SUMMARY BACKGROUND: Cancer-related fatigue is a pervasive symptom, affecting up to 90% of cancer patients throughout their illness, and can persist well after treatment has ended. Despite its prevalence, no definitive evidence-based treatment exists, leading to an abundance of proposed alternatives, including natural supplements. To further explore the potential effects of guaraná on cancer-related fatigue, a systematic review with meta-analysis was conducted and registered on the International Prospective Register of Systematic Reviews (CRD42023484144). METHODS: A thorough search of PubMed/MEDLINE and Cochrane Library was conducted using MeSH terms and related keywords for cancer-related fatigue and guaraná. Eligible studies were selected according to predetermined criteria and assessed for quality in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was independently performed by two reviewers, with any discrepancies resolved by a third researcher. RESULTS: In total, 4 full articles and 1 abstract, encompassing a total of 229 patients from 2009 to 2023, were included in the meta-analysis. Despite high heterogeneity between studies (I2=78%, ꭓ2=18.51, df=4, p=0.0010), the analysis revealed a significant benefit of using guaraná to alleviate cancer-related fatigue, with a standard mean difference of −0.77 (95%CI −1.34, −0.21) and a test for the overall effect of Z=2.68 (p=0.007). CONCLUSION: This meta-analysis provides support for the use of guaraná in the treatment of cancer-related fatigue. However, further investigation through larger prospective randomized controlled trials is necessary to validate these findings. BACKGROUND Cancerrelated Cancer symptom 90 illness ended prevalence evidencebased evidence based exists alternatives supplements cancerrelated metaanalysis meta CRD42023484144. CRD42023484144 CRD . (CRD42023484144) METHODS PubMedMEDLINE PubMed MEDLINE Interventions reviewers researcher RESULTS abstract 22 200 2023 metaanalysis. analysis. I2=78%, I278 I I2 78 (I2=78% ꭓ21851 ꭓ ꭓ2 18 51 ꭓ2=18.51 df4 df df=4 p=0.0010, p00010 p p=0.0010 , 0 0010 p=0.0010) 077 77 −0.7 95%CI 95CI CI 95 134 34 −1.34 −0.21 021 21 Z268 Z 2 68 Z=2.6 p=0.007. p0007 p=0.007 007 (p=0.007) CONCLUSION However findings 9 CRD4202348414 (CRD42023484144 20 202 I2=78% I27 7 (I2=78 ꭓ2185 5 ꭓ2=18.5 df= p0001 p=0.001 001 07 −0. 13 3 −1.3 −0.2 02 Z26 6 Z=2. p000 p=0.00 00 (p=0.007 CRD420234841 (CRD4202348414 I2=78 (I2=7 ꭓ218 ꭓ2=18. −0 −1. Z2 Z=2 p00 p=0.0 (p=0.00 CRD42023484 (CRD420234841 I2=7 (I2= ꭓ21 ꭓ2=18 − −1 Z= p0 p=0. (p=0.0 CRD4202348 (CRD42023484 I2= (I2 ꭓ2=1 p=0 (p=0. CRD420234 (CRD4202348 (I ꭓ2= p= (p=0 CRD42023 (CRD420234 (p= CRD4202 (CRD42023 (p CRD420 (CRD4202 CRD42 (CRD420 CRD4 (CRD42 (CRD4 (CRD

SUMMARY OBJECTIVE: Scientific writing in English is a daunting task for non-native English speakers. The challenges of writing in a foreign language are evident in the scientific literature where texts by non-native English-speaking scientists tend to be less clear and succinct, contain grammatical errors, and are often rejected by prestigious journals. METHODS: We conducted a non-systematic review of the most recent literature using the terms “Artificial Intelligence,” “Scientific Writing,” and “Non-English Speaking” to create a narrative review. RESULTS: Artificial intelligence can be a solution to improve scientific writing, especially for non-native English-speaking scientists. Artificial intelligence can assist in the search for pertinent scientific papers, generate summaries, and help with the writing of different sections of the manuscript, including the abstract, introduction, methods, results, and discussion. Artificial intelligence-based programs can correct grammatical errors and improve writing style, both of which are particularly helpful for non-native English speakers. Two artificial intelligence programs that can help with the search for pertinent scientific papers on the internet are Elicit and ResearchRabbit. Scispace Copilot can be used to summarize the retrieved reference. The artificial intelligence software programs such as Grammarly and Paperpal can correct grammatical and spelling errors, while ChatGPT can also restructure sentences and paragraphs, reword text, and suggest appropriate words and phrases. CONCLUSION: Overall, artificial intelligence can be an effective tool to improve the clarity, style, and coherence of scientific writing, helping non-native English-speaking scientists to communicate their research more effectively. OBJECTIVE nonnative non native speakers Englishspeaking speaking succinct journals METHODS nonsystematic systematic Intelligence, Intelligence Writing, Writing NonEnglish Non Speaking RESULTS summaries manuscript abstract introduction methods results discussion intelligencebased based style ResearchRabbit reference paragraphs text phrases CONCLUSION Overall clarity effectively

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. BACKGROUND rates treatment recurrence Thus followup follow up system OBJECTIVE METHODS Brazil consensus RESULTS 6 201 selected 5 followup, up, followup. up. 3 56.67% 5667 56 67 (56.67% stating 12 33.6%. 336 33.6% . 33 (33.6%) phase 11 1009 100 9 100.9% 42 22 CONCLUSION 20 56.67 566 (56.67 33.6 (33.6% 10 100.9 4 56.6 (56.6 33. (33.6 100. 56. (56. (33. (56 (33 (5 (3 (

RESUMO INTRODUÇÃO: Pacientes oncológicos e seus acompanhantes incorrem em custos não cobertos pelo Sistema Único de Saúde (SUS) durante o seu tratamento, com gastos relacionados a transporte, medicações sintomáticas, alimentação, perda de dias de trabalho dentre outros. OBJETIVO: Avaliar os custos incorridos e não cobertos pelo SUS por pacientes com câncer e seus acompanhantes durante a realização do tratamento, oncológico. MÉTODOS: Trata-se de um estudo transversal realizado com 110 pacientes oncológicos em tratamento com quimioterapia ou quimioterapia e radioterapia e 88 acompanhantes, no último mês, antes de sua inclusão no estudo. Correlacionamos os custos dispendidos com variáveis clínicas e sociodemográficas como sexo, idade, raça, estado civil, escolaridade, ocupação, naturalidade, procedência, renda mensal, renda familiar, moradia, comorbidades, tipo de neoplasia e estadiamento. RESULTADOS: Observamos que a média do custo global dos pacientes do estudo foi de R$ 747,92, que corresponde a 78,4% do salário mínimo e a média do custo dos acompanhantes foi de R$ 118,86 reais que equivale a 12,46% do salário mínimo. Dentre todas as variáveis analisadas, a média do custo global mensal dos pacientes correlacionou-se positivamente com a variável ocupação (p=0,021) assim como com a variável procedência (p = 0,038). Para as demais variáveis, não foram detectadas associações significantes. CONCLUSÃO: A correlação positiva encontrada entre ocupação e procedência com custos incorridos e não cobertos por pacientes sugere a criação de programas que viabilizem o pagamento dos custos não cobertos pelo SUS e a descentralização do acesso ao tratamento oncológico podem potencialmente facilitar a aderência do paciente ao tratamento oncológico.

SUMMARY INTRODUCTION: Cancer patients and their caregivers incur costs not covered by the Sistema Único de Saúde – SUS(Unified Health System) during their treatment, with expenses related to transportation, symptomatic medications, food, loss of working days, and others. OBJECTIVE: To evaluate the costs incurred and not covered for cancer patients and their caregivers during cancer treatment at SUS. METHODS: This is a cross-sectional study of 110 cancer patients undergoing chemotherapy, radiotherapy, and 88 caregivers in the last month prior to their inclusion in the study. We correlated costs with clinical and sociodemographic variables such as gender, race, age, marital status, education, occupation, place of birth, origin, monthly income, family income, housing, comorbidities, types of cancer, and staging. RESULTS: We observed that the average cost for study patients was R$ 747.92, which corresponds to 78.4% of the minimum wage, and the average cost for caregivers was R$ 118.86, which is 12.46% of the minimum wage. Among all variables analyzed, the average overall monthly cost for patients was positively correlated with the occupation (p = 0.021) and origin (p = 0.038) variables. For the other variables, no significant associations were detected. CONCLUSION: The positive correlation found between occupation and origin variables with costs incurred and not covered for patients suggests that the creation of programs that enable the payment of costs not covered by SUS and the decentralization of access to cancer treatment could potentially facilitate patients' adherence to cancer treatment.

RESUMO Objetivo: O câncer de pulmão é um importante problema de saúde pela sua alta incidência e mortalidade. O tratamento da doença metastática melhorou após o conhecimento de vias moleculares tumorais. Contudo, a terapia-alvo está indisponível para muitos pacientes do Sistema Único de Saúde (SUS). Nosso objetivo foi avaliar a relação custo-efetividade de erlotinibe, gefitinibe e afatinibe vs. quimioterapia no tratamento do câncer de pulmão não pequenas células no contexto do SUS. Métodos: Foram desenvolvidos modelos analíticos distintos baseados em dados da literatura. Os desfechos foram apresentados em quality-adjusted life years (QALY, anos de vida ajustados pela qualidade) e incremental cost-effectiveness ratio (ICER, relação custo-efetividade incremental). Todos os custos relacionados ao tratamento e terapias de suporte foram incluídos nos modelos. Resultados: No primeiro modelo, dados de estudos retrospectivos apontaram 2,01 anos de vida salvos e uma média de ganho de QALY de 1,169. O ICER variou entre R$ 48.451,29 (gefitinibe) e R$ 85.559,22 (erlotinibe). No segundo modelo, dados de uma meta-análise evidenciaram −0,01 ano de vida salvos e uma média de ganho de QALY de 0,178. O ICER foi de R$ 27.028,30 (gefitinibe) a R$ 75.203,26 (erlotinibe). Conclusões: Não existe um modelo analítico ideal para o SUS. Contudo, diferentes cenários disponíveis na literatura mostram que a terapia-alvo com o uso dessas drogas é custo-efetiva. A adoção de descontos nos preços dos medicamentos melhorará a relação custo-efetividade do tratamento.

ABSTRACT Objective: Lung cancer is an important health problem due to its high incidence and mortality. The treatment of metastatic disease improved after the molecular pathways of cancer came to be known. However, targeted therapy is unavailable to many patients treated within the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System). Our objective was to assess the cost-effectiveness of erlotinib, gefitinib, and afatinib versus that of chemotherapy for the treatment of non-small cell lung cancer in the context of the SUS. Methods: Different analytical models were developed based on data in the literature. The outcomes were presented in quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) per QALY gained. All costs related to treatment and supportive therapies were included in the models. Results: In one model, data from retrospective studies showed 2.01 life-years saved and a mean QALY gain of 1.169. The ICER per QALY gained ranged from R$48,451.29 (for gefitinib) to R$85,559.22 (for erlotinib). In another model, data from a meta-analysis showed −0.01 life-years saved and a mean QALY gain of 0.178. The ICER per QALY gained ranged from R$27,028.30 (for gefitinib) to R$75,203.26 (for erlotinib). Conclusions: There is no ideal analytical model for the SUS. However, targeted therapy with EGFR-tyrosine kinase inhibitors has been shown to be cost-effective in various scenarios. The adoption of drug price discounts will improve the cost-effectiveness of treatment.

ABSTRACT BACKGROUND: Lung cancer is the fourth most common cancer in Brazil. In the 2000s, better understanding of molecular pathways led to development of epidermal growth factor receptor (EGFR)-targeted treatments that have improved outcomes. However, these treatments are unavailable in most Brazilian public healthcare services (Sistema Único de Saúde, SUS). OBJECTIVE: To assess the potential number of years of life not saved, the budget impact of the treatment and strategies to improve access. DESIGN AND SETTING: Pharmacoeconomic study assessing the potential societal and economic impact of adopting EGFR-targeted therapy within SUS. METHODS: We estimated the number of cases eligible for treatment, using epidemiological data from the National Cancer Institute. We used data from a single meta-analysis and from the Lung Cancer Mutation Consortium (LCMC) study as the basis for assessing differences in patients’ survival between use of targeted therapy and use of chemotherapy. The costs of targeted treatment were based on the national reference and were compared with the amount reimbursed for chemotherapy through SUS. RESULTS: There was no life-year gain with EGFR-targeted therapy in the single meta-analysis (hazard ratio, HR, 1.01). The LCMC showed that 1,556 potential life-years were not saved annually. We estimated that the annual budget impact was 125 million Brazilian reais (BRL) with erlotinib, 48 million BRL with gefitinib and 52 million BRL with afatinib. Their incremental costs over chemotherapy per life-year saved were 80,329 BRL, 31,011 BRL and 33,225 BRL, respectively. A drug acquisition discount may decrease the budget impact by 30% (with a 20% discount). A fixed cost of 1,000 BRL may decrease the budget impact by 95%. CONCLUSION: Reducing drug acquisition costs may improve access to EGFR-targeted therapy for lung cancer.

RESUMO INTRODUÇÃO: Interação medicamentosa é uma importante causa de morbidade mundial. Apresenta especial importância em pacientes oncológicos, pois esses frequentemente estão em uso de polifarmácia, podendo haver interações entre os medicamentos e os quimioterápicos utilizados. OBJETIVO: Avaliar a interação medicamentosa entre a quimioterapia e outros medicamentos em pacientes oncológicos. MÉTODOS: Estudo transversal realizado em serviço ambulatorial de oncologia de um hospital público terciário. Foram incluídos 235 pacientes, identificando-se quais medicamentos eram utilizados por eles. Por meio do auxílio do banco de dados do MedScape e Epocrates, avaliaram-se as interações entre as medicações e os quimioterápicos, definindo sua frequência e dividindo sua gravidade da interação em leve, monitorização próxima e grave. RESULTADOS: Do total estudado, 161 pacientes apresentavam alguma interação medicamentosa, sendo nove tipos de interações leves, 23 tipos de interações com necessidade de monitorização próxima e dois tipos de interações graves. As interações mais frequentes foram entre fluoracil e leucovorin (32 casos) e ciclofosfamida e doxorrubicina (19 casos). As interações sérias foram entre aspirina e pemetrexed; e leucovorim e bactrim. CONCLUSÃO: No presente trabalho, interações medicamentosas foram frequentes, incluindo interações graves com potencial aumento de morbimortalidade. Assim, faz-se necessário que oncologistas tracem um plano terapêutico levando em consideração as possíveis interações medicamentosas entre a quimioterapia prescrita e demais medicações em uso pelos pacientes.

SUMMARY INTRODUCTION: Drug interaction is an important cause of global morbidity. It is of particular importance in cancer patients since they are often in use of polypharmacy, related to interactions between the drugs and the chemotherapeutics used. OBJECTIVE: To evaluate the drug interaction between chemotherapy and other drugs in cancer patients. METHODS: a cross-sectional study carried out in the outpatient oncology department of a public tertiary hospital. Two hundred thirty-five patients were included, and the drugs they were using were identified. Using the MedScape and Epocrates database, we evaluated the interactions between medications and chemotherapy by defining their frequency and dividing their severity from interaction into mild, close monitoring necessity and severe. RESULTS: 161 patients had some drug interaction. We identified 9 types of mild interactions, 23 types of interactions with close monitoring necessity, and 2 types of serious interactions. The most frequent interactions were between fluorouracil and leucovorin (32 cases) and cyclophosphamide and doxorubicin (19 cases). Serious interactions were between aspirin and pemetrexed; and leucovorin and Bactrim. CONCLUSION: In the present study, drug interactions were frequent, including serious interactions with a potential increase in morbidity and mortality. Thus, it is necessary for oncologists to draw up a therapeutic plan considering potential interactions between prescribed chemotherapy and current medications in use by patients.

RESUMO Objetivo Avaliar a relação custo-efetividade da adição de quimioterapia ou abiraterona à terapia de privação hormonal. Métodos Um modelo analítico foi desenvolvido para determinar a relação custo-efetividade da adição de docetaxel ou abiraterona comparada à terapia de privação hormonal isolada. Custos diretos e indiretos foram incluídos no modelo. Os efeitos foram expressos em Anos de Vida Ajustados para Qualidade corrigidos pelos efeitos colaterais de cada terapia. Resultados A adição de quimioterapia e de abiraterona à terapia de privação hormonal aumentou os Anos de Vida Ajustados para Qualidade em 0,492 e 0,999, respectivamente, em comparação à terapia de privação hormonal isolada. A abiraterona promoveu ganho de Anos de Vida Ajustados para Qualidade de 0,506 em relação ao docetaxel. O custo incremental por Anos de Vida Ajustados para Qualidade foi R$ 133.649,22 para o docetaxel, R$ 330.828,70 para a abiraterona e R$ 571.379,42 para a abiraterona comparada ao docetaxel. Conclusão A adição de quimioterapia à terapia de privação hormonal é mais custo-efetiva que a adição de abiraterona à terapia de privação hormonal. Contudo, descontos no custo da abiraterona poderiam tornar esse tratamento mais custo-efetivo.

ABSTRACT Objective To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation. Methods We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects. Results Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$ 133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively. Conclusion The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness.

RESUMO Objetivo: traçar o perfil epidemiológico de pacientes com câncer de pulmão atendidos em hospital público terciário de referência em oncologia e explorar variáveis que possam estar relacionadas com a sobrevida global (SG) desses pacientes. Método: foram extraídos dados dos prontuários de todos os pacientes com câncer de pulmão invasivo, entre agosto de 2008 e dezembro de 2013, atendidos consecutivamente no Serviço de Oncologia do Hospital Estadual Mário Covas. As informações obtidas foram submetidas à análise estatística. Resultados: do total de 210 pacientes, 39 foram excluídos da análise pela ausência de informações no prontuário. O tipo histológico mais frequente foi o adenocarcinoma, representando 39,41% da amostra, seguido do carcinoma espinocelular com 25,29% e de pequenas células com 13,53%. Outros tipos histológicos foram responsáveis pelos 21,76% restantes. Houve associação com significância estatística entre KPS ≤ 70%, linhas de quimioterapia paliativa realizadas e estágio ao diagnóstico com SG. A administração de terapia-alvo direcionada para pacientes com mutação do EGFR foi significativamente associada à melhor SG. A análise das variáveis laboratoriais (hemoglobina, albumina e desidrogenase lática – DHL) como possíveis fatores prognósticos de sobrevida não mostrou relação estatisticamente significativa. Entre os pacientes em estágio III e IV, a SG mediana foi de 10,1 meses. Conclusão: os fatores de risco para menor SG foram KPS ≤ 70%, menos de duas linhas de quimioterapia paliativa e estágios III e IV ao diagnóstico. A implementação do rastreamento tomográfico de pacientes de risco poderá permitir o diagnóstico mais precoce e a melhora desses resultados.

SUMMARY Objective: To describe the epidemiological profile of patients with lung cancer treated at a public tertiary referral hospital specializing in oncology, and to explore variables that may be related to the overall survival (OS) of these patients. Method: Data from the medical records of all patients with invasive lung cancer consecutively seen at the Oncology Department of Hospital Estadual Mário Covas between August 2008 and December 2013 were extracted. The information obtained was submitted to statistical analysis. Results: Of the total 210 patients, 39 were excluded from analysis due to lack of information in the medical record. The most common histological type was adenocarcinoma, representing 39.41% of the sample, followed by squamous cell carcinoma with 25.29% and small-cell carcinoma with 13.53%. Other histological types were responsible for the remaining 21.76%. There was a statistically significant association between Karnofsky performance status (KPS) ≤ 70%, palliative chemotherapy lines performed and stage at diagnosis, and OS. Additionally, administration of target therapy to patients with EGFR mutation was associated with significantly better overall survival. However, analysis of laboratory variables (hemoglobin, albumin and LDH) as possible prognostic factors for survival showed no statistically significant relationship. Among patients with stage III and IV, the median OS was 10.1 months. Conclusion: The risk factors for shorter OS were KPS score ≤ 70%, less than two lines of palliative chemotherapy, and stage III and IV at diagnosis. The implementation of CT screening for risk patients may allow earlier diagnosis of cases and improve these results.

RESUMO Introdução: O tratamento baseado em quimirradioterapia do Carcinoma Espinocelular de Orofaringe (CECOF) apresenta bons resultados no controle locorregional da doença com boas taxas de resposta clínica e patológica completas especialmente no pescoço. Objetivo: Determinar se a resposta patológica completa após quimiorradioterapia estárelacionada aos prognósticos dos pacientes com CECOF. Método: Os dados foram obtidos de maneira prospectiva da revisão de prontuários de pacientes com CECOF N2 e N3 submetidos a esvaziamento cervical planejado após quimiorradioterapia. Resultados: Um total de 19 pacientes foram avaliados. Metade dos indivíduos apresentou resposta patológica completa no pescoço. Recidiva à distância ou locorregional ocorreu em aproximadamente 42% dos pacientes e 26% deles morreram. A análise estatística demonstrou uma associação entre resposta patológica completa e menor taxa de recidiva (77,8% vs.20,8%; p = 0,017) e maior sobrevivência global (88,9% vs.23,3%; p = 0,049). Conclusão: A presença de resposta patológica completa após quimiorradioterapia influencia positivamente no prognóstico de pacientes com carcinoma espinocelular de orofaringe.

ABSTRACT INTRODUCTION: Chemoradiotherapy for squamous cell carcinoma of the oropharynx (SCCO) provides good results for locoregional disease control, with high rates of complete clinical and pathologic responses, mainly in the neck. OBJECTIVE: To determine whether complete pathologic response after chemoradiotherapy is related to the prognosis of patients with SCCO. METHODS: Data were prospectively extracted from clinical records of N2 and N3 SCCO patients submitted to a planned neck dissection after chemoradiotherapy. RESULTS: A total of 19 patients were evaluated. Half of patients obtained complete pathologic response in the neck. Distant or locoregional recurrence occurred in approximately 42% of patients, and 26% died. Statistical analysis showed an association between complete pathologic response and lower disease recurrence rate (77.8% vs. 20.8%; p = 0.017) and greater overall survival (88.9% vs. 23.3%;p = 0.049). CONCLUSION: The presence of a complete pathologic response after chemoradiotherapy positively influences the prognosis of patients with SCCO.

CONTEXTO:A leucemia mieloide aguda (LMA) refratária é considerada doença de difícil controle com regime quimioterápico de segunda ou terceira linha. Neste relato, é descrito o uso de azacitidina em combinação com lenalidomida como esquema de resgate.RELATO DE CASO:Paciente de 52 anos, do sexo feminino, com o diagnóstico de LMA refratária de alto risco citogenético, apresentava cariótipo complexo e monossômico, com t (3, 3), associado à monosomia do 7 e del 5q. Destaca-se que, após três ciclos da terapia combinada com azacitidina e lenalidomida, houve remissão morfológica, com manutenção da anormalidade citogenética relacionada ao cromossomo 3 e desaparecimento da anormalidade relacionada aos cromossomos 5 e 7.CONCLUSÃO:Azacitidina e lenalidomida podem ser opção terapêutica para pacientes com LMA refratária, como demonstrado neste caso.

CONTEXT:Refractory acute myeloid leukemia (AML) is a difficult disease to control with second or third-line chemotherapy regimens. In this report, we describe using azacitidine in combination with lenalidomide as salvage therapy.CASE REPORT:52-year-old female was diagnosed with refractory AML and high-risk cytogenetics: complex monosomal karyotype consisting of t (3, 3) in association with monosomy 7 and del 5q. Morphological remission associated with maintenance of the cytogenetic abnormality of chromosome 3 and disappearance of the abnormalities relating to chromosomes 5 and 7 was achieved after three cycles of combination therapy with azacitidine and lenalidomide.CONCLUSION:Azacitidine plus lenalidomide can be a therapeutic option for patients with refractory AML, as illustrated in this case.

RESUMO Objetivo: Avaliar a adesão dos médicos prescritores, de um centro privado especializado em oncologia, à diretriz de antiêmese profilática da American Society of Clinical Oncology, no primeiro ciclo de quimioterapia antineoplásica. Métodos: Foram avaliados retrospectivamente 139 esquemas de quimioterapia, de 105 pacientes, tratados no período de 2011 a 2013. Resultados: Foram observados 78% de taxa de não adesão à diretriz. As principais discordâncias com a diretriz foram prescrição de doses mais elevadas de dexametasona e uso excessivo de antagonista 5-HT3 para regimes de quimioterapia de risco emetogênico baixo. Pela análise univariada, malignidades hematológicas (p=0,005), uso de dois ou mais quimioterápicos (p=0,05) e regimes de alto risco emetogênico (p=0,012) foram fatores estatisticamente associados a maior adesão à diretriz. O tratamento baseado em paclitaxel foi o único fator estatisticamente significativo para a não adesão (p=0,02). Pela análise multivariada, a quimioterapia de alto risco emetogênico apresentou maior correlação com a adesão à diretriz (p=0,05). Conclusão: Houve maior aderência para a quimioterapia de alto risco emetogênico. Esforços educacionais devem se concentrar mais intensamente na gestão de regimes de quimioterapia com potencial emetogênico baixo e moderado. Talvez o desenvolvimento de lembretes gerados por sistemas informatizados possa melhorar a aderência à diretriz.

ABSTRACT Objective: To assess adherence of the prescribing physicians in a private cancer care center to the American Society of Clinical Oncology guideline for antiemetic prophylaxis, in the first cycle of antineoplastic chemotherapy. Methods: A total of 139 chemotherapy regimens, of 105 patients, were evaluated retrospectively from 2011 to 2013. Results: We observed 78% of non-adherence to the guideline rate. The main disagreements with the directive were the prescription of higher doses of dexamethasone and excessive use of 5-HT3 antagonist for low risk emetogenic chemotherapy regimens. On univariate analysis, hematological malignancies (p=0.005), the use of two or more chemotherapy (p=0.05) and high emetogenic risk regimes (p=0.012) were factors statistically associated with greater adherence to guidelines. Treatment based on paclitaxel was the only significant risk factor for non-adherence (p=0.02). By multivariate analysis, the chemotherapy of high emetogenic risk most correlated with adherence to guideline (p=0.05). Conclusion: We concluded that the adherence to guidelines is greater if the chemotherapy regime has high emetogenic risk. Educational efforts should focus more intensely on the management of chemotherapy regimens with low and moderate emetogenic potential. Perhaps the development of a computer generated reminder may improve the adherence to guidelines.

Objetivo Avaliar a percepção dos pacientes oncológicos e de seus cuidadores no início da abordagem diagnóstica e terapêutica, e durante os cuidados paliativos.Métodos Estudo transversal, realizado nos ambulatórios de oncologia e cuidados paliativos vinculados a Faculdade de Medicina do ABC. Foram coletados dados clínicos e demográficos de pacientes e de seus cuidadores, e aplicados questionários referentes aos elementos a serem elencados como importantes em relação ao tratamento.Resultados Foram incluídos 32 pacientes e 23 cuidadores que iniciavam o tratamento nos ambulatórios de oncologia, bem como 20 pacientes e 20 cuidadores nos ambulatórios de cuidados paliativos. Em relação aos pacientes do ambulatório de oncologia, os itens considerados mais importantes foram: médico disponível para discutir a doença e responder dúvidas (84%), confiança nos médicos (81%) e médico com linguagem acessível (81%). Para seus cuidadores, os seguintes aspectos foram considerados extremamente importantes: confiança nos médicos que cuidam do paciente (96%) e mesma equipe médica cuidando do seu familiar (87%). Para pacientes do ambulatório de cuidados paliativos, foram considerados extremamente importantes: confiança nos médicos (83%), estar com pessoas consideradas importantes (78%) e ser tratado de modo que preservasse sua dignidade (72%). Para seus cuidadores, foram considerados extremamente importantes: receber informação adequada sobre a doença e os riscos e benefícios do tratamento (84%), e sinceridade na comunicação das informações a respeito da doença (79%).Conclusão Confiança mediada por uma boa comunicação e a constância do cuidado foram valores tidos como fundamentais para a satisfação de cuidadores e de pacientes com câncer durante toda a evolução da doença.

Objective To evaluate the perception of oncology patients and their caregivers upon diagnosis and beginning of the therapy and during palliative care.Methods A cross-sectional study at the oncology and palliative care outpatients clinics of the Faculdade de Medicina do ABC. Clinical and demographic data from patients and their caregivers were collected and questionnaires regarding the elements considered important in relation to the treatment were applied.Results We enrolled 32 patients and 23 caregivers that were initiating treatment at the oncology outpatient clinic, as well as 20 patients and 20 caregivers at the palliative care clinic. Regarding the patients treated at the oncology clinic, the issues considered most important were a physician available to discuss the disease and answer questions (84%), trust in the physician (81%), and a physician with accessible language (81%). For their caregivers, the following issues were considered extremely important: trust in the medical team that treats the patients (96%), and the same medical team taking care of their relatives (87%). As to patients treated at the palliative care clinic, trust in the physician (83%), to be with people considered important to them (78%), and to be treated preserving their dignity (72%) were considered extremely important. For their caregivers, to receive adequate information about the disease and the treatment’s risks and benefits (84%), and sincere communication of information about the disease (79%) were considered extremely relevant.Conclusion Confidence through good communication and consistency in care were fundamental values to achieve satisfaction among caregivers and patients with cancer during all the course of disease development.