Trabalhos Científicos

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.

Background: Colorectal cancer is the third most common neoplasm, being treatable and potentially curable if diagnosed early. Adjuvant chemotherapy with oxaliplatin is debated for patients with stage II colon cancer with poor prognostic features such as obstruction or perforation, stage T4, resection of less than 12 lymph nodes, unfavorable histology. Objective: To evaluate the effectiveness of adding oxaliplatin to adjuvant chemotherapy in patients with stage IIA colorectal adenocarcinoma with less than 12 resected lymph nodes, IIB and IIC, given the controversy in the literature. Methods: An observational, analytical, retrospective cohort study was conducted. Data were obtained from medical records of two oncology hospitals in São Paulo, Brazil. Patients diagnosed with colorectal adenocarcinoma were eligible; ECOG 0 to 2; stage IIA with less than 12 resected lymph nodes, IIB and IIC, submitted to curative surgery; distal tumor more than 12 cm from the anal verge by endoscopy and/or above the peritoneal reflection at surgery; absence of gross or microscopic evidence of residual disease after surgery. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was overall survival (OS). Results: From 2014 to 2020, 32 eligible patient records were identified. Of these, the median age was 65 years, 53.1% men and 68.8% with ECOG 0. The left colon was the predominant location (28.1%), rectosigmoidectomy the most common surgery (43.8%) and 28.1% had less than 12 resected lymph nodes. Recurrence occurred in 28.1%, mainly in the lungs (12.5%). Most received adjuvant chemotherapy with oxaliplatin (62.5%). Survival analysis showed a median PFS of 70.9 months and OS greater than 105 months from the start of treatment. There was no significant difference in PFS between patients according to the number of resected lymph nodes, or in OS between those using oxaliplatin or not. Conclusion: Adjuvant oxaliplatin increases disease-free survival and overall survival in patients with colorectal adenocarcinoma EC IIA with less than 12 resected lymph nodes, IIB and IIC, although there is a need for controlled and prospective studies as it was noted that the literature is still is not unanimous as to the results.

Introduction: Pancreatic cancer ranks 14th among the most common types of cancer in Brazil. In 2021, it was the 5th and 7th cancer with the highest mortality in women and men respectively. Objective: To analyze the epidemiological profile and incidence rate of pancreatic cancer in Brazil from 2013 to 2023. Methods: This is an ecological, quantitative and descriptive study on cases of pancreatic cancer in the period of 2013-2023 in Brazil. Data was obtained through DATASUS. Sex, age group, region and staging were analyzed in relation to CID 10 C25. Incidence rates were calculated based on data from the Population Projection of Brazil by sex and age for the period 2010-2060 (2018 edition), available through IBGE. Results: In the period analyzed, 34,144 new cases of pancreatic cancer were recorded, of which 49.7% were men and 50.3% were women. The number of cases increased during the period analyzed, with 1,752 cases in 2013 and 4,716 cases in 2023. The age groups with the highest number of cases were 60-79 years old (55.0%) and 40-59 years old (35.6%). Most of the diagnoses described were clinical stage IV (40.4%), III (11.0%), II (5.3%) and I (2.1%). However, 39.4% of diagnoses were staged as unknown (21%) or not applicable (18.4%). The incidence of pancreatic cancer in Brazil increased in the period analyzed, from 0.88 cases per 100,000 inhabitants in 2013 to 2.2 cases per 100,000 inhabitants in 2023. The incidence rate increased in all variables evaluated. In the analysis by gender, there was a similar increase in the incidence of both genders during the period analyzed. In the analysis by age group, the 60-79 age group stands out, with an increase from 4.67 to 9.48 cases per 100,000 inhabitants. Conclusion: The incidence of pancreatic cancer in Brazil increased during the period analyzed. The incidence was similar between genders but was higher in the 60-79 and 80+ age groups. Other Brazilian and global analyses also showed an increased incidence in older patients, but there were differences in relation to gender (some with no difference between genders and others with a higher incidence in women). The underreporting of Brazilian data regarding cancer and the use of a projection of the Brazilian population to calculate the incidence represent limitations of our study. Due to the increased incidence of pancreatic cancer, normally diagnosed at advanced stages and high mortality, it is urgent to improve screening and earlier diagnosis.

Introduction: Melanoma is a skin cancer originating in melanocytes. Its clinical characteristics are asymmetric lesions with irregular edges, variable color, diameter greater than 6 mm, and rapid changes in their characteristics. Some of its risk factors are excessive exposure to the sun and previous or family history of skin cancer. Melanoma can cause metastasis to lymph nodes, lungs, and brain even when the epithelial lesion is small, which increases the chance of later diagnosis and worse prognosis. Objective: To analyze the increase in the number of deaths from melanoma in Brazil between 1996 and 2022. Method: This is a descriptive epidemiological study of the type of survey, using data from the Mortality Information System (SIM) available in the SUS database, TABNET. We collected data about the deaths caused by melanoma (CID C43) considering Brazilian federal units and regions, gender, ages, race/skin color, and education from 1996 to 2022. We correlated this data with the number of inhabitants according to the Brazilian Institute of Geography and Statistics. We analyzed the data through descriptive statistics through proportional distribution per 100.000 inhabitants. Results: The average mortality rate from melanoma in Brazil between 1996 and 2022 was 19.79. Males had a higher mortality rate in all years, federative entities, color/race, and age group (23.15). However, when analyzing the number of deaths (ND) in patients without education, females were higher (54%). The average female mortality rate was 16.57. Mortality increases with age, reaching 238 in patients aged 80 or over. The white race had the highest mortality rate (32.56), followed by yellow (7.46), black (5.72), brown (5.17), and indigenous (2.19). Mortality in 2022 increased by 181% compared to 1996. White color/race had a peak of ND in the range of 4 to 7 years of education, while black and brown in the range of 1 to 3 years. The region with the highest ND was the Southeast (47%), followed by the South (34%), Northeast (12%), Central-West (5%) and North of Brazil (2%). Conclusion: There was an increase in melanoma mortality over these 27 years in Brazil. This study identified the level of education and race as vulnerabilities to death, as well as the relationship between the female gender and lack of education. These topics can be better explored in new studies. There is a necessity for a greater investment in public policies with an emphasis on early diagnosis and treatment.

Introduction: Tongue cancer is considered a malignant neoplasm of the head and neck, with squamous cell carcinoma being the most common histological type. Major risk factors include smoking and excessive alcohol consumption, with a lesser incidence associated with human papillomavirus (HPV) infection and poor oral hygiene. Initial symptoms are often subtle and may include a non-healing sore, dysphagia, and local pain. Objective: Analyze the number of deaths due to tongue cancer in Brazilian regions between 2015 and 2022, emphasizing the distribution by gender and age group. Methods: An ecological study on the number of deaths from tongue cancer between January 2015 and December 2022, based on data from the Mortality Information System (SIM) on the website of the Department of Informatics of the Unified Health System (DATASUS). The selected variables were: Gender, age group, region, deaths by residence, ICD-10 C01 (Malignant neoplasm of the base of the tongue), and C02 (Malignant neoplasm of other and unspecified parts of the tongue). Results: During the analyzed period, 14,928 deaths from tongue cancer were recorded, with the majority registered in the Southeast region (51.53%), followed by the Northeast (22.64%), South (15.76%), Midwest (6.04%), and North (4.03%). From 2015 to 2022, the number of deaths rose by 13.46%. Mortality was more pronounced in males (78.49%). Regarding age group, the peak of deaths was recorded in the group that is between 50 and 69 years old (58.44%), followed by those older than 70 years (28.47%), and finally, those younger than 40 years (13.02%). Conclusion: The rising number of deaths from tongue cancer poses a significant challenge in head and neck oncology due to the difficulty of early diagnosis, given its often subtle initial symptoms. The Southeast region experiences the highest number of deaths, likely due to its dense population and metropolitan lifestyle. The higher mortality rate among males may be linked to their greater use of tobacco and alcohol. Most deaths occur in individuals over 50 years old, probably due to prolonged exposure to risk factors. This highlights the need for effective preventive strategies and public awareness to improve early diagnosis and reduce mortality rates.

Introduction: Work-related cancer encompasses all neoplasms caused by exposure to risk agents and situations in the work environment and processes, even after exposure has ceased. In Brazil, this cancer is compulsorily notifiable in the Notifiable Diseases Information System, in accordance with the regulations of the Unified Health System, as part of a national policy aimed at workers' health. Objective: To describe the profile of work-related cancer cases notified in Brazil in 2022. Method: This study describes the profile of work-related cancer cases notified in Brazil in 2022, based on data provided by the Department of Information and Informatics of the Unified Health System. The analysis considered variables such as age, diagnosis, race, gender and occupation, with data organized in Excel tables. Results: In 2022, Brazil recorded 206 cases of work-related cancer, with men predominating (66%) in relation to women. The racial distribution showed that 57% of cases affected whites, 33% browns and 6% blacks. Among whites, the most common neoplasms were skin and breast (14% each). Between brown people, malignant neoplasms of the bronchi and lungs predominated (13%). Among blacks, malignant neoplasms of the bronchi and lungs and the prostate were equally frequent (15% each). The occupations most affected were agricultural workers (36 cases), agricultural producers (26 cases) and bricklayers (19 cases). In the middle of agricultural workers, skin neoplasms (19.4%) and non-Hodgkin's lymphomas (13.9%) were most common. Farmers had leukemia (15.4%) and prostate cancer (7.7%). Bricklayers had a high prevalence of neoplasms of the skin (26.3%) and bronchi and lungs (10.5%). Exposure to UV rays, benzene, formaldehyde, DDT, diazinon, glyphosate, malathion, soot, silica and tar are associated with these cancers. Conclusion: Underreporting is a challenge for understanding the problem and formulating effective public policies. It is crucial to integrate information on occupations and exposures into patient anamnesis to improve case detection and prevention, facilitating the creation of more effective public health strategies.

Introduction: Pancreatic neoplasia, although rarely covered by the media, is highly lethal and ranks among the top five causes of cancer-related death. Its pathophysiology is still uncertain, but known risk factors include smoking, diabetes, aging, obesity, and genetic predisposition. Diagnosis often occurs at advanced stages due to the lack of early symptoms and the location of the organ. Its morbidity and mortality are higher in developed regions, and in Brazil, its incidence has been rising in recent decades, becoming an increasing public health concern. Objective: Evaluate the rates of malignant pancreatic neoplasms in the Southeast region of Brazil in a four-year period. Method: Descriptive and quantitative epidemiological study using data from the SUS Department of Informatics (DATASUS) from 2019 to 2022. Deaths due to malignant pancreatic neoplasms in the Southeast region were analyzed, along with initial incidence data by gender obtained from the National Cancer Institute (INCA). The analysis was conducted using Microsoft Excel. Results: From 2019 to 2022, there were 24,050 deaths due to malignant pancreatic neoplasms in the Southeast region, representing nearly 50% of the total deaths from this disease in the country during that period (48,322 deaths). There was a progressive increase in deaths in the region, from 5,913 in 2019 to 6,278 in 2022. Higher mortality was observed among women, with a continuous rise until 2022 (3,173 deaths), while among men, there was a slight fluctuation, with a decrease from 2,916 deaths in 2019 to 2,809 in 2020, followed by an increase to 3,105 deaths in 2022. These data highlight the epidemiological complexity of pancreatic carcinoma and the importance of surveillance and prevention. Conclusion: The analysis of pancreatic carcinoma deaths in the Southeast between 2019 and 2022 represents nearly half of all deaths from this disease in Brazil. Higher mortality was observed among women, while the rates among men showed variations. The consistent rise in deaths highlights the need for increased investment in further research to better understand the determining factors and to develop more effective therapeutic approaches. Therefore, it is crucial to strengthen screening policies and implement preventive measures, with a greater focus on the Southeast region, and also to adapt them to gender variations and regional disparities to improve clinical management and the overall landscape of pancreatic cancer in Brazil.

INTRODUCTION: Myelodysplastic syndromes (MDS) are a diverse group of clonal disorders that affect hematopoietic progenitor cells, with a risk of developing into acute myeloid leukemia. Although rare, affecting 4.46/100,000 inhabitants/year in Brazil, their high incidence in the elderly highlights the importance of epidemiological studies for a comprehensive view of MDS. It is therefore crucial to know the epidemiological profile of MDS in Brazil between January 2014 and June 2024. Aim: To analyze the epidemiological profile of myelodysplastic syndromes in Brazil between January 2014 and June 2024. METHODOLOGY: This descriptive observational study collected data on MDS from Informatics Department of the Unified Health System (DATASUS), organized by region and variables such as number of annual diagnoses (2014-2024), sex, age group (0-19, 20-39, 40-59, 60-79, 80+), and treatment modalities (surgery, chemotherapy, radiotherapy) and their duration (up to 30 days, 31-60 days, or more than 60 days). Diseases other than MDS were excluded. RESULTS AND DISCUSSION: From January 2014 to June 2024, 9,506 MDS cases were diagnosed, with 5,218 receiving treatment. The incidence was higher in the Southeast, South and Northeast. Treatment rates were lower than diagnosis rates in the South (1,364 diagnosed vs. 1,326 treated) and Midwest (301 diagnosed vs. 351 treated). By age group, the majority of diagnoses occurred in people aged 60-79 (4837), followed by 40-59 (1968), over 80 (1363), 0-19 (677), and 20-39 (661). Chemotherapy was the most common treatment (5,157 cases), with few surgeries (30) and radiotherapies (31). Most treatments lasted up to 30 days (2276), followed by more than 60 days (2080), and between 31-60 days (862). In 4288 cases, no modalities or durations were reported. The number of diagnoses in women was higher in all regions, with 4916 compared to 4590 in men. The higher incidence in the elderly aligns with expectations, but the gap between diagnosed and treated cases suggests a need for better post-diagnostic follow-up and early diagnosis practices. CONCLUSION: There is a need for earlier investigative practices and better post-diagnostic approaches to cover patients with MDS in the public health system, ensuring access to specialized services. Attention to aging as a risk factor, as well as regional and gender disparities, is essential to optimize diagnosis.

Introduction: The lack of data collection on Sexual Orientation and Gender Identity in health instruments makes it difficult to assess the real impact of cancer on the transgender and LGBTQIAPN+ population. However, there is evidence that trans people disproportionately face cancer risk factors. The lack of adequate screening, combined with the increase in these factors, results in a higher incidence of diagnoses in advanced stages, harming the health prognosis of this marginalized population. The biggest challenge for the LGBTQIAPN+ population without access to healthcare is the fear of discrimination by professionals, often based on negative experiences. The literature points to the lack of cultural competence of health professionals in dealing with sexual and, above all, gender minorities. Objective: To map the evidence available in the literature on the instruments/methodologies used to assess the knowledge of health professionals about oncological care for the transsexual people. Methods: A scoping review was conducted following the JBI methodology. The search for studies took place in 2023 and was conducted in seven databases, including studies that answered the question: “What is the level of knowledge of health professionals about oncological care for the transsexual people?” Results: 41 articles were selected that specifically addressed the knowledge of health professionals in caring for the LGBTQIAPN+ population, with a special focus on the trans population. Among them, 18 studies evaluated patients' perception of professionals' knowledge, while others used their own instruments to evaluate considering the global context of LGBTQIAPN+ health. Conclusion: There is no validated instrument to measure the knowledge of health professionals about oncological health aimed at the transsexual people, which highlights the need to develop and validate an instrument targeted at needs.

Palliative Care (PC) is an approach that aims to provide quality of life and prevent the patients and family members suffering in the face of life-threatening conditions, understanding the patient as a biopsychosocial being and integrating physical, social, psychological and spiritual. Despite the movement in favor of implementation of PC, there are still significant challenges to its integration into clinical practice, due to the lack of specialized professionals, resources limitations and the negative stigma that associates PC exclusively with death. Objective: To demonstrate the positive impact in quality of life and survival of cancer patients when undergoing early PC integration on the treatment. Methods: It’s a literature research in which the following health descriptors were searched at PubMed and SciElo: “palliative care”, “advanced cancer”, “early integration”, “quality of life”. 148 results were found through PubMed and 16 through SciElo. After an individual analysis based on the inclusion criteria: scientific articles related to the theme; studies published from 2017 to 2024; in portuguese (BR), and the exclusion criteria: duplicated articles; unfinished articles; paid articles and the ones that did not breach the selected theme, 112 articles from PubMed and 16 from SciElo were included in the study. Results: The early approach of PC, done up to 8 weeks after the diagnosis, can decrease the symptomatology in patients (5,6,7,9,12,13); decrease psychosocial suffering and improve quality of life; besides increasing survival rates (9,11). The efficient communication and the educational support are essential to better the involvement of patients and shared decision making (18). However, the failure of health care professionals in knowing the ideal time to implement this treatment and transmitting an end-of-life connotation to the patient, causing them to not adhere to PC, is the main hindrance to carrying out this early care (2,5,7). Conclusion: According to the analyzed literature, the early implementation of PC in cancer patients is responsible for a reduction in psychosocial suffering, improvement in quality of life and symptom relief, in addition to providing an increase in survival. Thus, the need to introduce this approach early is evident, in addition to a clear and informative conversation with the patient and their family about the credibility and advantages of Palliative Care is important.

Introduction: In December 2019, the SARS-CoV-2 virus and the disease it caused called COVID-19 were identified in China, generating a global pandemic. The severity of the pandemic and the exhaustion of health services required the prioritization of urgent and emergency surgeries and the suspension of elective surgeries, minimizing the spread of COVID-19. Interrupting cancer surgeries poses a potential risk to patients and studies remain scarce. Objective: To analyze the impact of the COVID-19 pandemic on surgical patients with gastrointestinal cancer treated by the Unified Health System SUS in a Tertiary Hospital in the South of Brazil in the year 2020 (COVID-19 Pandemic) compared to the year 2019 (pre pandemic). Materials and methods: Cohort study that evaluated adult patients with gastrointestinal tumors who underwent surgery between the pre-pandemic and pandemic periods. Results: 372 patients with gastrointestinal cancer who underwent surgery were included, of which (54%) during the pandemic and (46%) pre-pandemic. There was a 14% increase in emergency surgeries (P = 0.001); 11% reduction in the need for an intensive care unit (p= 0.034) and a 7-day reduction in hospital stay (P=0.003) during the pandemic, with no impact on 30-day mortality, general mortality or advanced cancer. SARS-CoV-2 infection had a rate of 11.9%, these had a higher overall mortality rate (8 [33%] positive vs 8 [8%] negative, P = 0.003), 30-day mortality (6 [25%] %] positive vs 5 [5.2 %] negative, P = 0.008), and length of stay (mean 57.38 ± 69.47 days for positive vs 30.24 ± 23.91 for negative, P = 0.008). Conclusions: There was no significant impact of the pandemic on overall and 30-day mortality or on the incidence of advanced cancer. We suggest not suspending oncological surgeries during pandemics.