INTRODUCTION Immunity in cancer patients is modified both by the cancer itself and by oncospecific treatments. Whether a patient’s adaptive immunity is impaired depends on their levels of naive lymphocytes and other cell populations. During the COVID-19 pandemic, cancer patients are at greater risk of progressing to severe forms of the disease and have higher mortality rates than individuals without cancer, particularly while they are receiving cancer-specific therapies. An individual’s protection against infection, their response to vaccines, and even the tests that determine the humoral immune response to SARS-CoV-2, depend on lymphocyte populations, meriting their study.
OBJECTIVE Estimate blood concentrations of lymphocytes involved in the immune response to new pathogens in cancer patients.
METHODS We carried out an analytical study of 218 cancer patients; 124 women and 94 men, 26–93 years of age, who were treated at the National Oncology and Radiobiology Institute in Havana, Cuba, March–June, 2020. Patients were divided into five groups: (1) those with controlled disease who were not undergoing cancer-specific treatment; (2) those undergoing debulking surgery; (3) patients undergoing chemotherapy; (4) patients undergoing radiation therapy and (5) patients currently battling infection. We evaluated the following peripheral blood lymphocyte subpopulations via flow cytometry: B lymphocytes (total, naive, transitional, memory, plasmablasts and plasma cells); T lymphocytes (total, helper, cytotoxic and their respective naive, activated, central memory and effector memory subsets); and total, secretory and cytotoxic natural killer cells and T natural killer cells. We also estimated neutrophil/lymphocyte ratios. Lymphocyte concentrations were associated with controlled disease and standard cancer therapy. For variables that did not fall within a normal distribution, ranges were set by medians and 2.5–97.5 percentiles. The two-tailed Mann–Whitney U test was used to measure the effect of sex and to compare lymphocyte subsets. We calculated odds ratios to estimate lymphopenia risk.
RESULTS All cancer patients had lower values of naive helper and cytotoxic T lymphocyte populations, naive B lymphocytes, and natural killer cells than normal reference medians. Naive helper T cells were the most affected subpopulation. Memory B cells, plasmablasts, plasma cells, activated T helper cells, and cytotoxic central memory T cells were increased. Patients undergoing treatment had lower levels of naive lymphocytes than untreated patients, particularly during radiation therapy. The risk of B lymphopenia was higher in patients in treatment. The odds ratio for B lymphopenia was 8.0 in patients who underwent surgery, 12.9 in those undergoing chemotherapy, and 13.9 in patients in radiotherapy.
CONCLUSIONS Cancer and conventional cancer therapies significantly affect peripheral blood B lymphocyte levels, particularly transitional T helper lymphocytes, reducing the immune system’s ability to trigger primary immune responses against new antigens.
KEYWORDS Cancer, lymphocyte subsets, flow cytometry, immunity, virus diseases, Cuba
INTRODUCTION Cancer is a major public health problem worldwide and in Cuba. Approximately one third of cancer patients develop a brain metastasis. Despite this, epidemiological studies are scarce, internationally and in Cuba; published research is mainly limited to autopsy studies and hospital case series.
OBJECTIVE Characterize patients with brain metastases residing in Habana del Este Municipality, Havana, Cuba, with respect to demographics, metastasis location and primary tumor site.
METHODS A retrospective descriptive study was carried out with data for all patients with histologically confirmed cancer diagnosed in 2014 and registered in primary health care in Habana del Este Municipality. Diagnostic reports from computed tomography and/or magnetic resonance imaging were used to identify patients with brain metastases. Study variables were age, sex, skin color, number and location of brain metastases, control of primary tumor, and presence of extracranial metastases. Percentages were calculated and presented in tables.
RESULTS We identified 832 cancer patients in the Habana del Este population of 181,473 (prevalence 458.5 per 100,000 population). Among patients with cancer, 27.6% (230/832) had brain tumors, among which 83% (191/230) were brain metastases and 17% (39/230) primary tumors, a ratio of 4.9:1. Brain metastases appeared in 23% (191/832) of cancer patients (prevalence 105.2 per 100,000 population). Among patients with brain metastases, 48.2% (92/191) were aged 41–60 years and 61.3% (117/191) were female sex. The majority, 59.7% (114/191) had multiple metastases. The most frequent primary tumor location was the breast (40.8%, 78/191), followed by the lung (31.9%; 61/191); 46.8% (211/451) of brain metastases were in the parietal lobe.
CONCLUSIONS Brain metastases are more prevalent in this Cuban municipality than reported in other countries, but they constitute a higher proportion of cancer cases than seen in other population-based studies. The study’s results underline the importance of detecting brain metastasis early, to permit timely interventions to improve quality of life and survival.
KEYWORDS Cancer, neoplasm metastasis, tumor metastasis/brain, epidemiology, prevalence, Cuba
CONTRIBUTION OF THIS RESEARCH This is the first epidemiological study of brain metastases in Cuba and one of the few carried out internationally.
La acción intersectorial en la salud consiste en las acciones que realiza el sector de la salud sobre la base de políticas coordinadas a nivel nacional y local, orientadas estratégicamente a resolver problemas de salud priorizados, donde las acciones de otros sectores pueden tener un impacto decisivo en los resultados. En Cuba, un ejemplo de este enfoque son los esfuerzos conjuntos por parte del Ministerio de Salud Pública y de la industria biotecnológica para el desarrollo y la aplicación de tecnologías que permitan la pesquisa, la detección temprana y el tratamiento del cáncer cervical. Los productos obtenidos se utilizan por el Sistema Nacional de Salud desde 2010, como parte de los esfuerzos que se realizan para reducir la mortalidad por cáncer cervical, Este es un ejemplo de acción intersectorial concebida para identifi car y contribuir a resolver los problemas que afectan el bienestar y la calidad de vida del pueblo.
PALABRAS CLAVE cáncer, acción intersectorial, biotecnología, cáncer cervical, diagnóstico temprano, colposcopia, tecnologías de salud, Cuba
Intersectoral action in health refers to actions led by the health sector based on coordinated national and local policies, strategically oriented to address priority health issues where actions by other sectors can have a decisive impact on health outcomes. A Cuban example of this approach is the joint efforts by the Ministry of Public Health and the biotechnology industry in development and application of technologies for cervical cancer screening, early detection and treatment. The resulting products have been used by the National Health System since 2010, as part of efforts to reduce cervical cancer mortality. This is an example of intersectoral action intended to identify and contribute to solving problems affecting people’s well-being and quality of life.
KEYWORDS Cancer, intersectoral action, biotechnology, cervical cancer, early diagnosis, colposcopy, health technologies, Cuba
Se revisaron las estrategias de investigación que recomiendan la OMS y otros organismos internacionales para detectar las principales localizaciones del cáncer, así como los requisitos comprendidos en la estrategia para el control del cáncer en Cuba. Universalmente se recomienda la pesquisa del cáncer cervical, de cáncer de mama y del cáncer colorrectal, los que se incluyen también en la estrategia cubana. Adicionalmente, en Cuba se indica el análisis de PSA en los hombres considerados en riesgo (hombres de más de 45 años con antecedentes familiares de cáncer de próstata), y aquellos de más de 50 años que soliciten el estudio; se recomienda el examen anual bucal y la enseñanza del autoexamen bucal para toda la población, así como el examen anual activo para detectar los casos de cáncer bucal en los mayores de 35 años. La pesquisa del cáncer de la piel se realiza mediante el examen físico de los individuos en riesgo. Para maximizar los beneficios de la detección temprana del cáncer se necesita de una mayor cobertura así como de las investigaciones sobre cuán bien se realizan las pesquisas bajo las actuales condiciones cubanas.
PALABRAS CLAVE Cáncer, detección temprana, examen, prevención secundaria, cáncer de mama, cáncer cervical, cáncer colorrectal, cáncer de la piel, cáncer bucal, Cuba
INTRODUCCIÓN Los años de vida ajustados por discapacidad constituyen una medida compuesta que integra los componentes de morbilidad y mortalidad. Es un indicador útil de la carga global de la enfermedad y es particularmente útil para la evaluación de los resultados de las intervenciones en salud. En los casos de cáncer de mama y del sistema reproductor, estos también pueden afectar negativamente las oportunidades de maternidad en las mujeres jóvenes.
OBJETIVO Determinar los años de vida ajustados por discapacidad por cáncer de mama y del sistema reproductor de la mujer cubana en edades de 15–44 años durante el período 1990-2006.
MÉTODOS Se realizó un estudio epidemiológico nacional, que utilizó las estadísticas de enfermedad en Cuba para 1990, 1995, 2000 y 2006. Los años de vida ajustados por discapacidad en mujeres de 15–44 años se calcularon para el cáncer de mama y tres cánceres del sistema reproductor femenino (cervical, endometrial y de ovario) como la suma de los años de vida perdidos por mortalidad prematura y los años vividos con discapacidad. Los años de vida perdidos por mortalidad prematura se determinaron a partir de las estimaciones específicas de la esperanza de vida por edad. Los años vividos con discapacidad se calcularon como el producto de la severidad (proporcionada por el Estudio Global de Carga de la Enfermedad de la OMS referido al año 1990) y la incidencia y la duración promedio, ambas obtenidas a través del programa DISMOD II. Los datos introducidos en el programa incluyen las estadísticas nacionales de incidencia, prevalencia y mortalidad.
RESULTADOS El cáncer de mama y el cáncer de cuello uterino mostraron las mayores tasas de años potenciales de vida perdidos por muerte prematura, con los mayores incrementos en el período (de 139 a 206.5 y de 114.7 a 215.2 por 100 000, respectivamente). Las neoplasias de endometrio y ovario aumentaron más discretamente. Se observó un aumento en años vividos con discapacidad en tres de estos cuatro tipos de cáncer; solamente se produjo una disminución en el cáncer de cuello uterino (de 12.7 a 9 por 100 000). El cáncer de mama y el cáncer de cuello uterino presentaron los más altos niveles de años de vida ajustados por discapacidad en los cuatro años estudiados, con un aumento de 146.9 a 227.8 y de 127.4 a 224.2 por 100 000, respectivamente, entre 1990 y 2006 en mujeres en edad reproductiva.
CONCLUSIONES Se observó una tendencia desfavorable en los años de vida ajustados por discapacidad por cáncer de mama y de cuello uterino en mujeres cubanas en edad fértil entre 1990 y 2006.
PALABRAS CLAVE Años de vida ajustados por discapacidad, AVAD, DALY, años de vida perdidos por mortalidad prematura, años vividos con discapacidad, cáncer, mama, sistema reproductor femenino, fertilidad, Cuba
A review was conducted of screening strategies for detecting the main cancer sites for which screening has been recommended, assessing WHO and other international organizations’ positions, as well as the requirements of Cuba’s cancer control strategy. Universally, screening is recommended for cervical, breast and colorectal cancer, all included in the Cuban strategy. Additionally, in Cuba, PSA testing is indicated for men considered at risk (aged >45 years with family history) and those aged >50 years who request it; annual oral exams and teaching of oral self-examination are recommended for the entire population; and for adults aged >35 years, active annual oral cancer case finding. Screening for skin cancer is performed by physical examination of individuals at risk. To maximize benefits of early cancer detection, greater coverage is needed as well as studies of how well screening is performing under current Cuban conditions.
KEYWORDS Cancer, early detection, screening, secondary prevention, breast cancer, cervical cancer, colorectal cancer, skin cancer, oral cancer, Cuba
INTRODUCTION Disability-adjusted life years is a composite measure that integrates the components of mortality and morbidity. It is a useful indicator of overall disease burden and is particularly useful for evaluating health intervention outcomes. In the cases of breast and reproductive system cancers, these can also negatively affect childbearing opportunities for young women.
OBJECTIVE Determine disability-adjusted life years for breast and reproductive system cancers in Cuban women aged 15–44 years during the period 1990–2006.
METHODS A national epidemiological study was conducted using Cuba’s disease and vital statistics registry data for 1990, 1995, 2000 and 2006. Disability-adjusted life years in women aged 15–44 years were calculated for breast cancer and three female reproductive system cancers (cervical, endometrial and ovarian), by summing years of life lost due to premature mortality and years lived with disability. Years of life lost due to premature mortality were determined based on age-specific estimates of life expectancy. Years lived with disability were calculated as the product of severities (provided by the 1990 Global Burden of Disease study) and incidence and average duration, both obtained via the DISMOD II program. Data entered in the program include national statistics on incidence, prevalence, and mortality.
RESULTS Breast cancer and cervical cancer proved to have the highest rates of potential years of life lost due to premature mortality, with the sharpest increases in the period (from 139 to 206.5 and 114.7 to 215.2 per 100,000, respectively). Endometrial and ovarian neoplasms crept up more slowly. An increase in years lived with disability was seen in three of these four types of cancer; only cervical cancer saw a decline (from 12.7 to 9 per 100,000). Breast cancer and cervical cancer presented the highest levels of disability-adjusted life years for all four years studied, rising from 146.9 to 227.8 and 127.4 to 224.2 per 100,000, respectively between 1990 and 2006.
CONCLUSIONS An unfavorable trend in disability-adjusted life years was seen for breast and cervical cancer between 1990 and 2006 in Cuban women of childbearing age.
KEYWORDS Disability-adjusted life years, years of life lost due to premature mortality, years lived with disability, cancer, breast, female reproductive system, fertility, Cuba
Over 2200 new cases of breast cancer are diagnosed annually in Cuba, and a decade ago I became one of them. Late in 2000, I underwent breast cancer surgery at the National Oncology and Radiology Institute in the Cuban capital. My experience—both with the disease and as a sociologist at the University of Havana studying gender relations—serves as the basis for the following essay. The article characterizes today’s Cuban women, particularly those of us with or at risk of breast cancer, and describes my own and others’ responses to our disease. My aim is to provide insights useful to the physicians, nurses, engineers, physicists, technicians, and service and administrative workers in Cuba’s health services who interact with us, whose increased awareness will make us feel more deeply understood and respected. In this context, I also reflect on the Cuban media’s portrayal of cancer, with recommendations for dismantling the biases of fatalism and even pity often conveyed.
KEYWORDS Cancer, breast cancer, survivorship, physician-patient relations, professional education, Cuba
INTRODUCTION: Recombinant human erythropoietin (RHuEPO) is an erythropoiesis stimulating agent (ESA) used to treat anemia in patients with total or relative erythropoietin deficit. In cancer patients, it is administered to optimize hemoglobin (Hb) levels, correct anemia and reduce the need for transfusions. Cuba produces a RHuEPO, registered in 1998 as ior®EPOCIM, that is widely used in the national public health system, mainly to treat patients with anemia due to chronic kidney disease (CKD).
OBJECTIVE: Evaluate the efficacy and safety of ior®EPOCIM in pediatric cancer patients with anemia following chemotherapy or radiotherapy. The working hypothesis posed an Hb increase ≥15 g/l in 70% of patients receiving ior®EPOCIM for 8 weeks.
METHODS: A Phase IV, multicenter, open clinical trial was conducted. Participants were 157 patients aged 1–19 years with anemia and cyto-histological diagnosis of cancer in any location. Patients received either 600 U/kg ior®EPOCIM intravenously, once weekly, or 150 U/kg ior®EPOCIM subcutaneously, 3 times a week, for 8 weeks. All patients had blood tests every week to determine hemoglobin and hematocrit, and reticulocyte and platelet counts. Mean number of transfusions required by patients during the treatment period was compared to the mean number of transfusions received in the preceding 8 weeks. Adverse events (AE) were recorded at the 4th and 8th weeks and classified by intensity and causality.
RESULTS: Hb levels rose ≥15 g/l in 68.8% of patients, and transfusion requirements decreased 17%. The most frequent adverse events were fever (19.3%), vomiting (10.2%) and flu-like syndrome (9.6%). Intensity of AE was predominantly mild. Only 7 AE were classified as very probably related to the product and none of those was severe.
CONCLUSIONS: ior®EPOCIM proved to be safe and effective at the doses and frequencies used in this patient population. As a result, this medication was recommended for use in all pediatric oncology and hematology services in the country.
Keywords: Erythropoietin, recombinant; anemia, cancer, pediatrics, medical oncology, Cuba
INTRODUCTION: Estimating childhood cancer incidence globally is hampered by lack of reliable data and uniform age limits for classifying and analyzing data reported. In Cuba, cancer data has been systematically gathered and processed by the National Cancer Registry (NCR) since 1964. The International Classification of Childhood Cancer (ICCC) is currently recommended for registering neoplasms in the population aged ≤19 years. Cancer incidence data published by the Cuban Ministry of Public Health, however, uses ICCC diagnostic groups for the population aged <15 years, and topographic sites for the population aged ≥15 years.
OBJECTIVE: The objectives of this study are to describe cancer incidence in the Cuban population aged ≤19 years in 2001–2003 using the ICCC, as well as geographic distribution of incidence by sex and by principal diagnostic groups.
METHODS: A descriptive study of cancer incidence in the population aged ≤19 years was conducted using NCR data for 2001–2003. ICCC diagnostic groups and subgroups were used, and 5 age groups (<1, 1–4, 5–9, 10–14 and 15–19 years) were analyzed. Total incidence and percentages for each diagnostic group were calculated. Number of cases in each diagnostic group and subgroup was also recorded by age group, and age-specific rates per 100,000 population aged ≤19 years (ASR) and age-adjusted rates to the standard world population aged ≤19 years (AAR) were calculated. AARs for leukemias, lymphomas and central nervous system (CNS) tumors were used to analyze childhood cancer risk by sex and geographical distribution in the country’s 14 provinces and Isle of Youth Special Municipality.
RESULTS: In 2001–2003, the NCR reported 1285 new cancer cases in the population aged ≤19 years for an overall incidence of 13.9 per 100,000 population aged ≤19 years (AAR). Highest risk was found in children aged <1 year with an ASR of 21.9 per 100,000 population aged ≤19 years. Leukemias, lymphomas and central nervous system tumors comprised 61.1% of new cases, and geographic distribution of these diagnostic groups varied by sex. Childhood cancer risk was highest for males in Ciego de Avila, Villa Clara and the Isle of Youth Special Municipality and highest for females in Sancti Spíritus, Villa Clara and Cienfuegos.
CONCLUSIONS: Incidence of childhood cancer in Cuba conforms to rates reported internationally and to the incidence pattern most common in Latin America. Further research is recommended to examine risk factors influencing geographical variations in incidence within Cuba.
Keywords Pediatrics, cancer, incidence, risk, registries, epidemiology
Introduction Cancer has been the second cause of death in Cuba since 1958. The National Cancer Registry (NCR) and the National Statistics Division of the Ministry of Public Health provide incidence, mortality and other relevant epidemiological data on the disease, as a basis for analysis and decision-making in public health planning for cancer control.
Objectives Describe trends in incidence and mortality of cancer in Cuba overall and by sex since 1990, and analyze the most current 3-year data for frequent types and risk of developing and dying from cancer, by age group, sex, site, and province.
Methods Cancer incidence and mortality were described using age-adjusted rates based on standard world population for 1990–2003 and 1990–2007, respectively. Crude and age-adjusted rates were calculated for the most common sites (excluding nonmelanoma skin cancer) by sex using the latest 3-year incidence data available (2001–2003) from the National Cancer Registry and mortality data (2005–2007) from the National Statistics Division of the Ministry of Public Health. To compare risk of developing and dying from cancer among Cuban provinces, age-adjusted rates were distributed in quartiles.
Results Cancer incidence and mortality have increased in both sexes since 1990. In 2001–2003, an average of 23,710 new cancer cases were diagnosed annually (excluding nonmelanoma skin cancer), and the average annual risk of developing cancer was 216.5 per 100,000 population for men and 204.0 per 100,000 population for women. Between 2005 and 2007, there were 19,671 average annual deaths from cancer in Cuba. The risk of developing and dying from cancer varies by age group and by geographic location but was highest in Havana City province. The sites with highest incidence and mortality were lung, female breast, prostate, colon, and uterine cervix.
Conclusions Cancer incidence and mortality are increasing in Cuba, and the differences by site, age, sex and geographical distribution analyzed in this article, as well as recommended further research, should serve to inform adoption and implementation of more effective strategies for the Ministry of Public Health’s national Comprehensive Cancer Control Program.
Keywords: Cancer, epidemiology, incidence, mortality, death rate, age distribution, sex distribution, registries, Cuba
