Planning cancer control in Latin America and the Caribbean.

Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.

Breast cancer in Brazil: present status and future goals.

Breast cancer is the most common cancer in women worldwide and 70% of breast cancer deaths occur in women from low-income and middle-income countries. Latin America has about 115,000 new cases of disease every year, with about 50,000 arising in Brazil. We examined the present status of breast cancer in Brazil as an example of the health effects of geographical, ethnic, and socioeconomic diversities on delivery of care. Our goal was to identify deficiencies that could be responsible for disparities in survival from breast cancer. We searched the English and Portuguese published work and reviewed national databases and Brazilian publications. Although the availability of publications specific to Brazil is low in general, we identified several factors that could account for disparities: delays in diagnosis due to low cancer awareness and implementation of mammography screening, unknown quality of surgery, and restricted access to radiotherapy and modern systemic therapies.

Denosumab and the current status of bone-modifying drugs in breast cancer.

BACKGROUND: Bone-modifying therapy is a primary research interest in breast cancer. Several features contribute to the importance of the bone environment in the management of breast cancer. Firstly, bone metastases represent the most common site of breast cancer metastases and secondly, the emergence of cancer treatment-induced bone loss (CTIBL) among breast cancer survivors and patients is of increasing concern. Furthermore, concordant with the "seed and soil" theory, agents that alter the bone microenvironment may even prevent tumor cell seeding in bone and limit cancer growth. MATERIAL AND METHODS: Medical databases and conference proceedings were searched to identify articles, abstracts and clinical trials that have or are investigating denosumab and bisphosphonates in cancer therapy. Our search included a predefined focus on bone-modifying therapies in early and advanced breast cancer. RESULTS AND DISCUSSION: Bisphosphonates (BPs) have an established role both in the prevention and treatment of CTIBL and have been studied in the adjuvant setting for early breast cancer (EBC). Denosumab is a monoclonal antibody directed against RANK ligand and thereby inhibits osteoclastogenesis and bone resportion. It is the newest agent approved for the treatment of postmenopausal osteoporosis and the prevention of skeletal-related events (SRE) in cancer patients with solid tumors and bone metastases. Denosumab has a favorable toxicity profile in comparison to BPs and has the potential to improve cancer outcomes. CONCLUSION: This review examines the existing role of denosumab in the treatment of bone complications of breast cancer and its potential role as adjuvant therapy.

Death anxiety in persons with HIV/AIDS: a systematic review and meta-analysis.

One of the most commonly cited psychological sequelae of HIV/AIDS is anxiety regarding death due to the illness (i.e., death anxiety; DA). However, extant research is inconclusive on several empirical issues, such as DA's relation to HIV/AIDS diagnostic status, the impact of illness-related symptoms on DA, and factors that may protect against DA. We conducted a systematic review of the empirical literature and meta-analysis to answer specific questions concerning correlates of DA in persons with HIV/AIDS and important factors that may help explain variability in effect size estimates. The meta-analysis included 18 studies (N = 1,757) examining DA in adults with HIV/AIDS. Meta-analytic findings indicated a small-to-medium effect of HIV/AIDS diagnostic status on DA, which was moderated by duration since diagnosis and by relation to the advent of highly active antiretroviral therapy. Results also indicated a small effect of illness-related symptoms on DA, which was moderated by participant age. Social support and intrinsic religiosity were modest protective factors, but results indicated that extrinsic religiosity may exacerbate or be exacerbated by DA. Finally, results indicated a medium-to-large relation between psychological symptoms and DA. The implications of these results and other study findings are discussed.