- Dr Sumanta Paledit
Research Interests:
Introdução: Câncer de pulmão é um dos diagnósticos mais relacionados a sofrimento, debilidade física e morte, o que favorece a alta incidência de distress existente nessa população. Estudos sugerem associação entre distress e pior... more
Introdução: Câncer de pulmão é um dos diagnósticos mais relacionados a sofrimento, debilidade física e morte, o que favorece a alta incidência de distress existente nessa população. Estudos sugerem associação entre distress e pior sobrevida. Objetivo: Investigou-se a relação entre níveis de distress e sobrevida global em pacientes com câncer avançado e recém-diagnosticado de pulmão com não pequenas células em primeira linha de tratamento. Método: Um total de 24 pacientes foram recrutados no período de 2009 a 2013 e responderam ao Termômetro de Distress (DT) no primeiro ciclo de quimioterapia. A sobrevida global foi calculada considerando-se as datas do diagnóstico histopatológico e do óbito. A associação entre sobrevida global e distress foi testada por meio da curva Kaplan-Meier. Resultados: Cerca de 54% dos pacientes foram identificados com distress moderado a grave (DT ≥ 4). Observou-se que esses doentes viveram menos (média de 6,4 meses) e reportaram maior número de problemas, notadamente nos domínios físicos e emocionais, quando comparados aos que apresentaram níveis baixos (DT ≤ 3). Foi observada correlação
inversa entre nível de distress e sobrevida (p < 0,05) e entre sobrevida global e problemas citados (p < 0,05). Identificou-se diferença significativa (p < 0,03) entre as curvas de sobrevida dos pacientes com distress moderado a grave versus pacientes com distress baixo. Conclusão: Distress moderado a grave ao início do tratamento esteve associado a pior sobrevida global. Recomendase a implantação da avaliação sistemática de distress, a exemplo das normatizações propostas em outros países. Novos estudos devem ser realizados para averiguar e aprofundar as evidências encontradas.
inversa entre nível de distress e sobrevida (p < 0,05) e entre sobrevida global e problemas citados (p < 0,05). Identificou-se diferença significativa (p < 0,03) entre as curvas de sobrevida dos pacientes com distress moderado a grave versus pacientes com distress baixo. Conclusão: Distress moderado a grave ao início do tratamento esteve associado a pior sobrevida global. Recomendase a implantação da avaliação sistemática de distress, a exemplo das normatizações propostas em outros países. Novos estudos devem ser realizados para averiguar e aprofundar as evidências encontradas.
Research Interests:
Purpose: It has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight... more
Purpose: It has become crucial to translate scientific findings and to find ways by which to mobilize local resources to improve the quality and accessibility of cancer care in developing countries. This study seeks to provide insight into challenge through examining differences in clinician documentation of patients with cancer treated at a Brazilian Public University Hospital.
Methods: ASCO Quality Oncology Practice Initiative (QOPI) measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined.
Results: Certain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management , patients' psychosocial status, and provision of a treatment summary at care completion.
Conclusion: These findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.
J Glob Oncol.
Methods: ASCO Quality Oncology Practice Initiative (QOPI) measures were used to examine the care provided in the departments of breast, colorectal, lymphoma, gynecology, and lung cancers. For this study, data from a representative sample of patients receiving chemotherapy in the previous month were extracted and quality of cancer care indicators examined.
Results: Certain elements of medical care were consistently and appropriately documented, including cancer diagnosis and stage, chemotherapy planning, administration, and summary. In general, considering the specific cancer management measures, patients received recommended care in accordance with recognized guidelines. Despite this, a number of important gaps in care were identified, including the assessment and treatment of pain, documentation of chemotherapy intention, symptom and toxicity management , patients' psychosocial status, and provision of a treatment summary at care completion.
Conclusion: These findings are encouraging in terms of adherence to core treatment guidelines in cancer care in Brazil. However, results suggest important opportunities for improving care across a number of domains, many of which represent a challenge throughout both developing and developed countries. This study may also provide preliminary guidance for enhancing educational and training programs for professionals and students alike, to implement high-quality, comprehensive cancer care.
J Glob Oncol.
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ABSTRACT Systemic therapy for metastatic renal cell carcinoma (mRCC) has evolved drastically, with agents targeting vascular endothelial growth factor (VEGF) and the mammalian target of rapamycin (mTOR) now representing a standard of... more
ABSTRACT Systemic therapy for metastatic renal cell carcinoma (mRCC) has evolved drastically, with agents targeting vascular endothelial growth factor (VEGF) and the mammalian target of rapamycin (mTOR) now representing a standard of care. The present paper is to review the current status of relevant clinical trials that were either recently completed or ongoing. (1) Though observation remains a standard of care following resection of localized disease, multiple trials are underway to assess VEGF- and mTOR-directed therapies in this setting. (2) While the preponderance of retrospective data favors cytoreductive nephrectomy in the context of targeted agents, prospective data to support this approach is still forthcoming. (3) The first-line management of mRCC may change substantially with multiple studies exploring vaccines, immune checkpoint inhibitors, and novel targeted agents currently underway. In general, prospective studies that will report within the next several years will be critical in defining the role of adjuvant therapy and cytoreductive nephrectomy. Over the same span of time, the current treatment paradigm for first-line therapy may evolve.
(Page 100) BACKGROUND: Reduce the incidence of moderate to severe distress and maximize quality of life (QOL) for patients with advanced cancer is a central focus and synonymous with high quality of cancer care. The presence and... more
(Page 100)
BACKGROUND: Reduce the incidence of moderate to severe distress and maximize quality of life (QOL) for patients with advanced cancer is a central focus and synonymous with high quality of cancer care. The presence and maintenance of moderate to severe distress and low QOL scores are associated with different variables. In view of such reality, this study examined demographic and clinical determinants of distress and QOL in patients with advanced cancer undergoing chemotherapy. METHOD: 372 patients with advanced gastrointestinal (33.9%), hematological (16.4%), breast (15.1%), gynecological (10.5%), lung (10.8%), genitourinary (5.6%) cancers were recruited from a private cancer center in Brazil. Of those, 61.8% were female, with a mean age of 58.9, 61.8%were married and 59.6% had at least the college degree. Assessment were obtained at first infusion (T1), halfway time point (T2) and at completion of treatment (T3), using the Distress Thermometer (DT) and the Functional Assessment of Chronic Illness Therapy-General (FACT-G). Linear regression was used to determine independent predictors of the distress and QOL. RESULTS: The prevalence of patients with moderate to severe distress decreased over time and the average of QOL scores increased. In general, the independent predictors of distress were: at T1– age, gender, education, marital status and type of cancer; at T2 – gender, education, marital status and type of cancer; and at T3 – age, gender, education, marital status and type of cancer. In addition, there were many variables predicting QOL at T1 (age, education and type of cancer), at T2 (education, marital status and type of cancer) and at T3 (gender, education, marital status and type of cancer). CONCLUSIONS: All demographic and clinical variables showed to be strongest and consistent determinants of distress and QOL. Of those variables, the analysis showed predictive value for: young (<50) and old (65–75) ages; married and divorced; high school and college degree; gastrointestinal, hematological and lung cancers. Some of the situations found may be explained by the consequences of the comorbidity of the disease and of the treatment, others by the comprehension of the prognosis and there is still those that are related to social supports necessary to deal and cope with the cancer journey. RESEARCH IMPLICATIONS: These findings can help the health team to prioritize resources in order to offer a high quality of cancer care, to examine existing barrier in the service and to identify different ways to offer target therapy for this patients that are not only dealing with the cancer diagnosis and the chemotherapy treatment, but also with the difficult news of the prognosis. Further studies are necessary to provide evidence for a general population. CLINICAL IMPLICATIONS: Identifying people at risk may guide clinicians in targeting interventions, optimizing the service. This data may also open honest communication of patients’ expectations. The involvement of supportive care specialists may improve emotional and existential distress associated with cancer care, mainly at end of life. ACKNOWLEDGEMENT OF FUNDING: None.
BACKGROUND: Reduce the incidence of moderate to severe distress and maximize quality of life (QOL) for patients with advanced cancer is a central focus and synonymous with high quality of cancer care. The presence and maintenance of moderate to severe distress and low QOL scores are associated with different variables. In view of such reality, this study examined demographic and clinical determinants of distress and QOL in patients with advanced cancer undergoing chemotherapy. METHOD: 372 patients with advanced gastrointestinal (33.9%), hematological (16.4%), breast (15.1%), gynecological (10.5%), lung (10.8%), genitourinary (5.6%) cancers were recruited from a private cancer center in Brazil. Of those, 61.8% were female, with a mean age of 58.9, 61.8%were married and 59.6% had at least the college degree. Assessment were obtained at first infusion (T1), halfway time point (T2) and at completion of treatment (T3), using the Distress Thermometer (DT) and the Functional Assessment of Chronic Illness Therapy-General (FACT-G). Linear regression was used to determine independent predictors of the distress and QOL. RESULTS: The prevalence of patients with moderate to severe distress decreased over time and the average of QOL scores increased. In general, the independent predictors of distress were: at T1– age, gender, education, marital status and type of cancer; at T2 – gender, education, marital status and type of cancer; and at T3 – age, gender, education, marital status and type of cancer. In addition, there were many variables predicting QOL at T1 (age, education and type of cancer), at T2 (education, marital status and type of cancer) and at T3 (gender, education, marital status and type of cancer). CONCLUSIONS: All demographic and clinical variables showed to be strongest and consistent determinants of distress and QOL. Of those variables, the analysis showed predictive value for: young (<50) and old (65–75) ages; married and divorced; high school and college degree; gastrointestinal, hematological and lung cancers. Some of the situations found may be explained by the consequences of the comorbidity of the disease and of the treatment, others by the comprehension of the prognosis and there is still those that are related to social supports necessary to deal and cope with the cancer journey. RESEARCH IMPLICATIONS: These findings can help the health team to prioritize resources in order to offer a high quality of cancer care, to examine existing barrier in the service and to identify different ways to offer target therapy for this patients that are not only dealing with the cancer diagnosis and the chemotherapy treatment, but also with the difficult news of the prognosis. Further studies are necessary to provide evidence for a general population. CLINICAL IMPLICATIONS: Identifying people at risk may guide clinicians in targeting interventions, optimizing the service. This data may also open honest communication of patients’ expectations. The involvement of supportive care specialists may improve emotional and existential distress associated with cancer care, mainly at end of life. ACKNOWLEDGEMENT OF FUNDING: None.
Research Interests:
(Page 147-148) BACKGROUND: Understanding the main challenges facing by cancer patients can improve the way service assess physical and psychosocial symptoms experienced by them. Creating strategy to improve symptom control (assessment... more
(Page 147-148)
BACKGROUND: Understanding the main challenges facing by cancer patients can improve the way service assess physical and psychosocial symptoms experienced by them. Creating strategy to improve symptom control (assessment and management) into early stages of cancer care can improve patient’s Health-Related Quality of Life (HRQOL). The present study aimed to identify predictors of HRQOL in colorectal cancer patients, in chemotherapy, focusing on emotional and physical problems reported at the mid-point of planned chemotherapy. METHOD: A total of 80 patients with gastrointestinal cancer, from a private cancer center in Brazil, were assessed at the mid-point of planned chemotherapy, using the Problem List of the Distress Thermometer (DT) and the Functional Assessment of Chronic Illness Therapy-General (FACT-G). Of those patients, 55% were female, a mean age of 56.2 (SD=13.6), 61.8%were married and 66.3% had at least the college degree. Patients were more diagnosed in advanced disease stage (86.8%) and the most prescribed chemotherapy regimen were: FOLFOX (61.5%), XELOX (12.8%) and FOLFIRI (11.5%). Linear regression was used to determine independent predictors of the HRQOL. RESULTS: Patients reported an average HRQOL score of 92.4 (SD=9.94), that is the 75th percentile of the US norm. Small differences in Physical (PWB), Family/Social (SWB), Emotional (EWB) and Functional Well-Being (FWB) scores were noted: 23.9 (50th percentile), 23.9 (75th percentile); 21.2 (50th percentile) and 23.1 (75th percentile), respectively. Linear regression analysis identified problems-related distress predicting lower HRQOL. From the Emotional Problems Category there were: fears, sadness and loss of interest in usual activities; from the Physical Problems Category there were: appearance, constipation, diarrhea, eating, fatigue, feeling swollen, nausea, sleep and tingling in hands/feet. CONCLUSIONS: Descriptive statistics provided for each sub-scale scores (PWB, SWB, EWB and FWB) and the FACT-G total score were compared with the normative mean scores found in the general US adult population. This data suggest a relatively good HRQOL, even when patients are facing the adversities arising from the chemotherapy side effects. Moreover, this findings explored how the side effect interfere in the HRQOL. Most of the physical problems identified as predicting lower HRQOL were related with the chemotherapy’s used, such as constipation, diarrhea, eating, fatigue and tingling in hands/feet. Colorectal cancer patients seem to be at risk for decreased HRQOL. RESEARCH IMPLICATIONS: These findings provide a basis for further research on predictors of HRQOL in colorectal cancer patients. Future research should further explore the treatment period and the effect of others variables on HRQOL, such as age and gender. CLINICAL IMPLICATIONS: These findings indicate some actions that can help patients to deal with this disease and treatment. Psycho-education, for example, could be done, preparing patients to create more realistic expectations about the effects of the disease and treatment. During the treatment, a more informed decision can be made with regard to the provision of additional supportive care. Finally, to prevent a poor post-treatment HRQOL, we can help the cancer-care team in selecting patients at high risk. ACKNOWLEDGEMENT OF FUNDING: None.
BACKGROUND: Understanding the main challenges facing by cancer patients can improve the way service assess physical and psychosocial symptoms experienced by them. Creating strategy to improve symptom control (assessment and management) into early stages of cancer care can improve patient’s Health-Related Quality of Life (HRQOL). The present study aimed to identify predictors of HRQOL in colorectal cancer patients, in chemotherapy, focusing on emotional and physical problems reported at the mid-point of planned chemotherapy. METHOD: A total of 80 patients with gastrointestinal cancer, from a private cancer center in Brazil, were assessed at the mid-point of planned chemotherapy, using the Problem List of the Distress Thermometer (DT) and the Functional Assessment of Chronic Illness Therapy-General (FACT-G). Of those patients, 55% were female, a mean age of 56.2 (SD=13.6), 61.8%were married and 66.3% had at least the college degree. Patients were more diagnosed in advanced disease stage (86.8%) and the most prescribed chemotherapy regimen were: FOLFOX (61.5%), XELOX (12.8%) and FOLFIRI (11.5%). Linear regression was used to determine independent predictors of the HRQOL. RESULTS: Patients reported an average HRQOL score of 92.4 (SD=9.94), that is the 75th percentile of the US norm. Small differences in Physical (PWB), Family/Social (SWB), Emotional (EWB) and Functional Well-Being (FWB) scores were noted: 23.9 (50th percentile), 23.9 (75th percentile); 21.2 (50th percentile) and 23.1 (75th percentile), respectively. Linear regression analysis identified problems-related distress predicting lower HRQOL. From the Emotional Problems Category there were: fears, sadness and loss of interest in usual activities; from the Physical Problems Category there were: appearance, constipation, diarrhea, eating, fatigue, feeling swollen, nausea, sleep and tingling in hands/feet. CONCLUSIONS: Descriptive statistics provided for each sub-scale scores (PWB, SWB, EWB and FWB) and the FACT-G total score were compared with the normative mean scores found in the general US adult population. This data suggest a relatively good HRQOL, even when patients are facing the adversities arising from the chemotherapy side effects. Moreover, this findings explored how the side effect interfere in the HRQOL. Most of the physical problems identified as predicting lower HRQOL were related with the chemotherapy’s used, such as constipation, diarrhea, eating, fatigue and tingling in hands/feet. Colorectal cancer patients seem to be at risk for decreased HRQOL. RESEARCH IMPLICATIONS: These findings provide a basis for further research on predictors of HRQOL in colorectal cancer patients. Future research should further explore the treatment period and the effect of others variables on HRQOL, such as age and gender. CLINICAL IMPLICATIONS: These findings indicate some actions that can help patients to deal with this disease and treatment. Psycho-education, for example, could be done, preparing patients to create more realistic expectations about the effects of the disease and treatment. During the treatment, a more informed decision can be made with regard to the provision of additional supportive care. Finally, to prevent a poor post-treatment HRQOL, we can help the cancer-care team in selecting patients at high risk. ACKNOWLEDGEMENT OF FUNDING: None.
Research Interests:
Background: Nutrition plays an important role to help patients to deal with chemotherapy side effects. Intense research were conducted on the impact of nausea, fatigue and alopecia. It would be also important to study how eating problems... more
Background: Nutrition plays an important role to help patients to deal with chemotherapy side effects. Intense research were conducted on the impact of nausea, fatigue and alopecia. It would be also important to study how eating problems can affect patient’s life. This study investigated the extent to which eating-related side effect can predict distress, anxiety/depression and low QoL over chemotherapy treatment.
Methods: We analyzed longitudinal data from 642 cancer patients, undergoing chemotherapy at a Brazilian cancer center. Assessments were obtained at the first infusion (T1) and at two follow-ups: mid-point (T2) and last day of chemotherapy regimen (T3), using Distress Thermometer, HADS and FACT-G. Descriptive statistics were used to characterize the sample, logistic regression to identify predictions variables and RM-ANOVA to check the variance/covariance matrix of the data.
Results: Eating problems showed to favor high scores of distress (T1, T2, T3), and depression (T1, T3) and low scores of quality of life (T1, T2). A significant interaction was found between eating and high level of distress, anxiety and depression; and between eating and low quality of life.
Conclusion: Eating-related problems can be considered an important side effect, that can impact on distress and QoL. Develop a nutrition program in which cancer patients receive evidence-based and individualized recommendations from a nutrition expert, based on their type of cancer, stage of disease, planned treatment, nutrition and weigh history and lab values, can be an effective strategy to decrease this side effect. Future studies should be conducted to evaluate this strategy.
Research implication: Further research is required to clarify how eating-related side effects can influence outcomes in patients undergoing cancer treatment, and also to identify how relevant is this symptom in the trajectory of the illness, affecting the patient's coping with this journey.
Clinical Implication: The present findings suggest the importance of a nutritional program over the treatment, helping patients to deal with the chemotherapy side effects, the disease symptoms and the sequelae of treatment.
Acknowledgement: None.
Methods: We analyzed longitudinal data from 642 cancer patients, undergoing chemotherapy at a Brazilian cancer center. Assessments were obtained at the first infusion (T1) and at two follow-ups: mid-point (T2) and last day of chemotherapy regimen (T3), using Distress Thermometer, HADS and FACT-G. Descriptive statistics were used to characterize the sample, logistic regression to identify predictions variables and RM-ANOVA to check the variance/covariance matrix of the data.
Results: Eating problems showed to favor high scores of distress (T1, T2, T3), and depression (T1, T3) and low scores of quality of life (T1, T2). A significant interaction was found between eating and high level of distress, anxiety and depression; and between eating and low quality of life.
Conclusion: Eating-related problems can be considered an important side effect, that can impact on distress and QoL. Develop a nutrition program in which cancer patients receive evidence-based and individualized recommendations from a nutrition expert, based on their type of cancer, stage of disease, planned treatment, nutrition and weigh history and lab values, can be an effective strategy to decrease this side effect. Future studies should be conducted to evaluate this strategy.
Research implication: Further research is required to clarify how eating-related side effects can influence outcomes in patients undergoing cancer treatment, and also to identify how relevant is this symptom in the trajectory of the illness, affecting the patient's coping with this journey.
Clinical Implication: The present findings suggest the importance of a nutritional program over the treatment, helping patients to deal with the chemotherapy side effects, the disease symptoms and the sequelae of treatment.
Acknowledgement: None.
Research Interests:
Background: Genitourinary cancers (GU) are common and represent a frequent cause of death. Disease and treatment can have profound effects on patients' life. Given the lack of distress data in GU, we explore biopsychosocial aspects of... more
Background: Genitourinary cancers (GU) are common and represent a frequent cause of death. Disease and treatment can have profound effects on patients' life. Given the lack of distress data in GU, we explore biopsychosocial aspects of being treated for GU.
Methods: 29 male patients (M=65.5 years) newly diagnosed with GU (37.9% prostate, 31% bladder, 20.7% renal) consented to and answered the Distress Thermometer, HADS and FACT-G. They were assessed at the first infusion (T1) and at two follow-ups: mid-point (T2) and last day of planned chemotherapy (T3).
Results: Moderate to severe distress was reported by 48,3% (T1), decreasing to 4.3% (T3); renal cancer showed the highest average at T1 and prostate at the follow-ups. For problems-related distress, a major frequency was reported by prostate cancer overtime. Clinically significant anxiety was reported by 41.4% (T1) reducing to 3.4% (T3); prostate reported the highest average overtime. Depression also decreased overtime (24.1% to 3.4%); kidney showed a higher average at T1, bladder at T2 and prostate at T3. QoL increased overtime, from an average of 86,2 (T1) to 94.8 (T3); kidney led the average at T1 and bladder over the follow-ups.
Conclusion: Our findings highlighted the importance of biopsychosocial screening, considering the overall prevalence rate for distress, the specific characteristics of GU and the fact that men have a strong inclination to turn inward, avoiding share emocional concerns. This results also suggest the benefit of an intervention before the first infusion, to elaborate a plan of care, focus on matching resource to patient’s needs.
Research Implications: These preliminary findings provide a basis for further research on GU, considering the lack informations in the literature about distress in GU patients during the treatment. More research is also need on the long-term impact of treatment side effects on distress and QoL.
Clinical Implications: The screening program showed to be an important step in the identifications of patients who are suffering with this diagnosis and treatment. The results also suggest the benefits of a psycho-educative intervention before the first chemotherapy infusion.
Methods: 29 male patients (M=65.5 years) newly diagnosed with GU (37.9% prostate, 31% bladder, 20.7% renal) consented to and answered the Distress Thermometer, HADS and FACT-G. They were assessed at the first infusion (T1) and at two follow-ups: mid-point (T2) and last day of planned chemotherapy (T3).
Results: Moderate to severe distress was reported by 48,3% (T1), decreasing to 4.3% (T3); renal cancer showed the highest average at T1 and prostate at the follow-ups. For problems-related distress, a major frequency was reported by prostate cancer overtime. Clinically significant anxiety was reported by 41.4% (T1) reducing to 3.4% (T3); prostate reported the highest average overtime. Depression also decreased overtime (24.1% to 3.4%); kidney showed a higher average at T1, bladder at T2 and prostate at T3. QoL increased overtime, from an average of 86,2 (T1) to 94.8 (T3); kidney led the average at T1 and bladder over the follow-ups.
Conclusion: Our findings highlighted the importance of biopsychosocial screening, considering the overall prevalence rate for distress, the specific characteristics of GU and the fact that men have a strong inclination to turn inward, avoiding share emocional concerns. This results also suggest the benefit of an intervention before the first infusion, to elaborate a plan of care, focus on matching resource to patient’s needs.
Research Implications: These preliminary findings provide a basis for further research on GU, considering the lack informations in the literature about distress in GU patients during the treatment. More research is also need on the long-term impact of treatment side effects on distress and QoL.
Clinical Implications: The screening program showed to be an important step in the identifications of patients who are suffering with this diagnosis and treatment. The results also suggest the benefits of a psycho-educative intervention before the first chemotherapy infusion.
Research Interests:
a obesidade é hoje um problema de saúde pública mundial. Países desenvolvidos e em desenvolvimento apresentam elevação de sua prevalência. A transição nutricional é um processo de modificações seqüenciais no padrão de nutrição e... more
a obesidade é hoje um problema de saúde pública mundial. Países desenvolvidos e em desenvolvimento
apresentam elevação de sua prevalência. A transição nutricional é um processo de modificações seqüenciais no
padrão de nutrição e consumo, que acompanha mudanças econômicas, sociais e demográficas e mudanças do
perfil de saúde das populações influenciando diretamente no perfil estético. Isso movimenta diversos campos do
saber no intuito de compreender novos parâmetros estéticos e de saúde redesenhados por condições emergentes,
mantendo viva a discussão sobre o belo, tema sondado desde a Grécia Antiga, que apresenta definições variadas
ao longo da história e do qual surgiram as noções e estudos sobre a estética e gosto. As ciências da saúde pregam
um modelo estético como conseqüência de hábitos saudáveis incorporados à vida e rotina das pessoas. A procura
por esse perfil, associado ao comodismo proporcionado pela estrutura econômica mercantilista, pode confundir o
paciente na busca de uma terapia adequada à obesidade levando-o a optar por procedimentos cirúrgicos, mesmo
sem indicações ou avaliações clínicas para tal. Este artigo busca, portanto, trazer uma reflexão acerca do belo e
da saúde aplicando-os à obesidade.
apresentam elevação de sua prevalência. A transição nutricional é um processo de modificações seqüenciais no
padrão de nutrição e consumo, que acompanha mudanças econômicas, sociais e demográficas e mudanças do
perfil de saúde das populações influenciando diretamente no perfil estético. Isso movimenta diversos campos do
saber no intuito de compreender novos parâmetros estéticos e de saúde redesenhados por condições emergentes,
mantendo viva a discussão sobre o belo, tema sondado desde a Grécia Antiga, que apresenta definições variadas
ao longo da história e do qual surgiram as noções e estudos sobre a estética e gosto. As ciências da saúde pregam
um modelo estético como conseqüência de hábitos saudáveis incorporados à vida e rotina das pessoas. A procura
por esse perfil, associado ao comodismo proporcionado pela estrutura econômica mercantilista, pode confundir o
paciente na busca de uma terapia adequada à obesidade levando-o a optar por procedimentos cirúrgicos, mesmo
sem indicações ou avaliações clínicas para tal. Este artigo busca, portanto, trazer uma reflexão acerca do belo e
da saúde aplicando-os à obesidade.
Introdução. O perfil epidemiológico tem grande importância no direcionamento das ações de saúde. Como centro de atenção secundária à saúde, o Hospital Regional da Asa Norte (HRAN), tem significante papel no diagnóstico de câncer no... more
Introdução. O perfil epidemiológico tem grande
importância no direcionamento das ações de
saúde. Como centro de atenção secundária à saúde,
o Hospital Regional da Asa Norte (HRAN), tem
significante papel no diagnóstico de câncer no
Distrito Federal.
Objetivo. Determinar o perfil epidemiológico dos
diagnósticos histopatológicos de câncer realizados
no HRAN em período de dois anos.
Método. Foram analisados laudos histopatológicos
realizados no HRAN de janeiro de 2010 a dezembro
de 2011. Para isso consideraram-se o tipo histológico
da neoplasia; tipo de material enviado para
análise (órgão acometido); sexo e idade do paciente
identificado; número do arquivo, mês e ano do
diagnóstico.
Resultados. Foram revistos 15.311 laudos, realizados
em 2010 (n = 8.490) e 2011 (n = 6.821), dos quais
2.234 cumpriram os critérios de inclusão. A idade
em média foi 62,5 anos, com 1.249 (55,8%) pacientes
do sexo masculino e 985 (44%) do feminino. Os
principais diagnósticos encontrados foram: neoplasias
de pele (68%), próstata (7%), intestino (4%),
cavidade oral (3%), mama (3%), pulmão (3%), estômago
(2%), esôfago e fígado (1%).
Conclusão. De acordo com a amostra estudada,
notou-se desproporção nos valores encontrados de
alguns tipos de câncer, confrontados com os dados
epidemiológicos disponíveis na literatura para essa
mesma região. Este estudo ressalta a importância
desse tipo de avaliação para a instituição e para a
gestão em saúde pública, podendo ser estendida
aos demais centros de saúde da rede pública e ser
realizada de maneira contínua.
importância no direcionamento das ações de
saúde. Como centro de atenção secundária à saúde,
o Hospital Regional da Asa Norte (HRAN), tem
significante papel no diagnóstico de câncer no
Distrito Federal.
Objetivo. Determinar o perfil epidemiológico dos
diagnósticos histopatológicos de câncer realizados
no HRAN em período de dois anos.
Método. Foram analisados laudos histopatológicos
realizados no HRAN de janeiro de 2010 a dezembro
de 2011. Para isso consideraram-se o tipo histológico
da neoplasia; tipo de material enviado para
análise (órgão acometido); sexo e idade do paciente
identificado; número do arquivo, mês e ano do
diagnóstico.
Resultados. Foram revistos 15.311 laudos, realizados
em 2010 (n = 8.490) e 2011 (n = 6.821), dos quais
2.234 cumpriram os critérios de inclusão. A idade
em média foi 62,5 anos, com 1.249 (55,8%) pacientes
do sexo masculino e 985 (44%) do feminino. Os
principais diagnósticos encontrados foram: neoplasias
de pele (68%), próstata (7%), intestino (4%),
cavidade oral (3%), mama (3%), pulmão (3%), estômago
(2%), esôfago e fígado (1%).
Conclusão. De acordo com a amostra estudada,
notou-se desproporção nos valores encontrados de
alguns tipos de câncer, confrontados com os dados
epidemiológicos disponíveis na literatura para essa
mesma região. Este estudo ressalta a importância
desse tipo de avaliação para a instituição e para a
gestão em saúde pública, podendo ser estendida
aos demais centros de saúde da rede pública e ser
realizada de maneira contínua.
Tivozanib is a novel tyrosine kinase inhibitor (TKI) which inhibits vascular endothelial growth factor (VEGF) receptors-1, -2, and -3 at nanomolar concentrations. A comprehensive MEDLINE and American Society of Clinical Oncology abstract... more
Tivozanib is a novel tyrosine kinase inhibitor (TKI) which inhibits vascular endothelial growth factor (VEGF) receptors-1, -2, and -3 at nanomolar concentrations. A comprehensive MEDLINE and American Society of Clinical Oncology abstract search was performed to gather all relevant clinical and translational data related to tivozanib. We discuss pre-clinical studies associated with tivozanib, and the results of a Phase I assessment in advanced solid tumors. We highlight combination studies with tivozanib, including pairings of tivozanib with cytotoxic therapy in patients with colorectal cancer and breast cancer. A randomized discontinuation Phase II study and a randomized Phase III study assessing the activity of tivozanib in metastatic renal cell carcinoma (mRCC) are described in detail. Tivozanib will face the challenge of entering an already crowded therapeutic space in mRCC-emerging combination studies and biomarker assessments may distinguish this agent among other VEGF-TKIs. The current review will outline the development pathway of tivozanib to date, and offer lessons learned and future opportunities.
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Background: The Quality Oncology Practice Initiative (QOPI) provides a standardized approach to assessing performance on a series of evidence- and consensus-based process measures in oncology. In 2015, the QOPI was utilized in a large... more
Background: The Quality Oncology Practice Initiative (QOPI) provides a standardized approach to assessing performance on a series of evidence- and consensus-based process measures in oncology. In 2015, the QOPI was utilized in a large oncology practice in Brazil to provide a baseline assessment, identify practice deficiencies and guide improvements. Feedback was provided to the oncology team and specific actions identified. This study reports the results of the follow-up QOPI assessment 2 years after the initial baseline was recorded. Methods: From data obtained in 2015 instructions were established for the documentation of physical and psychological symptoms, and of diagnosis and treatment discussions with patient, side effects and infertility risk, informed consent, and genetic services. No significant differences were found in the sociodemographic and clinical characteristics of the patient cohorts. Results: There was an overall increase in performance (60.6% to 77.1%; p < .01). Elements of medical care and of cancer management still consistently and appropriately documented (e.g., pathology, stage, and treatment). There were a significant improvement in performance on measures related to pain assessment (59.5% to 84.5%), and symptom/toxicity management (62.3% to 91.2%). Relatively poor performance persisted however, most notably in the assessment of patients’ psychosocial status (26.5%), discussion of treatment goals (45.6%) and fertility risks (7.4%). Informal feedback was garnered from team concerning areas of ongoing deficiency. Conclusions: There was a significant improvement in adherence to QOPI indicators. Performance in a number of domains remained relatively poor, despite clinical efforts. The reasons are likely multifactorial; and may include a lack of specific resources in a public service (e.g., absence of a fertility service), clinician-based factors that can be culturally driven (e.g., discomfort discussing prognosis), and inconsistent chart documentation. The QOPI provides important guidance in improving oncology care, with the current study suggesting a need for training on psychosocial assessment, as well as the role of an EMR system in ensuring appropriate documentation.
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Testicular cancer (TC) accounts for less than 1% of all male cancers. Despite a good prognosis, the typically young age at diagnosis and physical sequelae may cause distress in survivors. This study aims to explore the prevalence of... more
Testicular cancer (TC) accounts for less than 1% of all male cancers. Despite a good prognosis, the typically young age at diagnosis and physical sequelae may cause distress in survivors. This study aims to explore the prevalence of distress in TC survivors. Men previously diagnosed withTC receiving routine follow‐up care at a Brazilian Public Hospital were assessed for distress and anxiety/depression. A total of 26 patients participated (50% seminoma), with a mean age of 28.9, and the majority married and white. The survival rate was 50.8 months, 73.1% of patients received the BEP (2‐3 cycles) and 96.2% had an orchiectomy. Clinically significant symptoms of anxiety/depression was found in 7.7% of patients. However, 53.8% of non‐seminoma and 30.8% of seminoma reported high distress. Worry (53.8%), nervousness (30.8% vs 38.5%), fatigue (15.4% vs 46.2%), memory (38.5% vs 30.8%), pain (23.1% vs 38.5%), sex (23.1% vs 7.7%), sleep (15.4% vs 23.1%) and appearance (15.4%) were the most common problems reported. These findings suggest high rates of distress among long‐termTC survivors; however the majority possessed sub‐syndromal symptomatology and relatively few reported diagnosable symptoms of anxiety or depression. Distress may be associated with fear of recurrence and possible long‐term side effects. These data suggest a role for supportive care in assisting patients with TC in managing distress throughout the cancer continuum.
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Evidence supports the early integration of palliative care in oncology setting. We sought to describe rates of distress in patients diagnosed with incurable cancer and identify factors associated with these symptoms. A cross‐sectional... more
Evidence supports the early integration of palliative care in oncology setting. We sought to describe rates of distress in patients diagnosed with incurable cancer and identify factors associated with these symptoms. A cross‐sectional analysis of data from patients diagnosed with cancer stage IV, undergoing chemotherapy treatment at two cancer settings (public and private), was performed. It was enrolled 468 patients (61.8% public hospital). Most of them were female, white, married and diagnosed with GI and breast cancers. A greater proportion of patients from public hospital reported significantly more distress (44.6%vs 23.5%) and anxiety symptoms (22.1%vs 12.8%). However, the proportion of patients reporting depressive symptoms (17.3% vs 16.8%) did not significantly differ. Patients from public hospital tends to report significantly more financial (38.4% vs 16.8%), transportation (15.9% vs 2.2%), breathing (30.8% vs 11.2%), fatigue (60.2% vs 45.8%), and pain (52.9% vs 30.7%). Pain (B = 1.4), fatigue (B = 1.2) and breathing (B = 1.6) were associated with distress (ps < .001). Our findings highlight the substantial emotional morbidity experienced by patients at stage IV and also emphasize the benefit from targeted palliative care and psychosocial interventions. Patients treated at a public setting is at particularly risk for distress. Earlier intervention in patients' disease course may prevent ongoing burden and enhance their ability to cope with their disease.
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Cognitive Impairment has been frequently reported by breast cancer survivors (BCS). However, to our knowledge no study has beed previously conducted with Brazilian cancer patients. This pilot study attempted to explore the self‐reported... more
Cognitive Impairment has been frequently reported by breast cancer survivors (BCS). However, to our knowledge no study has beed previously conducted with Brazilian cancer patients. This pilot study attempted to explore the self‐reported cognitive function, considering the most common physical and psychosocial symptoms described in the literature. BCS were recruited from a Breast Cancer Outpatient Clinic of Brazilian public hospital. They were assessed by the Functional Assessment of Cancer Therapy—General and Cognitive Function (FACT‐G and FACT‐Cog), Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS). This pilot sample was composed by 13 BCS who were on average 50.4 (SD = 7.4) years old and 35.4 (SD = 8.1) months posttreatment. The Cognitive Function (M = 108.5, SD = 31.6) was significantly correlated with quality of life, anxiety/depression, fatigue, and sleep. The same was observed with the subscales Perceived Cognitive Impairment (M = 59; SD = 17.5), Comments from Others (M = 14.9; SD = 1.7) and Perceived Cognitives Abilities (M = 22.7; SD = 9.8). From this preliminary data, it was possible to note that the cognitive symptoms are also an issue for Brazilian BCS, with a significant impact on their life. Is was also observed that this late symptom has been poorly discussed among our health team, and probably being unrecognized and untreated. This study is ongoing, towards the implementation of effective evidence‐based supportive care practice to enhance BCS outcomes.
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Background: Depressive symptoms have been associated with poorer OS in pts with mRCC (Prinsloo et al J Behav Med 2015). In other malignancies, BPSD has also been linked to poorer OS, but in mRCC, this association is unclear. Methods:... more
Background: Depressive symptoms have been associated with poorer OS in pts with mRCC (Prinsloo et al J Behav Med 2015). In other malignancies, BPSD has also been linked to poorer OS, but in mRCC, this association is unclear. Methods: From a single institution, clinicopathologic information from pts with mRCC diagnosed between 2001 and 2016 were collected. Corresponding data from an electronic survey tool was obtained, comprised of 22 core items spanning physical, practical, functional and emotional domains. Each item was self-assessed by the pt on a 5-point Likert scale. The cumulative score was used to characterize BPSD as either as low BPSD (not a problem/mild) vs high BPSD (moderate/severe/very severe). Associations between BPSD level and clinicopathologic criteria (e.g., Heng risk) were interrogated, and OS was compared between patients characterized as low BPSD vs high BPSD. Results: A total of 102 pts (28.4 % F/71.6% M) were assessed with a median age of 63 (range, 24-80). 73.4 and 26.6% pts were characterized as having good/intermediate and poor risk by Heng criteria, respectively. 79.3% pts and 20.7% pts were characterized as having low and high BPSD, respectively. No association was found between BPSD and age or gender. However, married patients have a longer survival (48.65 mos vs 34.52 mos, P=.07). Pts with poor risk mRCC were noted to have a higher BPSD as compared to pts with mild BPSD (75% vs 25%, P=.22). Median OS in the overall cohort was 44.2 months (mos). Although not statistically significant, a trend towards prolonged OS in pts with low BPSD vs high BPSD was observed (45.81 mos vs 35.95 mos, P=.81). Conclusions: Our study suggests a potential link between Heng risk and BPSD, and further shows a compelling trend towards poorer OS in pts with higher BPSD. These results warrant confirmation in larger series. Targeted interventions to address elements related to BPSD have the potential to improve patient outcomes and should be developed.
Research Interests:
Background: Patients with advanced cancer experience symptoms that include pain, fatigue, and depression. We sought to describe prevalence and identify factors associated with biopsychosocial distress in older patients (65+) diagnosed... more
Background: Patients with advanced cancer experience symptoms that include pain, fatigue, and depression. We sought to describe prevalence and identify factors associated with biopsychosocial distress in older patients (65+) diagnosed with cancer stage IV.
Methods: Participants were recruited from two different types of health care facilities, public [PUB] and private [PRI] institutions, in Brazil. A cross-sectional analysis of common biopsychosocial symptoms (anxiety, depression, pain, and fatigue), and quality of life reported by older patients undergoing chemotherapy treatment was performed.
Results: Older patients (n=167) were enrolled (Mean age=73; SD=5.6); 59.3% from PUB. Majority were female (56.3%; 38.9% PUB), white (68.9%; 35.7% PRI, p<.01), married (59.3%; 32.1% PUB, p<.01); and diagnosed with GI (29.9%; 15.8% PUB), GU (16.2%; 4.9% PUB), and hematologic (13.8%; 7.5% PRI) cancers. Almost 16% of patients reported depression symptoms (9.6% PUB) and 12% of anxiety (8.4% PUB). PUB patients also reported associated lower QOL, which is at 50th percentile of the US norm (PRI is at 75th percentile). PUB patients reported significantly more biopsychosocial problems including distress (21.6% vs 7.2%), pain (28.1% vs 12.0%), fatigue (34.7% vs 16.8%), sleep (22.8% vs 15%), neuropathy (22.8% vs 8.4%), and financial toxicity (16.2% vs 5.4%), compared to patients treated at PRI (all p<0.05). Mostly pain (B=1.8; B=-6.6), fatigue (B=0.8; B=-6.5) and sleep (B=1.2; B=-8.3) were associated with moderate to severe distress and worst QOL (all p<.01).
Conclusion: Older patients with late-stage cancer in Brazil suffer substantial unrecognized morbidity which impacts their distress and QOL. Biopsychosocial screening for older patients should be included in quality cancer care. Moreover, patients treated within PUB show worse outcomes than PRI counterparts, and they are at higher risk for multiple physical, psychological, and financial morbidity. Earlier initiation of biopsychosocial screening with appropriate supportive care may improve their QOL.
Methods: Participants were recruited from two different types of health care facilities, public [PUB] and private [PRI] institutions, in Brazil. A cross-sectional analysis of common biopsychosocial symptoms (anxiety, depression, pain, and fatigue), and quality of life reported by older patients undergoing chemotherapy treatment was performed.
Results: Older patients (n=167) were enrolled (Mean age=73; SD=5.6); 59.3% from PUB. Majority were female (56.3%; 38.9% PUB), white (68.9%; 35.7% PRI, p<.01), married (59.3%; 32.1% PUB, p<.01); and diagnosed with GI (29.9%; 15.8% PUB), GU (16.2%; 4.9% PUB), and hematologic (13.8%; 7.5% PRI) cancers. Almost 16% of patients reported depression symptoms (9.6% PUB) and 12% of anxiety (8.4% PUB). PUB patients also reported associated lower QOL, which is at 50th percentile of the US norm (PRI is at 75th percentile). PUB patients reported significantly more biopsychosocial problems including distress (21.6% vs 7.2%), pain (28.1% vs 12.0%), fatigue (34.7% vs 16.8%), sleep (22.8% vs 15%), neuropathy (22.8% vs 8.4%), and financial toxicity (16.2% vs 5.4%), compared to patients treated at PRI (all p<0.05). Mostly pain (B=1.8; B=-6.6), fatigue (B=0.8; B=-6.5) and sleep (B=1.2; B=-8.3) were associated with moderate to severe distress and worst QOL (all p<.01).
Conclusion: Older patients with late-stage cancer in Brazil suffer substantial unrecognized morbidity which impacts their distress and QOL. Biopsychosocial screening for older patients should be included in quality cancer care. Moreover, patients treated within PUB show worse outcomes than PRI counterparts, and they are at higher risk for multiple physical, psychological, and financial morbidity. Earlier initiation of biopsychosocial screening with appropriate supportive care may improve their QOL.
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Background/Purpose: Rare cancers are a heterogeneous group of conditions that can be associated with unmet medical needs and poorer quality of life (QOL). Despite this, and because of their rarity, sufferers remain a poorly understood... more
Background/Purpose: Rare cancers are a heterogeneous group of conditions that can be associated with unmet medical needs and poorer quality of life (QOL). Despite this, and because of their rarity, sufferers remain a poorly understood group from the vantage of psychosocial concerns and QOL. Our main goal was to explore psychosocial outcomes reported by patients diagnosed with a rare form of cancer.
Methods: Data from 31 patients (64.5% female; M=51.32 of age) diagnosed with a rare cancer (74.2% at late disease stage) and treated at a Brazilian public hospital were evaluated for distress (DT), anxiety/depression (HADS) and QOL (FACT-G). All patients previous knew that their diagnostic was rare. Descriptive statistics and correlations between variables assessed were generated.
Results: 48.4% patients reported high distress levels, with 32.3% endorsing anxiety and 25.8% depression. A low mean QOL score was found (at 25th percentile of the US norm), with emotional and functional well-being the most impaired subscales. Statistically significant correlations were identified between distress, anxiety/depression and QOL (p<.01). The most concerns were nervousness (71%), worry (71%), pain (64.5%), sadness (51.6%) and fatigue (51.6%).
Conclusions: Patients reported poorer psychosocial outcomes and impaired QOL when compared to normative data, suggesting that this patient population may be at elevated risk. A rare cancer diagnosis can be traumatic and prompt anxiety and uncertainty. Given their rarity, limited disease specific support groups or counseling exists, thus potentially invoking feelings of isolation. Further research should be conducted to investigate psychosocial aspects and possible interventions targeting this poorly understood group.
Methods: Data from 31 patients (64.5% female; M=51.32 of age) diagnosed with a rare cancer (74.2% at late disease stage) and treated at a Brazilian public hospital were evaluated for distress (DT), anxiety/depression (HADS) and QOL (FACT-G). All patients previous knew that their diagnostic was rare. Descriptive statistics and correlations between variables assessed were generated.
Results: 48.4% patients reported high distress levels, with 32.3% endorsing anxiety and 25.8% depression. A low mean QOL score was found (at 25th percentile of the US norm), with emotional and functional well-being the most impaired subscales. Statistically significant correlations were identified between distress, anxiety/depression and QOL (p<.01). The most concerns were nervousness (71%), worry (71%), pain (64.5%), sadness (51.6%) and fatigue (51.6%).
Conclusions: Patients reported poorer psychosocial outcomes and impaired QOL when compared to normative data, suggesting that this patient population may be at elevated risk. A rare cancer diagnosis can be traumatic and prompt anxiety and uncertainty. Given their rarity, limited disease specific support groups or counseling exists, thus potentially invoking feelings of isolation. Further research should be conducted to investigate psychosocial aspects and possible interventions targeting this poorly understood group.
Research Interests:
Background/Purpose: Cancer during pregnancy can present complex and traumatic concerns. Little research has explored the impact of these two major life-changing events. We sought to explore the experience of gestational breast cancer... more
Background/Purpose: Cancer during pregnancy can present complex and traumatic concerns. Little research has explored the impact of these two major life-changing events. We sought to explore the experience of gestational breast cancer patients (GBCP) and identify unique challenges GBCP are facing, compared to not pregnant breast cancer patients (BCP).
Methods: A cohort study compared data from GBCP (n=6) and BCP (n=46), undergoing the same treatment at a Brazilian public hospital. Measures included the DT, HADS and FACT-G. GBCP also completed a semistructured interview.
Results: GBCP reported lower levels of distress, anxiety/depression and better QoL than BCP. The content analyses revealed that GBCP discovered their pregnancy weeks after their diagnosis. Fears were related to risk of miscarriage or potential harm of treatment to the unborn baby. Ultrasonography helped to monitor baby’s health and to lessen anxiety. After the first chemotherapy infusion, 83.3% turned their focus to their baby. One patient reported increased distress associated with smoking cessation efforts. Other preferred to minimize social contact and avoided celebrations until their baby's healthy birth. Health care providers was essential and helped them to address issues regarding baby’s health and well-being.
Conclusions: Unexpectedly, our preliminary findings suggest that GBCP experience less psychological turmoil than BC. It is possible that pregnancy provides a sense of meaning and a broader perspective for women diagnosed with cancer, possibly through the focus given to ensuring the health of their unborn child. Future studies should explore the long-term impact of GBCP.
Methods: A cohort study compared data from GBCP (n=6) and BCP (n=46), undergoing the same treatment at a Brazilian public hospital. Measures included the DT, HADS and FACT-G. GBCP also completed a semistructured interview.
Results: GBCP reported lower levels of distress, anxiety/depression and better QoL than BCP. The content analyses revealed that GBCP discovered their pregnancy weeks after their diagnosis. Fears were related to risk of miscarriage or potential harm of treatment to the unborn baby. Ultrasonography helped to monitor baby’s health and to lessen anxiety. After the first chemotherapy infusion, 83.3% turned their focus to their baby. One patient reported increased distress associated with smoking cessation efforts. Other preferred to minimize social contact and avoided celebrations until their baby's healthy birth. Health care providers was essential and helped them to address issues regarding baby’s health and well-being.
Conclusions: Unexpectedly, our preliminary findings suggest that GBCP experience less psychological turmoil than BC. It is possible that pregnancy provides a sense of meaning and a broader perspective for women diagnosed with cancer, possibly through the focus given to ensuring the health of their unborn child. Future studies should explore the long-term impact of GBCP.