Complicaciones tardías de Tratamientos Oncológicos en Pediatría
Luiz Fernando Lopes lf.lopes@yahoo.com
Carlos Rodriguez-Galindo
Galindo CR- JCO , 2015 Vol 33 N 27
Brasil – 12.600 casos em 2016 Estados Unidos – 12.000 a 13.000 casos/ano Paises Europeus (27 membros) 12.000 a 13.000 casos/ano No mundo – 200.000 casos/ ano 80% estao em paises pobres ou em desenvolvimento Taxas cura – 0 a 60%
Cancer death rates for children and adolescents aged 1–19 years, by sex: United States, 1999–2014
Cancer death rates for children and adolescents aged 1– 19 years, by age group: United States, 1999, 2006, and 2014.
Cancer death rates for children and adolescents aged 1– 19 years, by race: United States, 1999, 2006, and 2014
Percent distribution of cancer deaths for children and adolescents aged 1–19 years, by anatomical site: United States, 1999 and 2014
Distribution of the most cammon cancers in children age younger than 15 years in seleted populations
Ribeiro RC J Clin Oncol 33, 2015
Principal arma - quimioterapia
EL USO CATETER : ES FUNDAMENTAL !!!!!!
Infiltraciรณn de QT
Punciรณn venosa
DEVEMOS DESANIMARNOS ?
DEVEMOS DESANIMARNOS ?
DEVEMOS DESANIMARNOS ?
DATOS DE LA LITERATURA
■ ■
69% → 1 secuela tardía 36% → 2 o mas complicaciones moderadas o graves oeffinger et als. cancer 88: 1687-95 04/2000.
58% por lo menos 1 secuela tardia: ■ Infertilidad (14%) nefrectomia (11%) hipotiroidísmo (9%) alteraciones visuales (9%) sexuales (7%) disminución gh (7%) stevens et al. eur. j. cancer 34:694-8 04/1998 ■
SECUELAS QUIRURGICAS ESPLENECTOMIA: Compromiso de la función inmune (mayor riesgo de infección ). LAPARATOMIA: Riesgo de obstrucción intestinal. AMPUTACIONES: Limitación funcional, problemas cosméticos y efectos psicológicos
SECUELAS QUIRURGICAS CIRUGIA PÉLVICA: Impotencia, esterilidad e incontinencias NEFRECTOMIA: Riesgo de disfunción renal progresiva ENUCLEACIÓN: Deficiencia visual, problemas cosméticos NEUROQUIRURGIA: Perdida de “MASA”, hidrocefalia
SECUELAS DE LA RADIOTERAPIA
■ ■ ■ ■ ■ ■ ■ ■ ■ ■
crecimiento dentición estéticas hipertensión arterial hormonales cognitivas atrofia del snc infertilidad carditis neumonitis
SECUELAS DE LA QUIMIOTERAPIA
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cisplatina: lesión tubular renal y ototoxicidad
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ifosfamida: síndrome de fanconi
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antracíclicos: miocardiopatia posterior a 4 - 20 años del tratamiento (dosis dependiente y asociación a radioterapia y otros quimioterápicos) metotrexate: lesión de hepatócitos y alteraciones cognitivas(si ha utilizado intra-tecal) ciclofosfamida e procarbazida: esterilidad
DEPARTAMENTO DE PEDIATRIA
Organización de un Ambulatório para Pacientes fuera de Tratamiento: Importancia de un Equipo Multidisciplinar
Início- Enero 1999
DEPARTAMENTO DE PEDIATRIA
Especialidades Odonto logia
Segunda Neoplasia
Cardio Pediatria
Endocrino Pediatria
Gineco logia
Psiquiatria Psicologia
Fisio terapia
Reproducci ón
Fono Audiologia
Paciente
Neuro Pediatria
Servicio Social Nefro Pediatria
Radio terapia
Voluntária
Enferme ría
Urologia
Pacientes del Departamento de Pediatria del Hospital de CĂĄncer A C Camargo, por lo menos 5 aĂąos fuera de tratamiento oncolĂłgico.
etc..........
etc........
etc......
etc..................................... ............................................... ............................48 pรกginas.
REVISIÓN DE HISTORIA CLINICA
ENTREVISTA
DEVOLUTIVAS ( orientación del especialista)
DISCUSIÓN DE CASOS
ATENCIÓN POR ESPECIALISTAS
GE PE T T O : G rupo de E studos Pediรกtricos sobre E feitos T ardios da T erapia O ncolรณgica
GE PE T T O : G rupo de E studos Pediรกtricos sobre E feitos T ardios da T erapia O ncolรณgica 324 pacientes 22% leucemias 17% tumor de Wilms 12% linfoma no-Hodgkin 10% tumores รณseos 8% retinoblastoma 7,7% linfoma de Hodgkin 6,5% sarcoma de Tejidos Blandos 5,5% GCT 11% otros
Sistema de Graduaciรณn de las Toxicidades: Garre et al. 0: ausente,1:asintomatico;II-III: sintomatico;IV:sintomas extremos
GE PE T T O : G rupo de E studos Pediรกtricos sobre E feitos T ardios da T erapia O ncolรณgica
324 pacientes
Secuelas 2 secuelas >= 3 secuelas
64% 17% 22%
Incluye secuelas quirurgicas
GE PE T T O : G rupo de E studos Pediátricos sobre E feitos T ardios da T erapia O ncológica
324 pacientes 36 con secuelas orgánicas Grau I 34 con secuelas orgánicas Grau II 62 con secuelas orgánicas Grau III 1 con secuelas orgánicas Grau IV
Retirando secuela quirurgica
Jan 99 – Março 2009
Idade diagnostico Idade Gepetto
N 1003 1005
Minima 0 86 (7,1 anos)
Maxima 223 (18,5 anos) 683 (56,9anos)
Media 77,5 (6,4anos) 238,9 (19,9anos) tcg
DIAGN
LLA lma lnh lh wilms pnet osteo neuroblastoma rb neurofibromatose rms tcg histiocitose msd hepatoblastoma ganglioneuroblastoma fibrossarcoma tu supra renal tireoide SNC Ewing sarc NRMS raros meduloblastoma+histi ocitose Total
Percent 15,3 ,9 11,3 9,4 12,2 ,5 10,0 2,0 14,2 ,2 4,5 5,6 1,9 ,1 ,5 ,4 1,2 ,5 ,1 1,3 3,3 1,2 3,5
Valid Percent 15,3 ,9 11,3 500 9,4 12,2 ,5 400 10,0 2,0 14,2 ,2 300 4,5 5,6 1,9 ,1 200 ,5 ,4 1,2 ,5 100 ,1 1,3 3,3 0 1,2 3,5
1
,1
,1
1010
100,0
100,0
Count
Valid
rms
600 Cumulative
Frequency 155 9 114 95 123 5 101 20 143 2 45 57 19 1 5 4 12 5 1 13 33 12 35
Percent 15,3 16,2 27,5 36,9 49,1 49,6 59,6 61,6 75,7 75,9 80,4 86,0 87,9 88,0 88,5 88,9 90,1 90,6 90,7 92,0 95,2 96,4 Missing 99,9 100,0
SEXO
neurofibromatose rb neuroblastoma osteo pnet wilms lh lnh lma LLA masc ulino
feminino
ATIVSEXO
Missing
Total
não (quando adulto) sim Total não procede( quando criança) System Total
Percent 34,8 51,3 86,1
86
8,5
54 140 1008
5,4 13,9 100,0
Valid Percent 40,4 59,6 100,0
Cumulative Percent 40,4 100,0
600
500
400
ESTCIVIL outros
300
divorciado 200
separado casado
100
Count
Valid
Frequency 351 517 868
solteiro 0
Missing Missing
SEXO
masc ulino
feminino
GRAVIDEZ
Missing
Total
não engravidou normal fertilização assistida Total não procede (qdo crianca) System Total
Percent 30,6 9,5 ,2 40,3
515
51,1
87 602 1008
8,6 59,7 100,0
Valid Percent 75,9 23,6 ,5 100,0
Cumulative Percent 75,9 99,5 100,0
600
500
400
GRAVIDEZ
300
fertilizaç ão assisti 200
da normal
100
Count
Valid
Frequency 308 96 2 406
não engravidou 0
Missing Missing
SEXO
masc ulino
feminino
ESCOLA
Missing Total
analfabeto sabe ler e escrever fundamental incompleto fundamental completo ensino médio completo ensino médio incompleto ensino superior completo/incompleto escola especial excepcional 30,0 Total System
Percent ,6 1,0 23,7 5,2 25,0 24,9
Valid Percent ,6 1,0 24,4 5,3 25,7 25,6
Cumulative Percent ,6 1,6 26,0 31,4 57,1 82,7
153
15,2
15,6
98,4
12 3 1 979 29 1008
1,2 ,3 ,1 97,1 2,9 100,0
1,2 ,3 ,1 100,0
99,6 99,9 100,0 escola especial ensino superior comp
600
leto/incompleto ensino médio incompl
500
eto 400
ensino médio complet o
300
fundamental completo fundamental incomple
200
to sabe ler e esc rev er
100
Count
Valid
Frequency 6 10 239 52 252 251
analfabeto 0
Missing Missing
SEXO
masc ulino
feminino
TRABALHO
Missing Total
não e não procura nao, mas está procurando sim desempregado não procede Total System
Frequency 333
Percent 33,0
Valid Percent 33,8
126
12,5
12,8
46,6
428 16 82 985 23 1008
42,5 1,6 8,1 97,7 2,3 100,0
43,5 1,6 8,3 100,0
90,1 91,7 100,0
600
500
TRABALHO
400
não procede 300
desempregado sim
200 nao, mas está procur ando 100
Count
Valid
Cumulative Percent 33,8
não e não proc ura 0
Missing Missing
SEXO
masc ulino
feminino
FUMO
Missing Total
n達o sim n達o procede (quando crianca) Total System
Percent 72,9 16,7
Valid Percent 77,0 17,6
Cumulative Percent 77,0 94,7
51
5,1
5,3
100,0
954 54 1008
94,6 5,4 100,0
100,0
600
500
400
FUMO
300
n達o procede (quando 200
crianca) sim
100
Count
Valid
Frequency 735 168
n達o 0
Missing Missing
SEXO
masc ulino
feminino
DROGA
Missing Total
n達o sim n達o procede Total System
Percent 83,2 7,9 4,8 95,9 4,1 100,0
Valid Percent 86,8 8,3 5,0 100,0
Cumulative Percent 86,8 95,0 100,0
600
500
400
300
DROGA 200
n達o procede sim
100
Count
Valid
Frequency 839 80 48 967 41 1008
n達o 0
Missing Missing
SEXO
masc ulino
feminino
ALCOOL
Missing Total
n達o sim n達o procede (quando crianca) Total System
Percent 47,6 44,2
Valid Percent 49,4 45,9
Cumulative Percent 49,4 95,3
46
4,6
4,7
100,0
972 36 1008
96,4 3,6 100,0
100,0
600
500
400
ALCOOL
300
n達o procede (quando 200
crianca) sim
100
Count
Valid
Frequency 480 446
n達o 0
Missing Missing
SEXO
masc ulino
feminino
600
PENSUICI 500
Missing Total
não sim não procede Total System
Frequency 603 63 5 671 337 1008
Percent 59,8 6,3 ,5 66,6 33,4 100,0
Valid Percent 89,9 9,4 ,7 100,0
400
300
PENSUICI 200
não procede sim
100
Count
Valid
Cumulative Percent 89,9 99,3 100,0
não 0
Missing Missing
masc ulino
feminino
SEXO
600
SUICIDIO
Missing Total
não sim não procede Total System
Percent 64,0 2,0 ,5 66,5 33,5 100,0
Valid Percent 96,3 3,0 ,7 100,0
Cumulative Percent 96,3 99,3 100,0
400
300
SUICIDIO 200
não procede sim
100
Count
Valid
Frequency 645 20 5 670 338 1008
500
não 0
Missing Missing
SEXO
masc ulino
feminino
OBITO
Valid
nĂŁo sim Total
Frequency 997 13 1010
Percent 98,7 1,3 100,0
Valid Percent 98,7 1,3 100,0
Count OBITO sim LLA Hodgkin osteo Retino Total
Total 2 6 3 2 13
2 6 3 2 13
Cumulative Percent 98,7 100,0
Late Death St Jude´s Research Hospital 1962-1983 1762 patients ≼ 10 years from diagnostic
Hudson M; 3rd Int. Cont.Long Term Complitation, 1994
Late Death St Jude´s Research Hospital 1962-1983 1762 patients ≼ 10 years from diagnostic 89 death (31 relapse, 43 complications, 15 acidents)
Hudson M; 3rd Int. Cont.Long Term Complitation, 1994
Late Death St Jude´s Research Hospital 1962-1983 1762 patients ≼ 10 years from diagnostic 89 death (31 relapse, 43 complications, 15 acidents) 43 complications (30 cancer, 7 inf, 3 card, 2 neur, 1 hep)
Hudson M; 3rd Int. Cont.Long Term Complitation, 1994
Late Death
St Jude´s Research Hospital 1962-1983 1762 patients ≼ 10 years from diagnostic 89 death (31 relapse, 43 complications, 15 acidents) 43 complications (30 cancer, 7 inf, 3 card, 2 neur, 1 hep) 30 cancer ( 15 after ALL, 5 HD, 4 Retino, 6 others) Hudson M; 3rd Int. Cont.Long Term Complitation, 1994
Teses Doctorado- Maria de Fátima V. Rizzo – Fertilidad
Maestrado y Doctorado- Julio Cesar Santin –Cardiotoxicidad
Maestrado-Patricia Liberman- Ototoxicidad
Maestrado y Doctorado-Sandra Shimoda- Calidad de Vida
Teses Maestrado-Virginia Circhia Pinto- Ef.Tardios en la Odontogenesis Doctorado-Celia Lidia da Costa – Comorbilidades psiquiatricas Maestrado- Humberto Rigon- Secuelas tardias en sobrevivientes del cåncer infantil Maestrado- Natalia Leonetti- Estado Nutricional
Neurologo Pediatra- Carlos Alberto M. Osório
-Dra. Cândida Helena Pires de Camargo - Diretora do Serviço de Psicologia e Neuropsicologia do Ipq – HCFMUSP -Luciana de Carvalho Monteiro - psicóloga - Ipq - HCFMUSP -Camila Batista dos Santos - psicóloga aprimoranda – Ipq HCFMUSP
Estudio de las secuelas tardías neuro-cognitivas En los pacientes con Leucemia Linfocítica Aguda Funciones mentales: * cognición
* comportamiento * emoción/motivación
atención percepción memória lenguaje
TOTAL DE CONSULTAS
559
LEUCEMIAS AGUDAS BANCO DE DATOS VALORACIÓN NEUROLÓGICA
98 49 33
Valoración neurológica normal hemiplejía
32 01
NEUROIMAGENES
20
TCC RNM
12 08
LEUCOENCEFALOPATIA CALCIFICACIÓN
04 01
MUESTRA DE LA EVALUACIÓN - QI 12p = ( 9 WISC/WAIS ) ■
3 no completaron evaluación
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QI médio ( 90-109) 3 pts
■
QI média inferior (80 - 90) 3 pts
■
QI limítrofe (70-90) 2 pts
■
QI deficiencia mental leve ( 50-69) 1 pte
Déficit encontrados
Signos cognitivos:
1. Déficit de Atención: 12/12
Relacionado al deficit cognitivo Función verbal: relacionado con el lenguaje hablado Función no verbal:organización del pensamiento y funciones mentales
Déficit encontrados
Signos cognitivos: 2. Déficit específicos verbales: 0 Nominación y comprensión 3. Déficit no-verbales: 7/12 Capacidades asociativas que no envuelven el habla
Déficit encontrados
Signos cognitivos: 4. Déficit de memoria: 9/12 :visuales (reconocimiento) 3/12 :verbales (de nominación y comprensión)
Déficit encontrados
Signos cognitivos: 5. Disfunción ejecutiva: 8/12 (Deficit de abstracción, planeamiento,interpretaciones complejas) 6. Dificultades para cálculos: 7/12
7. Deficiencia Mental: 1/12
Lancet Haematol. 2016 Sep 14. [Epub ahead of print] Leukoencephalopathy and long-term neurobehavioural, neurocognitive, and brain imaging outcomes in survivors of childhood acute lymphoblastic leukaemia treated with chemotherapy: a longitudinal analysis. Melissa Hudson et al
Treated between June 1, 2000, and Oct 31, 2010 At least 5 years after their diagnosis, survivors completed neurocognitive testing, another brain MRI, and their parents completed neurobehavioural ratings of their child Between Feb 18, 2010, and Oct 22, 2014, 210 (70%) of 301 eligible survivors 190 were evaluable, 162 had an MRI. 56 participants had quantitative brain imaging data and were included in evaluable population analyses. 51 (27%) of the 190 evaluable participants had acute leukoencephalopathy.
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Compared with population norms, survivors were reported to have more neurobehavioural problems with working memory, organisation, initiation, and planning (p<0·001 for all). Survivors had worse scores than the general population on direct measures of memory span, processing speed, and executive function (p<0·05 for all). Survivors with a history of acute leukoencephalopathy had more neurobehavioural problems than survivors with no history of leukoencephalopathy on organisation Survivors with acute leukoencephalopathy also had reduced white matter integrity in the frontostriatal tract at follow-up: lower fractional anisotropy (p=0·069), higher axial diffusivity (p=0·020), and higher radial diffusivity (p=0·0077). A one-unit change in the radial diffusivity index corresponded with a 15·0 increase in raw score points on initiation, 30·3 on planning, and 28·0 on working memory (p<0·05 for all).
Enfermeira- Sandra Shimoda
Disability and health-related quality of life in long-term survivors of cancer in childhood in Brazil. Shimoda S, Horsman J, Furlong W, Barr R, de Camargo B. J Pediatr Hematol Oncol. 2008 Aug;30(8):563-70
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More than one-third of the 138 consecutive survivors who participated reported some cognitive disability or pain. Approximately one-quarter reported problems with vision, speech, or emotion. Mean HRQL was similar (P>0.05) among countries for survivors of acute lymphoblastic leukemia and Hodgkin disease. The results support the hypotheses that Brazilian survivors of cancer in childhood experience a wide range of disabilities and impaired HRQL, are similar to those in other countries, and should be assessed in long-term follow-up clinics.
Fonoaudiรณloga- Patricia Pecora Liberman Estudiar la ocurrencia de perdida auditiva en pacientes pediรกtricos oncolรณgicos fuera de tratamiento
Resultados Configuração audiométrica média dos limiares auditivos segundo o tipo de tratamento. 0,25 0,5 0 10 20 30 40 50 60 70 80 90 100
1
2
4
6
8
kHz
OD sem RxT/sem CDDP OE sem RxT/sem CDDP OD CDDP OE CDDP OD RxT OE RxT OD RxT + CDDP OE RxT + CDDP
Cardiologo Pediatra- Júlio Cesar Santin
Análisis ecocardiográfico tardío de la función cardíaca en pacientes sometidos a quimioterapia con antracíclicos Late echocardiography assessment of systolic and diastolic function of the left ventricle in pediatric cancer survivors after anthracycline therapy. Santin JC, Deheinzelin D, Junior SP, Lopes LF, de Camargo B. J Pediatr Hematol Oncol. 2007 Nov;29(11):761-5.
N = 117 PACIENTES EDAD AL DIAGNÓSTICO = 6,46 AÑOS EDAD ACTUAL = 21,45 AÑOS “FOLLOW-UP” = 14,87 AÑOS DOSIS TOTAL DE ANTRACÍCLICOS = 297,18 mg/m2.
ECOCARDIOGRAMA DOPPLER • FRACCIÓN DE ACORTAMIENTO ALTERADA ( < 28 % ) = 8 PACIENTES ( 6,8 % ) • CUANTO MAYOR FUE LA DOSIS TOTAL, LOS SINTOMAS CLÍNICOS TIENDEN A ESTAR MAS PRESENTES ( r = 0,236, p= 0,01 ) • CUANTO MAYOR EL TIEMPO DE “FOLLOW-UP” LOS SINTOMAS CLÍNICOS TIENDEN A ESTAR MAS PRESENTES ( r= 0,275, p=0,003 )
Ann Intern Med. 2016 January 19; 164(2): 93–101. Cardiac Outcomes in Adult Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy: A CrossSectional Study from the St. Jude Lifetime Cohort Melissa M. Hudson, et al
Results—Half (52.3%) of the survivors were male, median age 8.0 years (range: 0-24) at cancer diagnosis, 31.0 years (18-60) at evaluation. Cardiomyopathy was present in 7.4% (newly identified at the time of evaluation in 4.7%), coronary artery disease (CAD) in 3.8% (newly identified in 2.2%), valvular regurgitation/ stenosis in 28.0% (newly identified in 24.8%), and conduction/rhythm abnormalities in 4.6% (newly identified in 1.4%). Nearly all (99.7%) were asymptomatic. The prevalences of cardiac conditions increased with age at evaluation, ranging from 3-24% among those 30-39 years to 10-37% among those ≥40 years. On multivariable analysis, anthracycline exposure ≥250 mg/m2 increased the odds of cardiomyopathy (odds ratio [OR] 2.7, 95% CI 1.1-6.9) compared to anthracycline unexposed survivors. Radiation to the heart increased the odds of cardiomyopathy (OR 1.9 95% CI 1.1-3.7) compared to radiation unexposed survivors. Radiation >1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings.
Lancet Oncol. 2016 Sep;17(9):1325-34. Cumulative burden of cardiovascular morbidity in paediatric, adolescent, and young adult survivors of Hodgkin's lymphoma: an analysis from the St Jude Lifetime Cohort Study. , Robison LL et al
The patient cohort for our study was defined as patients treated at St Jude Children's Research Hospital who reached 18 years of age and were at least 10 years postdiagnosis of pathologically confirmed primary Hodgkin's lymphoma. Outcomes in the Hodgkin's lymphoma survivors were compared with a sample of SJLIFE community control participants, aged 18 years or older at the time of assessment,
Of 670 survivors treated at St Jude Children's Research Hospital, who survived 10 years or longer and reached age 18 years, 348 were clinically assessed in the St Jude Lifetime Cohort Study (SJLIFE); 322 eligible participants did not participate in SJLIFE. Age and sex frequency-matched SJLIFE community controls (n=272) were used for comparison. At age 50 years, the cumulative incidence of survivors experiencing at least one grade 3-5 cardiovascular condition was 45·5% (95% CI 36·6-54·3), compared with 15·7% (7·0-24·4) in community controls. Myocardial infarction and structural heart defects were the major contributors to the excess grade 3-5 cumulative burden in survivors. High cardiac radiation dose (≥35 Gy) was associated with an increased proportion of grade 3-5 cardiovascular burden, whereas increased anthracyline dose was not. Survivors aged 50 years will experience more than two times the number of chronic cardiovascular health conditions and nearly five times the number of more severe (grade 3-5) cardiovascular conditions compared with community controls and, on average, have one severe, life-threatening, or fatal cardiovascular condition.
Assistente Social- Maria Elizete Prado
Encaminamiento a enseñanza profesional Artes y ciudadania (informática, inglés, diseño industrial) Centro y Apoyo del menor (CAM) (cursos y práticas en empresas)
Encaminamiento para el mercado del trabajo SERT (Secr Empleo y Relaciรณn del Trabajo) PAT (Programa de atenciรณn al trabajo) O.A.T. (Oficina Abrigada del Trabajo)
Cirujano Dentista- Virginia M. Circhia Pinto
Estudio de las anomalias dentales y maxilofaciales en pacientes curados de cรกncer en la infรกncia
Hipoplasia de Esmalte
â&#x20AC;˘ Microdontia
• Alteraciones de Erupción • Alteraciones exfoliación de los decíduos • Microdontia
• Arizogénese
Evaluaci贸n preliminar 238 pacientes 73
(30,7%) no presentaron anormalidades dentales
124 96 73 70 63 62 50
(52.1%) (40.3%) (30.7%) (29.4%) (26.5%) (26.1%) (21%)
alteraci贸n del color del diente hipoplasia dental necesitan de correcci贸n ortod贸ntica microdientes enfermedad periodontal caries dentales hipodontia.
Psiquiatra- Célia Lidia da Costa
Evaluar la calidad de vida de los pacientes sobreviventes de cáncer infantil (SF-36). Evaluar la población en relación a la existéncia de morbilidades psiquiátricas y adecuación social (EAS, IES). Caracterizar la población en cuanto al comportamiento del riesgo para cáncer (Tabaquísmo, alcoholísmo, sexo seguro).
Resultados ■
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Retinoblastoma: dificultades emocionales y sociales (grupo de mayor prejuízo en la calidad de vida). Osteosarcoma: calidad de vida con prejuízo en capacidad funcional y aspectos sociales. Leucemia: mayores niveles de estress y pós- traumático.
Resultados
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Todos con sintomas de ansiedad considerados de moderados a graves.
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Cigarrillo, drogas, álcool: baja prevalencia.
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Mayoría sin preocupación con el uso de preservativos.
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“Conmigo todo bien....mi família es la que nunca sabe bien lo que yo era.......Es como si yo tubiera siempre que recordar a todo el mundo que estoy vivo.....pasa por mi cabeza si los médicos sabian lo que estavan haciendo......será que sabian que iba ha ser así?.......Es así con todo el mundo?”
“Interesante pasar mi experiencia de vida a otras personas....Siempre que tengo un problema, recuerdo que vencí un cáncer, y que quién vence un cáncer, supera cualquier situación¨.
Autores- creemos, al contrario, que esos paradigmas representan formas distintas de mirar el objeto, y que el conocimiento que de uno deriva, sumado al de otro, posibilitan al cientifico comprender partes complementarias de la misma realidad.
J Cancer Surviv. 2016 Aug;10(4):743-58. The unmet emotional, care/support, and informational needs of adult survivors of pediatric malignancies. , Robison LL et al ■
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A randomly selected/stratified sample of participants n = 1189; mean [SD] current age, 39.7 [7.7], range = 26-61 years; 60.9 % women; mean [SD] years since diagnosis, 31.6 [4.7]). Survivors self-reported demographic information, health concerns, and needs; diagnosis/treatment data were obtained from medical records. Adjusted proportional risk ratios (prevalence ratios, PRs) were used to evaluate 77 separate needs.
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54% of survivors reported unmet psycho-emotional, 41 % coping, and 35 % care/support needs; 51, 35, and 33 %, respectively, reported unmet information needs related to cancer/ treatment, the health care system, and surveillance. Having moderate/extreme cancer-related anxiety/fear was associated with all needs, including a >6-fold increased prevalence for help dealing with "worry” and anxiety and
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a >5-fold increased prevalence for "needing to move on with life” and dealing with "uncertainty about the future” .
Psicologa – Leila Nakamoto
Traducción de validación del inventário de crecimiento pós traumático en población de sobreviventes del cáncer infantil
Crianças sírias na escola do campo de refugiados al-zaacari, na Jordânia
Muchas Gracias!!!