Publications

Cancer burden is expected to increase in the next decades, especially in low- and middle-income countries (LMICs). There, including in Portuguese-speaking African countries, cancer care remains fragile and highly centralised. Global ONCOlogy Initiative (GONCO) is a pragmatic initiative launched in Portugal to support the development of decentralised oncology services through short, targeted interventions. This paper presents its conceptual design and the first two pilot projects, implemented in Lubango (Angola) and Mindelo (Cape Verde). GONCO follows a three-step model: digital planning, fieldwork and digital follow-up. In both sites, the program was co-developed with local teams and focused on establishing multidisciplinary tumour boards, improving service coordination and building capacity in clinical management, protocols and research. In Lubango, GONCO helped launch the oncology unit and research group. In Mindelo, it supported service restructure planning and the creation of a breast cancer working group. Remote collaboration sustained momentum after field visits. Challenges included hierarchical barriers, unreliable digital infrastructure and non-sustainable funding. Despite these, GONCO demonstrated that focused and adaptable models can catalyse oncology development in resource-constrained hospitals. GONCO provides a replicable, light-footprint model for early oncology development in LMICs.

Genitourinary-Rhabdomyosarcomas (GU-RMS) are challenging to treat due to the probable lifelong sequelae of local therapy. Western-world data show 3-year event-free survival (EFS) and overall survival (OS) of 77% and 86%, respectively, for localised disease, with dismal outcomes for metastatic disease. We studied the clinical profile, outcomes and prognostic factors of GU-RMS treated with a multimodal protocol. Treatment-naïve children ≤ 15years with biopsy-proven GU-RMS treated from January 2013 to June 2022 were retrospectively analysed. Local therapy performed at 10-12 weeks of induction was radiotherapy (RT) and/or surgery. Fifty-two patients with a median tumour size of 5.5 cm (range, 3.4-9.2 cm) were analysed. Four patients (7.8%) had alveolar histology. The bladder was the commonest site of primary (36.5%). Group distribution: I-7 (13.4), II-1 (1.9%), III-35 (67.3%) and IV-9 (17.3%). Local therapy was surgery in 11 (21.5%), RT in 25 (49%) or both in 14 (26.9%) patients. With a median follow-up of 56 months (95% confidence interval (CI): 49.1%-63.1%), 4-year EFS for groups I-IV, were 100%, 50% (95% CI: 41%-59%) and 33.3% (95% CI: 2.6%-64%) (p = 0.01), respectively. The corresponding 4-year OS were 100%, 72% (95% CI: 56.4%-87.6%) and 33.3% (95% CI: 2.6%-64%) (p = 0.007), respectively. Relapses were locoregional-4 (7.7%), metastatic-5 (9.6%) and combined-4 (7.7%). Tumour size > 6.45 cm significantly affected outcomes in the localised cohort (hazard ratio = 4.1, 95% CI: 1.38-12.1, p = 0.01). Outcomes of group III GU-RMS in children treated on a multimodal protocol in our study are suboptimal compared to those from co-operative group trials, probably affected by large tumours at presentation, warranting alternative strategies for optimisation of survival.

The 'Pancreatic Cancer' conference, held on 8 November 2024, at the San Giovanni di Dio e Ruggi d'Aragona University Hospital in Salerno, Italy, brought together leading experts in pancreatic surgery and oncology. The event aimed to provide a comprehensive overview of recent developments in the multidisciplinary treatment of pancreatic adenocarcinoma, with particular focus on advanced surgical strategies. Topics included neoadjuvant chemotherapy, surgical planning and techniques (open, laparoscopic, robotic), complex resections and management of postoperative complications. The conference was accredited by the National Continuing Medical Education Program and integrated into the regional 'Campania Pancreas' initiative. Featuring national and international speakers, including a keynote lecture by Prof. C.R. Ferrone from Cedars-Sinai Medical Centre, the meeting served as a platform for knowledge exchange and innovation in pancreatic cancer care.

PURPOSE: Evaluating cancer patients' social media use is crucial for understanding their preferences, needs and health behaviours. This study examined social media use in health management and analysed influencing factors using the Health Belief Model (HBM).

METHODS: A descriptive-analytic study was conducted in 2024 at hospitals affiliated with Urmia University of Medical Sciences. A total of 204 cancer patients who actively used social media participated. Data were collected using a structured and validated questionnaire. Descriptive statistics and regression analyses (SPSS v16) were applied to examine HBM constructs and their predictors.

RESULTS: The mean age of participants was 54 years; 54% were male and 46% female. Overall, 38% used social media for healthcare purposes. Perceptions across the HBM constructs were moderate to high. Cues to action had the highest mean score at 3.19 standard deviation (SD = 0.546), followed by perceived benefits (M = 3.13, SD = 0.429) and self-efficacy (M = 3.11, SD = 0.677). Age significantly negatively predicted self-efficacy (B = -0.223, β = -0.474, p < 0.001), perceived benefits (B = -0.144, β = -0.485, p < 0.001) and cues to action (B = -0.112, β = -0.296, p = 0.001).

CONCLUSION: The findings highlight the multifaceted role of social networks in cancer patient healthcare. Moderate HBM scores indicate the need for tailored digital interventions to strengthen perceived benefits, self-efficacy and responsiveness to cues to action, ultimately fostering patient-centred care and informed health decisions.

PURPOSE: Biomarkers for tailoring treatment in neoadjuvant triple-negative breast cancer (TNBC) are needed. We hypothesize that neutrophil-to-lymphocyte ratio (NLR) before neoadjuvant chemotherapy (NACT) can predict long-term outcomes in this population.

METHODS: We reviewed our institutional database to identify patients with clinical stages II-III TNBC who underwent NACT from 2012 to 2024 and retrospectively collected data from medical records. We calculated event-free survival (EFS) from the date of NACT initiation until death, disease recurrence or disease progression that precluded surgery; we calculated overall survival (OS) from the date of NACT initiation until death. Survival estimates were analysed using Kaplan-Meier method and compared with log rank test. The Cox regression model was used to calculate hazard ratios.

RESULTS: A total of 692 patients were included in the analysis. Of these, 63.3% had stage III disease, 60.8% had grade 3 tumours and 77.2% had a Ki-67 >50%. The most common NACT regimen used was anthracycline and taxane-based (96.8%). The overall pathological complete response (pCR) rate was 27.7%. After median follow-up of 59.6 months, NLR >2 was associated with poorer EFS (HR 1.71, 95% CI 1.33-2.18, p < 0.001) and OS (HR 1.76, 95% CI 1.34-2.31, p < 0.001). The results maintained statistical significance after adjusting for age, ki67, clinical stage and pCR status (p = 0.002).

CONCLUSION: NLR predicts long-term survival after NACT in TNBC and, as a readily and inexpensive information, should be further studied in current approaches of chemoimmunotherapy.

OBJECTIVE: This case report describes the capability of a smartphone-based electrocardiogram (ECG) in detecting multivessel coronary artery disease (CAD), with initial findings suggestive of double-vessel involvement, which was later confirmed as triple-vessel disease (TVD) by coronary angiography.

CASE REPORT: In this case report, we describe a 51-year-old woman with a known medical history of CAD, hypertension, TVD, and a prior episode of acute coronary syndrome who presented to Swami Rama Himalayan University, Dehradun, with complaints of chest pain. She had previously undergone percutaneous coronary intervention with stent placement. Conventional 12-lead ECG (Philips PageWriter ECG) indicated myocardial ischemia. Follow-up smartphone-based ECG (Spandan Pro) revealed inferolateral ischemia possibly affecting the left anterior descending artery (LAD) and left circumflex artery (LCX), with a possible diagnosis of double-vessel disease (DVD). Coronary angiography later confirmed the diagnosis of TVD with significant stenosis of the LAD, LCX, and right coronary artery, along with additional involvement of the left main coronary artery. Post-angiography, the patient was recommended for coronary artery bypass grafting as the first option and percutaneous transluminal coronary angioplasty as an alternative.

CONCLUSION: This case illustrates the clinical efficacy of the smartphone-based ECG device in detecting inferolateral ischemia suggestive of DVD in patients with suspected or known CAD and highlights its diagnostic concordance with standard investigations, particularly coronary angiography.

OBJECTIVE: The current study aims to describe the infection and infestation adverse events that may be associated with the use of ocrelizumab using real-world data.

METHODS: Infection and infestation adverse event reports with the generic name ocrelizumab as the primary suspect in the FAERS database from Q4 2003 to Q3 2024 were included in the study. The disproportionality analysis software package OpenVigil 2.1-MedDRA-v24, including the Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) algorithms, was used to determine signal strength of infection and infestation adverse events associated with ocrelizumab. The signal intensity for ROR and PRR was classified as low, medium and strong according to signal strength.

RESULTS: The analysis of infection and infestation reports of the drug pharmacovigilance database on the use of ocrelizumab revealed 161 positive signals. The most common adverse event reported was COVID-19 (n=2287, ROR 24.303; PRR 22.681). According to the disproportionality analysis, the top six adverse events with the highest ROR and PRR were encephalitis enteroviral (ROR 101.831; PRR 101.809), meningitis enteroviral (ROR 76.019; PRR 76.005), fallopian tube abscess (ROR 51.225; PRR 51.221), nasal herpes (ROR 45.676; PRR 45.662), neuroborreliosis (ROR 28.563; PRR 28.559) and babesiosis (ROR 25.507; PRR 25.5).

CONCLUSION: Ocrelizumab may increase the risk of many infections and infestations, including enterovirus-related central nervous system infections, tick-borne infections, COVID-19-related disorders, genital tract infections and herpes infections, and therefore requires careful monitoring in clinical practice.

Glossopharyngeal neuralgia (GN) is a rare neuropathic disorder characterized by sudden, unilateral, electric shock-like pain in the areas innervated by the glossopharyngeal nerve. Its diagnosis is frequently delayed because of its clinical overlap with odontogenic and otorhinolaryngological conditions. In the context of the COVID-19 pandemic, different cranial neuropathies have been reported, suggesting possible post-infectious mechanisms. We describe the case of a 54-year-old male dentist, without relevant medical history, who developed recurrent episodes of intense pain in the right pharynx and base of tongue after confirmed SARS-CoV-2 infection. Symptoms were triggered by swallowing, coughing, and salivary stimulation, reaching maximum intensity on the visual analogue scale (EVA 10/10). Brain and neck magnetic resonance imaging revealed no structural abnormalities. Treatment with carbamazepine (600 mg/day) partially reduced frequency and severity of attacks, while pregabalin (300 mg/day) showed no benefit. This case highlights the need to consider SARS-CoV-2 infection as a potential trigger of GN, underscores the importance of recent infectious history in the differential diagnosis, and emphasizes the relevance of early pharmacological management in clinical improvement.

BACKGROUND: ehealth improves the health-related quality of life for cancer patients and their families by providing easier access to medical information, promoting self-management, and providing personalised care through digital platforms. However, there is still a dearth of comprehensive understanding of their influences in developing countries.

OBJECTIVES: To identify several ehealth interventions accessible to family caregivers of people with cancer in developing countries and to assess the impact of these interventions on their health-related quality of life.

METHODS: The review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Health databases and search engines, including PubMed, Medline via Ovid, Embase via Ovid, and CINAHL via EBSCOhost, will be used. We will include quantitative or mixed method research evaluating e-health, with a particular emphasis on the health-related quality of life of family caregivers of cancer patients. Studies from developing countries, including peer-reviewed journals and grey literature, will be considered without regard to publication date.The study selection process involves screening titles and abstracts for relevance, then, doing a full-text assessment against the inclusion criteria. The Cochrane Risk of Bias tool for randomised controlled trials and ROBINS-I V2 for non-randomised studies will be employed to assess the quality of the included studies. The A Measurement Tool to Assess Systematic Reviews will assess the quality of this systematic review.

IMPLICATIONS: This review offers a thorough and impartial summary of current research on e-health tools and their impact on the health-related quality of life of family caregivers of cancer patients. It seeks to inform evidence-based decision-making across healthcare, policy development, and research design by identifying knowledge gaps, emphasising areas requiring further investigation, and steering future research.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024622302 https://www.crd.york.ac.uk/PROSPERO/view/CRD42024622302.

Multiple myeloma (MM) represents a significant global health challenge, with its incidence and mortality rates steadily increasing over recent decades. This review critically examines the current landscape of MM management, with a specific focus on resource-limited settings, where the disparities in diagnostic capabilities and treatment options are most pronounced. A comprehensive literature search was performed using multiple databases, encompassing peer-reviewed articles, clinical guidelines and conference abstracts from 2010 to 2024. Our analysis delineates the stark differences between therapeutic approaches in high-income versus low- and middle-income countries (LMICs). In high-income settings, the standard of care involves advanced induction regimens, autologous stem cell transplantation and maintenance therapy with novel agents, which collectively have contributed to improved patient outcomes. Conversely, LMICs often rely on more affordable yet less effective treatments, such as bortezomib- or thalidomide-based regimens, largely due to limited access to advanced diagnostics and high-cost therapies. Key challenges identified include late presentation, inadequate diagnostic infrastructure, economic constraints and a paucity of trained healthcare personnel. To address these issues, we propose a multifaceted strategy that emphasises the enhancement of diagnostic capacity, the adaptation of resource-stratified treatment guidelines and the strengthening of healthcare systems through targeted policy interventions and international collaborations. By bridging the gap between evidence-based MM care and the practical realities of under-resourced healthcare systems, this review aims to inform future clinical practice and policy, ultimately improving survival outcomes and reducing global health inequities in MM management.