Resignificación de la vida por parte de jóvenes sobrevivientes al cáncer hematológico / Resignification of Life by Young People Survivors of Hematologic Cancer

Introducción: Los jóvenes con enfermedades oncológicas enfrentan dificultades durante los períodos de diagnóstico, tratamiento y recuperación. Estos procesos complejos cargados de experiencias vitales inusitadas producen la transformación de su conciencia y los lleva a construir nuevos significados en la manera de comprender, relacionarse y actuar en el mundo que los rodea. Objetivo: Comprender el (re)significado de la vida a partir de la experiencia de los jóvenes que sobrevivieron al cáncer hematológico. Métodos: Estudio cualitativo, que utilizó la Teoría Fundamentada en Datos como metodología y el referencial de la Teoría de la Complejidad de Morin. Se realizaron entrevistas en profundidad a 12 adolescentes sobrevivientes de cáncer hematológico. El tamaño de muestra fue determinado al alcanzar nivel de saturación. El análisis fue simultáneo durante la recolección de los datos, mediante codificación abierta, axial y selectiva según lo señalan Strauss y Corbin. Resultados: Emergieron dos categorías: Reorganizando su vida por medio de cambios y aprendizajes para vencer al cáncer y, Asumiendo una mejor comprensión y compromiso con los demás y consigo mismo. Conclusiones: Las experiencias vividas por jóvenes sobrevivientes que padecen de cáncer modifican su forma de vivir y se tornan más comprensivos con el sufrimiento que ocasiona la enfermedad. Esta situación los hace más solidarios y comprometidos con su contexto social sobre todo con su familia y con pacientes oncológicos(AU)

Introduction: Young people with oncological diseases face difficulties during the periods of diagnosis, treatment and recovery. These complex processes loaded with unusual life experiences produce the transformation of their consciousness and lead them to construct new meanings in the way that they understand, relate and act in the world around them. Objective: To understand the (re)signification of life from the experience of young survivors of hematological cancer. Methods: A qualitative study was carried out, using the data driven theory as the methodology and Morin's complexity theory as the referent. In-depth interviews were conducted with twelve adolescent hematologic cancer survivors. The sample size was determined by reaching the saturation level. The analysis was simultaneous during data collection, using open, axial and selective coding according to Strauss and Corbin. Results: Two categories emerged: 1. reorganizing their life through changes and learning to overcome cancer and 2. assuming a better understanding and commitment to others and to themselves. Conclusions: The experiences lived by young cancer survivors modify their way of living as they become more understanding of the suffering caused by the disease. This situation makes them more supportive and committed to their social context, especially with their family and with cancer patients(AU)

Subclinical Anthracycline-Induced Cardiotoxicity in the Long - Term Follow-Up of Lymphoma Survivors: A Multi-Layer Speckle Tracking Analysis / Cardiotoxicidade Subclínica Induzida por Antraciclina no Seguimento a Longo Prazo de Sobreviventes de Linfoma: Uma Análise Speckle Tracking Multi-Layer

Abstract Background: Anthracycline generates progressive left ventricular dysfunction associated with a poor prognosis. Objectives: The purpose of this study was to evaluate whether layer-specific strain analysis could assess the subclinical left ventricular dysfunction after exposure to anthracycline. Methods: Forty-two anthracycline-treated survivors of large B-cell non-Hodgkin lymphoma, aged 55.83 ± 17.92 years (chemotherapy group) and 27 healthy volunteers, aged 51.39 ± 13.40 years (control group) were enrolled. The cumulative dose of epirubicin in chemotherapy group was 319.67 ± 71.71mg/m2. The time from last dose of epirubicin to the echocardiographic examination was 52.92 ± 22.32 months. Global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), subendocardial, mid and subepicardial layer of longitudinal (LS-ENDO, LS-MID, LS-EPI) and circumferential strain (CS-ENDO, CS-MID, CS-EPI) values were analyzed. Transmural strain gradient was calculated as differences in peak systolic strain between the subendocardial and subepicardial layers. A value of p < 0.05 was considered significant. Results: Conventional parameters of systolic and diastolic function showed no significant difference between two groups. Compared with controls, patients had significantly lower GCS and GLS. Multi-layer speckle tracking analysis showed significant reduction of circumferential strain of subendocardial layer, transmural CS gradient and longitudinal strain of all three layers. In contrast, the two groups did not differ in transmural longitudinal strain gradient and radial strains. Conclusions: It proved the preferential impairment of subendocardial deformation in long-term survivors after exposure to anthracycline. Multi-layer speckle tracking echocardiography might facilitate the longitudinal follow-up of this at-risk patient cohort.

Resumo Fundamentos: A antraciclina gera uma disfunção ventricular esquerda progressiva associada a um prognóstico ruim. Objetivos: O propósito deste estudo foi avaliar se a análise layer específico de strain poderia avaliar disfunção ventricular esquerda subclínica após exposição a antraciclina. Métodos: Foram inscritos quarenta e dois sobreviventes tratados com antraciclina por linfoma não Hodgkin de células B grandes, de 55,83 ± 17,92 anos (grupo de quimioterapia) e 27 voluntários saudáveis, de 51,39 ± 13,40 anos (grupo controle). A dose cumulativa de epirrubicina no grupo de quimioterapia foi de 319,67 ± 71,71 mg/m2. O tempo desde a última dose de epirrubicina até o exame ecocardiográfico foi de 52,92 ± 22,32 meses. Analisaram-se o strain longitudinal global (GLS), o circunferencial (GCS) e o strain radial (GRS), os valores das camadas subendocárdica, média e subepicárdica so strain longitudinal (LS-ENDO, LS-MID, LS-EPI) e do strain circunferencial (CS-ENDO, CS-MID, CS-EPI). O gradiente de strain transmural foi calculado como a diferença no strain sistólico pico entre as camadas subendocárdicas e subepicárdicas. Um valor de p < 0,05 foi considerado significativo. Resultados: Os parâmetros convencionais da função sistólica e diastólica não mostraram diferenças significativas entre dois grupos. Comparados aos controles, os pacientes apresentaram GCS e GLS significativamente menores. A análise de speckle tracking multi-layer mostrou uma redução significativa no strain circunferencial da camada subendocárdica, o gradiente transmural CS e o strain longitudinal das três camadas. Em contraste, os dois grupos não diferiram no gradiente de strain longitudinal transmural e de strain radiais. Conclusões: Provou-se a deterioração preferencial do strain subendocárdico em sobreviventes de longa duração após exposição à antraciclina. O ecocardiograma de speckle tracking multi-layer pode facilitar o acompanhamento longitudinal dessa coorte de pacientes em risco. (Arq Bras Cardiol. 2018; 110(3):219-228)