Does participation in therapeutic exercise programs after finishing oncology treatment still ensure an adequate health status for long-term breast cancer survivors? A ≥ 5 years follow-up study

PURPOSE

The aims of this study were to evaluate whether the effects of two therapeutic exercise programs are sustained over time (≥ 5 years) in long-term breast cancer survivors (LTBCS). Second, to determine the influence of the current level of physical activity (PA) performed on cancer-related fatigue (CRF) that these patients may present ≥5 years later.

METHODS

A prospective observational study was conducted with a cohort of 80 LTBCS in Granada during 2018. Firstly, considering their participation in one of the programs, they were allocated into two groups: usual care and therapeutic exercise program, to assess CRF, pain and pressure pain sensitivity, muscle strength, functional capacity, and quality of life. Secondly, they were also classified into 3 groups according to current level of weekly PA performed: ≤ 3, 3.1-7.4, and ≥ 7.5 (MET-hour/week) respectively, to assess its impact over CRF.

RESULTS

Although the positive effects of the programs are not sustained over time, a trend toward significance can be observed for a greater reduction in overall CRF levels, lower intensity of pain in the affected arm and cervical region, and greater functional capacity and quality of life in the group that underwent therapeutic exercise. Additionally, 66.25% of LTBCS are inactive ≥ 5 years after completion of the program and furthermore, such inactivity is accompanied by higher CRF levels (P .013 to .046).

CONCLUSION

The positive effects of therapeutic exercise programs are not maintained over time for LTBCS. Additionally, more than half of these women (66.25%) are inactive ≥ 5 years after completion of the program, this inactivity being accompanied by higher levels of CRF.

Positive and negative survivor-specific psychosocial consequences of childhood cancer: the DCCSS-LATER 2 psycho-oncology study

PURPOSE

Numerous studies investigated generic psychosocial outcomes in survivors of childhood cancer (CCS). The present study aimed to describe survivor-specific psychosocial consequences in CCS, and to identify socio-demographic and medical associated factors.

METHODS

CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963-2001) part 2 (age ≥ 18 years, diagnosed < 18 years, ≥ 5 years since diagnosis) completed the Benefit & Burden Scale (BBSC) and the Impact of Cancer-Childhood Cancer (IOC-CS). Items were scored on a 5-point Likert scale (range 1-5). We examined outcomes with descriptive statistics, and socio-demographic and medical associated factors with regression analyses, corrected for multiple testing (p < 0.004).

RESULTS

CCS, N = 1713, age mean (M) 36 years, 49% female, ≥ 15 years since diagnosis, participated. On average, CCS reported 'somewhat' Benefit (M = 2.9), and 'not at all' to 'a little' Burden (M = 1.5) of childhood cancer. Average scores on IOC-CS' positive impact scales ranged from 2.5 (Personal Growth) to 4.1 (Socializing), and on the negative impact scales from 1.4 (Financial Problems) to 2.4 (Thinking/Memory). Apart from cognitive problems, CCS reported challenges as worries about relationship status, fertility, and how cancer had affected siblings. Female sex was associated with more Personal Growth, and more negative impact. CCS more highly educated, partnered, and employed had higher positive and lower negative impact. CCS older at diagnosis reported more positive impact. CNS tumor survivors and those who had head/cranium radiotherapy had higher negative impact. CNS tumor survivors reported less positive impact.

CONCLUSION AND IMPLICATIONS

The majority of CCS reported positive impact of cancer while most CCS reported little negative impact. While this may indicate resiliency in most CCS, health care providers should be aware that they can also experience survivor-specific challenges that warrant monitoring/screening, information provision and psychosocial support.

Current status of AYA-generation breast cancer: trends worldwide and in Japan

Breast cancer (BC) is the most common cancer worldwide among women. In Japan, the incidence of BC gradually increased. The recent number of adolescent and young adult (AYA)-BC patients is approximately 4,000-5,000 every year, accounting for 5% of all BC cases. BC in young people has been attracting attention since Japan's third basic plan to promote cancer control programs incorporated cancer control measures for pediatric (age ≤ 14 years) and adolescent and young adult (AYA)-generation (age 15-39 years) cancers in 2018. Attention is needed to detect AYA-BC because of the presence of dense breasts. AYA-BC patients are clinically characterized by larger tumor size, more lymph node metastases, advanced stages, and a higher rate of aggressive phenotypes, such as triple-negative or HER2-positive subtypes, and are strongly associated with family history and genetic germline alterations, including hereditary breast and ovarian cancers. Given that AYA-BC patients show a poorer prognosis than older BC patients, they often require intensive therapies, including surgery, radiation, chemotherapy, and endocrine therapy. We must solve many survivorship-associated problems in AYA-BC patients, including fertility preservation, comorbidity after treatment, and long-term follow-up. Under these circumstances, national and local governments and various academic societies have started addressing these problems by formulating laws and guidelines, establishing medical systems, and offering financial support to conquer cancer and maintain a better quality of life. This review summarizes the current trends of AYA-BC worldwide and in Japan. Further Japan-specific data on AYA-BC are required to clarify its characteristics and improve prognosis and survivorship.

Long-Term Clinical Outcomes and Survivorship of Total Hip Arthroplasty for Pyogenic Arthritis: A Retrospective Cohort Study of 168 Hips

Objective

The aim of the present study was to evaluate the 10‐year outcomes of cementless total hip arthroplasty (THA) in adult patients with the late sequelae of septic arthritis of the hip.

Methods

We followed 166 consecutive patients (168 hips) who underwent cementless THA between March 2001 and December 2011. There were 79 men and 87 women, with a mean age of 50.4 years (range 21–76 years) at the time of index THA, all of whom had hip osteoarthritis secondary to hip pyogenic infection. The average duration of follow up was 10.6 years (range 6.9–17.2 years). Preoperative and postoperative clinical ratings were evaluated, including the hip dysfunction and osteoarthritis outcome score (HOOS), the Harris hip score (HHS), range of motion, a 100‐point visual analog scale for hip pain, and the severity of limp and limb length discrepancy (LLD). The anteroposterior and lateral radiographs of the hip and full‐length view of the lower extremities were obtained to assess the position of the components, radiolucent lines, osteolysis, loosening of components, and heterotopic ossification. The intraoperative and postoperative complications were also recorded.

Results

The mean HSS and hip pain score were 44.2 points (range 29–66 points) and 42.5 points (range 32–64 points), respectively, before the index surgery and significantly improved to 88.1 points (range 78–96 points) and 15.1 points (range 10–26 points), respectively, at final follow‐up examination. The HOOS and range of motion also improved significantly. The mean limb length discrepancy was reduced from 2.6 to 0.8 cm. The limp at last follow‐up examination was moderate in 3 cases because of hip osteoarthritis in the other limb, slight in 26, and absent in 137. A radiolucent line was observed in 12 hips (7.1%) around the acetabular or femoral components. A progressive radiolucent line around the undersized femoral stem in all zones was seen in 1 hip, resulting in aseptic loosening and breakage of the femoral component. There were 8 cases of intraoperative fracture, 7 cases of dislocation, and 7 cases of transient nerve palsy. Recurrence of infection occurred in 2 hips. Revision surgery was conducted in 2 hips because of isolated loosening of the acetabular cup and the femoral stem, respectively. Kaplan–Meier survival was 97% at 10 years, with revision for any reason with any component as an end‐point.

Conclusion

Improved surgical techniques and development of components with various sizes provided favorable results for cementless THA conducted for late sequelae of sepsis in these young and active patients. Although the incidence of complications was relatively high, the complications were treated successfully.

Menopausal symptoms in epithelial ovarian cancer survivors: a GINECO VIVROVAIRE2 study

OBJECTIVE

We have previously shown that epithelial ovarian cancer (EOC) and its treatments have negative effects on long-term quality of life (QoL) and fatigue. The present multicenter study investigated the main menopausal symptoms and gynecological management of EOC survivors (EOCS).

METHODS

166 patients with relapse-free ≥3 years after the end of treatment attended a consultation with a gynecologist, including a questionnaire related to vasomotor symptoms (VMS) and sexuality, a clinical examination, a blood sample and an osteodensitometry. QoL, fatigue, insomnia and mood disorders were measured with validated questionnaires and correlated to VMS. VMS and QoL were assessed according to natural menopause (NM) or surgical menopause (SM).

RESULTS

Mean age at the survey was 62 [21-83] years and stage III/IV (48%). Mean delay since the end of treatment was 6 years. Fifty-nine patients (36%) had SM. Half of patients reported VMS. Seventy-two percent of EOCS with SM had VMS compared to 41% with NM (P < .001). VMS were not associated with poor global QoL, fatigue, insomnia or mood disorders. Two-thirds of EOCS reported a decrease in libido. Patients with SM showed a greater decrease in libido than NM (P < .02). Fourteen percent of them had osteoporosis and 50% osteopenia. Among the 85 patients with VMS, 80 did not receive HRT after cancer treatment. At the time of the survey, only 7 (4%) patients were receiving hormone replacement therapy (HRT).

CONCLUSIONS

VMS and sexual disorders are frequently reported by EOCS, particularly among patients with SM. Most EOCS with menopausal symptoms could benefit from HRT to improve these symptoms.

Evolution of physical activity and body weight changes in breast cancer survivors five years after diagnosis - VICAN 2 & 5 French national surveys

Background

Regular physical activity (PA) and healthy body weight have proven benefits on survival in breast cancer (BC) survivors. We aimed to define predictors of long-term PA and weight gain in a representative sample of BC survivors.

Methods

Data were analysed from 723 women with BC who participated in both the 2012 and 2015 French National VICAN surveys.

Results

Five years after diagnosis, 26.0, 60.6, and 13.4 % of BC survivors reported regular, occasional and no PA, respectively. Moreover, 27.4 % had a weight gain ≥5 kg. In multinomial logistic regressions, regular and occasional PA were both associated with not having depressive disorders, with higher post-traumatic growth, and with a healthy and stable Body Mass Index. Occasional PA was associated with the use of non-conventional medicine, and regular PA with better mental quality of life and normal arm mobility. Weight gain ≥5 kg was associated with younger age, heavier body weight at diagnosis, and lymphedema 5 years after diagnosis.

Conclusions

Mental well-being is associated with successful long-term patient investment in PA. Psychological support and early management of disease sequelae are needed to help ensure BC survivors engage in and maintain healthy lifestyles.

•

A quarter of breast cancer survivors at 5 years reported regular physical activity.

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Occasional physical activity was associated with use of non-conventional medicine.

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Mental well-being was associated with long-term investment in physical activity.

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Early sequelae managing may help survivors engage in and maintain healthy lifestyles.

Physical activity and long-term fatigue among colorectal cancer survivors - a population-based prospective study

Background

Evidence suggests that physical activity (PA) is beneficial for reducing fatigue in colorectal cancer (CRC) survivors. However, little is known regarding long-term effects of PA on fatigue and whether pre-diagnosis PA is associated with less fatigue in the years after diagnosis. Our study aimed to investigate the association of pre- and post-diagnosis PA with long-term fatigue in CRC survivors.

Methods

This study used a German population-based cohort of 1781 individuals, diagnosed with CRC in 2003–2014, and alive at five-year follow-up (5YFU). Physical activity was assessed at diagnosis and at 5YFU. Fatigue was assessed by the Fatigue Assessment Questionnaire and the EORTC Quality of Life Questionnaire-Core 30 fatigue subscale at 5YFU. Multivariable linear regression was used to explore associations between pre- and post-diagnosis PA and fatigue at 5YFU.

Results

No evidence was found that pre-diagnosis PA was associated with less fatigue in long-term CRC survivors. Pre-diagnosis work-related PA and vigorous PA were even associated with higher levels of physical (Beta (ß) = 2.52, 95% confidence interval (CI) = 1.14–3.90; ß = 2.03, CI = 0.65–3.41), cognitive (ß = 0.17, CI = 0.05–0.28; ß = 0.13, CI = 0.01–0.25), and affective fatigue (ß = 0.26, CI = 0.07–0.46; ß = 0.21, CI = 0.02–0.40). In cross-sectional analyses, post-diagnosis PA was strongly associated with lower fatigue on all scales.

Conclusions

In this study, pre-diagnosis PA does not appear to be associated with less fatigue among long-term CRC survivors. Our results support the importance of ongoing PA in long-term CRC survivors. Our findings might be used as a basis for further research on specific PA interventions to improve the long-term outcome of CRC survivors.

Quality of life and the negative impact of comorbidities in long-term colorectal cancer survivors: a population-based comparison

PURPOSE

Colorectal cancer (CRC) is the third most common cancer in the USA. The objective of this study was to compare quality of life (QoL) across long-term colorectal cancer survivors and unaffected matched controls while adjusting for comorbidities.

METHODS

The National Cancer Institute (NCI)-funded Colon Cancer Family Registry (CCFR) was used to randomly select and recruit CRC survivors (≥ 5 years from diagnosis) and matched controls for a cross-sectional survey. Nine geographically diverse sites in the USA from the CCFR participated in the study. Telephone interviews were conducted using computer-assisted methods to assess QoL.

RESULTS

A total of 403 cases and 401 controls were included in the final sample. Unadjusted comparison revealed no significant difference between CRC survivors and controls with respect to measures of fatigue, social, emotional, functional, and physical well-being. Multivariate logistic regression revealed that case status had a significant negative influence on colorectal cancer-specific QoL measures. Higher comorbidity indices had a significant negative influence on overall QoL regardless of case status.

CONCLUSIONS

Quality of life among long-term CRC survivors is similar to control subjects, with the exception of worse CRC-specific QoL measures. Higher comorbidity indices were independently associated with poor QoL for both cases and controls.

IMPLICATIONS FOR CANCER SURVIVORS

Survivors and healthcare providers should be aware that long-term QoL is comparable to the general population; however, there is potential that digestive tract-specific issues may persist.

Potential determinants of physical inactivity among long-term colorectal cancer survivors

PURPOSE

Since physical activity (PA) has been shown to be associated with better prognosis and quality of life (QOL) in colorectal cancer (CRC) patients, this study focuses on the barriers of PA among CRC survivors.

METHODS

This study is based on a population-based study from Germany of 1343 women and men, diagnosed with CRC between 2003 and 2008 and being alive five years later. Multivariable logistic regression was used to explore associations between baseline as well as five-year follow-up (5YFU) characteristics and physical inactivity (PIA) at 5YFU. Quartiles were calculated based on metabolic equivalent hours per week of PA at baseline and at 5YFU. Participants in quartile 1 were defined as physically inactive, and patients in quartile 2 to quartile 4 were defined as physically active.

RESULTS

Cancer-specific factors such as having a stoma (odds ratio (OR) = 1.51, 95% confidence interval (CI) = 1.12-2.04), demographic factors such as living in a small town or city (OR = 1.46, 95% CI = 1.05-2.02; OR = 1.42, 95% CI = 1.01-2.02), older age (OR = 1.44, 95% CI = 0.80-2.58), or being divorced (OR = 1.72, 95% CI = 0.96-3.07), as well as lifestyle factors such as being a current smoker (OR = 1.54, 95% CI = 1.04-2.29) or being obese (OR = 1.43, 95% CI = 0.96-2.13) were associated with PIA at 5YFU. Subgroup analyses showed that the association between body mass index  and PIA was stronger in women than in men. Baseline PA was identified as a strong predictor of PIA at 5YFU.

CONCLUSIONS

Findings suggest that predominately patients with a stoma, patients living in a more populated area, being older, divorced, a current smoker, or obese were more likely to be physically inactive and therefore could be targeted to be more physically active.

IMPLICATIONS FOR CANCER SURVIVORS

Addressing barriers for PA might help to develop specific, individually tailored PA interventions to overcome PIA and improve the long-term outcome of CRC survivors.

Health status among long-term breast cancer survivors suffering from higher levels of fatigue: a cross-sectional study

PURPOSE

The aims of this study were to evaluate the health status of long-term breast cancer survivors (LTBCS) suffering from higher levels of fatigue, to highlight their needs, and to establish the key points of intervention support programs.

METHODS

A cross-sectional observational study was conducted at the Sport and Health Joint University Institute (iMUDS) between September 2016 and July 2017 with 80 LTBCS that were classified into non-fatigued (≤ 3.9) or fatigued (≥ 4) according to the Piper Fatigue Scale (PFS) total score. The instruments used were the European Organization for Research and Treatment of Cancer Core 30 and its breast cancer (BC) module, the Visual Analog Scale (VAS), the Brief Pain Inventory (BPI), the Scale for Mood Assessment (EVEA), the International Fitness Scale (IFIS), and the Charlson Comorbidity Index.

RESULTS

The analysis revealed that 41.2% of LTBCS were considered moderately fatigued and showed significantly higher levels for the categories of "nausea and vomiting" (P = .005), "pain," "dyspnea" and "insomnia" (P < .001), "appetite loss" (P = .002), "financial difficulties" (P = .010), "systemic therapy side effects" (P < .001), "breast symptoms" and "arm symptoms" (P = .002), and "upset by hair loss" (P = .016). In addition, LTBCS presented significantly higher levels of pain in the affected and non-affected arm, "sadness-depression." "anxiety," "anger/hostility" (All: P < .001), and lower general physical fitness (P < .001). The rest of the variables did not show significant differences.

CONCLUSION

LTBCS suffering from higher levels of fatigue had lower QoL, higher level of pain, worse mood state, and lower physical fitness.

Long-Term Survival of Women with Breast Cancer. Overview Supportive Care Needs Assessment Instruments

INTRODUCTION

Worldwide, breast cancer is the fifth leading cause of cancer death (after lung, stomach, liver and colon cancer), while among women it is first on the list. The incidence of breast cancer has made a dramatic increase since 1970 which is partly interpreted by the modern western life standards. The expected risk of breast cancer throughout a lifespan of an average is 1 in 11 women. The five-year survival rates for breast cancer are at 80% if it has not spread, and only at 40% for the metastatic type of cancer.The concept of survival comes from the US, where there is an active promotion of self-help difficulties coping strategies. Surviving from cancer may be a mixed experience. Survivors of cancer often say they are still running a full and meaningful life after experiencing a threatening disease. Others may find it difficult to handle the feeling that they have no right to be alive, which is probably related to the guilt of survival after the war. Although the survival potential for some is a satisfactory fee, others may be looking for improvement, change, or to adapt their life and struggle with the late effects of cancer after stopping the treatment.In recent years it has been observed that survival of women with breast cancer has increased significantly because of current antineoplastic therapeutic interventions. The definition of support needs derives from the one of supportive care considering that there is no theoretical framework or specific definition at the moment. "Supportive care is defined as the care which helps the individual and his/her family to deal with the experience of cancer and cover their bodily, emotional, psychological, social, mental and practical needs, as well as their need of information. It includes the period before the final diagnosis, during the diagnosis and the treatments or during the ongoing disease with recurrences and the survivors of the disease."

PURPOSE

The purpose of this review is to describe the tools used in research to measure and evaluate supportive care needs during long-term survival of women with breast cancer.

METHOD

An electronic search of articles was held in the PubMed database for the period from 2005 up to 2015. The terms used in the search were "breast cancer", "quality of life", "long-term survivorship" and "supportive care needs". The entry criteria of the articles were to be breast cancer diagnosis, written in English, quantitative methodology and include patients with at least a five-year survival. The sorting of articles were based on the inclusion and exclusion criteria according to the MOOSE Checklist systematic review. With the criteria set out, the articles incurred are a total of 249 from which 47 were excluded according to their title, 28 as they were articles of other types of cancer, 61 had direct objective the description of drugs, treatments and their cost, 5 did not study supportive care needs, 49 did not have direct research questions, 4 did not relate to the period of 10 years, and 6 were not associated with a five-year survival. From a total of 249 articles 43 met the inclusion criteria and 23 were finally included. These 23 articles were studied thoroughly by two independent researchers in order to record the analytical tools used by individual researchers to measure the supportive care needs.

RESULTS

There were several different methodological approaches identified, particularly in the way of recruiting and determining the patient research sample and complete questionnaires. Altogether 82 different tools were used to measure the support needs. Supportive care needs are divided into organic, psychological, socio-economic and spirituality. The commonly studied supportive care needs are related to mobility/functionality (39.8%), psychological well-being (37.3%), mainly depression, sexuality (14.5%), fatigue (7.2%) and spirituality (4.8%) of the surviving women. Some tools were discovered that studied bodily needs (47.6%), psychological needs (36.6%), a combination of the two (3.7%), socioeconomic needs (8.5%) and mental needs (1.2%). Tools such as Center for Epidemiologic Studies-Depression Scale (17.4%), Physical Component Scale (13%) and Beck Depression Inventory (13%) are included in the most commonly used ones.

CONCLUSIONS

The supportive care needs of breast cancer women during long-term survivorship are slightly explored, comparing to antineoplasmatic treatment period supportive care needs. This is probably due to the subjective nature of the concept examined. Approximately every scientific team worked on the study of supportive care needs on two or three different dimensions. More frequently examined are Physical and Psychological Care Needs. Gap is observed in exploring the social/economical and spiritual supportive care needs of women with breast cancer survivors as well as practical needs.

Perception of late effects among long-term survivors after haematopoietic stem cell transplantation: Descriptive analysis and validation of the Brief Illness Perception Questionnaire. A sub-study of the PROVIVO study

PURPOSE

To give a first description of the perception of late effects among long-term survivors after Allogeneic Haematopoietic Stem Cell Transplantation (HSCT) and to validate the German Brief Illness Perception Questionnaire (BIPQ).

METHODS

This is a secondary analysis of data from the cross-sectional, mixed-method PROVIVO study, which included 376 survivors from two Swiss HSCT-centres. First, we analysed the sample characteristics and the distribution for each BIPQ item. Secondly, we tested three validity types following the American Educational Research Association (AERA)Standards: content validity indices (CVIs) were assessed based on an expert survey (n = 9). A confirmatory factor analysis (CFA) explored the internal structure, and correlations tested the validity in relations to other variables including data from the Hospital Anxiety and Depression Scale (HADS), the number and burden of late effects and clinical variables.

RESULTS

In total, 319 HSCT recipients returned completed BIPQs. For this sample, the most feared threat for post-transplant life was long lasting late effects (median = 8/10). The expert-survey revealed an overall acceptable CVI (0.82), three items-on personal control, treatment control and causal representation-yielded low CVIs (<.78). The CFA confirmed that the BIPQ fits the underlying construct, the Common-Sense Model (CSM) (χ² (df) = 956.321, p = 0.00). The HADS-scores correlated strongly with the item emotional representation (r = 0.648; r = 0.656).

CONCLUSION

According to its overall content validity, the German BIPQ is a promising instrument to gain deeper insights into patients' perceptions of HSCT late effects. However, as three items revealed potential problems, improvements and adaptions in translation are therefore required. Following these revisions, validity evidence should be re-examined through an in-depth patient survey.

Cancer in Europe: Death sentence or life sentence?

With so many adults and children receiving successful treatment for their cancer, survivorship is now a 'new' and critical issue. It is increasingly recognised that the growing numbers of survivors face new challenges in their bid to return to 'normal' life. What is not yet so widely recognised is the need for a broad response to help them cope-with stigmatisation, misunderstanding, lifelong issues of confidence and social adaptation, and even access to employment and to financial services. As a further stage in its programme of attention to this aspect of cancer, the European Organisation for Research and Treatment of Cancer (EORTC) brought survivors, researchers, carers, authorities and policymakers together at a meeting in Brussels in March/April 2016, to learn at first hand about the posttreatment experience of cancer survivors. The meeting demonstrated that while research is well advanced in many of the medical consequences of survivorship, understanding is still lacking of many non-clinical, personal and administrative issues. The meeting raised the discussion of survivorship research beyond the individual to a population-based approach, exploring the related socioeconomic issues. Its exploration of initiatives across Europe countries provoked new thinking on the need for effective collaboration, with a new focus on non-clinical issues, including effective dialogue with financial service providers and employers, improvements in collecting, exchanging and accessing data, and above all, ways of translating research outcomes into action. This will require wider recognition that, as Françoise Meunier, Director Special Projects, EORTC, said, 'It is time for a new mind set'.

An unusual metastatic renal cell carcinoma with maintained complete response to sunitinib treatment

Recently, metastatic renal cell carcinoma (mRCC) treatment has changed dramatically with the onset of new therapies against molecular targets replacing immunotherapy as standard treatment. We report the case of a 49-year-old patient with a moderately differentiated renal clear cell carcinoma without extracapsular extension who underwent radical nephrectomy. Eight months after surgery, he developed a thyroid metastasis which was also treated surgically with a hemithyroidectomy. Seventy-five months after nephrectomy, the patient presented an upper gastrointestinal bleeding due to a duodenal metastasis that infiltrates the head of the pancreas. The treatment applied was surgery by duodenopancreatectomy, with positive surgical margins in the pathologic study. In addition to this, the extension study showed lung metastases requiring initiation of systemic treatment with sunitinib. The patient presented an excellent response to treatment, showing complete clinical and radiological response at 5 months of treatment (RECIST criteria) and a disease-free survival of 48 months until now, without evidence of toxicity. RCC has the potential to metastasize to almost any location, but thyroid and duodenal metastases in RCC are extremely rare. Moreover, this case also highlights the good responses that can be achieved in terms of disease-free survival, low toxicity and quality of life in this new era of therapies against molecular targets.