RESUMO
PURPOSE: Complementary and integrative medicine (CIM) use during cancer care has increased in Western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in Chile and South America. PATIENTS AND METHODS: Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile, from March to June 2017 were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining the prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included a two-tailed t test for continuous variables, Fischer's exact test for categorical variables, and logistic regression for association between CIM use and other variables. RESULTS: Of 432 patients surveyed, 66.9% were diagnosed with breast cancer, 84.8% were women, the majority of patients (58.1%) were between age 40 and 60 years, and 51.5% (n = 221) reported CIM use. No association was found between CIM use and the sociodemographic variables of sex, age, education, or income. In all, 44.6% of patients with breast cancer reported CIM use compared with 64.8% of patients with other cancer types (P > .001). Most commonly reported types of CIM used included herbals (49.1%), vitamins and minerals (40.8%), and prayer or meditation (40.4%). Most frequent reasons for CIM use were to "do everything possible" (72%) and to "improve my immune function" (67.8%). Most patients (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. CONCLUSION: The majority of patients surveyed reported engaging in CIM use, with just over half the users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this subject and contribute to improved outcomes.
Assuntos
Terapias Complementares , Atenção à Saúde , Medicina Integrativa , Neoplasias/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Our need to create a program for individuals at high risk for breast cancer development led us to research the available data on such programs. In this paper, we summarize our findings and our thinking process as we developed our own program. Breast cancer incidence is increasing worldwide. Even though there are known risk factors for breast cancer development, approximately 60% of patients with breast cancer have no known risk factor, although this situation will probably change with further research, especially in genetics. For patients with risk factors based on personal or family history, different models are available for assessing and quantifying risk. Assignment of risk levels permits tailored screening and risk reduction strategies. Potential benefits of specialized programs for women with high breast cancer risk include more cost -effective interventions as a result of patient stratification on the basis of risk; generation of valuable data to advance science; and differentiation of breast programs from other breast cancer units, which can result in increased revenue that can be directed to further improvements in patient care. Guidelines for care of patients at high risk for breast cancer are available from various groups. However, running a high-risk breast program involves much more than applying a guideline. Each high-risk program needs to be designed by its institution with consideration of local resources and country legislation, especially related to genetic issues. Development of a successful high-risk program includes identifying strengths, weaknesses, opportunities, and threats; developing a promotion plan; choosing a risk assessment tool; defining "high risk"; and planning screening and risk reduction strategies for the specific population served by the program. The information in this article may be useful for other institutions considering creation of programs for patients with high breast cancer risk.
RESUMO
La arteria umbilical única es la malformación más frecuente del cordón umbilical y se asocia a un aumento de las complicaciones del embarazo y del recién nacido, pesquisándose hasta un 68 por ciento de malformaciones congénitas entre las que destacan las cardiopatías. El ultrasonido con estudio de flujo doppler es un método diagnóstico sensible para el diagnóstico de arteria umbilical única. Se presentan tres casos clínicos de arteria umbilical única diagnosticados en el Servicio de Gineco-Obstetricia del Hospital San Juan de Dios, a los cuales se les realizó seguimiento desde el diagnóstico hasta el fin del embarazo. Este trabajo analiza el curso clínico de los tres casos de arteria umbilical única, revisando sus complicaciones y el resultado perinatal, además de destacar la importancia del doppler en el diagnóstico de esta patología.