RESUMO
The COVID-19 syndemic has raised many unanswered questions about the most important values in human life. It has revealed the limits of looking at mere survival and ignoring closeness, spirituality, and "connectedness". Spiritual accompaniment, in contrast, is a valid therapeutic tool for individuals suffering from life-threatening diseases, allowing a real recovery of the transcendent dimension of existence which retrieves one's relationship with the mystery, and reintegrates illness and death within one's horizon of thought. According to this vision, in the field of healthcare, people experienced in spiritual accompaniment may support patients through their disease journey by strengthening their resilience; this was extended in 2020 with telematic assistance, to patients with COVID-19, with very positive results. This gave impetus to the project to rebuild a rural village, suitable for pursuing the principles of green therapy (also known as echotherapy) in order to host patients in various stages of life-threatening illness who wish to deepen their spiritual search by receiving expert, non-confessional spiritual accompaniment, by living side by side with families and resident monks; there will also be a hospice oriented towards spiritual assistance, to accommodate patients in advanced stages of illness. The spiritual accompaniment proposed here is centered on meditation and is part of a historic tradition, although it is promoted with language adapted to the modern era. This has for decades helped many people following this path.
RESUMO
BACKGROUND AND OBJECTIVE: Anthracyclines are highly effective and widely used cytotoxic agents, but their application is often limited by cumulative dose-dependent cardiotoxicity. Dexrazoxane has been shown in several clinical trials to prevent the development of this serious toxicity. The aim of our study was to analyze the incidence of cardiac dysfunction over a 10-year period in patients with breast cancer who were treated with anthracycline-based regimens with addition of dexrazoxane, mainly in an adjuvant setting. METHODS: We conducted a retrospective analysis on a population of women with breast cancer treated at our institution between January 1993 and October 2003. We reviewed patients' medical records and data on patient characteristics, treatment history, and adverse events that were collected, starting from the time of first visit before starting therapy, with the use of software created and designed for clinical records management in our institution (1999 OK-DH). Patients underwent an ECG assessment prior to starting chemotherapy, and were clinically monitored for cardiac failure. Those who developed signs and symptoms suggestive of cardiac dysfunction underwent further ECG. If clinical findings indicated, echocardiography and further cardiologic investigations were performed. The main outcome measure was the development of signs and symptoms indicative of congestive heart failure (CHF). RESULTS: A total of 318 female patients were treated with an anthracycline (doxorubicin or epirubicin)-based combination chemotherapy regimen during this time, in most cases in the adjuvant setting (n = 285). Most patients (n = 302) had early-stage disease and only 16 women presented with metastatic disease with good life expectancy (at least 1 year). All patients received dexrazoxane 1000 mg/m(2) intravenously prior to anthracycline administration during each chemotherapy cycle. The median follow-up duration was 35 months. During this time, five patients (1.57%) developed signs and symptoms of CHF. No patient at our institution died of heart failure during the period analyzed. Dexrazoxane was well tolerated, with no reports of adverse events associated with this drug. CONCLUSIONS: The reported incidence of cardiotoxicity in this study represents a marked reduction compared with historical data for patients receiving anthracycline-based chemotherapy without dexrazoxane. Dexrazoxane appears to have a cardioprotective effect in women with early-stage or advanced breast cancer treated with anthracycline-based combination chemotherapy, mainly as an adjuvant treatment. Prospective, randomized, controlled clinical trials in adjuvant setting should be performed to confirm these results.
