Interinstitutional multidisciplinary virtual tumor board implementation for the management of breast cancer in a public health setting in Mexico.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 107-107
Author(s):  
Omar Peña-Curiel ◽  
Orestes Valles-Guerra ◽  
Karen M Velazquez-Ayala ◽  
Griselda Peña-Iturbide ◽  
Sonia Maria Flores Moreno ◽  
...  

107 Background: UNEME-DEDICAM (UD) clinics are part of a national public health initiative to provide women prompt access to cervical and breast cancer (BC) screening and diagnosis. Furthermore, UD clinics play a central role in the coordination and prioritization of patient transfer to treatment-specialized institutions. To facilitate this process, we planned and implemented an interinstitutional virtual multidisciplinary tumor board (VMDT). Herein, we present our current experience. Methods: We planned and implemented our VMDT in September 2020. Weekly sessions were established for the multidisciplinary discussion of every newly diagnosed patient at UD with a complete radiology and pathology report. Communication was accomplished through an encrypted and secure internet connection using Microsoft Teams software. VMDT members included breast pathologist, breast imaging, radio oncologist, medical oncologist, and surgical oncologist. Treatment consensus were registered in a Microsoft Word template and integrated into the medical record for each patient. Importantly, the report also included date and time for the consultation at the referral institution. Results: Between September 2020 through May 2021, 74 BC patients were diagnosed at UD. Mean age at diagnosis was 52 years. Sixty-eight patients had invasive BC, of whom early stage (I and II) accounted for 67% of patients; locally advanced (III) for 29%, and advanced (IV) for 4%. Luminal A and B type accounted for 68%; HER2+ve for 25%; and triple negative for 7%. Mean time from biopsy to complete histopathology report (biopsy-report interval) was 2.5 weeks. The mean time from VMDT consensus to patient´s first consultation at referral center (VMDT-referral interval) was 2 weeks. The mean time from biopsy to patient´s first consultation at referral center (total interval) was 5.5 weeks. Conclusions: The VMDT is a plausible strategy to streamline the inter-institutional organization for the timely care of BC patients. UD clinics play a central role in the coordination of transfer of BC patients to tertiary care centers.

2019 ◽  
pp. 1-7
Author(s):  
José A. Sánchez ◽  
Mayra G. Handal ◽  
Juan F. Vílchez Rodriguez ◽  
Sinthia I. Mejía ◽  
Annye P. Pagoaga

PURPOSE In cancer, clinical staging is related to outcomes, and this is linked to the evolution of the disease over time. In Honduras, cancer mortality is high, and time intervals from onset of symptoms to treatment of cancer are not known. We conducted a cross-sectional study to determine these intervals. PATIENTS AND METHODS This investigation was carried out from April 25 to August 30, 2018, and included 202 patients at the main cancer referral center in Honduras. For the purposes of the study, information was obtained from patients, their caregiver, medical records, or treatment cards. Patients older than age 18 years were included after informed consent was signed. RESULTS The mean time interval from onset of symptoms to cancer treatment was 232 days. Different intervals of time were identified, and the mean of these intervals was calculated in days as follows: 68 days from onset of symptoms to first medical evaluation; 146 days from first evaluation to oncologist consultation; 26 days from cancer specialist to the pathology report; and 86 days from the histopathologic diagnosis to the beginning of treatment. Once diagnosis was established, the average elapsed times to chemotherapy, radiotherapy, surgery, and chemoradiotherapy were 88, 102, 76, and 154 days, respectively ( P < .05, when surgery is compared against chemotherapy and radiotherapy). CONCLUSION The mean time interval from symptom presentation to treatment in patients with cancer is more than 7 months. This could explain the advanced stages of disease seen at the time of treatment in Honduras, which decrease chance of cure and increase the mortality rate of cancer). Appropriate intervention to decrease these intervals must be taken to reduce mortality.


2021 ◽  
Vol 15 (2) ◽  
pp. 65-68
Author(s):  
Sharmistha Roy ◽  
Mosammat Mira Pervin ◽  
Mohd Mejbahul Bahar ◽  
Samiron Kumar Mondal ◽  
Md Tariq Hasan

Breast cancer is one of the common cancers in women that causes financial health burden and or death in Bangladesh. Economically we are slowly rising from low to middle income country, which is changing our women's lifestyle. Risk factors of breast cancer include lifestyle factors like- age at first childbirth, parity, using oral contraceptives, BMI; which are also changing in our women. This study will look at our current incidence and patient profile of breast cancer patient. This is a retrospective study done in BIRDEM General Hospital. One hundred patient presenting with breast lump during the period of September 2018 -May 2019 were selected by purposive sampling. In <30 years age group 2 (13.6%) patient had cancer, 41% at <40 years, 53% in 51-60 , 83% in 61-70 age group. Thirty four out of 100 breast lump patient were diagnosed with cancer. Eleven had early cancer, 20 had locally advanced cancer, 3 presented with metastasis. In our study risk factor assessment did not show significant increase risk of in patients who are having cancer compared to those having benign breast disease with similar risk factors. The big number of advance and metastatic breast cancers in our study indicates self-breast examination and breast cancer screening program is still inadequate. Further research is required to find out breast cancer biology and pathogenesis rather than blindly accusing urbanized life style. Faridpur Med. Coll. J. 2020;15(2): 65-68


2017 ◽  
Vol 4 (12) ◽  
pp. 4010
Author(s):  
V. Hari Kumar ◽  
Abdul Ghader Barazandeh Moghadam

Background: For classification of ulcer of feet in diabetes, various systems of classification are in use. Notable among them are the University of Texas (UT) system and the Wagner system. One of the most recent such type of classification system is DUSS (Diabetic Ulcer Severity Score). Studies are required to validate the same. Objective was to test the validity of Diabetic Ulcer Severity Score (DUSS).Methods: Present follow up study was carried out among 50 known cases of diabetes having ulcer over foot. DUSS scoring was applied. Ulcer was graded into five grades. Patients were followed till the outcome was noted.Results: Most common ulcers were of DUSS score of 3. Major amputation was done in 15 (30%) patients and minor amputation in 12 (24%) patients. Toe amputation was done in total of 15 patients. None of the patients had forefoot amputation. Below knee amputation was done in total of 11 (22%) patients. Majority of the foot ulcers among study population with DUSS score 0, 1 and 2 healed by primary intension or skin grafting i.e., 1 (100%), 3 (75%) and 6 (46.15%) respectively. However, among those with score 3 and 4 majority required amputation i.e., 14 (70%) and 10 (83.33%) respectively. This difference in the DUSS score among the three groups was found to be statistically significant (P=0.004). The probability of healing with DUSS score 0 was 100%, 75% with DUSS score 1, 84.61% with DUSS score 2, 30% with DUSS score 3, 16.67% with DUSS score 4. The mean time for healing was 77 days. The mean time for amputation was 100 days.Conclusions: The proposed score classification system for the diabetic foot may enable better quality of life for diabetic patients and promote better low-cost care for millions of individuals worldwide.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Covolo ◽  
J Roncali ◽  
D Zaniboni ◽  
V Mapelli ◽  
E Ceretti ◽  
...  

Abstract Background Paediatrics associations in different international contexts recommended avoiding the use of screen media in children ages 0-2 years and limiting the use to one hour per day for children ages 2-5 years. In the light of these guidelines, the aim of this study was to investigate risk perception in the general population and use of digital devices (DD) in preschool children. Methods We carried out a cross-sectional study on 3115 Italian subjects including parents and non-parents, using an online survey. Parents answered questions about their children’s DD use. We used multiple linear regression analysis to assess the potential predictors of devices’ use in preschool children. Results Overall 74% of sample think that the use of DD by preschool children is a risk for health. They perceive risks, such as having eye irritation (83%), having sleep disorders (65%) more than benefits, e.g. communicating with distant relatives (47%), and learning new words (40%). Parents of preschool children represent the 74% of all parents (N = 1869). The 56% of parents with only 0-2 years children think that is not correct the use of DDs in toddlers, however the 25% of them allow their children to use them. The mean time use reported is 63±57 minutes. Among parents who have also children from 2 to 5 years, the 89% think it is correct the use of DD up to a maximum of one hour a day for children aged 2-5 years. However, the 58% of them allow their children to use it more than one hour. The mean time use reported is 61±52 minutes. Parents without a job, having low education level, with more than one child and having children ages 3 and older, are more prone to allow the use of DD to their children. Conclusions There is a discrepancy between risk perception and real attitude on DD use in children by parents. Public health actions must aim to increase awareness about a conscious use of DD in children considering the spread of DD in the society and younger people. Key messages The discrepancy between risk perception and actual behaviour means an underestimation of health impact of digital devices use in children. Health professionals are very concerned about the health risk of digital devices use in children. Considering the large use of digital devices, public health actors must pay attention to this matter.


2020 ◽  
Vol 12 (01) ◽  
pp. 68-75
Author(s):  
Panduranga Chikkannaiah ◽  
Deinu Thangngeo ◽  
Chanigaramaiah Guruprasad ◽  
Srinivasamurthy Venkataramanappa

Abstract Introduction Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Depending on the amount of mucin, it is classified into pure mucinous carcinoma (> 90%, PMC) and mixed mucinous carcinoma (MMC; < 90%). In comparison to most common subtypes, MC is having better prognosis. There exist clinicopathological differences among PMC and MMC and also MC and IDC-NOS. Materials and Methods MCs diagnosed between January 2012 and December 2017 were included. Fine needle aspiration cytology smears were screened for cellularity, ECM, nuclear pleomorphism, signet ring cells (SRC), mucinophages, and myxovascular fragments (MVF). Histopathology slides were screened to confirm the diagnosis. Immunohistochemistry slides were graded as per the standard protocol. Statistical analyses were performed by SPSS software. Results In the present study, MC constituted 3.3%. The mean age of the patients was 50.9 years. ECM, mucinophages, and SRC were the key diagnostic cytological features. The PMC and MMC were clinicopathologically distinct with respect to gross findings and lymph node status. MMCs were highly proliferative. The mean duration of follow-up was 24.5 months. Complications were more common in MMC than PMC. Lymph node involvement is the key prognostic factor and it is independent of other prognostic factors like age, size, and hormonal receptor status. Conclusion PMC are rare subtype of breast cancer. The diagnostic cytological features are ECM, MVF, and SRC. MMC and PMC are clinicopathologically and genetically distinct.


2019 ◽  
Vol 10 (04) ◽  
pp. 571-575
Author(s):  
Hamid Assadeck ◽  
Moussa Toudou-Daouda ◽  
Zakaria Mamadou ◽  
Mahadi Moussa-Konate ◽  
Fatimata Hassane-Djibo ◽  
...  

Abstract Objectives The aim of this study is to evaluate the management of epilepsy in the elderly at a tertiary referral center in Niger to obtain a comprehensive understanding to determine the intrahospital deficiencies to improve and to make recommendations in terms to improve the management of epilepsy in the elderly in Niger. Materials and Methods We conducted a retrospective study at the Neurology Outpatient Clinic of the National Hospital of Niamey (Niger) over a period of 5 years from May 2013 to May 2018, collecting all cases of patients aged 60 years or over diagnosed with epilepsy by neurologists. From the registers of consultation, we collected and analyzed for each patient the demographic, clinical, etiological, and therapeutic data, as well as the outcomes during follow-up visits. Results Of the 4,576 patients of all ages seen during the period of our study, we included 62 patients aged 60 years or over diagnosed with epilepsy with a hospital frequency of 1.35%. The mean age of patients was 65.82 ± 5.72 years (range: 60 and 83 years) with a predominance of the male sex (sex ratio at 1.6). Patients aged 60 to 64 years were the most represented (43.5%). Generalized tonic–clonic seizures were the most frequent (41.9%), followed by focal to bilateral tonic-clonic seizures (25.8%). All patients underwent electroencephalogram. Only 30 patients (48.4%) underwent brain imaging, and mainly brain computed tomography scan. The etiologies included poststroke epilepsy (25.8%), brain tumors (3.2%), cerebral toxoplasmosis (3.2%), and cerebral meningioma (1.6%). We found 41 cases (66.1%) of epilepsy without definite etiology and with an incomplete workup. Carbamazepine and phenobarbital were the only two antiepileptic drugs (AEDs) used. Conclusion The present study shows limited access to newer generation AEDs and diagnostic tests of epilepsy in Niger. Considerable efforts should be made to facilitate for people living with epilepsy the accessibility to diagnostic tests and the newer generation AEDs to improve the quality of epilepsy management in Niger.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10079-10079 ◽  
Author(s):  
J. B. Smerage ◽  
D. F. Hayes ◽  
G. V. Doyle ◽  
L. W. Terstappen ◽  
M. E. Brown ◽  
...  

10079 Background: Circulating tumor cells (CTCs) are a valuable prognostic factor in metastatic breast cancer, suggesting that CTCs, if present, may be clinically useful in other breast cancer (BC) settings. This study prospectively evaluated CTCs before and after neoadjuvant chemotherapy (NACT) in patients with operable breast cancer. Methods: 7.5 or 30ml of blood were drawn in CellSave tubes from 26 Pts about to receive NACT (docetaxel + capecitabine followed by adriamycin + cytoxan) followed by surgery. CTC analysis is being performed at multiple time points. Data presented are from baseline (prior to first dose), post-NACT, and 3 months after surgery. CTCs were measured by immunomagnetic separation and automated fluorescent microscopy using the CellSearch System (Veridex/Immunicon Corp). Results: Baseline CTCs: For the first 11 pts CTCs were analyzed from 7.5ml of blood. 36% (4/11) had ≥1 CTC, 27% (3/11) had ≥2 CTCs. Of pts with detectable CTCs, the mean was 2.75 CTCs/7.5ml (range 1–4). To improve baseline sensitivity, 30ml blood was drawn from the subsequent 15 pts. One sample was not evaluable. 50% (7/14) had ≥1 detectable CTC and 29% (4/14) had ≥2 CTCs. Of pts with detectable CTCs, the mean was 3.0 CTCs/30ml (range 1–10). CTCs post-neoadjuvant therapy: All 26 pts had 30ml of blood drawn for CTC analysis. 27% (7/26) had ≥1 CTC, and 8% (2/26) had ≥2 CTCs. Using as threshold of ≥2 CTCs to define elevated, CTCs post-chemotherapy were compared to the pathologic complete response (pCR). Sensitivity was 10% (2 of 18 pts with residual disease had elevated CTCs). Specificity was 100% (0 of 7 pts with a pCR had elevated CTCs). This correlated to a positive predictive value of 100% and a negative predictive value (NPV) of 28%. CTCs 3 months after surgery: Of 21 pts analyzed, only one pt (5%) had a single CTC. Long-term follow-up blood collection is ongoing. Conclusions: CTCs are detectable in ∼30% locally advanced BC. All patients with CTCs after NACT had residual disease at surgery, and no CTCs were detected in patients with pCR. However, the absence of CTCs after NACT did not predict pCR. Pts will be followed to determine if CTCs correlate with recurrence and survival. [Table: see text]


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