Complicaciones tardías de tratamientos oncológicos en pediatría - Dr. Luis Fernando Lopes

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

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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

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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

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QI média inferior (80 - 90) 3 pts

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QI limítrofe (70-90) 2 pts

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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!!!