A relevância da atenção farmacêutica no manejo de reações adversas no tratamento oncológico: uma revisão sistemática / The relevance of pharmaceutical care in the management of adverse reactions in oncologic treatment: a systematic review

Introdução: a atenção farmacêutica visa a melhoria da qualidade de vida do paciente, através de um modelo de prática profissional voltada à farmacoterapia inclusive em tratamentos oncológicos, dos quais muitas vezes são desconfortáveis para o paciente devido aos seus efeitos adversos. O profissional farmacêutico, dessa forma, tem o papel de tornar o tratamento menos oneroso para os pacientes.Objetivo: este trabalho tem como objetivo descrever a importância da atenção farmacêutica no tratamento oncológico, relatando a importância do acompanhamento do profissional farmacêutico para adesão do tratamento e efeitos colaterais mais comuns relatados pelos pacientes. Metodologia: para alcançar os dados esperados será utilizado um estudo de revisão bibliográfica, através do método prisma, com artigos dos anos de 2015 a 2020. A atenção farmacêutica em usuários de tratamento oncológico, também proporciona orientações sobre as prescrições e esclarece as queixas e dúvidas técnicas referentes ao uso dos antineoplásicos. Desta forma, tem-se o intuito de demostrar que a presença do profissional farmacêutico na atenção ao paciente em tratamento oncológico visa essencialmente promover condutas de prevenção, promoção, reabilitação, recuperação, de forma segura e eficaz.Resultados: foram identificados ao todo identificados 233 trabalhos, sendo selecionados 22 trabalhos que correspondiam aos critérios de elegibilidade escolhidos. Os artigos foram divididos em relação à temática abordada respondendo os objetivos dispostos nessa pesquisa. Quanto as reações adversas reportadas por farmacêuticos, é observável a importância deste profissional devido seu conhecimento clínico em reconhecê-las e classificá-las em relação ao seu risco. O farmacêutico em maioria das intervenções aplicadas, obteve um grande sucesso em relação a melhora do tratamento do paciente e consequentemente qualidade de vida deste. A interação entre o farmacêutico e a equipe multiprofissional demonstrou-se ser de grande importância devido a facilidade de criar propostas de intervenção para os problemas relacionados a medicamentos identificados. Conclusão: o farmacêutico é um elemento crucial em oncologia quando se trata de identificar e reportar reações adversas de forma a otimizar tratamentos, diminuir desconforto e melhorar da qualidade de vida do paciente quando se há a comunicação ideal entre os profissionais da equipe oncológica.

Oncologic Treatment of HIV-Associated Kaposi Sarcoma 40 Years on

The observation in 1981 of the emergence of Kaposi sarcoma (KS) among young men who had sex with men was one of the first harbingers of the HIV epidemic. With advances in HIV care, the incidence of HIV-associated KS (HIV+KS) has decreased over time in the United States. However, it remains a persistent malignancy among some HIV-infected populations and is one of the most common tumors in sub-Saharan Africa. Because of the relapsing and remitting nature of this cancer, patients with HIV+KS can experience significant, long-term, morbidity. Patients with severe HIV+KS may also have concurrent lymphoproliferative syndromes, malignancies, and/or infections that can contribute to mortality. Several chemotherapy agents were explored in clinical trials for HIV+KS during the early stage of the epidemic. As HIV+KS emerges with CD4 lymphopenia and immunodysregulation, T-cell–sparing options are important to consider. Here, we explore the pathogenesis of HIV+KS and the current evidence for immunotherapy and therapies that potentially target KS pathogenesis. This review provides the current landscape of therapies for HIV+KS and highlights management issues for patients with HIV and cancer.

Endovascular biopsy of a sigmoid sinus lesion using a stent retriever and aspiration catheter

A teenager with a history of acute myeloid leukemia presented with headache, nausea and blurry vision over a 2 week period. The MRI of the brain was concerning for the presence of a myeloid sarcoma within the right sigmoid sinus. For evaluation of venous obstruction and the underlying lesion the patient underwent a cerebral angiogram and transvenous biopsy of the sigmoid sinus lesion using a stent retriever and aspiration catheter. The tissue extracted was consistent with myeloid sarcoma. This pathologic finding was consistent with the recurrence of leukemia and guided the targeted oncologic treatment.

S-Adenosylmethionine Supplementation May Reduce Cancer-Related Fatigue: A Prospective Evaluation Using the FACIT-F Questionnaire in Colon Cancer Patients Undergoing Oxaliplatin-Based Chemotherapy Regimens

<b><i>Background:</i></b> Fatigue is a common distressing symptom for patients living with chronic or acute diseases, including liver disorders and cancer (<i>Cancer-Related Fatigue</i>, CRF). Its etiology is multifactorial, and some hypotheses regarding the pathogenesis are summarized, with possible shared mechanisms both in cancer and in chronic liver diseases. A deal of work has investigated the role of a multifunctional molecule in improving symptoms and outcomes in different liver dysfunctions and associated symptoms, including chronic fatigue: S-adenosylmethionine (SAM; AdoMet). The aim of this work is actually to consider its role also in oncologic settings. <b><i>Patients and Methods:</i></b> Between January 2006 and December 2009, at the University Campus Bio-Medico of Rome, 145 patients affected by colorectal cancer in adjuvant (<i>n</i> = 91) or metastatic (<i>n</i> = 54; <i>n</i> = 40 with liver metastases) setting and treated with oxaliplatin-based regimen (FOLFOX for adjuvant and bevacizumab + XELOX for metastatic ones), 76 of which with the supplementation of S-adenosylmethionine (AdoMet; 400 mg b.i.d.) (57% of adjuvant patients and 44% of metastatic ones) and 69 without AdoMet supplementation, were evaluated for fatigue prevalence using the Functional Assessment of Chronic Illnesses Therapy-Fatigue (FACIT-F) questionnaire, at 3 and 6 months after the beginning of oncologic treatment. Notably, the number of patients with liver metastases was well balanced between the group of patients treated with AdoMet and those who were not. <b><i>Results:</i></b> Among patients receiving oxaliplatin-based chemotherapy, both in adjuvant and in metastatic settings, after just 3 months from the beginning of chemotherapy, mean scores from questionnaire domains like FACIT-F subscale (7.9 vs. 3.1, <i>p</i> = 0.006), FACIT physical (6.25 vs. 3.32, <i>p</i> = 0.020), FACIT emotional (4.65 vs. 2.19, <i>p</i> = 0.045), and FACIT-F total score (16.5 vs. 8.27, <i>p</i> = 0.021) were higher in those receiving supplementation of AdoMet, resulting in reduced fatigue; a significant difference was maintained even after 6 months of treatment. <b><i>Discussion and Conclusions:</i></b> Mechanisms and strategies for managing CRF are not fully understood. This work aimed at investigating the possible role of S-adenosylmethionine supplementation in improving fatigue scores in a specific setting of cancer patients, using a FACIT-F questionnaire, a well-validated quality of life instrument widely used for the assessment of CRF in clinical trials.

Targeting DNA Repair Response Promotes Immunotherapy in Ovarian Cancer: Rationale and Clinical Application

Immune checkpoint inhibitors (ICI) have emerged as a powerful oncologic treatment modality for patients with different solid tumors. Unfortunately, the efficacy of ICI monotherapy in ovarian cancer is limited, and combination therapy provides a new opportunity for immunotherapy in ovarian cancer. DNA damage repair (DDR) pathways play central roles in the maintenance of genomic integrity and promote the progression of cancer. A deficiency in DDR genes can cause different degrees of DNA damage that enhance local antigen release, resulting in systemic antitumor immune responses. Thus, the combination of DDR inhibitors with ICI represents an attractive therapeutic strategy with the potential to improve the clinical outcomes of patients with ovarian cancer. In this review, we provide an overview of the interconnectivity between DDR pathway deficiency and immune response, summarize available clinical trials on the combination therapy in ovarian cancer, and discuss the potential predictive biomarkers that can be utilized to guide the use of combination therapy.

Situation of oncological patients during COVID-19 pandemic with particular emphasis on lung cancer patients

Introduction and purpose: The purpose of this study is to review literature about alterations to treatment regimens to lung cancer during COVID-19 pandemic accessible on PubMed platform. In pulmonary neoplasms, early diagnosis and treatment is a key to ensure patient safety. Burdening of healthcare systems during pandemic has resulted in many obstacles in oncologic treatment. A brief description of the state of knowledge: The lung cancer is the most frequent and the most deadly cancer in men and women. COVID-19 is a pulmonary infectious disease whose spread around the world has resulted in a pandemic. At the onset of the worldwide pandemic, many institutions, including healthcare facilities were closed, making it more difficult to provide oncological patients the treatment compliant with the standards. The anxiety of patients caused by the pandemic has caused delays in treatment that can cause progression of the disease. In patients with lung cancer mortality of COVID-19 was around 50%, which made their visits at hospital hazardous. Before the accessibility of anti-COVID-19 vaccines telemedical healthcare was one of the ways to provide healthcare to oncological patients. Conclusions: Patients with lung cancer are one of the risk groups of COVID-19. Delays in their treatment caused by the pandemic are potentially dangerous and negatively affect the therapy. Telemedicine is a useful too provide medical care, but has its own limitations.

Practice of Oncology in Low- income Setting: A Review of Four Years Activities in Togo

Purpose: Until 2016, there was no oncologist in Togo. This study reviewed the first four years of activities in the practice of clinical oncology in the country to provide the cancer profile, the treatment, and outcomes of patients.Methods: We performed a retrospective descriptive study of patients diagnosed with cancer seen in oncology in Togo from March 2016 to March 2020. Data on presentation, staging, treatment, and outcomes were reviewed. Statistics were computed using SPSS.Results: A total of 897 patients were included. There were 625 women (69.7%) and 272 men (30.3%). The mean age at diagnosis was 53.48 years for men and 52.39 for women and more than half of patients were under 60 years. A cancer diagnosis was histologically confirmed in 81.2% of patients. For both sexes, breast cancer was the commonest followed by cervix cancer, colorectal cancer, prostate, and stomach cancer. In men, prostate cancer ranked first followed respectively by gastric cancer and colorectal cancer. The most common cancer in women was breast cancer followed by cervix cancer. Majority of patients (60%) presented at a late stage. 531 patients (59.2%) received at least one cancer therapy modality but more than half of treated patients did not complete their treatment. After fifty-eight months of follow-up, only 132 patients (14.7%) in the all-study population are alive. Conclusion: This study describes the epidemiology and oncologic treatment in Togolese patients. Breast and Prostate are the leading cancer diagnoses in our population. Most patients presented at an advanced stage and the treatment was palliative in a majority of patients. There is an urgent need for early detection of cancer in Togo.

The Negative Impact of the COVID-19 Pandemic on Oncology Care at an Academic Cancer Referral Center

Objectives: COVID-19 created unexpected delays in oncologic treatment. This study sought to assess the volume of missed cancer-related services due to the pandemic. Methods: This case-controlled trial evaluated more than 345,000 oncologic clinic, lab, and radiation appointments from January 1, 2019, through December 31, 2020, and surgery appointments from January 1, 2019, through October 31, 2020. All patients at the Seidman Cancer Center with a cancer diagnosis based on a comprehensive list of 2178 International Classification of Diseases, Ninth Edition (ICD-9) and ICD-10 codes were included in the analysis. Subgroup analyses based on age, race, and sex were also performed. Results: Clinic, lab, and surgical visit cancellations increased by 4.20% (P <.001), 4.84% (P <.001), and 5.22% (P <.001), respectively. In the first 10 months of 2020, there were 703 (9.2%) fewer surgeries compared with the same time period in 2019. The following cancellation rates peaked in March 2020: clinic visits (26.53%), labs (43.66%), surgery (34.00%). Radiation oncology (12.53%) cancellations peaked in April 2020. Prior to the emergence of COVID-19, the group aged 0 to 39 years had the highest clinic cancellation rate (17.85%) compared with patients aged 40 to 64 years (15.95%) and 65 years and older (14.52%; P <.001). Men cancelled (15.63%) significantly more often than women (14.93%; P <.001) in 2019. This reversed during the pandemic: Women (19.56%) cancelled more frequently than men (19.20%; P <.036). Conclusions: There was a large increase in cancelled oncologic care in 2020, which has implications for delayed diagnosis and treatment. This was especially true for patients older than 65 years and for women. These delays could result in patients presenting with more advanced disease, complicating morbidities, and ultimately worse long-term outcomes.