Trabalhos Científicos

Introduction: The 21-gene platform Oncotype DX helps to select women with early ER-positive breast cancer who won’t benefit from adjuvant chemotherapy. This study aimed to assess the cost-effectiveness of using the 21-gene platform for guiding treatment decisions in these patients from the perspective of the Brazilian public health system (SUS). The analysis focused on the costs and outcomes associated with the platform compared to the standard risk factor-based treatment approach. Methods: A cost-effectiveness analysis was conducted over a 6-month time horizon. The analysis was based on standard values payable by SUS for adjuvant hormone therapy and chemotherapy. We measured effectiveness in quality-adjusted life years (QALYs) and performed sensitivity analyses for different hypothetical costs of the 21-gene platform. Results: The decision tree model showed that, when considering all patients, using usual clinical risk factors alone was favored over the 21-gene platform for treatment decisions. However, for patients classified as high risk according to clinical factors, the 21-gene platform was cheaper than the usual clinical risk factors up to a platform cost of US$ 294.75. The incremental cost-effectiveness ratio (ICER) for the platform was lower than the 2022 Brazilian gross domestic product per capita (used as the Willingness to Pay) up to a 21-gene platform cost of US$ 1,505.46. Conclusion: The use of the 21-gene platform can be cost-effective for guiding treatment decisions in early ER-positive breast cancer treated by the SUS for patients at high risk based on clinical factors, if we consider a cost limit of US$ 1,505.46 per test.

Objectives Establish whether CP screening for computed tomography every 2 years is cost-effective in a high-risk population in the perspective of the Brazilian public health scenario Methods For the quantification of the tracked population: smokers and ex-smokers 20 packs/year, aged between 50 and 80 years, it has was used information provided by the IBGE 2020 Demographic Census (Instituto Brasileiro de Geografia e Estatística) and Vigitel 2023 (Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico). Additionally, a non-tracked comparative population was outlined from the FOSP database (Fundação Oncocentro de São Paulo). To define the patient's journey and direct and indirect costs, DATASUS (Departamento de Informática so SUS) bases and information from a expert’s panel to validate assumptions were used. For economic evaluations the models of Markov were used, considering the costs of treatment and outcomes. Results Based on cost- effectiveness analysis (CEA) it was possible to demonstrate that the adoption of a lung cancer (LC) screening strategy with low-dose computed tomography (LDCT) in a previously defined high-risk populations (age between 50 and 80 years and current smokers and former smokers with a smooth load of 20 packs-year) was cost-effective with positive QALY results. Conclusions This study confirmed the premise that the implementation of LC tracking protocol in high-risk populations is cost-effective as early diagnosis and treatment provide medical and social benefits, balancing health costs, higher standards of Overall Survival (OS) and Disease Free Progression (DFP) as well as the possibility of social and family reintegration of the patients, maintaining their productivity.

Ovarian cancer is one of the main causes of mortality among women, often diagnosed in advanced stages with tumors disseminated in the peritoneal cavity. Immunotherapy has shown benefits in solid tumors, including ovarian cancer. Cowpea Mosaic Virus (CPMV) is a promising plant virus for use in immunotherapy due to its immunostimulatory properties and inability to infect humans. This study aimed to review the current literature on the use of CPMV in ovarian cancer models. A search was carried out in the PUBMED database in July 2024 using the descriptors "Ovarian Cancer" and "Cowpea Mosaic Virus". Articles published in the last five years that evaluated the effectiveness of CPMV were included. The results show that weekly intraperitoneal (IP) treatment with the CPMV vaccine in situ significantly delayed tumor growth, improved survival, and prevented recurrence in murine models of ovarian cancer. Injection of CPMV into cancerous tissue induced a potent immune response, converting immunosuppressive neutrophils into pro-inflammatory ones, which killed tumor cells and recruited dendritic cells, T cells, and NK cells to the tumor site. This resulted in the induction of costimulatory molecules in CD11b myeloid cells and the upregulation of interleukin-6 and interferon-γ, in addition to the downregulation of IL-10 and TGF-β, associated with the activation of macrophages and neutrophils to an antitumor phenotype. Conversion of immunosuppressive myeloid cells into potent antigen-presenting cells significantly improved effector and memory CD4+ and CD8+ T cell responses by promoting the cytotoxic activity of systemic tumor-specific CD8+ T cells. Combining in situ vaccination with immune checkpoint therapy generated tumor-specific immune responses and lasting protection against relapse. When CPMV was conjugated to a polymer, prolonged immunological stimulation was observed, likely due to the continued presence of CPMV in the IP space. These findings suggest that the therapeutic effects achieved by in situ CPMV vaccination can be harnessed to potentiate systemic antitumor immunity, providing a robust rationale for CPMV clinical trials.

Abstract. PURPOSE: To evaluate the feasibility and effectiveness of implementing virtual Molecular Tumor Boards (MTBs) through crowdsourcing molecular knowledge among Brazilian physicians to discuss complex genomic information in cancer patients comprehensively. PATIENTS AND METHODS: We established a virtual group on WhatsApp consisting of medical oncologists, radiation therapists, molecular biologists, geneticists, surgeons, and pathologists from various institutions across Brazil. RESULTS: From September 2022 to May 2024, we discussed 22 cases, with an average of 3.3 patients discussed per month. The group consisted of Medical Oncologists (60), Radiation Therapists (7), Molecular Biologists (4), Geneticists (5), Surgeons (13) and Pathologists (3). Most of the cases discussed were of breast cancer (6), followed by lung (5) and colorectal cancers (4). The group suggested management options for all cases for the treating physicians. CONCLUSION: Crowdsourcing molecular knowledge through a virtual group of physicians has proven to be a feasible and effective solution for developing countries facing financial constraints to fund single institutional MTBs. This approach allowed for comprehensive discussions of complex genomic information, providing valuable management options.

INTRODUCTION Colon and rectal cancer refers to tumors that begin in the portion of the large intestine called the colon and in the rectum, just before the anus. Also known as colorectal cancer, it is a treatable neoplasm and, in most cases, is curable when detected early. Many of these tumors originate from polypoid lesions, which are benign growths on the inner wall of the large intestine. OBJECTIVE To describe the number of cases of colon and rectal neoplasia in the regions of Brazil. METHOD This is a retrospective, descriptive, and quantitative study based on data from the DATASUS database. A comparative analysis was conducted between Brazilian regions, according to the detailed diagnoses C18 (malignant neoplasm of the colon) and C20 (malignant neoplasm of the rectum) over a 5-year period, from 2019 to 2023. RESULTS The total number of cases of malignant neoplasms of the colon and rectum combined was 174,055, with the majority being colon cancer at 118,718 cases and 55,337 cases of rectal cancer in Brazil during the study period. The Southeast region had the highest incidence with 84,909 cases, of which 57,252 were colon cancer, followed by the South region with 46,037 cases, of which 33,136 were colon cancer, the Northeast with 26,947 cases, of which 17,557 were colon cancer, the Central-West with 11,249 cases, of which 7,662 were colon cancer, and the North with 4,913 cases, of which 3,111 were colon cancer. When comparing cases by sex in Brazil, males had a total of 86,052 cases, including 56,800 colon cancer cases and 29,252 rectal cancer cases, while females had a total of 88,003 cases, including 61,918 colon cancer cases and 26,085 rectal cancer cases. CONCLUSION In this context, it is significant that colon cancer was the most frequent neoplasm, accounting for 68.2% of cases. The number of colon cancer cases was higher than that of rectal cancer in all Brazilian regions. The Southeast region had the highest incidence rate, representing 48.7% of all cases, while the North region had the lowest rate, with only 2.82% of cases, suggesting a potential underreporting or lack of access to healthcare. Regarding sex, colon cancer was more prevalent in women, accounting for 52.15% of cases, while rectal cancer was more prevalent in men, with 52.86% of cases.

Breast cancer requires a highly complex approach, for which an interdisciplinary team can improve outcomes by preventing drug mistakes and enhancing overall care quality. This study is an experience report conducted in a Brazilian private cancer center that aims to describe the organization and implementation of an interdisciplinary care pathway for breast cancer outpatients. The care pathway team included a clinical oncologist, a nutritionist, a psychologist, a pharmacist, a stomatologist, a nurse, and a social worker. One member is selected to ensure continuity of work and maintenance of schedules and records, and the pathway physician interlocks the interdisciplinary interventions to the attending oncologist. For screening candidates, all breast cancer patients in their first cycle of chemotherapy receive a validated quality-of-life assessment questionnaire: FACT-B4. In parallel, each professional must evaluate the case, establishing clinically relevant and measurable goals. All patients' health conditions can be targeted. Eligible patients present moderate or high impairments according to FACT-B or clinical demands involving three or more areas of the team. Patient refusal or follow-up by palliative care assistance were exclusion criteria. The identified problems are then discussed in bimonthly meetings, which serve as a platform for the team to review the patient's progress, discuss issues, and propose an action plan for each unmet goal. To involve patients in the care plan as active subjects, an empowerment letter is delivered informing them about the follow-up by an interdisciplinary team, and personalized goals are established. FACT-B4 is reapplied after three months to detect treatment-related burden and late-onset demands. The rate of successful interventions is calculated monthly. In our practice, 64 breast cancer patients were screened between January and June 2024. 17 were included in the pathway, generating 52 goals. We are pleased to report that 71% of these goals were successfully achieved. These included reducing distress thermometer, improving nutritional intake, healing oral cavity lesions, conducting pharmacotherapy reviews and implementing drug adherence strategies. In conclusion, with its unwavering patient-centered approach, we suggest that a care pathway is not just a viable model but a crucial one to improve patient-centered care for patients in breast cancer treatment and develop interdisciplinary interventions.

INTRODUCTION: Triple therapy based on a proteasome inhibitor, immunomodulator, and dexamethasone is the standard treatment for newly diagnosed patients with multiple myeloma who are candidates for autologous stem cell transplantation. However, the addition of daratumumab, an anti-CD38 monoclonal antibody, to this therapy suggests lasting benefits for this population. OBJECTIVES: This study aims to evaluate the efficacy and safety of the addition of daratumumab to the consolidated triple therapy (bortezomib, dexamethasone, and lenalidomide/thalidomide) in patients with multiple myeloma eligible for transplantation. METHODS: Studies comparing the use of daratumumab-based quadruplet therapy versus triplet consolidated therapy in transplantation-eligible patients with multiple myeloma were searched in PubMed, Scopus, and Cochrane Central. The main outcomes were disease progression or death, complete response or better, minimal residual disease status (MRD), and neutropenia. Statistical analysis was performed using Review Manager. RESULTS: Three randomized controlled trials and 2081 patients were included. Daratumumab-based therapy was used to treat multiple myeloma in 1045 (50.2%) patients. Follow-up ranged from 18 to 49 months. The median age was 59.5 years, with 58% male patients. 91.5% of the patients had a 0-1 Eastern Cooperative Oncology Group (ECOG) performance status and 81.4% had standard cytogenetic risk. Disease progression or death (HR 0.44; 95% CI 0.35-0.56; p < 0.00001) was significantly lower in patients treated with the addition of daratumumab, and complete response or better (RR 2.49; 95% CI 1.63-3.81; p < 0.0001) was significantly higher in the intervention group. The occurrence of minimal residual disease also significantly favored the daratumumab group (RR 3.00; 95% CI 2.11-4.25; p < 0.00001). However, hematological adverse effects were more common among patients treated with daratumumab, such as neutropenia (RR 1.47; 95% CI 1.09-1.98; p = 0.01). CONCLUSION: The addition of daratumumab to conventional triple therapy in newly diagnosed multiple myeloma patients reduces disease progression or death, increases complete response, and favors the occurrence of minimal residual disease, although it is associated with an increased risk of adverse effects such as neutropenia. Therefore, daratumumab-based therapy may be a preferred strategy to enhance treatment effectiveness.

Introduction: High Complexity Oncology Care Centers (HCOCC) aim to provide comprehensive care through excellence and innovation. Napoleão Laureano Hospital (NLH) is the leading HCOCC in Paraíba, managing 94% of adult outpatient cases and 44% of breast cancer cases in 2022. To enhance care, a partnership with Roche and UpFlux was formed to use artificial intelligence for optimizing hospital flow and reducing referral times and patient journey steps. Objective: The aim of this study is to map the actual journey of breast cancer patients treated at the High Complexity Oncology Care Center, identifying key indicators and barriers throughout this journey that may impact the patient experience. Once these barriers have been identified, the hospital can establish actions to mitigate them. Methods: Once the partnership was proposed, the roles were defined: NLH managed the project and addressed barriers, Roche provided funding and support, and UpFlux integrated the software and shared aggregated data. The project had two phases: the first, starting in July 2022, involved setting up and implementing UpFlux software at NLH; the second, beginning in November 2022 and lasting 12 months, focused on extracting data about patient journeys. Monitoring included biweekly and weekly meetings, with indicators like time between consultations and treatment initiation. UpFlux created custom dashboards to track these indicators. Results: Two patient groups were analyzed: Group 1 had 30 patients whose first appointment was over 60 days ago with no treatment started by July 2023, while Group 2 had 30 patients who started treatment between April and August but experienced over 60 days of delay from their first appointment. The project used a cyclical process involving patient navigation to identify delays, root cause identification, and actionable cause resolution. Identified issues included delays in exams, prior surgeries before chemotherapy, and radiotherapy delays. Action plans included alerts for patients nearing the 60-day mark, joint consultations, internalizing exams, and improving radiotherapy scheduling. Future plans involve adding a field in the electronic medical record for chemotherapy scheduling. Conclusion: The study was crucial in reinforcing a data-driven culture, validating or disproving assumptions, and monitoring outpatient flow to identify and address delays.

Introduction: Pediatric dental oncology is a medical subspecialty that takes care of oral evidence and dental treatments in children with cancer cells. Infantile cancers are rare conditions but they significantly affect children’s general and oral health. Chemotherapy, radiotherapy, and bone marrow transplantation may have different effects on oral health such as mucositis, xerostomia, severe infections and caries. It is therefore important to manage these complications properly for better patient quality of life and the success of treatment of cancer. Objective: This article aimed to review the prevailing literature on oral problems among childhood cancer patients, their prevention and management approaches as well as the role played by pediatric dentists in the multidisciplinary team of pediatric oncologists. Method: In conducting this literature review a search was carried out across scientific databases including PubMed, Scopus as well as Google Scholar using the keywords “dental oncology”, “oral complications”, “pediatric cancer” and “oral care in children with cancer”. The focus was on clinical studies, systematic reviews, and clinical practice guidelines published between 2010-2023.Results:Mucositis, dry mouth, oral infections, dysgeusia, and dental caries are the most common oral complications in children with cancer as revealed by the review. The highest proportion of children appear to have an issue with oral mucositis which is a side effect that comes from chemotherapy (and sometimes radiation therapy) around the head and neck area. Best practice guidelines include proper maintenance of good oral hygiene, use of topical agents for pain relief and wound healing as well as preventive measures like low power lasers. Furthermore, appropriate management and improved life quality among patients can only be achieved through collaboration between oncologists and pediatric dentists. Conclusion: Pediatric dental oncology is vital in managing cancer cases among young people because it prevents and treats disorders that affect their mouths negatively affecting their overall well-being. To provide holistic care and enhance cancer outcomes, oral care protocols must be implemented alongside inter-professional fields working together.

Introduction: Overall survival of children and adolescents with cancer has improved significantly in recent decades, however, socioeconomic disparities persist, resulting in lower survival rates, especially in low- and middle-income countries, such as, in Brazil. Objective: The aim of this study was to identify and analyze the spatial distribution of childhood cancer incidence and survival coefficients and verify their association with the Deprivation Index of a state in southeastern Brazil. Methods: A retrospective observational study was held in 2023. We have obtained clinical and sociodemographic data through the Tumor Registration Form of the Hospital-based Cancer Registry of a reference hospital for pediatric oncology in Vitória, ES, Brazil. The cities of residence in the state at the time of diagnosis were geocoded using the Brazilian Deprivation Index (BDI). Overall survival was estimated using Cox regression adjusting for sex, age at diagnosis, histological group and stratified by each BDI quintile. Results: The sample consisted of 865 new cases of pediatric neoplasms, with leukemias, Central Nervous System tumors and lymphomas being the most common. The estimated overall survival at 5 years was 61% (95%CI: 0.585-0.651; p=0.001) for children from the least disadvantaged city in the state. We observed a significant increase in the HR for death among children and adolescents in the most disadvantaged cities (Q5) (HR=2.12; 95%CI:1.06-4.23; p=0.034). Conclusion: In summary, we observed that socioeconomic level estimated through the Brazilian Deprivation Index was associated with worse survival among children and adolescents with cancer. Socioeconomically disadvantaged children and adolescents can constitute a group of high-risk patients, who are identifiable at the time of diagnosis and can be targets of personalized interventions to be delivered in a timely manner.

Pancreatic head adenocarcinoma (PHAC) is a highly aggressive neoplasm, often diagnosed at advanced stages due to the absence of early symptoms. Early diagnosis is crucial and involves a combination of imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), along with biomarkers like carcinoembryonic antigen (CEA) and CA 19-9. Staging is essential for determining prognosis and treatment and is commonly performed using the TNM (Tumor, Node, Metastasis) system. Scores such as the Modified Glasgow Prognostic Score (mGPS) and the Pancreatic Cancer Staging System (PCSS) have been used to assess clinical condition and treatment response, contributing to more precise stratification. Recent studies highlight the importance of accurate staging in selecting therapies, surgeries, and/or chemotherapies to improve patient survival and quality of life. The objective of this literature review is to analyze the diagnostic challenges of pancreatic head adenocarcinoma, emphasizing the need and importance of staging scores for patients with this neoplasm. For this literature review on PHAC, studies from the past 10 years related to the topic were used. The bibliographic search was conducted in online virtual libraries such as PubMed, Scielo, BVS, and guidelines from the Brazilian Society of Clinical Oncology (SBOC) and the American Society of Clinical Oncology (ASCO) on this pathology, using the terms “pancreatic head adenocarcinoma,” “staging and diagnosis of pancreatic neoplasm.” With significant advancements in the diagnosis and staging of PHAC, recent studies emphasize the use of the TNM system and PCSS for its evaluation. The diagnostic difficulty is due to its anatomical location and often asymptomatic nature in the early stages. When symptoms are present, they may be mistaken for other conditions, leading to delays in diagnosis and poorer prognosis. Additionally, changes in imaging tests may be subtle, such as pancreatic duct dilation and focal masses, complicating diagnosis. The combination of diagnostic and staging approaches represents a significant advancement in managing PHAC, concluding that TNM precision enhances understanding of progression and is also crucial for optimizing clinical management and improving prognosis for patients with PHAC.

Introduction: LMIC face unique challenges related to populational age transition and perspectives of soaring cancer incidence. Despite the pressing need for strong clinical research (CR) programs focusing on their unique needs, progress on this aspect appears to remain slow, unequal and too reliant on pharma-driven and late-stage clinical trials (CT). This study aims to investigate disparities in CR development among LMIC in terms of crude number and complexity of CT and to explore potential associations with level of economic growth (EG). Methods: From the World Bank site, we identified key countries that ranked as LMIC by 2001. To document crude number, proportion of phase I-II versus III and independent versus pharma-sponsored CT, we employed search engines from clinicaltrial.gov. To investigate associations between EG and CR development, we established correlation coefficients (CC) defined as weak (0,2–0,39), moderate (0,4–0,69) or strong (0,7–0,89) based on the pearson correlation coefficient. Results: Between 2001–2020, 16.977 CT with access in LMIC were registered. The Asian countries China and South Korea experienced both strong EG and robust increases in crude number of CT (strong CCs). South and Southeast Asian countries had strong EG but, at best, modest increases in CT (variable CCs). Most East European countries and Middle Eastern Turkey experienced robust EG with consistent increases in CT (moderate to strong and strong CCs, respectively). South and North American largest economies (Argentina, Brazil and Mexico) had mainly inconsistent EG but consistent increases in CT (weak to moderate CCs). For African countries, Egypt (but not South Africa) showed consistent EG and increases in CT (strong and weak CCs, respectively). Except for China and South Korea, other LMIC remained largely reliant on pharma-sponsored CT and having a low proportion of phase I-II relative to phase III CT. Conclusions: CR development has been largely unequal among LMIC. Strong EG may contribute to CR development in these countries, but only to some extent. Only China and South Korea were able meaningfully increase complexity of CR. These data reinforce the need for initiatives to support and develop academic cancer research in these regions.

Introduction:Prostate cancer (PC) is a neoplasm on the rise among the Brazilian population. North American studies indicate that black men are disproportionately affected by PC, with an earlier presentation, aggressive genotype and higher mortality. Objectives: To identify disease profile and treatment disparities among patients treated with PC. Methods: Retrospective and prospective data, covering the period from 2017 to 2024, were used. The study evaluated patients over 18 years old diagnosed with PC, with information collected through the analysis of clinical, epidemiological, and pathological variables in their respective medical records. Parameterized data were anonymized and extracted by the hospital's Big Data/Analytics system, while non-parameterized data were obtained through manual and individual extraction of each medical record. Results: The descriptive analysis of 2,387 patients treated at Private and Public Hospitals revealed that more than half were up to 75 years old. Regarding race, 58% of patients reported their ethnicity: 75.41% were white, 13.84% mixed-race, 7.35% black, 3.32% yellow, and 0.07% indigenous. Approximately 61.48% lived more than 10 km from their respective treatment center. SUS patients had a 2.5 times higher risk of metastasis at diagnosis (p<0.01) when compared to private service patients, and longer hospital stays (p<0.01). Regarding race, blacks (OR 2.27) and mixed-race (OR 1.89) had a higher risk of metastasis at diagnosis than whites. Furthermore, Black (OR 0.04), mixedrace (OR 0.26), yellow (OR 0.14) patients, and those >75 years old (OR 0.42) had a lower chance of undergoing robotic surgery. A distance >10 km from the treatment center reduced the chance of robotic surgery by 95% (OR 0.05, p<0.01). Patients older than 75 years old has statistically worse outcomes (p<0.01). Conclusions: The results of this study highlight significant disparities in PC patients. Black and mixed-race patients, as well as those from the public healthcare system, faced a higher risk of metastasis at diagnosis and lower chances of accessing advanced technologies, such as robotic surgery. Additionally, advanced age and the presence of metastasis were associated with reduced overall survival and longer hospitalization. These findings underscore the need for targeted interventions to reduce treatment access inequalities and improve clinical outcomes, particularly in vulnerable populations.

Introduction: The acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer, representing about 80% of the leukemia cases in children, with an incidence five times higher than acute myeloid leukemia (AML). ALL is a multifactorial hematologic disease that initiates in white blood cells developed from the lymphoid progenitor cells, which suffers genetic alterations, acquiring the capacity of uncontrolled proliferation and infiltration. ALL incidence varies between regions of Brazil, possibly due to socioeconomic factors. Therefore, risk stratification based on clinical factors and the identification of recurrent genetic alterations are important to help prognosis and treatment orientation. Objectives: Analyze the regional incidence of lymphoid leukemia in children and teenagers, aged 0 to 19, from 2019 to 2023, highlighting the variations in accordance with the different federative regions of Brazil. Methods: Data from the Hospital Information System of the SUS and the Mortality Information System of Datasus and Tabnet were used. The data were analyzed using age criteria (0 to 19 years) and region to generate the tables used as a base. Results: Between 2019 and 2023, 6,982 cases of lymphoid leukemia (LL) were recorded in children and adolescents (0-19 years) in Brazil. In 2019, there were 1,335 cases, followed by 1,384 in 2020 (+3.67%), 1,574 in 2021 (+13.73%), 1,360 in 2022 (-13.60%) and 1,329 in 2023 (-2.28%). The Southeast was the most affected region with 2,072 cases, followed by the Northeast with 1,753, the North with 1,515, the South with 1,057 and the Central-West with 585. The North and Midwest regions recorded the highest proportional increase in LL diagnoses over the years. In the Southeast and South, the incidence of LL lagged behind other neoplasms. Conclusion: Acute lymphoblastic leukemia is a major challenge in Brazil, with a significant number of diagnoses, especially in the Southeast , being the most common form of cancer among children and adolescents. Diagnosing the disease in the country involves a broad process, from identifying the initial symptoms to confirmation by specialized tests. Although access to centers of excellence and specialized resources is expanding, the availability and quality of care still vary significantly across regions, affecting treatment equity. Therefore, health policies and awareness programs are essential to improve access to the healthcare system and the quality of diagnosis, ensuring ade

Introduction: In Brazil, prostate cancer is the second most common cancer among men. Estimates for the period from 2023 to 2025 project approximately 72,000 new cases, emphasizing the need to examine factors influencing prostate cancer outcomes. This study focuses on analyzing prostate cancer mortality in Brazil, considering factors such as age, regional differences and socioeconomic indicators. Objectives: The primary objective is to analyze the correlation between prostate cancer mortality and the Gini index, and to assess how socioeconomic inequalities and regional variations might influence these rates. Methods: Ecological study with secondary data from 2011-2021. All data were sourced from Brazil’s public health database (DATASUS). Data on prostate cancer mortality were obtained using the ICD-10 category C61 (Malignant Neoplasm of the Prostate). Mortality rates were analyzed by age and standardized through the World Health Organization’s population. Descriptive statistics were used for both mortality and Gini index. Linear regression was used to analyze the relationship between mortality rates and the country’s administrative regions over the years. Multiple linear regression analysis was performed to analyze the impact of inequality on cancer mortality. Results: This study showed a significant decline in prostate cancer mortality rates over time among individuals aged 50-54 years (β = -0.0639, p = 0.016, R² = 0.4956) and 55-59 years (β = -0.1302, p = 0.002, R² = 0.6726). Notable decreases were observed in individuals aged 70-74 years (β = -2.0354, p = 0.0002, R² = 0.8048), 75-79 years (β = -3.1667, p = 0.0001, R² = 0.8265), and 80 years and older (β = -6.3263, p = 0.000, R² = 0.9422), highlighting a trend of decreasing mortality rates for those cohorts. Regional analysis revealed varying impacts of the Gini index on prostate cancer mortality with a significant negative correlation in the North (β = -169.0573, p = 0.017, R² = 0.5324), suggesting that higher income inequality may be associated with lower prostate cancer mortality in this region. No significant correlations were observed in the Northeast (p = 0.819), Southeast (p = 0.142), South (p = 0.318), or Central-West (p = 0.385) regions. Conclusions: These results indicate significant improvements in prostate cancer survival rates for older age groups with varying impacts of income inequality on mortality rates across different regions of Brazil

Introduction: Hormone therapy is a strategy for hormone-dependent neoplasms treatment, which aims to control or inhibit the action of hormone receptor proteins in tumor cells. This treatment reduces the rate of tumor growth and the risk of associated complications. Objective: This study aims to analyze the drug therapeutic strategies used to treat hormone-dependent tumors in the Mato Grosso region. Methods: The research adopted a cross-sectional, descriptive and quantitative epidemiological design. The analysis was performed based on data from medical records of patients undergoing cancer treatment at the Hospital Regional de Cáceres Dr. Antônio Fontes, in Cáceres, Mato Grosso, Brazil. The data collection period was from September 22 to December 8, 2023. The collected data were processed using Excel 2012. Results: Among the 319 medical records analyzed, 172 patients were undergoing hormone therapy, 66 with breast cancer and 106 with prostate cancer. In the breast cancer group, 63.6% of patients were using Tamoxifen Citrate, 39.4% were using Anastrozole and 1.5% were being treated with Fulvestrant. In the prostate cancer group, 96.2% were using Leuprorelin Acetate, 9.4% were using Flutamide, 1.9% were being treated with Goserelin Acetate and 0.9% were using Bicalutamide. Conclusion: Data analysis showed a predominance of Tamoxifen Citrate use among patients with breast cancer (63.6%) and Leuprolide Acetate among patients with prostate cancer (96.2%). These therapeutic choices are in line with established clinical guidelines for the treatment of hormone-dependent neoplasms, reflecting significant adherence to recommended practices. In the treatment of breast cancer, Tamoxifen Citrate, an estrogen receptor antagonist, is widely used, as is Anastrozole, an aromatase inhibitor. The lower use of Fulvestrant suggests a preference for treatments with greater clinical efficacy or more consolidated treatments. In the treatment of prostate cancer, the prevalence of Leuprolide Acetate, a gonadotropin-releasing hormone (GnRH) agonist, highlights the importance of effective hormonal suppression. The lower use of Flutamide, Bicalutamide and Goserelin Acetate suggests a preference for therapies that provide more continuous and efficient hormonal suppression. This study provides an in-depth insight into treatment profiles in the region and may contribute to optimizing therapeutic strategies, improving the management of patients with hormone-dependent cancer.

Introduction: Skin cancer is the most common neoplasm in Brazil, with high incidence and impact on public health. INCA estimates over 180,000 new cases of non-melanoma skin cancer and about 10,000 cases of melanoma, the most aggressive type, annually. These numbers, driven by factors such as high sun exposure and an aging population, place Brazil among the countries with the highest skin cancer incidence rates in the world. Objective: To investigate the incidence of skin cancer hospitalizations over the past 9 years, identify regional differences within Brazil, and determine the most affected sexes and age groups. Methods: An ecological study was conducted analyzing hospitalization, mortality, and length of stay data for skin cancer patients in Brazil from 2014 to 2023 using DATASUS. Statistical analysis was performed using the Statistics Kingdom platform, where linear regression tests were conducted to assess the relationship between incidence and mortality. Data normality was checked with the Shapiro-Wilk test, and ANOVA and Tukey-Kramer tests were applied to compare hospitalization incidence across different Brazilian regions and identify statistically significant variations among groups. Results: The linear regression indicated that the incidence of skin cancer hospitalizations between 2014 and 2023 showed no significant trend, despite suggesting an increase (p = 0.9301, R² = 0.001). The mortality rate exhibited a moderate increasing trend (p = 0.082, R² = 0.33). Length of hospital stay showed a decreasing trend (p = 0.00002, R² = 0.9). ANOVA analysis revealed significant differences in skin cancer incidence among Brazilian regions, notably: N - NE, N - SE, N - S, N - CENTRO OESTE, NE - SE, NE - S, S - SE, S - CENTRO OESTE, and SE - CENTRO OESTE. The distribution of hospitalizations by sex was 52% male and 48% female, with the most affected age group being 60-69 years and the predominant ethnicity being white (61.64%). Conclusion: The linear regression analysis showed no significant trend in skin cancer hospitalizations between 2014 and 2023, but mortality increased moderately. Length of hospital stay decreased consistently. Regional comparisons revealed significant differences, highlighting regional disparities in hospitalization management. Men, individuals aged 60 to 69 years, and white ethnicity are the most affected. These results underscore the need for targeted health policies and specific prevention strategies.

Introduction: Pain is a common and debilitating symptom in cancer patients, especially in those under palliative care, because there is a need for the conceptualization of symptoms as multidimensional experiences. The search for effective methods of relief is a priority in therapy treatment, management, and the onset of long-term survivorship or end-of-life care. The use of Cannabinoids like THC (tetrahydrocannabinol) and CBD (cannabidiol) has shown potential for pain relief and the nausea, emesia and fatigue associated with cancer treatment. Objectives: To analyze the effectiveness of cannabidiol in relieving pain in oncology patients receiving palliative care. Methods: An integrative literature review was conducted in the Virtual Health Library (BVS) using the descriptors “cancer pain,” “palliative care,” and “cannabis,” and the Boolean operator 'AND' The featured articles were published between 2020 and 2024. A total of 50 articles were initially found, 9 met the criteria. Results: The administration of Tetrahydrocannabinol (THC) and Cannabidiol (CBD) promotes pain relief in palliative cancer treatment, with improvements in the Visual Analogue Pain Scale (VAR) and in the questionnaire that assesses quality of life in cancer patients (EORTC QLQ 030). However, there were no differences in patient prognosis when comparing the treatment of each drug alone or together, only a more significant improvement in sleep when using THC. With the use of cannabinoids, symptoms related to cancer or anticancer treatment improved, including pain refractory to conventional treatment.There is also the self-prescription use of edible cannabis or tobacco, improving sleep quality, vomiting, nausea, headaches, muscle spasms and anxiety. The effects of improving sleep quality and reducing nausea and vomiting were also obtained using oral oils. Patients using these medications believe that Cannabis is more effective than some conventional treatments, especially in relieving pain, and for some, it also has a positive impact on the prognosis of the disease. Conclusion : The use of cannabinoids, such as THC and CBD, shows significant potential for alleviating pain and improving symptoms associated with cancer, especially in palliative care. However, these treatments should be used with caution due to the observed side effects from prolonged use, such as memory impairment.