TPS8653 Background: In the United States, non-squamous histology accounts for approximately 70% of all non-small-cell lung cancers (NSCLCs), and stage IV disease with no targetable alterations is associated with poor prognosis, with a median overall survival of around 2 years. Immunotherapy targeting programmed cell death (ligand)-1 (PD-1/PD-L1) with or without platinum-based chemotherapy (PBC) is a standard of care first-line (1L) chemotherapy for patients with advanced non-squamous NSCLC. Despite the efficacy of this approach, not all patients respond to PD-1/PD-L1 immunotherapy and more effective therapeutic strategies are needed. Inhibition of the co-inhibitory T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) pathway in combination with PD-1/PD-L1 blockade to increase immunotherapy efficacy is being investigated in NSCLC, as well as other cancer types. Preliminary results (Hiltermann TJN, et al. J Thorac Oncol [WCLC] 2024; abstract OA11.03) show that rilvegostomig, a monovalent, bispecific, humanized IgG1 monoclonal antibody targeting both PD-1 and TIGIT receptors, achieved encouraging antitumor response rates and durable responses with a manageable safety profile in NSCLC. The phase 3, randomized, double-blind, multicenter ARTEMIDE-Lung03 study (NCT06627647) will assess the efficacy and safety of rilvegostomig versus pembrolizumab, in combination with platinum-based doublet chemotherapy, as 1L treatment for participants (pts) with non-squamous metastatic NSCLC (mNSCLC). Methods: Approximately 878 pts will be randomized 1:1 to either Arm A: rilvegostomig + PBC (pemetrexed + cisplatin or carboplatin) intravenous (IV) every three weeks (Q3W) for 4 cycles followed by rilvegostomig + pemetrexed maintenance treatment IV Q3W, or Arm B: pembrolizumab + chemotherapy IV Q3W for 4 cycles followed by pembrolizumab + pemetrexed maintenance IV Q3W. Eligibility criteria include histologically or cytologically confirmed non-squamous mNSCLC not amenable to curative treatment, tumors expressing PD-L1 (TC ≥1%), an Eastern Cooperative Oncology Group performance status of 0 or 1, no sensitizing EGFR mutations, ALK or ROS1 rearrangements, or mutations in other oncogenes with approved 1L therapies available. Dual primary endpoints are progression-free survival (Response Evaluation Criteria in Solid Tumors v1.1 by blinded independent central review) and overall survival. Safety/tolerability and biomarkers will also be assessed. The study will be conducted across approximately 350 sites in 25−30 countries. Clinical trial information: NCT06627647 .
Introdução: A farmacêutica clínica especializada em Cuidados Paliativos tem se consolidado como integrante essencial da equipe multiprofissional, especialmente diante da complexidade do manejo farmacoterapêutico e da necessidade de individualização das metas assistenciais desse perfil de pacientes¹,². Objetivo: Relatar a experiência da inserção da farmacêutica na linha de Cuidados Paliativos, no acompanhamento de pacientes internados em um hospital filantrópico de Salvador, Bahia, entre junho e agosto de 2025, com ênfase em suas contribuições clínicas. Descrição do relato: A atuação farmacêutica incluiu a revisão diária das prescrições, das evoluções multiprofissionais registradas em prontuário, de exames laboratoriais e de laudos de imagem, seguida de visitas beira-leito diárias aos pacientes em cuidados paliativos exclusivos e visitas sob demanda para interconsultas. Além disso, incluiu participação em discussões clínicas semanais com a equipe multiprofissional, reuniões familiares e orientações a pacientes, familiares e cuidadores sobre condutas medicamentosas e ao uso seguro dos fármacos. As visitas conjuntas com médicas paliativistas, assistente social, enfermeira e psicóloga possibilitaram correlacionar sintomas relatados com a farmacoterapia em uso, favorecendo intervenções mais precisas. Observou-se, também, a necessidade contínua de ações educativas direcionadas tanto para profissionais de saúde quanto para familiares e cuidadores. No manejo farmacoterapêutico, destacaram-se intervenções voltadas à otimização da analgesia multimodal, rotação de opioides, prevenção e tratamento de sintomas como constipação, náuseas, vômitos, insônia, sialorreia e tosse. Também foram relevantes orientações sobre utilização de fármacos por via subcutânea (hipodermóclise), a adequação de diluições de medicamentos parenterais, a recomendações de desprescrição de fármacos sem benefício clínico e a racionalização de duplicidades terapêuticas. Dentre os principais resultados observados nesse período observou-se maior contribuição na otimização do controle de sintomas, maior segurança no uso de medicamentos, simplificação da farmacoterapia e fortalecimento do vínculo com pacientes, familiares e equipe multiprofissional, favorecendo uma prática transdisciplinar. A elevada taxa de aceitação das intervenções reforçou o reconhecimento do papel do farmacêutico no cuidado centrado no paciente. Conclusão: A experiência descrita pode demonstrar que a integração do farmacêutico clínico na linha de Cuidados Paliativos possui potencial significativo para a qualidade da assistência, apoiando a tomada de decisão compartilhada, a individualização terapêutica e a promoção do conforto. Ressalta-se, contudo, a necessidade de ampliar a formação especializada de farmacêuticos na área e de consolidar esse espaço de atuação nos serviços de saúde.
INTRODUCTION:The Brazilian Society of Surgical Oncology (SBCO) developed national guidelines for the rational use of blood concentrates in surgical procedures. METHODS:Between June and December 2024, a multidisciplinary team of 42 experts formulated 48 key questions on the rational use of blood concentrates in surgery. The guidelines were structured in three phases: preoperative, intraoperative, and postoperative. Expert groups performed literature reviews and proposed preliminary recommendations, which were later refined by the coordinators. An adapted grading system was used to assess the level of evidence, and an online voting process determined consensus among experts. CONCLUSION:Implementing a bloodless surgery protocol requires a meticulous and coordinated approach across multiple medical disciplines. Essential elements for success include patient and staff education, comprehensive preparation, and the use of advanced surgical techniques and technologies to optimize outcomes.
Abstract Length of hospital stay after colorectal surgery has decreased progressively with the adoption of enhanced recovery after surgery (ERAS) programs and minimally invasive techniques. Early discharge strategies, including discharge within 72 and 24 hours, as well as same-day discharge, have been increasingly implemented; however, concerns regarding safety and readmission persist. To systematically review the evidence on the feasibility and safety of early discharge after elective colorectal surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. The MEDLINE, Embase, and the Cochrane Library databases were searched for studies evaluating early discharge after elective colorectal surgery. Primary outcomes included 30-day readmission, postoperative complications, reoperation, and mortality. Secondary outcomes included length of stay and feasibility of early discharge targets. Observational cohorts and randomized studies conducted predominantly in ERAS-based settings were included. Discharge within 72 hours was consistently safe and widely achievable. Discharge within 24 hours, including evidence from a large cohort published in Colorectal Disease, was feasible in selected patients without increased major morbidity or mortality, with readmission rates generally ranging from 5 to 10%. Same-day discharge was achievable only in highly selected patients and required dedicated outpatient support. Early discharge after colorectal surgery is safe when embedded within structured perioperative pathways. Discharge within 24 hours represents a pragmatic intermediate strategy between conventional ERAS care and same-day discharge models and may be particularly relevant for centers seeking to optimize hospital bed utilization without compromising patient safety.
Background:Fragmentation of electronic health records in oncology hinders coordinated care, delays diagnoses, and limits therapeutic personalization. Blockchains promise to promote secure, interoperable, and patient-centered data governance; however, patient perceptions of blockchains remain underexplored, particularly in middle-income countries such as Brazil. Objective:We assessed opinions, attitudes, and willingness among patients with cancer to digitally share clinical information and the feasibility of applying blockchains to restructuring secure health data sharing in the Brazilian public health context. We had three research questions: (1) What is the level of digital health tool acceptance among patients with cancer in Brazil? (2) Which sociodemographic factors are associated with willingness to share health data? (3) Are blockchains feasible and acceptable for restructuring secure oncology data sharing? Methods:An exploratory, descriptive, cross-sectional self-report survey was conducted at Hospital Santa Izabel, a national oncology reference center in Salvador, Bahia, Brazil, between September and November 2023. A convenience sample of 110 outpatients with cancer was recruited systematically; data were collected via a self-administered questionnaire. The 20-item instrument, developed de novo and validated via expert panel and pilot testing, covered 5 content domains yielding 3 composite scoring domains: self-management, adherence, and governance. We used Cronbach α to assess internal consistency, independent 2-tailed t tests, 1-way ANOVA, and Pearson correlations to compare domain scores across sociodemographic groups, and a chi-square goodness-of-fit test to examine trust proportions across recipient types. Results:We received sufficiently complete responses from 94.5% (104/110) of patients. The sample was predominantly female (63/98, 64.3%), self-identified as pardo (mixed-race; 64/98, 65.3%), and lower income (55/96, 57.3% earned less than twice the minimum wage). Acceptance of technology was high: 86.4% (95/110) would use health apps and 89.1% (98/110) expressed interest in prevention-focused applications. Trust in data sharing varied significantly across recipient types (χ23=210.4; P<.001): 79.1% (87/110) trusted health care professionals, 51.8% (57/110) hospitals, 15.5% (17/110) the pharmaceutical industry, and 10% (11/110) the government. Anonymization and encryption significantly increased willingness to share (92/110, 83.6%). Younger patients (18-59 years) showed significantly higher adherence scores than those aged ≥60 years (mean 76.49, SD 19.16 vs mean 65.83, SD 26.66; t95=2.29; P=.02). Domain reliability was good to excellent (Cronbach α=0.8807 [adherence], 0.8504 [self-management], and 0.7576 [governance]). Conclusions:Patients with cancer in Brazil demonstrated high acceptance of digital health tools and openness to data sharing when privacy, security, and governance are guaranteed. This supports the feasibility of blockchain-based health data management systems, provided they incorporate patient-centered principles, digital inclusion strategies, and robust governance aligned with Brazilian regulations (the General Data Protection Law) and the Unified Health System (Sistema Único de Saúde) infrastructure. Importantly, patient support reflected acceptance of blockchain's functional principles, data security, anonymization, and auditability rather than familiarity with the technology itself, a distinction with direct implications for future implementation studies.
