Repositório RCAAP

This paper focuses on the issue of exploration of Palliative Care, stressing the importance of teamwork and therapeutic alliance. Palliative Care is active and comprehensive, it is also delivered by multidisciplinary teams who have had proper training to deal with patients that suffer of advanced and terminal disease, besides their families, when curative treatment not responds. Our objectives emphasise on ascertaining the evolution that this subject has had overtime, and explore the current importance given to the subject. To reach the goals it was made looking at databases, searching for existing research on the topic. It ends with a conclusion, offering answers to the objectives reflected on the topic and work made, enhancing tips and showing some contributions that might emerge.

Objectives: To assess the acceptability, and measure the impact on the health-related quality of life (QoL), of a mindfulness-based intervention (MBI) in supportive care of Portuguese cancer survivors. Methods: In 26 cancer outpatients, mostly women (96%), mostly with breast (58%) and gastrointestinal (23%) cancers, randomly assigned to intervention and control groups, we have measured QoL and Mindfulness at randomization, at the end of the program and 12 weeks after its completion. Results: In the intervention group, the attrition rate was null QoL had improved compared to controls, especially at 12-week follow-up. Conclusions: This pilot study shows that MBIs may be helpful in supportive care to Portuguese cancer survivors and opens up favorable perspectives for larger, more representative studies.

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The prevalence of patients living after a diagnosis of cancer has increased due to the rising incidence, better treatments and improved survival rate. The risk of further primary cancers might be expected to be rising because of the persisting effects of genetic and behavioural risk factors, long-term side-effects of chemo and radiotherapy, increased diagnostic sensitivity, and aging. The prevalence of multiple primary cancers is between 0.7% and 11.7%, and cancer patients have a 20% higher risk of new primary cancer compared with the general population. Breast, colon-rectum, and prostate are the sites with highest prevalence of multiple tumours since these tumours have higher incidence and longer survival. In this paper we review the theme of multiple tumours and summarise the most frequent cancer syndromes that lead to multiple tumours.

Patient blood management (PBM) is a safe approach aiming to improve a patient’s medical and surgical management in ways that boost and conserve their own blood. Approximately 32% to 60% of oncology patients have iron deficiency – the majority of whom are anaemic – therefore, it is important to discuss strategies to avoid excessive blood usage and the reduction of tumour progression and cancer recurrence. In this position paper experts together with the Anaemia Working Group Portugal discussed a PBM program in haematology and oncology, taking into account several factors that are currently used to approve the applied therapies, based on the latest reviewed information of the National Comprehensive Cancer Network®.

Goals: Sentinel lymph node biopsy (SLNB) is indicated when a mastectomy is performed by Ductal Carcinoma In Situ (DCIS). When mastectomy is performed after one or more attempts of breast conservative surgery (BCS), the need to perform SLNBis questionable. The goal of this study was to determine the histological upgrade rate and SLNB results in this specific group of patients.Methods: Retrospective study of a case series of patients submitted to total mastectomy and SLNB by CDIS after BCS between 2008 and 2016.Outcomes: We analysed 1,071 cases and selected 81 that fulfilled the inclusion criteria. The median age was 55 years. The diagnosis was made by screening tests in 88.6% of the cases. Microcalcifications were the main presentation (78.8%). The mastectomy totalisation was performed after one attempt of BCS due to positive or inadequate margins. The resection margins were positive in 46.9% of the cases. Residual disease in the mastectomy specimen was identified in 65.4%. The post-mastectomy upgrade rate was 4.9% (one case with microinvasion and three cases with invasion). The median number of sentinel nodes (SN) isolated were 2 (0-5) and the rate of lymph node metastasis was null.Conclusions: In this sample, the histological upgrade rate was very low. We didn´t find lymph node metastasis in any case, even in those cases with upgrade to invasive carcinoma. These findings suggest that lymph node staging can be safely omitted in DCIS patients submitted to mastectomy after attempted BCS.

Goals: To present and review the appearance of a rare case of lymphoedema secondary breast angiosarcoma (Stewart-Treves syndrome).Methods: Diagnostic computed tomography (CT) and magnetic resonance (MR) images and a specimen photograph are presented, with a clinical case discussion and a brief pathology description.Outcomes: Early diagnosis and prompt surgery are crucial to improve the poor prognosis of this tumor. Early signs of the condition vary, including purplish patches that develop into skin nodules, a mass under the skin, or a poorly healing eschar. Imagiological studies, mainly MR, aids in the diagnosis and disease extension assessment.Conclusion: Chronic lymphoedema in which clinical signs and CT/MR scans demonstrate nodules or enhanced skin thickening outside a radiated field in an oedematous limb after mastectomy and radiotherapy suggest the Stewart-Treves syndrome.

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