Associação entre o nível de atividade física e os estados de humor entre pacientes com câncer de mama tratadas com intuito de cura / The association between the level of physical activity and mood states in patients with breast cancer treated with curative intent

Objetivo: Analisar a associação entre o nível de atividade física e os estados de humor entre pacientes com câncer de mama tratadas com intuito de cura. Metodologia: Foram entrevistadas 354 mulheres que cumpriram os critérios de inclusão e exclusão e assinaram o termo de consentimento livre esclarecido. Para análise dos estados de humor foi utilizado o Profile Of Mood States - POMS. Para mensuração do nível de atividade física utilizou-se o Baecke. A caracterização da amostra se baseou na estatística descritiva (média, desvio padrão, mediana e porcentagem).O nível de atividade física, segundo o escore do Baecke, foi categorizado em tercis e foi considerado como a variável independente. Foi realizado o teste de médias com as escalas POMS. Para a associação entre o nível de atividade física através do escore Baecke e das escalas do POMS, foi realizado o teste t e ANOVA para teste de médias. Para todos os testes foi estabelecido um erro a = 5%, ou seja, os resultados foram considerados estatisticamente significativos quando p < 0,05. Resultados: Quando se comparou a média na pontuação do POMS de acordo com a atividade física do Baecke dividido em tercis, verificou-se associação entre a atividade física com Vigor (p<0,001) e a Fadiga (p=0,019). Conclusão: Conclui-se que a atividade física é um fator relacionado com a melhora nos estados de humor nas mulheres com câncer de mama tratadas com intenção curativa.

Atuação do enfermeiro em oncologia na perspectiva da genética e genômica / Oncology nursing practice from the perspective of genetics and genomics / Práctica de lo enfermero en oncología en la perspectiva de la genética y genómica

Este artigo tem como objetivo refletir sobre a atuação do enfermeiro em oncologia, sob a perspectiva da genética e da genômica, e sobre seu papel como membro integrante da equipe multiprofissional e interdisciplinar de aconselhamento genético oncológico. Trata-se de uma reflexão, fruto de leitura minuciosa da literatura da área, acrescida da experiência dos autores e discussões em grupo de pesquisa. No transcorrer desse trabalho, foi possível constatar que o enfermeiro precisa considerar o cuidado de saúde baseado em genômica e apropriar-se de competências essenciais. Essas competências abrangem a habilidade de mobilizar recursos genômicos na coleta da história familiar e nas orientações sobre testes genéticos a famílias em risco para síndromes neoplásicas hereditárias. O profissional de enfermagem pode atuar como referência para os demais membros da equipe de saúde, com potencial para integrar seus conhecimentos no cuidado, no ensino e em pesquisas em oncologia, sob a ótica da genética e da genômica.

This study aimed to reflect on oncology nurses' practice from the perspective of genetics and genomics, and their role as a member of the multiprofessional and interdisciplinary cancer genetics counseling team. This reflection is a result of the detailed reading of literature in the area, increased by the authors' experience and research group discussions. In the course of this work, it was verified that the nurse needs to consider genomic-based health care and incorporates essential competencies. These competencies include the ability to mobilize genomic resources in the family history assessment and in the guidelines on genetic testing for families at risk for hereditary neoplastic syndromes. The nursing staff may act as a reference for other members of the health team, with the potential to integrate their knowledge on care, teaching and research in oncology from the viewpoint of genetics and genomics.

Este estudio objetivó reflexionar sobre la práctica del enfermero en oncología en la perspectiva de la genética y genómica, y su papel como miembro del equipo multiprofesional e interdisciplinario del asesoriamento genético oncológico. Esta reflexión es resultado de lectura atenta de la literatura, además de la experiencia de los autores y discusiones del grupo de investigación. En el curso de este trabajo, fue posible constatar que el enfermero debe tener en cuenta el cuidado de salud basado en genómica y se apropiar de competencias esenciales. Estas competencias incluyen habilidad de movilizar recursos genómicos en la colecta de la historia familiar y orientaciones sobre testes genéticos para familias en riesgo de síndromes neoplásicas hereditarias. El profesional de enfermería puede actuar como referencia para los demás miembros del equipo de salud, con posibilidad de integrar sus conocimientos en asistencia, enseñanza e investigación en oncología, desde el punto de vista de la genética y genómica.

Predictors of quality of life in colorectal cancer patients treated with curative intention

This study aims to evaluate predictors of quality of life in patients treated for colorectal cancer (CRC) with curative intention. PATIENT/METHODS: All patients with CRC treated with curative intention were interviewed by telephone using the SF-36 questionnaire.RESULTS/FINDINGS: One hundred and one patients (44 men, 57 women) were included in this study with a mean age of 60.8 years. Sixty-nine patients were treated for rectal cancer and 32 for colon cancer. Of the total, 23 patients had a stoma (22.8%) and 55 (54.5%) reported comorbidities. The means of the SF-36 scales varied between 90 (emotional aspects) and 65 (physical aspects). Presence of comorbidities was a predictor factor of quality of life in six of eight SF-36 scales. The female patients attained lower scores on three scales: functional capacity, pain and vitality. Patients age 60 or over attained lower scores on two SF-36 scales: functional capacity and social aspects. Patients with a stoma had lower score on limitation due to emotional aspects. We concluded that comorbidities affect the quality of life of individuals with colorectal cancer. Health professionals should be prepared to address not only the limitations caused by cancer and its treatment, but also the limitations caused by chronic diseases.

Neoadjuvant chemoradiation therapy for soft tissue sarcomas of the extremities

INTRODUCTION AND OBJECTIVE: Neoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. The aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas. METHODS: A retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. All patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 Gy, concomitant with doxorubicin (60 mg/m²) chemotherapy. The main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. The median follow-up time was 32.1 months. RESULTS: The five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5 percent, 46.7 percent and 58.3 percent, respectively. For high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3 percent and 41.2 percent, respectively. Severe wound complications were observed in 41.8 percent of the patients who underwent surgery. These complications precluded adjuvant chemotherapy in 73.7 percent (14/19) of the patients eligible to receive it. CONCLUSIONS: In this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. The high rate of wound complications modified the planning of adjuvant treatment in most patients.

Familial adenomatous polyposis: data from the Hereditary Colorectal Cancer Registry (HCCR)

Family adenomatous polyposis (FAP) is a dominant autossomic disease responsible for nearly 1% of colorectal cancer (CRC) cases caused by mutations in gene APC and nearly complete penetrance. The identification of germinative mutations can be useful in the definition of the therapeutic conduct by means of the correlation genotype-phenotype. Objective: To describe clinical and molecular characteristics of families with FAP or attenuated FAP. Method: The study included families registered in the Hereditary Colorectal Cancer Registry of A.C.Camargo Hospital. Cancer records were registered and heredograms were created. Data were collected and stored in a database. Results: From 1992 to 2007 22 families were registered that had FAP, 16 with classic FAP, nine with Gardner Syndrome, and 6 with attenuated FAP. From 604 individuals, 120 had polyposis, 62 CRC, 10 desmoid tumors, three breast tumors, two tumors of the stomach, two thyroid tumors and one with prostate tumor. From 22 families, three were submitted to molecular analysis and mutations were identified in gene APC. Discussion: Half of the individuals presented CRC concomitant to polyposis, which can indicate a late diagnostic of the disease; three identified mutations presented correlations genotype-phenotype as predicted by the literature. Follow-up of patients with FAP, although they account for less than 1% of CRC cases, is vital for early cancer diagnosis.

Modelo de crenças em saúde em familiares de pacientes com câncer colorretal / Health belief model in relatives of colorectal cancer patients

A compreensão dos comportamentos de saúde dos indivíduos a cerca do câncer colorretal (CCR) possibilita o estabelecimento de intervenções que podem aumentar a adesão dos indivíduos a programas de detecção precoce. Objetivou-se nesta tese descrever quatro conceitos do Modelo de Crenças em Saúde (MCS) - ... verificar a associação entre características sociodemográficas, a história familiar de câncer colorretal, com as variáveis do MCS e a preocupação com o câncer; traduzir e validaros questionários Champion's Health Belief Model Scale (CHBMS) e Lerman's Cancer Worry Scale (CWS). ... Participaram da pesquisa familiares de indivíduos com CCR com história familiar registrada no Registro de Câncer Colorretal Hereditário do Hospital A.C. Camargo. ... Observaram-se os seguintes resultados: o alfa de Cronbach da CHBMS variou entre 0,759 e 0,892. A CWS apresentou solução com um fator e alfa de Cronbach de 0,880. Foram entrevistados 125 indivíduos, 51,2% pertencentes a famílias com Síndrome de Lynch. A média da percepção de risco populacional para CCR foi 47,6% e a pessoal 53,9%. Os fatores preditores da percepção de susceptibilidade foram: religião, óbito de familiares por câncer, número de familiares com CCR, e recebimento de informações sobre o risco de CCR. ... Foram variáveis preditoras da CWS: idade média de diagnóstico de CCR na família, primos com CCR, a as escalas de susceptibilidade, gravidade e barreiras do CHBMS. Concluiu-se que: a CHBMS e a CWS são escalas válidas e confiáveis para avaliação do MCS e da preocupação com o câncer; variáveis sociodemográficas e a história familiar de câncer contribuem para o MCS relacionado ao CCR.

In order to establish effective interventions to increase early detection programs´ compliance it is necessary to understand health beliefs related to colorectal cancer (CRC). This study aims included: to describe four Health Belief Model (HBM) concepts ­ perception of susceptibility, severity, benefits and barriers and cancer worry in individuals with family history of CRC; to verify the association between demographic variables, cancer family history and the HBM variables and cancer worry; to translate and validate into Portuguese the Champion's Health Belief Model Scale (CHBMS) and the Lerman's Cancer Worry Scale (CWS). The CHBMS and the CWS have been translated into Portuguese through a committee technique and changes were suggested by a panel of judges. The participants of this study were relatives of CRC patients (proband) whose cancer family history was included at A.C. Camargo Hospital Hereditary Colorectal Cancer Registry. The proband acquiescence to the study was followed by an indication of their relatives. The approach of the relatives included explanation of the study, acceptance to participate and telephone interview. A questionnaire with sociodemographic characteristics, risk perception and colorectal screening history, and the CHBMS and the CWS was filled out. To validate the CHBMS and CWS, factor analysis and reliability analysis were used. To verify the association between variables, mean test and linear and logistic regression analysis was performed. The following results were observed: Cronbach´s alpha of CHBMS scales varied from 0.759 to 0.892. The CWS had one factor solution with a Cronbach´s alpha of 0.880. A hundred and twenty-five individuals were interviewed, 51.2% of them belonged to Lynch Syndrome families. The mean populational risk perception was 47.6% and the personal risk perception was 53.9%. Characteristics that predicted higher perception of susceptibility were: religion, death of family members, number of relatives with CRC, previous information regarding CRC risk. Variables that predicted perception of severity were: educational level, religion, classification of risk, mean age of CRC diagnosis in family members, cousins with CRC and previous knowledge about colonoscopy procedure. Perception of susceptibility and having children predicted perception of benefits. Variables associated with perception of barriers were educational level, previous screening and perception of severity. Mean age of CRC diagnosis in family members, cousins with CRC, perception of susceptibility, perception of severity and barriers were the variables that predicted cancer worry. The CHMBS and CWS were valid reliable scales to evaluate the HBM and cancer worry in individuals at risk for CRC. Sociodemographic characteristics and family history were associated with HBM variables and cancer worry.

P16 and p27 Immunohistochemical Expression in Colorectal Cancer: Analysis of 128 Patients

P16 and p27 are inhibiting proteins of cyclin-dependent kinases (CDKIs) that act in the restriction points of the cellular cycle, and it avoids its progression to DNA verification and repair by the cellular apparatus. This way, there should be, physiologically, an inverse relation between the expression of these proteins and cellular proliferation. However, what is really observed are changeable amounts of p27 in normal and tumor tissues. P16 participation in tumorigenesis is controversial. The expression of p16 and p27 as a prognostic factor in colorectal cancer (CRC) patients is controversial. Objetive: To establish a correlation between p16 and p27 immunohistochemical expressions with clinical and anatomopathological variable from patients with CRC. Material and methods: descriptive and retrospective study, with 128 CRC patients, treated surgically between 2000 and 2004, with available material for immunohistochemical analysis through standardized methods. The association between categorical variables was done using Chi-square, Pearson or Fisher?s Exact tests, and the continuous variables were analyzed by t-Student. Global survival and disease-free period were calculated according to Kaplan-Meier method and the associations through log-rank test. Results: The average follow-up time of patients was 35 months. Positivity of p16 was detected in 100% of cases. Negativity of p27 in 6.3% (n=8) of cases, with a significant association (p30.05) between p27 negative and tumors located in right colon (62.5%, n=5) and mucinous (62.5%, n=5). The average global survival was 54.8 months, and the significant clinical and pathological variables associated to survival were: better for curative surgeries; better for early stages; better for well-differentiated tumors; worse for cases with sanguineous or vascular lymphatic invasion; worse for perineural invasion. Conclusions: p27 negative is more frequent in right colon...

Frequency of Colorectal Cancer and Extracolonic Tumors in Families That Meet Amsterdam Criteria I and II: Results From Hospital A. C. Camargo Hereditary Colorectal Cancer Registry

An estimated 1% to 10% of all colorectal tumors (CRC) are related to high-penetrance genes. Families with Lynch Syndrome, caused by mutations in MMR repair genes, present a high frequency, not only of CRC, but also extracolonic tumors. Objective:To verify the frequency of CRC and extracolonic cancers in families that meet Amsterdam I and II criteria. Methods: Families had been included that meet Amsterdam I and II criteria, in the Registry of Colorectal Cancer of A. C. Camargo Hospital from 1992 to 2007. Family history was taken and stored in the Cyrillic® 2.1 software. Data collection forms were filled. Results:1578 individuals were identified, and 337 of them presented tumors. CRC was the most frequent, with 221 individuals,with a mean age of 46 years at diagnosis. The most frequent extracolonic tumors were breast (17 cases), endometrium (15), stomach (14), urinary (12), leukemia (9), and prostate (6). Discussion: As expected, the age at diagnosis of colorectalcancer was younger than the general population; breast tumor was the most frequent; molecular studies must differentiate patients with Lynch Syndrome (LS) from those with familial colorectal cancer.

p53 and p21 Immunohistochemistry in Colorectal Cancer: Clinical and Pathological Correlation in 128 Cases

Mutations of tumoral suppressor TP53 gene are present in 75% of colorectal cancer (CRC) cases. Immunohistochemistry isa method capable of demonstrating the abnormal accumulation of p53 protein in the cell. Some studies associate p53immunohistochemical positivity and a worse prognosis, while others do not confirm this finding. There are controversiesregarding the prognostic value of p53 in CRC. The same doubts apply to p21 protein, activated by p53, which is the mainresponsible for stopping the cell cycle (checkpoints), both for repair or apoptosis purposes. Objective: The objective of thisstudy is to correlate p53 and p21 immunohistochemical expression both with clinical and anatomopathological variables andwith survival rates of patients with CRC. Materials and Methods: This is a descriptive and retrospective study having asresearch subjects 128 patients affected by CRC and treated surgically from 2000 to 2004, with available surgical specimensfor immunohistochemical analysis using standardized methods. The association among categorical variables was done byPearson chi-square or Fisher exact tests, and the continuous variables were analyzed by t-Student test. Overall survival anddisease-free period rates had been calculated according to Kaplan-Meier method and the associations by log-rank test. Results:Follow-up average time was 35 months. p53 and p21 alterations had been detected, respectively, in 67.2% and 27. 3% ofcases, with a significant association (p<0.05) between p53 and tumors located in rectum (76.0%) and left colon (70.7%), andbetween p21 and right colon (43.2%). p21 positive expression was related to CRC diagnostic at an older median age. Overallsurvival was 54 months, and the significant clinical and pathological related variables were the following: better for curativesurgeries; better for precocious stages; better for well-differentiated tumors; worse for cases with sanguineous or lymphatic...

Number of Disected Lymph Nodes In Colorectal Cancer Patients SubmittedTo Radical Surgery: The Quality of Oncology Treatment

Introduction: the correct evaluation of lymph node disease influences the therapeutical decisions of colon and rectal cancer(CRC) patients. The number of dissected lymph nodes is a variable that have prognostic value and serves as an indicator of thequality of oncology treatment. For a correct evaluation of N stage to be accepted, the minimum number of dissected lymphnodes considered must be 12. In rectal cancer patients submitted to neoadjuvant radiochemotherapy, the interpretation of thenumber of dissected lymph nodes remains inconclusive. Objective: is to evaluate the number of dissected lymph nodes in CRCpatients submitted to curative surgery and determine this latter impact in oncologic treatment results. In cases of rectalcancer, to study the effect of neoadjuvant radiochemotherapy in dissected lymph nodes count. Method: in the period 1991-2004, 852 CRC patients were treated in Hospital A. C. Camargo . Patients with metastases at the time of diagnosis,synchronous and metachronic tumors, total colectomy or total proctocolectomy and hereditary colorectal cancer were excluded.The sample was constituted by 423 patients with sporadic colorectal adenocarcinoma who undergone curative radical surgery(168 colon primary tumors and 255 rectal tumors). Colon cancer patients, treated primarily by surgery, had also receivedadjuvant chemotherapy (5-FU) according to risk criteria. Rectal cancer patients with fixed or half-fixed injuries or clinicallycompromised lymph nodes (T3, T4 or N+) had received neoadjuvant radiochemotherapy, followed by surgery and chemotherapy(5-FU). Results: the median of the number of dissected lymph nodes in colon cancer patients was 17. In the case of rectalcancer patients, the median of dissected lymph nodes in the groups with and without neoadjuvant radiochemotherapy had beenrespectively 9 and 15 (p<0.001). 5-year specific survival rates for colon and rectal cancer patients were respectively...

Complicações de estomas intestinais no tratamento do câncer: análise de 56 casos / Complications of intestinals stomas in the treatment of cancer: analysis of 56 cases

Apesar da técnica de construção de, um estoma ser relativamente simples, as complicações cirúrgicas são freqüentes. Dentre elas estão: necrose, obstrução, retração, estenose, prolapso, fístula periestomal, hérnia periestomal, dermatite periestomal, varizes, infecção, sangramento e separação cutâneo-mucosa. Através da análise aleatória de 56 prontuários, os objetivos deste trabalho foram: identificar a incidência das complicações relacionadas aos estomas intestinais de pacientes com câncer e verificar algumas características dos estomas construídos. Entre as complicações precoces mais comuns estão a dermatite (25 por cento) e a injúria mecânica (7,1 por cento). Dentre as complicações tardias estão: dermatite, retração, prolapso, hérnia, sangramento, implante da mucosa na pele periestomal, granuloma, distúrbio metabólico e lesão mecânica. As complicações podem ser reduzidas se algumas medidas forem implementadas: demarcação no pré-operatório, construção adequada do estoma, escolha adequada dos equipamentos, educação do paciente e cuidador e assistência multidisciplinar.

Controle da dor no pós-operatório / Postoperative pain

A dor é um fenômeno freqüente no pós-operatório e pode resultar em sofrimento e riscos desnecessários ao paciente. Estudos demonstram o inadequado alívio da dor após a cirurgia e sua relação com falhas na avaliação e falta de conhecimento sobre métodos analgésicos. O artigo discute o manejo da dor pós-operatória que inclui o uso de analgésicos antiinflamatórios não hormonais, opiáceos, intervenções cognitivo-comportamentais e alta tecnologia como cateter peridural e sistemas de analgesia controlada pelo paciente. Além disso, o adequado controle da dor inclui a discussão sobre aspectos éticos e econômicos.

The pain is a frequent sympton during the postoperative period and results in suffering and unnecessary risks for the patient. Studies show the inadequate pain relief after surgery and the relationship with erroneous assessment and non-acquaintance about analgesics methods. The article discuss the postoperative pain management wich includes the use of nonsteroidal antiinflammatory drugs, opioids, cognitive-behavior interventions and high-tech like epidural catheter and patient-controlled analgesia systems. Besides the adequate pain control includes the discussion about ethical and economic aspects.

Contradiçöes entre o relato de dor no pós-operatório e a satisfaçäo do doente com a analgesia / Contradictions between the prevalence of postoperative pain and pain relief satisfaction

Estudos mostram que a dor no pós-operatório é frequënte e inadequadamente controlada. Este trabalho tem por objetivos caracterizar o quadro álgico de doentes oncológicos no pós-operatório, os analgésicos prescritos e a satisfação do doente com a analgesia. O estudo foi realizado em um hospital escola e a população foi constituída por 55 doentes oncológicos, maiores de 19 anos, submetidos a procedimento cirúrgico entre setembro e outubro de 1997. Observou-se que 78,2 porcento dos doentes referiu dor nas primeiras 24 horas do pós-operatório. A média de intensidade de dor foi 5,6. Dor moderada foi referida por 58,3 porcento dos doentes e intensa em 27,1 porcento dos casos. Observou-se predomínio da dimensão afetiva na descrição da dor. Sono/repouso e movimentação no leito foram as atividades mais citadas como prejudicadas pela dor. A prescrição de antinflamatórios não hormonais associada a opiáceos foi a mais frequënte (57 porcento). O regime de administração em horário fixo exclusivo e o regime misto representaram, respectivamente, 45,2 porcento e 42,8 porcento das prescrições...