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Trabajo fin de grado en Enfermería, Objetivo: Evaluar la posible influencia que ejerce la cultura en relación a la presencia del pacto de silencio del paciente terminal en la sociedad actual. Material y métodos: se ha realizado una revisión narrativa mediante la búsqueda bibliográfica en bases de datos de Ciencias de la Salud (Cochrane Plus, PubMed, Cinahl, SCielo, PsycINFO y EBSCO Host), revistas científicas y sedes webs institucionales. Los artículos seleccionados responden a los siguientes criterios de inclusión: pacientes adultos, artículos publicados a partir del año 2000, en inglés, francés o español, a texto completo libre, referentes a enfermedad terminal respondiendo a la pregunta de investigación. Resultados: fueros incluidos 35 artículos clasificando los resultados en torno a tres categorías: perspectiva del paciente, perspectiva de la familia y perspectiva de los profesionales de la salud. Discusión/ Conclusiones: La actitud del paciente favorable a recibir información, difiere completamente de la opinión de la familia y los profesionales, éstos se oponen a ella por diversos motivos (protección al familiar enfermo, escasa formación en la comunicación…). Por otro lado, este deseo de conocer es independiente de la influencia social establecida., Objective: To evaluate the possible influence of culture in relation to the presence of the pact of silence of terminally ill patients in today’s society. Methods: a narrative review has been done through bibliographic research in Health Science databases (Cochrane Plus, PubMed, Cinahl, SCielo, PsycINFO and EBSCO Host), scientific magazines and institutional websites. The articles selected answer the following inclusion criteria: adult patients, articles published since 2000, in English, French or Spanish, Free Full Text, concerning terminal illness, answering the research question. Results: 35 articles were included and the results classified into three categories: patient´s perspective, family´s perspective and health professional’s perspective. Discussion/ Conclusions: The favorable attitude of the patient to receive information is completely different from the views of the family and professionals; they oppose it for several reasons (sick relative´s protection, poor communication training ...). On the other hand, this desire to know is independent of the established social influence.

Introduction Besides data reported in a Phase-III trial, data on sunitinib in pancreatic Neuroendocrine Tumors (panNETs) are scanty. Aim To evaluate sunitinib efficacy and tolerability in panNETs patients treated in a real-world setting. Patients and methods Retrospective analysis of progressive panNETs treated with sunitinib. Efficacy was assessed by evaluating progression-free survival, overall survival, and disease control (DC) rate (stable disease (SD) + partial response + complete response). Data are reported as median (25th–75th IQR). Results Eighty patients were included. Overall, 71.1% had NET G2, 26.3% had NET G1, and 2.6% had NET G3 neoplasms. A total of 53 patients (66.3%) had received three or more therapeutic regimens before sunitinib, with 24 patients (30%) having been treated with four previous treatments. Median PFS was 10 months. Similar risk of progression was observed between NET G1 and NET G2 tumors (median PFS 11 months and 8 months, respectively), and between patients who had received ≥ 3 vs ≤ 2 therapeutic approaches before sunitinib (median PFS 9 months and 10 months, respectively). DC rate was 71.3% and SD was the most frequent observed response, occurring in 43 pts (53.8%). Overall, 59 pts (73.8%) experienced AEs, which were grade 1–2 in 43 of them (72.9%), grade 3 in 15 pts (25.4%), and grade 4 in one patient (1.7%). Six pts (7.5%) stopped treatment due to toxicity. Conclusions The present real-world experience shows that sunitinib is a safe and effective treatment for panNETs, even in the clinical setting of heavily pre-treated, progressive diseases.

BACKGROUND & AIMS: Metformin seems to have anticancer effects. However, it is not clear whether use of glycemia and metformin affect outcomes of patients with advanced pancreatic neuroendocrine tumors (pNETs). We investigated the association between glycemia and progression-free survival (PFS) of patients with pNETs treated with everolimus and/or somatostatin analogues, as well as the association between metformin use and PFS time. METHODS: We performed a retrospective analysis of 445 patients with advanced pNET treated at 24 medical centers in Italy from 1999 through 2015. Data on levels of glycemia were collected at time of diagnosis of pNET, before treatment initiation, and during treatment with everolimus (with or without somatostatin analogues), octreotide, or lanreotide. Diabetes was defined as prior or current use of glycemia control medication and/or fasting plasma glucose level ≥ 126 mg/dL, hemoglobin A1c ≥ 6.5% (48 mmol/L), or a random sample of plasma glucose ≥ 200 mg/dL (11.1 mmol/L), with reported classic symptoms of hyperglycemia or hyperglycemic crisis. Patients were assigned to groups based on diagnosis of diabetes before or during antitumor therapy. PFS was compared between patients with vs without diabetes. Among patients with diabetes, the association between metformin use and PFS was assessed. We performed sensitivity and landmark analyses to exclude patients who developed diabetes while receiving cancer treatment and to exclude a potential immortal time bias related to metformin intake. RESULTS: PFS was significantly longer in patients with diabetes (median, 32.0 months) than without diabetes (median, 15.1 months) (hazard ratio for patients with vs without diabetes, 0.63; 95% confidence interval, 0.50-0.80; P = .0002). PFS of patients treated with metformin was significantly longer (median PFS, 44.2 months) than for patients without diabetes (hazard ratio for survival of patients with diabetes receiving metformin vs without diabetes, 0.45; 95% confidence interval, 0.32-0.62; P < .00001) and longer than for patients with diabetes receiving other treatments (median PFS, 20.8 months; hazard ratio, 0.49; 95% confidence interval, 0.34-0.69; P < .0001). In multivariable analysis, adjusted for other factors associated with outcomes, metformin was associated with longer PFS but level of glycemia was not. Metformin was associated with increased PFS of patients receiving somatostatin analogues and in those receiving everolimus, with or without somatostatin analogues. Sensitivity and landmark analyses produced similar results. CONCLUSIONS: In a retrospective study of patients with pNETs, we found a significant association between metformin use and longer PFS.