Impact of the delay to start treatment in patients with lung cancer treated in a densely populated area of Brazil

OBJECTIVES: The aim of this study is to evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment. METHODS: We retrospectively reviewed 509 patients with malignant lung neoplasms who were admitted to a single reference oncology center of the public health system between July 2008 and December 2014. Patients were considered eligible for this study if they were older than 18 years and had not undergone any previous oncology treatment when they were admitted to the institution. The following data were collected from all patients: age, gender, smoking status, tumor staging, time from the when the first symptoms were experienced by the patient to when the patient was diagnosed with cancer, time from the first appointment to cancer diagnosis, and time from when the patient was diagnosed with cancer to the initiation of treatment. RESULTS: The median time from symptom onset to diagnosis was three months. From the first appointment to diagnosis, the median time interval was one month; however, 79% of patients were diagnosed in up to two months. The median time from diagnosis to the start of treatment was one month, but most patients (82.5%) started treatment in up to two months. CONCLUSION: In our highly populated region with preferential access to the public health system, patients are required to wait a relatively long time to effectively begin treatment for lung cancer. This type of study is important to alert medical societies and government health agencies

Efficacy and safety of a device used to prevent fogging and residue buildup on surgical optics during video-assisted thoracic surgical procedures (LacrimaSurg): a pilot in vivo study

Introdução: Atualmente uma grande parte dos procedimentos cirúrgicos efetuados para o tratamento das mais diversas doenças são realizados com o emprego do vídeo. Apesar dos grandes avanços tecnológicos alguns problemas ainda atrapalham esta via de acesso. Um deles é o acúmulo de resíduos à frente da lente objetiva da óptica cirúrgica atrapalhando a visão do cirurgião. Para resolver o problema Abreu et al. (2015) desenvolveram um dispositivo, posteriormente chamado de LacrimaSurg, que funciona como um canal lacrimal da óptica prevenindo o embaçamento e acúmulo de resíduos na mesma, este dispositivo mostrou uma eficácia de 98,1% em estudo experimental ex vivo.Objetivos: Avaliar a viabilidade e a segurança do dispositivo em condições cirúrgicas reais. Métodos: Um estudo piloto in vivo incluiu 30 pacientes submetidos a procedimentos cirúrgicos torácicos empregando o LacrimaSurg. Os procedimentos foram gravados digitalmente para posterior análise pelos investigadores. As características dos pacientes (idade, sexo, índice de massa orporal, índice de comorbidades de Charlton), dados relativos ao ambiente cirúrgico (diferenças entre as temperaturas axilar do paciente e da sala cirúrgica) e dados inerentes ao procedimento em sí (tipo de cirurgia e tempo de duração de cada procedimento) foram registrados. Os investigadores assistiram aos vídeos cirúrgicos e registraram os eventos de sujeira e fogging da óptica que acarretaram em prejuízo da visão do cirurgião. Dados sobre o número de vezes que a óptica sujou, necessidade ou não de jatos de solução cristaloide e necessidade de limpeza mecânica da óptica foram coletados para a avaliação da eficácica. Dosagens séricas comparativas dos eletrólitos sódio e potássio pré e pósoperatórios foram registrados para a avaliação da segurança. Os dados foram organizados e analisados por meio de correlações lineares simples e teste t para as variáveis contínuas e teste exato de Fisher para as variáveis categóricas. Resultados: O uso do dispositivo permitiu que 97% dos procedimentos fossem realizados sem a necessidade de interrupção para limpeza mecânica da óptica. Não foram identificadas características inerentes aos pacientes ou aos procedimentos que colaborassem com o embaçamento ou sujeira da óptica. Não houve diferenças estatisticamente significativas entre os íons séricos pré e pós-operatórios dos pacientes, não foram observadas complicações pós-operatórias relacionadas ao uso do dispositivo. Conclusão: O dispositivo mostrou-se eficaz na prevenção de interrupções dos procedimentos cirúrgicos por sujeira ou embaçamento da óptica, seu uso foi considerado seguro não gerando complicações pós-operatórias.Introduction: Nowadays the great majority of the surgical procedures for the treatment of the most diverse kinds of diseases are video surgeries. Despite major technological advances, some problems still surgical modality. The buildup of residues in front of the lens hindering the surgeon\'s vision is one of this problems. To solve it, Abreu et al. (2015) developed a device called LacrimaSurg, which works as a lacrimal duct in the optics preventing fogging and residues buildup on it. This device showed an efficiency of 98.1% in an experimental ex vivo study. Objectives: Assess the feasibility and safety of the device under real surgical conditions. Methods: An in vivo pilot study included 30 patients undergoing thoracic surgical procedures using LacrimaSurg. The procedures were recorded for further analysis by the researchers. The characteristics of the patients (age, sex, body mass index, Charlton comorbidity index), data related to the surgical environment (differences between the axillary temperatures of the patient and the operating room) and data inherent to the procedure itself (type of surgery and duration of each procedure) were recorded. The investigators watched the surgical videos and recorded the residue buildup and fogging events that leaded to impaired surgeon\'s vision. Data regarding the number of times the optics got dirty, the need for further jets of crystalloid solution and the need for mechanical cleaning of the optics were collected to evaluate efficacy. Comparative serum measurements of sodium and potassium electrolytes before and after surgery were recorded for safety assessment. The data were organized and analyzed by means of simple linear correlations and t test for continuous variables and Fisher\'s exact test for categorical variables. Results: The use of the device allowed 97% of the procedures to be performed without interruption for mechanical cleaning of the optics. No characteristics inherent to the patients or to the procedures that contributed to the fogging or filth of the optics were identified. There were no statistically significant differences between pre- and postoperative serum ions, and no postoperative complications related to the use of the device were observed. Conclusion: The device was shown to be effective in preventing interruption of surgical procedures due to dirt or fogging of the optics, its use was considered safe and did not cause postoperative complications

Use of indwelling pleural catheters for the definitive treatment of malignant pleural effusion

ABSTRACT Objective: To evaluate the safety and feasibility of the use of indwelling pleural catheters (IPCs) in patients with malignant pleural effusion (MPE). Methods: We prospectively collected data from patients with MPE undergoing IPC placement between January of 2014 and July of 2015. All patients submitted to IPC placement had a life expectancy > 30 days, in accordance with the MPE treatment guidelines established by the British Thoracic Society. The data collected included gender, age, body mass index, primary cancer site, duration of IPC drainage, IPC-related complications, length of hospital stay, pleural effusion recurrence, and occurrence of spontaneous pleurodesis. Results: A total of 19 patients underwent IPC placement during the study period. Median overall survival after IPC insertion was 145 days. The median follow-up among the surviving patients was 125 days (range, 53-485 days), and the median time between catheter insertion and removal was 31 days (range, 2-126 days). There were IPC-related complications in 5 patients (26.2%), and spontaneous pleurodesis was achieved in 8 (42.0%). Among those 8 patients, the IPC was removed between days 30 and 126 in 4, and spontaneous pleurodesis occurred within the first 30 days in 4. Conclusions: The use of IPCs seems to be feasible and safe in patients with MPE

Impact of the delay to start treatment in patients with lung cancer treated in a densely populated area of Brazil

OBJECTIVES: The aim of this study is to evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment. METHODS: We retrospectively reviewed 509 patients with malignant lung neoplasms who were admitted to a single reference oncology center of the public health system between July 2008 and December 2014. Patients were considered eligible for this study if they were older than 18 years and had not undergone any previous oncology treatment when they were admitted to the institution. The following data were collected from all patients: age, gender, smoking status, tumor staging, time from the when the first symptoms were experienced by the patient to when the patient was diagnosed with cancer, time from the first appointment to cancer diagnosis, and time from when the patient was diagnosed with cancer to the initiation of treatment. RESULTS: The median time from symptom onset to diagnosis was three months. From the first appointment to diagnosis, the median time interval was one month; however, 79% of patients were diagnosed in up to two months. The median time from diagnosis to the start of treatment was one month, but most patients (82.5%) started treatment in up to two months. CONCLUSION: In our highly populated region with preferential access to the public health system, patients are required to wait a relatively long time to effectively begin treatment for lung cancer. This type of study is important to alert medical societies and government health agencies

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research