Stage at presentation of breast cancer in Luanda, Angola - a retrospective study

Background: It is expected that, by 2020, 15 million new cases of cancer will occur every year in the world, one million of them in Africa. Knowledge of cancer trends in African countries is far from adequate, and improvements in cancer prevention efforts are urgently needed. The aim of this study was to characterize breast cancer clinically and pathologically at presentation in Luanda, Angola; we additionally provide quality information that will be useful for breast cancer care planning in the country. Methods: Data on breast cancer cases were retrieved from the Angolan Institute of Cancer Control, from 2006 to 2014. For women diagnosed in 2009 (5-years of follow-up), demographic, clinical and pathological information, at presentation, was collected, namely age at diagnosis, parity, methods used for pathological diagnoses, tumor pathological characteristics, stage of disease and treatment. Descriptive statistics were performed. Results: The median age of women diagnosed with breast cancer in 2009 was 47 years old (range 25–89). The most frequent clinical presentation was breast swelling with axillary lymph nodes metastasis (44.9 %), followed by a mass larger than 5 cm (14.2 %) and lump (12.9 %). Invasive ductal carcinoma was the main histologic type (81.8 %). Only 10.1 % of cancer cases had a well differentiated histological grade. Cancers were diagnosed mostly at advanced stages (66.7 % in stage III and 11.1 % in stage IV). Discussion: In this study, breast cancer was diagnosed at a very advanced stage. Although it reports data from a single cancer center in Luanda, Angola it reinforces the need for early diagnosis and increasing awareness. According to the main challenges related to breast cancer diagnosis and treatment herein presented, we propose a realistic framework that would allow for the implementation of a breast cancer care program, built under a strong network based on cooperation, teaching, audit, good practices and the organization of health services. Conclusion: Angola needs urgently a program for early diagnosis of breast cancer.We thank Susana Santos for correction of the article in English language, and a Cancer Registry Staff from IACC, particularly Pedro Luis Hernandez Gonzalez, Paulo Ernesto Alves, Xacu Parica and Alberto Sivi Lutumba for their support in data acquisition. We also thank SEMED -Portugal in support for publication

Electronic Patient-Reported Outcomes After Thoracic Surgery: Toward Better Remote Management of Perioperative Symptoms

Health-related quality of life (HRQOL) after thoracic surgery is increasingly important due to steadily improving survival and better clinical outcomes after treatment for early-stage lung cancer. The recent article by Avery and colleagues describes HRQOL in patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer in a single UK center. This prospective, longitudinal study is one of the few to use validated, disease-specific survey instruments to study this population. Until the results of the UK-based VIOLET trial (comparing the impact of VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy) are available, this study provides the most contemporary information on HRQOL trajectory after lung cancer surgery. Importantly, the authors show HRQOL continues to suffer and residual symptoms persist at 1 year after minimally invasive lung cancer surgery. These findings demonstrate the need for longitudinal measurement of postoperative patient-reported outcomes (PROs) in order to (1) provide an adjunct to traditional clinical outcomes as measures of quality, and (2) improve symptom management in routine clinical practice. Given the heterogeneity of international guidelines regarding the optimal follow-up schedule and duration after thoracic surgery, electronic PRO (ePRO) platforms that automatically deliver PRO surveys to patients at home and alert providers for concerning responses may serve to effectively monitor patients beyond the standard post-surgical follow-up periods