Lung Cancer Screening in Brazil Comparing the 2013 and 2021 USPSTF Guidelines.

Importance: It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. Objective: To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. Design, Setting, and Participants: This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. Exposures: Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with ≥30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 pack-years and <15 years since cessation). Main Outcomes and Measures: The primary outcomes were the numbers of individuals eligible for LCS, the 5-year preventable deaths attributable to LC, and the number of YLGs if death due to LC was averted by LCS. Results: In Brazil, the eligible population for LCS was 27 280 920 ever-smokers aged 50 to 80 years (13 387 552 female [49.1%]; 13 249 531 [48.6%] aged 50-60 years; 394 994 Asian or Indigenous [1.4%]; 3 111 676 Black [11.4%]; 10 942 640 Pardo [40.1%]; 12 830 904 White [47.0%]; 12 428 536 [45.6%] with an incomplete middle school education; and 12 860 132 [47.1%] living in the Southeast region); 5 144 322 individuals met the USPSTF 2013 criteria for LCS (2 090 636 female [40.6%]; 2 290 219 [44.5%] aged 61-70 years; 66 430 Asian or Indigenous [1.3%]; 491 527 Black [9.6%]; 2 073 836 Pardo [40.3%]; 2 512 529 [48.8%] White; 2 436 221 [47.4%] with an incomplete middle school education; and 2 577 300 [50.1%] living in the Southeast region), and 8 380 279 individuals met the USPSTF 2021 LCS criteria (3 507 760 female [41.9%]; 4 352 740 [51.9%] aged 50-60 years; 119 925 Asian or Indigenous [1.4%]; 839 171 Black [10.0%]; 3 330 497 Pardo [39.7%]; 4 090 687 [48.8%] White; 4 022 784 [48.0%] with an incomplete middle school education; and 4 162 070 [49.7%] living in the Southeast region). The number needed to screen to prevent 1 death was 177 individuals according to the USPSTF 2013 criteria and 242 individuals according to the USPSTF 2021 criteria. The YLG was 23 for all ever-smokers, 19 for the USPSTF 2013 criteria, and 21 for the USPSTF 2021 criteria. Being Black, having less than a high school education, and living in the North and Northeast regions were associated with increased 5-year risk of LC death. Conclusions and Relevance: In this comparative effectiveness study, USPSTF 2021 criteria were better than USPSTF 2013 in reducing disparities in LC death rates. Nonetheless, the risk of LC death remained unequal, and these results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.

Factors associated with late-stage diagnosis and overall survival for lung cancer: An analysis of patients treated in a Brazilian hospital and a US-hospital from 2009 to 2019.

BACKGROUND: Lung cancer is a major public health problem due to its high incidence and mortality rates worldwide. Histology, socioeconomic conditions, access, quality of healthcare, and regional aspects are associated with lung cancer stages at diagnosis and survival outcomes. This paper aims to examine and contrast the factors associated with late-stage diagnosis of lung cancer and overall survival rates in two different settings: a Brazilian hospital and a US hospital, spanning from 2009 to 2019. METHODS: This is a retrospective cohort study of the incidence of lung cancer cases at the institution's cancer registry from a Brazilian and a US-based cohort. Descriptive analyses are presented using either the mean and standard deviation or the median and interquartile interval. Frequency is used to present categorical variables. Factors associated with late-stage lung cancer diagnosis were identified through bivariate and multivariable forward stepwise logistic regression. One-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. RESULTS: Between January 2009 and December 2019, a total of 5286 individuals were diagnosed with LC in the Brazilian cohort, and out of these cases, 85.6% were diagnosed with late-stage disease. The US-cohort consisted of 3594 individuals, of whom 60.3% were diagnosed with late-stage disease in lung cancer. The one-year overall survival was 8.6 months for the US cohort and 6.4 months for the Brazilian cohort. In both cohorts, late-stage diagnosis emerged as the most significant factor influencing overall survival. However, the factors associated with late-stage diagnosis differed between the US and Brazilian cohorts. In the Brazilian cohort, being male and belonging to black or brown ethnic groups, along with having a lower education level, were linked to late-stage diagnosis. On the other hand, in the US-based cohort, the factors related to late-stage diagnosis were being male, having been diagnosed before 2015, and possessing private insurance coverage. CONCLUSION: Late-stage diagnosis was associated with the worst survival in both the US and Brazilian cohorts. This study provides valuable information on inequities and barriers to access for lung patients with cancer from upper-middle-income and high-income countries.

First use of antineoplastic agents in women with breast cancer in the state of Rio de Janeiro, Brazil.

Context: Breast cancer is the most common cancer, except for non-melanoma skin cancer, among women in Brazil and worldwide. Breast cancer treatment involves surgery, radiotherapy and chemotherapy, which is used in 70% of patients. This study analyzes the utilization of antineoplastic agents among women undergoing their first round of chemotherapy in Brazil's public health system (SUS) in the state of Rio de Janeiro. Methods: Data from the SUS Outpatient Information System's authorizations for high-complexity outpatient procedures (APACs) billed between January 2013 and December 2019 were extracted, and three datasets were created: all type 1 and type 2 APACs (including all chemotherapy procedures performed); all type 1 APACs; and first type 1 APACs (containing data only for the first round of breast cancer chemotherapy). Names of antineoplastic agents were standardized to enable the subsequent classification of therapy regimens, mitigating limitations related to data quality. Absolute and relative frequencies were used to describe sociodemographic, clinical and treatment characteristics, therapy regimen and supportive drugs. Results: We analyzed 23,232 records of women undergoing their first round of chemotherapy. There was a progressive increase in the number of procedures over time. Women were predominantly white, lived in the capital and close to the treatment center. Most had stage 3 cancer at diagnosis (50.51%) and a significant proportion had regional lymph node invasion (37.9%). The most commonly used chemotherapy regimens were TAC (docetaxel, doxorubicine, cyclophosphamide) (21.05%) and and cyclophosphamide (17.71%), followed by tamoxifen (15.65%) and anastrozole (12.94%). Supportive drugs were prescribed to 386 women and zoledronic acid was predominant (59.58%). Conclusion: The findings point to important bottlenecks and possible inequities in access to treatment and medicine utilization for breast cancer patients in Brazil. Efforts to improve breast cancer treatment and prevention should not only focus on interventions at the individual level but address the disease as a public health problem. The study focused on women undergoing their first round of treatment, providing valuable insight into patient and treatment characteristics to inform policy decisions.

Quimioterapia para Câncer de Mama no Estado do Rio de Janeiro durante a Pandemia da Covid-19: Análise de Séries Temporais / Chemotherapy for Breast Cancer in the State of Rio de Janeiro during the COVID-19 Pandemic: Time Series Analysi / Quimioterapia para el Cáncer de Mama en el Estado de Río de Janeiro durante a la Pandemia de Covid-19: Análisis de Series de Tiempo

Introdução: O câncer é uma das principais causas de morte no Brasil e no mundo. Estimam-se 483 mil novos casos no país, para cada ano do triênio 2023-2025, excetuando-se o câncer de pele não melanoma, sendo o câncer de mama o mais incidente em mulheres, com 74 mil novos casos. Após a declaração da pandemia da covid-19 pela Organização Mundial da Saúde, vários Estados brasileiros estabeleceram medidas restritivas, visando à redução da contaminação, e os centros de referência em diagnóstico do câncer foram impactados. Objetivo: Analisar séries temporais das quantidades de procedimentos aprovados de quimioterapia para câncer de mama antes e durante a pandemia da covid-19 nos estabelecimentos habilitados para alta complexidade em oncologia no Estado do Rio de Janeiro. Método: Estudo descritivo com análises de séries temporais e ecológica, usando dados públicos de procedimentos de quimioterapia autorizados pelo Sistema Único de Saúde entre março de 2018 e fevereiro de 2021. Resultados: Foram identificados 394.926 procedimentos, representando um aumento de 47% com tendência linear crescente (R2 =0,5203) no período. Verificou-se um aumento de procedimentos para câncer de mama receptor hormonal positivo (46%) e carcinoma de mama HER-2 positivo (900%). Conclusão: Observou-se um aumento nos procedimentos de quimioterapia, assim como uma diminuição do deslocamento de tratamento dos grandes centros. Os resultados apontam para uma possível resposta efetiva da rede de atendimento e fortalecimento da regionalização durante o primeiro ano da pandemia.

Introduction: Cancer is one of the main causes of death in Brazil and worldwide. For each year of the triennium 2023-2025, 483,000 new cases are estimated for the country, except non-melanoma skin cancer, breast cancer being the most incident in women with 74,000 new cases. After the declaration of the COVID-19 pandemic by the World Health Organization, several Brazilian states determined restrictive measures to reduce the contamination and cancer diagnosis reference centers were impacted. Objective: To analyze the number of approved breast cancer chemotherapy procedures before and during the COVID-19 pandemic in SUS-affiliated cancer-care facilities in the State of Rio de Janeiro, Brazil. Method: Descriptive design, with time series and ecological analyses using publicly available data of chemotherapy procedures authorized by SUS between March 2018 and February 2021. Results: A total of 394,926 procedures were identified, an increase of 47% with a rising linear trend (R2 =0,5203) during the period. Increases in hormonal receptor-positive cancer (46%) and in HER-2 positive carcinoma (900%) were observed. The patients travelled smaller distances for chemotherapy procedures. Conclusion: Results point out a possible effective response by the cancer care network and strengthening of the regionalization during the first pandemic year.

Introducción: El cáncer es una de las principales causas de muerte en el Brasil y en el mundo. Se estiman 483 000 nuevos casos en el país, para cada año del trienio 2023-2025, excluyendo el cáncer de piel no melanoma, siendo el cáncer de mama el más incidente en mujeres, con 74 000 nuevos casos. Luego de la declaración de la pandemia de covid-19 por la Organización Mundial de la Salud, varios Estados del Brasil establecieron medidas restrictivas con el objetivo de reducir la contaminación y los centros de referencia para el diagnóstico del cáncer fueron impactados. Objetivo: Analizar series de tiempo de las cantidades de procedimientos de quimioterapia aprobados para el cáncer de mama, antes y durante la pandemia de covid-19, en los establecimientos calificados para la alta complejidad en oncología en el Estado de Rio de Janeiro, Brasil. Método: Diseño descriptivo con análisis de series de tiempo y ecológico, utilizando datos públicos de procedimientos de quimioterapia aprobados por el Sistema Único de Salud entre marzo de 2018 y febrero de 2021. Resultados: Fueran identificados 394 926 procedimientos, representando un aumento de 47% con una tendencia lineal creciente (R2 =0,5203) en el periodo. Fueron observados aumentos de procedimientos para cáncer de mama receptor hormonal positivo (46%) y carcinoma de mama HER-2 positivo (900%). Conclusión: Los resultados apuntan hacia una posible respuesta efectiva de la red de atención y fortalecimiento de la regionalización durante el primer año pandémico.

Aspectos Éticos Priorizados pela Revista Brasileira de Cancerologia / Ethical Aspects Prioritized by Revista Brasileira de Cancerologia / Aspectos Éticos Priorizados por la Revista Brasileira de Cancerologia

A Revista Brasileira de Cancerologia (RBC) preza pela integridade na pesquisa, estimulando a publicação de artigos desenvolvidos de forma respeitosa, honesta, rigorosa, transparente e aberta, além de envolver cuidado e respeito com os envolvidos. A revista viabiliza as correções em manuscritos sempre que estes afetarem substancialmente o significado ou a interpretação dos dados, mas que não comprometam os resultados ou conclusões gerais do artigo. Além disso, disponibiliza as retratações de um manuscrito indicadas por diversas razões, incluindo publicação duplicada, plágio, práticas de investigação não éticas. Sendo um periódico financiado pelo governo federal, a RBC não reproduz nem divulga anúncios publicitários em seus artigos ou em seu website, concentrando sua atuação na divulgação do conhecimento científico, com vistas ao aprimoramento dos serviços oferecidos pelo Sistema Único de Saúde (SUS) e por outros sistemas nacionais de saúde. Dentro de rígidos princípios éticos, a RBC segue crescendo tanto na publicação como no alcance nacional e internacional de seus artigos, expandindo pela ciência aberta a geração de novas práticas destinadas à prevenção e ao controle do câncer no cenário brasileiro e no contexto global.

Potential interactions between antineoplastic agents and medicines used to treat Covid-19.

INTRODUCTION: Cancer patients with Covid-19 are exposed to treatment combinations that can potentially result in interactions that adversely affect patient outcomes. This study aimed to identify potential drug-drug interactions between antineoplastic agents and medicines used to treat Covid-19. METHODS: We conducted a search for potential interactions between 201 antineoplastic agents and 26 medicines used to treat Covid-19 on the Lexicomp® and Micromedex® databases. The following data were extracted: interaction severity ("major" and "contraindicated") and interaction effects (pharmacokinetic and pharmacodynamic). We also sought to identify the therapeutic indication of the antineoplastic drugs involved in the potential drug-drug interactions. RESULTS: A total of 388 "major" or "contraindicated" drug-drug interactions were detected. Eight drugs or combinations (baricitinib, lopinavir/ritonavir, atazanavir, darunavir, azithromycin, chloroquine, hydroxychloroquine, and sirolimus) accounted for 91.5% of these interactions. The class of antineoplastic agents with the greatest potential for interaction was tyrosine kinase inhibitors (accounting for 46.4% of all interactions). The findings show that atazanavir, baricitinib, and lopinavir/ritonavir can affect the treatment of all common types of cancer. The most common pharmacokinetic effect of the potential drug-drug interactions was increased plasma concentration of the antineoplastic medicine (39.4%). CONCLUSIONS: Covid-19 is a recent disease and pharmacological interventions are undergoing constant modification. This study identified a considerable number of potential drug-drug interactions. In view of the vulnerability of patients with cancer, it is vital that health professionals carefully assess the risks and benefits of drug combinations.

Association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma.

BACKGROUND: This study aimed to evaluate the association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma. METHODS: We enrolled, in a retrospective cohort, 239 women treated with carboplatin and paclitaxel between 2008 and 2017. Pretreatment computed tomography scans were used to quantify skeletal muscle index (SMI), skeletal muscle radiodensity (SMD), and subcutaneous adipose tissue index (SATI). Chemotherapy doses, related toxicities, potential drug-drug interactions (DDI), and clinical variables were collected from medical records. Outcomes were the number of adverse events ≥ grade 3 toxicity, toxicity-induced modification of treatment (TIMT), and three-year survival. RESULTS: Average age was 56.3 years and 35.1% had myopenia. Almost 33% had TIMT and 51.3% presented any grade 3 toxicity. Potential severe DDI occurred in 48.1% of the patients and 65.1% died three years after the first treatment. The SMD and SATI below the median were independent predictors for the number of adverse events ≥ grade 3 and TIMT. Also, SMD was the only body composition parameter able to predict reduced three-year survival. The SMI was not associated with any of the outcomes. CONCLUSION: Fewer amounts of SATI and low SMD were associated with the occurrence of toxicity to chemotherapy, and the low SMD increased the risk of death in the three years after oncologic treatment.