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PURPOSE: This study investigated the role of resilience and coping strategies on breast cancer patients' well-being using a structural equation model. To achieve this objective, a model previously developed by Mayordomo's group was partially replicated using a longitudinal study design in an oncological sample. METHODS: The study was a longitudinal observational survey. Patients with breast cancer were recruited (N = 166). Resilience was measured with the Mexican Resilience Measurement Scale, coping strategies with the Forms of Coping and Dimensions Scale and perception of the psychological well-being with a short-form of Ryff's Scales of Psychological Well-Being at the start and end of adjuvant chemotherapy (T1 and T2 respectively). RESULTS: The results showed stability in the variables over time and revealed differences with respect to Mayordomo's model. The best predictor of well-being at T2 was well-being at T1. In addition, the model indicated that resilience had a direct impact on well-being through problem-focused coping. Indeed, resilience and problem-focused coping best explained well-being at T2. CONCLUSIONS: Both at the start and end of adjuvant chemotherapy for breast cancer, problem-focused coping positively predicted resilience, which in turn was a positive predictor of well-being. On the other hand, emotion-focused coping showed no association with resilience or well-being. As part of the multidisciplinary cancer team, oncology nurses have a key role to play in promoting resilience and problem-focused coping as an important goal of psychosocial interventions in breast cancer patients.
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Adaptação Psicológica , Neoplasias da Mama , Resiliência Psicológica , Humanos , Feminino , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Neoplasias da Mama/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Longitudinais , Adulto , Idoso , Quimioterapia Adjuvante/psicologia , México , Qualidade de Vida , Inquéritos e Questionários , Capacidades de EnfrentamentoRESUMO
OBJECTIVE: To describe the experience of implementing social robotics as an adjuvant during the hospitalization process in pediatric oncology patients. METHODS: Before and after cohort study, applying an intervention with the Lego Mindstorms EV3 kit in patients between 8 and 17 years old that are hospitalized with a cancer diagnosis. We excluded patients from the intensive care unit or when their treating physician recommended so. The intervention consisted of a three-phase workshop: an open architecture story, building a car robot using the Lego Mindstorm EV3 kit, and cooperative playing activities such as races and passing obstacles. RESULTS: Thirteen patients received the intervention with robotic lego. The median age was 15 years (IQR = 3), and 84.6% of the population (n = 11) were male. We found significant improvement in the language (topic management p = .011 and communicative intention p = .034). Other characteristics improved, but not significantly (self-care activities index, catching). No adverse events occurred during the intervention. CONCLUSIONS: The results of this pilot study suggest that implementing social robotics during hospitalization in children with cancer is a therapeutic adjuvant and safe intervention that promotes better communication, self-care, and a physical activity improvement. For future studies, the impact of this intervention could be measured in hospitalized pediatric cancer patients.
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Hospitalização , Neoplasias , Robótica , Humanos , Masculino , Criança , Feminino , Adolescente , Neoplasias/terapia , Projetos Piloto , Hospitalização/estatística & dados numéricos , Estudos de CoortesRESUMO
RESUMO: Objetivo: identificar sintomas de ansiedade e depressão em pacientes com câncer e associação com os aspectos clínicos e adesão ao tratamento oncológico. Método: estudo transversal, com amostra de conveniência, realizado entre setembro de 2020 e maio de 2021, incluindo pacientes com diagnóstico de câncer de todas as regiões do Brasil. Os instrumentos utilizados foram o Hospital Anxiety and Depression Scale e o Teste de Morisky. Análises de regressão logística multivariada foram realizadas para verificar associações. Resultados: mostra incluiu 69 pacientes, dos quais 69,6% apresentaram ansiedade e a mesma proporção apresentou depressão. Ansiedade e depressão simultânea foram de 59,4%. A ansiedade se associou com a presença de fadiga. Depressão se associou com o tempo de diagnóstico, astenia e local de tratamento. Ocorrência simultânea de ansiedade e depressão associou com astenia e local de tratamento. Conclusão: elevados índices de ansiedade e depressão ressaltam a necessidade de implementar ações de apoio psicossocial para pacientes com câncer.
ABSTRACT Objective: to identify symptoms of anxiety and depression in cancer patients and their association with clinical aspects and adherence to oncological treatment. Method: a cross-sectional study with a convenience sample conducted between September 2020 and May 2021, including patients diagnosed with cancer from all regions of Brazil. The instruments used were the Hospital Anxiety and Depression Scale and the Morisky Test. Multivariate logistic regression analyses were conducted to verify associations. Results: the sample included 69 patients, of whom 69.6% presented anxiety, and the same proportion presented depression. Simultaneous anxiety and depression were present in 59.4% of the cases. Anxiety was associated with the presence of fatigue. Depression was associated with the time of diagnosis, asthenia, and treatment location. The simultaneous occurrence of anxiety and depression was associated with asthenia and treatment location. Conclusion: high levels of anxiety and depression underscore the need to implement psychosocial support interventions for cancer patients.
RESUMEN: Objetivo: identificar síntomas de ansiedad y depresión en pacientes con cáncer y su asociación con aspectos clínicos y con la adherencia al tratamiento oncológico.. Método: estudio transversal, con muestra por conveniencia, realizado entre septiembre de 2020 y mayo de 2021, que incluyó pacientes diagnosticados con cáncer de todas las regiones de Brasil. Los instrumentos utilizados fueron la Hospital Anxiety and Depression Scale y el Test de Morisky. Se realizaron análisis de regresión logística multivariada para comprobar las asociaciones. Resultados: la muestra estuvo compuesta por 69 pacientes, el 69,6% de ellos presentó ansiedad y el mismo porcentaje presentó depresión. Se observó ansiedad y depresión simultáneas en el 59,4%. La ansiedad se asoció con la presencia de fatiga. La depresión se asoció con el tiempo de diagnóstico, la astenia y el lugar del tratamiento. La aparición simultánea de ansiedad y depresión se asoció con la astenia y el lugar del tratamiento. Conclusión: los altos índices de ansiedad y depresión indican que es necesario implementar acciones de apoyo psicosocial a los pacientes con cáncer.
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Background: Establishing adequate communication is part of the therapeutic process and of the integral approach to the oncology patient. The SPIKES protocol defines a series of general recommendations aimed at facilitating this process. To date, there is no questionnaire that makes it possible to personalize the communication of bad news in a systematized way. Some studies support the hypothesis that personality influences the communicative modes; therefore, the aim of this work is to try to establish nuances in the SPIKES protocol based on personality traits. Methods: Single-center, observational, prospective, descriptive and correlational study, conducted on a sample of 51 oncology patients based on a personality questionnaire and a communication questionnaire (based on the SPIKES protocol). Results: The scores recorded in all domains of the communication questionnaire were high. There was no significant correlation with the personality questionnaire domains. Conclusions: There are certain needs tending towards universality in the communication of bad news that the SPIKES protocol adequately reflects; it can be considered the gold standard. However, it is not possible to establish nuances in it according to personality traits based on the results of this work. In the strategy phase, attention should be paid to life and family planning in the context of oncologic disease.
Introducción: Establecer una adecuada comunicación forma parte del proceso terapéutico y del abordaje integral del paciente oncológico. El protocolo SPIKES emite una serie de recomendaciones generales destinadas a facilitar este proceso. No existe hasta la fecha un cuestionario que permita personalizar de una manera sistematizada la comunicación de malas noticias. Existen estudios que apoyan la hipótesis de que la personalidad influye en los modos comunicativos. Por ello, el objetivo de este trabajo fue intentar establecer matices en el protocolo SPIKES con base en los rasgos de personalidad. Materiales y métodos: Estudio unicéntrico, observacional, prospectivo, descriptivo y correlacional, realizado sobre una muestra de 51 pacientes oncológicos con base en un cuestionario de personalidad y un cuestionario de comunicación, el cual se basa a su vez en el protocolo SPIKES. Resultados: Las puntuaciones registradas en todos los dominios del cuestionario de comunicación fueron elevadas. Ninguna correlación con los dominios del cuestionario de personalidad resultó significativa. Conclusiones: Existen determinadas necesidades tendentes a la universalidad en torno a la comunicación de malas noticias que el protocolo SPIKES recoge adecuadamente, por lo que puede considerarse el gold standard. No se pueden establecer matices en este cuestionario en función de los rasgos de personalidad con base en los resultados de este trabajo. En la fase de estrategia, conviene prestar atención a la planificación vital y familiar en el seno de la enfermedad oncológica. Palabras Clave: protocolo SPIKES, comunicación de malas noticias, psicooncología, medicina personalizada, relación médico-paciente. ABSTRACT Background:Establishing adequate communication is part of the therapeutic process and of the integral approach to the oncology patient. The SPIKES protocol issues a series of general recommendations aimed at facilitating this process. To date, there is no questionnaire that makes it possible to personalize the communication of bad news in a systematized way. There are studies that support the hypothesis that personality influences the communicative modes. Therefore, the aim of this work is to try to establish nuances in the SPIKES protocol based on personality traits. Methods:Single-center, observational, prospective, descriptive and correlational study, conducted on a sample of 51 oncology patients based on a personality questionnaire and a communication questionnaire (based on the SPIKES protocol). Results: The scores recorded in all domains of the communication questionnaire were high. No correlation with the personality questionnaire Irene Solana López* , Manuel Meilan Uzcategui , Elia Martínez Moreno , Ignacio Juez Martel , David Gutiérrez Abad , Elena Lahoz León , Olga Mateo Rodríguez , Jaime Martínez Moreno , Carlos de Zea Luque , Ana Manuela Martín Fernández de Soignie , Fátima Escalona Martín , Isabel Santana Gómez y Juan Antonio Guerra Martínez Servicio de Oncología Médica, Hospital Universitario de Fuenlabrada, Madrid (Spain)Recibido: 05/02/2024Aceptado: 08/03/2024Publicado: 30/04/2024* Autor de correspondencia: Irene Solana López, irene.solana@salud.madrid.orgArtículo / ArticleISSN: 2661-6653DOI:https://doi.org/10.33821/736Cómo citar: Solana Lopez I, Meilan Uzcategui M, Martinez Moreno E, Juez Martel I, Gutierrez Abad D, Lahoz León E, Mateo Rodríguez O, Martinez Moreno J, de Zea Luque C, Martín Fernández de Soignie AM, Escalona Martín F, Santana Gómez I, Guerra Martinez JA. Análisis del protocolo SPIKES desde la perspectiva del paciente oncológico. Estudio prospectivo basado en cuestionarios. Oncología (Ecuador). 2024;34(1): 4-20. https://doi.org/10.33821/736Further exploring the SPIKES protocol from the perspective of oncology patients in terms of personality traitsProspective questionnaire-based study© 2024 Revista Oncología Ecuador. Publicado por la Sociedad de Lucha Contra el Cáncer, Ecuador. Este es un artículo de acceso abierto publicado bajo una licencia CC BY-NC-SA (http://creativecommons.org/licenses/by-nc-sa/4.0/)
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Comunicação , NeoplasiasRESUMO
Abstract Objective This article aimed to evaluate the psychological adjustment of Brazilian children experiencing cancer relapse by comparing their adjustment with cancer survivors and "healthy" children, based on the reports of their parents or caregivers. Method Participants were 140 caregivers of children in relapse (n = 24), remission (n = 59), and of children considered "healthy" (control group) (n = 57). The Behavior Assessment System for Children and the Family Environment Scale were applied. Data analyses were performed through Student's t-test, Chi-square, analysis of variance, and Pearson correlations. Results The results showed that children with cancer did not present more psychopathologies than the control group; however, they had more social and leadership skills. Protective (family cohesion) and risk factors (child´s age, number of relapses, treatment duration, caregiver's income and education level) were also observed. Conclusion This study proposes the screening of psychological symptoms for risk subgroups and the design of intervention strategies for this population.
Resumo Objetivo O presente artigo visou avaliar o ajustamento psicológico de crianças brasileiras em recidiva de câncer comparando-as com sobreviventes de câncer e com crianças "saudáveis", a partir do relato de seus pais/cuidadores. Método Os participantes foram 140 cuidadores de crianças em recidiva (n = 24), remissão (n = 59) e controle (n = 57). Foram aplicadas a Escala de Avaliação Comportamental para Crianças e a Family Environment Scale. As análises de dados foram realizadas com t de Student, Qui-quadrado, análises de variância e correlações de Pearson. Resultados Os resultados mostraram que as crianças com câncer não apresentaram mais psicopatologias que o grupo controle, mas mostraram mais habilidades sociais e de liderança. Também se observaram fatores protetores (coesão familiar) e de risco (idade, número de recidivas, duração do tratamento, renda e nível educacional dos cuidadores). Conclusão Propõe-se o rastreio de sintomas psicológicos nos subgrupos de risco e o delineamento de estratégias interventivas para esta população.
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Colorectal cancer is a leading cause of cancer death in Uruguay, yet less than half of the eligible population is up to date with screenings. Research is hampered because no measures exist to assess psychosocial factors that influence screening decisions in this population. To address this gap, we report on the development and psychometric validation of the Colorectal Cancer Literacy Scale-Uruguay Version, a scale based on the health literacy model. We developed an item pool based on the extant literature, obtained feedback from experts, and conducted focus groups with community participants and health care providers. After revision, we conducted a psychometric validation with a national community sample of 405 participants. Through an exploratory factor analysis, we identified four factors that were collapsed into two for theoretical and pragmatic reasons, representing (a) disposition toward cancer prevention and (b) attitudes, beliefs, and emotions about cancer. A third factor, knowledge about colorectal cancer, was examined separately given its distinct focus. Subsequently, we conducted a confirmatory factor analysis with the remaining sample participants using Rasch measurement theory for validation purposes and to further assess the scales' psychometric properties. The resulting 44-item scale presented a good model fit with adequate EAP reliabilities and good initial discriminant validity. Further criterion-related validity analyses should be performed when additional measures are available. The Colorectal Cancer Literacy Scale-Uruguay Version is a theoretically based measure that can bring to light barriers and facilitative factors in an underscreened population at risk. Implications for theory, research, and practice are discussed.
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Neoplasias Colorretais , Letramento em Saúde , Humanos , Psicometria , Uruguai , Emoções , Neoplasias Colorretais/diagnósticoRESUMO
We sought to determine differences by low- and middle- income countries (Brazil, Romania, and Turkiye) on the degree to which health care providers (HCPs) note unmet needs among patients with cancer (N = 741). HCPs endorsed sexuality/intimacy and financial concerns as the most common. Investigating age differences in unmet needs between Brazil and Turkiye, were that should be targeted by. Results revealed that unmet needs to manage emotional distress were higher among older patients in Turkiye, whereas unmet needs to manage insomnia/fatigue were higher among pediatric patients in Brazil. Findings may guide the development of programs to address unmet needs among patients.
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BACKGROUND: Psycho-oncology is a clinical specialty in which the humanistic aspects of cancer diagnoses and treatment are addressed to reduce the psychological burden for patients and their caregivers to optimize patient participation, cancer outcomes and quality-of-life, which is especially critical in cultures where cancer is perceived as invariably fatal. Psycho-oncology programs face multiple barriers in low- and middle-income countries, including limited resource allocation and lack of training, both of which have been impediments to psycho-oncology programs becoming recognized as core competencies in cancer management and part of a standard medical curriculum. PURPOSE: This paper discusses the role of the Global Breast Cancer Initiative (GBCI) in helping to overcome inequities in breast cancer care and improve clinical outcomes from a psycho-oncology perspective as a model for improved cancer care in limited resource settings. FINDINGS: GBCI applies a comprehensive framework encompassing all phases of cancer care (defined through three pillars spanning the continuum of cancer management) and includes addressing the physical, psychological, and social needs of women throughout the life-course. Efforts to promote policies that increase access to early detection and treatment programs and improve health literacy among the public are important strategies to mitigate the most common emotional and physical challenges reported by people with cancer accessing care. CONCLUSIONS: Future efforts will focus on the integration of culturally appropriate guidance to promote early cancer detection and treatment completion through training programs for clinicians to establish core competencies in psycho-oncology. Emerging advocacy efforts in the oncology arena may help guide the integration of psycho-oncology services into routine care in countries where these services are not already integrated into the standard curriculum.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/terapia , Psico-Oncologia , Países em Desenvolvimento , Oncologia , Qualidade de VidaRESUMO
OBJECTIVE: Anxiety and depression are frequent conditions among individuals undergoing antineoplastic therapy, but their relationship with oral mucositis is unclear. This systematic review evaluated the potential association of anxiety and depression with frequency and severity of chemo/radiotherapy-induced oral mucositis. MATERIALS AND METHODS: Electronic searches were undertaken in five databases supplemented by manual scrutiny and gray literature searches in three other databases. The risk of bias was assessed using the Joanna Briggs Institute tool. RESULTS: Eight observational studies conducted on 954 individuals (male-to-female ratio: 1.1:1; age range: six-82 years). Three (37.5%) studies included patients with solid tumors, two (25%) studies included hematopoietic/lymphoid tissue tumors, and two (25%) studies comprised mixed types of malignant neoplasms. Eight different instruments were used to assess oral mucositis, while seven different instruments were used to evaluate anxiety and depression. Associations of anxiety and/or depression with oral mucositis severity were reported in six (75.0%) studies. Oral mucositis-related symptoms, especially pain, were linked with depression in three (37.5%) studies. CONCLUSION: A relatively low number of cases and data heterogeneity hamper definitive conclusion about the potential association between anxiety/depression and oral mucositis. Further studies that could guide more personalized treatments are warranted to investigate this plausible bidirectional interaction.
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Antineoplásicos , Neoplasias , Estomatite , Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Depressão/complicações , Estomatite/induzido quimicamente , Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , AnsiedadeRESUMO
Background: The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life-threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment. Methods: A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: "quality of life" OR "health-related quality of life" OR "QoL" OR "HRQoL" OR "H-QoL" AND "chronic myeloid leukemia". Interval was set from January 2000 to December 2020. Results: 40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment versus TKI therapy as usual. The results of all these trials were examined and discussed. Conclusion: All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects.
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RESUMO Objetivo: compreender as repercussões psicossociais do pós-tratamento radioterápico para o câncer do colo uterino. Método: estudo qualitativo, com a participação de pacientes em pós-tratamento radioterápico para o câncer do colo uterino em um ambulatório de enfermagem oncoginecológica, localizado no Município do Rio de Janeiro - Brasil. Os dados foram coletados durante os meses de março e abril de 2019 por meio de entrevista aberta e submetidos à análise de conteúdo. Resultados: definiram-se quatro categorias: o constructo de papéis sociais: a perda da identidade feminina; a sexualidade da mulher pós-tratamento para o câncer do colo uterino: repercussões conjugais; dificuldades de adaptação à nova condição de vida: reconstruindo a imagem corporal; convivendo com o câncer do colo uterino: repensando a vida e reconstruindo valores através da rede de apoio. Considerações finais: os resultados contribuem para o direcionamento do cuidado, aumentando a qualidade de vida e auxiliando a reorganização da vida profissional, social e familiar dessas mulheres.
ABSTRACT Objective: to understand the psychosocial repercussions of post radiotherapy treatment for cervical cancer. Method: qualitative study, with the participation of patients in post radiotherapy treatment for cervical cancer in an onco-gynecologic nursing outpatient clinic, located in the Municipality of Rio de Janeiro - Brazil. Data were collected during the months of March and April 2019 by means of open interview and submitted to content analysis. Results: four categories were defined: the construct of social roles: the loss of female identity; the sexuality of post-treated women for cervical cancer: marital repercussions; difficulties in adapting to the new life condition: rebuilding the body image; living with cervical cancer: rethinking life and rebuilding values through the support network. Final considerations: the results contribute to the direction of care, increasing the quality of life and helping these women reorganize their professional, social, and family lives.
RESUMEN Objetivo: conocer las repercusiones psicosociales del tratamiento post-radioterapia del cáncer de cuello de útero. Método: estudio cualitativo, con la participación de pacientes en tratamiento post radioterapia para cáncer de cuello uterino en una consulta externa de enfermería oncoginecológica, ubicada en el Municipio de Río de Janeiro - Brasil. Los datos fueron recolectados durante los meses de marzo y abril de 2019 a través de una entrevista abierta y fueron sometidos a un análisis de contenido. Resultados: se definieron cuatro categorías: la construcción de los roles sociales: la pérdida de la identidad femenina; la sexualidad de las mujeres después del tratamiento del cáncer de cuello uterino: las repercusiones conyugales; las dificultades de adaptación a la nueva condición de vida: la reconstrucción de la imagen corporal; la convivencia con el cáncer de cuello uterino: el replanteamiento de la vida y la reconstrucción de los valores a través de la red de apoyo. Consideraciones finales: los resultados contribuyen a la orientación de los cuidados, aumentando la calidad de vida y ayudando a la reorganización de la vida profesional, social y familiar de estas mujeres.
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ABSTRACT Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.
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RESUMO Objetivo. Destacar os objetivos, as conquistas, os desafios e as próximas etapas da Iniciativa Global para o Câncer Infantil (GICC), um projeto criado pela Organização Mundial da Saúde para melhorar a atenção psicossocial em centros de câncer pediátrico na América Latina e no Caribe. Métodos. O projeto foi lançado no Peru, o primeiro país focal da GICC, em novembro de 2020. A fase de diagnóstico incluiu uma pesquisa e uma entrevista semiestruturada com profissionais de saúde para avaliar as práticas de atenção psicossocial nas instituições, bem como uma pesquisa para avaliar as necessidades dos cuidadores. Na segunda fase, foi desenvolvido um plano estratégico para atender às necessidades identificadas, incluindo uma adaptação de padrões de atenção psicossocial, o estabelecimento de grupos de trabalho multicêntricos, a expansão da proposta e o desenvolvimento de materiais. Resultados. O estudo constatou que, de acordo com padrões internacionais, a atenção psicossocial não estava sendo adequadamente oferecida. Seis padrões adaptados foram propostos e validados, e mais de 50 profissionais de saúde da região participaram de atividades on-line para apoiar o projeto. O processo de implementação está em andamento, com a formação de cinco grupos de trabalho multidisciplinares e um comitê regional e a produção de 16 relatórios técnicos. Conclusão. Este projeto representa um avanço substancial para melhorar a atenção psicossocial para pacientes pediátricos com câncer e suas famílias nos países da América Latina e do Caribe. A criação de grupos de trabalho e intervenções baseadas em evidências fortalecem a proposta e sua implementação. É preciso desenvolver políticas de saúde que incluam atenção psicossocial segundo padrões estabelecidos para alcançar resultados sustentáveis na qualidade de vida das crianças com câncer e de suas famílias.
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O presente estudo buscou investigar a percepção que pacientes adultos de uma unidade de terapia intensiva (UTI) oncológica têm acerca da experiência de internação nesse setor. Trata-se de uma pesquisa de abordagem qualitativa e de compreensão. Sete pacientes de um hospital de câncer na região Sul do país foram pesquisados. Eles responderam a uma entrevista semiestruturada, a qual foi gravada e posteriormente transcrita, o que possibilitou o acesso às concepções prévias desses sujeitos acerca da UTI, aspectos psicológicos presentes durante a internação e concepções posteriores à experiência de internamento na unidade. Tais informações foram interpretadas por meio da análise de conteúdo. A partir dos resultados, foi possível verificar que a experiência de internação em contextos de terapia intensiva pode ser afetada, favorável ou desfavoravelmente, pelo conjunto de regras que o paciente traz consigo acerca do que é a UTI. Além disso, foi possível compreender também que os estímulos aversivos existentes nesse ambiente podem ser atenuados pela presença da família e por uma relação acolhedora e sensível com a equipe de saúde, favorecendo, assim, o repertório de enfrentamento do paciente frente a esse momento crítico de saúde.(AU)
This study aims to investigate the perception of adult patients in an oncology intensive care unit (ICU) regarding the experience of hospitalization in this sector. This is a research with a qualitative approach and understanding. Seven patients from a cancer hospital in the southern region of the country were surveyed. They answered a semi-structured interview, which was recorded and later transcribed, on the subjects' previous conceptions about the ICU, psychological aspects present during hospitalization, and conceptions subsequent to the hospitalization experience in the Unit. Such information was interpreted through content analysis. From the results, it was possible to verify that the experience of hospitalization in intensive care contexts can be affected, favorably or unfavorably, by the set of rules that the patient brings with them about what the ICU is. In addition, it was also possible to understand that the aversive stimulus existing in this environment can be attenuated by the presence of the family and by a welcoming and sensitive relationship with the health team, thus favoring the patient's coping repertoire when facing a critical moment of health.(AU)
Este estudio pretendió investigar la percepción que tienen los pacientes adultos sobre la experiencia de hospitalización en una Unidad de Cuidados Intensivos (UCI) de oncología. Se trata de una investigación con enfoque cualitativo y de comprensión. Participaron siete pacientes de un hospital oncológico en la región Sur de Brasil. Se aplicó una entrevista semiestructurada, que fue grabada y, posteriormente, transcrita, lo que permitió acceder a las concepciones previas de los sujetos sobre la UCI, los aspectos psicológicos presentes durante la hospitalización y las concepciones posteriores a la experiencia de internación en la Unidad. Dicha información se interpretó mediante análisis de contenido. A partir de los resultados, fue posible constatar que la experiencia de hospitalización en cuidados intensivos puede ser afectada favorable o desfavorablemente por el conjunto de normas que el paciente trae consigo sobre qué es la UTI. Además, se constató que los estímulos adversos existentes en este ambiente pueden mitigarse mediante la presencia de la familia y la relación acogedora y sensible con el equipo de salud, lo que favorece así el repertorio de afrontamiento del paciente ante este momento crítico de salud.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Psicologia Médica , Saúde , Psico-Oncologia , Unidades de Terapia Intensiva , Ansiedade , Dor , Cuidados Paliativos , Equipe de Assistência ao Paciente , Prognóstico , Psicologia , Qualidade da Assistência à Saúde , Qualidade de Vida , Radioterapia , Reabilitação , Descanso , Segurança , Sinais e Sintomas , Sono , Apoio Social , Estresse Psicológico , Cirurgia Geral , Assistência Terminal , Terapêutica , Biópsia , Institutos de Câncer , Cura Homeopática , Doença , Risco , Entrevista , Sistemas Integrados e Avançados de Gestão da Informação , Vida , Afeto , Morte , Atenção à Saúde , Confiança , Depressão , Tratamento Farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Empatia , Prevenção de Doenças , Humanização da Assistência , Acolhimento , Estudos de Avaliação como Assunto , Detecção Precoce de Câncer , Fadiga , Medo , Terapia de Alvo Molecular , Conforto do Paciente , Tristeza , Solidariedade , Modelos de Assistência à Saúde , Angústia Psicológica , Apoio Familiar , Familiares Acompanhantes , Promoção da Saúde , Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Imunoterapia , Institucionalização , Solidão , Medicina , Anticorpos , Neoplasias , AntineoplásicosRESUMO
Resumen La evaluación subjetiva ha sido descripta como una variable mediadora para la respuesta emocional. Se presenta con diferentes contenidos y estilos. El estilo cognitivo se refiere a la manera en que se piensa sobre el estresor, por ejemplo: la rumiación (pensamientos intrusivos, repetitivos, que generan malestar emocional), la evitación (intentos por no pensar en el estresor) y el compromiso cognitivo (enfocados en búsqueda de sentido o solución). En base a esta respuesta emocional, se busca explorar y describir los pensamientos relacionados con el cáncer en un grupo de diez pacientes con la enfermedad. En un estudio cualitativo, se les pidió a diez pacientes con cáncer que indicaran los cinco pensamientos más frecuentes desde su diagnóstico. Se analizó el contenido mediante la técnica top down (teoría a contenido) y, a partir de los estilos de respuestas cognitivas, se clasificó el contenido de los pensamientos reportados por estilo de pensamiento (rumiación, compromiso cognitivo o evitación), por temporalidad (pasado, presente y futuro) y por valencia (positiva o negativa). Posteriormente, se hizo el análisis bottom up (contenido a teoría). Se hicieron tablas cruzadas para identificar los contenidos según el estilo de pensamiento, la temporalidad y la valencia. En los pensamientos con estilo rumiativo, el enfoque temporal se dirigía en su mayoría al futuro y al pasado, mientras que el compromiso cognitivo se enfocaba en el presente. Esta diferencia fue estadísticamente significativa mediante una prueba de chi cuadrado. Dentro de los temas relacionados con la incertidumbre, se refirieron a la muerte, al pronóstico de la enfermedad, a la respuesta de la familia y a las finanzas (en el futuro) y a las causas y culpa (en el pasado).
Abstract Cancer has been defined by the World Health Organization as "a disease caused by abnormal cells growing uncontrollably in the body, going beyond their usual boundaries, invading adjoining parts of the body and spreading to other organs". Being diagnosed with cancer has been described as an experience with diverse emotional reactions and difficulties in adaptation, having psychological consequences, being most common depression, anxiety and psychological distress; but also, some patients present positive consequences after having a cancer diagnosis, such as post traumatic growth, which includes positive changes presented after the disease experience. Subjective appraisal about cancer has been defined as a mediating variable for the emotional response presented after a stressor, such as cancer diagnosis, treatment, or important changes during disease process (initiating and finalizing treatment, presenting relapse or remission, as well as when having control studies). The subjective appraisal can be presented with different thought content and styles. Thought style is referred as the way thoughts about the stressor are presented, it has been classified as rumination (thoughts that are intrusive and repetitive that also increase psychological distress), cognitive engagement (thoughts associated with problem solving and meaning finding) or avoidance (aiming to stop thinking about stressor or feeling associated with it). Depending on the thought style presented at a stressor, could be the emotional response (anxiety, depression, distress, post-traumatic growth). The aim of the present study was to describe the thoughts (style, content, valence and temporality) related to cancer diagnosis in a group of ten oncologic patients. To identify if differences between thought style, valence and temporality were presented. The study design is qualitative from a phenomenological point of view. Ten oncologic (different cancer type, clinical stage and treatment) patients were asked to write the five more frequent thoughts since their cancer diagnosis. Each thought was classified by: thought style, valence, and temporality (top-down, classifying the thoughts according to theory). The same thoughts were also classified in semantic units (bottom-up, classifying the thoughts according to their own contents), generating concerns from the content. Cross tabs were made to identify contents and temporality for thought style and valence, which were analyzed by chi square to identify differences between thought style, temporality and valence. The most common thought style was cognitive engagement, followed by rumination (almost same frequency). On what respects to thought style and temporality, rumination was more focused on past (causes and attributions of cancer) and future (uncertainty about death and treatment effectiveness); meanwhile, cognitive engagement was focused on present (to enjoy present moment and focus on daily actions). Chi square was made to identify if this difference was significant, showing temporality was significantly different in cognitive engagement and rumination. The concerns identified in study participants were uncertainty about future and disease, family (communication and wellness of the family), finances (due to expensive treatments), causes and guilt about having cancer. Thoughts that were more centered in present, were more likely to be associated with cognitive engagement. Cognitive engagement has been described previously as an important variable associated with post traumatic growth. Thoughts centered in the past and present were more associated with rumination. Rumination has been associated with depression and post-traumatic stress disorder. Because of mediating role of thought style in disease adaptation, emotional response to the disease, and the relation of this adaptation with the perception of quality of life in cancer patients, the design of psychological interventions aiming on promoting cognitive engagement by problem solving skills, meaning finding, and focusing on present could be a research line derived from present studies results.
RESUMO
On 7 January 2020, the southern region of Puerto Rico was struck by a 6.4 magnitude earthquake, followed by continual seismic activity. Our team performed secondary analyses to explore the relationship between exposure to seismic activity, protection (support) received, and barriers to health care access for cancer patients. Methods: The research team collected data from the database of a longitudinal case-control cohort parent study concerning the impact of Hurricane Maria in Puerto Rican cancer patients. The participants from the parent study were recruited in community clinics. The extracted data was collected from 51 cancer patients who completed the parent study's interviews from January−July 2020 (seismic activity period). Barriers to health care were assessed using the Barrier to Care Questionaries (BCQ), which is composed of five subscales: skills, marginalization, knowledge and beliefs expectations, and pragmatics. Exposure to seismic activity and protection was assessed using their respective subscales from the Scale of Psychosocial Impact of Disasters. Results: The results showed a significant relationship between exposure to seismic activity and barriers to health care (p < 0.001) and its five subscales (p < 0.01). These results shed light on potential access to care barriers that could hinder cancer patient treatment in the event of a natural disaster.
Assuntos
Tempestades Ciclônicas , Neoplasias , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino , Humanos , Neoplasias/epidemiologia , Neoplasias/terapia , Porto RicoRESUMO
Lung cancer (LC) is the most frequent and deadly neoplasm in the world, and patients have shown a tendency to have more emotional distress than other cancer populations. Dignity Therapy (DT) is a brief intervention aimed to improve emotional well-being in patients facing life-threatening illness. OBJECTIVE: To analyze the effect of DT on anxiety, depression, hopelessness, emotional distress, dignity-related distress, and quality of life (QoL) in a group of Mexican patients with stage IV LC undergoing active medical treatment with baseline emotional distress. METHOD: In this preliminary pretest-posttest study, patients received three sessions of DT and were evaluated with the HADS, Distress Thermometer, Patient Dignity Inventory, single-item questions, and QLQ-30. RESULTS: In total, 24 out of 29 patients completed the intervention. Statistically significant improvements were found in anxiety, depression, emotional distress, hopelessness, and dignity-related distress with large effect sizes. Patients reported that DT helped them, increased their meaning and purpose in life, their sense of dignity, and their will to live, while it decreased their suffering. No changes were found in QoL. SIGNIFICANCE OF RESULTS: DT was well accepted and effective in improving the emotional symptoms of LC patients with distress that were undergoing medical treatment. Although more research is warranted to confirm these results, this suggests that DT can be used in the context of Latin-American patients.
Assuntos
Neoplasias Pulmonares , Neoplasias , Angústia Psicológica , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/terapia , Depressão/etiologia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Neoplasias/psicologia , Qualidade de Vida/psicologia , Respeito , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia , Estresse Psicológico/terapia , Inquéritos e QuestionáriosRESUMO
Resumo Estudo prospectivo e transversal, para determinar a prevalência de prejuízo cognitivo decorrente da quimioterapia e explorar fatores preditores e mediadores em sobreviventes de câncer de mama. Utilizou-se o Termômetro de Distress, Escala de Ansiedade e Depressão, Functional Assessment of Chronic Illness Therapy-General e Cognitive Function. As sobreviventes (N = 62) reportaram uma alta prevalência de distress (46,8%) e de ansiedade (24,2%), com baixos escores nas subescalas déficit cognitivo e habilidades cognitivas percebidos. O funcionamento cognitivo esteve associado à idade (β = 1,42; p = 0,002), atuação profissional (β = -23,12; p = 0,004), depressão (β = -5,43; p = 0,001) e qualidade de vida (β = 1,24; p = 0,001). Prejuízo cognitivo deve ser considerado no serviço de Psico-Oncologia.
Abstract Prospective and cross-sectional study to determine the prevalence of cognitive impairment resulting from chemotherapy, and to explore predictors and mediators in survivors of breast cancer. We used the Distress Thermometer, Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-General and Functional Assessment of Cancer Therapy-Cognitive Function. Survivors (N = 62) reported a high prevalence of distress (46.8%) and anxiety (24.2%), with low scores on cognitive deficit and cognitive skills perceived subscales. Cognitive functioning was associated with age (β = 1.42; p = 0.002), professional performance (β = -23.12; p = 0.004), depression (β = -5.43; p = 0.001), and quality of life (β = 1.24; p = 0.001). Cognitive impairment must be considered in Psycho-Oncology service.
RESUMO
O objetivo deste trabalho é divulgar a Psico-Oncologia como uma área de conhecimento que ampliou as possibilidades de atendimento ao portador de câncer seu familiar e equipe de saúde. O surgimento da Psico-Oncologia é influenciado por diversos fatores relacionados ao desenvolvimento das ciências, mas não deixa de ser uma necessidade que responde a uma demanda dos últimos anos, quando o câncer não para de atingir cada vez mais pessoas, levando as pesquisas a descobertas intrigantes, mas que muitas vezes não explicam o surgimento e a evolução da doença. A Psico-Oncologia nasce enfatizando os fatores psicossociais, biológicos e psicológicos no atendimento ao portador de câncer, e busca também uma compreensão maior dos processos de adoecimento e desenvolvimento da moléstia bem como as implicações na vida familiar dos portadores de câncer.
This work aims at divulging the main concepts of Psycho-Oncology as a new area of knowledge, involving the attendance of cancer patients, their families and health teams. Psycho-Oncology's creation was influenced by many different factors related to scientific development, but also constitutes an answer for a contemporary demand in face of an unprecedented number of new cases. This situation has conducted research to important discoveries, notwithstanding in many cases not being able to explain the causes nor the evolution of the disease. The reasons justifying this work involve the need for a systematized account accompanied of some necessary critical reflections, since information on the area is still scarce.
RESUMO
Abstract Objectives: to understand indicators of the social representation of the coronavirus in adolescents undergoing cancer treatment during the COVID -19pandemic. Methods: the theory of social representations was used as theoretical and methodological support in its procedural approach in an exploratory study of a qualitative nature. The free word association technique was used in the application of virtual forms using guidelines of the snowball method. The terms 'Coronavirus', 'Going to the hospital' and 'Cancer treatment' were applied. After that moment, the participants were asked for a hierarchy and justification of the evoked words. Data analysis was based on content analysis and frequency distribution of the content produced. Results: articulations were made on the impacts that the pandemic situation had on the treatment experience of that population. It was identified a character endowed with fear and tension about the elaboration of the reality of these subjects in the current period in face of the inevitability of a hospital scenario that facilitates contamination and facing the immunological vulnerability characteristic of their treatments. Conclusions: the participants constructed different contents of psychological suffering aimed at expressions of fear and insecurity experienced during the pandemic period in the face of assistance in the hospital setting. This study is understood as a contribution to more effective actions in order to adapt the care plan of this population, aiming at future professional interventions.
Resumo Objetivos: compreender indicadores da representação social do coronavírus em jovens em tratamento oncológico durante a pandemia do COVID-19. Métodos: utilizou-se como apoio teórico-metodológico a teoria das representações sociais na sua abordagem processual em estudo exploratório de natureza qualitativa. Empregou-se a técnica de associação livre de palavras na aplicação de formulários virtuais utilizando diretrizes do método bola de neve. Foram aplicados os termos indutores 'Coronavírus', 'Ir ao hospital' e 'Tratamento contra o câncer'. Após esse momento foi solicitado aos participantes uma hierarquização e justificativa das palavras evocadas. A análise dos dados foi pautada na análise de conteúdo e distribuição de frequência dos conteúdos produzidos. Resultados: realizou-se articulações sobre os impactos que a conjuntura pandêmica gerou na experiência de tratamento da referida população. Identificou-se um carácter dotado de receio e tensão sobre a elaboração da realidade desses sujeitos no período atual diante da inevitabilidade de um cenário hospitalar facilitador da contaminação e frente a vulnerabilidade imunológica característica de seus tratamentos. Conclusões: os participantes construíram diferentes conteúdos de sofrimento psicológico voltados para expressões de medo e insegurança vivenciadas no período da pandemia diante da assistência em cenário hospitalar. Entende-se este estudo como uma contribuição para ações mais efetivas no intuito de adequar o plano de cuidado dessa população, visando futuras intervenções profissionais.