SILVIA MOULIN RIBEIRO FONSECA

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico

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Autor e Coautores FMUSP-HC Normalizados: JULIA TIZUE FUKUSHIMA ×

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  • article 156 Citação(ões) na Scopus
    Transfusion Requirements in Surgical Oncology Patients A Prospective, Randomized Controlled Trial
    (2015) ALMEIDA, Juliano Pinheiro de; VINCENT, Jean-Louis; GALAS, Filomena Regina Barbosa Gomes; ALMEIDA, Elisangela Pinto Marinho de; FUKUSHIMA, Julia T.; OSAWA, Eduardo A.; BERGAMIN, Fabricio; PARK, Clarice Lee; NAKAMURA, Rosana Ely; FONSECA, Silvia M. R.; CUTAIT, Guilherme; ALVES, Joseane Inacio; BAZAN, Mellik; VIEIRA, Silvia; SANDRINI, Ana C. Vieira; PALOMBA, Henrique; RIBEIRO JR., Ulysses; CRIPPA, Alexandre; DALLOGLIO, Marcos; DIZ, Maria del Pilar Estevez; KALIL FILHO, Roberto; AULER JR., Jose Otavio Costa; RHODES, Andrew; HAJJAR, Ludhmila Abrahao
    Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
  • article 9 Citação(ões) na Scopus
    Brazilian cardio-oncology: the 10-year experience of the Instituto do Cancer do Estado de Sao Paulo
    (2020) COSTA, Isabela B. S. da S.; BITTAR, Cristina S.; FONSECA, Silvia M. R.; SILVA, Carolina M. P. D. e; REHDER, Marilia H. H. dos Santos; RIZK, Stephanie I.; CRUZ, Cecilia B. B. V.; FIGUEIREDO, Clara S.; ANDRADE, Fernanda T. de A.; BARBERINO, Ludmila de A.; COSTA, Fernanda A. de S.; MACHADO, Letticya P.; GONZALEZ, Thalita B.; ALMEIDA, Marcel P. C.; FUKUSHIMA, Julia T.; KALIL FILHO, Roberto; HAJJAR, Ludhmila Abrahao
    BackgroundIn recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes.MethodsA retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity).ResultsFrom a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48-66], 66 [58-74] and 69 [62-76], p <0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p <0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p <0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p <0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p =0.650]).ConclusionThe number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.