SUMMARY BACKGROUND: Breast cancer is a public health problem with both high incidence and cure rates. After treatment, patients are monitored for long periods of time due to the risk of recurrence. Thus, staging and follow-up strategies should consider not only the best results for the patient but also its costs for the public health system. OBJECTIVE: The objective of this study was to quantify the waste of resources on breast cancer follow-up and evaluate its impact on the public health system. METHODS: This is a retrospective analysis of consecutive medical records to identify the intervals between consultations and tests used for staging and during the first 2 years of follow-up of patients with breast cancer treated at a public hospital in Brazil. Data were compared with the guidelines of the main international consensus. RESULTS: Medical records of 60 consecutive patients treated in 2018 were selected, of whom 52 had 2 or more years of follow-up, and 8 had only 1 year of complete follow-up. A total of 34 patients (56.67%) underwent excessive examinations for stating. During follow-up, 125 surplus consultations were performed (33.6%). In this phase, 111 surplus exams were also performed, representing an increase of 100.9%. A total of 423 laboratory tests were performed for 18 patients in the first year and 229 tests for 14 patients in the second year. CONCLUSION: Excessive tests and consultations significantly burdened the Unified Health System without any benefit to patients. Better adherence to staging and follow-up recommendations could reduce costs and optimize the limited resources used in the public health system.

Resumo Objetivo: avaliar se o tempo da cirurgia até o primeiro tratamento adjuvante (quimioterapia, radioterapia ou hormonioterapia) em pacientes com câncer de mama é um fator de risco para pior sobrevivência global (SG). Métodos: estudo retrospectivo em que foram coletados dados dos prontuários de todas as mulheres com câncer de mama invasivo, diagnosticadas entre janeiro de 2005 e dezembro de 2010, atendidas consecutivamente em um serviço acadêmico de oncologia. Resultados: foram incluídas 348 mulheres, com mediana de tempo entre a cirurgia e o primeiro tratamento adjuvante de 2 meses. A sobrevivência global foi pior entre as mulheres com maior tempo entre a cirurgia e o primeiro tratamento adjuvante. Após análise multivariada, essa variável permaneceu como fator de risco independente para SG, juntamente com receptor de estrógeno negativo, presença de invasão angiolinfática e maior tamanho tumoral. Conclusão: o tempo entre a cirurgia e o primeiro tratamento adjuvante é um fator de risco independente para a sobrevivência global de mulheres com câncer de mama invasivo.

Summary Background: to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS). Method: data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed. Results: three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test). Conclusion: each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.

This work deals with the study of those events that can generate family crises. The concept of significative event of the family life is defined, and it is established a difference between them and the family crises. The different stages through which the family life passes by and the significative events that constitute risk peaks within this cycle are analyzed.

El trabajo aborda el estudio de aquellos acontecimientos que pueden generar crisis familiares. Se define el concepto de acontecimiento significativo de la vida familiar y se establece una diferenciación de estos con las crisis familiares. Se realiza un recorrido por las diferentes etapas que atraviesa el ciclo de vida familiar y de los acontecimientos significativos que constituyen momentos de riesgo en éste.

PURPOSE: Complete androgen blockade (CAB) does not prolong overall survival (OS) in patients with castration refractory prostate cancer (CRPC). Although there is variable clinical benefit with second-line hormone manipulation, we do not know which patients might benefit the most. OBJECTIVES: To identify clinical predictors of benefit of complete androgen blockade. MATERIALS AND METHODS: We reviewed the records for 54 patients who received treatment with CAB in the setting of disease progression despite castration. We evaluated progression-free survival (PFS) and OS according to PSA at diagnosis, Gleason scores, age, testosterone level, and duration of prior disease control during castration in first line treatment. RESULTS: Among 54 patients who received CAB, the median PFS was 9 months (CI 4.3-13.7) and OS was 36 months (CI 24-48). We did not find an effect of PSA at diagnosis (p = 0.32), Gleason score (p = 0.91), age (p = 0.69) or disease control during castration (p = 0.87) on PFS or OS. Thirty-four patients subsequently received chemotherapy, with a mean OS of 21 months (CI 16.4-25.5, median not reached). CONCLUSION: Age, Gleason score, PSA at diagnosis and length of disease control with castration did not affect PFS or OS. In the absence of predictors of benefit, CAB should still be considered in CRPC.

The impact of retirement and aging on family health as normative events of the stage of contraction the family goes through in its vital cycle is presented. Aging was studied between September 2001 and December 2002 in 58 families who had at least an elderly among their members. Retirement was analyzed from May 2003 to June 2004 in 70 families who had al least a member with less than a year of retirement. In both cases, descriptive and cross-sectional studies were conducted aimed at assessing the repercussion of these events on family health. An instrument that allows to evaluate the level of repercussion of the event on family health was used. On applying it, it was possible to determine that aging showed a repercussion from mild to moderate, whereas retirement had a repercussion from elevated to moderate, both with favorable sense. It was observed that the most affected areas due to the presence of the older adult were the socieconomic and family functioning. The socieconomic sphere and the health status were the most affected as regards retirement.

Se presenta el impacto en la salud familiar de la jubilación y la vejez, como eventos normativos propios de la etapa de contracción por la que atraviesa la familia en su ciclo vital. Se estudió la vejez en 58 familias que tenían en su seno, al menos, un integrante de la tercera edad, en el período comprendido entre septiembre de 2001 y diciembre de 2002; y la jubilación en 70 familias que tenían en su seno, al menos, un miembro con menos de un año de jubilación, en el período comprendido entre mayo de 2003 y junio de 2004. En ambos casos se realizaron estudios descriptivos y transversales. Se propuso como objetivo valorar la repercusión en la salud familiar de estos eventos. Se utilizó un instrumento que permite evaluar el nivel de repercusión del evento en la salud familiar. Mediante su aplicación logramos determinar que la ancianidad presentó una repercusión de leve a moderada, mientras que la jubilación presentó repercusión de elevada a moderada con sentido favorable ambas. Se observó que las áreas más comúnmente afectadas por la presencia de un adulto mayor fueron la socioeconómica y el funcionamiento familiar, mientras que en la jubilación fueron el área socioeconómica y estado de salud.

An analysis is made of the importance of studying the stress that is generated when the family copes with the different vital events it goes through. Some of the theoretical positions that serve as a basis to study family stress and their main authors are exposed. Emphasis is made on the need of studying family stress, not as something that is always unfavorable, and it is proposed how to approach this topic from a systemic perspective. A model for evaluating the impact of these events on family health is recommended.

En este trabajo se hace un análisis de la importancia del estudio del estrés que puede generar a las familias el afrontamiento a los diferentes eventos vitales que atraviesan. Se exponen algunas de las posiciones teóricas que sirven de base para el estudio del estrés familiar y sus principales autores. Se enfatiza en la necesidad del estudio del estrés familiar, no visto como algo siempre desfavorable, y se presenta una propuesta sobre la forma de tratar el tema desde una perspectiva sistémica, proponiendo un modelo de evaluación de la repercusión de estos eventos en la salud familiar.

A brief sketch of the appearance and significance of the gender role is made in this paper. It is also related to some indicators of family functioning and it is analyzed to what extent this relationship may affect its favorable expression, alter the internal dynamics of the family relations and act as a pathogenic factor in family health

En este trabajo se realiza un breve bosquejo del surgimiento y significación del rol de género y se relaciona con algunos de los indicadores de funcionamiento familiar, analizando en qué medida puede afectar la expresión favorable del mismo, alterar la dinámica interna de las relaciones familiares y actuar como factor patógeno en la salud familiar

In this paper it is made an analysis of the main psychosocial risk factors that may influence on the adolescents. It is also made a distinction between the psychological risk factors and the social ones. It is considered that a better knowledge of these factors may help the family physician to give attention to this social group in order to prevent the appearance of future health problems.

En el presente trabajo se realiza un análisis de los principales factores de riesgo psicosociales que pueden incidir en los adolescentes, y se hace una distinción entre los factores de riesgo psicológicos y los sociales; se considera que el conocimiento más profundo de éstos puede servir de ayuda al médico de la familia en la atención a este grupo social, con el objetivo de prevenir la aparición de futuros problemas de salud.