20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment

Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines

Atendimento de reabilitação à pessoa idosa vítima de acidentes e violência em distintas regiões do Brasil Rehabilitation service to the elder person victim of accidents and violence on different regions of Brazil

Objetiva-se descrever a estrutura e caracterizar o atendimento prestado por serviços de reabilitação que atendem idosos vítimas de acidentes e violência, baseando-se nas principais políticas públicas de saúde dirigidas à população idosa no país. Seguindo os princípios da triangulação de métodos, aplicou-se um questionário a 19 serviços de reabilitação (cinco em Manaus, sete em Recife, dois em Brasília, dois no Rio de Janeiro e três em Curitiba) composto por 27 questões referentes à estrutura e organização do serviço e registro dos dados. Foram entrevistados gestores e profissionais sobre fluxo, caracterização e especificidades do atendimento ao idoso, redes de proteção, avaliação dos serviços e sugestões. Os serviços de Manaus e Brasília estão mais bem preparados para atender aos idosos vítimas de acidentes e violência. Os de Brasília sobressaem nas questões mais específicas ao atendimento do idoso. As unidades de reabilitação de Recife apresentam-se menos preparadas, especialmente nos itens de suporte laboratorial, capacitação de profissionais para identificar e atender os casos de idosos em situação de violência, registro e análise dos dados. Conclui-se que o atendimento de reabilitação apresenta grandes fragilidades na implantação das políticas públicas e na inserção do tema da violência.<br>The purpose of this work is to describe the structure and characterize the services offered for rehabilitation of elder people, victims of accidents and violence, based on the main public policies of health for this population in Brazil. Following the principles of the triangulation method, a 27 question questionnaire was applied to 19 rehabilitation services (five in Manaus, seven in Recife, two in Brasília, two in Rio de Janeiro and three in Curitiba) about structure and organization of the service besides data registration. Managers and health professionals were interviewed about the flow, characterization and specificities of the service to elder people, protection chains, services evaluation and suggestions. Services in Manaus and Brasília are better prepared to attend elder victims of accidents and violence. The services in Brasília surpass the specific issues of elderly care. The rehabilitation units in Recife are more unprepared, especially regarding laboratorial support, qualification of professionals to identify and attend the cases of violence, registration and analysis of data. It is concluded that the rehabilitation service presents great fragility on the implantation of public policies and in insertion of the violence theme

Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer : meta-analysis of individual patient data from ten randomised trials

Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21.4% for NACT versus 15.9% for adjuvant chemotherapy (5.5% increase [95% CI 2.4-8.6]; rate ratio 1.37 [95% CI 1.17-1.61]; p = 0.0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38.2% for NACT vs 38.0% for adjuvant chemotherapy; rate ratio 1.02 [95% CI 0.92-1.14]; p = 0.66), breast cancer mortality (34.4% vs 33.7%; 1.06 [0.95-1.18]; p = 0.31), or death from any cause (40.9% vs 41.2%; 1.04 [0.94-1.15]; p = 0.45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. Copyright (c) The Author(s). Published by Elsevier Ltd.Peer reviewe

Tendências dos estudos com idosos mais velhos na comunidade: uma revisão sistemática (inter)nacional

O estudo objetivou identificar e analisar as tendências e tipos de estudos, publicados no país e no exterior, envolvendo idosos >80 anos residentes na comunidade. Realizou-se uma revisão sistemática da literatura nacional nas bases de dados LILACS e SciELO e internacional nas bases PUBMED e EMBASE, nas duas últimas décadas. Selecionaram-se 162 referências internacionais e 12 nacionais. Predominou a área das ciências biológicas, tanto no nível nacional (50%) quanto internacional (74,1%). Todos os trabalhos nacionais foram observacionais, sendo 91,7% de estudos transversais. Dentre os internacionais, 93,3% foram observacionais. Destes, 48,1% de estudos transversais e 37,6% de estudos de corte. Os Estados Unidos foram responsáveis por 41,4% do total de publicações internacionais. O Brasil e a China foram os únicos países em desenvolvimento a apresentar produções internacionais. Apesar do significativo aumento no número de produções científicas internacionais a partir de 2005, o mesmo ainda não foi constatado em nível nacional