The Challenge of Metastatic Colorectal Cancer

Colorectal cancer (CRC) is a very common disease with a high rate of mortality around the world, representing the second most frequent cause of cancer-related death. As the majority of patients are diagnosed with advanced cancer with a subsequent low five-year survival rate (10%), it is imperative to develop new strategies to treat this challenging patient population. Traditionally, patients received successive lines of chemotherapy and discontinued the treatment or switched to a different one in the event of disease progression. But despite the therapeutic advances achieved with combination chemotherapy regimens, particularly FOLFOX and FOLFIRI, considerable research has been necessary to further optimize chemotherapy for patients with metastatic colorectal cancer (mCRC). However, progress has been achieved over recent years. The most relevant relates to the approval of several new effective therapeutic drugs, such as monoclonal antibodies, which have greatly improved the outcomes for metastatic disease. The last agent approved has been panitumumab, which has been designed to target the epidermal growth factor receptor molecular pathway involved in the appearance and spread of cancer

Evaluación de dos estrategias de seguimiento del cáncer de colon desde el punto de vista del coste-efectividad

Este trabajo tiene como objetivo la evaluación comparativa desde el punto de vista del coste-efectividad de dos estrategias de seguimiento del Cáncer de Colon llevadas a cabo en el Servicio de Oncología del Hospital Clínico Universitario de Valladolid. Para ello se realizó un estudio retrospectivo de dos grupos de pacientes intervenidos quirúrgicamente en el periodo 2000-2001 sometidos a dos estrategias de seguimiento diferenciadas de acuerdo a la periodicidad: Grupo 1 o estándar y grupo 2 o minimalista. Se consideró la perspectiva hospitalaria para el análisis de los costes y de la efectividad. Los resultados obtenidos muestran que la modalidad de seguimiento más coste-efectiva es la minimalista. Estos resultados se mantienen relativamente estables tras la aplicación del análisis de sensibilidad excepto al aplicar la variación de costes con eliminación de los costes innecesarios que favorece a la estrategia estándar. De acuerdo a los resultados obtenidos sería interesante la realización de un análisis prospectivo para extraer conclusiones definitivas.Departamento de Anatomía y Radiologí

Life after Breast Cancer: Dealing with Lymphoedema

Background In recent years, breast cancer (BC) mortality rates have declined, reflecting advances in early detection. Prevention and management of treatment sequelae that could impair function or quality of life have increased in relevance. Lymphoedema after BC treatment is one of these sequelae. It is caused by an acquired interruption or damage to the axillary lymphatic system and it is characterized by an abnormal accumulation of fluids and other substances in the tissue. Purpose We observed a group of patients with incidents of BC aiming to estimate the lymphoedema incidence, degree, time course, symptoms and treatment they received. Methods and Results We evaluated 127 women. Median age was 58 years. 66% were postmenopausal. The median number of axillary nodes was 9. Over the first five years of follow-up we were informed about hand/arm swelling, thickness or tiredness by 37% of this group. The median of axillary nodes affected by metastatic cells in our patients with lymphoedema was 6. The symptoms they referred to us as the most relevant were heaviness (33%), tiredness (27%), jewelry or clothing too tight (25%), swelling and indentations (9%) and difficulty writing (6%). Several of them had psychological problems. Conclusion We know of the relevance of lymphoedema in BC patients but its natural history and most effective therapies are poorly understood. Self-reported symptoms are relevant to promptly start therapy

El estándar DICOM y su nivel de implantación en Europa

Every time they are more hospitals that install a PACS systems to allow a correct functioning of the standard DICOM and this way to provide a faster and more effective service to patients through informatics systems. This article will review the basic architecture of the standard DICOM and how this system contributes to improve health services and a better management of patients´ data. Likewise, the disadvantages of DICOM will be analyzed, focusing primarily on the privacy of information and the article will conclude giving a global perspective of the implantation both in our country and in the rest of Europe.Cada vez son más los hospitales que instalan un sistema PACS (Picture Archiving and Communication System) para permitir el correcto funcionamiento del estándar DICOM (Digital Imaging and Communication in Medicine) y poder así proporcionar un servicio más rápido y eficaz a los pacientes a través de plataformas informáticas. En este artículo se estudiará la arquitectura básica que presenta el estándar DICOM y cómo éste contribuye a una mejora de la sanidad y a un mejor tratamiento de los datos de pacientes. Así mismo, se realizará un análisis de los inconvenientes de cara a la privacidad de los datos y se finalizará dando una perspectiva global de su implantación tanto en nuestro país como en el resto de Europa