Neutropenia: occurrence and management in women with breast cancer receiving chemotherapy

Objectives

to identify the prevalence, and describe the management of, neutropenia throughout the chemotherapy treatment among women with breast cancer.

Methods

observational study, cycles of chemotherapy. 116 neutropenic events were recorded, and 63.3% of the patients presented neutropenia at some point of their treatment, 46.5% of these presenting grade II. The management used was temporary suspension between the cycles and the mean number of delays was 6 days. The study was prospective and longitudinal, where the evaluation of the hematological toxicities was undertaken at each cycle of chemotherapy, whether neoadjuvant or adjuvant.

Results

79 women were included, who received 572 cycles. However, the reasons for the suspensions were the lack of a space in the chemotherapy center, followed by neutropenia.

Conclusion

neutropenia is one of the most common and serious adverse events observed during the chemotherapy. Nursing must invest in research regarding this adverse event and in management strategies for organizing the public health system, so as to offer quality care.     

Beliefs related to adherence to oral antidiabetic treatment according to the Theory of Planned Behavior

OBJECTIVE:

to identify salient behavioral, normative, control and self-efficacy beliefs related to the behavior of adherence to oral antidiabetic agents, using the Theory of Planned Behavior.

METHOD:

cross-sectional, exploratory study with 17 diabetic patients in chronic use of oral antidiabetic medication and in outpatient follow-up. Individual interviews were recorded, transcribed and content-analyzed using pre-established categories.

RESULTS:

behavioral beliefs concerning advantages and disadvantages of adhering to medication emerged, such as the possibility of avoiding complications from diabetes, preventing or delaying the use of insulin, and a perception of side effects. The children of patients and physicians are seen as important social references who influence medication adherence. The factors that facilitate adherence include access to free-of-cost medication and taking medications associated with temporal markers. On the other hand, a complex therapeutic regimen was considered a factor that hinders adherence. Understanding how to use medication and forgetfulness impact the perception of patients regarding their ability to adhere to oral antidiabetic agents.

CONCLUSION:

medication adherence is a complex behavior permeated by behavioral, normative, control and self-efficacy beliefs that should be taken into account when assessing determinants of behavior.     

Quality of life,clinical characteristics and treatment adherence of people living with HIV/AIDS

OBJECTIVES:

to assess the quality of life of people living with HIV/AIDS and verify its association with clinical characteristics and treatment adherence.

METHOD:

cross-sectional study conducted in a hospital in the state of Paraíba, Brazil. A questionnaire was used to collect socio-demographic and clinical data. The quality of life scale proposed by the World Health Organization and a questionnaire to measure treatment adherence were used.

RESULTS:

of the 314 interviewees, 190 (60.5%) were male, aged 43 years on average, 121 (38.5%) had attended up to five years of schooling, 108 (34.4%) received up to two times the minimum wage, and 112 (35.7%) were on sick leave. In regard to clinical variables, individuals with an undetectable viral load scored higher in all the domains concerning quality of life, with statistically significant differences in three domains. Regarding treatment adherence, 235 (73.8%) presented poor adherence and those who strictly adhered to treatment obtained better scores in quality of life. The results show that quality of life is better among individuals adherent to ART. Supporting people to adhere to the antiretroviral treatment should be a persistent task of healthcare workers and other people participating in the treatment, such as family members and friends.     

乳腺癌合并副乳腺癌诊治探讨

目的 探讨乳腺癌合并副乳腺癌的诊治.方法 2007-2010年收治5例副乳腺癌,其中1例合并乳腺癌,对其临床资料进行综合分析.结果 行乳腺癌改良根治术1例,行副乳腺扩大切除术+腋窝淋巴结清扫术4例.术后均给予化疗及放疗,1例行内分泌治疗.4例随访2年,均未发现复发及转移,1例现正在行术后CAP方案序贯化疗.结论 副乳腺癌是一种罕见且预后较差的恶性肿瘤.诊断主要依靠影像学检查和术后病理.应遵循以手术为主的综合治疗原则,术后辅助治疗有可能改善患者的生存期.     

Factors associated to persistence with hormonal therapy in women with breast cancer

OBJECTIVE

To analyze factors associated with persistence to breast cancer hormone therapy in order to contribute to the quality of care improvement.

METHODS

Retrospective longitudinal study, based on secondary data. A cohort of 5,861 women with breast cancer registered in different datasets of the Brazilian National Cancer Institute and the Brazilian Unified Health System were analyzed. All women were treated at this hospital, which provides free medication, and the follow-up period was from January 2004 to October 2010. Sociodemographic, behavioral, and clinical variables, as well as aspects of lifestyle and health care, were considered in the explanation of variations in the persistence to hormone therapy, applying the Kaplan-Meier method and the Cox proportional hazard model.

RESULTS

Overall persistence to hormone therapy was 79.0% at the end of the first year, and 31.0% in five years of treatment. The risk of discontinuing hormone therapy was higher among women under 35 years old, with more advanced disease (stages III and IV), alcohol drinkers, those undergoing chemotherapy, and for each additional hospitalization, exam performed, and month between diagnosis and beginning of treatment. In the opposite direction, the risk of discontinuity was lower among women who had at least finished high school, those with partner, with a family history of cancer, those who had undergone breast surgery, and who had outpatient visits to a Mastologist, and a Clinical Oncologist.

CONCLUSIONS

The majority of the women with breast cancer (69.0%) do not persist with hormone treatment for the five years recommended, increasing the risk of inadequate clinical results. The results show aspects of care that can provide better results.     

不同类型音乐对缓解乳腺癌患者化疗焦虑、抑郁的效果研究

目的:探讨不同类型音乐对缓解乳腺癌术后患者化疗焦虑、抑郁的作用。方法:将首次接受化学治疗的乳腺癌改良根治术后120例患者分为莫扎特音乐干预组(莫扎特音乐+化疗)40例、梁祝音乐干预组(梁祝音乐+化疗)40例和对照组(单纯化疗)40例,检测3组肿瘤患者的抑郁及焦虑自评量表(SDS、SAS)、汉密尔顿抑郁及焦虑量表(HAMD、HAMA)和生活质量评定(QLQ-CCC)指标的变化。结果:对照组化疗后SDS、SAS、HAMD和HAMA与化疗前比较差异无统计学意义(P>0.05),化疗后QLQ-CCC明显低于化疗前差异有统计学意义(P<0.01);莫扎特音乐干预组化疗后SDS、SAS、HAMD和HAMA低于化疗前但差异无统计学意义(P>0.05),化疗后QLQ-CCC与化疗前差异无统计学意义(P>0.05);梁祝音乐干预组化疗后SDS、SAS、HAMD和HAMA明显低于化疗前差异有统计学意义(P<0.01),化疗后QLQ-CCC与化疗前差异无统计学意义(P>0.05)。结论:梁祝音乐能明显降低乳腺癌化疗患者的焦虑、抑郁及提高患者生活质量;莫扎特音乐降低乳腺癌化疗患者的焦虑、抑郁不明显,但不会降低患者生活质量。     

Medication adherence and quality of life among the elderly with diabetic retinopathy

OBJECTIVE:

to investigate the factors related to medication adherence and its relation to Health- Related Quality of Life (HRQoL) in elderly people with diabetic retinopathy.

METHOD:

one hundred (n=100) elderly outpatients with diabetic retinopathy taking antihypertensives and/or oral antidiabetics/insulin were interviewed. Adherence was evaluated by the adherence proportion and its association with the care taken in administrating medications and by the Morisky Scale. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was used to evaluate HRQoL.

RESULTS:

most (58%) reported the use of 80% or more of the prescribed dose and care in utilizing the medication. The item "stopping the drug when experiencing an adverse event", from the Morisky Scale, explained 12.8% and 13.5% of the variability of adherence proportion to antihypertensives and oral antidiabetics/insulin, respectively.

CONCLUSION:

there was better HRQoL in the Color Vision, Driving and Social Functioning domains of the NEI VFQ-25. Individuals with lower scores on the NEI VFQ-25 and higher scores on the Morisky Scale presented greater chance to be nonadherent to the pharmacological treatment of diabetes and hypertension.     

治疗及支持系统对罹患乳腺癌患者术后抑郁的影响

摘要:目的　探讨女性乳腺癌患者术后抑郁的发生状况及治疗及支持系统对抑郁的影响。方法　选取唐山市三级甲等医院就诊的 337例女性乳腺癌术后患者进行问卷调查。结果　女性乳腺癌患者术后抑郁患病率为38.58%,多重回归分析显示,放疗与否、内分泌治疗与否、疤痕疼痛与否及社会支持水平与乳腺癌患者术后抑郁相关,（P＜0.05）。结论　乳腺癌术后抑郁的患病率较高,应提高社会支持度,降低乳腺癌术后抑郁的发生。     

广州市社区女性乳腺癌患者焦虑抑郁状况及其影响因素研究

目的了解广州市社区女性乳腺癌患者出院后的焦虑和抑郁情况,分析其相关影响因素。方法采用多阶段整群抽样方法抽取广州市内包括昌岗、沙园、晓港等16个社区在内的所有满足条件的乳腺癌患者（2010-2012年确诊并经过治疗且调查时未住院的广州市户籍乳腺癌患者）进行问卷调查。调查问卷内容包括患者的人口学资料、诊疗信息、患者肿瘤家族史、经济状况,以及焦虑自评量表（SAS）和抑郁自评量表（SDS）。采用单因素卡方检验和多因素logistic回归分析患者的人口学特征、诊疗信息、肿瘤家族史等因素对乳腺癌患者焦虑、抑郁状况的影响。结果共发出问卷260份,回收有效问卷245份,有效率为94．2％。被调查乳腺癌患者平均年龄为（57．2±11．7）岁,高中及以上文化程度占50．6％（124／245）,以正常退休人群为主,占57．1％（140／245）。调查对象的焦虑标准分平均为（35．7±7．7）分,高于国内常模的（29．78±10．07）分（P〈0．01）,焦虑患者占被调查人数的28．6％（70／245）;调查对象的抑郁平均粗分为（38．7±9．2）分,抑郁患者占被调查人数的49．0％（120／245）。多因素非条件logistic回归表明,相对于无治疗副作用的乳腺癌患者,不管是1—2种,还是3种及以上副作用的患者,其发生焦虑、抑郁状况的风险更高（焦虑：OR=21．9、12．2;抑郁：OR=6．2、4．8）;相对于希望家人/亲朋好友支持的患者,希望医生支持的患者更容易发生焦虑（OR=2．2）;相对于医生不重视的、无癌症家族史的患者,医生重视、有癌症家族史的患者发生抑郁风险更低（OR均为0．4）。结论广州社区女性乳腺癌患者焦虑抑郁率较高。应加强对患者的医学指导和心理干预,降低患者治疗副作用,提高医生对患者的支持力度,加强患者对于癌症相关治疗的了解,以降低乳腺癌患者的焦虑抑郁等心理问题。     

The meaning of pharmacological treatment for schizophrenic patients

OBJECTIVE:

to understand the meaning of medication therapy for schizophrenic patients and formulate a theoretical model about the study phenomenon.

METHOD:

a qualitative approach was employed, using Symbolic Interactionism as the theoretical and Grounded Theory as the methodological framework. The research was developed between 2008 and 2010 at three community mental health services in the interior of the State of São Paulo - Brazil. Thirty-six patients and thirty-six family members were selected through theoretical sampling. The data were mainly collected through open interviews and observation and simultaneously analyzed through open, axial and selective coding.

RESULTS:

the meaning of the pharmacotherapy is centered on the phenomenon "Living with a help that bothers", which expresses the patients'' ambivalence towards the medication and determines their decision making. The insight, access, limitations for self-administration of the drugs and interactions with family members and the health team influenced the patient''s medication-related behavior.

CONCLUSION:

the theory presented in this study provides a comprehensive, contextualized, motivational and dynamic understanding of the relation the patient experiences and indicates potentials and barriers to follow the medication treatment.     

Systemic Arterial Hypertension in the Emergency Service: medication adherence and understanding of this disease

Objective:

to identify the epidemiological profile of hypertension patients, how much they understand about the disease and the rate of adherence to treatment by these patients who had been hospitalized in the Brazilian emergency service.

Methods:

this cross-sectional study was performed with 116 patients, both male and female and aged over 18 years, who had been hospitalized in the Emergency Service of a University Hospital between March and June, 2013. The studied variables were data referring to socio-demographics, comorbidities, physical activity and knowledge regarding the disease. Patient adherence to treatment and the identification of the barriers were respectively evaluated using the Morisky test and the Brief Medication Questionnaire.

Results:

most of the patients involved in this study were women (55%), with white skin color (55%), married (51%), retirees or pensioners (64%) and with a low educational level (58%). Adherence to treatment, in most cases (55%), was moderate and the most prevalent adherence barrier was recall (67%). When medication was acquired at no cost to the patient, there was greater adherence to treatment.

Conclusion:

this study''s patients had a moderate understanding about the disease. The high correlation between the number of drugs used and the recall barrier suggests that monotherapy is an option that can facilitate treatment adherence and reduce how often the patients forget to take their medication.     

Comparative analysis of non-adherence to medication treatment for systemic arterial hypertension in urban and rural populations

OBJECTIVE:

to evaluate the indexes and the main factors associated with non-adherence to medication treatment for systemic arterial hypertension between urban and rural areas.

METHOD:

analytical study based on an epidemiological survey with a sample of 247 hypertensive residents of rural and urban areas, with application of a socio-demographic and economic questionnaire, and treatment adherence assessment. The Pearson''s Chi-square test was used and the odds ratio (OD) was calculated to analyze the factors related to non-adherence.

RESULTS:

the prevalence of non-adherence was 61.9% and it was higher in urban areas (63.4%). Factors significantly associated with non-adherence were: male gender (OR=1.95; 95% CI 1.08-3.50), age 20-59 years old (OR=2.51; 95% CI 1.44-4.39), low economic status (OR=1.95; 95% CI 1.09-3.47), alcohol consumption (OR=5.92, 95% CI 1.73-20.21), short time of hypertension diagnosis (OR=3.07; 95% CI 1.35-6.96) and not attending the health service for routine consultations (OR=2.45; 1.35-4.42).

CONCLUSION:

the socio-demographic/economic characteristics, lifestyle habits and how to relate to health services were the factors that presented association with non-adherence regardless of the place of residence.     

Validation of the Adherence Determinants Questionnaire scale among women with breast and cervical cancer

Objectives:

the aim was to translate and culturally adapt the Adherence Determinants Questionnaire scale for the Portuguese language in the Brazilian context, and to check its reliability and validity to analyze the elements of the adherence of patients to the clinical treatment for breast and cervical cancer.

Method:

this was a methodological study, carried out in two oncology reference centers. The sample consisted of 198 participants, with 152 being treated for breast cancer and 46 being treated for cervical cancer. The content validation was performed by a committee of experts. The construct validation was demonstrated through factor analysis and the reliability was analyzed using Cronbach''s alpha.

Results:

the committee of experts made the necessary adjustments so that the scale was adapted to the Brazilian context. The factor analysis suggested a reduction from seven to five factors and the maintenance of 38 items similar to those of the original scale. The reliability, investigated through Cronbach''s alpha, was .829, showing high internal consistency.

Conclusion:

it was concluded that the Brazilian version of the Adherence Determinants Questionnaire scale is a valid and reliable instrument that is able to measure the elements of adherence to the treatment for breast and cervical cancer.     

联合化疗治疗乳腺癌的临床治疗体会

目的对于联合化疗治疗乳腺癌的临床治疗体会进行探讨。方法本组75例,均为女性,年龄28～67岁,平均45．3岁,术后均经病理证实。采用CAF方案29例,CMF方案25例,CEF方案12例,ET方案9例。所有患者化疗4～6个疗程,每个疗程间隔28d。结果本组病例就诊后24h内即明确诊断者70例（93．33％）,就诊后2～4d内明确诊断5例（6．67％）。本组75例中出现化疗药物外溢至皮下发生疼痛、红肿者5例,发生率6．7％;静脉炎19例,发生率25．3％;胃肠道反应71例,发生率94．7％,骨髓抑制23例,发生率30．7％;口腔炎26例,发生率34．7％;脱发57例,发生率76％。75例联合化疗治疗乳腺癌方案中,明显好转18例（24％）,轻度好转16例（21．33％）,缓解不明显7例（9．33％）,无效34例（45．33％）,有效率54．67％。结论化疗药物虽可最大限度的杀死癌细胞,但其不良反应也不容忽视,化疗期间运用科学有效的护理方法,可以减轻化疗中出现的各种不良反应。     

Elaboration and validation of instrument to assess adherence to hypertension treatment

OBJECTIVE

To elaborate and validate an instrument of adherence to treatment for systemic arterial hypertension, based on Item Response Theory.

METHODS

The process of developing this instrument involved theoretical, empirical and analytical procedures. The theoretical procedures included defining the construct of adherence to systemic arterial hypertension treatment, identifying areas involved and preparing the instrument. The instrument underwent semantic and conceptual analysis by experts. The empirical procedure involved the application of the instrument to 1,000 users with systemic arterial hypertension treated at a referral center in Fortaleza, CE, Northeastern Brazil, in 2012.. The analytical phase validated the instrument through psychometric analysis and statistical procedures. The Item Response Theory model used in the analysis was the Samejima Gradual Response model.

RESULTS

Twelve of the 23 items of the original instrument were calibrated and remained in the final version. Cronbach’s alpha coefficient (α) was 0.81. Items related to the use of medication when presenting symptoms and the use of fat showed good performance as they were more capable of discriminating individuals who adhered to treatment. To ever stop taking the medication and the consumption of white meat showed less power of discrimination. Items related to physical exercise and routinely following the non-pharmacological treatment had most difficulty to respond. The instrument was more suitable for measuring low adherence to hypertension treatment than high.

CONCLUSIONS

The instrument proved to be an adequate tool to assess adherence to treatment for systemic arterial hypertension since it manages to differentiate individuals with high from those with low adherence. Its use could facilitate the identification and verification of compliance to prescribed therapy, besides allowing the establishment of goals to be achieved.