RESUMO
OBJECTIVE: The main objective of this study is to evaluate the rate of continuity and satisfaction with hormonal intrauterine device in renal transplant recipients. METHODS: This was a prospective observational study. The sample consisted of patients treated at a Family Planning Outpatient Clinic, from August 2016 to September 2021. Information on each patient's age, parity, and associated diseases as well as satisfaction with the method were analyzed. Patients were invited to participate through electronic messages, and the questionnaire included questions about acceptance of the contraceptive method. RESULTS: A total of 40 patients were included in the study. The mean age of the renal transplant patients was 32.5 years. The mean duration of hormonal intrauterine device use was 37 months. Acceptance of the method was high, with 97.5% of patients remaining on the method for 1 year and 85% of patients using the hormonal intrauterine device at the time of the study. There were no pregnancies or renal transplant complications in the study. Regarding satisfaction with the method, the majority (77.5%) scored 10. CONCLUSION: Patients were satisfied or very satisfied with the hormonal intrauterine device. Therefore, the continuation rate was high. Furthermore, this contraceptive method proved to be safe and effective in kidney transplant recipients. No complications, graft rejection, or graft failure were observed after intrauterine hormonal device insertion and during follow-up.
Assuntos
Dispositivos Intrauterinos , Transplante de Rim , Gravidez , Humanos , Feminino , Adulto , Anticoncepção , Rim , Pacientes AmbulatoriaisRESUMO
The increasing population in urban areas in the last decades requires an effort to understand the geochemistry of contaminant elements in urban soil. Topsoil plays a crucial role in the exposure of Potentially Toxic Elements (PTEs) to humans through ingestion, dermal contact, and inhalation. In Chile, the last census revealed that 88.6% of people live in cities or towns and only 11.4% in rural areas. This study presents the first systematic geochemical survey of urban soil in the city of Valdivia, in the South of Chile. Topsoil samples (0-10 cm depth) were collected in less disturbed locations within the city at 130 sampling sites using a grid of 0.25 km2 squares covering a total area of approximately 30 km2. The concentrations of Al, Fe, Na, Ca, Mg, K, Ti, Be, V, Cr, Mn, Co, Ni, Cu, Zn, As, Mo, Sn, Cd, Se, Pb and Hg were measured. The results showed that high concentrations of Cu, V, Zn and Pb are located mainly in the city's northern area and exceed international soil quality legislation for agricultural use. Data processing comprised plotting of individual spatial distribution maps and the use of a combination of multivariate statistical methods. Hierarchical cluster analysis and principal component analysis identified three element associations. The two element groups V-Al-Ti-Fe-Cr-Co-Mn-Be-Ni and Ca-Na-K-As-Mg are interpreted as a dominant lithological origin related to the most pristine soil conditions in less populated areas. By contrast, the Sn-Pb-Zn-Mo-(Cu-Hg) association presents a significant correlation with urbanization indicators, including vehicular traffic and industrial activities developed since the end of the nineteenth century in Valdivia.
Assuntos
Mercúrio , Metais Pesados , Poluentes do Solo , Humanos , Solo , Metais Pesados/análise , Monitoramento Ambiental/métodos , Chile , Chumbo/análise , Poluentes do Solo/análise , Mercúrio/análise , Medição de RiscoRESUMO
SUMMARY OBJECTIVE: The main objective of this study is to evaluate the rate of continuity and satisfaction with hormonal intrauterine device in renal transplant recipients. METHODS: This was a prospective observational study. The sample consisted of patients treated at a Family Planning Outpatient Clinic, from August 2016 to September 2021. Information on each patient's age, parity, and associated diseases as well as satisfaction with the method were analyzed. Patients were invited to participate through electronic messages, and the questionnaire included questions about acceptance of the contraceptive method. RESULTS: A total of 40 patients were included in the study. The mean age of the renal transplant patients was 32.5 years. The mean duration of hormonal intrauterine device use was 37 months. Acceptance of the method was high, with 97.5% of patients remaining on the method for 1 year and 85% of patients using the hormonal intrauterine device at the time of the study. There were no pregnancies or renal transplant complications in the study. Regarding satisfaction with the method, the majority (77.5%) scored 10. CONCLUSION: Patients were satisfied or very satisfied with the hormonal intrauterine device. Therefore, the continuation rate was high. Furthermore, this contraceptive method proved to be safe and effective in kidney transplant recipients. No complications, graft rejection, or graft failure were observed after intrauterine hormonal device insertion and during follow-up.
RESUMO
Northern Chile, NW Argentina, and SW Bolivia, ("the lithium triangle"), represent a world class reservoir of lithium, but this extraordinary enrichment is still controversial, and different processes have been invoked over the years, including, geothermal waters associated with active volcanism, leaching of soluble salts from volcanic rocks and leaching of lithium-rich clays. The Salar de Atacama (SDA) represents one of the richest reservoirs of Li in northern Chile and has been extensively studied during the past years. Most of the studies have been focused in the southern and southeastern portions, where the highest lithium concentrations have been reported. However, a comprehensive model of water recharge at SDA is still imprecise. We used a combination of isotopic methods, including δ7Li, δ11B and 87Sr/86Sr ratios, with their chemical composition of a set of water samples from salt lakes, geothermal manifestations, groundwaters and surficial diluted waters (rivers and streams with low salinity). This study explores the hydrogeochemical processes controlling the water composition and solute distribution of the SDA. Our data confirm that weathering of the ignimbrites constitutes one of the most important processes in relation of solute origin in the region, where deep water-rock interactions would operate at high temperature, enhancing leaching of Li and other solutes. We determine that groundwater flow entering the SDA has undergone pre-enrichment processes (e.g., leak from Altiplano salt lakes; evaporite dissolution, among others) associated with salt inputs in the Western Cordillera. Our results provide a step forward to a comprehensive understanding of the processes that govern brine formation and lithium enrichment in a hyperarid environment, contributing to a sustainable exploration and exploitation of lithium in these environments.
Assuntos
Água Subterrânea , Água , Monitoramento Ambiental/métodos , Água Subterrânea/química , Isótopos , LítioRESUMO
As sequelas da hanseníase interferem no bem-estar físico, na vida pessoal e socioeconômica. Devido a essa complexidade, fica difícil relatar objetivamente a abrangência do impacto da hanseníase, porém, o modelo de Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) surgiu para classificar as condições de doença e suas consequências biopsicossociais, facilitando o diagnóstico clínico funcional de uma maneira mais realística, além da esfera biomédica. O objetivo deste estudo foi mapear as incapacidades cinésio-funcionais de pessoas com hanseníase utilizando a CIF. Trata-se de um estudo transversal, com amostra composta por pessoas com hanseníase, recrutadas no Centro de Especialidades Médicas de Aracaju e Hospital Universitário. Para coleta de dados foram utilizadas avaliações padronizadas e validadas, representando cada domínio da CIF. A análise foi descritiva e as disfunções, que foram prevalentes em 5% dos participantes, foram selecionadas como relevantes. Participaram 29 voluntários, 44,9 (±13,72) anos, 60% sexo masculino. As incapacidades funcionais mais presentes foram: 1) Estrutura do corpo - "Estrutura das áreas da pele - s810" com 78%; 2) Função do corpo - "Função tátil - b265" e "Funções relacionadas a força muscular - b730" com 100% de presença; 3) Atividade - "Levantar e carregar objetos - d430" e "Andar - d450" apresentaram limitação em 100% dos participantes; 4) Participação "Recreação e Lazer - d920" foi observada em 89% dos participantes; 5) Impacto ambiental - "Serviços, sistemas e políticas de saúde - e580" em 56% dos participantes e nos fatores pessoais o estigma com 100% de presença. Este estudo determinou quais aspectos biopsicossociais são os mais relevantes em pessoas com hanseníase e os seus resultados podem ser usados como planejamento de prevenção e tratamento dessa doença. (AU)
Leprosy sequelae interfere with physical, personal and socioeconomic life. Due to this complexity, it is difficult to objectively report the extent of the impact of leprosy; however, the International Classification of Function, Disability and Health (ICF) model classifies disease clinical conditions and their biopsychosocial consequences, facilitating a more realistic functional clinical diagnosis of leprosy, beyond the biomedical sphere. The objective of this study was to map the functional movement related disabilities of people with leprosy using the ICF. This is a cross-sectional study, with a sample composed of people with leprosy, recruited at the Aracaju Medical Specialty Center and University Hospital. For data collection, standardized and validated evaluations were used, representing each ICF domain. The analysis was descriptive, and the dysfunctions that were prevalent in 5% of the participants were selected as relevant. Twenty-nine volunteers participated, 44.9 (± 13.72) years, 60% male. The most present functional disabilities were: 1) Structure of the body - "Structure of the skin areas - s810" with 78%; 2) Body function - "Tactile function - b265" and "Functions related to muscular strength - b730" with 100% presence; 3) Activity - "Lifting and loading objects - d430" and "Floor - d450" presented limitation in 100% of participants; 4) Participation "Recreation and Leisure - d920" was observed in 89% of participants; 5) Environmental impact - "Health services, systems and policies - e580" in 56% of the participants and in the personal factors the stigma with 100% presence. This study determined which biopsychosocial aspects are most relevant in people with leprosy and its results can be used as planning for the prevention and treatment of this disease. (AU)
Assuntos
Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Avaliação da Deficiência , HanseníaseRESUMO
CONTEXT AND OBJECTIVE: Patients with advanced head and neck (H/N) and esophageal squamous cell carcinoma (SCC) often have a poor performance status and a dire prognosis. Our aim was to evaluate the feasibility, activity and quality of life (QOL) of an outpatient chemotherapy regimen consisting of cisplatin, 5-fluorouracil and leucovorin (CFL). DESIGN AND SETTING: Prospective phase II study conducted at a Brazilian public institution. METHODS: Fifteen patients with residual, recurrent or metastatic SCC of the H/N or esophagus received bolus infusions of leucovorin 20 mg/m(2)/day and 5-fluorouracil 370 mg/m(2)/day on days 1-4, and 90 minutes of infusion of cisplatin 25 mg/m(2)/day on days 1-3, every 21 to 28 days, depending on hematological recovery. We also evaluated QOL by applying the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC QLQ-C30) before each cycle. RESULTS: The overall response rate was 36%, and the mean overall survival and progression-free survival were six and three months, respectively. We observed grade 3 or higher hematological toxicity in seven patients and one patient had grade 3 nausea and vomiting. One patient died because of neutropenic fever. Seven out of the 12 patients who could be evaluated regarding QOL presented an improvement in their overall health status and functional QOL scores over the course of the treatment. CONCLUSIONS: CFL is an active outpatient protocol with tolerable toxicity and a favorable QOL impact. Larger studies are warranted, in order to confirm these results.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Cisplatino/administração & dosagem , Análise Custo-Benefício , Métodos Epidemiológicos , Neoplasias Esofágicas/tratamento farmacológico , Feminino , Fluoruracila/administração & dosagem , Humanos , Infusões Intravenosas , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Adulto JovemRESUMO
CONTEXT AND OBJECTIVE: Patients with advanced head and neck (H/N) and esophageal squamous cell carcinoma (SCC) often have a poor performance status and a dire prognosis. Our aim was to evaluate the feasibility, activity and quality of life (QOL) of an outpatient chemotherapy regimen consisting of cisplatin, 5-fluorouracil and leucovorin (CFL). DESIGN AND SETTING: Prospective phase II study conducted at a Brazilian public institution. METHODS: Fifteen patients with residual, recurrent or metastatic SCC of the H/N or esophagus received bolus infusions of leucovorin 20 mg/m²/day and 5-fluorouracil 370 mg/m²/day on days 1-4, and 90 minutes of infusion of cisplatin 25 mg/m²/day on days 1-3, every 21 to 28 days, depending on hematological recovery. We also evaluated QOL by applying the European Organization for Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC QLQ-C30) before each cycle. RESULTS: The overall response rate was 36 percent, and the mean overall survival and progression-free survival were six and three months, respectively. We observed grade 3 or higher hematological toxicity in seven patients and one patient had grade 3 nausea and vomiting. One patient died because of neutropenic fever. Seven out of the 12 patients who could be evaluated regarding QOL presented an improvement in their overall health status and functional QOL scores over the course of the treatment. CONCLUSIONS: CFL is an active outpatient protocol with tolerable toxicity and a favorable QOL impact. Larger studies are warranted, in order to confirm these results.
CONTEXTO E OBJETIVO: Pacientes com carcinoma espinocelular (CEC) de cabeça e pescoço e esôfago frequentemente tem um baixo Karnofsky Performance Status (KPS) e um prognóstico ruim. Nosso objetivo foi avaliar eficácia, taxa de resposta e qualidade de vida nesse contexto, em pacientes tratados com o regime ambulatorial cisplatina, 5-fluoruracil e leucovorin (CFL). TIPO DE ESTUDO: Estudo prospectivo fase II conduzido em uma instituição pública brasileira. MÉTODOS: 15 pacientes com CEC de cabeça e pescoço e esôfago persistente, recorrente ou metastático receberam leucovorin 20 mg/m²/dia, in bolus seguido de 5-fluoruracil 370 mg/m²/dia, in bolus nos dias 1 a 4 e cisplatina 25 mg/m²/dia em infusão de 90 minutos nos dias 1 a 3 a cada 21 ou 28 dias, dependendo da recuperação hematológica. Qualidade de vida foi analisada utilizando o questionário EORTC QLQ-C30, aplicado antes de cada ciclo. RESULTADOS: A taxa de resposta objetiva foi de 36 por cento e a sobrevida global e a sobrevida livre de progressão médias foram de 6,7 e 3,7 meses, respectivamente. Toxicidade hematológica maior ou igual a grau 3 foi observada em sete pacientes e um paciente apresentou náusea e vômito grau 3. Um paciente foi a óbito por neutropenia febril. Sete de 12 pacientes avaliáveis apresentaram melhora no estado geral de saúde e oito nas escalas funcional e sintomática com o tratamento. CONCLUSÃO: CFL é um protocolo ambulatorial factível, com toxicidade aceitável e com impacto favorável na qualidade de vida. Estudos maiores devem ser realizados para confirmar estes resultados.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Qualidade de Vida , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Cisplatino/administração & dosagem , Análise Custo-Benefício , Métodos Epidemiológicos , Neoplasias Esofágicas/tratamento farmacológico , Fluoruracila/administração & dosagem , Infusões Intravenosas , Leucovorina/administração & dosagem , Pacientes Ambulatoriais , Adulto JovemRESUMO
Com alta incidência, as neoplasias de pulmão e estômago lideram as causas de morte por câncer em todo o mundo. Como na doença avançada, o tratamento quimioterápico para as duas neoplasias é paliativo e seu impacto na sobrevida, quando detectado, é modesto, qualidade de vida (QV) deve ser considerada um dos objetivos primários do tratamento. ... Utilizamos para isso o Short Form-36 (SF-36) em três momentos: antes do início do tratamento, em oito e em dezesseis semanas. Buscamos definir se houve ganho de QV com a quimioterapia, que aspectos da QV mais se beneficiaram, e em que situações clínicas os ganhos foram mais representativos em cada neoplasia. Confrontamos os resultados com a variação do performance status (PS) e com a resposta tumoral, e investigamos se a QV tem valor prognóstico para sobrevida em cada neoplasia avaliada. Em CP, encontramos ganho de QV na amostra avaliada (n=45), expressa pelo SF-36 (p=0,035, ANOVA), com significância estatística nos componentes Dor, Aspecto Social e Saúde Mental. Os pacientes com baixo PS (p=0.002, Friedman) e baixa escolaridade (p=0.001, Friedman) apresentaram maiores ganhos de QV que os de melhor PS e alta escolaridade. Em CG, não houve ganho de QV (n=24) com o tratamento quimioterápico (p=0,221, Friedman). No entanto, pacientes com baixo PS (p=0,019, ANOVA), alta escolaridade (p=0,040, ANOVA) e os portadores de comorbidades (p=0,048, Friedman) apresentaram maiores ganhos de QV que os de bom PS, baixa escolaridade e os que não apresentavam comorbidades, respectivamente. Encontramos correlação significativa entre variação da QV e variação do PS em CP (p=0,003, ANOVA) e em CG (p=0,001, ANOVA), mas não encontramos correlação com resposta tumoral ao tratamento em nenhuma das duas neoplasias. QV mostrou valor prognóstico para sobrevida em CG (p=0,0053, log rank), mas não em CP (p=0,0875, log rank).
With high incidence, lung and gastric cancers lead cancer death worldwide. For both neoplasias chemotherapy in advanced disease is palliative with modest or none impact on survival. As such, quality of life (QoL) becomes the main goal of the treatment. We investigated the impact of chemotherapy for advanced non-small cell lung cancer (NSCLC) and gastric cancer (GC) on patients' quality of life treated in the Hospital A. C. Camargo and Faculdade de Medicina do ABC between july/03 and june/05. Quality of life, measured by the Short Form-36 (SF-36), was assessed in three moments: before treatment, after eight and sixteen weeks. We sought to investigate whether QoL improved with chemotherapy, which aspects of QoL would benefit more and also which features at presentation would predict QoL improvement. Overall results were compared with performance status (PS) variation and tumor response rates. Finally, we studied the prognostic value of QoL in survival in both neoplasias. There was improvement of QoL in the NSCLC sample (n = 45), expressed by SF-36 (p=0,035, ANOVA). The following aspects of QoL changed significantly: Pain, Social Functioning and Mental Health. Lower performance status (p=0.002, Friedman) and low educational level (p=0.001, Friedman) predicted a larger improvement of QoL. Overall, QoL did not change with chemotherapy in GC patients (n= 24) (p=0,221, Friedman). However, patients with lower PS (p=0,019, ANOVA), high educational level (p=0,040, ANOVA) and bearers of comorbidity (p=0,048, Friedman) displayed a larger improvement of QoL. Variation of QoL correlated with PS variation either in NSCLC (p=0,003, ANOVA) and GC (p=0,001, ANOVA) patients. No correlation was found between QoL variation and tumoral response. QoL showed significant prognostic value in survival in CG sample (p=0,0053, log rank), but not in NSVLC (p=0,0875, log rank) (AU)
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Humanos , Masculino , Feminino , Neoplasias Gástricas , Neoplasias Pulmonares , Qualidade de Vida , Tratamento Farmacológico , SobrevidaRESUMO
CONTEXT AND OBJECTIVE: In metastatic breast cancer cases, the currently available therapeutic approaches provide minimal improvement in survival. As such, quality of life (QOL) becomes one of the main objectives of treatment. It is not known whether current treatments derived from trials improve QOL. The aim was to evaluate changes in QOL among metastatic breast cancer patients receiving treatment derived from trials. DESIGN AND SETTING: Prospective observational QOL survey in a tertiary cancer center. METHODS: To evaluate the influence of current treatments on patients' QOL, the Medical Outcomes Study Short Form-36 (SF-36) and the Beck Depression Inventory (BDI) were applied on three occasions: before starting treatment and at the 6th and 12th weeks, to consecutive metastatic breast cancer patients over a one-year period. RESULTS: We found an improvement in QOL in the sample evaluated (n = 40), expressed by changes in the overall SF-36 score (p = 0.002) and the BDI (p = 0.004). Taken individually, the SF-36 components Pain, Social Functioning and Mental Health also improved significantly. Patients with worse initial performance status and secondary symptoms displayed greater improvement than those with better initial performance status and asymptomatic disease (p < 0.001). Patients who received more than one type of therapy showed larger gains than those given only one type (p = 0.038). CONCLUSIONS: In our environment, current metastatic breast cancer treatments can improve QOL, especially among symptomatic patients and those with low performance status.
Assuntos
Neoplasias da Mama/terapia , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Neoplasias da Mama/psicologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Inventário de Personalidade , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
CONTEXT AND OBJECTIVE: In metastatic breast cancer cases, the currently available therapeutic approaches provide minimal improvement in survival. As such, quality of life (QOL) becomes one of the main objectives of treatment. It is not known whether current treatments derived from trials improve QOL. The aim was to evaluate changes in QOL among metastatic breast cancer patients receiving treatment derived from trials. DESIGN AND SETTING: Prospective observational QOL survey in a tertiary cancer center. METHODS: To evaluate the influence of current treatments on patients' QOL, the Medical Outcomes Study Short Form-36 (SF-36) and the Beck Depression Inventory (BDI) were applied on three occasions: before starting treatment and at the 6th and 12th weeks, to consecutive metastatic breast cancer patients over a one-year period. RESULTS: We found an improvement in QOL in the sample evaluated (n = 40), expressed by changes in the overall SF-36 score (p = 0.002) and the BDI (p = 0.004). Taken individually, the SF-36 components Pain, Social Functioning and Mental Health also improved significantly. Patients with worse initial performance status and secondary symptoms displayed greater improvement than those with better initial performance status and asymptomatic disease (p < 0.001). Patients who received more than one type of therapy showed larger gains than those given only one type (p = 0.038). CONCLUSIONS: In our environment, current metastatic breast cancer treatments can improve QOL, especially among symptomatic patients and those with low performance status.
CONTEXTO E OBJETIVO: As abordagens terapêuticas atuais para o câncer de mama metastático não asseguram aumento na sobrevida. Sendo assim, qualidade de vida passa a ser um dos principais objetivos do tratamento. Apesar disso, desconhecemos a influência dos tratamentos atualmente utilizados na qualidade de vida dessa população. O objetivo do estudo foi avaliar a influência do tratamento oncológico na qualidade de vida de portadoras de câncer de mama metastático. TIPO DE ESTUDO E LOCAL: Estudo prospectivo da variação da qualidade de vida de portadoras de câncer de mama metastático tratadas em um centro médico terciário. MÉTODOS: Realizamos um levantamento prospectivo da influência dos tratamentos oncológicos, incluindo quimioterapia, tratamento hormonal, radioterapia, cirurgia e suporte clínico, na qualidade de vida de pacientes tratadas no Centro de Tratamento e Pesquisa Hospital do Câncer, em São Paulo. Utilizamos para isso o Medical Outcomes Study's Short Form-36 (SF-36) e o Inventário de Depressão de Beck (IDB), aplicados em três ocasiões: antes do início, na 6ª e na 12ª semanas após o início do tratamento. RESULTADOS: Encontramos melhora de qualidade de vida na amostra avaliada (n = 40), expressa pela variação dos índices do SF-36 (p = 0,002) e do IDB (p = 0,004). Os componentes do SF-36 que apresentaram ganhos mais significativos foram dor, aspecto social e saúde mental. Como esperado, as pacientes com piores Performance Status (PS) e com sintomas secundários presentes apresentaram maiores ganhos em sua qualidade de vida que as de bom PS e as assintomáticas (p < 0,001). Da mesma forma, aquelas que receberam mais de uma modalidade terapêutica em comparação com as que só receberam um tipo de tratamento (p = 0,038). CONCLUSÕES: Em nosso meio, a abordagem atual para o câncer de mama metastático mostrou-se capaz de melhorar a qualidade de vida das pacientes, especialmente das que se apresentam com sintomas secundários à doença de base ou com baixo PS.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Neoplasias da Mama/secundário , Neoplasias da Mama/terapia , Qualidade de Vida/psicologia , Análise de Variância , Neoplasias da Mama/psicologia , Depressão/diagnóstico , Depressão/psicologia , Inventário de Personalidade , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
Estudamos a variação da qualidade de vida (QV) das portadoras de câncer de mama metastático do Hospital AC Camargo submetidas a tratamento oncológico, entre maio de 2001 e abril de 2002. Trata-se de um câncer de alta incidência em todo o mundo. Sem comprovação de aumento de sobrevida do câncer de mama metastático com as armas terapêuticas atualmente disponíveis, QV torna-se o principal objetivo do tratamento oncológico e, como tal, necessita ser mensurada. Utilizamos para isso o Short Form-36 do Medicai Outcomes Study (SF-36) e o Inventário de Depressão de Beck (IDB), em três momentos: antes do início do tratamento, em seis e em doze semanas. Buscamos definir se houve ganho de QV com o tratamento instituído, que aspectos da QV mais se beneficiaram, e em que situações clínicas e modalidades terapêuticas os ganhos foram mais representativos. Confrontamos os resultados com a variação do performance status (PS) e com os critérios de resposta tumoral. Encontramos que houve ganho de QV na amostra avaliada (n=40), expressa pelo SF-36 (p=0,002, Friedman), com significância estatística nos componentes Dor, Aspecto Social e Saúde Mental. O IDB também variou positivamente (p=0,004, Friedman), com resultados significativos para os componentes Tristeza, Distúrbio do Sono e Perda de Peso. Pacientes com pior PS inicial e com sintomas secundários apresentaram maiores ganhos de QV (p<0.001, ANOVA), que as de melhor PS inicial e as assintomáticas. As pacientes que receberam mais de uma modalidade terapêutica no período avaliado apresentaram maiores ganhos no SF-36 (p=0,038, ANOVA) do que as que só se submeteram a um tipo de tratamento. Encontramos correlação significativa entre variação da QV, medida pelo SF-36 e pelo IDB, e variação do PS e resposta tumoral
We have studied the quality of life(QoL) variation of the metastatic breast cancer carriers of the Hospital AC Camargo submitted to oncologic treatment, between May 2001 and April 2002. With no corroboration of survival improvement in metastatic breast cancer carries with the currently available therapeutic weapons, QoL becomes the main objective of the oncologic treatment and so it needs to be measured. To achieve it, we have used the Medicai Outcomes Study's Short Form-36 (SF-36) and the Beck Depression lnventory(BDI), in three moments: before the beginning of the treatment, in six and twelve weeks. We aim at defining if there was a gain of QoL with the instituted treatment, which aspects of QoL have benefited more and in which clinicai situations and therapeutic modalities the gains were more representative. We have confronted the results with the performance status (PS) variation and with the tumoral response rates. We have found out that there was improvement of QoL in the evaluated sample (n = 40), expressed by SF-36 (p=0.002, Friedman), with statistical significance in the components Pain, Social Functioning and Mental Health. The BOI has also varied positively (p=0.004, Friedman), with significant results to the components Sadness, Sleeping Disturbance and Weight Loss. Patients with worse initial PS and with secondary symptoms have displayed larger improvement of Qol (p<0.001, ANOVA) than the ones with better initial PS and asymptomatic disease. Patients who received more than one therapeutic modality in the evaluated period have displayed larger gains in SF-36 (p=0,038, ANOVA) than the ones who were submitted to only one type of treatment. We have found significant correlation between variation of the Qol, measured by SF-36 and BDI, and variation of the PS and tumoral response