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Objetivo: relatar o caso de um paciente jovem diagnosticado com rabdomiossarcoma alveolar avançado; descrever o planejamento da assistência de enfermagem prestada ao paciente e sua família. Método: trata-se de estudo de caso instrumental, após aprovação do Comitê de Ética, em um hospital geral de grande porte do município de São Paulo, São Paulo, Brasil. Para o planejamento do cuidado utilizou-se se as etapas do processo de enfermagem e técnicas e modelos conceituais: comunicação de más notícias, construção de habilidades para o autogerenciamento e os princípios do cuidado humanizado (acolhimento e clínica ampliada). Resultados: paciente masculino, 19 anos, que evoluiu para óbito. Paciente e sua família foram os focos das intervenções a partir da detecção de doze diagnósticos de enfermagem: proteção ineficaz, risco de quedas, risco de confusão aguda, integridade da membrana mucosa oral prejudicada, dor crônica, ansiedade relacionada à morte, disposição para religiosidade melhorada, sofrimento espiritual, enfrentamento defensivo, sobrecarga de estresse, risco de sentimento de impotência e tensão do papel de cuidador. Conclusão: casos complexos exigem o uso adequado e sistemático de teorias e modelos conceituais que subsidiem o cuidado, bem como o uso de técnica para a comunicação de más notícias.

Objective. There is a need to develop and validate biomarkers for treatment response and survival in tubo-ovarian high-grade serous carcinoma (HGSC). The chemotherapy response score (CRS) stratifies patients into complete/near-complete (CRS3), partial (CRS2), and no/minimal (CRS1) response after neoadjuvant chemotherapy (NACT). Our aim was to review current evidence to determine whether the CRS is prognostic in women with tubo-ovarian HGSC treated with NACT.Methods. We established an international collaboration to conduct a systematic review and meta-analysis, pooling individual patient data from 16 sites in 11 countries. Patients had stage IIIC/IV HGSC, 3-4 NACT cycles and >6-months follow-up. Random effects models were used to derive combined odds ratios in the pooled population to investigate associations between CRS and progression free and overall survival (PFS and OS).Results. 877 patients were included from published and unpublished studies. Median PFS and OS were 15 months (IQR 5-65) and 28 months (IQR 7-92) respectively. CRS3 was seen in 249 patients (28%). The pooled hazard ratios (HR) for PFS and OS for CRS3 versus CRS1/CRS2 were 0.55 (95% CI, 0.45-0.66; P < 0.001) and 0.65 (95% CI 0.50-0.85, P = 0.002) respectively; no heterogeneity was identified (PFS: Q = 6.42, P = 0.698, I2 = 0.0%; OS: Q = 6.89, P = 0 648, I2 = 0.0%). CRS was significantly associated with PFS and OS in multivariate models adjusting for age and stage. Of 306 patients with known germline BRCA1/2 status, those with BRCA1/2 mutations (n = 80) were more likely to achieve CRS3 (P = 0.027).Conclusions. CRS3 was significantly associated with improved PFS and OS compared to CRS1/2. This validation of CRS in a real-world setting demonstrates it to be a robust and reproducible biomarker with potential to be incorporated into therapeutic decision-making and clinical trial design. (C) 2019 The Authors. Published by Elsevier Inc.

e18171 Background: The perception of symptoms, diagnosys, access to a cancer care institute and the first-line of therapy are milestones of cancer care. The success of an oncological treatment is directly relatable to these key-points and the time gaps between them. Growing research in developing countries points out the challenges of offering quality of care in this setting as social, cultural, economic and political factors are deeply intertwined. The objective of this study is to identify the key-points of cancer care, the time gaps between them and the time-related end-points of patients refered to a medical oncology department of a public university hospital in São Paulo, Brazil, in the period of one year. Methods: This is a observational retrospective study based on review of medical records of all cancer patients refered to the medical oncology department of a public university hospital in São Paulo, Brazil, from 01/01/17 to 12/31/17. The analysis was performed in January 2019. The data collected comprises the age at diagnosys, gender, primary tumor site, stage (AJCC 7th ed. staging system), onset of symptons, date of hystopathological diagnosys, the first therapeutic modality and when it was offered, intention of care (curative or palliative), outcomes and the following time-relations: symptoms-dyagnosis (SD), dyagnosis-treatment (DT) and symptoms-treatment (ST). Results: From 358 profiles, 275 were included. The average age at diagnosys was 58,7 years (15-88 years). Men were 147 (53,4%) and 128 (46,5%) were women. The most common primary tumor sites were gastrointestinal tract 22,9%, head and neck 20,3%, cutaneous melanoma 17,8% and genitourinary tract 16%. 160 (58,1%) patients were diagnosed at advanced/metastatic stages (III/IV). The median time-relations were: 5,5 months for SD; 2 months for DT and 8 months for ST. The first treatment offered was surgery at 63,2% of cases, radiotherapy 17,8%, systemic therapy 16,7% (endocrine therapy, targeted therapy or chemotherapy) or palliative care 1,8%. The intention of the initial treatment: 76,3% were curative and 23,2% palliative. At time of analysis, 63,6% of patients were alive, 19,2% deceased and 16,7% of unknown outcome. Conclusions: Our data endorses prevalent findings of developing countries epidemiological studies: late diagnosys, non-curative treatments and poor outcomes. Known causes are desfavorable social-economic conditions, symptom neglection, ineffective cancer screening and deficiency of public cancer care networks. We emphasize time goals as important quality indexes to guide new solutions.

Patients with cancer are at risk for metabolic disorders. The pathophysiologies include organic dysfunction due to systemic dissemination, dysfunction due to anticancer treatment, paraneoplastic metabolic changes due to tumor proliferation mechanisms, and metabolites production. The main metabolic emergencies in cancer patients are the tumor lysis syndrome, hypercalcemia, hyponatremia, and adrenal insufficiency.

Objective: To assess aspects related to cancer in indigenous population. Methods: This is a retrospective study developed in a public university hospital. We included patients with 18 or more years of age, diagnosed with solid tumors, and followed between 2005 and 2015. Clinical features were assessed by descriptive statistics, and survival was evaluated by Kaplan-Meier curves and multivariate Cox regression. Results: Fifty patients were included. The cancer incidence was 15.73 per 100,000. The mean age at diagnosis was 54 years and most patients were female (58%). Cancer of the cervix (28%) and prostate (16%) were the most common. The mean time between the onset of symptoms and the diagnosis was 9 months and from diagnosis to the treatment was 3.4 months. Disease diagnosed at stage IV (17%) had worse overall survival (HR: 11.4; p