Terapia dirigida en tumores sólidos

El manejo diagnóstico y terapéutico de los pacientes con tumores malignos ha progresado intensamente durante los últimos años. La incorporación de conocimientos y técnicas de diferentes ciencias biológicas a la oncología ha contribuido a mejorar el modo de enfocar, aliviar y curar al enfermo que padece una neoplasia. Las células se convierten en cancerosas en un proceso de dos etapas consecutivas: proliferación descontrolada y/o supervivencia alterada y adquisición de capacidad invasiva y metastásica. Este proceso de desarrollo y diseminación de las células neoplásicas se produce dentro del organismo del paciente con capacidad defensiva constituida por el sistema inmune a la que supera e, incluso, utiliza en su propio crecimiento. Los nuevos fármacos de diseño molecular tienen como objetivo fundamental el control de la proliferación aunque una de sus grandes desventajas es que raramente existe una sola alteración genética responsable del desarrollo y progresión del cáncer, por lo que se necesita la utilización de varias moléculas en un mismo paciente para conseguir el control tumoral. En la actualidad existen diversos agentes multiselectivos dirigidos contra varias dianas moleculares con excelente perfil de respuesta. En el presente capítulo se analizan las principales vías de abordaje molecular terapéutico en tumores sólidos, con especial hincapié en las terapias que utilizan biomarcadores predictivos EGFR, la terapia antiangiogénica y los inhibidores de la ruta PI3K/AKT/mTOR

La reinserción laboral en los pacientes con cáncer colorrectal

Aim: Employment and work-related disability were investigated in a cohort of colorectal cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 73 colorectal cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. Results: Eighty six per cent of patients were unable to work after diagnosis, but 55% returned to work at the end of treatment. The age, having a metastatic illness and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. Conclusions: This is the fi rst exploratory study in Spain about labour reintegration in colorectal cancer. Further studies are necessary.Objetivo: Analizar los factores que infl uyen en la vuelta al trabajo en una cohorte de enfermos con cáncer colorrectal y los posibles problemas de discriminación que pueden tener. Pacientes y métodos: El estudio incluyó 73 pacientes consecutivos diagnosticados de un cáncer colorrectal y empleados en el momento del diagnóstico. Los pacientes rellenaron un cuestionario que incluía aspectos demográficos, clínicos y laborales. El estudio fue aprobado por el Comité Ético y de Investigación Clínica del Hospital La Paz. Todos los pacientes dieron su consentimiento para participar en el estudio y para la utilización de los datos de su historia clínica. Resultados: El 86% de los pacientes pasaron a inactivos tras comenzar el tratamiento de la enfermedad y un 45% lo seguían estando tras éste. No hubo diferencias en la influencia de las distintas variables analizadas con respecto a la actividad laboral tras el diagnóstico. Sin embargo, la edad avanzada, el tener un estadio IV de la enfermedad y la presencia de secuelas derivadas del tumor o del tratamiento de éste, sí infl uyeron en la reinserción laboral una vez fi nalizado el tratamiento específico. La mayoría de los pacientes no creían que el tener la enfermedad les perjudicaría en su puesto de trabajo y, en casi todos los casos, tanto sus compañeros como sus jefes conocían que tenían un tumor. Conclusiones: Éste es el primer estudio exploratorio en nuestro país acerca de la reinserción laboral de los pacientes diagnosticados de una neoplasia maligna colorrectal. Son necesarios más trabajos para poder establecer las medidas adecuadas para la mejora de este proceso

Returning to work in colorectal cancer patients

Aim: Employment and work-related disability were investigated in a cohort of colorectal cancer patients to describe a possible discrimination and other work issues. Patients and Methods: The study included consecutively 73 colorectal cancer patients who were employed at diagnosis. The questionnaire included cancer-related symptoms and work-related factors. Clinical details were obtained from the medical record. Patients were interviewed face to face. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate. Results: Eighty six per cent of patients were unable to work after diagnosis, but 55% returned to work at the end of treatment. The age, having a metastatic illness and the sequelae of the disease or its treatment were independently associated with the ability to work after the end of treatment. Almost all patients told their employers and co-workers about their disease. Conclusions: This is the fi rst exploratory study in Spain about labour reintegration in colorectal cancer. Further studies are necessary

Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention

Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.The authors would like to thank Mr. Sergio Rodríguez Villar (Department of Preventive Medicine, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain) for his support in recording the data and managing the database. They also extend their gratitude to the European Regional Development Fund (ERDF) and the Spanish Health Research Fund (Fondo de Investigación Sanitaria/ FIS) for supporting the research project PI19/00987, and the Alcorcón Foundation University Teaching Hospital for the HUFA 2018 grant, which enabled this study to be completed.S