RESUMO
OBJECTIVE: To identify distinct trajectories of toxicity in colorectal cancer (CRC) patients after adjuvant chemotherapy and its impact on quality of life (QoL) and psychological symptoms. METHODS: A prospective, multicenter study was conducted in 157 patients. A latent class analysis defined the unobserved latent constructs that can be predicted as symptom clusters, considering the intensity of four types of adverse events (AEs). Patients completed EORTC-QLQ-C30, BSI-18, PDRQ-9, and DRS scales. RESULTS: Ninety-six percent had some degree of toxicity, with grades 3-4 being the most common: neurotoxicity (7.2%), hematological (13.1%), digestive (5.2%), and skin toxicity (1.4%). Three distinct latent classes were identified (high [72.5%], mild [16.9%], and low [10.6%] toxicity). Patients with high toxicity had the worst QoL scores and moderately high somatization and psychological distress scores. CONCLUSIONS: Adjuvant chemotherapy for CRC was associated with frequent toxicity that negatively impacted QoL and psychological wellbeing.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/psicologia , Análise de Classes Latentes , Qualidade de Vida , Idoso , Antimetabólitos Antineoplásicos/efeitos adversos , Capecitabina/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Tomada de Decisões , Emoções , Feminino , Fluoruracila/efeitos adversos , Humanos , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/efeitos adversos , Relações Médico-Paciente , Estudos Prospectivos , Piridinas/efeitos adversos , EspanhaRESUMO
PURPOSE: The aim of this study was to analyze differences in physician and patient satisfaction in shared decision-making (SDM); patients' emotional distress, and coping in subjects with resected, non-metastatic cancer. METHODS: 602 patients from 14 hospitals in Spain were surveyed. Information was collected regarding physician and patient satisfaction with SDM, participants' emotional distress and coping, as well as patient sociodemographic and clinical characteristics by means of specific, validated questionnaires. RESULTS: Overall, 11% of physicians and 19% of patients were dissatisfied with SDM; 22% of patients presented hopelessness or anxious preoccupation as coping strategies, and 56% presented emotional distress. By gender, female patients showed a higher prevalence of dissatisfaction with SDM (23 vs 14%), anxious preoccupation (26 vs 17%), and emotional distress (63 vs 44%) than males. Hopelessness was more prevalent in individuals with stage III disease than those with stages I-II (28 vs 18%). CONCLUSION: Physicians must be mindful of the importance of emotional support and individual characteristics when communicating treatment options, benefits, and adverse effects of each alternative to oncological patients.
Assuntos
Quimioterapia Adjuvante , Tomada de Decisões , Satisfação no Emprego , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Médicos/psicologia , Adulto , Idoso , Quimioterapia Adjuvante/psicologia , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Humanos , Masculino , Oncologia/métodos , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Médicos/estatística & dados numéricos , Fatores Socioeconômicos , Espanha/epidemiologia , Inquéritos e QuestionáriosRESUMO
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 (p < 0.01); between information sub-scale scores (factor 1) and satisfaction (p < 0.01), and between treatment sub-scale scores (factor 2) and satisfaction (p < 0.01). 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 (p < 0.01) 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.
Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Oncologia , Neoplasias/cirurgia , Médicos/psicologia , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Estudos ProspectivosRESUMO
In this paper we studied the externally disposed plasma membrane antigens in Entamoeba invadens using the enzymatic iodination technique. Sodiumdodecyl-sulfate-polyacrylamide gels of solubilized trophozoite proteins revealed six labeled peaks ranging from 14,000 to 67,000 daltons in gradient slab gels. Over 60 percent of the labeled was in the polypeptide of 67,000 daltons. Concanavalin A binding to these trophozites induced cell surface coat release consituted by three radioactive bands of 67,000, 60,000 and 24,000 daltons. Using an affinity chromatography method with Con A conjugated to Sepharose 4B, trophozoites in culture mixture with these beads during three hours at 22 degree C, released three components that were eluted from immobilized Con A, 67,000, 60,000 and 56,000 daltons revealed in gradient slab gels. In several determinations, the 67,000 daltons glycoprotein consistently was the major surface component, and the most immunogenic as analyzed from rabbits sera immunized with whole cell extracts as well with cell surface coat.