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Introducao: Pacientes com câncer do trato gastrointestinal apresentam alta incidencia de desnutricao energetico- proteica. A caracterizacao do estado nutricional e fundamental para os pacientes com câncer, inclusive para avaliacao do prognostico. Objetivo: Avaliar a associacao entre estado nutricional, a resposta inflamatoria e a mortalidade em pacientes com câncer do trato digestivo. Metodos: Trata-se de uma coorte com pacientes com câncer no trata digestivo do Instituto de Medicina Integral Prof Fernando Figueira. Para determinacao do estado nutricional foram utilizadas medidas antropometricas (peso, altura, indice de massa corporal, circunferencia de braco), para determinacao do escore de prognostico de Glasgow, utilizou-se de valores de albumina e proteina C Reativa. Alem da avaliacao do desfecho obito em um ano de acompanhamento. Resultado: Foram analisados dados de 50 pacientes em acompanhamento nutricional ambulatorial adultos e idosos, sendo 52 do sexo feminino. A prevalencia de desnutricao de 52% segundo IMC. Pacientes desnutridos apresentam pior prognostico, com associacao estatisticamente significativa (p< 0,05). O estado nutricional e o estado inflamatorio diagnostico pelo escore de prognostico de Glasgow esta associada ao desfecho obito (p< 0,05). Discussao: O estado nutricional e um ponto chave no prognostico do paciente oncologico. O componente inflamatorio contribui para essa perda ponderal e para as complicacoes associadas ao tratamento oncologico, como infeccoes, sepse, baixa tolerância ao tratamento que podem causar o obito Conclusao: A relacao entre o estado inflamatorio, nutricional e o obito destacam a importância do acompanhamento nutricional dos pacientes oncologicos com doencas do trato digestivo desde do inicio do tratamento, com objetivo de evitar e/ou minimizar a desnutricao desses individuos, contribuindo para melhor prognostico.

Objectives: to analyze the lethality and clinical characteristics in Pernambuco women with neoplasia that were infected by SARS-CoV-2. Methods: a cross-sectional, retrospective study with female patients with neoplasm sin the state of Pernambuco registered and made available by the Secretariat of Planning and Management of the State of Pernambuco (SEPLAG PE). Secondary data from public domain notifications and the independent factors associated with death were analyzed through logistic regression. The value ofp

Objective: The aim of the present study was to evaluate health-related quality of life (HRQoL) changes at 6 to 12 months after cancer diagnosis and to assess the impact of age in older adults with cancer. Methods: A cohort study using patients ≥60 years old diagnosed with cancer. Health-related quality of life scores were calculated according to the European Organisation for Research and Treatment of Cancer questionnaire. Student’s t tests for paired samples and a binomial logistic regression were performed. Results: The study included 241 patients. At diagnosis, the affected HRQoL functions were physical and emotional functions, financial difficulties, pain, and insomnia. At follow-up, cognitive function ( P < .001) and dyspnea ( P = .004) worsened, while emotional function improved ( P = .003). Discussion: At the 6 to 12 months of follow-up, older adult cancer patients showed worsening cognitive function and dyspnea and improved emotional function. These HRQoL changes were not associated with age.

Background The incidence of breast cancer (BC) in LMICs has increased by more than 20% within the last decade. In areas such as Latin America (LA), addressing BC at national levels evoke discussions surrounding fragmented care, limited resources, and regulatory barriers. Precision Medicine (PM), specifically companion diagnostics (CDx), links disease diagnosis and treatment for better patient outcomes. Thus, its application may aid in overcoming these barriers. Recent findings A panel of LA experts in fields related to BC and PM were provided with a series of relevant questions to address prior to a multi‐day conference. Within this conference, each narrative was edited by the entire group, through numerous rounds of discussion until a consensus was achieved. The panel proposes specific, realistic recommendations for implementing CDx in BC in LA and other LMIC regions. In these recommendations, the authors strived to address all barriers to the widespread use and access mentioned previously within this manuscript. Conclusion This manuscript provides a review of the current state of CDx for BC in LA. Of most importance, the panel proposes practical and actionable recommendations for the implementation of CDx throughout the Region in order to identify the right patient at the right time for the right treatment.

Background: Cancer was one of the biggest global challenges in public health before COVID-19 pandemic and even higher challenge in low- and middle-developed countries. Confronting both conditions reveal inequalities. We determined lethality and factors associated with mortality in cancer patients who developed severe acute respiratory syndrome (SARS) due to COVID-19 in a northeast region of Brazil. Methods: Cross-sectional study developed from secondary data of a Brazilian state. We selected cases of cancer patients aged 20 years or older, who developed SARS due to COVID-19 (confirmed by reverse transcription-polymerase chain reaction) and were notified between March 07, 2020, and May 08, 2021. Logistic regression analyzed the effects of different variables on lethality. Findings: We identified 756 cancer patients aged 66·3±15·3 years (51·9% males). Global lethality was 75·8% and progressively increased with age. Tumor type was not described in 25·5% (193) of patients, 3·2% had history of cancer, 11·6% had hematologic cancer, and 59·7% had solid tumors. However, different types or topography of tumors did not influence mortality risk. Adjusted multivariate analyses showed age (adjusted odds ratio [aOR] 1·02; 95%CI 1.01-1·03; p < 0·001) and previous chronic pulmonary disease (aOR 2·02; 95%CI 0·96-4·28; p = 0·064) as risk factors for mortality, and overweight (aOR 0·50; 95%CI 0·23-1·10; p = 0·087) and cough (aOR 0·57; 95% I 0·40-0·83; p = 0·003) as protective factors. Interpretation: Cancer patients who developed SARS due to COVID-19 presented a highly disproportional mortality risk. Death was high in the study population, age increased by 2% the chance of death for each year of life, and lethality was higher in patients older than 80 years. Coordinated proactive strategies are needed to reduce the probability of infection and increase safety and early detection in cancer patients. Funding: This work was supported by grants from the National Key Research and Development Program of China (2018YFC1004701, LD), the National Nature Science Foundation of China (82001629 for XS; 81871128, 81571391 and 81401166 for LD; 82030040 for HS), the Jiangsu Province Social Development Project (BE2018602, HS), Jiangsu Provincial Medical Youth Talent (QNRC2016006, LD), the Youth Program of Natural Science Foundation of Jiangsu Province (BK20200116, XS) and Jiangsu Province Postdoctoral Research Funding (2021K277B, XS). Declaration of Interest: The authors have declared that no conflicts of interest exist. Ethical Approval: The human studies were approved by the Ethics Review Board of the Center for Reproductive Medicine, Shandong University (IRB No. 2021-45), and all samples were donated voluntarily for scientific research after informed consent was obtained.

Objective: To evaluate the levels of circulating platelet–leukocyte aggregates in women with breast cancer (BC). Methods: A cross-sectional study was carried out between 2018 and 2019 with 27 women, who aged between 18 and 60 years, diagnosed with BC and 15 healthy women (controls). For the evaluation of the circulating platelet aggregate, samples of peripheral blood were collected at the time of routine laboratory tests for diagnosis and before treatment. Platelet aggregate analysis was performed using monoclonal antibodies by flow cytometry. Mann–Whitney U and Kruskal–Wallis tests were used to analyze medians between two and three groups, respectively. Values of p

Objective: To evaluate the frequency of pressure injuries and associated factors in the older pacients with gastrointestinal cancer. Methods: Cross-sectional study of 212 individuals aged 60 years and older and diagnosed with untreated gastrointestinal cancer confirmed by histology, cytology or immunohistochemistry. Patients who had undergone previous cancer treatment, except surgical ones, were excluded. The variables studied were: pressure injury, nutritional status, weight loss in the three months prior to the assessment, functionality, level of physical activity, presence of comorbidities and laboratory variables. For media comparisons, Student's test and categorical variables or square test or Fisher's exact test were used. In the multivariate analysis using logistic regression, the Wald test was used to evaluate the independent effects of factors with p

Muitas mulheres com malignidades ginecológicas serão curadas ou tornar-se-ão sobreviventesde longo prazo. Diferentes tratamentos (cirurgia, radioterapia, quimioterapia) para cânceres ginecológicospodem causar insuficiência ovariana ou aumento dos sintomas da menopausa, além de efeitos negativos acurto e longo prazo sobre a saúde sexual e qualidade de vida (QV). O manejo dos sintomas menopausais eda disfunção sexual é importante nos esforços para otimizar a QV dessas mulheres. O objetivo deste artigoé apresentar uma visão abrangente da saúde sexual das sobreviventes de câncer ginecológico e discutir asopções de tratamento baseadas em evidências. Método: Trata-se de estudo descritivo com abordagemqualitativa para verificação do benefício e da segurança do uso de terapia hormonal nessas pacientes, bemcomo os problemas de saúde sexual comumente encontrados e as opções para seu manejo. Resultados:Dados disponíveis sugerem que o uso de terapia hormonal em pacientes com cânceres ginecológicos nãotem um impacto negativo no resultado oncológico e resulta em melhora dos sintomas vasomotores e geniturinários da menopausa. Evidências quanto à segurança do uso de terapia hormonal em mulheres comneoplasias dependentes de estrogênio são escassas. A disfunção sexual é prevalente entre as sobreviventesde câncer ginecológico como resultado de seu tratamento, impactando negativamente a QV. Muitas pacientes esperam que os profissionais de saúde iniciem uma discussão sobre sexualidade, mas a maioria nunca discutiu questões relacionadas à saúde sexual com seu médico. Conclusões: Profissionais da oncologia podem ter um impacto significativo na QV das sobreviventes de câncer ginecológico abordando os sintomas menopausais e as preocupações de saúde sexual. As candidatas à terapia hormonal em oncologia ginecológica incluem mulheres com menopausa induzida ou sintomas menopausais diagnosticadas com câncer endometrial de baixo grau, em estágio inicial, e cânceres de colo uterino, vulva, vagina e ovário. Estratégias simples podem ser implementadas na prática clínica para tratar as questões sexuais. O encaminhamento para provedores especializados em saúde sexual pode ser necessário nos casosmais complexos.

Regular physical activity prevents and treats cancer patients by assisting and improving the immune system. Co-stimulatory molecules that activate the immune system have been studied in cancer, such as immune checkpoint molecules of the CD40/CD40L pathway. This study aimed to characterize plasma levels of soluble CD40 (sCD40) and CD40 ligand (sCD40L) in older people with gastrointestinal tract (GIT) cancer and associate results with physical activity. This prospective and exploratory cohort study was performed with 24 older people with GIT cancer and 23 healthy elderly individuals as controls. Physical activity level was classified as active or sedentary according to the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Plasma levels of sCD40 and sCD40L were determined using Enzyme-Linked Immunosorbent Assay. Plasma levels of sCD40 were higher, while sCD40L were lower (p = 0.0171) in older people with GIT cancer than controls (p = 0.0038). Regarding physical activity, active older people with GIT cancer presented lower plasma levels of sCD40 and sCD40L than those sedentary with GIT cancer (p = 0.0228 and p = 0.0236), respectively. Our findings suggest that GIT cancer stimulates the immune system in older people, elevates levels of sCD40, and reduces levels of sCD40L. Physical activity may be a protective factor for the immune system of these patients since it acts on sCD40/sCD40L pathway.

RESUMO Verificou-se a reprodutibilidade e repetibilidade de um manual de exercícios físicos domiciliares em diferentes níveis de escolaridade em idosas com câncer de mama. Estudo seccional realizado entre agosto e novembro de 2016 no Instituto de Medicina Integral Professor Fernando Figueira (Imip), região metropolitana de Recife, Pernambuco. Vinte e duas idosas (idade 66.2±3.5 anos) diagnosticadas com câncer de mama em uso de hormonioterapia receberam um manual instrucional composto por 12 exercícios, a serem realizados de forma autônoma e independente em domicílio para melhoria das aptidões físicas. O manual foi entregue na primeira consulta e após seis semanas verificou-se sua reprodutibilidade por meio da avaliação de concordância em “certo” ou “errado” dos movimentos por um profissional de educação física e um fisioterapeuta. Os resultados foram analisados pelo coeficiente kappa de Cohen (k). Verificou-se uma relação interavaliadores de concordância “quase perfeita” (superior a 0,88) entre todos os 12 exercícios. Considerando a execução “certa” dos movimentos, verificou-se que seis exercícios apresentaram concordância interavaliadores com variação entre 68,2% e 90,9%; por outro lado, quando considerada a execução “errada”, observou-se variação entre 54,4% e 68,2%. Além disso, dois exercícios resultaram em 50% para “certo” e “errado”. Quanto ao nível de escolaridade, apenas o exercício 6 apresentou significância estatística (p-valor=0,03). O manual de exercícios físicos domiciliares parece ser reprodutível em idosas com câncer de mama em todos os níveis de escolaridade, para melhorar a aptidão física e promover o autocuidado funcional. RESUMEN Se verificó la reproducibilidad y repetibilidad de un manual de ejercicios físicos domiciliarios en diferentes niveles de escolaridad en ancianas con cáncer de mama. Métodos: Investigación seccional realizada entre agosto y noviembre de 2016 en el Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), del área metropolitana de Recife, Pernambuco. Veinte y dos ancianas (66.2±3,5 años) diagnosticadas con cáncer de mama en uso de terapia hormonal recibieron un manual instructivo compuesto por 12 ejercicios para realizar de forma autónoma e independiente a domicilio, mejorando las aptitudes físicas. Se entregó el manual en la primera consulta y después de seis semanas se verificó su reproducibilidad a través de la evaluación de concordancia en «correcto» o «incorrecto» de los movimientos, por un profesional de educación física y un fisioterapeuta. Resultados: Los resultados fueron analizados por el coeficiente kappa de Cohen (k). Se verificó una relación interevaluadores de concordancia «casi perfecta» (superior a 0,88) entre los 12 ejercicios. Considerando la ejecución «correcta» de los movimientos, se verificó que seis ejercicios presentaron concordancia interevaluadores con variación entre el 68,2% al 90,9%; por otro lado cuando se considera la ejecución «incorrecta», se observó variación entre el 54,4% al 68,2%. Además, dos ejercicios resultaron en un 50% para «correcto» y «incorrecto». En cuanto al nivel de escolaridad, sólo el ejercicio 6 presentó significancia estadística (p-valor = 0,03). Conclusiones: El manual de ejercicios físicos domiciliarios parece ser reproducible en ancianas con cáncer de mama en todos los niveles de escolaridad, para mejorar la aptitud física y promover el autocuidado funcional. ABSTRACT The reproducibility and repeatability of a manual of home physical exercises at different levels of schooling in elderly women with breast cancer was investigated. Methods: A cross-sectional study carried out between August and November, 2016 at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), in the metropolitan area of Recife, Pernambuco. Twenty-two elderly women (aged 66.2±3.5 years) diagnosed with breast cancer using hormone therapy received an instructional manual composed of 12 exercises, to be performed independently and at home to improve physical fitness. The manual was delivered at the first consultation and after six weeks its reproducibility was checked by a physical education professional and a physiotherapist who assessed the “right” or “wrong” execution of the movements. Results: The results were analyzed by Cohen’s kappa coefficient (k). There was an “almost perfect” inter-rater relationship (higher than 0.88) across all 12 exercises. As regards the “right” execution of movements, six exercises presented inter-rater agreement with variation between 68.2% and 90.9%; on the other hand, as regards the “wrong” execution, the variation was between 54.4% and 68.2%. In addition, two exercises resulted in 50% for “right” and “wrong”. Regarding schooling, only exercise 6 had statistical significance (p-value=0.03). Conclusions: The manual of home physical exercises seems to be reproducible in elderly women with breast cancer at all levels of schooling, to improve physical fitness and promote functional self-care.

Introduction: to evaluate the effect of short-course (i.e.: 30 minutes) HIPEC on health-related quality of life (HRQoL) in our feasibility study; NCT02249013. Methods: a prespecified secondary end-point of our open-label, multicenter, single-arm, phase 2 trial on safety and efficacy was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30, version 3.0). Patients were required to complete the HRQoL questionnaire at baseline, after HIPEC, and after the end of the treatment. Changes of HRQoL over time were assessed by median scores for each domain and analyzed by Friedman`s test at a significant two-sided level of 0.05. Results: fifteen patients with high tumor burden EOC were recruited from our public health system between February 2015 and July 2019. A baseline EORTC QLQ-C30 questionnaire and at least one follow-up questionnaire was received from all of the patients. No significant difference over time in the QLQC30 summary scores was observed (p>0.05). The transitory impairment on patients HRQoL immediately after the short-course HIPEC trended to return to baseline at the end of the multimodal treatment. Conclusions: we found no significant impairment of short-course HIPEC on patients HRQoL into the context of our comprehensive treatment protocol. RESUMO Objetivo: avaliar o impacto da quimioterapia intraperitoneal hipertérmica (HIPEC) de curta duração (i.e.: 30 minutos) na qualidade de vida (QoL) relacionada à saúde (HRQoL) no contexto de ensaio clínico terapêutico piloto; NCT02249013. Métodos: avaliou-se o desfecho secundário predeterminado de HRQoL em ensaio clínico de fase 2 de segurança e eficácia, aberto, multicêntrico, de braço único, utilizando-se o questionário European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30, versão 3.0). As pacientes foram solicitadas a responder o questionário de HRQoL antes do tratamento, após a HIPEC, e ao fim do tratamento interdisciplinar. As variações da HRQoL ao longo do tempo foram avaliadas pelas medianas dos escores de cada domínio e analisadas pelo teste de Friedman, considerando-se nível de significância estatística bicaudal de 5%. Resultados: quinze pacientes com câncer de ovário de grande volume tumoral foram recrutadas do sistema de saúde pública (i.e.: SUS) entre fevereiro de 2015 e julho 2019. Um questionário basal e pelo menos um questionário de acompanhamento foram coletados de todas as pacientes. Não se observou diferença significativa ao longo do tempo na HRQoL em nenhum dos domínios ou sintomas estudados (p> 0,05). O comprometimento transitório da HRQoL imediatamente após a HIPEC de curta duração tendeu a retornar à linha de base ao final do tratamento multimodal. Conclusões: não se observou impacto significativo da HIPEC de curta duração sobre a HRQoL no contexto deste protocolo de tratamento interdisciplinar.

BACKGROUND AND OBJECTIVES The prognosis of colorectal cancer (CRC) has improved in the last decades, however, a lower overall survival persists in the elderly. The understanding of immunity changes in the elderly with CRC will allow the emergence of new treatments with higher response rates. 4-1BB and CD40L, an immune checkpoint stimulator, play an important role in T-cell responses and platelets. Our aim was to characterize the soluble levels of CD40L and 4-1BB in CRC elderly patients. METHODS A cross-sectional study was performed in 41 patients with CRC and 35 healthy elderly controls. Patients with CRC were divided into three groups according to staging: 13 patients with advanced tumor restricted to the organ (stages II); 16 patients with lymph node metastasis (stage III); and 12 patients with distant metastasis (stage IV). RESULTS There were higher levels of soluble s4-1BB and sCD40L in CRC elderly stage II patients when compared with healthy controls (P = .0009 and P

e18571 Background: cervical cancer (CC) reveals regional and social inequalities and should be understood not only as an oncological indicator, but essentially as an indicator of social vulnerability and health care needs.CC is the second most incident and the most deadly among women from the Northeast’S Brazil and the third most incident in Brazil Although the HPV vaccine coverage and the Pap smear test are available through the Brazilian public health system, the coverage of the target population is low. objective: Verify the conditions of access/use of the health system by women with cervical cancer (CC) and their families. Methods: Cross-sectional study involving cancer patients admitted to IMIP between 2016 and 2019. The variable data were related to the sociodemographic profile, preventive examination, Human Papillomavirus (HPV) and the influence of the diagnosis of CC on the search for preventive and screening measures by women's family members. Results: Out of the 285 participants,between 9-21 years old and 101 between 25-69 years old. Of the patients studied,55,8% lives urban area. It has a higher performance of biopsies in the public sector (59,5%). The sociodemographic analysis highlights the non-white race (78,2%) and only 6,8% with complete high school. The knowledge about performing the Pap smear reached 88,9% and the disinformation about the HPV reached 44,4%.the school was the largest source of information about the HPV vaccine (30,6%). Related to the influence of cancer, 62,2% said that young family members underwent HPV vaccination and 82,2% related their diagnosis to search for preventive in family members over 25 years old. a much higher percentage than vaccination coverage and preventive exam in the study region report that the diagnosis of cancer influenced the decision to vaccinate (42%) and update the pap test (69%). about 30% of patients had never taken the pap test. the early start (15 - 19y) of the pap test was not significant for the periodic performance of the pap test. 46% reported the lack of information about the importance of the exam as a reason for not performing it and 34% reported fear. conclusion :Strengthening educational activities and offering vaccines against HPV and Pap smears in the diagnosis of a case of cervical cancer can be an opportunity to expand the coverage of preventive measures more effectively among people close to the patient and her community, which cannot be missed. The school was an important source of information about the HPV vaccine and should be directly involved in this fight.Reducing an inequality cycle.

e13628 Background: Cervical cancer (CC) is the second most incident and the most deadly among women from the Northeast’S Brazil and RECIFE-Pernambuco and the third most incident in Brazil. The occurrence of CC expresses a reality of inequality and inequity and should be understood not only as an oncological indicator, but essentially as an indicator of social vulnerability and health care needs. Its distribution occurs heterogeneously. Methods: Determine the geolocation of areas of greatest risk of occurrence of SC from the social and health determinants Considering the high incidence and mortality related to cervical cancer between 2006-2015, in the city of Recife, we used the spatialization technique to identify the most vulnerable territories for our intervention in the city of Recife. Results: 3,844 Cervical Cancer notifications AND 276 OBITUATIONS registered in the period 2006-2015 and the number of deaths in the period from 2009 to 2018, as a result, there are five areas of high influence. from spatialization, the heat zone generated by the 47 deaths that occurred in the north of the city of Recife WAS DETERMANED. Regarding the cytopathological supply, the ratio in 2018 was 0.37, being below the state average, which is 0.41. With a deficit of 45,041 screening cytopathological exams in the age group 25-64 years.the III Health Region was identified, based on the analysis of information from the State Health Secretary, which shows to be one of the areas of great social vulnerability, since 63% of the 22 municipalities that make up this health region and its population is in extreme poverty, according to IBGE (2010). Conclusions: The occurrence of deaths and new cases of cervical cancer in the city of Recife occurs geographically unequally and is associated with indicators of social vulnerability. IS IT POSSIBLE to identify a priority region to intensify public actions for prevention and early diagnosis. A challenging scenario has been found and must be actively addressed.

Objetivo: Conhecer, na população oncogeriátrica, a imunossupressão como efeito adverso do uso de opioides. Essa classe de drogas é utilizada para o controle de sintomas, principalmente, dor de intensidade moderada à forte. Há amplo conhecimento clínico sobre os efeitos colaterais mais comuns, como náusea, vômito e constipação, mas pouco é discutido sobre a imunomodulação provocada pelos opioides. Revisão Bibliográfica: Para a população de idosos com câncer, o controle de sintomas como a dor é fundamental no seguimento clínico. O adequado tratamento álgico é feito, muitas vezes, com a prescrição de opioides que entram para uso crônico e contínuo. Além das reações adversas clinicamente observadas, há vários relatos na literatura da investigação dos efeitos imunomoduladores dessas drogas e relação com risco aumentado de sepse e maior mortalidade. Considerações finais: Considerar a importância do efeito imunossupressor dos opioides no planejamento terapêutico, principalmente para os tratamentos contínuos, de forma a utilizar essa droga, sempre que bem indicada, mas com segurança.

Background The importance of classifying cancer patients into high- or low-risk groups has led many research teams, from the biomedical and bioinformatics fields, to study the application of machine learning (ML) algorithms. The International Society of Geriatric Oncology recommends the use of the comprehensive geriatric assessment (CGA), a multidisciplinary tool to evaluate health domains, for the follow-up of elderly cancer patients. However, no applications of ML have been proposed using CGA to classify elderly cancer patients. Objective The aim of this study was to propose and develop predictive models, using ML and CGA, to estimate the risk of early death in elderly cancer patients. Methods The ability of ML algorithms to predict early mortality in a cohort involving 608 elderly cancer patients was evaluated. The CGA was conducted during admission by a multidisciplinary team and included the following questionnaires: mini-mental state examination (MMSE), geriatric depression scale-short form, international physical activity questionnaire-short form, timed up and go, Katz index of independence in activities of daily living, Charlson comorbidity index, Karnofsky performance scale (KPS), polypharmacy, and mini nutritional assessment-short form (MNA-SF). The 10-fold cross-validation algorithm was used to evaluate all possible combinations of these questionnaires to estimate the risk of early death, considered when occurring within 6 months of diagnosis, in a variety of ML classifiers, including Naive Bayes (NB), decision tree algorithm J48 (J48), and multilayer perceptron (MLP). On each fold of evaluation, tiebreaking is handled by choosing the smallest set of questionnaires. Results It was possible to select CGA questionnaire subsets with high predictive capacity for early death, which were either statistically similar (NB) or higher (J48 and MLP) when compared with the use of all questionnaires investigated. These results show that CGA questionnaire selection can improve accuracy rates and decrease the time spent to evaluate elderly cancer patients. Conclusions A simplified predictive model aiming to estimate the risk of early death in elderly cancer patients is proposed herein, minimally composed by the MNA-SF and KPS. We strongly recommend that these questionnaires be incorporated into regular geriatric assessment of older patients with cancer.

Objective Cervical cancer is a global public health challenge. Since 1999, platin based chemoradiation (CRT) is the standard treatment for those patients with locally advanced disease. However, this population still has a dismal prognosis and, alternatives approaches such as adjuvant chemotherapy are controversial, especially because of increased toxicity. Neoadjuvant chemotherapy (NACT) could be an option for more intensive treatment with manageable toxicity. Methods A phase II, prospective, non-randomized trial was conducted at a reference center in Recife, Brazil. Locally advanced cervical cancer patients (Ib2–IVa) were treated with neoadjuvant cisplatin 35mg/m 2 and gemcitabine 1000mg/m 2 D1 and D8, for 2cycles. Then, they received CRT (50.4Gy) with weekly cisplatin 40mg/m 2 followed by brachytherapy. Response rate (RR) and toxicity were the primary endpoints. Progression-free survival (PFS) and overall survival (OS) were secondary endpoints. Results Between Sep/2013 and Oct/2015, 50 patients were initiated on NACT and CRT. RR was 81% at the end of treatment. Hematological and gastrointestinal toxicity were most common. Grade 3/4 toxicity was 20% during NACT and 44% during CRT. Late adverse events were present in 20% of patients. PFS at 1 and 3-years were 73.4% (IC 58.7–83.6) and 53.9% (IC 36.9–68.3), respectively; and, OS at 1 and 3-years were 93.9% (IC 82.4–98.0) and 71.3% (IC 53.3–83.3), respectively. Conclusion In our hands NACT in locally advanced cervical cancer patients did not show a meaningful improvement in ORR. Nevertheless, we believe it should be further explored in prospective trials.

e23035 Background: According to the World Health Organization (WHO), the definition of "elderly" varies according to the degree of development of the country. In Low and Medium Development Countries (LMDC), a person aged 60 or older is considered elder, opposed to developed countries (65 or older). It is in LMDC that is occurring the largest relative increase in the incidence of cancer, specially those related to aging. The Comprehensive Geriatric Assessment (CGA) is still underutilized in oncological clinical practice, especially in LMDC. Objectives: To determine predictive factors for the occurrence of early death (in the first six months of surveillance) and to perform the development and temporal validation of a practical prognostic score based on the CGA to predict early death (up to 180 days) in elderly cancer patients. Methods: A prospective cohort enrolled elderly patients ≥ 60 years with a recent cancer diagnosis admitted between 2015-2017. The CGA performed at the time of admission included the following instruments: CCI; KPS; MMSE; TUG test; IPAQ; ADL; MNA; MNA-SF; GDS15; PPS and Polypharmacy. The studied outcome was early death, defined as the one that occurred within the first six months after the diagnosis. Survival analysis (Kaplan-Meier) and Cox proportional hazard regression was performed. Results: 889 patients were included in the study, performed at a referral center in cancer of a teaching hospital in Northeastern Brazil. The independent risk factors for death identified by CGA were: Mini exam of mental state (MMSE) as a continuous variable (HR 1.04 95% CI 1.00-1.07), Geriatric depression scale (GDS-15) ≥ 10 (HR 1 , 50 IC95% 1.10-2.07), Karnofsky Functional Performance Scale (KPS) < 50 (HR 1.57 IC95% 1.02-2.42), Katz Index ≤4 (HR 2.58 IC95% 1.68-3.97) and the Mininutrition assessment (MAN-SF) < 12 (HR 2.96 IC95% 2.00-4.39), with higher risk for early death amongst patients with abnormalities detected by the scales performed at admission (log rank < 0.001). Conclusions: Comprehensive geriatric assessment is an important tool to identify fragility in elderly cancer patients. Some of its scales should be incorporated into clinical practice, as they are simple and significant prognostic markers and identify patients with a higher risk of death in the first twelve months.

e23040 Background: Elderly oncology patients are not often included in studies of new therapeutic guidelines. The modified-G8 is easy to use, has satisfactory accuracy and does not require additional tools. Its value for predicting early death has not been evaluated. Objective: To evaluate accuracy of the modified G8 instrument for prediction of early death (up to 6 months) in elderly Brazilian patients (≥ 60 years). Methods: We used data from a prospective cohort with participants aged 60 years or older and a recent diagnosis of a solid neoplasm, followed in a geriatric oncology outpatient clinic between 2015 and 2017. Sociodemographic, clinical and laboratory data were obtained, along with CGA. From the primary data, we developed a modified-G8 score using 6 as the cut-off point, normal being < 6 and abnormal being ≥ 6. The primary outcome was early death (occurring within up to 6 months) considered the gold standard for the accuracy study of modified-G8 as a predictor of early death. Through bivariate and Cox multivariate analysis, the risk for early death (Hazard Ratio - HR crude and adjusted) was determined. Overall survival was estimated using the Kaplan-Meier method, and the log-Rank test was used for comparisons according to the categorization of the scores. Results: Of the 889 participants included, 537 (60%) had modified G8 scores ≥ 6 (abnormal). The overall mean score was 9.9 ± 8.4; mean age was 72,5 years (range, 60–97 years), 38% were 60 and 70 years of age. Fifty-two percent of the participants were male. The most common tumor sites were prostate (31%) and breast (16%), followed by digestive and gynecological (both with 11%). On analysis of accuracy, we found sensitivity 91.7% (95% CI 86–95.7), specificity 45.7% (95% CI 42.1–49.4), positive predictive value 24.8% (95% CI 21.2–28.6) and negative predictive value 96.6% (95% CI 94.1–98.2), area under the ROC curve 81.7% (95% CI 77.9–85.4). The crude HR for early death among those who had abnormal scores was 8.3 (95% CI 4.6–14.9) and the age-adjusted HR, tumor site and metastatic disease at diagnosis was 4.5 (95% CI 2.5–8.3) times greater and survival was lower (log-rank p 0.001). Conclusions: The modified G8 predicted early death in an elderly population (≥ 60 years) with cancer in a northeastern Brazilian institution. Satisfactory prognostic accuracy was obtained. This instrument could reduce the number of patients who would follow-up with CGA, saving time and resources, and accelerating individualized treatment.

e23036 Background: The G8, a questionnaire with 8 questions, has been specifically developed as a screening tool for vulnerability in older patients (70+) with cancer, with results suggesting 14 points as a threshold (equivalent to 90% sensitivity and 60% specificity). Its prognostic value for early death was not evaluated in Brazilian population. Methods: Cancer patients (60 years or older) with solid organ malignancies were included in a prospective cohort in a Brazilian Geriatric Oncology Clinic, between 2015 and 2017. Before the start of any oncologic therapy, a Comprehensive Geriatric Assessment (CGA) with 12 questionnaires was performed. For this study, we analyzed the G8 (Figure 1) considering items from Mini Nutritional Assessment (MNA), polypharmacy ( > 3 medications per day), self reported health status and the age of patient. G8 score was considered abnormal if ≤14, and early death (within six months of surveillance) was the gold standard for the study accuracy. Cox proportional hazard risk and Kaplan-Meier survival curves were performed. Results: 889 patients were enrolled and there were 145 (16.3 %) early deaths. Overall, 52% were male, the extremes of age were from 60 to 97 (mean 72.5 ± 0.24), and 38% were < 70 years old. The most common cancers were prostate (31.2%), digestive tract (21.9%) and breast (16.0%); 30.4% were metastatic. 470 (52,9%) from all patients had abnormal (≤ 14) G8 score; 128 (27.2%) who had abnormal G8 score died within the first 6 months, versus 17 (4.1%) with normal score (Table 1). At cut point 14, the G8 sensitivity was 88.3% (CI95% 81.9 - 93.0); specificity 54.0% (CI95% 50.4 - 57.7); positive predictive value 27.2% (CI95% 23.3 - 31.5); negative predictive value 95.9% (CI95% 93.6 - 97.5); area under ROC curve was 0.819 (Figure 2). For those older than 70, the G8 sensitivity was 91% (CI95% 83.4 - 96.1). Abnormal scores showed significant differences in survival probability (Figure 3). Conclusions: G8 score is a strong and consistent predictor of overall 6-month survival, regardless of age, metastatic status or tumor site in Brazilian older (60 or older) oncologic patients. This finding strengthens the clinical utility of this instrument in the Geriatric Oncology and may be an option to extend the practice of Geriatric Assessment in countries with medium-low economic development, even in the younger elderly population.

RESUMO O objetivo do estudo foi analisar a continuidade da assistência a mulheres com câncer de colo uterino. Estudo de caso qualitativo, em redes de saúde. Realizaram-se entrevistas com roteiro semiestruturado e técnica de análise narrativa de conteúdo. As mulheres perceberam barreiras no diagnóstico, no tratamento e na acessibilidade entre níveis de atenção. Observaram comunicação informal entre especialistas; limitações na comunicação entre níveis de atenção; inexistência de contrarreferência; e que o vínculo paciente-serviço era maior na esfera da oncologia. A falta de contrarreferência dificultou a acumulação de conhecimento e a coordenação do cuidado pela Atenção Básica. ABSTRACT The aim of the study was to analyze the continuity of care for women with cervical cancer. Qualitative study of case, in health networks. Interviews were performed with semi-structured script and technique of content's narrative analysis. Women perceived barriers in the diagnosis, treatment and accessibility between levels of care. They observed informal communication between specialists; limitations in the communication between levels of care; absence of counter-reference; and that the patient-service relationship was greater in the oncology sphere. The lack of counter-reference hindered the accumulation of knowledge and coordination of care for Primary Care.

SUMMARY Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011) with a minimum length of hospital stay of two hours. Student’s t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%). 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%), breast (13.6%) and prostate (10.5%); 70.7% were in advanced stages (IV, 47.1%); 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals. RESUMO Objetivo: descrever o perfil clínico e sociodemográfico de pacientes oncológicos atendidos na emergência de um Centro de Alta Complexidade em Oncologia, observando a cobertura dos cuidados paliativos e assistência domiciliar. Método: estudo de corte transversal com adultos oncológicos atendidos na emergência (setembro a dezembro de 2011) e tempo de permanência superior a 2 horas. Usaram-se teste t-Student de comparação de médias e qui-quadrado. Resultados: participaram 191 pacientes, 47,6% idosos, 64,4% mulheres e 75,4% procedentes de Recife e região metropolitana. Dor (46,6%) foi o sintoma prevalente à admissão. Os pacientes sob cuidados paliativos eram 4,2% e sob atenção domiciliar, 2,1%. Os cânceres mais frequentes foram colo uterino (18,3%), mama (13,6%) e próstata (10,5%), sendo 70,7% em estadios avançados (IV, 47,1%) e 40% sem terapia oncológica. Conclusão: a procura da emergência por causa de dor deveu-se, provavelmente, à baixa cobertura de cuidados paliativos e atenção domiciliar, os quais precisam ser associados precocemente à terapia oncológica para minimização do sofrimento dos pacientes/familiares e integrar as competências de oncologistas e profissionais de emergências.

e22017Background: Aging is the major risk factor for cancer. Health-related Quality of Life (HRQoL) is an important aspect to be studied in the elderly population with cancer, not only as an end-po...

10049Background: Recognizing prognostic factors is important when evaluating elderly people with cancer to decide the appropriate treatment. The Oncogeriatric Index (OGI) was developed to predict e...

e17074Background: Toll-Like Receptors (TLRs) are important in oncology research due to its role in the activation of various biological factors, inflammation and its influence on tumor progression....

e17514Background: Cervical cancer is still the third most incident cancer among Brazilian women. early diagnosis and access to oncological therapy are challenging. For 135 patients treated in 2016/...

e24142Background: Elderly cancer group is a heterogeneous and growing one. In the elderly, Toll-Like Receptors(TLRs) have been described as related to the immunosenescence process, carcinogenesis a...

e22053Background: Elderly oncology population(EOP) corresponds to an increasing and heterogeneous group with high risk to infectious complications. Advances in antimicrobial therapy have not accomp...

e21533 Background: To determine if the nutritional risk according Mini Nutritional Assessment Short-Form (MNA®-SF) is an independent factor for short-term outcomes (infection, un programmed hospitalization and premature death) within the first six months after study entry. Methods:Prospective cohort study of elderly patients (≥ 60 years) with a recent diagnosis of cancer admitted to an outpatient oncology unit. At baseline sociodemographic and clinical variables were determined and comprehensive geriatric assessment (CGA) was conducted including MNA-SF. The outcomes were first Healthcare-associated Infection, un programmed hospitalization and death. Data were analyzed using multivariate Cox proportional hazards models; overall survival was estimated using the Kaplan–Meier method and survival curves were compared using the Log rank test. Results:The cohort consisted of 608 elderly patients followed for 180 days or until the censured data. Mean age was 71.9 years (range: 60‒96), 305 (50.2%) participants were at risk of malnutrition. During this period, 216 (35.5%) participants were hospitalized, 179 (29.4%) HAI and 100 (16.4%) died. After adjustment for age, site of cancer and cancer stage the multivariate regression Cox model showed that being undernourished was an independent predictor of infection (HR = 1.88, 95%CI 1.32-2.67, p < 0.001) hospitalization (HR = 1.5, 95% CI:1.10- 2.06, p = 0.012) and death (HR = 3.12, 95% CI: 1.74‒ 5.78, p < 0.001) Conclusions:Nutritional risk at admission was identified as a significant predictor of risk for premature death, infection, and need for hospitalization in elderly cancer patients. The use of MNA-SF should be incorporated into regular geriatric assessment of older patients with cancer

e21537 Background: Components of the comprehensive geriatric assessment (CGA) correlate with risk of early mortality in elderly cancer patients (ECP). However, its complexity and the time required for its administration. The aim of this study was to determine the impact of each CGA domain on overall survival(OS) and to first step for the development of a prognostic scoring system to stratify ECP. Methods: a prospective cohort study. Participants with a recent diagnosis of cancer were from eight hospitals and one cancer center in Brazil and were recruited during their first medical appointment at the outpatient oncologic clinic. A basal CGA was done before the care decision (ADL, Charlson Comorbidity Index- CCI, Karnofsky Performance status – KPS, GDS15, IPAQ, MMSE, MNA, MNA-SF, PS, PPS, Polipharmacy, QLQc30, TUG). During the follow up of six months, information about the treatments performed and early death was collected. OS was estimated using the Kaplan–Meier method, and survival curves were compared using the Log rank test for categorical variables. A multivariate Cox proportional hazards model was used to select early death risk factors. A clinical score considering the number of risk variables was created. Results: From 2015-2016, 608 ECP, mean age 71.9 (SD ±7.4; range 60-96), 50.7% male, were enrolled. 100 (16.4%) ECP died in less than six months of follow-up. In our multivariate model, controlled by age, site of cancer and cancer stage, the remaining significant risk factors were malnutrition/nonutrition determined by MNA (HR 3.3, 95%CI 1.81-5.99, p < 0.001), KPS < 50% (HR 2.44, CI 1.56-3.81, p < 0.001) and CCI > 2 (HR 1.6, CI 1.09-2.52, p = 0.018). The risk for early death according to the number of risk variables: three (HR 12.99, CI 5.69-29.60, p < 0.001), two (HR 5.65, CI 2.61-12.24, p < 0.001) or one (HR 2.7, CI 1.28-5.87, p = 0.009). Conclusions: a practical clinical score using three instruments of the CGA (MNA, KPS and CCI) can predict independent the risk for an early death in ECP. The development of a practical system for risk scoring, incorporating few clinical prognostic factors, helps to stratify patients into risk groups and to plan a personalized care.

e21534 Background:With the aging of the population, cancer in the elderly people is becoming an increasingly common and complex health problem, particularly in low-middle-income countries, where physical inactivity and obesity have also been challenging and correlated with cancer and aging. The aim of this study is to determine whether the baseline physical inactivity per International Physical Activity Questionnaire(IPAQ) is an independent factor of premature death in the first six months.Methods: prospective cohort study of elderly patients (≥ 60 years). Participants with a recent diagnosis of cancer were from eight community hospitals and one cancer center in Northeast Brazil and were recruited during their first medical appointment at the outpatient oncologic clinic. Sociodemographic and clinical variables were determined and baseline comprehensive geriatric assessment (CGA) was conducted including IPAQ and Time Up and Go test. Data were analyzed using multivariate Cox proportional hazards models, overall survival was estimated using the Kaplan–Meier method and survival curves were compared using the Log rank test. Results:From 2015-2016, 608 patients, mean age 71.9 (SD ±7.4; range 60-96), 50.7% male, were enrolled. Main diagnoses were prostate cancer (29.1%), digestive system cancer (25.5%) and breast cancer (16.0%). 40.3% were considered obese/overweight (BMI ≥ 27). 42.1% were considered physically inactive per IPAQ. The mean of the Time Up and Go test on the physically inactive group by IPAQ was of 13.11s (SD ± 6.5), and of 22.72s (SD± 16.7) on the physically active one. After adjustment for age, site of cancer and cancer stage, the multivariate regression Cox model showed that being physically inactive is an independent predictor for early death (HR = 2.35, 95% CI: 1.50‒ 3.66, p < 0.001).Conclusions:Physical inactivity at admission was identified as a significant predictor of risk for premature death in elderly cancer patients. The evaluation of the physical activity should be incorporated into regular geriatric assessment of elderly cancer patients.

e16612Background: Cancers are increasing with aging and thus the number of elderly cancer patient is expected to increase significantly in years to come. The aims were to evaluate the cellular immune profiling associated with prostate cancer in elderly patients. Methods: We prospectively enrolled patients, who were treated and followed-up in the department geriatric clinicaloncology. Between 2015 and 2016, a prospective cohort study in 346 elderly incident cancer patients ( ≥ 60 years) , at the time of enrollment, assessed and collected socio-demographic and clinical variables and collected peripheral blood analysis in Experimental translational exploratory study. using PBMC were stained with following antibodies: anti-CD4, anti-CD8, anti-CD28, anti-CD20, anti-CD16, anti-CD56 and analyzed by four-color flow cytometry on a FACS Verse BD Bioscience. We analyzed the immune profiling of elderly patients with prostate cancer and non-cancer ( > 65). Results: We enrolled 38 patients with prostate cancer and the ...

10046Background: the elderly cancer is a heterogeneous and growing group. In the elderly, the genes of toll-like receptors (TRL) has been described as related to immunosenescence process, carcinoge...

e21529Background: Health-related quality of life (QoL) is a major concern for older patients with cancer. Methods: Between 2015 and 2016, a prospective cohort study in 346 elderly incident cancer p...

133 Background: the elderly cancer group is a heterogeneous and growing one. In the elderly, the genes of toll-like receptors (TLR) have been described as related to the immunosenescence process and carcinogenesis. The relationship of this gene family with carcinogenesis and immunoregulatory responses seems a promising field. Methods: Between 2015 and 2016, a prospective cohort study in 445 elderly patients with incident cancer ( ≥ 60 years) at the time of admission, assessed and collected sociodemographic and clinical variables and collected analysis of peripheral blood in translational exploratory study. Determination of TLR2 and TLR9 was performed by flow cytometry with monoclonal antibodies anti-TLR2 and TLR9 in the peripheral blood at the beginning of anti-cancer therapy in older patients with cancer. Results: 445 elderly patients were included with incident cancer, age of 71.13 years (SD 7.41) means. Most were male (50.9%) and self-reported black or brown skin color (71.4%). The topography of prostate cancer was more frequent (29.4%), followed by the digestive system (24.3%). They were mostly patients with advanced stage (III and IV) at nutritional risk (52.6%) and reported using up to 5 medications (77.2%). Patients were followed for an average of 128 days (SD 54.37). During this period, there were 62 deaths (13.9 %) with a mean overall survival of 165 days (95% CI 161.25 to 170.02). There are significant differences in the percentage values of TLR9 (p = 0.0009) and TLR2 (p = 0.04) in monocytes between the groups of patients who died in less than 6 months of treatment and those who survived. Conclusions: Overexpression of TLR9 and TLR2 may be a protective factor for the occurrence of early death in elderly patients with cancer.