No abstract

Two clinical trials have suggested that the combination of vascular endothelial growth factor inhibitor with chemotherapy is associated with venous thromboembolism (VTE). This retrospective cohort study investigates whether a similar association exists when matrix metalloproteinase inhibitor (prinomastat) is combined with chemotherapy. Patients (n=1,023) with stage IIIB, IV, or recurrent non-small cell lung cancer (NSCLC) were followed during 2 randomized, double-blind trials of prinomastat versus placebo orally bid, plus gemcitabine/cisplatin (GC) or paclitaxel/carboplatin (PC). VTE included deep venous thrombosis (DVT) or pulmonary embolism (PE) confirmed by imaging or autopsy. Risks identified in univariate analysis (incidence densities compared by t test) were confirmed in multivariate analysis (proportional hazards model). During 7,500.3 patient-months, 58 VTE (31 PE, 27 isolated DVT) were confirmed in 54 patients. On univariate analysis, VTE was associated with central venous catheter placed within 3 months, 15 mg prinomastat plus GC, and to a lesser extent, 15 mg prinomastat plus PC, baseline performance status, and histologic type. VTE incidence was not increased by 15 mg prinomastat alone (post-discontinuation of chemotherapy), by chemotherapy plus placebo, or by 5 or 10 mg prinomastat plus chemotherapy. On multivariate analysis,VTE hazards (95% confidence interval) were 5.69 (2.61, 12.40) with recently placed central catheter, 2.78 (1.42, 5.43) with 15 mg prinomastat plus GC, and 2.06 (0.98, 4.31) with 15 mg prinomastat plus PC; performance status and histology were nonsignificant. We can conclude that combined treatment with 15 mg prinomastat plus chemotherapy approximately doubles the hazard of VTE among patients with advanced NSCLC.

Conventional stroke risks are thought responsible for most cerebral ischemic events (CIE) in adult cancer patients. Also suspected as a risk is cisplatin chemotherapy, alone or in combination with tumor angiogenesis inhibitor. We investigated whether treatment or tumor characteristics, independently of conventional stroke risks, are associated with CIE in a retrospective cohort study of 1,559 patients with advanced non-small cell lung cancer or hormone-refractory prostate cancer followed during 3 clinical trials of matrix metalloprotease inhibitor (prinomastat) versus placebo, with chemotherapy (gemcitabine/cisplatin, paclitaxel/carboplatin or mitoxantrone/prednisone). During 11,907 patient-months, 28 CIE (17 cerebral infarction, 11 transient ischemic attack) were diagnosed in 24 patients, all but 1 over 55 years. Neither prinomastat, platinum-based chemotherapy nor their combination was associated with CIE after age 55. However, such events were predicted by the presence of distant metastases in the liver or lungs and not in distant lymph nodes (hazard estimate 4.6, 95% CI 2.0–10.5, adjusted for conventional stroke risks). Further studies are needed to verify this preliminary finding and determine its generalizability to advanced tumors other than lung or prostate cancer.

Objetivos: explorar los puntos de vista de médicos de familia acerca de los conocimientos más importantes, actitudes y habilidades (competencias) que deben tener en su práctica profesional para la promoción de salud. Método: estudio cualitativo, descriptivo, que combina dos técnicas de recolección de datos: entrevista en profundidad y grupo focal, conducido en los meses de noviembre y diciembre de 2011 y abril de 2012, se realizaron tres grupos focales y cinco entrevistas a profundidad en médicos de familia rigurosamente seleccionados, de amplia experiencia, procedentes de varios policlínicos de los municipios Santiago de Cuba y de Guantánamo; se dirigieron a los temas: concepto personal de promoción de salud, conocimientos, habilidades y actitudes. Resultado: hubo un predominio en la concepción educativa de la promoción de salud más que de los aspectos ambientales, comunitarios e intersectoriales de ésta. Se identificaron conocimientos, actitudes y habilidades, resaltando la necesidad de más habilidades y actitudes que de conocimientos, estas últimas se enfocaron en la implementación de modelos y teorías actualizadas. Conclusiones: la formación y entrenamiento en promoción de salud dentro de la Medicina Familiar necesitan estar basados en las competencias percibidas por los propios médicos de familia según su desempeño laboral.

No abstract