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RESUMEN Objetivos. Comparar la mortalidad por todas las causas de pacientes oncológicos no vacunados que recibieron quimioterapia o inmunoterapia durante la pandemia, con aquellos tratados antes de la pandemia. Materiales y métodos. Realizamos un estudio de cohortes en cuatro hospitales terciarios en Argentina. Pacientes ambulatorios con una neoplasia sólida de cualquier estadio en tratamiento citotóxico o inmune intravenoso fueron elegibles. La cohorte pandémica se enroló durante la fase inicial del brote y se comparó con una cohorte de un período anterior a la pandemia utilizando emparejamiento por puntuación de propensión (PSM, por sus siglas en inglés). Los sujetos se emparejaron por edad, sexo, seguro de salud, factores de riesgo para complicaciones graves por COVID-19, estado funcional, tipo de cáncer y tratamiento, línea de tratamiento e índice de masa corporal. La mortalidad por todas las causas se estimó en ambas cohortes después de seis meses de seguimiento. Resultados. 169 pacientes fueron reclutados entre abril y agosto de 2020 para la cohorte pandémica y 377 para la cohorte prepandémica en el mismo período de 2019, 168 pacientes fueron emparejados. Luego de la PSM, la mortalidad por todas las causas fue del 17,9% en la cohorte pandémica y del 18,5% en la cohorte prepandémica, Riesgo Relativo: 0,97 (intervalo de confianza al 95 %: 0,61-1,52; p=0,888). En la cohorte pandémica, 30/168 pacientes fallecieron, ninguno por infección por COVID-19. Conclusiones. No hemos observado un aumento de mortalidad en pacientes ambulatorios no vacunados en tratamiento oncológico endovenoso activo durante la pandemia por COVID-19.
ABSTRACT Objectives. To compare all-cause mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic. Materials and methods. We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage under-going cytotoxic or intravenous immunotherapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a pre-pandemic cohort using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, risk factors for severe COVID-19 complications, performance status, cancer type and treatment, line of treatment, and body mass index. All-cause mortality was estimated for both cohorts after 6 months of follow-up. Results. A total of 169 patients were recruited between April and August 2020 for the pandemic cohort and 377 for the pre-pandemic cohort in the same months of 2019; 168 patients were matched. After PSM, all-cause mortality was 17.9% in the pandemic cohort and 18.5% in the pre-pandemic cohort; the Relative Risk was 0.97 (95 % confidence interval: 0.61-1.52; p=0.888). In the pandemic cohort, 30/168 patients died, but none from COVID-19. Conclusions. Our findings show that the mortality rate of unvaccinated ambulatory patients on active intravenous oncology treatment during the COVID-19 pandemic did not increase.
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Humans , Male , Female , Patient CareABSTRACT
Background: Many newer drugs are approved every year for the treatment of cancers. With the limitation of clinical trials data on long-term safety, there is a need for constant monitoring of drugs use in various population. Occurrence of adverse drug reactions (ADRs) due to anticancer drugs is high due to their cytotoxic effects. Aims and Objectives: This study aims to analyze ADR reported due to anticancer drugs in relation to frequency of their occurrence, causality, severity, and preventability. Materials and Methods: This was a retrospective analysis of ADRs due to cancer chemotherapeutic agents that were spontaneously reported between January 2017 and June 2018. Data were collected from the suspected ADR notification forms submitted to ADR Monitoring Centre of the institute. Data were analyzed for type of cancers, medications used, type of ADRs, causality assessment, severity, and preventability. Results: A total of 545 ADRs were reported from 391 cases, with majority in females (65.1%). Breast was more commonly involved cancer (16.62%) and cisplatin was the common individual drug reported to cause ADRs (16.15%). The most common ADR reported was paresthesia (13.03%) followed by diarrhea (12.29%). Causality assessment revealed that most cases were probably related (61.65%). Most of the cases were moderately severe (61.28%) and most of the reported ADRs were not preventable (72.65%). Conclusion: Toxicities due to anticancer drugs can affect different organs. Most of the reported cases in this study are not preventable and of moderately severe. Appropriate use of preventive strategies helps in reduction in the occurrence and severity of ADRs.
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A quimioterapia do câncer pode ocasionar reações adversas medicamentosas (RAM), podendo resultar de interações medicamentosas (IM) e impactar na adesão. O presente estudo relatou as RAM apresentadas por pacientes em quimioterapia (QT) e propôs estratégias de intervenções. Este trabalho foi aprovado em comité de ética (5.160.503), sendo incluídos 23 pacientes em quimioterapia (oral- VO e/ou endovenosa- EV) e todos foram entrevistados. Recebiam apenas o QTEV, 20 pacientes e 2 QTEV e VO, a maioria em tratamento paliativo (50%), predomínio de estadiamento IV, sendo as doenças mais presentes de pâncreas (27,3%), estômago (22,7%) e mama (18,2%) e esquema mais usado foi Carboplatina + Paclitaxel. As principais comorbidades foram diabetes e hipertensão arterial. As interações medicamentosas foram classificadas em graves (45%), moderadas (55%) e intencional (75%), sendo necessário introdução de medicamentos de suporte (61%). Houve RAM de maior gravidade, neutropenia, sendo necessário a suspensão temporária, e de menor gravidade náuseas. Houve um óbito relacionado a evolução de doença e, talvez, o tratamento possa ter contribuído. Ao final, foram feitas as intervenções para cada caso e validado o formulário para a consulta farmacêutica a pacientes oncológicos.
Cancer chemotherapy can cause adverse drug reactions (ADRs), which can result from drug interactions (IM) and impact adherence. The present study reported the ADRs presented by patients undergoing chemotherapy (CT) and proposed intervention strategies. This work was approved by the ethics committee (5,160,503), and 23 patients on chemotherapy (oral-VO and/or intravenous-IV) were included and all were interviewed. Only received CTIV, 20 patients and 2 CTIV and VO, most in palliative treatment (50%), predominance of stage IV, being the most common diseases of pancreas (27.3%), stomach (22.7%) and breast (18.2%) and the most used regimen was Carboplatin + Paclitaxel. The main comorbidities were diabetes and arterial hypertension. Drug interactions were classified as severe (45%), moderate (55%) and intentional (75%), requiring the introduction of supportive drugs (61%). There were more severe ADRs, neutropenia, requiring temporary suspension, and less severe nausea. There was one death related to the evolution of the disease and, perhaps, the treatment may have contributed. At the end, interventions were made for each case and the form for the pharmaceutical consultation to cancer patients was validated.
La quimioterapia contra el cáncer puede causar reacciones adversas a los medicamentos (RAM), que pueden ser consecuencia de interacciones farmacológicas (IM) y repercutir en la adherencia. El presente estudio reportó las RAM presentadas por pacientes en quimioterapia (QT) y propuso estrategias de intervención. Este trabajo fue aprobado en comité de ética (5.160.503), se incluyeron 23 pacientes en quimioterapia (oral- VO y/o endovenosa-EV) y todos fueron entrevistados. Recibieron sólo QTEV, 20 pacientes y 2 QTEV y VO, la mayoría en tratamiento paliativo (50%), predominio de estadiaje IV, siendo las enfermedades más presentes las de páncreas (27,3%), estómago (22,7%) y mama (18,2%) y el esquema más utilizado fue Carboplatino + Paclitaxel. Las principales comorbilidades fueron la diabetes y la hipertensión arterial. Las interacciones farmacológicas se clasificaron como graves (45%), moderadas (55%) e intencionadas (75%), requiriendo la introducción de fármacos de apoyo (61%). La RAM más grave fue la neutropenia, que requirió la suspensión temporal, y la menos grave las náuseas. Hubo una muerte relacionada con la evolución de la enfermedad y, tal vez, el tratamiento pudo haber contribuido. Al final, se realizaron intervenciones para cada caso y se validó el formulario de consulta farmacéutica a pacientes oncológicos.
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Humans , Male , Female , Adult , Middle Aged , Patients , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Palliative Care , Pharmaceutical Preparations , Carboplatin/adverse effects , Paclitaxel/adverse effects , Diabetes Mellitus , Drug Interactions , Hypertension , Nausea/drug therapy , Neoplasms/drug therapy , Neutropenia/drug therapyABSTRACT
OBJECTIVE@#To evaluate the clinical efficacy of Huangqi Sijunzi decoction (HQSJZD) for treating cancer-related fatigue (CRF) of spleen and stomach Qi deficiency type after chemotherapy in patients with breast cancer.@*METHODS@#A total of 94 breast cancer patients who developed CRF of spleen and stomach Qi deficiency type after chemotherapy were randomized into chemotherapy group (n=47) and traditional Chinese medicine (TCM) + chemotherapy group (n=47). The patients in chemotherapy group received the AC or EC regimen and non-drug interventions including psychological counseling, and those in TCM + chemotherapy group received oral administration of HQSJZD in addition to chemotherapy for 21 days as a treatment cycle, after which improvement of fatigue was assessed using Modified Piper Fatigue Scale. The active ingredients and targets of HQSJZD were screened using the TCM System Pharmacology Analysis Platform (TCMSP); the CRF- and breast cancer-related disease targets were retrieved based on data from the GeneCards, NCBI gene and OMIM databases to construct the component-target network and the protein-protein interaction (PPI) network. GO functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes KEGG pathway enrichment analysis of the target genes were performed to construct the component-disease-pathway-target biological network. The binding strength of the major drug ingredients and CRF key targets were predicted using AutoDock software.@*RESULTS@#The scores for somatic fatigue, emotional fatigue and cognitive fatigue, along with the overall fatigue score, showed more significant improvements in TCM+chemotherapy group than in chemotherapy group (P < 0.001), and the response rate reached 89.4% in the combined treatment group. We identified 250 targets for HQSJZD, 2653 CRF-related genes, 15 329 breast cancer-related genes and 161 prescription-disease intersected targets, from which topological analysis identified 66 potential key targets. GO and KEGG enrichment analyses predicted multiple pathways related with the disease. Molecular docking results suggested that the core ingredients of HQSJZD showed high affinities to the key targets AKT1, CASP3, IL6, JUN and VEGFA, among which AKT1 might be the most important target for HQSJZD to treat CRF.@*CONCLUSION@#HQSJZD can obviously improve CRF symptoms in breast cancer patients possibly by regulating multiple signaling pathways including PI3K-Akt through AKT1.
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Female , Humans , Breast Neoplasms/drug therapy , Drugs, Chinese Herbal/pharmacology , Medicine, Chinese Traditional , Molecular Docking Simulation , Network Pharmacology , Phosphatidylinositol 3-KinasesABSTRACT
Objective:To study the effects of broad-spectrum antibiotics and induced antibiotic-resistant bacteria on the efficacy of 5-fluorouracil (5-FU) chemotherapy for mice with colon cancer and to investigate the underlying mechanisms associated with anti-tumor immune responses.Methods:BALB/c mice were subcutaneously injected with CT26 colon cancer cells and randomized into four groups: tumor-bearing control group, antibiotic group treated with ampicillin, streptomycin and colistin, 5-FU group and anitibiotic+ 5-FU group. Tumor volumes and body weights were measured and recorded. Seven days after the last 5-FU treatment, the percentages of splenic immune cell subpopulations and proliferated CD8 + T cells after co-culturing with CT26 were analyzed by flow cytometry. Gut microbiota composition was detected by 16S rRNA sequencing and the bacteria in mesenteric lymph nodes (mLN) were isolated and cultured. Bone marrow-derive macrophages were stimulated with identified bacteria and the expression of M1 and M2 polarization markers were assessed by quantitative PCR. The proliferation of CD8 + T cells co-cultured with bacteria-treated macrophages was analyzed by flow cytometry. In addition, tumor-bearing mice were treated with 5-FU and oral gavage of bacteria isolated from antibiotic+ 5-FU group or PBS. Tumor volumes, gut microbiota composition and the percentages of proliferated CD8 + T cells co-cultured with CT26 were assessed. Results:Tumor volumes were larger and body weights were lower in the antibiotic+ 5-FU group than in the 5-FU group. The percentages of CD4 + T cells, CD8 + T cells and neutrophils did not varied significantly after using antibiotics, however, the percentage of monocytes was increased in the antibiotic group. The percentage of proliferated tumor-specific CD8 + T cells in the antibiotic+ 5-FU group was decreased compared with that in the 5-FU group. Compared with the control group and 5-FU group, antibiotic usage was associated with the changes in gut microbiota composition with decreased α diversity indexes. Escherichia coli, Klebsiella pneumonia, and Proteus mirabilis were isolated from mLNs of the antibiotic group, 5-FU group and antibiotic+ 5-FU group, respectively. Bone marrow-derived macrophages stimulated with Proteus mirabilis expressed arginase at a high level, which was a M2 polarization marker of macrophage, and associated with the decreased percentage of proliferated CD8 + T cells after co-culturing. Bacteria of the genus Proteus were enriched in the gut microbiota of 5-FU-treated tumor-bearing mice with the oral gavage of Proteus mirabilis. Although no significant inhibitory effect on tumor growth was observed, the oral gavage of Proteus mirabilis was associated with the decreased percentage of proliferated tumor-specific CD8 + T cells in vitro. Conclusions:Broad-spectrum antibiotics inhibited the efficacy of chemotherapy and the proliferation of tumor-specific CD8 + T cells, in which antibiotic-resistant bacteria might be involved.
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More than half the cancer patients undergoing cancer chemotherapy develop adverse drug reactions (ADRs). Cancer chemotherapeutic agents have a lower risk-benefit ratio than other drug therapy and kill cancerous as well as the normal rapidly dividing cells including bone marrow cells, gastrointestinal epithelium, hair follicles, etc. Their main ADRs are nausea and vomiting, mucositis, constipation, diarrhea, hematological toxicities, cardiac toxicity, alopecia, gonadal toxicity pulmonary toxicity, neurotoxicity, nephrotoxicity, etc. The severity of the adverse effects may range from mild nausea to life-threatening neutropenia. Administering premedication and antidotes are very vital in these patients. Upon the occurrence of adverse effects, immediate steps should be taken to manage them. Though the ADRs due to anticancer medications are not avoidable, careful monitoring of the patients and modulating the drug schedules/dosages can help in minimizing them. Healthcare professionals should also develop strategies to minimize the occupational hazards associated with these drugs
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Reactive oxygen species (ROS) which were partial metabolites of oxygen are highly reactive. Different concentrations of ROS have different effects on tumor development. Tumor cells have a high level of reactive oxygen species. The antioxidant system of tumor is in highly activated state, and thus modulation of reactive oxygen species levels could be an effective strategy to target cancer cells. Treatment with small molecules that disrupt the redox balance can kill tumor cells first. This paper outlines the main ideas of developing anti-tumor drugs based on reactive oxygen species regulation, and summarizes the representative drugs and research progress according to the mechanism of action, in an effort to suggest potential reference and ideas for developing anti-tumor drugs based on reactive oxygen species regulation.
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OBJECTIVE@#To evaluate the clinical efficacy and partial action mechanism of mild moxibustion combined with salt-separated moxibustion for gastrointestinal discomfort caused by chemotherapy for breast cancer.@*METHODS@#A total of 48 patients were randomly divided into an observation group and a control group, 24 cases in each group. The patients in the control group were treated with intravenous infusion of tropisetron hydrochloride (5 mg), once a day for three days; the patients in the observation group were additionally treated with mild moxibustion at Zusanli (ST 36), Zhongwan (CV 12), Guanyuan (CV 4), Qihai (CV 6) and salt-separated moxibustion at Shenque (CV 8), 15 min per treatment, once a day for 7 days. Before treatment and on the 7th day of chemotherapy, the levels of pepsinogenⅠ(PGⅠ), pepsinogenⅡ (PGⅡ), the ratio of PGⅠto PGⅡ (PGR) and gastrin 17 (G-17) in serum were measured. Before treatment and on the 3rd, 5th, 7th day of chemotherapy, the gastrointestinal reactions (nausea, vomiting, constipation, diarrhea) were compared between the two groups.@*RESULTS@#On the 7th day of chemotherapy, the serum levels of PGⅠ, PGⅡand G-17 in the observation group were lower than those in the control group (0.05). The total scores of nausea, vomiting and constipation during chemotherapy in the observation group were significantly lower than those in the control group (all <0.05).@*CONCLUSION@#The mild moxibustion combined with salt-separated moxibustion could effectively improve the symptoms of nausea, vomiting and constipation caused by chemotherapy in patients with breast cancer, and its mechanism may be related to the down-regulation of the levels of PGⅠ, PGⅡ and G-17 in serum.
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Humans , Acupuncture Points , Breast Neoplasms , Therapeutics , Moxibustion , Nausea , Treatment OutcomeABSTRACT
Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by seizures, headaches, altered mental status, cortical blindness and typical transient lesions on MRI. PRES may be associated with chemotherapy, molecular targeted drugs and immunosuppressive agents used in patients with cancer. PRES is a very rare condition in cancer patients. PRES is usually reversible with appropriate supportive care and most patients can be restarted with treatment.
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Background: Cancer is a multi-cellular disease which can arise from any cell type and organs. Adverse drug reactions (ADR) are undesirable consequence of cancer chemotherapeutic drugs. A great importance has to be given for their assessment, detection, monitoring, reporting and preventing these ADR for the beneficial effects of the patients. So the present study was undertaken for the purpose of detecting and quantifying those adverse reactions which is of some importance in therapeutic setting.Methods: A prospective observational study conducted in chemotherapy ward, male and female patients of any age receiving cancer chemotherapy and presenting with ADR’s in duration of 3 months.Results: 160 patients were observed. Out of 160 patients 123 presented with ADR’s. Most common ADR’s were loss of appetite (67.6), diarrhea (61.8%), vomiting (21.5%), nausea (17.7%), anemia (24.7%). Cisplatin, paclitaxel, oxaliplatin, doxorubicin, gefitinib are common drugs causing ADR’s.Conclusions: Cancer chemotherapeutic drugs are associated with various adverse reactions. This study shows the importance of active monitoring of these reactions and measures to prevent their effects early in the treatment of cancer.
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Introducción: El nexo entre quimioterapia y Cardiomiopatía de Takotsubo es cada vez más reconocido en años recientes, pero aunque la causalidad está establecida, los reportes aún son escasos, la cantidad de fármacos relacionados es creciente y los mecanismos de acción no están completamente dilucidados. Reporte de caso: Se presenta el caso de una paciente con Mieloma Múltiple que luego de una sesión de quimioterapia con Ciclofosfamida y Talidomida, desarrolla de forma súbita un cuadro compatible con síndrome coronario agudo; fue sometida a una angiocoronariografía que mostró arterias coronarias sin lesiones significativas, y balonamiento apical, hallazgos consistentes con Cardiomiopatía de Takotsubo. Conclusiones: La Miocardiopatía de Takotsubo puede representar una forma de disfunción cardiaca dentro del espectro de la cardiotoxicidad inducida por quimioterapia, que difiere de la forma más común que es la toxicidad por dosis acumulada. Dada la cantidad creciente de casos reportados, incluso la presencia de recidiva tras la re administración del mismo agente quimioterápico, deben identificarse adecuadamente los implicados y evitar su uso en pacientes de alto riesgo.(AU)
Introduction: The link between chemotherapy and Takotsubo cardiomyopathy has become increasingly recognized in recent years, although causality remains to be established and the mechanism of action is not yet fully understood. Case Report: Here we present the case of a patient with Multiple Myeloma, that after of cytotoxic treatment with cyclophosphamide and thalidomide, developed coronary acute syndrome. She went onto have coronary angiography that demonstrated unobstructed coronary arteries and Apical ballooning, consistent with Takotsubo C a r d i o m y o p a t h y. C o n c l u s i o n : Ta k o t s u b o cardiomyopathy may represent a form of cardiac dysfunction within the spectrum of chemotherapy￾induced cardiac toxicity that differs from the more common cumulative-dosing toxicity. Given the increasing amount of case report, and the presence of recurrence after the re administration from the same chemotherapy agent; must be properly identified and avoid its use in high risk patient.(AU)
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This study aimed to clarify the resources required to relieve distress during palliative care delivery to cancer patients. Between April 2015 and March 2017, 1479 outpatients receiving chemotherapy for cancer were screened using the Japanese version of the Support Team Assessment Schedule (STAS-J). When the STAS-J result was 2 points and higher, the patient was considered positive for distress. A certified nurse or pharmacist performed STAS-J screening and, in cases where the patient exhibited distress, took steps to alleviate the problem themselves or consulted another resource. Distress was identified in 181 (12.2%) of the 1479 patients. These 181 patients needed 288 resources. The resources used to alleviate distress were categorized as follows: direct support by certified nurse or pharmacist (153), consultation with the attending physician (98) and other (37). The required resource included the following twelve professionals: attending physician, ophthalmologist, dermatologist, dentist, orthopedic surgeon, palliative care physician, certified nurse, certified pharmacist, medical social worker, clinical psychologist, volunteers for cancer patients, and palliative care team. The frequency of the intervention by the certified nurse or pharmacist (61, 39.9%) in directly alleviating psychiatric distress was significantly higher than by consultation with the attending physician (10, 10.2%) (p<0.0001). However, the frequency of consultation with the attending physician in alleviating physical distress (88, 89.8%) was significantly higher than that of the certified nurse or pharmacist (92, 60.1%) (p<0.0001). We conclude that the certified nurse or pharmacist is important for the delivery of palliative cancer care, because they can directly provide relief from psychiatric distress.
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Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) tissue levels, and positive immunostaining for TNF-α, IL-1β, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.
Subject(s)
Animals , Male , Stomatitis/prevention & control , Xerostomia/prevention & control , Amifostine/therapeutic use , Protective Agents/therapeutic use , Fluorouracil/adverse effects , Inflammation/prevention & control , Stomatitis/chemically induced , Stomatitis/pathology , Xerostomia/chemically induced , Xerostomia/pathology , Cricetinae , Disease Models, Animal , Inflammation/chemically induced , Inflammation/pathologyABSTRACT
Introduction: Breast cancer has a good prognosis when treated early. However, the mortality rate in Brazil is still high. The time interval between radiological suspicion and diagnosis/treatment impacts the survival. Methods: This is a retrospective crosssectional study that assessed patients treated at a reference center, with abnormal breast imaging findings and subsequent confirmation of breast cancer, from January 2011 to June 2015. We reviewed variables related to the dates of the abnormal test result, first mastology appointment, biopsy, surgery, and the start of chemotherapy when indicated. Time intervals were compared using the Friedman and Kruskal-Wallis tests with the software SPSS® 23.0. Results: We analyzed 65 patients. The median time between the abnormal test result and first mastology appointment was 35 days; between first mastology appointment and biopsy, 31 days; between biopsy and surgery, 85 days; and between surgery and chemotherapy, 137 days. The last two intervals showed significant differences (p<0.001). Discussion: Breast cancer patients had a significant delay until surgery and the start of chemotherapy. Early integration of the multidisciplinary team involved in this process and internal audits are necessary to optimize time intervals.
Introdução: O câncer de mama apresenta bom prognóstico quando tratado precocemente, entretanto, a mortalidade no Brasil continua elevada. O tempo entre suspeita radiológica e diagnóstico e tratamento tem impacto na sobrevida. Métodos: Foi realizado um estudo transversal e retrospectivo que avaliou pacientes atendidas em centro de referência com imagem mamária alterada e posterior confirmação de câncer de mama de janeiro de 2011 a junho e 2015. Foram revisadas variáveis relacionadas às datas do exame alterado, da primeira consulta, da biópsia, da cirurgia e do início da quimioterapia, quando indicada. Os intervalos de tempo foram comparados pelos testes Friedman e Kruskal-Wallis, pelo programa SPSS® 23.0. Resultados: Foram analisadas 65 pacientes. A mediana de tempo entre exame alterado e primeira consulta foi 35 dias, entre consulta na mastologia e biópsia foi 31 dias, entre biópsia e cirurgia foi 85 dias e entre cirurgia e quimioterapia foi 137 dias. Foram observadas diferenças significativas nos dois últimos intervalos (p<0,001). Discussão: As pacientes com câncer de mama apresentaram atraso significativo até a cirurgia e até o início da quimioterapia. Há necessidade da integração precoce da equipe multidisciplinar implicada nesse processo e auditorias internas a fim de otimizar os intervalos de tempo
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Invasive aspergillosis is a major concern in neutropenic patients.We studied the utility of Galactomannan antigen detection test inserum using ELISA technique for early detection of invasiveaspergillosis. Diagnostic accuracy of Galactomannan index (GMI)test was maximum at a cut-off of > 1.5 with a negative predictivevalue of more than 95%
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BACKGROUND: The present study describes our 10-year experience with uveoretinal adverse events that manifest because of chemotherapy. METHODS: A retrospective chart review was performed for all patients who presented to the ophthalmologic department while undergoing systemic chemotherapy between July 2005 and June 2015. RESULTS: A total of 55 patients (mean age, 51.2 years, 38 women [69.1%]) suspected of having uveoretinal disease owing to the use of chemotherapeutic agents alone were enrolled. Breast cancer was the predominant disease (36.4%); noninfectious anterior uveitis (21.8%) was the most common condition. Bilateral involvement was observed in 16 patients (29.1%). Although cisplatin (21.8%) was the most commonly used drug, daunorubicin, cytarabine, tamoxifen, toremifene, and imatinib were also frequently used. The median duration until ophthalmologic diagnosis was 208.5 days (range, 19–5,945 days). The proportion of patients with final visual acuity (VA) < 20/40 Snellen VA (0.5 decimal VA) was 32.7%. However, no relationship was observed between final VA < 20/40 and age, sex, therapeutic agents, and metastasis. CONCLUSION: Uveoretinal complications were mostly mild to moderate and exhibited a favorable response to conservative therapy. A considerable number of patients exhibited significant irreversible loss of vision after cessation of the causative chemotherapeutic agent. Ophthalmological monitoring is required during chemotherapy.
Subject(s)
Female , Humans , Antineoplastic Agents , Breast Neoplasms , Cisplatin , Cytarabine , Daunorubicin , Diagnosis , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Imatinib Mesylate , Molecular Targeted Therapy , Neoplasm Metastasis , Retrospective Studies , Tamoxifen , Toremifene , Uveitis , Uveitis, Anterior , Visual AcuityABSTRACT
Objective To construct the continuing nursing management model for lung cancer chemotherapy complications based on m-health. Methods Literature research, qualitative interviews and expert group meeting were used to build the continuing nursing management model for lung cancer chemotherapy complications based on m-health. Results The nursing management model of lung cancer chemotherapy complications including service objectives, service providers, service objects, service time, service flow, service platform and related personnel responsibilities were determined. Conclusions The continuing nursing management model for lung cancer chemotherapy complications based on m-health has strong scientific and practical characteristics, which is helpful for patients to timely monitor the occurrence of complications of chemotherapy, access the corresponding prevention and intervention measures.
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Objective To develop chemotherapy training system for new nurses in cancer special hospital and to provide related references.Methods The initial chemotherapy training system for new nurses in cancer special hospital was developed by literature review.Two rounds of expert consultation were conducted among 22 experts from 14 cities in China via Delphi Technique to finalize the training system.Results The recovery rates were 100.00％ and 90.90％,and the authority coefficients were both 0.82,coordination coefficients of two rounds of consultation were statistically significant by chi-square test (P＜0.01),the coefficient of variation of each item ranged from 0.00 to 0.21 in the second round.The chemotherapy training system consisted of 6 first-level indicators,13 second-level indicators and 50 third-level indicators.Conclusion The study methods were scientific,experts had high level of enthusiasm and authority,and had agreed opinions for each indicator of the developed chemotherapy training system for new nurses in cancer special hospital which can be used for training new nurses.
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Objective To summarize and analyze the adverse reactions caused by cancer chemo-therapy drugs in clinical practice and the specific influencing factors,so as to make more scientific and ef-fective chemotherapy for the treatment of cancer patients.Methods 80 cases of cancer patients treated in our hospital from December to October 2013 in were selected as the research objects.Results Adverse effects of cancer chemotherapy drugs emerged strictly speaking is inevitable,the patient should be the high-est incidence of bad hair in the digestive system,boil down to:nausea,loss of appetite,alopecia and diar-rhea.Conclusions Fully grasp the application of chemotherapeutic drugs adverse reaction and its influen-cing factors,and for making treatment scheme,for improving the treatment effect has important clinical sig-nificance.
ABSTRACT
Background and purpose:Previous researches have shown that procalcitonin differentiates infec-tious from non-infectious fever and assesses the severity of infectious diseases. This study aimed to investigate the clin-ical value of procalcitonin in patients with chemotherapy-induced febrile neutropenia.Methods:A total of 147 patients with chemotherapy-induced febrile neutropenia admitted to intensive care unit from Jan. 2012 to Dec. 2014 were di-vided into infectious group and fever of unknown origin group according to clinical symptoms, signs and etiology. The infectious group was divided into sepsis, severe sepsis, and septic shock groups according to the severity of infection. The procalcitonin levels were compared between different groups.Results:A procalcitonin cut-off value>0.935 ng/mL provided a sensitivity of 90.0%, speciifcity of 90.0% and AUC=0.905. The procalcitonin level of the infectious group was signiifcantly higher than that of the fever of unknown origin group [1.805 (1.268-2.523) ng/mLvs 0.555 (0.398-0.818) ng/mL,P<0.001]. There is a signiifcant difference between the severe sepsis group and the sepsis group [13.885 (7.600-17.961) ng/mLvs 1.805 (1.268-2.563) ng/mL,P<0.001]. Compared with the severe sepsis group, the value of procalcitonin in the septic shock group was signiifcantly higher [23.800 (20.050-30.478) ng/mLvs 13.885 (4.955-19.133) ng/mL,P<0.001].Conclusion:Plasma procalcitonin is a useful marker for diagnosing neutropenia in patients with infection. Meanwhile, procalcitonin can be used to assess the severity of infection in patients with neutropenia.