Trabalhos Científicos

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.

Introduction: Datopotamab duruxtecan (Dato-DXd) is a monoclonal antibody conjugated to a potent topoisomerase I inhibitor, targeting TROP2. Currently, Dato-DXd is employed in the treatment of certain malignancies, including non-small cell lung cancer (NSCLC). The use of this medication, in this context, has brought promising results in objective response rate (ORR), progression-free survival (PFS) and overall survival (OS), along with favorable safety and tolerability profiles, positioning it as an alternative to systemic chemotherapy. Objective: To review the clinical effects of Dato-DXd in NSCLC, as well as to provide data on OS, PFS, response rate, and adverse events. Method: This is a literature review whose content was obtained from the PubMed and LILACS databases, using the following search strategy: the MeSH descriptors "datopotamab deruxtecan" and "Lung cancer" were used, and the Boolean operator "and" was included between them. The search was conducted on August 10, 2024. In PubMed, nine articles were found, while no studies were identified in LILACS. All articles that had a title and abstract consistent with the studied topic were included. Works that were not published in English were excluded. Thus, a sample of 9 articles was reached (n=9). Results: The phase III TROPION-Lung01 trial, which randomized 604 patients with NSCLC into two arms, one to receive Dato-DXd 6mg/kg and the other to Docetaxel 75 mg/m2 every 3 weeks, with a median follow-up of 12.9 months, favoring the Dato-DXd arm, presenting PFS of 5.5 months versus 3.6 months (HR 0.63 - 95% CI 0.51-0.79), with statistical significance (p-value 0.004). The multicenter phase I TROPION-PanTumor01 trial, which included 180 patients with NSCLC, revealed that Dato-DXd, generally used in the third-line of therapy, presented manageable side effects, such as nausea (64% of patients), mucositis/stomatitis (60%), fatigue (28%) and alopecia (42%), with interstitial lung disease or pneumonitis in 6% of patients. Only 10% required dose reduction, and 14% had to discontinue the drug. The same study reported an OS of 11.4 months (95% CI, 7.1 to 20.6 months) and an ORR of 26%. Conclusion: There was promising antitumor activity of Dato-DXd as monotherapy and a manageable safety profile in patients with advanced NSCLC, previously treated with several lines, still obtaining encouraging results.

INTRODUCTION: Mammography is crucial for identifying neoplastic lesions at early stages, allowing for early breast cancer diagnosis and reducing associated mortality rates.METHODOLOGY: A cross-sectional descriptive quantitative study was conducted to assess the incidence of neoplastic breast lesions in Paraíba. Data collection used TABNET tools with access to the DATASUS database from January 2019 to July 2024, as well as the Ministry of Health’s mortality information system (SIM) database from January 2019 to July 2022. The target population consisted of women who had mammograms during this period. Analyzed variables included age, diagnostic findings, and mortality in Paraíba. Incidence rates were calculated based on 347,651 patients who underwent exams between 2019 and 2024, assessing parameters such as the number of mammograms per year, prevalent findings, and age groups by service location.RESULT: For women aged 40 to 60, there was a 2.4% decrease in the number of exams from 2019 to 2022. During this period, worse prognosis mammographic findings increased by 15%, with cancerous lesions and Category 3 findings being most prominent. Additionally, there was an 8.9% increase in mortality rates for this age group.CONCLUSION: The temporal overlap of decreased exam rates, increased worse prognosis findings, and rising mortality rates for breast neoplasms in women aged 40 to 60 in Paraíba underscores the health impact of reduced screening policies and worsening quality of life due to delayed cancer diagnosis. There is an urgent need for increased governmental efforts to promote breast health among women in Paraíba.

Introduction: To an effective evaluation of hereditary predisposition to cancer, it’s necessary to have a detailed personal and family history, of at least three generations from maternal and paternal sides, to be able to suspect the diagnosis of one or more syndrome of hereditary cancer even before of molecular tests, in addition to understanding the biopsychosocial needs of each patient Objective: Show the benefits gathered in a cancer genetics risk assessment clinics after the implantation of nursing consultation prior to the first medical evaluation. Methodology: Analysis of the proposed operational procedure to implantation and following up of procedures carried out over a week to guarantee agreement. Results: All patients scheduled to the first evaluation of cancer genetics risk assessment received a link to answer questions about personal and family history, followed by orientation to go through an online appointment with the nurse navigator before the first evaluation with a clinical geneticist. Prior to the nursing appointment, the nurse prepares the patient's pedigree with the information received. During the consultation he validates the information, in addition to seeking further details about the history and evaluating the patient in his biopsychosocial aspects. The main gain was an increased precision of the pedigree for consultation with the geneticist. With the guidance of the nurse, patients sought the information necessary for medical consultation. During the nursing appointment, it was also possible to identify patients who needed help obtaining health insurance coverage and the urgency of each case, facilitating patient flow. Another indirect gain was the patient's bond with their care team. Conclusion: The specialist nurse is an essential component for cancer genetics risk assessment. The nursing consultation prior to the first medical evaluation is one moment in which this professional can contribute to counseling, within their responsibilities, participating in data collection and patient education process, promoting gains in the quality of care.

Introduction: Breast cancer is the most common type of cancer among women in Brazil, second only to non-melanoma skin cancer. In the case of advanced disease, even without a curative perspective, there are treatment options that aim not only to increase survival but also to relieve symptoms and improve or maintain quality of life. It is well established in the literature that patients with advanced disease who have not received prior treatments, express hormonal receptors, and are postmenopausal benefit from the addition of an aromatase inhibitor (AI) with a CDK4/6 inhibitor. Objectives: To analyze progression-free survival and the safety of using AI combined with ribociclib (a CDK4/6 inhibitor) over 18 months in a group of 25 patients with metastatic luminal breast cancer in the first line of treatment. Methods: This is an observational, longitudinal, retrospective study designed to evaluate progression-free survival and the safety of using ribociclib combined with AI in hormone receptor-positive, HER2-negative metastatic breast cancer patients in the first line of treatment at a public institution in Belo Horizonte, Minas Gerais, Brazil. Recruitment occurred in 2023, selecting 25 patients who had not been exposed to other systemic treatments in a metastatic setting and who agreed to participate in a partnership with Novartis, which committed to providing ribociclib to the 25 selected patients until disease progression, toxicity, or incorporation of the technology into the public health system. Data were collected anonymously from medical records, following the ethical principles defined by Resolution 196/96 on research involving human subjects in Brazil. Results: The analysis included 24 female patients and 1 male patient, with a mean age of 56 years. After 18 months of follow-up, 16 patients (64%) continued using the therapeutic strategy, 6 patients (24%) experienced disease progression, and 3 patients (12%) had dose-limiting toxicities. Of the 16 patients currently on ribociclib, 9 (56.25%) are using 600 mg of the drug, and 7 (43.75%) have had dose reductions due to adverse effects, primarily afebrile neutropenia. No hepatic or QT interval toxicities were recorded. Conclusion: The use of ribociclib combined with AI has proven to be a safe and beneficial therapeutic addition in controlling advanced breast cancer, with data consistent with previous randomized studies in a real-world setting

INTRODUCTION: The need for a palliative care (PC) team in oncology reference centers rises in the sphere of Brazilian public health and increasingly, the population and health professionals unite in favor of a humanitarian philosophy that aims to provide care to affected individuals diseases that represent a potential threat to life. OBJECTIVE: The study aims to develop a conceptual map for the implementation of a hospital palliative care service in a High Complexity Oncology Treatment Unit (UNACON) of a public hospital in the northern region of the state of Rio Grande do Sul, in addition to presenting a bibliographical review on the topic, assisting in a possible future scenario of implementing this service METHODS: Through a retrospective, observational, analytical and descriptive study, through the collection and quantitative and descriptive analysis of data, collected through the Hospital Cancer Registry (HCR), in the public domain, of cancer patients receiving care at the UNACON location under study between 2015-2020. For data description, calculation of absolute and relative frequencies of categorical variables was additionally used, in addition to analysis of variance, in which p values lower than 0.05 were considered significant. The program used was SPSS, version 23. RESULTS: According to the mapping of PC services in Brazil, the majority of these services were concentrated in the Southwest region (58%), Northeast (20%) and South region (14%) and the majority of PC centers recently started their activities between 2011 -2018. Epidemiological data related to UNACON in a study between 2015 and 2020, reveal that the average age range of care remains constant, with the highest range demonstrated in the period of 64,14 years in 2015. There were fluctuations between hospital records depending on the number of patients: 1.138, 1.045, 1.031, 1,002 and 1.047 between 2015-2020. Furthermore, only in 2018 was the number of cases by gender of care higher for females, n=506 and n=496 for males, and the general percentage throughout the study period of female individuals was 47,9% and males of 52,1%. CONCLUSION: Thus, it can be inferred that a researched institution presents sufficient criteria to include a PC service, together with its UNACON, corroborating the quality of life of patients. However, several challenges must be overcome, such as scientific improvement and hospital management in the context under study.

Purpose Molecular classification of endometrial cancer (EC) has emerged as a key approach to individualize therapy and define prognostic outcomes. This study aimed to implement the traditional ProMisE classification in a Brazilian population, compared with a molecular setting of ProMisE biomarkers, and evaluate its impact on patients’ prognosis. Patient and Methods A prospective cohort of 114 patients with primary EC treated at Barretos Cancer Hospital (BCH) between October 2020 and December 2022 was conducted. Pathology diagnosis, staging, treatment, and follow-up data were collected. The traditional ProMisE methodology was carried out by POLE hotspot sequencing and immunohistochemistry (IHC) for p53 and mismatch repair (MMR) proteins. We further evaluate the MMR and TP53 status by molecular approach, namely microsatellite instability (MSI) by PCR-based and TP53 mutation analysis by next-generation sequencing (NGS). The results of the 4 molecular groups in both methodologies were compared regarding agreement accuracy and survival outcomes. Results Among the 114 cases, the traditional ProMisE groups were: POLEmut 15.8%, MMRd 28.1%, p53abn 27.2%, and no specific molecular profile (NSMP) 28.9%. Considering the molecular classification approach, we observed a POLEmut group of 15.8%, MSI group of 23.7%, TP53 mutation of 27.2%, and NSMP of 33.3%. Importantly, both traditional and molecular ProMisE approaches were associated with significant distinct outcomes, with POLEmut patients exhibiting a better prognosis, whereas the p53abn/TP53 mutated having a worse survival time. Conclusion We reported for the first time the Brazilian profile of the ProMisE classification of endometrial cancer and demonstrated the prognostic impact of the traditional and molecular ProMisE classification on patient outcomes.

Introduction: The term "cancer survivor" can have various meanings in the literature. Most commonly, a cancer survivor refers to anyone who has been diagnosed with cancer¹,². There are over 32 million cancer survivors worldwide, and this number is expected to continue growing. However, both human and institutional resources are limited and must be used rationally and optimally. Given this duality, our initial plan was to develop an institutional protocol for the safe discharge of patients from specialized primary care settings. Thus, this integrative review aims to examine the current literature on transitional care from the oncology care team’s perspective. Objective: To examine the current literature on transitional care from the perspective of the oncology care team. Method: An integrative review of articles from the LILACS and BDENF/BVS, MEDLINE/PubMed, and Scopus databases was conducted using the descriptors "Cancer survivor," "Transitional Care," and "Primary Care." Eligible articles were reviewed to synthesize findings. The review followed the five stages of integrative review methodology: problem formulation, literature search, data evaluation, data analysis, and presentation. Results: The initial search yielded 29 articles. One duplicate article was removed, and 28 articles were subjected to a title and abstract review. Only 14 articles met the inclusion criteria. Conclusion: Transitions of care between cancer specialists and primary care physicians (PCPs) require ongoing improvement. The transition is a complex process during which patients, the oncology care team, and the primary care team may face unpredictability, partly due to the lack of evidence-based models. Barriers include the need for improved communication, knowledge/information sharing, financial toxicity, and resources for quality survivorship care. A survivorship care plan could enhance communication between cancer specialists and PCPs, improve survivors' receipt of cancer-related care, reduce costs, and support preventive care. Advancements in survivorship care education may lead to more effective care coordination and smoother transitions in the future.

Introduction: Breast cancer is one of the most prevalent forms of global cancer, being especially common among women. In 2015, the National Cancer Institute (INCA) published guidelines for early detection of breast cancer in Brazil. Besides that, the diagnosis still occurs in advanced stages and the mortality rates remain high. This raises questions regarding the limits imposed by the current protocol of the Ministry of Health, that advocates the start of screening for breast cancer only from the age of 50. Objectives: Analyze the epidemiological aspects of the incidence of breast cancer incidence in Brazil between 2019 and 2023 and to question the effectiveness of the conventional age for screening. Methodology: The study is a descriptive epidemiological analysis, using data from DATASUS (TABNET) between the years 2019 and 2023. The age group was used as a parameter to assess the incidence of breast cancer in Brazil. Results: Between 2019 and 2023, 65,385 cases of breast cancer were reported in Brazil. The highest incidence was observed in the age groups of 50 to 54 years (13.5%), 55 to 59 (13.4%) and 60 to 64 (12.6%), with a gradual increase in cases from adolescence until the peak in the mentioned ages. A decrease in incidence was observed after the age of 65, but cases remain prevalent in older ages. In the age group of 45 to 49 years, 8,103 cases (12.3%) were recorded, a relevant incidence for an age group not included in the Ministry of Health's screening protocol. There were also 6,605 cases (10.1%) in the age group of 40 to 44 years and 3,851 cases (5.8%) in the age group of 35 to 39 years. Conclusion: The incidence of breast cancer in Brazil over the past five years has shown a significant increase among women under the age of 49, who are currently not included in the mandatory screening guidelines set by the Ministry of Health. This study observed a marked and relevant increase in the age group of 40 to 49 years, despite the predominance of cases among those aged 50 to 54, followed by a decrease in incidence in those over 65 years. In this context, it is reasonable to consider that early breast cancer screening, before the age recommended by the Ministry of Health, which starts at 50, would be beneficial for the Brazilian population. Including younger women in the screening protocol could improve early detection and treatment of the disease.

INTRODUCTION: Cancer is one of the major malignant diseases that significantly impacts global public health and exhibits complex patterns of incidence and mortality. Over the past 10 years, cancer incidence in Brazil has shown significant variations influenced by age and sex. Therefore, it is crucial to conduct a comprehensive analysis of the data related to cancer incidence in Brazil. OBJECTIVE: To analyze and understand data related to cancer incidence in Brazil over a 10-year period, based on the data provided by DataSUS. The goal is to quantify, examine, and compare the variations according to age group, geographical region, and sex through epidemiological analysis. METHODOLOGY: Data available from the DataSUS Tabnet from 2019 to 2023 were collected. The data selection criteria included those related to sex and age group available during the same period. RESULTS: From 2019 to 2023, 1.676.147 cases of breast cancer were recorded in Brazil. The highest incidence was observed in the age groups of 60 to 64 years (13.2%), 65 to 69 years (12.9%), and 55 to 59 years (11.7%), with a gradual increase in cases from adolescence to the highest rates in these age ranges. There was a decline in incidence after age 69, although cases remained prevalent in older ages. Notably, 315.908 cases (7.4%) were recorded between 45 and 49 years, 252.956 cases (5.9%) between 40 and 44 years, and 191.775 cases (4.5%) between 35 and 39 years — age groups not included in the mandatory screening by the Ministry of Health. CONCLUSION: Over the past five years, there has been a significant increase in breast cancer cases among women under 49 in Brazil, an age group currently not covered by the mandatory screening by the Ministry of Health. The highest incidence occurs between 50 and 54 years, followed by a decrease in cases among those over 65. These data suggest that early screening, before age 50, could be beneficial for the population, allowing not only for detection but also for more effective interventions.

Patients accessing the public health system often present with more advanced stages of breast cancer at diagnosis and appear to have a worse prognosis. The present study aimed to identify the profile of breast cancer patients accessing the Unified Health System (Sistema Unico de Saude; SUS) Oncology Service in Rio de Janeiro, Brazil, as well as their histopathological and immunohistochemical characteristics, access to treatment, and percentage of deaths during the evaluated period. Patients with a diagnosis of breast cancer confirmed by histopathology and immunohistochemistry between January 2022 and September 2023 were included in the study. Patient data were recorded in Microsoft Excel spreadsheets and analyzed for the frequency of observed variables. The percentage of deaths that occurred during the studied period was recorded in February 2024. The study included 106 patients with confirmed breast cancer diagnoses, 105 of which were females with mean age of 59 years. Most patients (52.83%) were at stage III (p<0.0001), followed by stage II (27.3%), stage IV (12.26%), and stage 0 (4.7%). The most common type of breast cancer was invasive carcinoma of no special type (73.6%), followed by lobular (10.5%), micropapillary (6.6%), mucinous (2.8%), cribriform (0.9%), and metaplastic (0.9%). The remaining patients had in situ carcinoma (4.7%). Half of the patients had luminal B subtype (p<0.0001), followed by luminal A (22.7%), triple-negative (11.3%), triple-positive (9.4%), and HER2-enriched (6.6%). The majority of patients (53.7%) received neoadjuvant or adjuvant chemotherapy, whereas 13.2% received palliative chemotherapy and 33% did not receive any chemotherapy. All luminal patients received hormonal treatment, except those at stage 0 (in situ). All ten triple-positive patients and four of the seven HER2-enriched patients were treated with HER2 blockers. Five patients died (4.7%) during the studied period, four of which were stage IV and receiving palliative chemotherapy. Most patients had luminal B and stage III breast cancer, indicative of a worse prognosis in terms of response to therapies. Nonetheless, access to the hormonal and anti-HER2 drug therapies available through SUS likely had a positive impact on the short- and medium-term follow-up of these patients. Early diagnosis of breast cancer and facilitated access to specialized public health services can result in long-term benefits and cost reductions for the country.

Introduction: Cancer registries are essential for epidemiological analyses, public health planning and quality of care evaluation. Most of its data come from hospital-based cancer registries. In Brazil, following National Cancer Institute and World Health Organization standards, basic sociodemographic characteristics on these databases originate from administrative records. Brazil has a regulation for filling out the race/skin color question in health information system forms since 2017. Racial disparity in cancer care and outcomes is one of the greatest challenges that Brazil faces. A great amount of information and analyses to understand and deal with this disparity comes from secondary data as cancer registries. Objective: To compare self-reported skin color to race/skin color reported in the same patient's hospital cancer registry. Methods: This is a cross-sectional study of breast cancer patients. A review of electronic medical records was performed including all patients whose treatment for breast cancer began in 2022/23. Skin color self-reported data was obtained from a cancer center retrospective cohort study that analyzed time between diagnostic and first treatment. Results: We retrieved 176 cases where women self-reported skin color. Mean age was 61, ranging between 27 and 87 years old. Concordant data was seen in 86,9% of the records. In this sample, 40 patients (22,7%) self-reported as black (the aggregation definition of the IBGE Brazilian categories for “preto” and “pardo”), even though only 15,9% was registered as non-white patients. Among the 23 discordant color identification, 56,5% was a misclassification of black patients to white. There was just one patient that was classified the other way around, she self-reported to be white and it was registered as “Pardo”. The discordant data left was inside the black category (“preto” to “pardo” and vice-versa). Discussion: We found almost 7% of relevant discordance rate. This is different from American and English studies, whose records and self-reported data did not agree on around 5% of cases. The precision of this data is crucial to study disparity in cancer care. Although this is a small, selected sample, probably, it represents the race/skin color information quality on cancer registries. Understanding the source of inconsistency is extremely relevant to improve sociodemographic information in medical records. More Brazilian studies are necessary to confirm these results.

Introduction: Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer characterized by erythema, edema, and skin changes such as nipple inversion and peau d'orange. These symptoms are primarily due to the presence of numerous dermal tumor emboli that obstruct lymphatic drainage. Despite the distinct symptomatology between IBC and non-IBC, the molecular differences between these two forms of breast cancer remain largely unexplored. The Advanced Glycation End Product Receptor (AGER/RAGE) is a transmembrane receptor overexpressed in various cancers, is associated with epithelial-to-mesenchymal transition, and has been implicated in breast cancer pathogenesis. The overexpression of AGER is linked to rapid tumor progression and metastasis. Objective: To measure and compare the levels of AGER expression in patients with IBC and non-IBC. Method: Indirect immunofluorescence was analyzed in 35 samples (19 IBC and 16 non-IBC). Both sample types were stained with DAPI, which binds to the nuclear area, and an anti-AGER monoclonal antibody, which binds to the receptor. Four fields were selected for each sample, and AGER expression was quantified as a percentage of the immunofluorescence intensity area. The expression data and clinicopathological parameters were compared, including the prognostic values of these biomarkers. The transcriptomic data of IBC and non-IBC microarray data from the Gene Expression Omnibus repository (GEO) were used to investigate the expression of AGER genes. Results: Tumor samples from IBC patients showed higher AGER immunoexpressions than the non-IBC group and were associated with obesity and Ki-67 expression (p <0.05). AGER expression in IBC versus non-IBC was also statistically associated with triple-negative molecular subtypes. External validation by analyzing three external GEO datasets confirmed the higher expression of AGER in IBC than in non-IBC samples. Conclusion: Overall, tumor samples from IBC patients showed higher AGER expressions than other breast cancer types.

Introduction: Lung cancer is the most common cancer diagnosed worldwide (excluding nonmelanoma skin cancer) and is the leading cause of global cancer related deaths. In Brazil, it is the fourth most common cancer, with an estimated 32.560 new cases a year. A lack of standardization in systemic cancer therapy among patients in the public health system can lead to inequalities in outcomes. Objective: This study aims to identify differences in systemic cancer therapy comparing treatment protocols among institutions and with the protocol recommended by the Brazilian Ministry of Health (MS), the World Health Organization (WHO), Essential Medicines List, the Magnitude of Clinical Benefit Scale (MCBS) from the European Society for Medical Oncology (ESMO) guidelines. Methods: Between September 2023 and January 2024, a national cross-sectional study was conducted by requesting systemic lung cancer therapy protocols from all public cancer centers, using Brazil’s Freedom of Information Law (Law nº 12.527/2011). Results: A total of 95 responses from all five regions cancer centers were received and 43 regarding lung cancer protocols. In the adjuvant setting of patients with NSCLC without driver mutation, the treatments offered are 100% adequate considering availability of chemotherapy, but only 6% of the cancer centers offer immunotherapy. In the setting of definitive treatment with concomitant chemoradiation, none of the centers offer immunotherapy, but all of them offer the proper chemotherapy regimens. In the metastatic setting, 100% of the centers comply with the chemo regimens, and 51% of the centers offer targeted therapies for EGFR mutations, and 2% for ALK fusion (treatments that exclude 2nd or 3rd generation drugs, such as Osimertinib, Alectinib or Brigantinib). Furthermore, no center reported offering treatment with targeted therapies for molecular alterations including ROS-1, RET, MET, HER-2, BRAF, NTRK and KRAS G12C. Conclusion: Within the context of outdated guidelines by the Ministry of Health, cancer centers do offer all chemotherapy drugs. Only half of the centers offer the recommended EGFR-targeted therapy. Immunotherapy, not yet recommended by the MH or by WHO-EML but universally recommended by international guidelines such as ESMO, has very limited availability among the cancer centers. The observed inequality contradicts one of the cornerstones of the Brazilian public health system and warrants further discussion of this issue.