Trabalhos Científicos

Introduction: In Brazil, the incidence rate of soft tissue sarcomas (STS) has shown a significant increase, with approximately 3,400 new cases diagnosed annually. This growth can be partially attributed to advancements in diagnostic techniques, which allow for earlier and more accurate detection of these rare neoplasms. Risk factors such as genetic syndromes, immunosuppression, chronic lymphedema, infections, and occupational exposures may also contribute to the rise in diagnosed cases. Objective: This study aims to analyze the epidemiological profile of soft tissue sarcoma in Rio de Janeiro. Methods: The DATASUS database was utilized, analyzing records from the Mortality Information System (SIM) based on disease classification according to ICD-10. This study is an observational and detailed investigation of deaths occurring over the last 5 years in the state of Rio de Janeiro. For the analysis, criteria such as marital status, year, race/ethnicity, sex, education level, and age were considered. Additionally, data from the metropolitan region of the state were analyzed. Finally, the records were organized using Excel as a tool for data analysis and investigation. Results: In the municipality of Rio de Janeiro, 358 deaths from soft tissue sarcoma were recorded, representing 42% of the total cases in the state. The most affected age group was 60 to 69 years, corresponding to 22% of the cases. Among the recorded deaths, 37% were individuals who were married. The predominant education level was 8 to 11 years, accounting for 32% of the deaths. The white population was the most affected, with 61% of the cases, and the incidence was slightly higher among men, who represented 51% of the cases. Conclusion: The study reveals that the white population and those with lower educational levels are most affected by soft tissue sarcoma. The incidence between sexes did not show significant discrepancies, but there is a direct correlation between increasing age and the number of deaths from sarcoma. Given the rise in mortality, it is essential to better understand the risk factors and analyze incidence trends to improve prevention and treatment strategies, as well as to guide future research in the area.

Introduction: Breast cancer is a complex disease requiring a comprehensive approach for treatment and management. The care pathway for breast cancer patients integrates a multidisciplinary team, focusing on nurse navigators, clinical pharmacy, dentistry, physical therapy, nutrition, and psychology to provide personalized support and enhance treatment quality. Objective: This study analyzes indicators of toxicity, hospitalization rates, recurrence, survival, and contributions from nursing, pharmaceutical, dental, and physical therapy interventions, alongside the distribution of breast cancer subtypes among patients treated in the care pathway. Methods: A retrospective analysis was conducted on data from 17 patients treated between 2022 and 2024. Key information regarding adverse events, hospitalizations, toxicity, recurrences, and age distribution was collected. The nurse navigator's role was evaluated concerning patient monitoring and education. The clinical pharmacy was assessed for medication management and support. Dentistry managed mucositis using laser therapy during chemotherapy, while physical therapy addressed neuropathy through laser treatments and physical activity. Among the analyzed cases, 25% had triple-negative breast cancer, 50% had HER2-positive tumors, and 25% had luminal disease. Results: In 2022, 2023, and 2024, there were 27, 28, and 19 reported events of grades 1 and 2 toxicity, respectively, with no patients experiencing grades 3 or 4. Hospitalization rates remained below 20%, indicating effective management of toxicity. This achievement is due to the collaborative efforts of the multidisciplinary team, including ongoing monitoring by the nurse navigator, medication management by clinical pharmacy, laser therapy from dentistry, physiotherapeutic support for neuropathy, and interventions from nutrition and psychology. The predominant age group was 36 to 45 years, with an overall survival rate of 100%. Conclusion: The multidisciplinary approach within the breast cancer care pathway has proven crucial for optimizing treatment outcomes. Contributions from nurse navigators, clinical pharmacy, dentistry, physical therapy, nutrition, and psychology have improved toxicity management and minimized hospitalization rates, ensuring thorough patient monitoring and education. Strengthening these specialties should remain a priority to enhance patient experience and clinical outcomes.

Background Misdiagnosis or delayed diagnosis of T-DXd-associated ILD/p is common, contributing to increased morbidity and mortality. In Brazil and elsewhere, access to pulmonologists and radiologists specialized in ILD/p is limited. Our study aimed to assess the feasibility of using a digital platform for independent adjudication and real-time management of suspected ILD/p cases nationwide through remote, asynchronous, multidisciplinary discussions. Methods Our digital platform consists of a phone/web-based app, which allows for the uploading of anonymized clinical data and digital images by the referring physician, and asynchronous discussion between specialists (pulmonologists, radiologists, and medical oncologists) through a confidential, HIPAA-compliant chat. For our pilot feasibility study, we extracted data from the first 22 cases of suspected ILD/p submitted through the platform. We focused our analysis on the adjudication rate of ILD/p, time from submission to adjudication (TSTA), and time from submission to formulation of the therapeutic plan (TSTFT). Results Among the first 22 submitted cases, 15 (68%) had clinical, radiological, and laboratory features consistent with ILD/p. Data obtained from independent adjudication committees in a pooled analysis of 9 phase I and II T-DXd studies demonstrate 84.8% concordance in suspected ILD/p cases, while in our study we observed 68% concordance. Confirmed ILD/p cases were grade ≤ 2 (80%) or grade 3 (20%). The median TSTA was 7.84 hours (range 0.30-59.75 hours) and the median TSTFT was 12.23 hours (range 0.33 - 69.08 hours). Conclusions Developing a digital platform for adjudication and management of T-DXd-associated ILD/p was feasible and effective, as evidenced by diagnostic rates consistent with those reported in clinical trials, and abbreviated TSTA and TSTFT. Approximately 32% of patients suspected of having ILD/p had other evident causes to justify the clinical and radiological findings, potentially benefiting from continued treatment. This novel strategy may help mitigate clinical challenges in areas that lack ILD/p experts.

Introduction:The emergency department (ED) of a general hospital presents challenges in providing care to cancer patients. Navigation is a process that can contribute to expediting care, offering patient-centered care, and reducing healthcare costs. Objective: To describe the experience of implementing an oncology navigation process in the adult ED of a private general hospital.Methods: This is an experience report on the implementation of a multi-stage navigation project. In this summary, the focus is on demonstrating indicators related to the time of care during the patient's journey in the ED. The project was implemented in a private general hospital. The team responsible for developing the project identified the cancer patient journey in the ED and selected indicators (total number of visits in the ED and cancer patients; triage time; time to medical care; time to outcome). A nurse who worked in the sector, after intensive training related to oncology navigation, had the following responsibilities: to identify cancer patients who came to the department, coordinate patient care in light of the nursing process, and serve as an interface between the ED and Oncology care teams. The indicators were collected from records in the electronic medical record. Results: We will present the indicators comparing the average between March 2022 and February 2023 (referred to as the pre-project period) and March 2023 (the month of project implementation) through February 2024 (referred to as the implementation period). The average monthly visits during the pre-project period were 10,583 and 11,090 during the implementation period. The average monthly visits of cancer patients were 106.25 during the pre-project period and 238 during the implementation period. The average triage time was 00h06min during the pre-project period and 00h09min during the implementation period. The average time to medical care was 00h43min during the pre-project period and 00h37min during the implementation period. The time to outcome was 11h39min during the pre-project period and 04h12min during the implementation period. Conclusion: With the implementation of the navigation nurse in the emergency department, it was possible to observe a reduction in the time to medical care and time to outcome. Implications for practice: The navigation nurse plays a fundamental role in all care scenarios for cancer patients. In a general emergency department, they can contribute to improving care for patient

INTRODUCTION The treatment of muscle-invasive bladder cancer (MIBC) is complex and requires a multidisciplinary collaboration among surgery, radiation, and medical oncology. Although neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) and lymph node dissection has been considered the standard treatment for MIBC. Determining the optimal treatment for each individual patient with MIBC requires efficient collaboration between healthcare providers. Today, multidisciplinary team meetings (MDTMs) helps in decision-making and treatment decisions about providing personalized therapeutic plans for patients. METHODS A retrospective, single-center cohort study in which patients undergoing radical cystectomy were selected and were subdivided into two groups according to whether or not neoadjuvant therapy was performed. Participants were allocated to two groups according to the implementation of the multidisciplinary team meetings in 2021, 2019 before the meetings and 2022 after. The effects of the discussions between the groups were compared. The results were obtained through statistical analysis (SPSS version 22.0) of several characteristics, such as: time to oncology consultation, time to neoadjuvant therapy, time to cystectomy, time to adjuvant. A secondary objective was to quantify the effect of neoadjuvant on the stage of the tumor. RESULTS Forty patients were selected, nineteen from 2019 and twenty-one after the start of the meetings. Approximately 85% of patients were discussed at the multidisciplinary team meetings. There was an increase in the neoadjuvant therapy rate from 25% to 37,5%. There was a change in the profile of neoadjuvant medications, with more MVAC used in 2022 (0% vs 80%, p=0.071), with no serious complications recorded. The adjuvant therapy rate was higher (26.7% vs 35.7%) and there was a reduction in the median number of weeks for oncology consultation since diagnosis (28 vs 5, p=0.062). Although there was no statistical significance in the times to neoadjuvant therapy and time to cystectomy, there was a trend towards their reduction (7.6 vs 6.2 and 13.3 vs 8.4 weeks, respectively). CONCLUSION Multidisciplinary meetings can positively impact different oncological outcomes, as seen in international series. The results of the present study demonstrated a trend of benefit to treatment after the establishment of the meetings, although the short selection period and number of patients included negatively interfered in this analysis.

Introduction: The colorectal cancer, with adenocarcinoma as its most common histological type, generally develops from adenomatous polyps, which are considered precursor lesions of the neoplasm. It commonly spreads to nearby lymph nodes and progresses to liver metastases. Some of the risk factors include age, family history of colorectal cancer, sedentary lifestyle and the use of alcohol and tobacco. The disease progresses slowly with subtle symptoms, including changes in bowel habits, hematochezia and weight loss. Objective: Analyze the number of colorectal cancer deaths in the Brazilian regions from 2012 to 2022, emphasizing the distribution by gender and age group. Methods: An ecological study on the number of deaths from colorectal cancer between January 2012 and December 2022, based on data from the Mortality Information System (SIM) on the website of the Department of Information Technology of the Unified Health System (DATASUS). The selected variables were: Gender, age group, region, deaths by occurrence, ICD-10 C18 (Malignant neoplasm of the colon), and C20 (Malignant neoplasm of the rectum). Results: During the analyzed period, 181.749 deaths from colorectal cancer were recorded, with the majority registered in the Southeast region (55.27%), followed by the South (20.35%), Northeast (14.67%), Midwest (6.62%), and North (3.07%). From 2012 to 2022, the number of deaths rose steadily, with a growth rate of 47.19%. There was a slight predominance of deaths among females (50.62%). Regarding age group, the peak of deaths was recorded between 60 and 79 years (50.54%), followed by 40 to 59 years (23.76%), over 80 years (22.13%), and finally under 40 years (3.54%). Conclusion: The increasing number of colorectal cancer deaths presents a major challenge in gastrointestinal oncology, as early-stage diagnosis is difficult and patients often seek treatment at more advanced stages. The analyzed data indicate that the Southeast region has the highest number of deaths, likely due to its high population density and urban lifestyle. There was no significant difference in death rates between genders, with peak lethality observed in patients aged 60 to 79 years. This highlights the importance of colorectal cancer screening through colonoscopy in individuals over 45 years old to detect and remove polyps early, thereby improving the chances of cure and extending survival.

Introduction: The practice of clinical oncology in Brazil presents significant challenges, which vary considerably among different regions of the country. These disparities are influenced by a complex combination of socio-economic, structural, and political factors that directly affect the access and quality of treatment offered to cancer patients. Objective: To provide crucial insights for policymakers, healthcare managers, and clinical oncologists, assisting in the implementation of targeted strategies to improve access, efficiency, and treatment quality of cancer treatment by identifying the challenges for clinical oncologists across different regions of Brazil. Method: An observational analysis of the major challenges in practicing as a clinical oncologist in Brazil, according to each region of the country (Southeast, South, Northeast and Central-West/North), based on the SBOC Clinical Oncology Census carried out in 2023, through an online questionnaire, which included 761 oncologists working in the public and private service. Results: Difficulty in accessing new medications (54%) and high treatment costs (46%) were the challenges that most impacted clinical oncologists' work in all regions of Brazil. However, the South had the greatest difficulty in accessing new medicines (65%) and the Northeast had the highest percentage of excess demands via WhatsApp (42%). For the other challenges mentioned in the SBOC Census, no regional differences were observed. In relation to the public and private service, we identified that difficulty in accessing new medicines and late diagnoses occur more frequently in the public service (60% and 42%) compared to the private service (52% and 26%), respectively. On the other hand, excess demand for WhatsApp is more frequently in the private service (35%) compared to the public service (18%). Conclusion: The research identifies key challenges in clinical oncology in Brazil, such as limited access to new medications, high treatment costs, and excessive workload due to constant WhatsApp communication. These issues vary by sector and region. To address them, health policies must be improved at all government levels. Federal policies should enhance medication access and control costs, while state and municipal strategies should address local needs, optimizing communication and workload management. Targeted approaches can improve healthcare access and support oncologists, leading to more effective patient care.

Introduction: Patients with resectable (RT) and borderline (BD) pancreatic cancer still have poor prognosis despite neoadjuvant chemotherapy. Recently folfirinox (FFX) become the preferred scheme, although its use is still debatable, especially for RT patients. Objective: We aim to perform a systematic review and meta-analysis to compare the outcomes of using neoadjuvant FFX versus US for patients with RT and BD pancreatic cancer. Methods: We searched PubMed, Embase, and Cochrane Central for studies comparing neoadjuvant FFX with US for patients with RT and BD pancreatic cancer. The main outcomes of interest were overall survival (OS) and progression-free survival (PFS). Statistical analysis was performed using R statistical software 4.3.2. We considered as significant p-values < 0.05. Results: We included 647 patients from 8 studies, 3 randomized controlled trials, and 5 retrospectives. Of those studies, 3 were related to RT tumors, also 3 to BD, and 2 included both BD and RT. The mean age in the FFX group was 63.76 and in the US group was 65.43 years. The mean follow-up time was 20.4 months. The mean OS was 36.75 months in the FFX group and 27.82 in the control group. Statistical analysis showed a 1-year OS hazard ratio of 0.48 (95% CI 0.13–1.82; p = 0.28). The mean PFS was 12.95 and 15.91 months in the intervention and control groups, respectively, with a 2-year PFS hazard ratio of 0.81 (95% CI 0.44–1.50; p = 0.51). The FFX group presented a lower rate of adjuvant chemotherapy (62.17% vs. 76.36%; OR 0.47; 95% CI 0.23–0.98; p = 0.043), morbidity (54.92% vs. 67.16%; OR 0.81; 95% CI 0.13–5.02; p = 0.822), and reoperation (5.59% vs.11.65%; OR 0.55; 95% CI 0.05–6.53; p = 0.640). R0 resection was achieved in 70.31% of the patients in the FFX group and 75.31% in the US group (OR 0.81; 95% CI 0.16–4.12; p = 0.795). When conducting a proportional analysis, a complete response to FFX was observed in 4.06 per 100 patients (3.24%; 95% CI 1.84–8.76), while a partial response was in 24.32 per 100 patients (25.97%; 95% CI 15.25–36.46). Conclusion: The FFX group exhibited a trend toward higher mean OS, whereas the US group demonstrated a higher PFS, despite not reaching statistical significance. We had a high heterogeneity, which indicates that both RT and BD tumors should not be in the same analysis, as many of the studies did. Therefore, we do not have enough data to recommend the use of neoadjuvant FFX for RT patients, and its use should be individualized.

Introduction: The Central Nervous System (CNS), comprising the brain and spinal cord, is vital for coordinating bodily functions. Tumors in the CNS manifest as various intracranial and spinal neoplasms. Understanding the risk factors of these tumors is crucial for early identification, proper management, and effective preventive strategies. Advances in the identification of neurogenetic biomarkers have the potential to transform the diagnosis and treatment of CNS tumors, enabling early detection, risk stratification, and the development of personalized therapies. Objectives: This study aims to review the literature on risk factors and neurogenetic markers associated with CNS tumors. The focus is on identifying and analyzing how these factors influence the development of neoplasms and how neurogenetic markers can amplify or mitigate their impact on CNS carcinogenesis. Methodology: The systematic review followed PRISMA guidelines. The research was conducted in databases such as PubMed and Web of Science. Studies in English and Portuguese from 2014 to 2024 were included. A total of 26 articles were selected for review. Results: Biomarkers such as MGMT gene promoter methylation, specific genetic variants, and polymorphisms are associated with susceptibility to CNS tumors and chemotherapy resistance. CNS carcinogenesis involves a complex interaction between genetic, environmental, and behavioral factors, such as smoking and alcohol consumption. Advanced sequencing technologies and bioinformatics have been crucial in identifying new biomarkers and understanding the molecular pathways of CNS cancer. These approaches are essential for personalized medicine and the development of more effective and targeted therapies. Conclusion: The review highlighted the complexity of factors contributing to CNS tumors, including genetic, epigenetic, environmental, and behavioral influences. Understanding these factors is essential to improving preventive and therapeutic strategies. The results reinforce the importance of an integrative approach, considering genetic and epigenetic markers. Continued research is necessary to understand the interactions between markers and cancer development, aiming to enhance prevention, diagnosis, and treatment.

Background: The role of the neutrophil to lymphocyte ratio (NLR) as a prognostic factor in metastatic breast cancer (MBC) is still controversial. Our aim was to analyze its importance in survival prediction in recurrent MBC. Methods: A retrospective cohort study including 351 recurrent MBC patients was performed. Clinical and pathological attributes were retrieved from patients' medical files and their importance in the overall survival were evaluated using the Cox univariate and multivariate proportional hazard models. Collinear variables were filtered out to test the final regression model. A confidence interval of 95% was used to select significant variables and the Wald test was used to infer the best NLR cutoff value to discriminate into low and high categories. Results: The median overall survival time was 12.3 months. In univariate analyses, the variables ER expression, PR expression, previously treated with adjuvant chemo, NLR, PLR (platelet-lymphocyte ratio), age at diagnosis and the main metastatic site (bone/lymph node, visceral or central nervous system) variables were significant to determine the hazards. After filtering the collinear variables, the final model was tested with 6 variables based on 295 patients and the NLR, the hormone receptor (ER or PR) status and the age at diagnosis were considered significant (Table 1). The best NLR value to discriminate against patients was 4.42 (Wald test= 46.0) and there were 222 patients categorized as low and 83 as high NLR category. The median overall survival time was 19.5 and 4.4 months in NLR-low and NLR-high groups, respectively (p< 0.0001). Conclusions: NLR is an independent prognostic factor in recurrent MBC patients.

Introduction: Inflammatory cells and their mediators in the tumor microenvironment are thought to have an important role in cancer development and progression in patients with cancer. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are relatively simple parameters that can easily assess the inflammatory state of an individual. They act as prognostic factors in several types of cancer, including breast cancer. Objective: The aim of this study was to investigate the association between NLR and PLR with sociodemographic, clinical, anthropometric, and quality of life factors of hospitalized women with non-metastatic breast cancer. Methods: A cross-sectional observational study was conducted at a reference center for oncological treatment in Southeast Brazil. Female participants aged over 18 years, with a histopathological diagnosis of stage I, II or III breast cancer, in any phase of antineoplastic treatment, were included. Results: We observed a high risk for participants, with high mean values of NLR and PLR, indicating low antitumor activity and worse prognosis. The binary logistic regression model showed that there was a significant association of the NLR marker and marital status (OR=3.1; 95%CI=1.06-8.57; p =0.03) and, in relation to PLR, a trend was shown for a higher chance in women of black ethnicity to have increased PLR compared to white women (OR=4.13; 95%CI=0.96-17.70; p=0.05). However, the inflammatory markers (NLR and PLR) did not show any significant association with nutritional factors. Conclusion: The biomarkers NLR and PLR are important prognostic predictors in breast cancer patients. These biomarkers are easily accessible in clinical practice through a simple blood test.

Introduction: Non-Hodgkin Lymphomas are a group of lymphocytic cancers that can affect B, T and natural killer (NK) cells, and spread in a disorderly manner. Although this neoplasm increases with age, the pediatric population accounts for a smaller proportion, primarily involving subtypes derived from B-cell progenitors. In this context, lymphomas represent the third most common neoplasm in this age group, constituting 60% of Non-Hodgkin Lymphomas cases. Objective: Demonstrate the prevalence of hospitalizations and deaths due to Non-Hodgkin Lymphoma in the children aged 0 to 9 years in São Paulo state from 2019 to 2023, categorized by race, sex and age distribution. Method: This is an epidemiological study with a quantitative, descriptive and retrospective approach on hospitalizations due to Non-Hodgkin Lymphoma, conducted through data extraction from the Department of Informatics of the Unified Health System, covering the time series from 2019 to 2023. The variables included race/color, sex, age and hospitalization. The data was imported from the Hospital Information System into Microsoft Excel, where they were tabulated and used for descriptive statistics. Results: During the analyzed period, 1,314 patients were diagnosed and hospitalized with Non-Hodgkin Lymphoma. The analysis by sex shows higher prevalence in males, with 957 hospitalizations, representing 72.4%. The predominant age group was 5 to 9 years, with 809 children (61.6%). Additionally, the most common races/colors were white, with 735 cases (55.9%), and mixed race, with 444 cases (33.8%). The epidemiological profile revealed important patterns that could be targeted for public health campaigns and interventions for clinical management and early diagnosis. Conclusion: This epidemiological study on hospitalizations due to Non-Hodgkin Lymphoma from 2019 to 2023 shows a significant predominance of hospitalizations among males. Furthermore, there is a high incidence of hospitalizations among children aged 5 to 9 years, with a notable peak in 2019 for this age group. Identifying at-risk groups, such as boys and children aged 5 to 9 years, allows for more effective targeting of efforts and resources, aiming at health promotion and disease prevention. The data highlighted the need for preventive interventions and public health policies focused on these specific populations to reduce the incidence and severity of hospitalizations due to Non-Hodgkin Lymphoma.

The development of chemotherapeutics has been based on the concept that cancer is a cell-autonomous genetic disease. The idea that transformed cells proliferate and invade in an unrestricted manner neglects the fact that malignant cells are embedded within a tumor microenvironment. Paclitaxel is a well-known cytotoxic drug used in the treatment of breast, ovarian and non-small cell lung cancer and its mechanism of action involves cell death of cancer cells through apoptosis. There is evidence that, at reduced non-cytotoxic concentrations, paclitaxel has anti-tumoral biological effects that involve modulation of the microenvironment. In this study, we used a model of oral squamous cells carcinoma (OSCC) microenvironment to assess the effect of a non-cytotoxic concentration/dose of paclitaxel on tumor progression and dissemination. We investigated the influence of non-cytotoxic paclitaxel on cancer-associated fibroblast (CAFs) and monocytes in addition to neoplastic cells. Invasion was assessed in vitro, using 3D cell cultures comprised of OSCC cell lines (SCC9 or H314), monocytes and CAFs. Tumor dissemination was assessed in vivo by injecting SCC9 cells, monocytes, and CAFs into zebrafish larvae, which were subsequently treated for three days with paclitaxel. Outcomes assessed were tumor size, metastasis and phenotype of the cells by immunofluorescence (vimentin and α-SMA). We also used a heterotopic xenograft model in male Balb/c nude mice injected with H314 cells. Fifteen days post-injection, mice were treated with a low dose of paclitaxel or vehicle. After an additional 12 days, mice were euthanized and the tumors were measured and collected. Outcomes assessed were tumor volume, morphology and phenotype of the cells. Tumor tissue were analyzed by hematoxylin/eosin staining (morphology), immunohistochemistry (cytokeratin and ki67), and immunofluorescence (CD80 and CD163). Paclitaxel decreased the invasion of tumor cells in vitro and reduced tumor size and metastasis in vivo. Non-cytotoxic paclitaxel reduced expression of vimentin in cancer cells, and of α-SMA in CAFs/monocytes in the zebrafish model. Monocyte/macrophages were skewed towards an anti-tumoral phenotype. In conclusion, the results demonstrate that paclitaxel has cytotoxicity-independent anti-tumoral effects, reducing tumor progression and dissemination by modulating cells in the microenvironment. Repurposing of paclitaxel in reduced doses may have potential as an adjunct treatment in OSCC.

INTRODUCTION: Breast cancer is one of the leading causes of mortality among women worldwide. Antineoplastic therapy improves survival, but due to its nonspecific cellular effects, patients with this disease experience various adverse effects. OBJECTIVE: This study aims to evaluate the prevalence of chemotoxicity in women with breast cancer and analyze factors associated with its development. MATERIALS AND METHODS: This was an observational cross-sectional study conducted with adult women diagnosed with breast cancer and treated at the Oncology Nutrition Outpatient Clinic of a University Hospital. Socioeconomic data were collected, and clinical and anthropometric assessments were performed. The data were presented as mean and standard deviation or as percentages. Associations were analyzed using the Chi-Square Test, and p-values less than 0.05 were considered statistically significant. The statistical analyses were performed using SPSS 25.0. RESULTS: The study included 41 participants with an average age of 59.1 ± 14.0 years. Most patients had advanced disease (Stage 4, 46.3%). The predominant subtypes were Luminal B (29.2%) and triple-negative (24.3%). Based on current BMI, 61% were overweight or obese. Younger women had a higher average BMI compared to older participants (30.15 ± 6.52 vs. 25.34 ± 4.99 kg/m², p = 0.013). Treatment-related toxicity was observed in 51.2% of women. Gastrointestinal toxicity (52.3%) and general adverse effects (61.9%) were common. Younger age was associated with chemotoxicity (52.29 ± 12.25 vs. 66.40 ± 12.25 years, p = 0.001).Younger women had double the risk of chemotoxicity (p = 0.019; V-Cramer = 0.367; RR = 2.1). CONCLUSION: A high prevalence of chemotoxicity was observed in women with advanced breast cancer. Overweight and obesity were common in the studied sample. Chemotoxicity was associated with younger age.

Introduction: Among the various physical changes experienced by women, the impact on nutritional status is noteworthy. For some women, breast cancer treatment may result in weight loss due to chemotherapy-induced gastrointestinal symptoms. However, a significant proportion experience the opposite effect, with an increase in body fat and a weight gain of 1 to 5 kg during chemotherapy. Objective: Given the various nutritional challenges faced by women with breast cancer during chemotherapy, the objective of this study was to evaluate and compare the nutritional status of women with stage I, II, and III breast cancer in the first and third cycles of outpatient chemotherapy and to identify associated factors. Methods: The prospective longitudinal study was conducted at a Reference Hospital for Cancer Care in Brazil and included women aged ≥18 y diagnosed with stage I to III breast cancer receiving outpatient chemotherapy. Assessments were performed during the 1st and 3rd cycles of chemotherapy, including anthropometric measurements, sociodemographic data, clinical information, and quality of life. Nutritional risk was assessed using the NRS-2002. Results: Overweight was predominant in both chemotherapy cycles. Approximately 6.67% and 10% of patients were at nutritional risk in the 1st and 3rd chemotherapy cycles, respectively. Anxiety/depression was prevalent in the 1st chemotherapy cycle and was significantly associated with nutritional risk (P = 0.002). The variables age in cycle 3 and pain/discomfort in cycle 1 (P = 0.049 and P = 0.043, respectively) showed a significant association with nutritional risk. Conclusion: This study highlights the complex interaction between nutritional status, neuropsychological symptoms, and sociodemographic characteristics in breast cancer patients during chemotherapy, and underscores the need for personalized interventions to improve oncological care.

Introduction: The nutritional status of breast cancer patients might be negatively affects by the therapeutic process due to side effects such as mucositis, nausea, and vomiting, which occur together as a cluster of gastrointestinal symptoms, along with anorexia, all of which are determinants of patients' dietary habits and consequently impact on their nutritional status. Objective: The purpose of this study was to assess the nutritional status of women with non-metastatic malignant breast cancer and to identify factors associated with it. Methods: A cross-sectional observational study was con-ducted at a High Complexity Oncology Assistance Center in the Southeast region of Brazil, with the aim of assessing the nutritional status of women undergoing treatment for stage I, II, or III breast cancer. Patients in palliative care or undergoing reconstructive surgery were excluded. Data collection took place between June 2022 and March 2023 and included questionnaires, physical examinations, laboratory tests, and anthropometric assessments. Nutritional status was assessed using measures such as BMI and skinfold thickness, while nutritional risk was assessed using the Nutritional Risk Screening (NRS-2002) tool. Results: Significant associations were found between nutritional risk and educational level (p=0.03) and BMI (p=0.01). Binary logistic regression analysis revealed a significant association between educational level and nutritional risk, indicating that lower educational level was associated with higher odds of nutritional risk (OR=4.59; 95% CI=1.01-21.04; p=0.049). In addition, regarding BMI, it was observed that a BMI above 20.5 kg/m2 was associated with a higher likelihood of nutritional risk (OR=0.09; 95% CI=0.01-0.89; p=0.039). Conclusions: It is crucial to consider the nutritional status of breast cancer patients, alongside clinical factors, to offer comprehensive and personalized care. Gaining in-sight into the socio-demographic variables linked to nutritional risk can significantly contribute to our understanding of breast cancer. This knowledge, in turn, can aid in identifying effective strategies for public policy, health promotion, and prevention efforts aimed at tackling this condition.

Introduction: Oncology patients undergo significant changes in their routines, impacting access to and management of their treatment journey. The nurse navigator (NN) plays a crucial role in identifying and overcoming barriers, particularly during the initial nursing consultation. Objective: To analyze the barriers faced by oncology patients during the initial consultation with the NN in a navigation program (NP) at a Cancer Center. Method: A retrospective cross-sectional study, approved by the Research Ethics Committee (CAAE: 47748821.7.0000.5432). Data collected between October 2021 and March 2024 were analyzed in absolute numbers, percentages, and through the cross-referencing of sociodemographic variables and barriers. Results: A total of 9,083 patients were analyzed, with 58% being female and most aged between 50-69 years. Although most patients did not present significant communication, diagnosis understanding, or transportation barriers, patients over 70 years old (26%) showed greater difficulty in understanding their diagnosis and treatment (p<0.0001). Additionally, 44.4% of patients reside outside the city of São Paulo, facing geographical barriers to treatment access. Low education (8.8%) was a relevant factor, impacting treatment comprehension. In terms of support, 17% of patients have a friend or family member as their primary caregiver, suggesting possible dependence on others for treatment management. Approximately 17.4% use public or private transportation to access the hospital, and 11.1% reported little or no family support. Women have less family support compared to men. Referrals to the multidisciplinary team included nutrition (7.4%), physiotherapy (3.9%), nursing (6.9%), and psychology (1.9%), highlighting the need for comprehensive and personalized care. Conclusion: The study reinforces the role of the NN in proactively identifying barriers to healthcare access, enabling targeted interventions and promoting equity. Identifying these barriers during the initial consultation is crucial to improving patient experience, reducing disparities in access to care, and enhancing clinical outcomes.

Introduction: Patient navigation is carried out in a humanised way, starting with the nursing consultation, addressing the side effects of the treatment to be carried out and its management, scheduling guidance on starting treatment, communication with the entire multi-professional team, such as the nutritionist and, if necessary, the psychology service. The nurse navigator aims to ensure continuity of treatment inside or outside the oncology unit (as long as the patient is in our institution), validates all medical prescriptions (triple-check stage) and monitors the administration of antineoplastic therapy when administered outside the oncology unit (intensive care unit, inpatient unit, surgical centre). The Nurse Navigator also registers, monitors results, advises and refers patients for genetic testing on platforms sponsored by pharmaceutical companies. Objectives: To establish a navigation protocol for breast cancer patients at Santa Catarina Hospital. Methodology: This is a bibliographic survey, from June to October 22, using the following databases: BIREME, LILACS, PubMed, comprising 12 studies followed by descriptive observational research. This made it possible to create a protocol to better target the public. Inclusion criteria: primary diagnosis of breast cancer. non- metastatic, female, aged between 20 and 60. The following were excluded: starting treatment at another service, palliative, loss of source of payment, tumour recurrence. Results: To assess whether the stipulated goals were achieved after the initial interventions. Conclusion: In the care of oncological patients, the role of the nurse navigator is very relevant, both for the patient and for the multi-professional team, the navigator acts as a facilitator in the process as a whole. Knowing that the nurse's work process is focussed on care and on assisting the patient in all their dimensions (physical, emotional, psychosocial and family). It is clear from this study that the implementation of Navigation Programmes guided by a well-defined protocol for the profile of the patient to be navigated, with the nurse as an actor in the coordination of care and continuous care, provides patients, services and the health system with a differential in terms of quality of care.

Introduction: The glioblastoma multiforme (GBM) is a malignant brain tumor that affects the central nervous system (CNS) and contains cancer stem cells (GSCs), which are resistant to conventional treatments such as surgery, radiotherapy, and chemotherapy, contributing to its recurrence. Therefore, new methods such as immunotherapy with oncolytic viruses are being investigated. The Zika virus (ZIKV) has demonstrated oncolytic potential against GSCs by infecting them and inducing an antitumor response. Studies indicate that ZIKV can lyse GBM cells, promoting tumor cell death without damaging healthy cells, and also activate the patient’s immune system, offering a promising and less toxic approach for treatment. Objectives: Evaluate viral therapy with ZIKV as a promising alternative for the treatment of glioblastoma and the remaining challenges in the use of this new approach. Methodology: A literature review was conducted in the PUBMED database, focusing on articles about oncolytic viral therapy with ZIKV for glioblastoma treatment. The descriptors “oncolytic viral therapy”, “Zika virus” and “glioblastoma” were used, including publications from 2017 onwards. Results:The inoculation of ZIKV strains in animal models with glioblastoma resulted in delayed tumor growth. Intracerebral administration is a ZIKV vaccine in mice inhibited glioblastoma progression without severe effects; the treatment enhanced the efficacy of anti-ligand immunotherapy. ZIKV infected GBM stem cells and inhibits in vitro proliferation, with 60% strain infection post-inoculation. Among the infected cells, 90% expressed the GSC marker (SOX2). Conclusion: Research in mice shows that ZIKV is promising as an oncolytic virus for the treatment of glioblastoma. ZIKV exhibits high selectivity for GBM stem cells and their markers SOX2 and integrin αvβ5, with low toxicity to non-tumor cells. Additionally, it increases the recruitment of T and myeloid cells, promoting a better immune response against the tumor and potentially be used in combination with chemotherapy. Future studies should evaluate clinical challenges, such as possible adverse effects in humans and the need for tests to determine previous exposure to ZIKV and the expression of SOX2 in tumor cells.

Introduction: Osteosarcoma is the most common bone tumor in children and adolescents, typically occurring during growth. It mainly affects the knee joint but can also involve the femur and tibia. Its development is influenced by programmed cell death mechanisms. Symptoms include pain, swelling, and fractures, leading to systemic issues such as weight loss and anemia. Biopsy is the most accurate diagnostic and therapeutic tool. Osteosarcoma is a primary neoplasm, rare in soft tissues, with a metastasis rate over 85%, potentially affecting the lungs, liver, and brain. Early diagnosis and treatment are crucial, highlighting the need for studies on its nature and therapy. Methodology: This integrative literature review searched PubMed and BVS databases for articles using "osteosarcoma," "pediatric," and "treatment" from 2019 to 2024. Sixteen articles were found, with thirteen included in the study. Results: Pathophysiology remains unclear, but dysfunctional apoptotic pathways are linked to development (N=2), with therapeutic approaches targeting these pathways being promising. Accelerated bone growth in adolescents (N=1) and high birth weight (N=2) are associated with higher neoplastic risk. Poor prognosis correlates with lactate dehydrogenase >1000 IU/ml, necrosis index <90, and metastasis, mainly pulmonary (N=2). Recommended treatments include tumor removal surgery, radiotherapy, and multi-agent chemotherapy, with adjuvant chemotherapy improving survival compared to surgery alone. Medical failures, unclear signs, and delays, especially in Brazil, worsen prognosis. A study found that 50% of patients end with amputation. Conclusion: Osteosarcoma is aggressive and requires early diagnosis for better prognosis. Investigate bone pain, swelling, and functional limitations with radiological exams. Biopsy should follow detailed evaluation in uncertain cases. Multimodal treatment with neoadjuvant chemotherapy, limb-sparing resection, and radiotherapy offers the best cure chances, especially in specialized centers. The lack of precise biomarkers highlights the need for further research to develop effective classification systems and new agents. Advancements in diagnosis and treatment are essential for improving outcomes.

This systematic review was conducted to identify otoprotective measures and treatments for ototoxicity induced by high-dose Cisplatin-based concurrent chemoradiotherapy (CRT) administered as adjuvant, or definitive, therapy in head and neck cancer (HNC) patients. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed Central, Medline, and SciELO databases were used as sources in March 2024. The inclusion criteria were prospective or retrospective cohort studies, case-control studies, and phase II or III trials published in English, with full-text availability, which analyzed ototoxicity following otoprotective measures or treatments in high-dose Cisplatin-based CRT (100 mg/m² intravenous every 21 days) for HNC patients. Article selection was performed independently by three analysts, covering database searches, duplicate removal, and relevant article selection. Out of 216 initially identified articles, 11 were assessed in the final analysis: four involving low-dose Cisplatin-based CRT (three at 40 mg/m² IV weekly and one at 20 mg/m² IV weekly), three utilizing high-dose intra-arterial Cisplatin-based CRT and Sodium Thiosulfate, one study with intratympanic Sodium Thiosulfate administered before high-dose Cisplatin-based CRT, one involving Nedaplatin-based CRT, one with intratympanic Dexamethasone prior to weekly Cisplatin-based CRT, and one with Acetylcysteine administered before high-dose Cisplatin-based CRT. Most intervention did not show a statistically significant reduction in ototoxicity compared to high-dose Cisplatin-based CRT alone. Statistically significant reductions in ototoxicity were observed in only one out of the three studies using high-dose intra-arterial Cisplatin-based CRT with Sodium Thiosulfate, the study with Nedaplatin-based CRT, and the study with intratympanic Dexamethasone prior to weekly Cisplatin-based CRT. The only strategy demonstrating lower ototoxicity rates and comparable survival outcomes to high-dose Cisplatin-based CRT was low-dose Cisplatin-based CRT. Our systematic review identified a limited number of studies on otoprotective measures for high-dose Cisplatin-based CRT, with most studies showing negative results, small patient populations, and low-quality standards. The only measure showing a trend toward reducing ototoxicity while maintaining similar survival data to the high-dose Cisplatin-based CRT was the use of low-dose Cisplatin-based CRT.

Introduction: Survival of children and adolescents with cancer might be correlated with the level of socioeconomic and social development. Accurate data are crucial for health policy planning and improvement of outcomes. Objective: The purpose of this study was to analyze overall survival at 1, 2, and 5 years after childhood cancer in a Southeastern Brazilian state and identify associated factors. Methods: The study cohort included all patients diagnosed with cancer before the age of 19 years and forwarded to the reference center hospital for the treatment of childhood cancer located in the southeastern region of Brazil, between January 2007 and December 2015. For 5-year survival, the Kaplan-Meier and LogRank methods were used, in addition, the Cox proportional hazards model for specific cause of death was calculated in the multivariate analysis. Results: Among 960 referred patients, all of them were followed-up for 5 years. The overall five-year survival was 76% (95%CI: 73.679.0) at 1 year, 69% (95%CI: 66.572.4) at 2 years, and 62% (95%CI: 58.765.0) at 5 years. Girls had a 28% lower risk of dying from cancer in 5 years compared to boys (HR=0.72; 95%CI: 0.5790.901; p=0.004). The highest survival rates were found for individuals with Hodgkin lymphomas 87.6% (95%CI: 78.8-97.4). The lowest 5-year survival rates were observed for patients with acute myeloid leukemia 40.8% (95%CI: 30.8-54.1). Individuals diagnosed with lymphomas (HR=0.31, 95%CI: 0.190.49; p<0.001) had a better 5-year survival than those with leukemias. Pediatric patients diagnosed with CNS tumours had 13% more risk of specific mortality by CNS tumours than those diagnosed with leukemia (HR=1.13, 95%CI: 0.831.53; p<0.434). Conclusion: We observed a lower overall survival of children and adolescents with cancer in a region of Brazil when compared to high-income countries, which was associated with sex and diagnostic groups. Childhood cancer survival is closely related to socioeconomic context. Some approaches can result in better survival rates, such as investing in public education, improved training of health professionals, investing in the detection of childhood cancer, strengthening and access to oncology services, clinical research and international cooperation.

Introduction: Breast cancer is the most common neoplasm in women, being a public health problem due to its high incidence and morbimortality. The aim of the study is to provide an overview of breast cancer care in the SUS between 2015 and 2022. Methods: Descriptive study with data from the SUS Information Systems and the INCA Cancer Hospital Registry for ICD-10 C50 between 2015 and 2022. Results: Between 2015 and 2022, approximately 18 million screening mammograms were performed for women aged 50 to 69 by the SUS, with costs exceeding 800 million reais. During the Covid-19 pandemic, there was a significant reduction in the number of mammograms performed, with a 41.5% drop in 2020 and 18.9% in 2021 compared to 2019. In 2022, there was an increase of just over 1% in the number of mammograms compared to 2019. About 38% of breast cancer diagnoses occurred at advanced stages (3 and 4). Acre and Roraima had the worst staging outcomes (56%), while Rio Grande do Sul and São Paulo had the lowest percentages of diagnoses at stages 3 or 4. The average time between the first consultation and diagnosis was 34 days, with about 33% of cases taking more than 30 days for confirmation. Sergipe and Amazonas had the worst performances in the time to diagnosis. The average time between diagnosis and the start of treatment was 179 days, with Sergipe and Rondônia being the states with the worst performance. Between 2015 and 2022, nearly 532 thousand Hospitalization Authorizations were reported, with a total cost of over one billion reais. About 14 million high-complexity procedures for breast cancer treatment were performed, with about 400 thousand of radiotherapy and the rest of chemotherapy, with total costs close to five billion reais. There was a significant reduction in the number of radiotherapy procedures over the period. The number of deaths from breast cancer reached 140,589. São Paulo recorded the highest number of deaths, followed by Rio de Janeiro. Discussion and conclusion: Brazil faces challenges in the diagnosis and treatment of breast cancer, despite the 30 and 60-day laws and the National Policy for Cancer Prevention and Control. The Covid-19 pandemic worsened the situation, reducing the number of mammograms, hospital capacity, and diagnoses, highlighting the urgent need to improve access to health services and the prognosis of the disease.

BACKGROUND:The poly-ADP ribose polymerase inhibitors (PARPi) are antineoplastic drugs highlighted in the treatment of neoplasms with mutations in the BRCA1/2 genes. The PARPi prevents double-strand break repair, which causes irreversible DNA damage, leading to cell death.OBJECTIVE: This study aimed to analyze the mechanisms and therapeutic applications of PARP inhibitors as a potential therapeutic option for the treatment of ovarian, no-ovarian gynecologic, breast and prostate cancers. METHODS: A literature review was done, including searches in the SciELO and PubMed databases using the keywords "PARP inhibitor", "Treatment" and "Cancer" with the boolean operator "AND". The selected articles include topics related to ovarian, non-ovarian gynecologic, breast or prostate cancers. RESULTS: PARP inhibitors demonstrate significant benefits in the treatment of gynecologic cancers, breast cancer, and ovarian cancer. In non-ovarian gynecological cancers, drugs like Niraparib and Dostarlimab improved progression-free survival (PFS) compared to chemotherapy, with a hazard ratio (HR) of 0.60 (95% CI, 0.43–0.82; p=0.007). The combination of Durvalumab and Olaparib also showed favorable results, presenting a median PFS of 15.1 months, superior to the 9.6 months achieved by chemotherapy, with an HR of 0.55 (95% CI, 0.43–0.69; p<0.0001). In BRCA1/2 breast cancer, PARP inhibitors prolonged PFS, with an HR of 0.72 in patients previously treated with platinum and 0.68 in treatment-naive patients. In ovarian cancer, PARP inhibitors showed an HR of 0.46 in newly diagnosed patients and 0.36 in patients with BRCAm mutations. Although PARP inhibitors are generally well tolerated, there is an increase in hematological adverse events, including anemia (relative risk [RR] of 14.26), thrombocytopenia (RR of 6.86), and neutropenia (RR of 4.33). CONCLUSION: PARP inhibitors emerge as a promising therapeutic approach in the treatment of gynecologic, breast and ovarian cancers. Data reveal that PARPi, such as Niraparib, Dostarlimab and Olaparib, provide improvements in PFS, especially in patients with mutations in the BRCA1 and BRCA2 genes. Although PARP inhibitors are generally well-tolerated, there is an increase in hematological adverse events. Thus, the continuity of research and the optimization of the use of these agents are essential to maximize their clinical benefits and minimize adverse effects.

Introduction: In the Brazilian context, the Ministry of Health has been investing efforts to address the increasing demand for oncology treatment in the country. Among the various suggested strategies, the implementation of navigation programs stands out. Currently, different models of these programs adapted to institutional realities both hospital-based and outpatient are observed. Objective: To describe the models of patient navigation programs implemented from the perspective of healthcare managers. Methods: This descriptive study with a qualitative approach employed the snowball sampling method for participant recruitment. The study was approved by the Research Ethics Committee (approval report nº 5.908.102). Data analysis was conducted using thematic analysis as per Minayo. Results: Healthcare managers with navigation programs implemented for over a year participated in the study. These programs are more prevalent in the Southeast and South regions and are more frequent and structured within the supplementary network in the outpatient setting. Key attributes include coordination with other institutions, care coordination, and elimination of barriers, which facilitate and optimize the care flow. Barriers mentioned include changes in care culture, navigator nurse training, lack of scaling guidelines, and the absence of a guiding flow for implementation and maintenance. Conclusion: This research is relevant for clinical practice, education, research, and management. It contributes to a situational diagnosis of navigation programs in Brazil, highlighting that despite public policies, patient navigation remains scarce within the SUS (Sistema Unico de Saúde). The development of models and strategies is recommended to guide all aspects of navigation and expand programs throughout Brazil.