le conceden, el rol que desempeñan, la evaluación que hacen, y las barreras y facilitadores que encuentran para su uso. METODOS: Se realizó una encuesta a oncólogos médicos, oncólogos radioterápicos y cirujanos generales que ejercían en Andalucía (España). Se recogieron variables sociodemográficas, clínico-asistenciales y de aspectos de la TDC. La TDC se evaluó mediante el cuestionario SDM-Q-Doc. Se emplearon contrastes no paramétricos para determinar las posibles diferencias entre especialidades médicas. RESULTADOS: El cuestionario se envió a 351 médicos y la tasa de respuesta fue del 37,04%. Respondieron 63 mujeres y 67 hombres, con un promedio de 45,6 años de edad y 18,04 años de experiencia. El 33,08% eran oncólogos médicos, el 34,61% oncólogos radioterápicos y el 29,23% cirujanos generales. El 82,3% no tenía formación en TDC y el 33,8% reconocía saber bastante y utilizarla en su práctica habitual. El 80% consideró que era muy útil. El 60% respondió que la decisión sobre el tratamiento la tomaban mayormente ellos. Al evaluar la TDC con la escala SDM-Q-Doc, todas las especialidades obtuvieron más de 80 puntos sobre 100. Las principales barreras para aplicar la TDC fueron la dificultad del paciente para entender lo que necesitaba saber, la falta de instrumentos de apoyo, así como la falta de tiempo. CONCLUSIONES: Un 82% de los médicos no tiene formación en TDC y un 66% no la utiliza en su práctica habitual, tomando la decisión sobre el tratamiento mayoritariamente ellos. Es importante adoptar estrategias para aumentar la formación en TDC e implementarla en la práctica clínica diaria.

Cost-utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain.

PURPOSE: Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain. METHODS/PATIENTS: Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value. RESULTS: The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold. CONCLUSION: Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies.

Conocimiento y evaluación de la toma de decisiones compartidas en la práctica oncológica desde el punto de vista médico / Physicians' awareness and assessment of shared decision making in oncology practice

OBJETIVO: La implementación de la Toma de Decisiones Compartidas (TDC) en oncología es escasa. El objetivo del estudio fue determinar el conocimiento de la TDC que tienen los médicos que tratan a pacientes con cáncer, la utilidad que le conceden, el rol que desempeñan, la evaluación que hacen, y las barreras y facilitadores que encuentran para su uso. MÉTODOS: Se realizó una encuesta a oncólogos médicos, oncólogos radioterápicos y cirujanos generales que ejercían en Andalucía (España). Se recogieron variables sociodemográficas, clínico-asistenciales y de aspectos de la TDC. La TDC se evaluó mediante el cuestionario SDM-Q-Doc. Se emplearon contrastes no paramétricos para determinar las posibles diferencias entre especialidades médicas. RESULTADOS: El cuestionario se envió a 351 médicos y la tasa de respuesta fue del 37,04%. Respondieron 63 mujeres y 67 hombres, con un promedio de 45,6 años de edad y 18,04 años de experiencia. El 33,08% eran oncólogos médicos, el 34,61% oncólogos radioterápicos y el 29,23% cirujanos generales. El 82,3% no tenía formación en TDC y el 33,8% reconocía saber bastante y utilizarla en su práctica habitual. El 80% consideró que era muy útil. El 60% respondió que la decisión sobre el tratamiento la tomaban mayormente ellos. Al evaluar la TDC con la escala SDM-Q-Doc, todas las especialidades obtuvieron más de 80 puntos sobre 100. Las principales barreras para aplicar la TDC fueron la dificultad del paciente para entender lo que necesitaba saber, la falta de instrumentos de apoyo, así como la falta de tiempo. CONCLUSIONES: Un 82% de los médicos no tiene formación en TDC y un 66% no la utiliza en su práctica habitual, tomando la decisión sobre el tratamiento mayoritariamente ellos. Es importante adoptar estrategias para aumentar la formación en TDC e implementarla en la práctica clínica diaria

OBJECTIVE: Implementation of Shared Decision Making (SDM) in oncology is limited. The objective of the study was to determine the extent of physicians' awareness of Shared Decision Making (SDM) in their treatment of cancer patients, the usefulness that they assign to SDM, the role they play, their assessment of SDM, and perceptions of the main barriers and facilitators to its use. METHODS: A questionnaire was completed by medical oncologists, radiation oncologists and general surgeons working in Andalusia (Spain). Sociodemographic, clinical-care and aspects of SDM variables were collected. SDM was evaluated using the SDM-Q-Doc questionnaire. Non-parametric contrasts were used to determine the possible differences between medical specialties. RESULTS: The questionnaire was sent to 351 physicians. The response rate was 37.04%, 63 women and 67 men, with an average age of 45.6 years and 18.04 years' experience. Of these, 33.08% were medical oncologists, 34.61% radiation oncologists and 29.23% general surgeons. A total of 82.3% stated they had received no training in SDM, whereas 33.8% said they knew a lot about SDM and applied it in practice; 80% considered it to be very useful. In addition, 60% of respondents said they were mainly the ones who made the decisions on treatment. An evaluation of SDM on the SDM-Q-Doc scale showed that all the specialities scored more than 80/100. The main barriers to applying SDM were the difficulty patients experienced in understanding what they needed to know, the lack of decision aids and time. CONCLUSIONS: Some 82% of physicians have no training in SDM and 66% don't use it in practice, with decisions on treatment taken mainly by the physicians themselves. Strategies to increase training in SDM and to implement it into clinical practice are important

Irradiación de áreas ganglionares en pacientes sin linfadenectomía axilar / Axillary radiation in patients without axillary lymphadenectomy

La biopsia selectiva del ganglio centinela (BSGC) es actualmente una propuesta estándar para la estadificación de la axila en pacientes con cáncer de mama con una clara tendencia a minimizar la cirugía axilar incluso en presencia de ganglio centinela (GC) positivo. En caso de GC negativo la BSGC ha reemplazado a la linfadenectomía axilar (LA) demostrando equivalente supervivencia, mientras que los más sólidos consensos (American Society of Clinical Oncology) y, hasta fechas recientes, las guías de la National Comprehensive Cancer Network recomendaban completar la LA cuando se identifican metástasis en el GC. Esto da como resultado un excelente control locorregional y proporciona información que permite tomar decisiones sobre tratamientos adyuvantes tanto al oncólogo médico como al oncólogo radioterápico. No obstante, en los últimos tiempos múltiples estudios han debatido el valor terapéutico de la linfadenectomía quirúrgica, cobrando especial relevancia a raíz de la publicación del ensayo del American College of Surgeons Oncology Group (ACOSOG) Z0011, en el que se cuestiona el valor de esta actitud terapéutica y se propone únicamente una BSGC, omitiéndose la LA, en pacientes seleccionadas con uno o 2 GC positivos. La evidencia científica nos dice que la radioterapia puede jugar un papel fundamental en el control de la enfermedad axilar y, a fecha de hoy, no sabemos si la baja tasa de recidiva a este nivel, en los estudios mencionados, puede estar influida por la irradiación de la mama y axila inferior. Serían necesarios estudios con un diseño apropiado para contestar esta pregunta. En ausencia de más datos, nuestra propuesta es la irradiación axilar valorando individualmente los factores de riesgo de recidiva locorregional(AU)

Sentinel lymph node biopsy (SLNB) is currently a standard approach for staging of the axilla in patients with breast cancer, with a clear tendency to minimize surgery even in the presence of a positive axillary sentinel lymph node (SLN). The strongest consensus (American Society of Clinical Oncology) and, until recently, the National Comprehensive Cancer Network guidelines used to recommend complete axillary lymphadenectomy when metastases were identified in the SLN. However, SLNB has replaced axillary lymphadenectomy in SLN-negative patients and has demonstrated equivalent survival. This approach results in excellent locoregional control and provides information that allows both the medical oncologist and the radiation oncologist to take decisions about adjuvant treatments. Many recent studies, however, have debated the therapeutic value of surgical lymphadenectomy. This debate has become particularly important after the publication of the trial of the American College of Surgeons Oncology Group (ACOSOG) Z0011, which questions the value of this therapeutic approach and proposes SLNB alone, without lymphadenectomy, in selected patients with one or 2 positive SLN. The scientific evidence indicates that radiotherapy may play a major role in the control of axillary disease and, to date, it is not known whether the low recurrence rate in the axilla reported in the above-mentioned studies may have been influenced by radiation of the breast and lower axilla. To answer this question, new and appropriately designed trials are needed. In the absence of more data, we propose the use of axillary radiation, but with assessment of the risk factors for locoregional recurrence in each patient(AU)

Results of consevative treatment of breast cancer in low risk women with hypofractionated radiotherapy

Objetivos: Actualmente la irradiación de toda la mama después de una intervención quirúrgica conservadora sigue siendo un procedimiento estándar en el cáncer de mama, en la que clásicamente se administra una dosis de 50 Gy con fraccionamiento de 2 Gy. Sin embargo, diferentes dosis y fraccionamiento han demostrado al menos la misma eficacia. El objetivo principal del estudio fue determinar la tasa de recidiva local en pacientes sometidas a cirugía conservadora y radioterapia postoperatoria hipofraccionada. Los objetivos secundarios fueron la incidencia y el grado de toxicidad aguda y tardía. Pacientes y métodos: Desde enero de 2004 a diciembre de 2006, se seleccionó a 122 pacientes para radioterapia hipofraccionada con las características siguientes: edad ≥ 50 años, estadio temprano, margen de resección libre de tumor y espesor de la mama < 23 cm. La dosis administrada fue 42,5 Gy con fraccionamiento de 2,66 Gy por sesión. Resultados: Con una mediana de seguimiento de 58,29 meses, 116 (95,08%) pacientes están vivas: 114 libres de enfermedad y 2 con metástasis óseas. La recidiva local a 5 años fue 1,64% y sólo un caso (0,81%) presentó recidiva regional. Hubo un 2,46% de pacientes con segundo tumor primario y un 4,91% con metástasis. La toxicidad, tanto aguda como tardía, ha sido leve. Conclusiones: La radioterapia hipofraccionada en pacientes de riesgo bajo proporciona los mismos beneficios que el tratamiento clásico con una baja toxicidad aguda y tardía (AU)

Aims: Whole breast irradiation, typically administered at a dose of 50 Gy in 2 Gy fractions after conservative surgery, continues to be a standard procedure in breast cancer. However, different doses and fractionation have shown to be at least as effective. The main objective of this study was to determine the rate of local recurrence in patients undergoing conservative surgery and hypofractionated postoperative radiotherapy. The secondary objectives were to determine the incidence and grade of both acute and delayed toxicity. Patients and methods: From January 2004 to December 2006, 122 patients who had the following characteristics were selected to receive hypofractionated radiotherapy to the whole breast: age ≥ 50 years, early stage, tumour free resection margins ≥ 10 mm, thickness of the breast ≤ than 23 cm. The total dose was 42.5 Gy with fractionation of 2.66. Results: With a median follow up of 58.29 months, 116 (95.08%) patients were alive: 114 were free of disease and 2 had metastases. The 5 year local recurrence rate was 1.64%, and only in one case (0.81%) there was a regional recurrence. Only 2.46% of the patients developed a second primary tumour. Distant metastases were present in 4.91%. Toxicity, both acute and late, was mild (grade 1-2). Conclusions: Hypofractionated radiotherapy, in patients with low risk breast cancer after conservative surgery, provides the same benefits as the classical treatment with a low acute, as well as and delayed, toxicity (AU)