Oral and oropharyngeal cancer: time from first symptoms to treatment initiation and associated factors

Abstract The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.

Sedation and analgesia for procedures in the pediatric emergency room / Sedação e analgesia para procedimentos no pronto-socorro de pediatria

Abstract Objective: Children and adolescents often require sedation and analgesia in emergency situations. With the emergence of new therapeutic options, the obsolescence of others, and recent discoveries regarding already known drugs, it became necessary to review the literature in this area. Data sources: Non-systematic review in the PubMed database of studies published up to December 2016, including original articles, review articles, systematic reviews, and meta-analyses. References from textbooks, publications from regulatory agencies, and articles cited in reviews and meta-analyses through active search were also included. Data synthesis: Based on current literature, the concepts of sedation and analgesia, the necessary care with the patient before, during, and after sedoanalgesia, and indications related to the appropriate choice of drugs according to the procedure to be performed and their safety profiles are presented. Conclusions: The use of sedoanalgesia protocols in procedures in the pediatric emergency room should guide the professional in the choice of medication, the appropriate material, and in the evaluation of discharge criteria, thus assuring quality in care.

Resumo Objetivo: Crianças e adolescentes necessitam frequentemente de sedação e analgesia em situações de emergência. Com o surgimento de novas opções terapêuticas, a obsolescência de outras e descobertas recentes das drogas já conhecidas, fez-se necessário uma nova revisão da literatura nessa área. Fontes dos dados: Revisão não sistemática na base de dados PubMed de estudos publicados até dezembro de 2016, inclusive artigos originais, artigos de revisão, revisões sistemáticas e metanálises. Também foram incluídos referências de livros-texto, publicações de agências reguladoras, além de artigos citados nas revisões e metanálises através de busca ativa. Síntese dos dados: Com base na literatura atual, são apresentados os conceitos de sedação e analgesia, os cuidados necessários com o paciente antes, durante e após a sedoanalgesia, além de indicações quanto à escolha apropriada dos fármacos de acordo com o procedimento a ser feito e o perfil de segurança desses. Conclusões: O emprego de protocolos de sedoanalgesia em procedimentos no pronto-socorro pediátrico deve orientar o profissional na escolha da medicação, do material adequado e na avaliação dos critérios de alta e garantir, assim, qualidade na assistência.

Por que tratamos câncer de boca em estádios avançados? / Why do we treat mouth cancer in advanced stages?

No Brasil, registros hospitalares de câncer revelam a boca como a oitava localização mais frequente de tumores malignos, sendo a maioria delas diagnosticada em estádio avançado. Em países desenvolvidos, as taxas de diagnóstico tardio são cerca de 40%. O diagnóstico e tratamento precoces representam mais chance de cura, baixo custo emenos morbidade. Este artigo objetiva verificar as possíveis razões de atraso no diagnóstico e tratamento das neoplasias bucais e refletir sobre os seus motivos. Os termos neoplasias bucais, diagnóstico, epidemiologia e terapia foram introduzidos nas bases de dados MEDLINE, LILACS e SCIELO. Foram analisados 31 estudos, entre 1995 e 2011,que discorriam sobre o atraso diagnóstico em relação ao paciente, ao profissional e ao sistema de saúde. Observou-se que o atraso diagnóstico associou-se a: a) pacientes: solteiros, etilistas e com medo do diagnóstico; b) médico: pouco conhecimento sobre o assunto e alta carga de trabalho; c) sistema de saúde: filas para atendimento médico, distância de unidades de saúde e centros de referência da moradia do paciente e experiênciasnegativas no serviço de saúde. É fundamental entender as possíveis causas de atraso e limitações dos serviços de saúde e de seus profissionais para que medidas adequadas sejam tomadas individual e coletivamente para propiciar diagnóstico e tratamento precoce aos pacientes.

In Brazil, hospital cancer records reveal the mouth as the eighth most frequent location of malignant tumors, most of them being diagnosed at advanced stages. In developed countries, diagnosis of late rates is about 40%. Early diagnosis and treatment represent increased chances of a cure, low cost, and less morbidity. This article aims to assess thepossible reasons for delays in the diagnosis and treatment of oral cancer and reflects on the reasons. The terms mouth neoplasias, diagnosis, epidemiology, and therapy were introduced in the MEDLINE, LILACS, and SciELO databases. A total of 31 studies published between 1995 and 2011 were analyzed, which discoursed about the delayed diagnosis in relation to patients, professionals, and healthcare systems. It was observedthat the diagnostic delay was associated with: a) patients: single, alcoholic, and afraid of the diagnosis; b) Professionals: little knowledge on the subject and high workload; c) healthcare systems: queues for medical care, distance between the patient?s residence and healthcare units and reference centers, and negative experiences in the healthcareservice. It is critical to understand the possible causes of delay and limitations of healthcare services and its professionals for appropriate actions to take place individually and collectively providing early diagnosis and treatment to these patients.