Objective The aim of this study was to analyze the psychometric properties of the Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) in a sample of medical oncologists who provide ...adjuvant treatment to patients with non-metastatic resected cancer and the correlations between the total SDM-Q-Doc score and physician satisfaction with the information provided. Methods Prospective, observational and multicenter study in which 32 medical oncologists and 520 patients were recruited. The psychometric properties, dimensionality, and factor structure of the SDM-Q-Doc were assessed. Results Exploratory factor analyses suggested that the most likely solution was two-dimensional, with two correlated factors: one factor regarding information and another one about treatment. Confirmatory factor analysis based on cross-validation showed that the fitted two-dimensional solution provided the best fit to the data. Reliability analyses revealed good accuracy for the derived scores, both total and sub-scale, with estimates ranging from 0.81 to 0.89. The results revealed significant correlations between the total SDM-Q-Doc score and physician satisfaction with the information provided (p0.01); between information sub-scale scores (factor 1) and satisfaction (p0.01), and between treatment sub-scale scores (factor 2) and satisfaction (p0.01). Medical oncologists of older age and those with more years of experience showed more interest in the patient preferences (p = 0.026 and p = 0.020, respectively). Patient age negatively correlated with SDM information (p0.01) and physicians appear to provide more information to young patients. Conclusion SDM-Q-Doc showed good psychometric properties and could be a helpful tool that examines physician's perspective of SDM and as an indicator of quality and satisfaction in patients with cancer.
Preoperative chemoradiotherapy (CRT) is the treatment of choice for rectal cancer (RC), but half of the patients do not respond, suffer unnecessary toxicities, and surgery delays. We aimed to develop ...a model that could predict a clinically meaningful response to CRT by using formalin-fixed paraffin-embedded (FFPE) biopsies.
We first carried out an exploratory screening of candidate genes by using SAGE technology to evaluate dynamic changes in the RC transcriptome in selected refractory patients before and after CRT. Next, 53 genes (24 from SAGE and 29 from the literature) were analyzed by qPCR arrays in FFPE initial biopsies from 94 stage II/III RC patients who were preoperatively treated with CRT. Tumor response was defined by using Dworak's tumor regression grade (2-3-4 vs. 0-1). Multivariate Cox methods and stepwise algorithms were applied to generate an optimized predictor of response and outcome.
In the training cohort (57 patients), a 13-gene signature predicted tumor response with 86% accuracy, 87% sensitivity, and 82% specificity. In a testing cohort (37 patients), the model correctly classified 6 of 7 nonresponders, with an overall accuracy of 76%. A signature-based score identified patients with a higher risk of relapse in univariate (3-year disease-free survival 64% vs. 90%, P = 0.001) and multivariate analysis (HR = 4.35 95% CI: 1.2-15.75, P = 0.02), in which it remained the only statistically significant prognostic factor.
A basal 13-gene signature efficiently predicted CRT response and outcome. Multicentric validation by the GEMCAD collaborative group is currently ongoing. If confirmed, the predictor could be used to improve patient selection in RC studies.
Antecedentes/Objetivo: Este estudio analiza las propiedades psicométricas del cuestionario Shared Decision-Making (SDM-Q-9) en pacientes con cáncer resecado, no metastásico y elegibles para ...quimioterapia adyuvante. Método: Estudio multicéntrico, prospectivo, transversal en el que se reclutaron 568 pacientes que respondieron al SDM-Q-9 después de visitar a su oncólogo quien, a su vez, completó el SDM-Q-versión médico. Se estudiaron la fiabilidad, la estructura factorial análisis factorial exploratorio (EFA), análisis factorial confirmatorio (CFA) y la validez convergente de las puntuaciones del SDMQ-9. Resultados: La escala SDM-Q-9 mostró una estructura factorial clara, compatible con un factor general fuerte y replicable, y un factor de grupo secundario. La puntuación del factor general mostró una buena fiabilidad en términos de coeficiente omega: 0,90. La asociación entre la percepción del médico y del paciente en la SDM fue débil y no logró alcanzar significación estadística. Los hombres y los pacientes mayores de 60 años mostraron mayor satisfacción con la toma de decisiones compartidas con el oncólogo. Conclusiones: El cuestionario SDM-Q-9 puede ayudar en la evaluación de la toma de decisiones compartidas desde la perspectiva de los pacientes con cáncer y como indicador del grado de calidad y satisfacción en la relación médico-paciente.
Bevacizumab plus taxane chemotherapy improves progression-free survival (PFS) versus taxane monotherapy in the first-line treatment of HER2-negative metastatic breast cancer (MBC) and appears ...promising in the second-line setting. This retrospective analysis evaluated the efficacy and safety of this combination in a real-world setting.
Eligible patients received bevacizumab (10 mg/kg days 1 and 15, every 28 days) plus paclitaxel (80 mg/m(2) days 1, 8, and 15, every 28 days) as first-line therapy for MBC, or as subsequent lines, including bevacizumab continuation therapy, at La Paz University Hospital between August 2007 and October 2012. End points included objective response rate (ORR), PFS, overall survival (OS), and safety.
Seventy-eight patients were included. Median PFS was 12.8 months for patients receiving first-line treatment and 9.3 months for subsequent lines. Forty-five patients (57.7%) continued bevacizumab after stopping paclitaxel, and had significantly longer PFS and OS than those who did not (hazard ratio HR 0.40, 95% confidence interval CI 0.248-0.653, P<0.001; HR 0.39, 95% CI 0.218-0.710, P=0.002; respectively). In the continuation phase, estrogen receptor-positive patients had longer PFS and OS when receiving hormone therapy plus bevacizumab versus patients receiving only bevacizumab (HR 0.50, 95% CI 0.24-1.04, P=0.06; HR 0.43, 95% CI 0.16-1.16, P=0.09; respectively). Thirty-five patients (44.9%) reported grade 3-4 adverse events.
Bevacizumab plus paclitaxel was effective in HER2-negative MBC. Continuation of bevacizumab and addition of hormone therapy following paclitaxel therapy could be beneficial.
Stoicism has been used to describe a wide range of behaviors in the face of disease that go from silence, resistance to the adversity, or ‘to make the best of a bad disease’. This study pursued two ...objectives: 1) analyze the psychometric properties of the Spanish version of the LSS; 2) assess the relation between stoicism and gender, age, and the five-factor personality model. NEOcoping is a prospective, multicenter, observational, non-interventionist study. Patients were recruited consecutively at thirteen Spanish teaching hospitals. The following scales were administered: Liverpool Stoicism Scale (LSS) and Big Five Inventory (BFI-10). A total of 443 patients (250 females) with a mean age of 59.8 years (SD =12.3) were enrolled. Colon cancer was the most common (40.0%), followed by breast cancer (32.7%). At the total-scale level, mean LSS was lower than the originally reported British series and higher than Latvian sample. The four-factor structure fitted the data well, had a clear interpretation, and the derived scales showed acceptable reliabilities. The personality trait of introversion predicted 4.1% of the variance of stoicism (p<.001). The LSS scale demonstrates good psychometric properties to appraise stoicism in the Spanish population with resected cancer.
A gravidez não planejada na adolescência é bastante comum no Brasil e, com frequência, tem como origem a falta de educação sexual. Isso, consequentemente, pode levar a consecutivas gestações pelas ...jovens que desconhecem informações sobre métodos contraceptivos. Desse modo, este projeto teve como objetivo amparar, esclarecer dúvidas e disseminar informações sobre o uso de métodos anticoncepcionais para adolescentes grávidas e no puerpério. Trata-se de um relato de experiência realizado por oito discentes do curso de medicina da Universidade Federal de Pernambuco (UFPE) sobre as intervenções feitas no Hospital das Clínicas - UFPE e nas Unidades de Saúde da Família da Mangueira, Coqueiral II, São Miguel e Bongi, todas em Recife-PE. A extensão teve duas etapas, uma de formação teórica entre docentes e discentes, e outra de aplicação prática, que precisou ser adaptada devido à ausência de todas as pacientes nas rodas de conversas marcadas, assim, o projeto utilizou-se de conversas individuais. O projeto atingiu 74 gestantes e puérperas adolescentes, no formato remoto ou presencial, e 30 delas concordaram em participar. As conversas envolveram temáticas esclarecedoras sobre educação sexual e nelas 93,3% das participantes mostraram interesse em usar anticoncepcional no puerpério, 83,3% delas já utilizado anteriormente, e 53,3% possuíam conhecimento sobre mais de um método disponibilizado pelo Sistema Único de Saúde (SUS). Após a adaptação da abordagem, o projeto teve adesão satisfatória, podendo ser um precursor de medidas de intervenções sobre planejamento familiar durante o pré-natal da adolescente grávida. Palavras-chave: Anticoncepção; Planejamento Familiar; Gravidez na adolescência Approach to Sexual and Reproductive Education for Teenage Mothers in Recife-PE, Brazil Abstract: Unplanned teenage pregnancy is quite common in Brazil and often stems from a lack of sexual education. Consequently, this can lead to consecutive pregnancies among young girls who are unaware of information about contraceptive methods. Thus, this project aimed to support, clarify doubts, and disseminate information about the use of contraceptive methods for pregnant adolescents and those in the postpartum period. It is an experiential report conducted by eight medical students from the Federal University of Pernambuco (UFPE) on the interventions carried out at the Hospital das Clínicas - UFPE and the Family Health Units of Mangueira, Coqueiral II, São Miguel, and Bongi, all in Recife-PE (Brazil). The project consisted of two stages, one involving theoretical training for teachers and students and another involving practical application, which had to be adapted due to the absence of all patients in the scheduled group discussions, thus resorting to individual conversations. The project approached 74 pregnant and postpartum teenage girls, either remotely or in person, and 30 agreed to participate. The conversations involved informative topics about sexual education, and it was noted that 93.3% of the participants were interested in using contraception in the postpartum period, with 83.3% of them having already used contraceptives in the past and 53.3% knowing more than one method provided by the Unified Health System (SUS). After adapting the approach, the project had satisfactory adherence and could be a precursor to interventions regarding family planning during prenatal care for pregnant adolescents. Keywords: Contraception; Family Development Planning; Pregnancy in Adolescence
Introduction
Hepatic toxicity of breast cancer therapy is well known, usually consisting of elevation in the serum levels of hepatic enzymes or fatty infiltration of the liver. The chemotherapeutic ...agents most commonly linked to hepatotoxic effects are methotrexate, anthracyclines, taxanes and cyclophosphamide. There are few reports of patients with liver metastasis having radiological findings mimicking cirrhosis, both in the presence or the absence of prior systemic chemotherapy. Hepatotoxicity of antineoplastic drugs and cellular necrosis induced by response of liver metastases to chemotherapy may play a critical role in its physiopathology.
Materials and Methods
This article reports a series of ten women with breast cancer (nine with liver metastasis) treated with chemotherapy or hormonotherapy.
Results
They had low risk factors for hepatic disease, but developed a cirrhosis-like appearance in the computed tomography scan. The patient without liver metastasis is the second of this kind described in the literature. Relatively few reports have documented clinical sequelae of portal hypertension. In our series, three patients had oesophageal bleeding varices needing be hospitalised. To our knowledge, these are the first cases reported in the literature.
Conclusions
This suggests that some manifestations of portal hypertension may develop in association with the cirrhosis-like pattern induced by breast cancer therapy.
Las variables psicológicas son las que más se han relacionado con el padecimiento de trastornos depresivos en pacientes oncológicos. El objetivo de este estudio es analizar la relación entre ...dimensiones de personalidad y mecanismos de afrontamiento en una muestra de pacientes oncológicos. Método: 40 pacientes diagnosticados de cáncer de mama, colon o pulmón en estadios no metastáticos y de un trastorno depresivo (DSM IV) se compararon con 39 pacientes con los mismos diagnósticos oncológicos pero que no presentaron ningún episodio depresivo. Para evaluar el afrontamiento se utilizó el MAC (Mental Adjustment Cancer Questionnaire) y para evaluar las dimensiones de personalidad se utilizó el TCI-R (Inventario de Temperamento y Carácter revisado de Clonninger). Resultados: Los pacientes deprimidos presentaron mecanismos de afrontamiento caracterizados por evitación ansiosa, desamparo y fatalismo y menor espíritu de lucha. Los pacientes deprimidos mostraron dimensiones de personalidad caracterizadas por altas puntuaciones en evitación del daño y bajas puntuaciones en dependencia de la recompensa. Las dimensiones de personalidad de persistencia y auto-dirección se correlacionaron con estilos de afrontamiento caracterizados por indefensión-desesperanza y fatalismo en la muestra de pacientes deprimidos, mientras que se correlacionaron con mayor espíritu de lucha en la muestra de pacientes no deprimidos. Entre los no deprimidos se encontró de nuevo que el espíritu de lucha era mayor cuanto meno tendencia a la evitación del daño presentaba el paciente. Conclusiones: Nuestros datos apoyan la importancia de la evaluación del estilo de afrontamiento y personalidad y apuntan a la importancia de otros factores como el mundo de creencias o asunciones básicas del sujeto como mediadora entre las variables de personalidad y de afrontamiento y el trastorno depresivo.
Este artigo discute a questão das pessoas que vivem em situação de rua, com objetivo de compreender suas causas, efeitos e possíveis medidas para superar este fenômeno no âmbito do acesso à saúde. À ...luz da Lei 8.080/90, foi feita uma análise dos maiores déficits do acesso à saúde, a partir das condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento do Sistema Único de Saúde a partir da perspectiva das pessoas em situação de rua. É medida necessária a realização de políticas públicas em saúde voltadas para essa parcela da população, aplicando os princípios do SUS e garantindo o direito à vida e à saúde.
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