RESUMO
Radiotherapy treatment-induced intestinal injury and gut microbial perturbation/dysbiosis have been implicated in the pathobiology of cancer-related fatigue. The objective of this brief review was to explore the available evidence of the relationship between intestinal injury and self-reported fatigue, especially among cancer patients. The scientific evidence-including our own-linking gut mucosal barrier dysfunction and gut microbial perturbation/dysbiosis induced by cancer treatment with worsening of cancer related fatigue (perhaps through the gut-brain axis) is limited but promising. Emerging data suggest that lifestyle interventions and the administration of specific probiotics may favorably modulate the gut microbiota and potentially mediate beneficial effects leading to improvements in fatigue.
Assuntos
Disbiose , Fadiga , Intestinos/efeitos da radiação , Neoplasias/radioterapia , Lesões por Radiação , Eixo Encéfalo-Intestino , Humanos , Intestinos/lesõesRESUMO
PURPOSE: To investigate whether there are differences in diversity, taxonomic composition, and predicted functional pathways of the gut microbiome between Island Hispanic Puerto Ricans (HPR) and mainland non-Hispanic whites (NHW) measured before and at the end of chemo-radiation (CRT) for Rectal Cancer. METHODS: Fifty-six stool samples of newly diagnosed rectal cancer patients (25 HPR and 31 NHW) were amplicon-sequenced during chemo-radiotherapy. 16S rRNA gene data was analyzed using QIIME2, phyloseq, and LEfSe. RESULTS: We observed similar within-sample alpha diversity for HPR and NHW participants during CRT. However, at the end of CRT, several taxa were present at significantly different abundances across both groups. Taxa enriched in the gut of HPR compared to NHW included Muribaculaceae, Prevotella 2 and 7, Gemella, Bacillales Family XI, Catenibacterium, Sutterella, Pasteurellales, and Pasteurellaceae genera, whereas over-represented taxa in NHW participants were Turicibacter and Eubacteriaceae. Significant differences in predicted HPR microbiota functions included pathways for synthesis of L-methionine and degradation of phenylethylamine and phenylacetate. CONCLUSION: In this pilot study, taxonomic analyses and functional predictions of the gut microbiomes suggest greater inflammatory potential in gut microbial functions among HPR rectal cancer patients undergoing CRT compared to that of NHW participants.
Assuntos
Quimiorradioterapia/métodos , Microbioma Gastrointestinal , Hispânico ou Latino/estatística & dados numéricos , Neoplasias Retais/microbiologia , População Branca/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Porto Rico/epidemiologia , Neoplasias Retais/epidemiologia , Neoplasias Retais/terapia , Estados Unidos/epidemiologiaRESUMO
The knowledge base of cancer-related symptoms is increasing; yet, limited attention has been given to provide evidence on differences in the perception of cancer symptoms between ethnic groups, especially in the Hispanic Puerto Rican (PR) population. To examine whether there are significant differences in the severity, distress, interference, and frequency of cancer symptoms between island Hispanic PR and mainland non-Hispanic whites. In this secondary data analysis, data from 109 Hispanic PR was matched by age, gender and cancer diagnosis with data from non-Hispanic whites. Cancer symptoms were assessed using the Cancer Symptom Scale (CSS). Mann-Whitney statistical test was used to evaluate pairwise differences between Hispanic PR and non-Hispanic whites on symptoms from the CSS. There were significant differences on some symptoms including PR reporting: (a) more intense itching, swelling, taste change, difficulty sleeping, bloating, depression, sadness, worry, and nervousness; (b) significantly greater distress about taste change, appetite, anxiety, depression, worry, and feeling nervous; (c) rash, anxiety, depression, sadness, and nervousness interfered the most with their daily lives; and, (d) that the frequency of occurrence of the symptoms of pain, itching, dizziness, taste change, anxiety, sadness, and nervousness was higher compared to non-Hispanic whites. PR cancer patients are at increased risk for experiencing greater severity of cancer symptoms compared to non-Hispanic whites. But because the Hispanic oncology population does not always report symptoms, risking under-assessment and under-management, this suggests there may be a greater need for symptoms surveillance for this population.
Assuntos
Depressão/etnologia , Neoplasias/etnologia , Estresse Psicológico/etnologia , População Branca/etnologia , Fatores Etários , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Índice de Gravidade de Doença , Estados Unidos/epidemiologiaRESUMO
Although symptoms during cancer treatments are prevalent and are important clinical outcomes of childhood cancer, the symptom experiences of Puerto Rican children along with the symptom alleviation/care practices that parents provide during cancer treatments have received limited attention. To examine the occurrence/severity of symptoms on the Therapy-Related Symptom Checklist-Children (TRSC-C), reported by mothers of Puerto Rican children undergoing cancer treatments and identifying mothers' symptom alleviation/management strategies. Descriptive study conducted between January and May 2012. Mothers of 65 Puerto Rican children/adolescents undergoing cancer treatments responded to the Spanish versions of the TRSC-C, Symptom Alleviation: Self-Care Methods, and a Demographic and Health form. The children/adolescents' mean age was 9.2 (1-17) years; 62% were boys; 56 had chemotherapy; 9 had chemoradiotherapy. Children diagnoses were 35.4% leukemia, 24.6% solid tumors, 24.6% nervous system tumors, and 15.4% other. On the TRSC-C, the symptoms experienced by 70% or more of the children were: irritability (77%), nausea (75%), and hair loss (72%). On the Symptom Alleviation: Self-Care Methods, the most commonly reported symptom alleviation category was "taking prescribed medicines." Puerto Rican mothers reported the use of alleviation practices to treat their children experiencing symptoms during pediatric cancer treatments. Patients and caregivers need to be educated about treatment-induced side effects, and the life-threatening consequences of underreporting and undermanagement. Symptoms should always be addressed at the time of initiation of primary or adjuvant cancer therapy because pretreatment symptoms may persist or get worse across the trajectory of treatment. A continuous assessment and management of symptoms during the childhood cancer trajectory can optimize clinical care and improve quality of life of patients and families.
Assuntos
Hispânico ou Latino , Mães/psicologia , Neoplasias/complicações , Neoplasias/terapia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Porto Rico , Qualidade de Vida , AutocuidadoRESUMO
BACKGROUND: Disease management programs (DMP) have been shown to be effective in management of patients with heart failure (HF). OBJECTIVE: To describe the experience at the Heart Failure and Transplantation Clinic of the Cardiovascular Center of Puerto Rico and the Caribbean (HFTC-CCPRC) implementing a model of DMP to a Hispanic population afflicted by HF. METHODS: A retrospective study was performed. Medical records from patients referred to the HFTC-CCPRC from 1999 to 2005 were selected for review. Information regarding drug regimen, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) determinations by echocardiography or scintigraphic ventriculography, left ventricular dimensions measurements, maximal oxygen consumption (MVO2 max) determination, hospitalizations, and death cases were obtained from the initial evaluation and at 3, 6, and 12 months post-intervention at the HFTC-CCPRC. RESULTS: A total of 633 records were screened, from which 244 had complete information for analysis. After 12 months of treatment at the HFTC-CCPRC, NYHA functional class had decreased from 2.70 + 0.59 to 2.13 +/- 0.53 (p < 0.01). LVEF had also increased from 21.0 +/- 8.2% to 39.9 +/- 14.6% (p < 0.01). Hospitalization rate was reduced from 62.7% within the year prior to initial evaluation to 7.2% at the end of the 12-month period (p < 0.01). CONCLUSIONS: In our patient population, we found significant improvement in several parameters, including NYHA functional class, LVEF, and hospitalization rate after intervention at the HFTC-CCPRC. These findings are most likely related to improved guideline adherence, and are consistent with published data regarding the value of DMP's.