Under the national plan for addressing cancer, prevention and detection play important roles. However, the cost of treatments and late diagnosis represent a significant burden on health services. At the National Cancer Institute, more than half of patients present with tumors in advanced stages, and approximately 10% of patients seen for the first time exhibit terminal-stage malignancies, where there are no feasible cancer treatment options, and the patients are instead admitted to the hospital exclusively for palliative symptomatic management. In 2010, the National Cancer Plan began implementing a model of integrative management of palliative care in oncology that has gradually come to include symptomatic palliative care, involving ambulatory, distant and hospitalized management of patients with cancer, in its final stages and, more recently, in earlier stages. ResumenEn el marco del plan nacional para abordar el cáncer, la prevención y la detección juegan un papel importante. Sin embargo, el costo de tratamientos y diagnóstico tardío representan una carga significativa en los servicios de salud. En el Instituto Nacional del Cáncer, más de la mitad de los pacientes presentan tumores en etapas avanzadas, y aproximadamente10% de los pacientes que acuden a consulta por primera vez presentan malignidades en etapa terminal, donde no hay opciones factibles para de tratamiento del cáncer; en su lugar, los pacientes son admitidos en el hospital exclusivamente para manejo sintomático paliativo. En 2010, el Plan Nacional del Cáncer comenzó a implementar un modelo de gestión integral de los cuidados paliativos en oncología que ha logrado gradualmente incluir cuidados sintomáticos paliativos, incluyendo manejo ambulatorio, distante y hospitalizado de los pacientes con cáncer en fase final y, más recientemente, en las primeras fases.Palabras clave: oncología integrada; cuidados paliativos; cuidado del cáncer terminal http://dx.doi.org/10.21149/spm.v58i2.7803

Carcinoma of the uterine cervix is the most frequent malignancy in women in developing countries. Based on the possible synergistic effect of the combination of interferon and radiotherapy, a clinical trial was conducted in patients with advanced cervical cancer. The objective was to evaluate the efficacy and security of such a therapeutic approach. This prospective phase II trial was done at the Instituto Nacional de Cancerología in Mexico City. The study included 17 consecutive patients with previously untreated squamous cell cervical cancer, clinical stages III and IV, and tumor mean size of 9.7 cm. The patients received radiotherapy and interferon alpha-2b at a dose of 5 x 106 IU/m2 3 times a week for 6 weeks. Eleven (64%) complete responses were obtained among these patients. Long-term survival was observed in 4 patients (24%) who achieved complete response and are alive after 10 years of follow-up. Immediate toxicity was mild. Late toxicity included the development of proctitis in 13 patients, colostomy was performed in 3 (23%) of them. Our results indicate that the combination of radiotherapy and this cytokine is an active therapy for squamous cell carcinoma of the uterine cervix.

Background: Data describing the characteristics, treatment, and survival of oncological patients referred to PCS remains scarce. Aim: To establish the characteristics of oncological patients referred to PCS, including their profile, treatment, and survival within a 7-year period. Design: Retrospective review of medical records. Clinical variables such as treatment and dates were included. Ji2 or Wilcoxon tests were used accordingly; Kaplan-Meier and log rank test were used to estimate survival. Setting/Participants: Consecutive oncological patients diagnosed between 2012 and 2018 sent to PCS were included. Results: We studied 5,631 patients, 58% female and 59% at advanced stage. Median age was 59 years, with 6 years or less of formal education and low monthly income ($152.4 USD). Neoplasms included breast (12%), stomach (12%), colorectal (10%) and cervical cancer (9%). Median referral time was 5.1 months; pain was the main reason for referral. Morphine was the most prescribed opioid with 47%. Median overall survival was 3.1 months. Conclusions: Morphine remains the paradigm of treatment making necessary to emphasize information on its optimal use. Additional measures such as education for cancer prevention and early referral to PCS are vital to improve survival and quality of life.

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Background: Cancer is a major burden of disease and a public health problem, as it is one of the main causes of morbidity and mortality worldwide. It is estimated that 25% of cancer patients die without receiving proper pain management. Objective: To acknowledge the epidemiological profile of first-time patients at the palliative care service of a referral center, along with the pharmaceutical treatment and social and familiar implications of the treatment costs in first-time patients. Methods: A survey including 28 questions was conducted including 490 first-time patients at the National Cancer Institute in Mexico City. Results: Median age was 53 years; 63.3% (n = 310) were females; 72% were married or single (50.5% and 21.2%, respectively). The most frequent diagnoses were gastrointestinal tumors, followed by urological, and skin/soft tissue carcinomas (19.8%, 12.5%, and 12%, respectively). Pain prevalence was 50.4% among the cohort. From the subgroup of participants with pain, 26.7% presented an intensity ≥7. Conclusions: As most patients in our study presented pain, there is a need of strengthening public policy about opioid treatments.