3 research outputs found
Caracterização de mulheres com câncer cervical atendidas no Inca por tipo histológico
OBJECTIVE: To determine the distribution of sociodemographic, reproductive, clinical and lifestyle habits in the cohort of women diagnosed with cervical cancer, assisted at Inca between 2012 and 2014, according to the histological type. METHODS: Retrospective observational study of a hospital cohort of 1,004 women diagnosed with cervical cancer. Data were obtained from the Inca hospital cancer registry, physical and electronic records. RESULTS: The most frequent histological type was squamous cell carcinoma (83.9%). Approximately 70% of the women aged more than 40 years. The study includes non-white women (67.4%), with less than 8 years of education (51.9%), with onset of sexual activity up to 16 years of age (40.7%), who were pregnant before (95.5%), with more than one pregnancy (82.9%), and more than two children (52.7%); 45.8% of the women were smokers or former smokers. Cervical adenocarcinoma was positively associated with earlier staging (IA-IIA) (OR = 1.79; 95%CI 1.03–3.13), as well as women with ≥ 12 years of education (OR = 6.30; 95%CI 1.97–20,13), who had no children (OR = 3.81; 95%CI 1.20 – 12,08) or who had up to two children (OR = 1.74; 95%CI 1.05 – 2,87). CONCLUSIONS: The difference between histological types is highlighted, suggesting that women with cervical adenocarcinoma may represent a distinct clinical entity of cervical neoplasia, which may require different approaches from those used in squamous cell carcinoma.OBJETIVO: Determinar a distribuição das caracterĂsticas sociodemográficas, reprodutivas, clĂnicas e de hábitos de vida na coorte de mulheres diagnosticadas com câncer cervical, atendidas no Inca entre 2012 e 2014, segundo o tipo histolĂłgico. MÉTODOS: Estudo observacional retrospectivo de uma coorte hospitalar de 1.004 mulheres diagnosticadas com câncer cervical. Os dados foram obtidos pelo Registro Hospitalar de Câncer do Inca, prontuários fĂsicos e eletrĂ´nicos. RESULTADOS: O tipo histolĂłgico mais frequente foi o carcinoma de cĂ©lulas escamosas (83,9%). Aproximadamente 70% das mulheres foram diagnosticadas com mais de 40 anos de idade. Houve a predominância de mulheres nĂŁo brancas (67,4%), com menos de 8 anos de escolaridade (51,9%), com inĂcio da atividade sexual atĂ© 16 anos de idade (40,7%), que já engravidaram alguma vez na vida (95,5%), com mais de uma gestação (82,9%) e mais de dois filhos (52,7%); 45,8% das mulheres eram tabagistas ou ex-tabagistas. O adenocarcinoma cervical esteve positivamente associado ao estadiamento mais precoce (IA-IIA) (OR = 1,79; IC95% 1,03–3,13), assim como a mulheres com ≥ 12 anos de estudo (OR = 6,30; IC95% 1,97–20,13), que nĂŁo tiveram filhos (OR = 3,81; IC95% 1,20–12,08) ou que tiveram atĂ© dois filhos (OR = 1,74; IC95% 1,05–2,87). CONCLUSĂ•ES: Destaca-se a diferença entre os tipos histolĂłgicos, sugerindo que as mulheres com adenocarcinoma cervical possam representar uma entidade clĂnica distinta de neoplasia cervical, podendo demandar abordagens diferentes das utilizadas no carcinoma de cĂ©lulas escamosas
Assessment of waiting time in therapeutic management and its effects on the survival of women diagnosed with cervical cancer in a hospital cohort at INCa-II
Submitted by RepositĂłrio Arca ([email protected]) on 2019-07-03T19:29:58Z
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Previous issue date: 2016Fundação Oswaldo Cruz. Escola Nacional de SaĂşde PĂşblica Sergio Arouca. Rio de Janeiro, RJ, Brasil.O câncer cervical Ă© um grave problema de saĂşde pĂşblica nos paĂses em desenvolvimento,
cuja mortalidade pode ser afetada por diversos fatores, como o atraso para o encaminhamento e
tratamento na unidade hospitalar de referĂŞncia. Avaliar os tempos de espera no tratamento prescrito
segundo os fatores sociodemográficos, ambientais e clĂnicos, e os seus efeitos na sobrevida de
mulheres diagnosticadas e tratadas com câncer do colo de útero nos anos de 2012 a 2014. Estudo
observacional retrospectivo de uma coorte hospitalar de mulheres diagnosticadas com câncer de colo
de útero e tratadas no INCa/II. Os dados foram obtidos pelo Registro Hospitalar de Câncer /INCa,
prontuário fĂsicos e eletrĂ´nicos, e do sistemas de faturamento hospitalar. Os intervalos analisados
foram divididos no tempo entre : o diagnĂłstico e o atendimento no INCa (T1), o diagnĂłstico e o inĂcio
do tratamento (T2), o diagnĂłstico e final do tratamento (T3), o inĂcio e fim do tratamento (T4), o inĂcio
da radioterapia e final da braquiterapia (T5), o final da radioterapia e inĂcio da braquiterapia (T6). As
pacientes matriculadas em 2012 foram seguidas até dezembro de 2015 para a análise de sobrevida
câncer-especĂfica. Entre as 671 pacientes incluĂdas no estudo, o tempo mediano T1 foi de 29 dias; de
T2 foi de 117 dias; de T3 foi de 262 dias; de T4 de 140 dias; de T5 foi de 170 dias; e de T6 foi de 111
dias. Os fatores associados ao atraso no T1 foram Estadiamento inicial (OR 1,5; 1,05-2,13) e cor nãobranca (OR 1,54; 1,08-2,20); já os fatores associados a T2 foram baixo grau de instrução (OR 2,18;
1,06-4,46), Idade > 40 anos (OR 2,13; 4,35) e cor nĂŁo-branca (OR 2,45; 1,23-4,80); enquanto os
associados a T3 foram tratamento radioterápico (OR 5,67; 3,04-10,57), baixo grau de instrução (OR
1,63; 1,08-2,46) e cor da pele nĂŁo-branca (OR 1,53; 1,05-2,24). Os fatores associados a T4 foi nĂŁo ter
feito CAF (OR 2,86; 1,61-9,24), estádio avançado (OR 6,44; 4,50-9,24), tratamento radioterápico (OR
27,17; 13,14-56,18); enquanto a T5 foram Idade > 40 anos (OR:7,52; 3,16-17,87), ter companheiro
(OR:4,97; 2,06-11,97); cor não-branca (OR 4,27; 2,29-9,94), alto grau de instrução (OR 3,39; 1,37-
8,37), Ocupação com maior renda (OR 3,50; 1,30-9,36), ter comorbidade (OR 6,80; 1,98-22,46),
estádio avançado (OR 27; 13,33-54,68). Apenas idade > 40 anos esteve associada a T6 (OR 5,80;
3,23-10,46). Entre as mulheres com estadiamento inicial, o atraso entre inĂcio e tĂ©rmino do tratamento
( 60 dias 72,2%) e entre o diagnĂłstico e fim do tratamento ( 120
dias 83,7%) afetaram significativamente a sobrevida em 36 meses. Todos os intervalos apresentaram
um tempo de espera maior que o recomendado pela literatura. Os intervalos até o tratamento
apresentaram forte associação com o baixo nĂvel sĂłcio econĂ´mico e com o estadiamento avançado.
Porém, o estadiamento avançado não teve a sobrevida afetada, devido à urgência na realização do
tratamento pelas piores condições clĂnicas da mulher. O maior tempo dos diferentes tratamentos
realizados, apresentou fatores relacionados ao sistema. Apenas o atraso entre inĂcio e tĂ©rmino do
tratamento afetou estatisticamente a sobrevida em 36 meses na coorte estudada.Cervical cancer is a serious public health problem in developing countries, where mortality
can be affected by several factors including the delay for referral and treatment in the hospital of
reference. To assess waiting times the prescribed treatment according to sociodemographic factors,
environmental and clinical, and its effects on the survival of women diagnosed and treated with
cervical cancer in the years 2012-2014. This is a study retrospective observational hospital of a cohort
of women diagnosed with cervical cancer and treated at the INCa / II. Data were obtained from the
Hospital Cancer Register / INCa, physical and electronic records, and hospital billing systems. The
intervals analyzed were divided into time between diagnosis and care in INCa (T1), between diagnosis
and initiation of treatment (T2), between diagnosis and completion of treatment (T3) between the
beginning and end of treatment (T4) between the beginning and end of the radiation and end of
brachytherapy (T5) between the top end of radiotherapy and initiation of brachytherapy (T6). Patients
enrolled in 2012 were followed until December 2015 for cancer-specific survival analysis. Among the
671 patients included in the study, the median time T1 was 29 days; T2 was 117 days; T3 was 262
days; T4 140 days; T5 was 170 days; and T6 was 111 days. Factors associated with delay in T1 were
Initial staging (OR 1.5; 1.05 to 2.13) and non-white (OR 1.54; 1.08 to 2.20); since the factors
associated with T2 were low educational level (OR 2.18; 1.06 to 4.46), Age> 40 years (OR 2.13; 4.35)
and non-white (OR 2.45; 1.23 to 4.80); while associated with T3 were radiotherapy (OR 5.67; 3.04 to
10.57), low level of education (OR 1.63; 1.08 to 2.46) and skin color nonwhite (OR 1.53; 1.05 to
2.24). Factors associated with T4 was not doing CAF (OR 2.86; 1.61 to 9.24), advanced stage (OR
6.44; 4.50 to 9.24), radiotherapy (OR 27 17; 13.14 to 56.18); while the T5 were age> 40 years (OR
7.52; 3.16 to 17.87), having a partner (OR 4.97; 2.06 to 11.97); non-white (OR 4.27; 2.29 to 9.94),
highly educated (OR 3.39; 1.37 to 8.37), Occupation with higher income (OR 3.50; 1, 30 to 9.36),
have comorbidity (OR 6.80; 1.98 to 22.46), advanced stage (OR 27; 13.33 to 54.68). Only age> 40
years was associated with T6 (OR 5.80; 3.23 to 10.46). Among women with early stage, the delay
between the beginning and end of treatment ( 60 days 72.2%) and between
diagnosis and end of treatment ( 120 days 83.7%) significantly affected the
survival rate at 36 months. All intervals presented a wait time much higher than recommended in the
literature. Intervals to treatment were strongly associated with low socioeconomic level and the
advanced stage. However, the advanced stage was not affected survival due to the urgency in making
the treatment the worst clinical conditions of women. The longer the different treatments performed,
presented factors related to the system. But only the delay between the beginning and end of treatment
statistically affect survival at 36 months in the study cohort