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Introducción: La ifosfamida es un agente alquilante utilizado para el tratamiento de enfermedades oncohematológicas. Entre sus eventos adversos agudos se encuentra la neurotoxicidad. Esta puede presentarse desde el inicio de la infusión hasta tres días después. El tratamiento consiste en suspender la administración y asegurar una adecuada hidratación. Objetivo: Describir eventos neurológicos asociados al uso de ifosfamida en pacientes pediátricos con enfermedades oncohematológicas. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo y transversal. Los datos se obtuvieron de historias clínicas de pacientes internados en el Hospital Garrahan que infundieron ifosfamida y desarrollaron síntomas neurológicos. Se analizaron edad, diagnóstico de base, dosis de ifosfamida, síntomas neurológicos y su relación con la infusión, tratamiento instaurado, exámenes complementarios y posibles factores de riesgo asociados. Resultados: Se registraron un total de catorce eventos neurológicos en doce pacientes, sin diferencia de sexo, con una mediana de edad de 9,5 años. La enfermedad de base más prevalente fue osteosarcoma. Las convulsiones fueron el síntoma más frecuente (50%), seguido de somnolencia y paresias. La combinación de ifosfamida y etopósido con/sin carboplatino se asoció en un 36% cada uno. El 64% desarrolló neurotoxicidad dentro de las primeras cuatro horas. Ningún paciente presentó alteraciones en los exámenes complementarios. Todos presentaron recuperación ad integrum. Conclusión: Este estudio brinda información acerca del tiempo de aparición de esta complicación, lo cual facilitará su detección precoz y tratamiento oportuno (AU)
Introduction: Ifosfamide is an alkylating agent used for the treatment of cancer. Among its acute adverse events is neurotoxicity. This can occur from the beginning of the infusion up to three days afterwards. Treatment consists of discontinuing administration and ensuring adequate hydration. Objective: To describe neurological events associated with the use of ifosfamide in children with cancer. Materials and methods: Observational, descriptive, retrospective, and cross-sectional study. Data were obtained from clinical records of patients admitted to the Garrahan Hospital who received ifosfamide infusion and developed neurological symptoms. Age, baseline diagnosis, ifosfamide dose, neurological symptoms and their relationship with the infusion, treatment, complementary tests, and possible associated risk factors were analyzed. Results: A total of fourteen neurological events were recorded in twelve patients, without difference in sex and with a median age of 9.5 years. The most prevalent underlying disease was osteosarcoma. Seizures were the most frequent symptom (50%), followed by drowsiness and paresis. The combination of ifosfamide and etoposide with/without carboplatin was associated in 36% each. Sixty-four percent developed neurotoxicity within the first four hours. None of the patients presented with abnormalities in the complementary examinations. All recovered ad integrum. Conclusion: This study provides information about the time of onset of this complication, which will facilitate its early detection and timely treatment (AU)
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Neurotoxicity Syndromes/diagnosis , Neurotoxicity Syndromes/etiology , Ifosfamide/adverse effects , Neoplasms/drug therapy , Seizures/chemically induced , Incidence , Cross-Sectional Studies , Retrospective Studies , Antineoplastic Agents, Alkylating/adverse effectsABSTRACT
Objetivo: Analizar el rol predictivo de las estrategias de afrontamiento y el soporte social percibido, sobre los estilos de humor en padres migrantes de niños con cáncer. Método: Se empleó un diseño cuantitativo transaccional-correlacional y un muestreo no probabilístico por conveniencia. Participaron 62 progenitores (11 hombres y 51 mujeres) entre los 20 y 61 años, quienes respondieron la Escala del Sentido del Humor (HSQ), el Cuestionario de Estimación del Afrontamiento (COPE) y el Medical Outcomes Study Social Support Survey (MOS-SSS). Resultados: Se establecieron modelos de regresión para el humor afiliativo (R²=0,19, p<0,001) y agresivo (R²=0,25, p<0,001), ambos considerados estilos de humor orientados a los demás. Respecto a los estilos orientados a uno mismo, para el humor de mejoramiento personal se desarrollaron dos modelos, el primero considera el soporte social global (R²=0,25, p< 0,001) y el segundo el soporte afectivo (R²=0,27, p< 0,001); y de la misma forma para el humor de descalificación personal, un modelo incluye el soporte social global (R²=0,28, p< 0,001) y el segundo el soporte instrumental (R²=0,27, p< 0,001). Conclusión: Las estrategias de afrontamiento y el soporte social en relación con los estilos de humor en contexto de enfermedad y migración demuestra la efectividad de ciertas estrategias y estilos considerados desadaptativos ante una situación altamente estresante.
Objective: To analyze the predictive role of coping strategies and social support over humor styles in parents who migrate along with children with cancer. Method: A transactional-correlational quantitative design and non-probabilistic convenience sampling were used. It involved 62 parents (11 men and 51 women) between 20 and 61 years. They answered the Humor Styles Questionnaire (HSQ), COPE Inventory (COPE) and the Medical Outcomes Study Social Support Survey (MOS-SSS). Results: Regression models were developed for affiliative (R²=0,19, p<0,001) and aggressive humor (R²=0,25, p<0,001), both considered humor styles towards others. For self-oriented humor styles, two models were built to predict self-enhancing humor. The first model considers global social support (R²=0,25, p<0,001), while the second model, affective support (R²=0,27, p<0,001). Likewise, the first model explaining self-defeating humor considers global social support (R²=0,28, p<0,001) and the second, instrumental support (R²=0,27, p<0,001). Discussion: Coping strategies and social support in relation to humor styles in the context of illness and migration demonstrate the effectiveness of certain strategies and styles considered maladaptive in face of a highly stressful situation.
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ABSTRACT This study aims to investigate up-to-date scientific information about physical activity, COVID-19, and childhood cancer. This study is an integrative review. Research was conducted in the Science Direct database, using keywords in three different combinations. In total, 50 publications classified as the most relevant of each keyword combination were selected, 26 eligible publications were reached from August 2019 to July 2021, of which nine were duplicates. When exclusion criteria were applied, 11 complete studies were selected. The level of physical activity (PA) of children diagnosed with cancer or those who survived cancer is low. Changes due to the COVID-19 pandemic include the decrease in the level of PA and the increase in the use of technological devices. The minimum PA recommendations for this population vary but some evidence supports its importance and benefits in minimizing the adverse effects arising from cancer and from the performed medical treatment. Exercise-based interventions should be chosen and carried out considering the type of cancer and the stage of treatment the child is in due to the evidence of its effectiveness.
RESUMEN Este estudio tiene como objetivo investigar, en la base de datos ScienceDirect, la información científica actualizada sobre actividad física, COVID-19 y cáncer infantil, mediante una revisión integradora, en la cual se utilizaron las palabras clave en tres combinaciones diferentes. Se seleccionaron cincuenta publicaciones clasificadas como las más relevantes de cada combinación, y se alcanzaron 26 publicaciones elegibles en el periodo entre agosto de 2019 y julio de 2021, de las cuales nueve fueron textos duplicados. Al aplicar los criterios de exclusión, se seleccionaron 11 artículos completos. El nivel de actividad física (AF) de los niños diagnosticados de cáncer o supervivientes de cáncer es bajo, y entre los cambios provocados por la pandemia de la COVID-19 se encuentran la disminución del nivel de AF y el aumento en el uso de dispositivos tecnológicos. Las recomendaciones mínimas de AF para esta población varían entre sí, sin embargo, existe evidencia que respalda su importancia y los beneficios en la minimización de los efectos adversos derivados del propio cáncer y del tratamiento médico realizado. Las intervenciones basadas en ejercicios, para la cual ya existe evidencia de efectividad, deben elegirse y llevarse a cabo teniendo en cuenta el tipo de cáncer y la etapa de tratamiento en la que se encuentra el niño.
RESUMO O objetivo deste trabalho é investigar, na base de dados Science Direct, informações científicas sobre atividade física, covid-19 e câncer infantojuvenil, através de uma revisão integrativa, utilizando três combinações de palavras-chave. Cinquenta publicações mais relevantes de cada combinação de palavras-chave foram selecionadas, e chegou-se a 26 artigos elegíveis no período compreendido entre agosto de 2019 e julho de 2021, dos quais nove eram textos duplicados. Aplicando-se os critérios de exclusão, foram selecionados 11 estudos completos. Constatou-se que o nível de atividade física (AF) de crianças com câncer ou sobreviventes do câncer é baixo e que entre as mudanças causadas pela pandemia de covid-19 estão a diminuição do nível de AF e o aumento do uso de dispositivos tecnológicos. As recomendações mínimas de AF para essa população variam, entretanto há evidências que sustentam sua importância e seus benefícios ao minimizar os efeitos adversos oriundos do próprio câncer e do tratamento médico realizado. As intervenções baseadas em exercícios, para as quais já há evidência de eficácia, devem ser escolhidas e realizadas a partir do tipo de câncer e na fase do tratamento em que a criança está.
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Abstract Background Fear of cancer recurrence is one of the most distressing psychological consequences in cancer survivors and their informal primary caregivers (IPC). IPC of childhood cancer survivors (CCS) are often their mothers, which could intensify fear of cancer recurrence (FCR) and its impact on both IPC and CCS. However, the phenomenon has not been widely described in this specific population. Objective To summarize and analyze current evidence on the evaluation and management of FCR among IPC of CCS. Method A narrative review of studies included in four databases (PsycInfo, Medline, CINALH, and Web of Science) with no language or year of publication restrictions. Results Measures specifically developed to assess FCR among IPC of CCS comprising an interview and a questionnaire with initial psychometric evaluations and two short, online intervention programs based on cognitive-behavioral-contextual therapy were identified (ENGAGE and CASCAdE). Both have demonstrated acceptability in parents of CCS in high-income countries; preliminary evidence also exists of the effectivity of CASCAdE in reducing FCR. Discussion and conclusion Given the limitations of this area of psychological evaluation, the Fear of Cancer Recurrence Inventory, originally developed for adult cancer survivors, constitutes the most suitable tool for evaluating FCR among IPC of CCS. The CASCAdE program seems a promising intervention for IPC of CSS, although cultural adaptations, evaluations of its acceptability in low- and middle-income countries, and controlled studies in large samples are still required.
Resumen Antecedentes El miedo a la recurrencia del cáncer es una de las consecuencias psicológicas más angustiantes en los supervivientes y sus cuidadores primarios informales (CPI). Los CPI de supervivientes de cáncer infantil (SCI) a menudo son sus madres, lo que podría intensificar el miedo a la recurrencia (MR) y su impacto tanto a los CPI como a los SCI. Sin embargo, el fenómeno no se ha descrito ampliamente en esta población específica. Objetivo Resumir y analizar la evidencia actual sobre la evaluación y manejo del MR entre CPI de SCI. Método Se realizó una revisión narrativa de los estudios incluidos en cuatro bases de datos (PsycInfo, Medline, CINALH y Web of Science) sin restricciones de idioma o año de publicación. Resultados Se identificaron instrumentos desarrollados específicamente para evaluar MR entre CPI de SCI que comprenden una entrevista y un cuestionario, además de dos programas de intervención en línea basados en terapia cognitivo-conductual-contextual (ENAGE y CASCAdE). Ambos demostraron aceptabilidad en los padres de SCI en países de ingresos altos. También existe evidencia preliminar de la efectividad de CASCAdE en la disminución del MR. Discusión y conclusión Dadas las limitaciones de esta área de evaluación psicológica, el Inventario del Miedo a la Recurrencia del Cáncer, desarrollado originalmente para supervivientes adultos, constituye la herramienta más adecuada para evaluar MR en los CPI de SCI. El programa CASCAdE parece una intervención prometedora para CPI de SCI, aunque aún requiere adaptaciones culturales, evaluaciones de aceptabilidad en países de ingresos medio-bajos y estudios controlados con nuestras más grandes.
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Objetivo: Este estudio evaluó el efecto de la proximidad a fuentes industriales de contaminación del aire sobre la aparición de clústeres de casos de cáncer infantil en el Área Metropolitana del Valle de Aburrá, del departamento de Antioquia, durante el período 2000-2015. Metodología: La información de casos de cáncer infantil en menores de 15 años residentes del área metropolitana se obtuvo del Registro Poblacional de Cáncer de Antioquia, de dicho periodo. Se identificaron 32 conglomerados industriales, a partir del inventario de la autoridad ambiental local. Se realizaron pruebas de escaneo circular de Kulldorf locales y focalizadas, para detectar clústeres de cáncer infantil en los municipios y alrededor de los conglomerados industriales respectivamente. Se usó un modelo de regresión multivariable ajustado por estrato socioeconómico, para evaluar el efecto de las variables espaciales. Resultados: La tasa de incidencia específica en el Valle de Aburrá para el periodo evaluado fue de 117,13 casos por millón de niños menores de 15 años. Las tasas de incidencia más altas se presentaron en los municipios de Medellín y Sabaneta. La prueba de Kulldorf identificó 12 clústeres espaciales y 8 espacio-temporales con significación estadística en 7 de los municipios, particularmente en Bello y Medellín. Las pruebas focalizadas identificaron clústeres alrededor de 20 conglomerados industriales. En los modelos multivariables, un conglomerado en Bello evidenció asociación estadísticamente significativa e inversa entre la incidencia y la distancia al conglomerado con direccionalidad sureste. Conclusión: Algunos conglomerados espacio-temporales de cáncer infantil en el Área Metropolitana del Valle de Aburrá entre 2000 y 2015 están relacionados con proximidad a fuentes industriales de contaminación del aire.
Objective: This study evaluated the effect of proximity to industrial sources of air pollution on the occurrence of clusters of childhood cancer cases in the Aburrá Valley Metropolitan Area, Department of Antioquia, during the 2000-2015 period. Methodology: The information on childhood cancer cases in children under 15 years of age residing in the metropolitan area was obtained from the Registro Poblacional de Cáncer de Antioquia (Antioquia Cancer Population Registry) for that period. 32 industrial clusters were identified based on the local environmental authority's inventory. Local and targeted Kulldorff's circular scan tests were performed to detect childhood cancer clusters in the municipalities and surrounding the industrial clusters, respectively. We used a multivariate regression model adjusted for socioeconomic strata to assess the effect of spatial variables. Results: The specific incidence rate in the Aburrá Valley for the evaluated period was 117.13 cases per million children under 15 years of age. The highest incidence rates occurred in the municipalities of Medellín and Sabaneta. The Kulldorff test identified 12 spatial clusters and 8 space-time clusters that were statistically significant in 7 municipalities, particularly in Bello and Medellín. The targeted tests identified childhood cancer clusters surrounding 20 industrial clusters. In multivariate models, an industrial cluster in Bello showed a statistically significant inverse association between incidence and distance from the industrial cluster toward the southeast. Conclusion: Some space-time childhood cancer clusters in the Aburrá Valley Metropolitan Area between 2000 and 2015 are related to proximity to industrial sources of air pollution.
Objetivo: Este estudo avaliou o efeito da proximidade a fontes industriais de poluição do ar sobre a aparição de agrupações de casos de câncer infantil na Área Metropolitana do Valle de Aburrá, do departamento de Antioquia, durante o período 2000-2015. Metodología: A informação de casos de câncer infantil em menores de 15 anos residentes da área metropolitana foi obtida do Registro Populacional de Câncer de Antioquia, de tal período. Foram identificados 32 conglomerados industriais, a partir do inventário da autoridade ambiental local. Foram realizados testes de varredura circular de Kulldorf locais e focalizados, para detectar agrupações de casos de câncer infantil nos municípios e ao redor dos conglomerados industriais, respectivamente. Foi usado um modelo de regressão multivariável ajustado por nivel socioeconômico, para avaliar o efeito das variáveis espaciais. Resultados: A taxa de incidência específica no Valle de Aburrá para o período avaliado foi de 117,13 casos por milhão de crianças menores de 15 anos. As maiores taxas de incidencia apresentaram-se nos municípios de Medellín e Sabaneta. O teste de Kulldorf identificou 12 agrupações de casos espaciais e 8 espaço-temporais com significação estatística em 7 dos municípios, particularmente em Bello e Medellín. As provas focalizadas identificaram agrupações de casos ao redor de 20 conglomerados industriais. Nos modelos multivariáveis, um conglomerado em Bello evidenciou associação estatisticamente significativa e inversa entre a incidência e a distância com o conglomerado orientado ao sudeste. Conclusão: Algumas agrupações de casos espaço-temporais de câncer infantil na Área Metropolitana do Valle del Aburrá entre 2000 e 2015 estão relacionadas com a proximidade a fontes industriais de poluição do ar.
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Resumen Con el advenimiento de tratamientos multidisciplinarios y de alta calidad, la supervivencia global a cinco años por cáncer en la población pediátrica ha mejorado considerablemente, llegando a ser hasta de 80% en países de altos ingresos. En Colombia también ha habido un aumento progresivo de la supervivencia global a 5 años, particularmente para las neoplasias hematológicas. En consecuencia, el número de supervivientes de cáncer infantil ha aumentado de forma importante en los últimos años y junto con ellos la aparición de eventos adversos tardíos relacionados con mayor morbilidad y riesgo de muerte prematura en la edad adulta. Aunque se han venido implementando estrategias de seguimiento a supervivientes de cáncer infantil en países de altos ingresos, en Colombia se han realizado pocos esfuerzos para la implementación de estas estrategias. De hecho, la práctica común en la mayoría de los centros de tratamiento consiste en dar de alta al niño que cumple 5 años de seguimiento oncológico, sin instrucciones precisas para dicho seguimiento. El objetivo del presente trabajo es argumentar sobre la necesidad de diseñar e implementar estrategias de seguimiento para supervivientes de cáncer infantil en el contexto colombiano.
Abstract With the advent of high-quality multidisciplinary treatments, the overall 5-year cancer survival in the pediatric population has improved considerably, reaching up to 80% in high-income countries. In Colombia, there has also been a progressive increase in overall 5-year survival, particularly for hematologic malignancies. Consequently, the number of childhood cancer survivors has increased significantly in recent years and, together with them, the occurrence of late adverse events related to increased morbidity and risk of premature death in adulthood. Although follow-up strategies have been implemented for childhood cancer survivors in high-income countries, few efforts have been made in Colombia to implement these strategies. In fact, the common practice in most treatment centers is to discharge children who have had 5 years of cancer follow-up, without precise instructions for long-term follow-up. This paper aims to argue about the need to design and implement follow-up strategies for survivors of childhood cancer in the Colombian context.
Subject(s)
Child , Total Quality Management , Mortality, Premature , Cancer Survivors , Neoplasms , Health Strategies , Aftercare , SurvivorshipABSTRACT
Abstract: Objective: To determine the magnitude of mortality due to acute lymphoblastic leukemia (ALL) nationally and by age group, sex, state of residence and insurance status, as well as to evaluate time trends during the period 1998-2018 Materials and methods: We obtained ALL mortality data and estimated age-standardized national, state-level and health insurance mortality rates. We conducted a joinpoint regression analysis to describe mortality trends across the study period and estimate the average annual percent change (AAPC). Results: In a 20-year period, age-standardized ALL mortality rates increased from 1.6 per 100 000 in 1998 to 1.7 in 2018. Nationally, a constant annual increase in mortality was observed for both sexes (1998-2002 AAPC 0.6 in boys, and 1998-2002 AAPC 0.3 in girls). We observed heterogeneity in childhood ALL at a state level. Conclusion: Our results reflect the social, economic, geographic diversity of the country. Monitoring and surveillance of this disease is crucial to assess quality of care.
Resumen: Objetivo: Determinar la magnitud de mortalidad por leucemia linfoblástica aguda (LLA) infantil a nivel nacional, por grupo de edad, sexo, estado y derechohabiencia, así como evaluar las tendencias en el tiempo. Material y métodos: Se estimaron las tasas de mortalidad estandarizadas por edad y estratificadas. Se realizó un análisis de regresión joinpoint para estimar el cambio porcentual anual promedio (AAPC). Resultados: En un periodo de 20 años, las tasas de mortalidad por LLA aumentaron de 1.6 por 100 000 en 1998 a 1.7 en 2018. A nivel nacional, se observó un aumento anual constante para ambos sexos (1998-2002 AAPC 0.6 en niños, y 1998-2002 AAPC 0.3 en niñas). Existe heterogeneidad en la LLA infantil a nivel estatal. Conclusión: Los resultados reflejan la diversidad social, económica y geográfica del país. El seguimiento y la vigilancia de esta enfermedad es fundamental para evaluar la calidad de atención e implementar medidas para su control.
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ABSTRACT Introduction In Brazil, 8,000 new cases of childhood cancer are estimated each year, whose causes are still little known, although some have genetically determined factors. Approximately 70% of human cancers have alterations in the TP53 gene, which encodes the protein responsible for inhibiting the disordered growth of cells exposed to injuries. However, the frequency of alterations in the expression of TP53 in childhood cancers in Brazil remains poorly known. Objective To evaluate the expression of TP53 gene in patients with childhood cancer in northeastern of Santa Catarina, Brazil. Materials and Methods: Retrospectively, 282 patients diagnosed with cancer between 2005 and 2015 in Joinville were included. TP53 expression was evaluated by immunohistochemistry using a score based on the intensity and percentage of stained cells. Results The p53 protein was positive in 25.2% of cases, with no difference between sexes. Considering the five main groups of tumors in the sample, the expression was positive in 31.8%, 27.3%, 20%, 17.2% and 5.9% of lymphomas, nephroblastomas, neuroblastomas, tumors of the Central Nervous System and leukemias, respectively. Conclusion The prevalence of TP53 expression was evaluated in different childhood cancers in the northeastern of Santa Catarina. Positivity was higher among lymphomas and lower in leukemias, but with no significant difference among the five most frequent tumors. Further studies that allow correlation with aggressiveness and disease evolution are required.
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La fatiga es una complicación que afecta a los pacientes con cáncer infantil aproximadamente al 65%. OBJETIVO: analizar la prevalencia de la fatiga en niños y adolescentes con cáncer y su interferencia en las actividades de la vida cotidiana. MATERIALES Y MÉTODOS: el enfoque de la investigación es cuantitativo, con alcance descriptivo, en base a las variables fatiga, edad, sexo y tipo de cáncer, posee un diseño no experimental y los instrumentos que fueron utilizados son historia clínica, base de datos e inventario breve de la fatiga. Muestra: Son 104 pacientes de 5 a 18 años de edad. RESULTADOS: de los 104 pacientes, 58 son del género masculino y 46 del género femenino. La fatiga asociada a otras complicaciones, 94 dieron positivo para la fatiga y 10 negativos, de los cuales el 40% presento fatiga con atrofia muscular (42 pacientes), el 35% fatiga con trastornos motores (36 pacientes), el 15% fatiga con trastornos posturales (16 pacientes) y el 10% sin fatiga. En la prueba de los 6 minutos, se determinó que el 10,6% del total de la muestra pasaron la prueba, mientras que la diferencia del (89,4%) no pasó. CONCLUSIÓN: la fatiga interfiere en las actividades de la vida cotidiana y es muy común en pacientes con leucemia con predomino al sexo masculino y la edad promedio es de 5 a 10 años.
Fatigue is a complication that affects approximately 65% of patients with childhood cancer. OBJECTIVE: to analyze the prevalence of fatigue in children and adolescents with cancer and its interference with activities of daily living. MATERIALS AND METHODS: the research approach is quantitative, with descriptive scope, based on the variables fatigue, age, sex and type of cancer, it has a non-experimental design and the instruments used were clinical history, database and brief fatigue inventory. Sample: 104 patients from 5 to 18 years of age. RESULTS.: of the 104 patients, 58 were male and 46 were female. Fatigue associated with other complications, 94 were positive for fatigue and 10 negative, of which 40% presented fatigue with muscular atrophy (42 patients), 35% fatigue with motor disorders (36 patients), 15% fatigue with postural disorders (16 patients) and 10% without fatigue. In the 6-minute test, it was determined that 10.6% of the total sample passed the test, while the difference (89.4%) did not pass. CONCLUSION: fatigue interferes with activities of daily living and is very common in patients with leukemia with male predominance and the average age is 5 to 10 years.
A fadiga é uma complicação que afeta aproximadamente 65% dos pacientes com câncer infantil. OBJETIVO: analisar a prevalência da fadiga em crianças e adolescentes com câncer e sua interferência nas atividades da vida diária. MATERIAIS E MÉTODOS: a abordagem de pesquisa é quantitativa, com escopo descritivo, baseada nas variáveis fadiga, idade, sexo e tipo de câncer, tem um desenho não experimental e os instrumentos utilizados são história clínica, banco de dados e breve inventário de fadiga. Amostra: 104 pacientes de 5 a 18 anos de idade. RESULTADOS: dos 104 pacientes, 58 eram homens e 46 eram mulheres. A fadiga associada a outras complicações, 94 foram positivas para fadiga e 10 negativas, das quais 40% apresentaram fadiga com atrofia muscular (42 pacientes), 35% fadiga com distúrbios motores (36 pacientes), 15% fadiga com distúrbios posturais (16 pacientes) e 10% sem fadiga. No teste de 6 minutos, foi determinado que 10,6% do total da amostra passou no teste, enquanto a diferença (89,4%) não passou. CONCLUSÃO: a fadiga interfere nas atividades da vida diária e é muito comum em pacientes com leucemia com predomínio masculino e idade média de 5 a 10 anos.
Subject(s)
Male , Female , Adolescent , Fatigue , Leukemia , Prevalence , Motor DisordersABSTRACT
Resumen El cáncer infantil comprende diferentes y numerosos tipos de tumores que se desarrollan en niños y adolescentes de 0 a 19 años, cuyos efectos secundarios en su mayoría, derivan de los tratamientos recibidos y pueden persistir durante el tiempo. Objetivo. Determinar el impacto del cáncer en la condición física y calidad de vida en niños, niñas y adolescentes. Materiales y métodos. De enfoque cuali-cuantitativo, con alcance descriptivo y relacional, posee un diseño no experimental de corte transversal, una muestra poblacional de 104 pacientes de ambos sexos y en edades de 5 a 18 años. Resultados. Predomina el sexo masculino y la edad promedio del grupo está entre los 9 y 12 años, siendo la Leucemia linfoblástica aguda la de mayor incidencia; se muestra déficit en la fuerza muscular, flexibilidad, predominio de fatiga y escasa o nula actividad física. Conclusión. El análisis de este estudio y sus conclusiones, se puede evidenciar que existen diferentes estados de bienestar y que su condición física se puede ver influenciada por el tipo cáncer, duración y tratamiento recibido, lo cual trae como consecuencia en ellos, una marcada baja en su funcionabilidad y por ende impacto en la ejecución e integración de sus actividades de la vida diaria y calidad de vida.
Abstract Childhood cancer comprises different and numerous types of tumors that develop in children and adolescents from 0 to 19 years of age, the majority of which side effects derive from the treatments received and can persist over time. Objective: To determine the impact of cancer on the physical condition and quality of life in children and adolescents. Materials and methods: With a qualitative-quantitative approach, with a descriptive and relational scope, it has a non-experimental cross-sectional design, a population sample of 104 patients of both sexes and ages 5 to 18 years. Results: males predominate and the average age of the group is between 9 and 12 years old, with acute lymphoblastic leukemia the one with the highest incidence; It shows a deficit in muscular strength, flexibility, a predominance of fatigue and little or no physical activity. Conclusion: The analysis of this study and its conclusions, it can be evidenced that there are different states of well-being and that their physical condition can be influenced by the type of cancer, duration and treatment received, which results in a marked decrease in its functionality and therefore impact on the execution and integration of its activities of daily life and quality of life.
Resumo O câncer infantil compreende diferentes e numerosos tipos de tumores que se desenvolvem em crianças e adolescentes de 0 a 19 anos, a maioria dos quais efeitos colaterais são decorrentes dos tratamentos recebidos e podem persistir ao longo do tempo. Objetivo. Determinar o impacto do câncer na condição física e na qualidade de vida de crianças e adolescentes. Materiais e métodos. Com abordagem qualitativo-quantitativa, com abrangência descritiva e relacional, tem desenho transversal não experimental, amostra populacional de 104 pacientes de ambos os sexos e idades de 5 a 18 anos. Resultados. o sexo masculino predomina e a idade média do grupo está entre 9 e 12 anos, sendo a leucemia linfoblástica aguda a de maior incidência; Apresenta déficit de força muscular, flexibilidade, predomínio de fadiga e pouca ou nenhuma atividade física. Conclusão. A análise deste estudo e suas conclusões, pode ser evidenciado que existem diferentes estados de bem-estar e que sua condição física pode ser influenciada pelo tipo de câncer, duração e tratamento recebido, o que resulta em uma diminuição acentuada do sua funcionalidade e, portanto, impactam na execução e integração de suas atividades de vida diária e na qualidade de vida.
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Resumen Objetivo: Describir los efectos cardiovasculares del tratamiento del cáncer infantil en supervivientes mediante métodos clínicos, electrocardiográficos y ecocardiográficos. Material y métodos: Estudio transversal y observacional de casos y controles de 34 pacientes de una clínica de supervivientes de cáncer infantil, evaluados de forma clínica, con electrocardiograma, ecocardiografía convencional y strain. Edad promedio de 13.03 años; dosis acumulada de antracíclicos promedio de 219.5 mg/m2; siete además con radiación a tórax. Análisis con pruebas T de Student y regresión lineal. Resultados: Fracción de expulsión izquierda preservada en supervivientes. Strain longitudinal izquierdo en dos, tres cámaras y circunferencial disminuido en supervivientes (p < 0.05). Los enfermos sometidos a radioterapia y antracíclicos mostraron un incremento de la frecuencia cardíaca, disminución de la fracción de expulsión y fracción de acortamiento izquierdos (< 0.05). Ventrículo derecho sin cambios significativos. Discusión y conclusiones: Existe un gran número de supervivientes de cáncer infantil tratados con cardiotóxicos y radioterapia; éstos pueden experimentar cambios en el strain miocárdico ventricular (aun con fracción de expulsión normal) o arritmias, como lo muestra el grupo estudiado, que concuerda con protocolos internacionales previos. Es importante su evaluación cardiovascular completa para predecir el riesgo de insuficiencia cardíaca como parte de un seguimiento protocolizado en clínicas de cardiooncología bien establecidas.
Abstract Objective: To describe the cardiovascular effects of childhood cancer treatment in survivors through clinical, electrocardiogram and echocardiographic methods. Material and methods: Prospective, observational case-control study of 34 patients of a Childhood Cancer Survivors Clinic, evaluated clinically, with electrocardiogram, with conventional echocardiography and strain. Average age 13.03 years; cumulative average anthracyclic dose 219.5 mg/m2; seven also with chest radiation. Analysis with student T tests and linear regression. Results: Left ejection fraction in survivors was preserved. Longitudinal left strain in 2, 3 chambers and circumferential was decreased in survivors (p < 0.05). Those undergoing radiotherapy and anthracyclic presented increased heart rate, ejection fraction and left shortening fraction decreased (< 0.05). Right ventricle without significant changes. Discussion and conclusions: There are a large number of childhood cancer survivors treated with cardiotoxics and radiotherapy. They may present changes in ventricular myocardial strain (even with normal ejection fraction) and/or arrhythmias, as evidenced in the group studied, which is consistent with previous international studies. Its complete cardiovascular evaluation is important to predict the risk of heart failure as part of a protocolized follow-up in well-established cardio oncology clinics.
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Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Neoplasms/complications , Neoplasms/therapy , Cardiovascular Diseases/epidemiology , Case-Control Studies , Cross-Sectional Studies , Cancer Survivors , MexicoABSTRACT
BACKGROUND@#Patient navigators are trained to provide support and guidance to patients throughout the cancer care continuum. They help "navigate" through the maze of doctors' clinics, outpatient centers, insurance and payment systems, patient-support organizations, and other components of the health care system. Yet there is no existing patient satisfaction tool to assess the patient navigation program in the Philippines for pediatric cancer. @*OBJECTIVES@# This study aims to evaluate satisfaction with the patient navigation program using a validated Satisfaction with Interpersonal Relationship with Navigator (SN-I-Ph) Measure among Filipino caregivers in a tertiary referral center for childhood cancer.@*METHODOLOGY@#The tool was first translated for cultural appropriateness, translated, and back translated into Filipino; the content validity and internal consistency were tested. Caregivers of Filipino children with cancer were recruited to answer the survey and the results analyzed.@*OUTCOME@#Content validity for all 9 items was acceptable with scores of 4.5-5 and internal consistency showed satisfactory results with cronbach alpha of 0.9067. A total of 202 participants were recruited to join the survey. Results showed mean±SD of 42.6±7.8. All the 9 items showed excellent satisfaction.@*CONCLUSION@#This study showed good satisfaction with the interpersonal relationship of the navigators among caregivers. Participants enrolled in the patient navigation program reported a positive overall experience with the medical care.@*RECOMMENDATIONS@#The tool is recommended for use among hospitals with the patient navigation program to assess satisfaction of the caregivers. Further studies can assess caregiver’s satisfaction as to logistic aspects as well as how to measure benefits and outcomes with the program.
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Patient NavigationABSTRACT
Objective：We conducted a new physical fitness test and assessed activity and social participation in pediatric cancer survivors who participated in our hospital events and examined its characteristics and issues.Subjects：A total of 30 children aged 5 years or older (median age 9 years, 17 boys, 13 girls) were enrolled in the study. They were chosen from a pool of 44 pediatric cancer survivors who participated in our hospital's long-term follow-up events from August 2018 to August 2019.Methods：Medical records and evaluations performed at the events were examined retrospectively. Survey items included sex, diagnosis, age at evaluation and onset, years since discharge, physical and cognitive functions, new physical fitness test results, and ability to perform basic physical activity.Results：Regardless of the number of years since discharge from the hospital, physical fitness tended to be lower than the national average for both sexes and all ages, with a particular decline in endurance. Twenty-six of the 30 subjects (87%) were able to attend school all day and go out for a day. In addition, 11 (37%) participated in physical activities other than physical education and club activities.Conclusions：Childhood cancer survivors may have a long-term, persistent decline in physical fitness, even if they are able to participate in academic, leisure, and social activities, such as exercise lessons. It is beneficial to provide continuous support for physical fitness during hospitalization and throughout life, as well as to accomplish activities and social participation in accordance with growth.
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Objective：We conducted a new physical fitness test and assessed activity and social participation in pediatric cancer survivors who participated in our hospital events and examined its characteristics and issues.Subjects：A total of 30 children aged 5 years or older (median age 9 years, 17 boys, 13 girls) were enrolled in the study. They were chosen from a pool of 44 pediatric cancer survivors who participated in our hospital's long-term follow-up events from August 2018 to August 2019.Methods：Medical records and evaluations performed at the events were examined retrospectively. Survey items included sex, diagnosis, age at evaluation and onset, years since discharge, physical and cognitive functions, new physical fitness test results, and ability to perform basic physical activity.Results：Regardless of the number of years since discharge from the hospital, physical fitness tended to be lower than the national average for both sexes and all ages, with a particular decline in endurance. Twenty-six of the 30 subjects (87%) were able to attend school all day and go out for a day. In addition, 11 (37%) participated in physical activities other than physical education and club activities.Conclusions：Childhood cancer survivors may have a long-term, persistent decline in physical fitness, even if they are able to participate in academic, leisure, and social activities, such as exercise lessons. It is beneficial to provide continuous support for physical fitness during hospitalization and throughout life, as well as to accomplish activities and social participation in accordance with growth.
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Resumen Objetivo: Estudiar el crecimiento postraumático en sobrevivientes pediátricos de linfoma o tumores sólidos, tratados en el Servicio de Oncología del Hospital Nacional de Niños, de enero de 1990 a diciembre 2013. Métodos: Este es un estudio descriptivo con pacientes sobrevivientes de cáncer quienes se encontraban en remisión, por un tiempo mayor o igual a 5 años. Se analizó las características clínicas de los pacientes (sexo, lugar de residencia, edad, tipo y localización del tumor, tratamiento recibido, presencia de metástasis o recaída), así como se efectuó una entrevista sobre la condición psicosocial de los sobrevivientes, con énfasis en las consecuencias de la enfermedad en su vida actual. Resultados: Se analizaron las características clínicas de 30 pacientes sobrevivientes. Se encontró que el tipo de tumor más común en el grupo entrevistado fue el linfoma no Hodgkin (30 %), seguido de sarcomas (20 %). Las localizaciones tumorales mayormente observadas en estos pacientes fueron en cabeza y cuello (46,7 %), seguidas por abdomen y pelvis (26,7 %). El tratamiento más frecuente fue la combinación de quimioterapia, radioterapia y cirugía (37,7 %). Pero cabe resaltar que el 80 % de los pacientes tratados recibió quimioterapia como parte de su tratamiento y la mayoría reportó efectos adversos y dificultades relacionadas. El procedimiento quirúrgico más empleado fue la biopsia (53,3 %). La mayoría de los pacientes no presentó recaídas (83,3 %) ni metástasis (93,3 %). Con respecto a su condición actual, la edad promedio al momento de la entrevista fue de 15,9 años, y la mayoría residía en la provincia de San José (40 %), con sus padres y hermanos (36,7 %). La mayoría señaló reacciones positivas ante el diagnóstico, con actitudes buenas y cooperadoras. El mayor vínculo socioafectivo descrito corresponde a la familia y los amigos; un grupo importante de los pacientes recalca el apoyo institucional. Conclusiones: A pesar de que con este trabajo no se pueden realizar generalizaciones sobre los pacientes en remisión de cáncer infantil, la información obtenida permite conocer de manera indirecta el impacto psicosocial de la enfermedad oncológica en la condición actual de un grupo de pacientes, y resalta una actitud positiva en los sobrevivientes.
Abstract Objective: To study resilience (post-traumatic growth) in pediatric cancer survivors who were treated in the Oncology Service of the National Children's Hospital, from January 1990 to December 2013. Methods: descriptive study with cancer survivors who were in remission, for a time greater tan or equal to 5 years. The clinical characteristics of the patients (sex, place of residence, age, type and location of the tumor, treatment received, presence of metastasis or relapse) were analyzed, as well as an interview on the psychosocial condition of the survivors, with emphasis on the consequences of the disease in their current life. Results: 30 survivors of childhood cancer were interviewed and the clinical characteristics were analized. Among the results, the most common type o tumor found was non Hodgkin lymphoma (30%), followed by sarcomas (20%). The tumor locations mostly observed in these patients were in the head and neck (46.7%), followed by the abdomen and pelvis (26.7%). The most frequent treatment was the combination of chemotherapy, radiotherapy and surgery (37.7%). But it should be noted that 80% of treated patients received chemotherapy as part of their treatment and the majority reported adverse effects and related difficulties. The most widely used surgical procedure was biopsy (53.3%). The majority of patients had no relapses (83.3%) or metastases (93.3%). Regarding their current condition, the average age at the time of the interview was 15.9 years, and the majority resided in the province of San José (40%), with their parents and siblings (36.7%). The majority indicated positive reactions to the diagnosis, with good and cooperative attitudes. The greatest socio-affective link described during their disease corresponds to family and friends and hospital health workers. Conclusions: Although, with this work, generalizations cannot be made about patients in remission of childhood cancer, the information obtained allows us to indirectly know the psychosocial impact of the oncological disease in the current condition of a group of patients in our country, and highlights a positive attitude in survivors.
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Humans , Child , Adolescent , Child , Costa Rica , Resilience, Psychological , Cancer Survivors/psychology , Posttraumatic Growth, Psychological , NeoplasmsABSTRACT
En Argentina, la mortalidad por cáncer infantil es mayor que en países más desarrollados, siendo el diagnóstico tardío una de las posibles causas. Nuestro objetivo fue determinar la frecuencia de obstáculos al diagnóstico enfrentados por las familias de niños con cáncer asistidas por un Organismo No Gubernamental, y algunos factores demográficos, institucionales y médicos asociados. Se realizó un análisis retrospectivo observacional y cuantitativo del recorrido diagnóstico de los niños con cáncer asistidos por la Fundación N.D. Flexer, Argentina, entre el 1/1/2011 y el 31/12/2015. El resultado primario fue la presencia de obstáculos para acceder al diagnóstico. Se consideró que existió un obstáculo cuando tuvieron lugar consultas no orientativas, demora familiar, demora institucional, autoderivación y/o más de 30 días entre la aparición de síntomas y el diagnóstico. La frecuencia dentro de cada categoría se contrastó mediante la prueba de χ2. La influencia de distintas variables se evaluó mediante una regresión logística multivariada. De 1818 familias incluidas, 63.5% enfrentaron algún tipo de obstáculos. Resultaron moduladores negativos el diagnóstico antes del año, de tumor renal y la concurrencia a un hospital público de la Ciudad de Buenos Aires o de capital provincial como centro de primer contacto (todos p < 0.0001). Resultaron moduladores positivos el diagnóstico de tumor óseo (p = 0.009) y los centros de atención primaria (p < 0.0001) y consultorios particulares (p = 0.001) como centros de primer contacto. El principal factor no biológico asociado a la frecuencia de obstáculos al diagnóstico de cáncer infantil fue el tipo de centro de primer contacto.
In Argentina, mortality from childhood cancer is higher than in more developed countries, with late diagnosis being one of the possible causes. Our objective was to determine the frequency of barriers to diagnosis faced by families assisted by a Non-Governmental Organization, and some associated demographic, institutional and medical factors. A retrospective observational and quantitative analysis of the diagnosis pathway of children with cancer assisted by the N.D. Flexer Foundation, Argentina, between 1/1/2011 and 12/31/2015 was carried out. The primary outcome was the presence of barriers to diagnosis. It was considered that there was a barrier when there were consultations without diagnostic suspicion, family delay, institutional delay, self-derivation and/ or more than 30 days between the onset of symptoms and diagnosis. The frequency of barriers within each category was contrasted by the χ2 test. A multivariate logistic regression was used to examine its association with relevant variables. Among the 1818 families included, 63.5% faced delays/ barriers to diagnosis. Negative modulators were diagnosis at age younger than 1-year, renal tumor and first attention at a public hospital of the City of Buenos Aires or a provincial capital hospital (all p < 0.0001). Positive modulators were the diagnosis of bone tumor (p = 0.009) and first attention at a primary healthcare center (p< 0.0001) or private doctor's office (p= 0.001). The main non-biological factor associated with the possibility of facing barriers to diagnosis was the type of first contact-health institution.
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Humans , Female , Infant , Child, Preschool , Child , Adolescent , Delayed Diagnosis/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Neoplasms/diagnosis , Argentina/epidemiology , Time Factors , Logistic Models , Retrospective Studies , Age Factors , Early Detection of CancerABSTRACT
Introducción: Para predecir una infección en estadios tempranos en niños con cáncer se han evaluado marcadores como ESD, PCR y PCT. Objetivo: evaluar la precisión diagnóstica para bacteriemia de estos marcadores al ingreso en niños con fiebre y leucemia aguda (LA) o linfoma (L) internados entre 2013-2016. Métodos: estudio analítico retrospectivo. Revisión de historias clínicas. Se calcularon sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y área bajo la curva ROC para cada marcador en MedCalc® V16.8.4. Se obtuvo autorización del Comité de Ética. Resultados:en total se internaron 31 niños con diagnóstico de LA y L, 19 presentaron fiebre y 12 no. Hubo 40 episodios de fiebre clasificados en 4 grupos: bacteriemia 14 (35%), infección documentada microbiológicamente 5 (12.5%), infección documentada clínicamente 2 (5%) y fiebre de origen desconocido 19 (47.5%). Los niveles de PCT fueron mayores en el grupo de bacteriemia registrando un valor promedio de 1,17ng/ mL (p: 0.045). El área bajo la curva ROC entre el grupo con y sin bacteriemia fue de 0.50 para ESD, 0.65 para PCR y 0.83 para PCT con S de 77.78%, E de 66.67%, VPP de 50% y VPN de 92.86%. Discusión: la PCT mostró ser el más eficaz que ESD y PCR para predecir bacteriemia. se deben realizar investigaciones con biomarcadores con el objeto de disminuir el uso inadecuado de antibióticos en pacientes con fiebre secundaria a enfermedad y acortar los tiempos de tratamiento en pacientes con infecciones adecuadamente resueltas mejorando ampliamente la calidad de vida en niños con cáncer (AU)
Introduction: To predict infection in early stages in children with cancer, markers such as ESR, CRP, and PCT have been evaluated. Objective: To evaluate the diagnostic precision for bacteremia of these markers on admission of children with fever and acute leukemia (AL) or lymphoma (L) admitted between 2013- 2016. Methods: A retrospective analytical study. Review of the clinical records. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the ROC curve were calculated for each marker in MedCalc® V16.8.4. The study was approved by the Ethics Committee. Results: Overall, 31 children with AL and L were admitted, 19 of whom presented with fever and 12 did not. There were 40 episodes of fever classified into 4 groups: bacteremia 14 (35%), microbiologically documented infection 5 (12.5%), clinically documented infection 2 (5%), and fever of unknown etiology 19 (47.5%). PCT levels were higher in the group with bacteremia with a mean value of 1.17ng/mL (p:0.045). The area under the ROC curve between the groups with and without bacteremia was 0.50 for ESR, 0.65 for CRP, and 0.83 for PCT with a sensitivity of 77.78%, specificity of 66.67%, PPV of 50%, and NPV of 92.86%. Discussion: PCT showed a greater efficacy than ESD and CRP to predict bacteremia. Research on biomarkers should be conducted to reduce the inadequate use of antibiotics in patients with fever secondary to disease and to shorten treatment times in patients with adequately resolved infections, thereby improving quality of life in children with cancer (AU)
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Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Blood Sedimentation , Leukemia/complications , Polymerase Chain Reaction/methods , Bacteremia/diagnosis , Fever/complications , Lymphoma/complications , Acute Disease , Retrospective Studies , Risk Factors , Bacteremia/microbiologyABSTRACT
RESUMO O câncer infantil apresenta 70% de chance de cura se diagnosticado precocemente, embora seja uma doença rara, e pode resultar na morte. A associação entre o câncer e a morte passa a ser conhecida pelas crianças, de alguma forma, desde o momento do diagnóstico, esse encontro é constante. Nesta pesquisa buscou-se desvelar se o tema da morte de si mesma ou de outras crianças com câncer são abordados por meio dos desenhos-estórias. A pesquisa foi desenvolvida em uma associação que presta assistência psicossocial, hospedagem, alimentação e transporte às crianças e aos acompanhantes durante o tratamento oncológico. Colaboraram com a pesquisa cinco crianças que estavam em tratamento oncológico e hospedadas na casa, sendo quatro do sexo feminino e uma do sexo masculino. Como instrumento para coleta dos dados foi utilizado entrevista semiestruturada com os responsáveis, objetivando identificar informações gerais a respeito das crianças. Posteriormente, com as crianças, foi executado o procedimento de desenho-estória, por meio de desenhos e associações verbais, introduzido por Walter Trinca, em 1972. Para análise e compreensão dos dados coletados, utilizou-se o modelo de Amedeo Giorgi. Posteriormente foram construídos dois eixos temáticos: as diversas perdas no adoecer e a morte de si e de seus companheiros de enfermaria. Os resultados desvelam que a criança busca compressão do que ocorre consigo e com o ambiente onde se encontra, lidam com a incerteza em relação ao futuro, podendo sentir a proximidade da morte e expressar seus sentimentos e emoções.
RESUMEN El cáncer infantil, presenta un 70% de probabilidad de curación si se diagnostica precozmente, aunque es una enfermedad rara, puede resultar en la muerte. La asociación entre el cáncer y la muerte pasa a ser conocida por los niños, de alguna forma, desde el momento del diagnóstico, ese encuentro es constante. En esta investigación se buscó desvelar si el tema de la muerte de sí misma o de otros niños con el cáncer son abordados por medios de los dibujos historias. Se desarrolló la investigación en una asociación que ayuda a la asistencia psicosocial, alojamiento, alimentación y transporte a los niños y acompañantes durante el tratamiento oncológico. Colaboraron con la investigación, cinco niños que estaban en tratamiento oncológico y hospedados en la casa, siendo cuatro del sexo femenino y una del sexo masculino. Como instrumento para la recolección de datos se utilizó una entrevista semiestructurada con los responsables, con el objetivo de identificar informaciones generales sobre el niño. Posteriormente con los niños, se ejecutó el procedimiento de dibujo historia, por medio de dibujos y asociaciones verbales, introducido por Walter Trinca, en 1972. Para el análisis y la comprensión de los datos recolectados, se utilizó el modelo de Amadeo Giorgi. Posteriormente se construyeron dos ejes temáticos: las diversas pérdidas en el enfermar y la muerte de sí y de sus compañeros de enfermería. Los resultados desvelan que el niño busca comprensión de lo que ocurre con él y con el ambiente en que se encuentra, se ocupa de la incertidumbre con respecto al futuro, pudiendo sentir la proximidad de la muerte y expresar sus sentimientos y emociones.
ABSTRACT Childhood Cancer presents 70% chance of cure if diagnosed early, although it is a rare disease, it can result in death. The association between cancer and death becomes known to children, somehow, from the moment of diagnosis, this encounter is constant. This study sought to reveal if the subject of the death of itself or of other children with cancer are approached through the drawings stories. The research was developed in an association that provides psychosocial assistance, lodging, food and transportation to children and companions during cancer treatment. Collaborated with the research, five children who were on cancer treatment and hosted in the house, four girls and one boy, collaborated with the research. As a tool for data collection, a semi-structured interview was applied with those responsible for the children, aiming to identify general information about the child. Later, with the children, the drawing-and-story procedure was applied, by means of drawings and verbal associations, introduced by Walter Trinca, in 1972. For analysis and understanding of the information collected, we used the model of Amedeo Giorgi. Later, two thematic axes were constructed: the various losses when getting sick and the death of oneself and the ward mates. The results reveal that the child seeks to understand what happens to it and the environment, deals with uncertainty about the future, being able to feel the proximity of death and express its feelings and emotions.
Subject(s)
Humans , Male , Female , Child , Life , Death , Medical Oncology , Neoplasms/psychology , Child Behavior/psychology , Child, Hospitalized/psychology , Drawing , Diagnosis , EmotionsABSTRACT
OBJECTIVES: Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer. METHODS: A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review. RESULTS: Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19). CONCLUSIONS: Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.
Subject(s)
Pregnancy , Brain , Case-Control Studies , Delivery of Health Care , Folic Acid , Health Education , Health Promotion , Odds RatioABSTRACT
Este artigo pretendeu realizar uma breve revisão de literatura da psico-oncologia sobre os efeitos do diagnóstico e tratamento de câncer na vida do indivíduo para, em seguida, relacionarmos com a teoria analítica sobre sonhos, trauma e a doença como símbolo. O objetivo deste trabalho é estudar os sonhos desses pacientes, entre 10 e 12 anos, estejam eles ainda em tratamento ou não, a fim de relacionar os elementos e/ou temáticas comuns aos sonhos deste grupo, com a experiência com a doença, suas sequelas e a teoria analítica. Foram realizadas entrevistas com o paciente e seu responsável, além da coleta dos relatos de sonhos das crianças. A análise do material nos aproximou da situação psíquica dos sujeitos, na qual, a partir dos elementos e estruturas oníricas, foi possível perceber uma fragilidade emocional intensa e a possibilidade de dissociação psíquica. Os temas oníricos remetem à doença e ao seu tratamento apontando para uma tentativa de elaboração dessas vivências.
This article aims to perform a literature review of psycho-oncology on the effects of cancer diagnosis and treatment on the individual's life, and then relate to the analytical theory about dreams, trauma and disease as a symbol. The objective of this study is to study the dreams of these patients, between 10 and 12 years old, whether they are still undergoing treatment or not, in order to study the elements and/or the themes common to the dreams of this group, relating them to the experience with the disease and its sequels and analytical theory. Interviews were conducted with the patient and his / her caregiver, as well as the collection of reports of children's dreams. The analysis of the material brought us closer to the psychic situation of the subjects, where, from the dream elements and structures, it was possible to perceive an intense emotional fragility and the possibility of psychic dissociation. The morbid themes and aspects related to the disease and its treatment point to an attempt to elaborate these experiences.
Este artículo pretendió realizar una revisión de literatura de la psicooncología sobre los efectos del diagnóstico y tratamiento de cáncer en la vida del individuo, para luego relacionarse con la teoría analítica sobre sueños, trauma y la enfermedad como símbolo. El objetivo de este trabajo es estudiar los sueños de estos pacientes, entre 10 y 12 años, estén ellos todavía en tratamiento o no, a fin de relacionar los elementos y/o temáticas comunes a los sueños de este grupo, con la experiencia con la enfermedad, sus secuelas y la teoría analítica. Se realizaron entrevistas con el paciente y su responsable, además de la recolección de los relatos de sueños de los niños. El análisis del material nos acercó a la situación psíquica de los sujetos, donde, a partir de los elementos y estructuras oníricas, fue posible percibir una fragilidad emocional intensa y la posibilidad de disociación psíquica. Los temas oníricos remiten a la enfermedad y su tratamiento apuntando hacia un intento de elaboración de esas vivencias.