Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. / [Artículo traducido] Modelo de estratificación de riesgo de atención farmacéutica para pacientes oncológicos con neoplasias sólidas o hematológicas.

OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

Percepção dos profissionais de enfermagem sobre manejo de reação infusional a antineoplásicos: estudo qualitativo / Perception of nursing professionals on the management of infusion reactions to antineoplastics: qualitative study

Identificar a percepção dos profissionais de enfermagem sobre o manejo de reação infusional imediata a antineoplásicos. Método: Trata-se de um estudo descritivo de caráter exploratório com abordagem qualitativa realizado em um hospital no Rio Grande do Sul. Resultados: Todos os participantes afirmaram saber identificar uma reação infusional. Após a identificação da reação, nota-se que a maioria obedeceu a uma ordem de condutas a serem realizadas. Quanto aos cuidados para prevenção das reações infusionais, a maioria dos participantes mencionou a administração de medicamentos pré-quimioterápicos, como antialérgicos e antieméticos. Conclusão: Os achados demonstram que a maioria dos profissionais sabe reconhecer e manejar, porém há a necessidade de treinamentos e padronização das ações.(AU)

To identify the perception of nursing professionals about the management of immediate infusion reactions to antineoplastic drugs. Method: This is a descriptive, exploratory study with a qualitative approach carried out in a hospital in Rio Grande do Sul. Results: All the participants said they knew how to identify an infusion reaction. After identifying the reaction, it was noted that the majority followed an order of conduct to be carried out. As for precautions to prevent infusion reactions, most of the participants mentioned the administration of pre-chemotherapy drugs, such as anti-allergic and anti-emetic drugs. Conclusion: The findings show that most professionals know how to recognize and manage them, but there is a need for training and standardization of actions.(AU)

Identificar la percepción de los profesionales de enfermería sobre el manejo de las reacciones infusionales inmediatas a medicamentos antineoplásicos. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, realizado en un hospital de Rio Grande do Sul. Resultados: Todos los participantes afirmaron saber identificar una reacción a la infusión. Después de identificar la reacción, la mayoría siguió un orden de conducta. En cuanto a las precauciones para prevenir las reacciones a la infusión, la mayoría de los participantes mencionó la administración de fármacos prequimioterápicos, como antialérgicos y antieméticos. Conclusión: Los hallazgos muestran que la mayoría de los profesionales saben reconocerlas y manejarlas, pero es necesaria la formación y la estandarización de actuaciones.(AU)

Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms.

OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of "clinical and health services utilization" and "treatment-related." Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

Propuesta de protocolo de dispensación activa de antineoplásicos orales para pacientes de novo en un servicio de farmacia hospitalaria / Proposal of an active dispensation protocol of oral antineoplasics for newly diagnosed patients for an outpatient hospital pharmacy service

Introducción: La propuesta para elaboración de un protocolo de dispensación activa de antineoplási-cos orales para pacientes de novo responde a una necesidad detectada por el Servicio de Oncología y el Servicio de Farmacia de Consulta Externa y Urgencias del Hospital México. Actualmente los pacientes recién diagnosticados retiran los medica-mentos sin la dispensación activa por el farmacéu-tico, lo cual puede comprometer la adherencia al tratamiento. Objetivo: Proponer un protocolo de dispensación activa de antineoplásicos orales para pacientes de novo para la farmacia de consulta externa del Hospital México que le permita al personal farma-céutico brindar este servicio.Método: Se realizó una búsqueda bibliográfica sobre los cánceres de próstata, pulmón y mama. Se seleccionaron los medicamentos a incluir en el programa. Se elaboró un protocolo de dispensación activa y los materiales educativos dirigidos a los pacientes atendidos por el Servicio de Farmacia de Consulta Externa y Urgencias del Hospital México con prescripción de antineoplásicos orales. Resultados: Se incluyeron 11 antineoplásicos ora-les no contemplados en otros servicios de atención farmacéutica del Hospital México. Se desarrolló el procedimiento de dispensación activa según los lineamientos de la Caja Costarricense de Seguro Social para medicamentos de compra. Se elabora-ron 11 boletines educativos para pacientes. Conclusiones: El protocolo de dispensación activa de antineoplásicos orales propuesto permitirá que la farmacia de consulta externa del Hospital México brinde este servicio de forma estandarizada a los pacientes. (AU)

Introduction: New patients prescribed with oral an-tineoplasics do not receive any indications on how to take their treatments properly. The outpatient pharmacy service of the Hospital México is in need for a protocol for active dispensing of oral antineo-plasics to promote therapy adherence. Objective: The aim of this work was to propose an active dispensing protocol of oral antineoplasics for the outpatient pharmacy service of the Hospi-tal México that enables pharmacists to offer this service to patients. Method: A literature review was conducted on pul-monary, prostate and breast cancer, as well as on different pharmaceutical care programs to develop the active dispensing protocol and the information materials for patients. Results: 11 oral antineoplasics were included in the program. A protocol for active dispensing of oral antineoplasics was developed, according to the guidelines of the Caja Costarricense de Seguro Social. Eleven patient information brochures were made. Conclusion: The active dispensing program of oral antineoplasics developed will allow the outpatient pharmacy service of the Hospital México to offer a standardize service to patients. (AU)

Actividad citotóxica y antiproliferativa de un extracto rico en fucoidan de Lessonia trabeculata sobre células de adenocarcinoma mamario murino 4T1

Introducción. Los tumores neoplásicos se caracterizan por su invasividad y metástasis. Las células neoplásicas tienen heterogeneidad genética, por lo cual pueden desarrollar resistencia a los quimioterápicos. Por esta razón, las plantas continúan siendo una fuente importante de nuevos productos anticancerígenos. Objetivo. Evaluar la actividad citotóxica y antiproliferativa de un extracto rico en fucoidan de Lessonia trabeculata nativa (EFLt) sobre la línea celular de adenocarcinoma mamario murino, triple negativo 4T1. Métodos. La citotoxicidad y la IC50 se determinaron en monocapas de 4T1 empleando el reactivo MTT. Para demostrar la actividad antiproliferativa se aplicaron los métodos de cierre de herida y anticlonogénico utilizando las IC50 del EFLt y Dox (doxorubicina). El cierre de herida fue evaluado mediante barrido de tiempos discretos; el efecto anticlonogénico fue evaluado 7 días postratamiento mediante el conteo de colonias y se determinó la fracción de sobrevivencia. Adicionalmente, se evaluaron la citotoxicidad y actividad antiproliferativa combinando las IC50 de EFLt y Dox. El porcentaje de migración y conteo de colonias se realizó con el programa ImageJ. Resultados. La IC50 del EFLt (950 μg/mL) produjo 56% de citotoxicidad, 80,3% de inhibición de la migración celular, 68% de inhibición en la formación de colonias. La IC50 de Dox fue 0,5 μg/mL. Conclusiones. El EFLt ejerce citotoxicidad dependiente de la concentración y tiene efecto antiproliferativo sobre 4T1. Se requiere continuar los ensayos en modelos de mayor complejidad que permitan esclarecer el potencial antitumoral del EFLt.

Introduction. Neoplastic tumors are characterized by invasiveness and metastasis. Neoplastic cells are genetically heterogeneous and can develop resistance to chemotherapeutic agents. For this reason, plants continue to be an important source of new anticancer products. Objective. To determine the cytotoxic and antiproliferative activity of a fucoidan-rich extract of native Lessonia trabeculata (EFLt) on the tripe negative murine mammary adenocarcinoma cell line 4T1. Methods. Cytotoxicity and IC50 were determined in 4T1 monolayers using the MTT reagent. To demonstrate antiproliferative activity, "wound" closure and anticlonogenic methods were applied using the IC50 of EFLt and Doc (doxorubicin). "Wound" closure was evaluated by discrete times sweep to determine percentage inhibition of cell migration; the anticlonogenic effect was evaluated by colony counting 7 days after treatment and the survival fraction was determined. In addition, cytotoxicity and antiproliferative activity were evaluated by combining the IC50 of EFLt and Dox. Percent migration and colony counts were performed using ImageJ software. Results. The IC50 (950 μg/mL) of EFLt was 56% cytotoxicity, 80,3% inhibition of cell migration, 68% inhibition of colony formation.The ICof Dox was 0,5 μg/mL. Conclusions. EFLt exerts concentration-dependent cytotoxicity and antiproliferative effect on 4T1. Further studies in more complex models are needed to elucidate the anti-tumor potential of EFLt.

Alterações osteometabólicas em pacientes em tratamento antineoplásico: revisão de escopo / Osteometabolic changes in patients under antineoplastic treatment: scoping review

Objetivo: sintetizar as principais evidências acerca das alterações osteometabólicas presentes nos pacientes em tratamento antineoplásico. Métodos: trata-se de uma revisão de escopo, seguindo a metodologia do Instituto Joanna Briggs, nas bases de dados PubMed/MedLine, Cochrane Library, LILACS, The British Library e Google Scholar. A revisão está protocolada no Open Science Framework. Resultados: muitos antineoplásicos possuem efeito na arquitetura óssea, reduzindo sua densidade, tais como moduladores seletivos de receptores de estrogênio, inibidores da aromatase, terapia de privação androgênica, e glicocorticoides. Para evitar tais desfechos, o tratamento e prevenção podem ser realizados pela suplementação de cálcio e vitamina D, exercícios físicos, uso de bifosfonatos, denosumab, e moduladores seletivos do receptor de estrogênio. Conclusão: pessoas com maior risco de desenvolver câncer também possuem maior risco de osteopenia e osteoporose, quando processo já estabelecido e em tratamento antineoplásico, devido ao compartilhamento de fatores de risco. Torna-se evidente a necessidade da densitometria óssea nos pacientes em tratamento contra o câncer para de prevenção e promoção de saúde óssea nesses pacientes, além de mais pesquisas com alto nivel de evidência para subsidiar tal uso.

Objective: To summarize the main evidence regarding osteometabolic changes in patients undergoing antineoplastic treatment. Methods: This is a scoping review, following the methodology of the Joanna Briggs Institute, using PubMed/MedLine, Cochrane Library, LILACS, The British Library, and Google Scholar. This review is registered in the Open Science Framework. Results: Many antineoplastics affect bone architecture by reducing its density, such as selective estrogen receptor modulators, aromatase inhibitors, androgen deprivation therapy, and glucocorticoids. To avoid such outcomes, treatment and prevention can be achieved by calcium and vitamin D supplementation, physical exercise, use of bisphosphonates, denosumab, and selective estrogen receptor modulators. Conclusion: people at a higher risk of developing cancer also have a higher risk of osteopenia and osteoporosis when the process is already established and undergoing antineoplastic treatment because of the grouping of risk factors. The need for bone densitometry in patients undergoing cancer treatment to prevent and promote bone health in these patients is evident, in addition to more research with a high level of evidence to support such use.

Percepção do enfermeiro sobre os cuidados relacionados ao extravasamento de drogas antineoplásicas / Percepción de profesionales de enfermería sobre los cuidados relacionados con la extravasación de medicamentos antineoplásicos / Perception of the nursing professional about the care related to extravasation of antineoplastic drugs

Introdução: O uso de quimioterapias antineoplásicas atuando a nível celular com objetivo de tratar as neoplasias malignas, pode levar ao surgimento da toxicidade dermatológica, ocasionada pelo extravasamento, que consiste em um dano tecidual decorrente da infiltração, por via endovenosa, dos quimioterápicos aos tecidos circunvizinhos do local puncionado, necessitando de uma atuação profissional rápida e efetiva para evitar desfechos desfavoráveis para o paciente. Objetivo: Compreender a percepção do enfermeiro sobre os cuidados relacionados ao extravasamento de drogas antineoplásicas. Método: Trata-se de um estudo de campo, descritivo-exploratório com abordagem qualitativa, realizado com quinze enfermeiros que atuam no ambulatório e enfermarias da oncologia adulto de uma instituição hospitalar filantrópica localizada em Recife/Pernambuco, Brasil. Os dados foram coletados entre janeiro e dezembro de 2020 através de entrevista e passaram por análise de conteúdo temática-categorial. Resultados: Emergiram duas categorias. Cuidados preventivos: da identificação dos fatores de riscos à educação do paciente e equipe de saúde; Cuidados diretos: da identificação da ocorrência ao gerenciamento institucional do evento. Conclusão: Compreendeu-se que a percepção do enfermeiro destaca a importância do planejamento da assistência, incluindo a intervenção imediata, o registro do evento e o acompanhamento do paciente após o extravasamento, como forma de realizar um cuidado especializado e com maior segurança.

Introducción: El uso de quimioterapias antineoplásicas que actúan a nivel celular con el objetivo de tratar neoplasias malignas puede conducir a la aparición de toxicidad dermatológica. Esta es causada por extravasación, que consiste en daño tisular producto de la infiltración, por vía endovenosa, de los agentes quimioterápicos a los tejidos circundantes del sitio de punción. Lo anterior, requiere una actuación profesional rápida y eficaz para evitar resultados desfavorables para la persona. Objetivo: Comprender la percepción de profesionales de enfermería sobre el cuidado relacionado con la extravasación de fármacos antineoplásicos. Método: Se trata de un estudio de campo descriptivo-exploratorio con abordaje cualitativo, realizado con quince personas enfermeras que actúan en las salas de oncología de población adulta y ambulatoria de un hospital filantrópico ubicado en Recife/Pernambuco, Brasil. Los datos fueron recolectados entre enero y diciembre de 2020, a través de entrevistas y fueron sometidos a análisis de contenido por categorías temáticas. Resultados: Emergieron dos categorías: atención preventiva (desde la identificación de factores de riesgo hasta la educación de la persona y del equipo de salud) y atención directa (desde la identificación de la ocurrencia hasta la gestión institucional del evento). Conclusión: Se entendió que la percepción de la persona profesional de enfermería destaca la importancia de la planificación del cuidado, incluyendo la intervención inmediata, el registro de eventos y el seguimiento después de la extravasación, como forma de realizar cuidados especializados y con mayor seguridad.

Introduction: The use of antineoplastic chemotherapies acting at the cellular level with the aim of treating malignant neoplasms can lead to the emergence of dermatological toxicity caused by extravasation. This toxicity consists of tissue damage resulting from the infiltration, by intravenous route, of the chemotherapeutic agents to the surrounding tissues, requiring quick and effective professional action to avoid unfavorable outcomes for the patient. Objective: To understand the nurses' perception of care related to extravasation of antineoplastic drugs. Method: This is a descriptive-exploratory field study with a qualitative approach; it was carried out with fifteen nurses who work in the outpatient and adult oncology wards of a philanthropic hospital located in Recife/Pernambuco, Brazil. Data were collected between January and December 2020 through interviews and underwent thematic-category content analysis. Results: Two categories emerged: Preventive Care: from the identification of risk factors to the patient and health team education; and Direct Care: from the identification of the occurrence to the institutional management of the event. Conclusion: It was understood that the nurse's perception highlights the importance of care planning, including immediate intervention, event registration, and patient follow-up after extravasation, to perform specialized care and with greater safety.

Characteristics of patients with hypersensitivity reactions to chemotherapeutic and biological agents and desensitization behavior / Características de pacientes com reações de hipersensibilidade a agentes quimioterápicos e biológicos e comportamento de dessensibilização

Introduction: Hypersensitivity to chemotherapeutic and biological agents has increased in recent years due to their frequent use. Avoidance has been the first line of defense, leading to decreased treatment efficacy and increased adverse events. Objective: To characterize the sociodemographic and clinical aspects of patients with hypersensitivity reactions to chemotherapeutic agents who underwent desensitization and biological procedures in a Colombian city. Methods: This observational, descriptive, retrospective, multicenter study was conducted in patients with hypersensitivity reactions to chemotherapeutic and biological agents who underwent desensitization. Results: In the 14 included patients with a history of hypersensitivity reactions to chemotherapeutic and biological agents (57.1% women; median age 42.5 years), 45 desensitization procedures were performed. The most commonly prescribed drug was rituximab (57%). The skin was the most frequent reaction site (78.6%), and systemic corticosteroids were the most common treatment (78.6%). Breakthrough reactions occurred in 31.1% of the patients and only premedication with corticosteroids was associated with less severe reactions. All cases of desensitization were successful. Conclusions: Desensitization to chemotherapeutic and biological agents proved to be a useful and safe tool in a Colombian population.

Introdução: A hipersensibilidade aos agentes quimioterápicos e biológicos aumentou nos últimos anos devido ao seu uso frequente. Evitar tem sido a primeira linha de ação, levando à diminuição da eficácia do tratamento e ao aumento de eventos adversos. Objetivos: Caracterizar os aspectos sociodemográficos e clínicos de pacientes com reações de hipersensibilidade a agentes quimioterápicos submetidos a dessensibilização e procedimentos biológicos em uma cidade colombiana. Métodos: Foi realizado um estudo observacional, descritivo, retrospectivo e multicêntrico em pacientes com reações de hipersensibilidade a agentes quimioterápicos e biológicos submetidos à dessensibilização. Resultados: Foram incluídos 45 procedimentos de dessensibilização em 14 pacientes com histórico de reações de hipersensibilidade a agentes quimioterápicos e biológicos (57,1% mulheres, com mediana de idade de 42,5 anos). O medicamento mais relatado foi o rituximabe (57%). O envolvimento cutâneo foi o mais frequente (78,6%) e os corticosteroides sistêmicos foram o tratamento mais utilizado (78,6%). As reações ocorreram em 31,1% e apenas a pré-medicação com corticosteroides foi associada a uma menor gravidade destas. Todos os casos de dessensibilização foram bem-sucedidos. Conclusões: A dessensibilização a agentes quimioterápicos e biológicos provou ser uma ferramenta útil e segura em uma população colombiana.

Manejo de reações adversas dermatológicas em pacientes submetidos à terapia quimioterápica antineoplásica / Management of dermatological adverse reactions in patients undergoing antineoplastic chemotherapy

Objetivo: o presente estudo tem como objetivo reunir recomendações de cuidados considerando a prevenção e tratamento de lesões de pele induzidas pelo tratamento com quimioterápicos antineoplásicos, de acordo com os estudos e consensos atuais. Metodologia: realizou-se um estudo bibliográfico para levantamento das relações entre os principais fármacos antineoplásicos e suas intercorrências dermatológicas, bem como seus respectivos manejos, para subsidiar a orientação e aconselhamento aos profissionais de saúde que acompanham o paciente oncológico. Resultado: os principais problemas dermatológicos decorrentes do uso de antineoplásicos correspondem às lesões de pele, tais como a descoloração, hiperpigmentação, fotossensibilidade, eritemas, descamação e prurido. Também são recorrentes os efeitos adversos que acometem os pelos e cabelos, resultando em alopecia, e a modificação do crescimento e lesões nas unhas. Tratamentos específicos para cada caso são capazes de amenizar ou reverter os problemas. Conclusão: as reações adversas aos medicamentos envolvendo quimioterapia são frequentes na prática oncológica, e variam em termos de frequência e gravidade, atingindo diversos anexos cutâneos. O adequado manejo destes efeitos melhora a integridade da pele e demais estruturas, proporcionando a esses pacientes a melhoria da autoestima e da qualidade de vida.

Objective: the present study aims to gather care recommendations considering the prevention and treatment of skin lesions induced by treatment with antineoplastic chemotherapy, according to current studies and consensus. Methodology: a bibliographical study was carried out to survey the relationships between the main antineoplastic drugs and their dermatological intercurrences, as well as their respective management, to subsidize the guidance and counselling of health professionals who treat cancer patients. Result: the main dermatological problems arising from the use of antineoplastic agents correspond to skin lesions, such as discoloration, hyperpigmentation, photosensitivity, erythema, scaling and pruritus. Adverse effects that affect hair and body hair are also recurrent, resulting in alopecia, and the modification of growth and lesions on the nails. Specific treatments for each case can alleviate or reverse the problems. Conclusion: adverse drug reactions involving chemotherapy are frequent in oncology practice, and vary in terms of frequency and severity, affecting various skin appendages. Proper management of these effects improves the integrity of the skin and other structures, providing these patients with improved self-esteem and quality of life.

Quimioterapia antineoplásica frente al cáncer de mama en mujeres embarazadas: Prevención de Extravasaciones / Antineoplastic chemotherapy against breast cancer in pregnant women: Extravasation Prevention

El cáncer gestacional se puede definir como el cáncer que ocurre durante el embarazo o durante el primer año posterior al parto. Entre ellos, el cáncer de mama ocupa el primer lugar en frecuencia con una incidencia en aumento y que se sitúa cerca de 1 por cada 3.000 mujeres embarazadas. En la mujer embarazada el diagnóstico de cáncer representa un desafío en términos de manejo clínico, debido a la necesidad de garantizar la seguridad materna y asegurar el estado de gestación. Este tiende a retrasarse y detectarse en estadios más tardíos debido a que los síntomas asociados pueden relacionarse fácilmente con una situación normal de gestación. Las embarazadas diagnosticadas de cáncer deben ser evaluadas por un comité multidisciplinario de tumores, especializado en cáncer durante el embarazo. Uno de los tratamientos utilizados para el abordaje del cáncer de mama es la quimioterapia antineoplásica, que debe ser administrada en un hospital, atendiendo a diferentes factores como son el estado general del paciente, las posibles enfermedades previas, el tipo, estadio y localización del tumor, así como la semana de gestación en la que se encuentra la mujer. A partir de la semana 13-14 de gestación puede iniciarse el tratamiento, siendo los regímenes más utilizados a día de hoy: ciclos de 3 semanas de FAC (5-fluorouracilo, doxorrubicina y ciclofosfamida), FEC (5-fluorouracilo, epirubicina y ciclofosfamida), AC (doxorrubicina y ciclofosfamida) y EC (epirubicina y ciclofosfamida) o epirubicina semanal como monoterapia. Asimismo, destaca el uso de los taxanos (paclitaxel como agente único). La enfermera constituye un pilar fundamental dentro del equipo multidisciplinario de tumores, especializado en cáncer de mama durante el embarazo, que atenderá y acompañará a la embarazada durante todo el proceso de la enfermedad. El cáncer de mama, y más en la embarazada, conlleva una serie de cambios en su vida que requieren diferentes procesos de adaptación física, psicológica y social (AU)

Gestational cancer can be defined as cancer that occurs during pregnancy or within the first year after delivery. Among them, breast cancer occupies the first place in frequency with an increasing incidence that is situated at about 1 per 3.000 pregnant women. In pregnant women, the diagnosis of cancer represents a challenge in terms of clinical management, due to the need to guarantee maternal safety and ensure the state of pregnancy. This tends to be delayed and detected at later stages because the associated symptoms can be easily related to a normal pregnancy situation. Pregnant women diagnosed with cancer should be evaluated by a multidisciplinary tumor team, specialized in cancer during pregnancy. One of the treatments used to address breast cancer is antineoplastic chemotherapy, which must be administered in a hospital, taking into account different factors such as the general condition of the patient, possible previous diseases, the type, stage and location of the tumor, as well as the week of gestation in which the woman is. Treatment can be started from week 13-14 of gestation, the most widely used regimens to date are: 3-week cycles of FAC (5-fluorouracil, doxorubicin and cyclophosphamide), FEC (5-fluorouracil, epirubicin and cyclophosphamide), AC (doxorubicin and cyclophosphamide) and EC (epirubicin and cyclophosphamide) or weekly epirubicin as monotherapy. Likewise, the use of taxanes (paclitaxel as a single agent) stands out. The nurse is a fundamental pillar within the multidisciplinary team of tumors, specialized in breast cancer during pregnancy, who will care for and accompany the pregnant woman throughout the disease process. Breast cancer, and more in pregnant women, entails a series of changes in their lives that require different processes of physical, psychological and social adaptation. (AU)

Adherencia y calidad de vida en los pacientes con leucemia linfocítica crónica tratados con antineoplásicos orales / Adherence and quality of life in patients with chronic lymphocytic leukemia treated with oral antineoplastic drugs

Objetivos: evaluar la adherencia y la calidad de vida de los pacientes con leucemia linfocítica crónica tratados con antineoplásicos orales. Comparar la adherencia y la calidad de vida según el fármaco recibido y según la línea de tratamiento.Métodoestudio descriptivo prospectivo realizado de junio a noviembre de 2021 en un hospital terciario. Se incluyeron pacientes con leucemia linfocítica crónica, atendidos en la consulta de Farmacia Oncológica y tratados con antineoplásicos orales desde al menos 6 meses antes de la inclusión en el estudio. Se estimó la adherencia mediante el cuestionario Morisky’s 8 item Medication Adherence Scale y el recuento de medicación sobrante, considerándose adherentes si su tasa de adherencia era ≥ 90%. Para evaluar la calidad de vida, se utilizó el cuestionario EQ-5D-3L del grupo EuroQol, la escala Functional Assessment of Chronic Illness Therapy – Fatigue y el QLQ-C30 de la European Organization for Research and Treatment of Cancer. Se programaron 2 entrevistas: en el momento de la inclusión y a los 3 meses. Se revisó la historia clínica, recogiéndose variables demográficas y clínicas. El análisis estadístico se realizó con el programa SPSS® 25.0.Resultadosse incluyeron 23 pacientes, todos fueron adherentes según el recuento de medicación, 20 presentaron adherencia alta, y 3 media, según Morisky’s 8 item Medication Adherence Scale. Los resultados del cuestionario EQ-5D-3L mostraron que los pacientes eran autónomos para su cuidado personal y sus actividades cotidianas, el 69,6% no tenían problemas de movilidad, el 78,3% no tenía ansiedad/depresión y el 56,5% presentaba algún tipo de dolor. (AU)

Objective: To evaluate adherence and quality of life to oral antineoplastic treatment in patients with chronic lymphocytic leukemia. To compare adherence and QoL according to treatment subgroups and treatment-line subgroups.MethodsWe conducted a descriptive prospective study from June to November 2021 in a tertiary care hospital. Patients treated at the Oncology Pharmacy with a diagnosis of chronic lymphocytic leukemia and treatment with oral antineoplastics for at least 6 months before inclusion in the study were included. Adherence was assessed using Morisky’s 8 item Medication Adherence Scale and leftover pills counts, considering adherents if their adherence rate was ≥ 90%. Quality of life was assessed with Euro-Qol EQ-5D-3L questionnaire, Functional Assessment of Chronic Illness Therapy – Fatigue scale and QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer. Two interviews were scheduled: at the time of inclusion and at 3 months. Variable collected: demographic data, clinical data (disease and treatment); and response (scores obtained from questionnaires and adherence rate). The data statistical analysis was carried out with SPSS® 25.0 software.ResultsTwenty three patients were included, all of them showed an adherence rate higher than 90%; 20 patients were considered high adherent, and 3 patients medium adherent to treatment according to Morisky’s 8 item Medication Adherence Scale. (AU)

Diseño y validación de una escala de adherencia a antineoplásicos orales / Design and validation of an adherence scale to oral antineoplastic drugs

Objetivo: diseñar y validar una escala para medir la adherencia a antineoplásicos orales. Disponer de una herramienta sencilla, validada y aplicable a la rutina asistencial que permitirá detectar e identificar la falta de adherencia para establecer estrategias que permitan mejorarla y optimizar la calidad de los servicios sanitarios.Métodoestudio de validación de una escala diseñada para evaluar la adherencia a antineoplásicos orales en una muestra de pacientes ambulatorios que recogen su medicación en 4 hospitales españoles. Se analizará su validez y fiabilidad, elaborada a partir de un estudio previo de metodología cualitativa, mediante la teoría clásica de los test y el análisis Rasch. Se examinará su funcionamiento, el ajuste de los ítems, la estructura de respuesta y de las personas a las predicciones del modelo, así como la dimensionalidad, la fiabilidad ítem-persona, la adecuación del nivel de dificultad de los ítems a la muestra, y el funcionamiento diferencial de los ítems en función del sexo. (AU)

Objective: To design and validate a questionnaire to measure adherence to oral antineoplastic drugs. The availability of a simple, validated tool that can be applied to routine care will make it possible to detect and identify non-adherence in order to establish strategies to improve adherence and optimize the quality of healthcare services.MethodValidation study of the questionnaire designed to assess adherence to antineoplastic drugs in a sample of outpatients who collect their medication in two Spanish hospitals. Its validity and reliability will be analyzed, based on a previous qualitative methodology study, using classical test theory and Rasch analysis. We will examine its performance, item fit, response structure and person fit to the predictions of the model, as well as dimensionality, item-person reliability, the appropriateness of the level of difficulty of the items to the sample, and the differential performance of the items according to gender.

Design and validation of an adherence scale to oral antineoplastic drugs. / Diseño y validación de una escala de adherencia a antineoplásicos orales.

OBJECTIVE: To design and validate a questionnaire to measure adherence to oral antineoplastic drugs. The availability of a simple, validated tool that can be applied to routine care will make it possible to detect and identify non-adherence in order to establish strategies to improve adherence and optimize the quality of healthcare services. METHOD: Validation study of the questionnaire designed to assess adherence to antineoplastic drugs in a sample of outpatients who collect their medication in two Spanish hospitals. Its validity and reliability will be analyzed, based on a previous qualitative methodology study, using classical test theory and Rasch analysis. We will examine its performance, item fit, response structure and person fit to the predictions of the model, as well as dimensionality, item-person reliability, the appropriateness of the level of difficulty of the items to the sample, and the differential performance of the items according to gender.

Avaliação de sintomas climatéricos em mulheres jovens submetidas à quimioterapia / Assessment of climacteric symptoms in young women undergoing chemotherapy / Evaluación de síntomas climatéricos en mujeres jóvenes sometidas a quimioterapia

RESUMO Objetivo: Descrever a prevalência de sintomas climatéricos em mulheres submetidas a tratamento oncológico e analisar sua relação com a quantidade de ciclos quimioterápicos. Métodos: Estudo transversal com 47 mulheres submetidas à quimioterapia em dois hospitais de referência oncológica de São Luís, Maranhão, Brasil, entre março de 2019 e julho de 2020. Utilizou-se questionário estruturado contendo variáveis sociodemográficas e informações sobre função menstrual e sintomas. Foram realizadas análise bivariada e regressão logística binária para avaliar a relação entre as variáveis previsoras e quantidade de ciclos quimioterápicos. Resultados: Média de idade de 31,71 anos, amenorreia e fogacho, foram os sintomas mais frequentes, porém, sem relação com o número de ciclos quimioterápicos. Não houve associação entre a presença de efeitos climatéricos com o tipo de quimioterapia (p=0,15). Conclusão: Reafirma-se que quimioterápicos podem causar sintomas climatéricos enfatizando a necessidade de medidas para amenizar os sintomas nas pacientes que enfrentam essa problemática.

ABSTRACT Objective: To describe the prevalence of climacteric symptoms in women undergoing cancer treatment and to analyze its relationship with the number of chemotherapy cycles. Methods: Cross-sectional study with 47 women undergoing chemotherapy in two cancer reference hospitals in São Luís, Maranhão, Brazil, between March 2019 and July 2020. A structured questionnaire was used containing sociodemographic variables and information on menstrual function and symptoms. Bivariate analysis and binary logistic regression were performed to assess the relationship between predictor variables and number of chemotherapy cycles. Results: Mean age was 31.71 years, and amenorrhea and hot flushes were the most frequent symptoms, however, unrelated to the number of chemotherapy cycles. There was no association between the presence of climacteric effects and the type of chemotherapy (p=0.15). Conclusion: The results reaffirmed that chemotherapy can cause climacteric symptoms, thus emphasizing the need for measures to alleviate symptoms in patients facing this problem.

RESUMEN Objetivo: Describir la prevalencia de síntomas climatéricos en mujeres sometidas a tratamiento oncológico y analizar su relación con la cantidad de ciclos quimioterápicos. Métodos: Estudio transversal con 47 mujeres sometidas a quimioterapia en dos hospitales oncológicos de referencia de São Luis, Maranhão, entre marzo de 2019 y julio de 2020. Se utilizó cuestionario estructurado incluyendo variables sociodemográficas e información sobre función menstrual y síntomas. Fueron practicados análisis bivariado y regresión logística binaria para evaluar la relación entre las variables de previsión y la cantidad de ciclos quimioterápicos. Resultados: Media etaria de 31,71 años, los síntomas más frecuentes fueron amenorrea y sofocos, aunque sin relación con la cantidad de ciclos quimioterápicos. No hubo asociación entre presencia de efectos climatéricos y tipo de quimioterapia (p=0,15). Conclusión: Se reafirma que los quimioterápicos pueden causar síntomas climatéricos, enfatizándose la necesidad de medidas para aliviar los síntomas en las pacientes que enfrentan esta problemática.

Satisfação com os cuidados de enfermagem de pacientes oncológicos em uso de antineoplásicos ambulatorial / Satisfaction with nursing care of oncology patients on outpatient antineoplastic drugs / Satisfacción con los cuidados de enfermería en pacientes oncológicos que utilizan fármacos antineoplásicos en régimen ambulatorio

RESUMO Objetivo: avaliar a satisfação do usuário oncológico ambulatorial em uso de antineoplásicos sobre os cuidados de enfermagem. Métodos: estudo transversal com abordagem quantitativa, realizado no Serviço de Quimioterapia de um hospital universitário localizado em Belém-PA - Brasil, com 200 usuários no período de junho de 2019 a junho de 2022, através de entrevista e uso do Instrumento de Satisfação do Paciente. Aplicou-se análise de qui-quadrado de Pearson e considerou-se p-valor ≤0,05. Resultados: os usuários relataram bom índice de satisfação na média geral dos domínios (>90%), destacando o domínio técnico-profissional, seguido do educacional e confiança. As variáveis de esclarecimento sobre as orientações médicas, dar bons conselhos, tomar iniciativa após as respostas dos pacientes foram associadas à satisfação do usuário conforme a topografia do câncer e a disponibilidade da equipe àqueles com diferentes graus de estadiamento. Conclusão: este estudo auxilia gestores na identificação e planejamento de melhorias nas áreas e serviços.

ABSTRACT Objective: Evaluate the satisfaction of outpatient oncology users taking antineoplastic drugs about nursing care. Methods: Exsectional study with a quantitative approach, carried out at the Chemotherapy Service of a university hospital located in Belém-PA - Brazil, with 200 users, from June 2019 to June 2022, through interviews and use of the Patient Satisfaction Instrument. Chi-square analysis, Pearson p-value, and chi-square analysis were applied, and the p-value ≤ 0.05 was considered. Results: Users reported good satisfaction in the overall average of the domains (>90%), highlighting the technical-professional domain, followed by the educational and confidence domains. The variables of clarification of medical guidelines, giving good advice, and taking the initiative after patient responses were associated with user satisfaction according to cancer topography and staff availability to those with different degrees of staging. Conclusion: This study assists managers in identifying and planning improvements in areas and services.

RESUMEN Objetivo: evaluar la satisfacción de los usuarios de oncología ambulatoria que utilizan fármacos antineoplásicos sobre los cuidados de enfermería. Métodos: estudio seccional con enfoque cuantitativo, realizado en el Servicio de Quimioterapia de un hospital universitario situado en Belém-PA - Brasilcon 200 usuarios en el período de junio de 2019 a junio de 2022, mediante entrevista y utilización del Instrumento de Satisfacción del Paciente. Se aplicó el análisis chi-cuadrado de Pearson y el valor p ≤0,05. Resultados: los usuarios declararon una buena satisfacción en la media global de los dominios (>90%), destacando el dominio técnico-profesional, seguido de los dominios educativo y de confianza. Las variables de aclaración sobre las directrices médicas, dar buenos consejos, tomar la iniciativa tras las respuestas de los pacientes se asociaron con la satisfacción de los usuarios según la topografía del cáncer y la disponibilidad del personal ante los distintos grados de estadificación. Conclusión: este estudio ayuda a los directivos a identificar y planificar mejoras en áreas y servicios.

Evaluation of Salivary Flow Rate in Patients undergoing Chemotherapy for Solid Tumors / Avaliação de Fluxo Salivar em Pacientes Submetidos à Quimioterapia para Tumores Sólidos

Chemotherapy for cancer treatment offers the possibility of eradicating neoplastic cells, however, its use can result in systemic and oral adverse effects, with emphasis on the qualitative-quantitative modification of saliva. To evaluate the stimulated salivary flow rate (SFR) in patients undergoing chemotherapy for treatment of solid malignancies. This was a cross-sectional study with twenty patients diagnosed with solid tumors undergoing chemotherapy with cytotoxic drugs. Subjects were submitted to stimulated sialometry in the 1st cycle of chemotherapy (baseline, 7th day and 14th day). Additionally, sociodemographic data regarding these patients were collected in a standardized questionnaire. Descriptive and inferential statistical analysis were performed, with a significance level of p<0.05. There was a predominance of women (75%) aged over 40 years old (90%). The most prevalent tumor location was breast (55%), followed by ovaries (15%), and the most used drug was cyclophosphamide (50%). In the sample, no statistically significant result was observed with regard to SFR (p>0.05) in the studied periods. The data suggest that the 1st cycle of chemotherapy was not able to induce significant changes in the SFR. New studies need to be performed for the prospective identification of potential changes in salivary parameters.(AU)

A quimioterapia para tratamento do câncer oferece possibilidade de erradicação das células neoplásicas, todavia, seu emprego pode resultar em efeitos adversos sistêmicos e em cavidade oral, com destaque para modificação quali-quantitativa da saliva. Avaliar a velocidade de fluxo salivar (VFS) estimulado em pacientes sob quimioterapia para tratamento de neoplasias malignas sólidas. Tratou-se de um estudo transversal, no qual vinte pacientes com tumores sólidos sob regime quimioterápico com drogas sabidamente citotóxicas, foram submetidos à sialometria estimulada no 1º ciclo de quimioterapia (baseline, 7º dia e 14º dia). Adicionalmente, foram coletados dados referentes às características sociodemográficas desses pacientes. Foi realizada análise estatística descritiva e inferencial, com nível de significância p<0,05. Observou-se predominância de mulheres (75%) em idade acima dos 40 anos (90%). A localização do tumor mais prevalente foi a mama (55%), seguida de ovários (15%) e a droga mais utilizada foi a ciclofosfamida (50%). Na amostra não foi observado resultado estatisticamente significativo no que diz respeito à variável VFS (p>0,05) nos períodos estudados. Os dados sugerem que o 1° ciclo de quimioterapia não foi capaz de induzir alterações significativas na VFS. Novos estudos precisam ser realizados para a identificação prospectiva de potenciais alterações nos parâmetros salivares.(AU)

[Translated article] Adherence and quality of life in patients with chronic lymphocytic leukemia treated with oral antineoplastic drugs.

OBJECTIVE: To evaluate adherence and quality of life to oral antineoplastic treatment in patients with chronic lymphocytic leukemia. To compare adherence and quality of life according to treatment subgroups and treatment-line subgroups. METHODS: We conducted a descriptive prospective study from June to November 2021 in a tertiary care hospital.  Patients with chronic lymphocytic leukaemia, seen at the Oncology Pharmacy and treated with oral antineoplastic drugs for at least 6 months prior to inclusion in the study were included. Adherence was assessed using Morisky's 8 item Medication Adherence Scale and leftover pills counts, considering adherents if their adherence rate was ≥90%. Quality of life was assessed with Euro-Qol EQ-5D-3L questionnaire, Functional Assessment of Chronic Illness Therapy - Fatigue scale and QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer. Two interviews were scheduled: at the time of inclusion and at 3 months. The clinical history was reviewed and demographic and clinical variables were collected. The data statistical analysis was carried out with SPSS® 25.0 software. RESULTS: Twenty three patients were included, all of them showed an adherence rate higher than 90%; 20 patients were considered high adherent, and 3 patients médium adherent to treatment according to Morisky's 8 item Medication Adherence Scale. The results of the EQ-5D-3L questionnaire showed that the patients were all of them autonomous in their personal care and daily activities, 69.6% did not have any mobility problems and 78.3% did not have anxiety/depression; 56.5% had some type of pain. Eighteen patients had no fatigue, and 5 had mild/moderate fatigue according to Functional Assessment of Chronic Illness Therapy - Fatigue scale. The results of the EORTC QLQ-C30 questionnaire showed that patients had a high /healthy functional level, a good quality of life and a low level of symptoms. Analysis by treatment subgroups and by treatment-line subgroups did not show statistically significant differences in adherence or quality of life. CONCLUSIONS: Patients diagnosed with chronic lymphocytic leukemia and treated with oral antineoplastic therapies showed a high adherence rate and referred a good quality of life.

[Translated article] Design and validation of a scale to measure adherence to oral antineoplastic drugs.

OBJECTIVE: Design and validate a scale to measure adherence to oral antineoplastic drugs. The availability of a simple, validated tool that can be applied to routine care will make it possible to detect and identify non-adherence in order to establish strategies to improve adherence and optimize the quality of healthcare services. METHOD: Validation study of the scale designed to assess adherence to antineoplastic drugs in a sample of outpatients who collect their medication in two Spanish hospitals. Its validity and reliability will be analyzed, based on a previous qualitative methodology study, using classical test theory and Rasch analysis. We will examine its performance, item fit, response structure and person fit to the predictions of the model, as well as dimensionality, item-person reliability, the appropriateness of the level of difficulty of the items to the sample, and the differential performance of the items according to gender.

Adherence and quality of life in patients with chronic lymphocytic leukemia treated with oral antineoplastic drugs. / Adherencia y calidad de vida en los pacientes con leucemia linfocítica crónica tratados con antineoplásicos orales.

OBJECTIVE: To evaluate adherence and quality of life to oral antineoplastic treatment in patients with chronic lymphocytic leukemia. To compare adherence and QoL according to treatment subgroups and treatment-line subgroups. METHODS: We conducted a descriptive prospective study from June to November 2021 in a tertiary care hospital. Patients treated at the Oncology Pharmacy with a diagnosis of chronic lymphocytic leukemia and treatment with oral antineoplastics for at least 6 months before inclusion in the study were included. Adherence was assessed using Morisky's 8 item Medication Adherence Scale and leftover pills counts, considering adherents if their adherence rate was ≥ 90%. Quality of life was assessed with Euro-Qol EQ-5D-3L questionnaire, Functional Assessment of Chronic Illness Therapy - Fatigue scale and QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer. Two interviews were scheduled: at the time of inclusion and at 3 months. Variable collected: demographic data, clinical data (disease and treatment); and response (scores obtained from questionnaires and adherence rate). The data statistical analysis was carried out with SPSS® 25.0 software. RESULTS: Twenty three patients were included, all of them showed an adherence rate higher than 90%; 20 patients were considered high adherent, and 3 patients medium adherent to treatment according to Morisky's 8 item Medication Adherence Scale. The results of the EQ-5D-3L questionnaire showed that the patients were all of them autonomous in their personal care and daily activities, 69.6% did not have any mobility problems and 78.3% did not have anxiety/depression; 56.5% had some type of pain. Eighteen patients had no fatigue, and 5 had mild/moderate fatigue according to Functional Assessment of Chronic Illness Therapy - Fatigue scale. The results of the EORTC QLQ-C30 questionnaire showed that patients had a high /healthy functional level, a good quality of life and a low level of symptoms. Analysis by treatment subgroups and by treatment-line subgroups did not show statistically significant differences in adherence or quality of life. CONCLUSIONS: Patients diagnosed with chronic lymphocytic leukemia and treated with oral antineoplastic therapies showed a high adherence rate and referred a good quality of life.

Osimertinibe comparado a Erlotinibe Gefitinibe ou quimioterapia para tratamento de carcinoma pulmonar de células não pequenas com mutação do gene do receptor do fator de crescimento epidérmico (EFGR): revisão rápida / Osimertinib compared to erlotinib, gefitinib or chemotherapy for the treatment of non-small cell pumonary carcinoma with epidermal growth factor receptor (EFGR) gene mutation: rapid review

Mesilato de osimertinibe, gefitinibe, erlotinibe, quimioterapia padrão. Indicação: Câncer de pulmão de células não pequenas com mutação do receptor do fator de crescimento epidérmico (EGFR). Pergunta: Mesilato de osimertinibe é mais eficaz e seguro que gefitinibe, erlotinibe ou quimioterapia para os desfechos de sobrevida global, sobrevida livre de progressão e de segurança no tratamento de carcinoma pulmonar de células não pequenas com mutação do EGFR? Métodos: Levantamento bibliográfico foi realizado na base de dados PUBMED e EPISTEMONIKOS, seguindo estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica das revisões sistemáticas com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: Foram selecionadas duas revisões sistemáticas que atenderam aos critérios de elegibilidade. Conclusão: Mesilato de osimertinibe é mais eficaz do que gefitinibe ou erlotinibe na melhora da sobrevida global e da sobrevida livre de progressão em pacientes virgens de tratamento. Em pacientes previamente tratados, o mesilato de osimertinibe não é superior à quimioterapia padrão à base de platina no prolongamento da sobrevida global, mas é mais eficaz no aumento da sobrevida livre de progressão. Para câncer avançado, mesilato de osimertinibe não é mais eficaz do que a quimioterapia com ou sem pemetrexede para prolongar a sobrevida global, mas é mais eficaz em melhorar a sobrevida livre de progressão. Gefitinibe combinado com quimioterapia à base de pemetrexede foi superior à quimioterapia com ou sem pemetrexede na melhora da sobrevida global e da sobrevida livre de progressão

Osimertinib mesylate, gefitinib, erlotinib, standard chemotherapy. Indication: Non-small cell lung cancer with epidermal growth factor receptor (EGFR) mutation. Question: Is osimertinib mesylate more effective and safer than gefitinib, erlotinib or chemotherapy for overall survival, progression-free survival and safety outcomes in the treatment of non-small cell lung cancer with EGFR mutation? Methods: A bibliographic search was done in the PUBMED and EPISTEMONIKOS database, following predefined search strategies. The methodological quality of systematic reviews was evaluated using the Assessing the Methodological Quality of Systematic Reviews Version 2 tool. Results: Two systematic reviews were selected because they met the eligibility criteria. Conclusion: Osimertinib mesylate is more effective than gefitinib or erlotinib in improving overall survival and progression-free survival in treatment-naive patients. In previously treated patients, osimertinib mesylate is not superior to standard platinum-based chemotherapy in prolonging overall survival, but it is more effective in increasing progression-free survival. For advanced cancer, osimertinib mesylate is not more effective than chemotherapy with or without pemetrexed in prolonging overall survival, but it is more effective in improving progression-free survival. Gefitinib combined with pemetrexed-based chemotherapy was superior to chemotherapy with or without pemetrexed in improving overall survival and progression-free survival