RESUMO
PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean 5511.59 vs 1457.22; P = 0.028) and ED costs (161.25 vs 14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.
Assuntos
Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Síndrome do Carcinoide Maligno/economia , Absenteísmo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Custos Diretos de Serviços , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Síndrome do Carcinoide Maligno/patologia , Síndrome do Carcinoide Maligno/terapia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/economia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Presenteísmo/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Trabalho/estatística & dados numéricosRESUMO
INTRODUCTION: The aim of this study was to analyze the associations between perceived social support and sociodemographic variables on coping strategies. METHODS: A prospective, cross-sectional, multicenter study was conducted in 404 women with resected, non-metastatic breast cancer. Participants completed questionnaires: perceived social support (MSPSS), coping strategies (Mini-MAC), and psychological distress (BSI-18). RESULTS: Sociodemographic factors as age, education, and partnership status were associated with coping strategies. As for maladaptive strategies, hopelessness was more frequent in older people and lower educational level; fatalism in older and single people, and cognitive avoidance was associated with lower educational level. Suppor t from family, friends, and partners was associated with a greater fighting spirit. In contrast, high psychological distress (anxiety and depression) was associated with greater use of maladaptive strategies. CONCLUSION: Young people, a high level of education, having a partner, low psychological distress, and seeking social support were associated with the use of adaptive cancer coping strategies.
Assuntos
Adaptação Psicológica , Neoplasias da Mama/psicologia , Determinantes Sociais da Saúde , Apoio Social , Fatores Sociodemográficos , Fatores Etários , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Estado Civil , Pessoa de Meia-Idade , Estudos Prospectivos , Angústia Psicológica , Análise de Regressão , EspanhaRESUMO
OBJECTIVE: To identify distinct trajectories of toxicity in colorectal cancer (CRC) patients after adjuvant chemotherapy and its impact on quality of life (QoL) and psychological symptoms. METHODS: A prospective, multicenter study was conducted in 157 patients. A latent class analysis defined the unobserved latent constructs that can be predicted as symptom clusters, considering the intensity of four types of adverse events (AEs). Patients completed EORTC-QLQ-C30, BSI-18, PDRQ-9, and DRS scales. RESULTS: Ninety-six percent had some degree of toxicity, with grades 3-4 being the most common: neurotoxicity (7.2%), hematological (13.1%), digestive (5.2%), and skin toxicity (1.4%). Three distinct latent classes were identified (high [72.5%], mild [16.9%], and low [10.6%] toxicity). Patients with high toxicity had the worst QoL scores and moderately high somatization and psychological distress scores. CONCLUSIONS: Adjuvant chemotherapy for CRC was associated with frequent toxicity that negatively impacted QoL and psychological wellbeing.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/psicologia , Análise de Classes Latentes , Qualidade de Vida , Idoso , Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Tomada de Decisões , Emoções , Feminino , Fluoruracila/efeitos adversos , Humanos , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/efeitos adversos , Relações Médico-Paciente , Estudos Prospectivos , Piridinas/efeitos adversos , EspanhaRESUMO
BACKGROUND AND RATIONALE: Thromboembolic complications are a serious, preventable and common event in cancer patients that contributes to increasing morbidity and mortality. Despite increasing knowledge on cancer-associated thrombosis (CAT), there are still several aspects of diagnosis, clinical management, treatment and prognosis with uncertainties that are under-represented in randomized clinical trials. For this reason, the Spanish Society of Medical Oncology (SEOM) launched in June 2018 a registry of CAT. METHODS/DESIGN: TESEO is an ongoing prospective, non-interventional, multicentric study in consecutive cancer patients with newly diagnosed of thromboembolic event (TEE). Eligibility criteria include being > 18 years with a histologically confirmed diagnosis of cancer and a symptomatic or incidental TEE confirmed with an imaging technique in the previous month or any time after the cancer diagnosis and signing of informed consent. The study consists of two types of integrated but independent prospective registries. Regular CAT sub-registry includes information on patient's cancer´s characteristics, anticoagulant treatment provided and outcome data. Special CAT sub-registry includes variables related to special situations of CAT that comprise patients with severe kidney failure, thrombocytopenia, high risk of bleeding related to the cancer or with coexistence of bleeding and patients who receive new treatments such a targeted therapy, antiangiogenics agents and immunotherapy. The registry considers the status of the cancer and the time to assess how the prognosis is changed based on when the thrombus occurs. Some outcomes such as rethrombosis, major bleeding, tumor progression and survival will be valued in various time intervals including 1, 3, 6 and 12 months after the even in the first year; and then every 6 months until the patient's death. RESULTS: After 18 months and with 35 centers and researchers, the registry has 1128 patients. CONCLUSION: TESEO registry will provide clinical real-world evidence for prevention, treatment and complications of CAT in different scenarios that are under-represented in randomized clinical trials.
Assuntos
Neoplasias/complicações , Sistema de Registros/estatística & dados numéricos , Tromboembolia/epidemiologia , Inibidores da Angiogênese/uso terapêutico , Anticoagulantes/uso terapêutico , Progressão da Doença , Hemorragia/epidemiologia , Humanos , Imunoterapia , Oncologia , Terapia de Alvo Molecular , Neoplasias/terapia , Prognóstico , Recidiva , Insuficiência Renal/epidemiologia , Sociedades Médicas , Espanha/epidemiologia , Trombocitopenia/epidemiologia , Tromboembolia/tratamento farmacológico , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do Tratamento , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologiaRESUMO
Gastric cancer (GC) is the fifth most common cancer worldwide with a varied geographic distribution and an aggressive behavior. In Spain, it represents the sixth cause of cancer death. In Western countries, the incidence is decreasing slightly, with an increase in gastroesophageal junction adenocarcinoma (GEJA), a different entity that we separate specifically in the guideline. Molecular biology advances have been done recently, but do not yet lead to the choice in treatment approach except in advanced disease with overexpression of HER2. Endoscopic resection in very early stage, perioperative chemotherapy in locally advanced tumors and preliminary immune therapy resulting in advanced disease are the main treatment innovations in the GC/GEJA treatment. We describe the different evidences and recommendations following the statements of the American College of Physicians.
Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Ensaios Clínicos como Assunto/normas , Junção Esofagogástrica/patologia , Guias de Prática Clínica como Assunto/normas , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Humanos , Oncologia , Sociedades MédicasRESUMO
INTRODUCTION: Depression in cancer patients is prevalent and negatively impacts their quality of life. Likewise, it correlates with lower overall survival. The aim of this work is to analyze whether different coping strategies, as well as sociodemographic and clinical factors are associated with the presence of depressive symptoms in individuals with a resected, non-metastatic neoplasm about to initiate adjuvant chemotherapy. METHODS: NEOcoping is a cross-sectional, prospective, observational, multicenter study. Clinical (tumor site and stage, time to diagnosis, risk of recurrence, and type of adjuvant treatment) and sociodemographic characteristics (age, gender, marital status, educational level, occupational sector, and employment status), coping strategies (Mini-MAC scale), and depressive symptoms (BSI scale) were collected. A two-block linear regression model was performed to determine the predictive variables of depressive symptoms. RESULTS: 524 adults with resected, non-metastatic cancer were recruited. Twenty-six percent of patients have clinically significant depressive symptoms. Being female, < 40 years of age, having breast and stomach cancer, and > 50% chance of recurrence were associated with increased risk of depression. Likewise, depression was associated with greater helplessness and anxious preoccupation, and less fighting spirit. Age, gender, and risk of recurrence accounted for only 7% of the variance in depressive symptoms. Including coping strategies in the regression analysis significantly increased the variance explained (48.5%). CONCLUSION: Early psychological intervention in patients with maladaptive coping strategies may modulate the onset of depressive symptoms, especially in those at higher risk for depression.
Assuntos
Adaptação Psicológica , Depressão/psicologia , Neoplasias/psicologia , Idoso , Escalas de Graduação Psiquiátrica Breve , Quimioterapia Adjuvante , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Neoplasias/cirurgia , Prevalência , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Sistema de Registros , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Feminino , Humanos , Quimioterapia de Manutenção , Masculino , Pessoa de Meia-Idade , Platina/administração & dosagem , Platina/efeitos adversos , Intervalo Livre de Progressão , Pirimidinas/administração & dosagem , Pirimidinas/efeitos adversos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Fatores de Tempo , Adulto JovemAssuntos
Oncologia , Neoplasias/complicações , Sistema de Registros/estatística & dados numéricos , Sociedades Médicas , Trombose Venosa/etiologia , Antineoplásicos/efeitos adversos , Cisplatino/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Espanha , Trombose Venosa/tratamento farmacológicoRESUMO
INTRODUCTION: Our aim was to assess efficacy and safety and prognostic factors associated with TAS-102 in clinical practice. METHOD: Retrospective, multicenter, and observational study including patients with advanced refractory colorectal cancer who started TAS-102 between March 2016 and August 2018. The primary end point was overall survival (OS). Secondary end points included progression-free survival, toxicity and analyze prognostic factors present at the beginning of TAS-102. RESULT: 84 patients were evaluable. The median OS was 8.30 (95% CI 6.23-9.87) months and PFS was 2.62 (95% CI 2.36-3.05) months. In multivariate analysis, ECOG 0 and reduced dose combined with more cycles were associated with better prognosis. Patients with an ECOG > 0 had worse prognosis (HR 3.34, 95% CI 1.09-10.27, p = 0.035). 95.2% experienced some type of adverse effect and 45.2% had grade ≥ 3 toxicities. CONCLUSION: Results suggest reconsidering TAS-102 in patients with ECOG > 0, something that should be investigated in prospective randomized clinical trials.
Assuntos
Neoplasias do Colo/tratamento farmacológico , Pirrolidinas/uso terapêutico , Neoplasias Retais/tratamento farmacológico , Trifluridina/uso terapêutico , Uracila/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Esquema de Medicação , Combinação de Medicamentos , Estudos de Viabilidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Pirrolidinas/efeitos adversos , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Timina , Resultado do Tratamento , Trifluridina/efeitos adversos , Uracila/efeitos adversos , Uracila/uso terapêuticoRESUMO
BACKGROUND: Our study analyzes the incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer. METHODS: A multi-institutional, prospective, observational study was conducted with 750 participants of 14 hospitals in Spain. Participants' socio-demographic and clinical characteristics were collected using a standardized self-report form and using EORTC QoL-QLQ-C30, BSI, Mini-MAC questionnaires. RESULTS: In women, sleep problems, depression and anxious preoccupation were observed in 65, 41 and 21%, respectively. In men, sleep problems, depression and anxious preoccupation were reported in 51, 29 and 61%, respectively. More sleep problems, depression and anxious preoccupation were found among women than males. Depression was a significant predictor of anxious preoccupation. In males, sleep problems partially mediated this association. This was not confirmed in women. CONCLUSION: Our findings point toward the importance of developing interventions that decrease depression and sleep problems in cancer.
Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Neoplasias , Qualidade de Vida , Transtornos do Sono-Vigília/epidemiologia , Adaptação Psicológica , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Prevalência , Prognóstico , Estudos Prospectivos , Psicometria , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
Nutritional deficiency is a common medical problem that affects 15-40% of cancer patients. It negatively impacts their quality of life and can compromise treatment completion. Oncological therapies, such as surgery, radiation therapy, and drug therapies are improving survival rates. However, all these treatments can play a role in the development of malnutrition and/or metabolic alterations in cancer patients, induced by the tumor or by its treatment. Nutritional assessment of cancer patients is necessary at the time of diagnosis and throughout treatment, so as to detect nutritional deficiencies. The Patient-Generated Subjective Global Assessment method is the most widely used tool that also evaluates nutritional requirements. In this guideline, we will review the indications of nutritional interventions as well as artificial nutrition in general and according to the type of treatment (radiotherapy, surgery, or systemic therapy), or palliative care. Likewise, pharmacological agents and pharmaconutrients will be reviewed in addition to the role of regular physical activity.
Assuntos
Neoplasias/terapia , Estado Nutricional , Cuidados Paliativos , Guias de Prática Clínica como Assunto/normas , Qualidade de Vida , Ensaios Clínicos como Assunto , Humanos , Avaliação Nutricional , Prognóstico , Sociedades MédicasAssuntos
Antineoplásicos/efeitos adversos , Neutropenia Febril/prevenção & controle , Neoplasias/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Medição de Risco/normas , Índice de Gravidade de Doença , Neutropenia Febril/induzido quimicamente , Neutropenia Febril/diagnóstico , Humanos , Prognóstico , Sociedades MédicasRESUMO
INTRODUCTION: This study analyzes the prevalence of malnutrition, depression, anxiety, and somatization and which factor has the biggest effect on quality of life (QoL) in individuals with resected cancer. METHODS: A prospective study was conducted among 747 participants. Participants completed the EORTC-QLQ30, MST, and BSI-18 questionnaires. RESULTS: Prevalence for risk of malnutrition, depression, anxiety, and somatization were 36.4%, 35.5%, 35.2%, and 48.8%, respectively. Hierarchical multiple regression analyses revealed that malnutrition risk, somatization, depression, and anxiety accounted for 50.8% of the variance in functional scale, 45.3% in symptom scale, and 52.2% in global health. Malnutrition, somatization, depression, and anxiety displayed high explanatory power on all health-related QoL (HRQoL) scales. CONCLUSION: The risk of malnutrition and psychological symptoms is strongly associated with HRQoL in cancer patients; thus, medical oncologists should develop effective interventions that contribute to lowering the risk of malnutrition and psychological distress, thereby improving subjects' HRQoL before initiating adjuvant chemotherapy.
Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Desnutrição/epidemiologia , Neoplasias/cirurgia , Qualidade de Vida , Estresse Psicológico/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Estudos Transversais , Depressão/etiologia , Feminino , Seguimentos , Humanos , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e QuestionáriosRESUMO
Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided.
Assuntos
Antineoplásicos/efeitos adversos , Neutropenia Febril/prevenção & controle , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Neoplasias/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Índice de Gravidade de Doença , Adulto , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Neutropenia Febril/induzido quimicamente , Neutropenia Febril/diagnóstico , Humanos , Prognóstico , Medição de Risco , Sociedades MédicasRESUMO
NENs are a heterogeneous family of tumors of challenging diagnosis and clinical management. Their incidence and prevalence continue to rise across all sites, stages and grades. Although improved diagnostic techniques have led to earlier detection and stage migration, the improved prognosis documented over time for advanced gastrointestinal and pancreatic neuroendocrine tumors also reflect improvements in therapy. The aim of this guideline is to update practical recommendations for the diagnosis and treatment of gastroenteropancreatic and lung NENs. Diagnostic procedures, histological classification and therapeutic options are briefly discussed, including surgery, liver-directed therapy, peptide receptor radionuclide therapy, and systemic hormonal, cytotoxic or targeted therapy, and treatment algorithms are provided.
Assuntos
Neoplasias Brônquicas/terapia , Neoplasias Gastrointestinais/terapia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Guias de Prática Clínica como Assunto/normas , Neoplasias Brônquicas/diagnóstico , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Neoplasias Gastrointestinais/diagnóstico , Humanos , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Prognóstico , Sociedades MédicasRESUMO
PURPOSE: Despite the burgeoning geriatric population with cancer and the importance of understanding how age may be related to mental adjustment and quality of life so far, differences in coping strategies and psychological harm between the elderly and adults are hardly being taken into account to modify the approach to this population. The aim of this prospective study is to describe the differences in psychological characteristics between older and adult cancer patients and examine dissimilarities in their psychological evolution during adjuvant chemotherapy. METHODS: Adults (18-69 years old) and older patients (≥ 70) with newly diagnosed non-metastatic resected cancer admitted to receive adjuvant chemotherapy were recruited. Patients completed the following questionnaires: mini-mental adjustment to cancer, brief symptom inventory, shared decision-making questionnaire-patient's version, multidimensional scale of perceived social support, EORTC quality-of-life instrument, life orientation test-revised, and satisfaction with life scale. RESULTS: 500 cancer patients (394 adults and 106 older) were evaluated. The impact of the diagnosis was less negative among older patients, with no differences in coping strategies, quality of life, or search for support. Regarding psychological changes from the beginning to the end of the adjuvant treatment, both age groups reported more somatic symptoms, increased psychological difficulty, reduced coping strategies, and a significant decrease in quality of life at the end of postoperative chemotherapy. CONCLUSION: Although there were clear psychological differences between adults and senior cancer patients, their evolution during adjuvant chemotherapy was similar, with deterioration in quality of life and coping. This negative psychological impact of adjuvant chemotherapy should be taken into account when considering interventions.
Assuntos
Adaptação Psicológica , Quimioterapia Adjuvante/psicologia , Neoplasias/tratamento farmacológico , Neoplasias/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida/psicologia , Adulto JovemRESUMO
PURPOSE: Gastroenteropancreatic neuroendocrine tumors are a heterogeneous group of low incidence neoplasms characterized by a low proliferative activity and slow growth. Their response to targeted therapies is heterogeneous and often does not lead to tumor shrinkage. Thus, evaluation of the therapeutic response should differ from other kind of tumors. METHODS: To answer relevant questions about which techniques are best in the assessment of progression or treatment response a RAND/UCLA-based consensus process was implemented. Relevant clinical questions were listed followed by a systematic search of the literature. The expert panel answered all questions with recommendations, combining available evidence and expert opinion. Recommendations were validated through a questionnaire and a participatory meeting. RESULTS: Expert recommendations regarding imaging tools for tumor assessment and evaluation of progression were agreed upon. Available imaging techniques were reviewed and recommendations for best patient monitoring practice and the best way to evaluate treatment response were formulated.
Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/patologia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Diagnóstico por Imagem/métodos , Progressão da Doença , HumanosRESUMO
PURPOSE: The aim of this study was to analyze differences in physician and patient satisfaction in shared decision-making (SDM); patients' emotional distress, and coping in subjects with resected, non-metastatic cancer. METHODS: 602 patients from 14 hospitals in Spain were surveyed. Information was collected regarding physician and patient satisfaction with SDM, participants' emotional distress and coping, as well as patient sociodemographic and clinical characteristics by means of specific, validated questionnaires. RESULTS: Overall, 11% of physicians and 19% of patients were dissatisfied with SDM; 22% of patients presented hopelessness or anxious preoccupation as coping strategies, and 56% presented emotional distress. By gender, female patients showed a higher prevalence of dissatisfaction with SDM (23 vs 14%), anxious preoccupation (26 vs 17%), and emotional distress (63 vs 44%) than males. Hopelessness was more prevalent in individuals with stage III disease than those with stages I-II (28 vs 18%). CONCLUSION: Physicians must be mindful of the importance of emotional support and individual characteristics when communicating treatment options, benefits, and adverse effects of each alternative to oncological patients.
Assuntos
Quimioterapia Adjuvante , Tomada de Decisões , Satisfação no Emprego , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Médicos/psicologia , Adulto , Idoso , Quimioterapia Adjuvante/psicologia , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Humanos , Masculino , Oncologia/métodos , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Médicos/estatística & dados numéricos , Fatores Socioeconômicos , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Anxiety and depression affect cancer patients' quality of life. Our objectives were to determine the prevalence of anxiety and depression and analyze the association between positive psychological factors, sociodemographic factors, and clinical factors in oncological patients initiating adjuvant treatment. METHODS: A prospective, multicenter cohort of 600 consecutive patients completed the Brief Symptom Inventory, Mini-Mental Adjustment to Cancer, Life Orientation Scale-Revised, and Multidimensional Scale of Perceived Social Support questionnaires. RESULTS: Prevalence of anxiety and depression was 49.8 and 36.6%, respectively. Women and younger individuals were more anxious and depressed than men and seniors. Employed participants suffered more anxiety than retirees, and singles exhibited more depression than married or partnered subjects. Logistic regression analysis showed that hope, optimism, social support, being male, and older were significantly associated with a lower risk of anxiety and depression (p < 0.001). CONCLUSIONS: The high prevalence of anxiety and depression among Spaniards with cancer starting adjuvant chemotherapy suggests that more attention should be paid to mental health in these individuals. These findings are important for cancer patients because they can benefit from interventions that increase positive psychological factors such as hope, optimism, and social support to reduce anxiety and depression.
Assuntos
Ansiedade/epidemiologia , Quimioterapia Adjuvante/estatística & dados numéricos , Depressão/epidemiologia , Neoplasias/epidemiologia , Neoplasias/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/psicologia , Terapia Combinada , Estudos Transversais , Depressão/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Prevalência , Qualidade de Vida , Fatores de Risco , Apoio Social , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. METHODS: A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. RESULTS: Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients. CONCLUSIONS: There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan.