PURPOSE Breast cancer is the most common malignancy in Brazilian women, with 66,280 new cases in 2020 (with 20% overexpressing human epidermal growth factor receptor 2 [HER2]). The trastuzumab biosimilar was the first oncology biosimilar approved in Brazil for HER2-positive breast cancer treatment. This study aimed to assess the current level of knowledge of biosimilars, comfort of use, extrapolation indications, and switching of practices among oncologists in Brazil. METHODS A 24-question survey was developed using an online platform that sought information regarding responders' characteristics and use of biosimilars. The survey analyzed the basic knowledge of biosimilars, trastuzumab biosimilars, level of comfort with extrapolation, switching treatment regimens, and opinions concerning the cost of HER2-positive breast cancer therapy. Data were collected between July and September 2019 and included 144 oncologists from five Brazilian regions. RESULTS In total, 95% of respondents could identify the most appropriate definition of biosimilars and 96% felt comfortable prescribing trastuzumab biosimilars. Although 63% of respondents would use the biosimilar in all settings wherein the reference biologic was approved, 35% would use the biosimilar for cases involving metastatic disease. Although 82% of oncologists were in favor of switching from a reference biologic to a biosimilar, 18% would avoid switching regimens. The lack of studies detailing switching to other regimens and the correct timing to switch was the major concern. The cost of HER2 therapy was a significant concern for most oncologists. CONCLUSION Oncologists demonstrated a high level of knowledge of biosimilars and encouraging levels of prescriber use; however, extrapolation and switching treatment regimens are barriers to the effective use of biosimilars in cancer treatment. Efforts should be concentrated on strategies involving medical education programs on biosimilars.
To reduce false-negative rates (FNR) in sentinel lymph node biopsy (SLNB) of clinically positive (cN+) axilla in patients undergoing neoadjuvant chemotherapy (NAC). The removal of three or more lymph nodes with dual-tracer mapping including a radioisotope was used. However, in the Brazilian Unified Health System, the radioisotope tracer is not feasible in some hospitals. We conducted a crosssectional study to evaluate the detection rate of sentinel lymph node (SLN) in patients who converted from cN+ to ycN0 after NAC using blue dye as a single-agent mapping tracer. Methods: During the period of March 2018 to September 2019, 34 patients who underwent NAC with cN+ who converted to ycN0 were enrolled in the study. The SLNB was performed using blue dye as a single-agent mapping followed by axillary lymph node dissection (ALND). Results: The detection rate of sentinel lymph node was of 85.3%, being SLNB not possible for five patients (14.7%), due to fibrosis. The mean number of removed SLN was 2.5. Conclusions: The use of blue dye as a single-agent mapping tracer demonstrated an acceptable detection rate of 85.3%. Although the FNR was possible to be determined, the small sample size might overestimate this rate. The removal of three or more lymph nodes with single-agent mapping tracer might be indicated for breast cancer patients who converted to ycN0 after NAC in the Brazilian health public services, in which radioisotope tracer is not suitable.
e13010 Background: Brazil has a complex health-care system which comprises 76% of population in the public unified health system (SUS) and only 24% in private system. Even with most of the population in the public system low resources has been allocated SUS by the government compared with that in private system. Breast cancer (BC) is the more frequent malignant neoplasm in Brazilian women, including HER2 overexpression, and the most are treated in SUS. Although, the HER2 blockage benefits in overall survival have been demonstrated since 2005, the adjuvant and neoadjuvant HER2 blockage was included in SUS protocols only 2013 while the metastatic only 2018. Brazil and development countries have limited accesses to biological drugs and target therapies due to the high cost. The biosimilar technology would improve the patient access to these drugs, health-care savings with efficacy and safety. In 2017, Brazil has approved the first biosimilar in oncology, the anti-HER2 monoclonal antibody trastuzumab-dkst. Our aim is understanding the reasons that hampered the Brazilian oncologists changing practice about biosimilars. Methods: We submitted an on-line survey with 12 questions to 144 Brazilian oncologists which are registered in Brazilian Clinical Oncology Society from North, Northeast, Center east, Center west and Southeast regions in Brazil. The questions were about the anti-HER2 biosimilars knowledge, the manufacturing process, the costs, the biosimilars-based clinical trial, the drug efficacy and safety. Results: We observed that all responders have 9 years experienced oncologist with mean of care 15 patient with HER2 BC per month. In total, 95% of oncologist knows biosimilar definition and 96% assume prescribe biosimilars without doubts. However, 81% oncologists would prescribe biosimilars to all patients, 82% would interchanges and 63% would extrapolate the indication. Conclusions: This survey was conducted to understand the Brazilian oncologist knowledge about biosimilar. We demonstrated a high knowledge of biosimilar definition, however with high percentage indicated adherence barriers. The pharmacovigilance, clinical trials that support biosimilar approval and extrapolation concepts are the main aspects to be addressed. The opportunity of patient access with biosimilars is real and it is the oncologist’s duty to engage in medical education programs. This study could highlight a crucial need for greater strategies to educate physicians, to disseminate biosimilars and provide more informed decision making.
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Context: The verification of quality of life at work (QLW) indices can provide information on factors that directly interfere with personal and collective satisfaction and motivation, with reflections on the excellence of the structure and service. Objective: To evaluate the quality of life at work of active nurses. Material and methods: descriptive and correlational, cross-sectional study with a quantitative approach, carried out with 104 nurses in the service of a tertiary public hospital, in the municipality of Aracaju/SE from August 2018 to July 2019. Results: Factors such as working conditions, safety and remuneration are degrading factors in the quality of life at work and these also have direct repercussions on health and the quality of nursing care provided. Conclusion: Low levels of quality of life at work have direct negative repercussions on nurses' health. It is suggested that further studies evaluate the measures taken by hospital institutions to investigate the effectiveness of quality of life at work in nursing.
A demência é uma síndrome clínica caracterizada por sintomas que progressivamente reduzem a capacidade cognitiva e funcional do cérebro, afetando vários aspectos da vida do indivíduo. Os sintomas se apresentam de várias formas, e dentre estas, a perda de memória aparece em cerca de 70-80% desses indivíduos. A doença de Alzheimer é a forma mais comum da demência, podendo atingir em 2050, cerca de 130 milhões de pessoas ao redor do mundo. Por causa da complexidade fisiopatológica da doença, e do seu maior fator de risco, a idade, ainda não há nenhuma medicação que possa ser admitida como tratamento ideal para evitar a progressão da mesma. Isso tem permitido que prescrições em não conformidade com as orientações da bula, sejam indicadas e realizadas para o manejo da doença, que além de aumentar os efeitos colaterais dos medicamentos, também aumentam a mortalidade desses pacientes. Dessa maneira, os estudos têm sido direcionados aos tratamentos alternativos, como o uso da Cannabis sativa e seus derivados, com foco no delta-9-hidrocannabinol (THC) e o cannabidiol (CBD), que têm se mostrado eficazes para várias doenças neurológicas e neurodegenerativas. Esta revisão teve como objetivo realizar uma discussão abrangente acerca da fisiopatologia, bem como o uso delta-9-hidrocannabinol (THC) e o cannabidiol (CBD) e no tratamento da doença de Alzheimer. Trata-se de uma revisão bibliográfica integrativa em que os mais recentes artigos (2017-2021) foram incluídos para compor a amostra da pesquisa. Todos os artigos estão contidos nas bases de dados PubMed, SciELO e Google Acadêmico, nos idiomas inglês e português. Para isso, foram utilizados as Palavras-chave "cannabis" e "alzheimer's disease therapy". A inclusão foi feita através da leitura dos títulos e resumo dos artigos e foram selecionados 39 artigos, dos quais 22 foram utilizados. O uso de THC e CBC em alguns estudos científicos reduz o comprometimento da memória em estágios mais avançados da DA, além de previnir e reparar a neurodegeneração e neuroinflmação e ser um possível antioxidante. É ineficaz o uso dos cannabinoides em sintomas neuropsiquiátricos e mostra efeitos benéficos no equilíbrio e na marcha. Assim foi possível identificar que, o Alzheimer é uma doença extremamente debilitante e progressiva, e que infelizmente não há comprovação científica concreta de tratamentos eficazes para reverter ou interromper a doença.
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