Trabalhos Científicos

Introduction: Hospital-based Cancer Registries (HCRs) are systematic sources of information, installed in general or specialized oncology hospitals, with the purpose of collecting data regarding the diagnosis, treatment and evolution of patients treated in these institutions. The HCRs also provide information for both hospital administration and researchers interested in information on treatment results in different groups and risk factors or prognostic factors as well as to contribute to individual patient care, since they ensure the follow-up of these patients. Objective: To describe and highlight the importance of Hospital Cancer Registries (RHC) based on an analysis of the epidemiological profile of patients with prostate cancer in the oncology care network (RAO) of a Brazilian state. Methods: Hospital-based exploratory descriptive study, based on the secondary database via tumor records form from the HCRs of the entire Cancer Care Network of Espírito Santo state between 2000 and 2020. Statistical analyses were conducted in RStudio and R. The sample was stratified between analytical and non-analytical cases and the groups compared using the Student's t-test and Person's chi-square test, in addition, a binary logistic regression was performed. Results: We retrieved 13,519 new records of prostate neoplasms from 2000-2020, where 9838 were analytical cases and 3681 were non-analytical. The present historical series showed an increasing trend (p<0.001). The mean age of patients was 69.00 years, of which 69.49% were elderly men at least 65 years old, 64.31% declared themselves non-white, 53.38% had elementary education with educational level, 65.01% were married and residents of the state of Espírito Santo in 96.48%. In addition, 67.91% were referred by the SUS, 95.74% had the occurrence of only one primary tumor, with the tumor being classified as adenocarcinoma in 98% of the records. The first treatment received at the hospital was surgery in 23.68%, followed by hormone therapy in 21.01% of cases. Conclusion: There was a growing trend in the number of prostate cancer cases over the years in the state, with a tropism for elderly, married men with low educational levels. This characterization may be useful for guiding the development of public policies in the area of oncology, with the objective of planning effective measures and actions for cancer surveillance at different levels of health care, aiming to improve men's health care.

INTRODUCTION Palliative care is a type of treatment whose approach aims to improve the quality of life of patients, alleviating suffering through early identification, focusing on the person as the focus of care and not just the disease. A viable means for palliative care would be hypodermoclysis, a technique for administering medications when intravenous access is not feasible, as discussed by writers Linda L. Emanuel and S. Lawrence Librach. In addition to presenting advantages, such as ease of administration, less pain and discomfort compared to intravenous infusion, and lower risk of infection. OBJECTIVES The study aims to provide a comprehensive review on the recent implementation of hypodermoclysis, emphasizing its importance in minimizing the discomfort of palliative care in cancer patients. METHODS Studies between 2007 and 2024 on hypodermoclysis in palliative care of cancer patients were analyzed, of which four were included in this review. RESULTS The studies demonstrated significant improvements in the quality of life of palliative care patients treated with hypodermoclysis. The strategy relieved pain and increased acceptability, considering the less invasive approach compared to intravenous infusion. Some advantages, such as low cost, possibility of early hospital discharge, and minimal risk of local and systemic complications, make its use convenient and associated with fewer side effects. Patients were able to move better and engage in more regular human behaviors, and had a lower rate of complications and infections, making the process safer. Emotional well-being improved, due to the reduction of anxiety and stress related to the psychological factors involved in conventional treatment. CONCLUSION In the oncological context, maintaining comfort and quality of life are priorities, and hypodermoclysis offers a less invasive alternative, allowing adequate management of symptoms and continuity of treatment in a less traumatic way for the patient. Therefore, it represents an effective tool in the therapeutic context of palliative care, providing a more humanized approach focused on the needs of patients. Expanding knowledge about this technique and its correct application can result in significant improvements in clinical practice, offering patients a better quality of life and dignity in final care.

Introduction: The Integrated Care for Older People (ICOPE) screening tool, advocated by the Pan American Health Organization, brings together six assessments that measure the intrinsic capacities of the elderly: cognitive decline, reduced mobility, poor nutrition, visual impairment, hearing loss and depressive symptoms. Objectives: to test the ICOPE tool on elderly people diagnosed with cancer and to assess their acceptability in relation to the screening tool. Method: a cross-sectional, quantitative study, approved by the institutional ethics committee, in which 80 patients over the age of 60, diagnosed with cancer of any etiology and beginning clinical treatment with antineoplastic chemotherapy and/or radiotherapy took part. Location: Clinical Oncology Outpatient Clinics of a public university in São Paulo, São Paulo, Brazil. Data collection between June 2023 and March 2024. The instruments used were sociodemographic and clinical, the ICOPE Screening Tool and acceptability assessment (domains evaluated: convenience, efficacy, and adherence). Statistical analyses were descriptive. Results: The majority of participants were male (55%), aged between 60 and 70 years (63.75%); diagnosed with gastrointestinal cancer (25%); stages III and IV (63.75%) and performance status - ECOG of 0 and 1 (66.25%). The results of the ICOPE tool tests showed: a low rate of cognitive decline (82.50% approved); reduced mobility (61.25% not approved); 58.75% with weight loss; 11.25% with loss of appetite; 76.25% with symptoms of visual impairment; 51.25% failed the whisper test; 56.25% reported being emotionally well and 88.75% did not lose the pleasure of performing any activity. Regarding acceptability: 90% agreed with the convenience and effectiveness dimensions, which assessed the benefits and ease of answering the ICOPE items; 99% said they felt no fear; 79% expressed interest in taking the test again at another time; but 31% reported not understanding the reasons for some of the tests carried out. Conclusion: The ICOPE Screening Tool revealed lower intrinsic functionalities for tests assessing mobility, weight loss, visual and hearing impairment. Acceptability was very high; however, some respondents did not understand the importance of some tests, which indicates the need for health education in relation to the functional capacities of the elderly.

Introduction: Cancer-related fatigue is a distressing, persistent and subjective feeling of tiredness or physical, emotional and/or cognitive exhaustion. Although it is recognized that fatigue resulting from cancer treatments compromises quality of life, it is not always documented and evaluated. The Advanced Practice Nurse (EPA) promotes active listening, assessing the patient for symptoms, to develop an individualized plan and promote systematic care in all phases of treatment. Objective: To expose the experience of the EPA in the early identification of fatigue, in the guidance and management of the event in patients revealed with gastrointestinal (GIT) tumors, undergoing venous treatment, referral for resolution or non-progression of toxicity, through telemonitoring and in-person consultations at an Oncology Clinic in Rio de Janeiro(RJ). Methods: Quantitative, descriptive, retrospective, and longitudinal study developed by the EPA in Oncology at a private institution in RJ, from December 2023 to May 2024. The sample consisted of adult individuals with GIT exposed to treatment with intravenous chemotherapy. Epidemiological information was collected from the patients. The degree of fatigue was assessed using the CTCAE 4.0 scale (Common Terminology Criteria for Adverse Events), through anamnesis. All data were collected from the Tasy electronic datalake and transported to Excel for subsequent analysis. This project was approved by the Ethics Committee under opinion CAAE: 80441324.6.0000.0227.Result: Fatigue was identified 122 times during the treatment of 55 patients, 26 females and 29 males. The most prevalent degree of intensity was grade 1 (69.6%), grade 2 (28.6%) and grade 3 (1.6%). Consultation and telemonitoring brought efficiency in recording symptoms and early identification, documenting intensity and frequency, facilitating interventions and allowing a low number of hospital referrals (1.6%), with its management being significantly controlled in the home environment. Conclusion: The American Society of Clinical Oncology (ASCO) estimates that between 30% and 60% of cancer patients experience moderate to severe fatigue during the course of the disease and treatment, with the level fluctuating according to the protocol or days of treatment, impacting quality of life. The EPA's role in identifying and managing events related to fatigue brought effectiveness in recording and evolution related to the symptom, with less than 2% of hospitalizations.

Introduction: Li-Fraumeni Syndrome (LFS) is a hereditary cancer predisposition syndrome associated with mutations in the TP53 gene. In the Brazilian population, the R337H variant plays a significant role in cancer predisposition, highlighting the need for early detection and effective management through targeted screening and genetic counseling. Therefore, an analysis of this variant is essential to improve patient outcomes and reduce the burden of LFS-related cancers in Brazil. Goal: To determine the relationship between the R337H variant and Li-Fraumeni Syndrome in Brazil. Method: This integrative literature review was conducted by searching for scientific articles in the PubMed database using the descriptors "Li-Fraumeni syndrome," "screening," "Brazil," and "R337H variant." A total of six articles were found, and five were selected for inclusion in this study. Results: The TP53 R337H variant was identified in 2% of tumor genomic profiles, and its presence was frequently associated with a family history compatible with Li-Fraumeni syndrome (LFS) in Brazil. The median age of patients was 47 years old, ranging from 29 to 68 years old. The most common tumors seen in carriers include adrenocortical carcinoma, breast cancer, central nervous system tumors, lung cancer and osteosarcoma. Even when Chompret clinical criteria were not met, the presence of the variant indicated the need for germline testing and genetic counseling. Germline testing confirmed the presence of R337H, especially for founder mutations. Although rarely reported in international databases, R337H is prevalent in adrenocortical tumors in Brazil, suggesting multiple mechanisms of origin, from acquired mutations to potential germline origins. The detection of R337H in tumor tests should alert healthcare professionals to the need to refer patients for germline testing and genetic counseling, aiming for early detection and appropriate management of LFS and the prevention of cancer among mutation carriers. Conclusion: It is therefore evident that the R337H variant of the TP53 gene is a precursor to the predisposition and genesis of tumors corresponding to Li-Fraumeni Syndrome, in individuals with an average age of 47 years in Brazil. Therefore, even in the absence of clinical criteria for the molecular diagnosis of LFS, complementary germline tests are essential to exclude the syndrome, as well as to support professionals in relation to the prevention or treatment of patients with this mutation.

Introduction: Infections caused by HPV are the main cause of cervical cancer, the third most common cancer in women in Brazil. Among the identified genotypes, HPV16 is one of the most prevalent worldwide, and the study of its genetic variations is essential. Objective: To identify in silico the polymorphisms of the E5 oncogene of HPV16 (E5HPV16). Methods: Sequences were collected from the National Center for Biotechnology Information (NCBI) database using the accession numbers provided by BURK et al. 2013. Subsequently, the multiple alignment of the sequences was performed using the CLUSTALW program, part of the Molecular Evolutionary Genetics Analysis 6.0 (MEGA6) software. Results: The E5HPV16 variants are classified into lineages A, B, C, and D and their sublineages A1 (European, E) – reference, A2 (European, E), A3 (European, E), A4 (Asian, E(As)), B1 (African-1, Afr1a), B2 (African-1, Afr1b), C (African-2, Afr2a), D1 (North American (NA)1), D2 (Asian-American (AA)2), and D3 (Asian-American (AA)1). E5HPV16 contains 252 nucleotides, encoding 83 amino acids. Fourteen polymorphic sites were observed, 7 synonymous and 7 non-synonymous. Considering the complete genome analysis, the polymorphisms were described at positions 3858, 3868, 3967, 3979, 3991, 4017, 4034, 4042, 4043, 4049, 4059, 4077, and 4089. For the E5HPV16 sequence, the polymorphisms were at positions 09, 19, 118, 130, 142, 165, 185, 193, 194, 200, 210, 228, and 240, with 9 amino acid substitutions in the oncoprotein. Conclusion: The literature suggests an oncogenic risk due to these polymorphisms. However, functional studies are needed to assess the impact of these mutations.

Introduction: People with cancer are at increased risk for developing thromboembolic events both due to the disease and its treatment. Studies show that chemotherapy increases the chance of these events occurring. Objective: To identify the incidence of thromboembolic events in people with breast cancer undergoing chemotherapy. Method: Observational, retrospective study, carried out by collecting data from medical records at a reference oncology service in the state of Rio de Janeiro. The sample consisted of 134 medical records of people with breast cancer receiving care at that institution in the period between March 11, 2020 and March 11, 2021. The study was approved under opinions nº: 4,486,636 and 4,509,083. Results: A female population was identified, mostly white and with an average age of 58 years. Of the 134 eligible records, 111 were from women undergoing chemotherapy and, of these, 38 women developed a thromboembolic event. The most prevalent event was deep vein thrombosis. Conclusion: The study showed a high incidence of thromboembolic events in women with breast cancer undergoing chemotherapy, whether as exclusive treatment or combined with other therapies. This finding guides the health team in effective care planning, focusing on actions that minimize complications related to chemotherapy treatment in this population. New factor association studies are suggested in order to identify the most relevant factors in the occurrence of these events in this population.

Introduction: Although advances have been made in laws to guarantee equality and diversity in access to healthcare for gender minorities, there is a lack of guidance on cancer screening and care for this population. The presence of cis-heteronormative assumptions among healthcare professionals can hinder the patient/caregiver relationship. The literature points to the lack of preparation of professionals to serve these minorities and the low level of training offered in health courses on the topic, highlighting the need for specific tools to assess this competence. Objective: Build and validate an instrument to assess health professionals' oncological knowledge about the transgender population. Methods: Methodological study with a quantitative approach carried out in a cancer center located in the state of São Paulo, approved by the Research Ethics Committee (CEP) under no. CAAE: 65531822.9.0000.5432 and consists of four stages: Literature review and construction of the instrument; Validation of content by experts in the field; Pilot test; Psychometric analysis. Using Pasquali's assumptions as a theoretical basis, the construction of the instrument was based on a scoping review on the topic. Validation by experts took place using the Delphi technique. The pilot test was carried out online through the RedCap platform during the months of April to September 2023. Results: A sample of 133 participants was obtained. The Exploratory Factor Analysis indicated an instrument with seven categories that was subjected to Confirmatory Factor Analysis obtaining the following results: P-value (Chi-square) = 0.001; CFI = 0.924; TLI = 0.895; RMSEA = 0.063; SRMR = 0.067. Conclusion: Despite the limitations, the results of this study provide preliminary evidence that the instrument "HEALTHCARE PROFESSIONAL PREPARATION FOR ONCOLOGICAL CARE FOR THE TRANSGENDER POPULATION" is a valid, reliable and culturally appropriate tool.

Background: Acute Myeloid Leukemia (AML) and Myelodysplastic Syndromes (MDS) associated with hereditary predisposition syndromes account for 5-20% of global adult cases. Germline testing is recommended for individuals diagnosed at age 50 or younger, as well as those with a family history or dysmorphic abnormalities. Germline variants in the TP53, CEBPA, GATA2, RUNX1, ETV6, and DDX41 genes are most frequently implicated. The first four genes together explain up to 30% of germline variants in AML and MDS, while DDX41 variants are found in 2.6% of adult AML cases. Ideally, DNA testing would utilize non-blood contaminated tissue samples, such as fibroblasts from skin biopsies, though these methods can be logistically challenging. Somatic testing, being more accessible, can potentially flag germline variants. Aim: Identify potential germline variants in adult AML or MDS patients treated at a cancer center in Brazil. Methods: From July 2022 to July 2024, patients with AML, MDS, mixed phenotype leukemia with a myeloid component, or myeloid sarcoma underwent routine somatic next-generation sequencing using a myeloid gene panel. Somatic variants were retrospectively reviewed. Variants with a variant allele frequency of 30% or higher in the genes CEBPA, DDX41, RUNX1, ANKRD26, ETV6, and GATA2 were considered potentially germline, as well as the c.1010G>A variant in TP53. For patients with additional available tumors, the c.1010G>A variant in TP53 was also assessed in non-hematological tumors. Clinical and pathological data were collected. Results: A total of 45 adult patients were included, with ages ranging from 22 to 83 years (median age: 52 years). Diagnoses included MDS in 26%, myeloid sarcoma in 2%, mixed phenotype leukemia in 4%, and AML in 68%. Eight patients (18%) had potentially germline variants. Two patients had the TP53 variant c.1010G>A: a 22-year-old female with MDS and an 83-year-old male with MDS whose variant was previously identified in a lung cancer sample. Suspected germline CEBPA variants were found in four patients (ages 32 to 70), including one with MDS and three with AML. Additionally, a suspected germline DDX41 variant was identified in a 64-year-old male with AML, and a suspected RUNX1 germline variant was found in a 75-year-old male with AML secondary to MDS. This study underscores the potential of somatic NGS in identifying germline variants in AML and MDS patients. Further research is required to validate this approach.

Introduction: Cancer can significantly alter personal image, leading to socio-emotional impacts. The Image Consulting Service (ICS) provides guidance and practical resources to help minimize or manage potential physical appearance changes in alignment with treatment directives. Interventions include hair care during chemotherapy, cryotherapy, and radiotherapy; counseling on wigs and hair prostheses; restorative makeup; recommendations for inclusive fashion (mastectomy, ostomy); and enhancement of appearance at the end of life. Objective: To describe the ICS integrated within the multidisciplinary team. Method: This observational descriptive study quantitatively outlines the activities of the ICS in the Oncology Department of a Private Hospital. Data were collected for managerial purposes and categorized into a) patient assistance, b) supplier meetings, c) educational activities, and d) institutional event planning. Data are presented in absolute numbers and percentages. Results: Data from March 13, 2018, to August 9, 2024, were analyzed. Of the 2506 patients served by ICS, 94.8% were women. The average age was 49 years for females and 37 years for males, with 96% having an oncological diagnosis. Activities included a) 2506 consultations (69% were recommendations on appearance, mainly hair care per pharmaceutical guidelines, 24% were patient welcoming, and 7% monitoring visits), b) 195 supplier meetings, c) 33 educational activities, and d) 42 event planning sessions. The Net Promoter Score (NPS) for ICS, an indicator of patient satisfaction (0-10), was 9.21. ICS also organized discussion groups for patients, makeup master-classes, and a fashion show involving 18 patient-models and 165 participants. Conclusion: The role of Image Consulting is to positively impact self-esteem and self-care routines, aiming to help patients feel good about themselves during various stages of cancer treatment. An NPS of 9.21 indicates high service satisfaction, adding significant value to humanized care. Among the events held, the fashion show fostered connection and self-esteem, with a positive reception. To our knowledge, no other similar service is integrated within a multidisciplinary team, making this a pioneering initiative in an oncology center.

Background: Pembrolizumab (P) combined with neoadjuvant chemotherapy (CT) is the standard of care for stage II-III triple-negative breast cancer (TNBC) based on the Keynote-522 trial. However, approximately 13% of patients (pts) experience immune-related adverse events (irAEs) of grade ≥3. Objective: This study aims to describe patterns of irAEs in real-world scenarios during P treatment for early-stage TNBC. Methods: The Neo-Real/GBECAM 0123 study is a real-world collaborative study evaluating pts with early-stage TNBC treated with neoadjuvant P plus CT between July 2020 and July 2024 across ten Brazilian cancer centers. This analysis focuses on irAE evaluation, including time to onset, management, resolution, and the association between irAEs and pathological complete response (pCR). Results: A total of 368 pts were included, with a median age of 43 years (range 23-87); 70.9% had stage II and 25.5% had stage III disease. Overall, 31% of patients (n=114) presented with any grade of irAEs. Most of irAEs (73%) occurred during the neoadjuvant phase while 27% happened during the adjuvant period. The most frequent irAEs were endocrine (34.3%), cutaneous (20.4%) and gastrointestinal (19%). A total of 45 pts (12%) experienced grade ≥3 irAEs, predominantly gastrointestinal (34%), with a 22.6% incidence of hepatitis. No fatal irAEs occurred. The median duration of irAEs was 29.5 days (range 2-418). Among the 114 who presented with irAEs, 58 pts (53.6%) needed corticosteroids, and 2 pts required additional immunosuppressive therapy. At last follow-up, 69.9% of irAEs had resolved. Among 31 pts with persistent irAEs, most had endocrine irAE: thyroiditis (17), adrenal insufficiency (4), hypophysitis (2), and diabetes mellitus (1). Immunotherapy rechallenge was possible in 53.6% of cases. Permanent discontinuation of P was necessary for 51 pts (13.9% of those exposed to P). No significant association was observed between irAEs and clinic-pathologic features nor pCR status. Conclusions: In this real-world data analysis, we observed a similar incidence of irAEs as reported in the Keynote-522 trial. Most pts experienced resolution of their irAEs, but a significant proportion required permanent discontinuation of pembrolizumab. Additionally, some pts experienced lasting dysfunctions, particularly endocrine, demanding lifelong support. Careful monitoring and management of these events are essential. Identifying pts who do not require pembrolizumab remains a challenge.

Introduction: The number of patients admitted to Massachusetts General Hospital (MGH) for immune-related adverse events (irAEs) has increased yearly, requiring expertise and collaboration across medical specialties. Specialized teams have emerged as crucial for optimizing patient outcomes and advancing irAE management and research. However, there remains a gap in understanding how to train individuals to lead these specialized teams. Methods: We evaluated the impact of the Severe Immunotherapy Complications (SIC) clinical and translational research fellowship program at MGH over five years. Deidentified and personalized surveys were used to gather feedback from faculty, subspecialists, fellows, and residents regarding their experiences within the program. The SIC fellowship at MGH launched in October 2017 and was the first-of-its-kind SIC service. The program includes six core components: inpatient service, outpatient clinics, network integration, survivorship clinic, research, and mentorship. Results: Fifty surveys were analyzed. Most oncology faculty specialized in melanoma and skin cancers (41%), head/neck cancers (12%), or thoracic oncology (12%), with 94% having attended the SIC service for over a year and 30% for over four years. Subspecialists included cardiology, rheumatology, dermatology, hematology, endocrinology, nephrology, infectious diseases, and allergy and immunology doctors, with almost 80% having been in the SIC service for over four years. All subspecialists agreed that collaborating with the oncology attending and the SIC fellow in caring for patients was “very effective”. Most of them (80%) considered that the collaboration with the SIC fellow contributed to a “very great extent” to their ability to understand the oncology perspective in the management of irAEs. Among fellows and residents, 95% found the academic curriculum effective, and 100% found the clinical experience in the SIC inpatient unit to be “very effective” or “effective” in deepening their understanding of irAEs. Most oncology and subspecialty faculty (92%) considered the fellows equipped to build SIC teams and lead similar efforts elsewhere. Conclusion: Sharing our experience with the SIC fellowship program is vital for advancing clinical programs globally and ensuring future healthcare professions are well-prepared to manage severe immunotherapy complications.

Introduction International guidelines recommend genetic testing and counseling for high-risk hereditary and familial breast cancer to improve clinical decisions and manage cancer risk for patients and their families. Nevertheless, several barriers impact patients' journey, such as prevention, diagnosis, treatment, and risk management. Objective To assess the barriers faced by high-risk breast cancer women in Brazil within the context of the global MAGENTA study. Methods The survey consisted of 38 individualized online questions and was conducted to identify local and regional barriers. The percentage of responses was calculated based on the total number of respondents to that question. Chi-square tests were used when applicable. Herein, we report a part of the results of the survey of Brazilian women and compare them with MAGENTA global findings. Patient advocacy groups disseminated the research. Results The survey was completed by 207 women. Brazilian women underwent more genetic testing than global (81% vs 63%, p<0.001), and 60% received genetic counseling in Brazil vs 35% of the global women ( p<0.001). The median age was 40 vs 47 years and had a higher level of education (high school and beyond, p<0.001). Genetic testing changed their breast cancer treatment in 71% of responders. Although genetic testing increased psychological stress (42%) and treatment costs (20%), 79% of respondents agree that patients diagnosed with breast cancer should undergo genetic testing before starting treatment. Of note, 99% reported not regretting taking the test, with over 90% being willing/very willing to encourage their family members to take it. For 50% of patients, genetic testing was offered after treatment initiation, and the self-awareness of genetic testing and counseling before disease diagnosis was reported as moderate/very low by 89% of respondents. Conclusion Genetic testing directly impacts clinical decisions and patient outcomes. Despite the higher levels of formal education among the women in our study, which do not reflect the general Brazilian population, there remains a critical gap in information regarding genetic testing and counseling. This underscores the urgent need to integrate genetic testing into the patient journey, ensuring equitable access and information across all regions. This reflects the benefits for the whole population, including the public segment.

Background: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly impacting vulnerable populations such as oncology patients. Understanding the epidemiological and clinical outcomes of COVID-19 in this group is crucial for developing effective management strategies. Our study analyzed its impact on Brazilian oncology patients. Methods: This retrospective study evaluated the epidemiological and clinical outcomes of 125 oncology patients with COVID-19 treated at the Cancer Hospital from 2020 to 2022. Data on tumor types, mortality, and associated factors were collected and analyzed. The impact of COVID-19 vaccination on hospitalization and mortality among these patients was also assessed. Results: The most common tumor types were breast cancer and cancers of the hematopoietic and reticuloendothelial systems. Mortality among oncology patients with COVID-19 was significantly higher compared to those who died from cancer-related causes, emphasizing the severity of the infection in Brazilian oncology patients. COVID-19 exhibited a higher lethality in cancers of unknown primary site (metastatic cancer), bronchi and lungs, and bladder. Factors such as age, education level, and smoking history were significantly associated with mortality. A notable association was also found between COVID-19 vaccination and hospitalization among cancer patients. Vaccination not only reduced hospitalizations but also contributed to the survival of cancer patients. Conclusion: These findings indicate the critical importance of vaccination in cancer patients to mitigate the adverse impacts of COVID-19 in this vulnerable population.

Background: Adjuvant chemotherapy with mFOLFOX6 is standard treatment in stage III colon cancer patients. Retrospective data have pointed toward a better toxicity profile without compromising efficacy with omission of bolus 5-FU in metastatic setting. In adjuvant scenario, there is no data about 5-FU omission with toxicity and relapse risk. This study aimed to assess clinical features associated with 5-FU bolus omission and its impact in adjuvant stage III colon cancer patients. Methods: Retrospective chart review of stage III colon cancer patients receiving adjuvant FOLFOX chemotherapy with (bolus) or without (non-bolus) 5-FU bolus from January 1, 2019 through December 31, 2022 at AC Camargo Cancer Center. We analyzed which clinical factors were associated with 5-FU bolus omission and its association with toxicity. The primary endpoint was disease-free survival (DFS). Cox regression multivariable analyses for DFS was performed to adjust for prognostic variables: stage III risk (low – T3 and N1 vs high – T4 and/or N2), 5-FU bolus omission (yes vs no). Results: Data analysis cutoff was July 31, 2024, with 89 patients included in the bolus arm and 26 in the non-bolus arm. Median follow-up time was 37.4 months. No difference was found in median DFS (72.1 vs. 80.8 months, p=0.06) or OS (Not reached vs. 75.7 months, p=0.39) between the bolus and non-bolus arms, respectively. In Cox analysis, 5-FU bolus use was not associated with improved DFS or OS. Regarding factors associated with 5-FU bolus omission, age>70 years (P<0.001) and ECOG 1 (P=0.004) were more common in patients in which the assistant oncologist omitted 5-FU bolus. Regarding safety, 5-FU bolus was associated with increased risk of hematological toxicity grade ≥3 (16.8% vs 0, P=0.02) and all grade 3 toxicity (30.6% vs 3.8%). Conclusions: This is the first study to date that analyzed the impact of empirically eliminating 5-FU bolus in stage III colon cancer patients receiving FOLFOX. Results showed no significant difference in median DFS or OS. Oncologists more often excluded since beginning 5-FU bolus in older and more fragile patients. 5-FU bolus was associated with higher toxicity, especially hematological. The result of this study suggests a consideration of empirically eliminating 5-FU bolus from the mFOLFOX6 regimen to avoid additive toxicities without negatively impacting efficacy.

Introduction: Acute myeloid leukemia (AML) is an aggressive malignant neoplasm marked by abnormal proliferation of hematopoietic progenitor cells. AML’s significant clinical, molecular, and morphological heterogeneity directly impacts therapeutic options and patient outcomes. Recently, genetic profiling, including cytogenetic and molecular analyses, has become essential in diagnosing AML. Beyond diagnosis, genetic profiling is crucial in risk stratification, personalized treatment, and prognosis. Objective: To analyze the impact of genetic profiling on treatment outcomes in AML patients using scientific literature. Methods: Relevant studies published in English between 2014 and 2024 were analyzed, with MEDLINE and Web of Science as primary databases. Only controlled and randomized clinical trials were selected to ensure high scientific evidence. The search strategy included keywords: Acute Myeloid Leukemia; Genetic Profile; Therapeutics. Results: Out of 179 articles, 9 were selected. In 1,280 AML patients (median age 60), dominant mutations in FLT3-ITD/TKD, NPM1, DNMT3A, ASXL1, IDH2, and IDH1 genes were identified. These studies highlight the significant impact of mutational profiles on AML treatment, particularly their negative effect on Event-Free Survival (EFS). Mutations in NPM1 and FLT3-ITD are linked to poor prognosis and resistance to standard treatment. However, a phase I study showed that venetoclax with mivebresib reduced bone marrow blasts and achieved complete remission (CR). A phase III trial pointed that MAPK and FLT3 F691L gene mutations were associated with resistance to gilteritinib, although it was superior to chemotherapy for refractory AML. Decitabine presented lower EFS in elderly patients, possibly due to higher rates of DNMT3A, FLT3-ITD, and TP53 mutations. Gemtuzumab ozogamicin benefits were limited to favorable and intermediate-risk profiles, with no benefits in high-risk categories. CPX-351 had good CR results, particularly when combined with stem cell transplantation or additional induction chemotherapy cycles. Conclusions: Genetic profiling is essential in AML for personalizing treatment and shaping prognosis. Mutations like FLT3-ITD and NPM1 indicate poor outcomes, while venetoclax with mivebresib shows promise in certain subgroups. This study underscores the importance of incorporating genetic profiling into clinical practice and calls for further research on personalized approaches to overcome resistance.

Introduction: Local treatments, such as definitive pelvic radiation or local surgery, are often used to reduce morbidity and tumor progression in metastatic cervical cancer. However, the impact of these treatments on overall survival in stage IVB cervical cancer remains uncertain. Objective: This systematic review and meta-analysis aims to evaluate the effect of local treatment on overall survival (OS) and progression-free survival (PFS) compared with systemic treatment alone in patients with metastatic cervical cancer. Methods: We searched MEDLINE, Cochrane, and EMBASE to identify studies comparing local treatment in stage IVB cervical cancer versus systemic treatment alone up to March 2024. The primary outcomes of interest were OS and PFS. We performed statistical analyses using R Studio and RevMan 5.4.1. We pooled hazard ratios (HR) for OS and PFS and odds ratios (OR) for other binary outcomes with a random-effects model. We defined a significant threshold as a p-value < 0.05. We assessed heterogeneity using I² statistics, with I² > 25% being defined as high heterogeneity. The PROSPERO registration is CRD42024541408. Results: We included six studies with a total of 3,033 patients, of whom 1,311 (43.2%) received local treatment, and 1,722 (56.7%) were in the systemic treatment group. Squamous cell carcinoma accounted for 74.3% of the diagnoses. In the control group, 784 (45.5%) patients received palliative radiotherapy concurrent with systemic treatment. Patients in the local treatment group had significantly better OS (HR: 0.524; 95% CI: 0.355 - 0.772; p=0.001) and PFS (HR: 0.305; 95% CI: 0.098 - 0.955; p=0.042) compared with those who received systemic therapy alone. Partial response (OR: 0.53; 95% CI: 0.10-2.73; p=0.45), complete response (OR: 3.37; 95% CI: 0.00-2394.6; p=0.72), and disease recurrence (OR: 0.38; 95% CI: 0.07 – 1.97; p=0.25) were similar in both groups. Conclusions: Our systematic review and meta-analysis support the use of local treatment, either definitive pelvic radiation or surgery, as part of the management of metastatic cervical cancer. Local treatment significantly improved OS and PFS compared to patients receiving systemic therapy alone.

Introduction: Cervical cancer is a common and well-recognized neoplasm in clinical practice. It has a strong genetic link and is associated with a sexually transmitted disease, Human Papillomavirus (HPV). The prognosis of this disease mainly depends on early diagnosis through specific cytopathological tests such as the Pap smear. Objective: Due to the SARS-CoV-2 pandemic, many patients were underserved due to various factors, such as fear of contracting COVID-19 and social distancing. Consequently, there has been an increase in mortality and cases for several chronic diseases. This study aims to examine whether the pandemic significantly impacted the number of deaths and diagnoses of cervical cancer by comparing pre- and post-pandemic variables. Materials and Methods: We analyzed retrospective data from January 2013 to June 2024 on cervical cancer from the Cancer Information System (SISCAN), hospital morbidity of SUS, and outpatient production, available on the TabNet/DATASUS platform. Data collection utilized R software with the "microdatasus" package (R. F. SALDANHA, 2019), including variables like gender, age, place of residence, procedures, and specific diagnoses. Data analysis was performed using Excel for better organization. Results: From the data collected via R, we observed a total of 65,801 diagnoses of cervical cancer and 10,774 deaths. This value increased from an average of 855.5 deaths annually in the pre-pandemic period (2013-2018) to an average of 1,029 deaths in the post-pandemic period (2019-2024). Additionally, a decrease in preventive exams was observed, especially the Pap smear (cervical cytology), with a reduction of over 90% between the compared periods, from an average of 5,741,338 to 420,692 exams. There was also an increase in the time from diagnosis to treatment, particularly for diagnoses with more than 60 days to treatment, rising from an average of 2,300 patients to 3,300. Conclusion: From the findings, we can demonstrate a pattern of increasing deaths and diagnoses over the period from 2013 to 2024, which was likely exacerbated by the pandemic, given the reduction in the number of exams, the increase in the time till the treatment, and the significant increase in deaths between the two periods. This underscores the urgent need to reinstate incentives for screening and diagnosing cervical cancer.