RESUMO
BACKGROUND: Chemotherapy (CT) is a systemic treatment using a combination of antineoplastic drugs, orally or intravenously, that inhibit tumor growth and fast-growing normal cells. Due to its nonspecificity, chemotherapy can cause a series of adverse effects, such as altered taste (dysgeusia), associated with malnutrition and, consequently, other adverse effects in the gastrointestinal tract and increased mortality risk. This study aimed to evaluate the influence of dysgeusia on the incidence of other adverse effects and overall survival during antineoplastic chemotherapy. MATERIAL AND METHODS: An observational, retrospective, cross-sectional study was conducted using data from the Electronic Health Record system of the Cancer Institute of Ceará over two years. Before the CT session, the multi-professional team evaluated the patient for the presence and severity of adverse effects (AE), using scores from the CTCAE v5.0 scale. Dysgeusia scores were collected and associated with clinical pathological data, with other adverse effects (nausea, vomiting, diarrhea, oral mucositis, anorexia, constipation), and with overall survival. Chi-square and Mantel-Cox log-rank tests were used. RESULTS: Of 5744 patients evaluated, dysgeusia presented a frequency of 50.6%, being directly associated with female gender (p=0.001), overweight (p=0.022), high tumor stages (p=0.009), a combination of adjuvant and neoadjuvant (p=0.010) and four-year survival (p=0.030). Dysgeusia frequency was directly associated with diarrhea (p<0.001), anorexia (p<0.001), oral mucositis (p<0.001), nausea (p<0.001), constipation (p<0.001) and vomiting (p<0.001), and inversely associated with fatigue (p=0.035). CONCLUSIONS: Dysgeusia during CT increases the risk of other adverse effects and negatively impacts prognosis.
Assuntos
Antineoplásicos , Disgeusia , Neoplasias , Humanos , Disgeusia/induzido quimicamente , Disgeusia/epidemiologia , Estudos Transversais , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/complicações , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Adulto , Taxa de Sobrevida , Idoso de 80 Anos ou mais , Adulto Jovem , AdolescenteRESUMO
BACKGROUND: Early studies have highlighted the possible development of dysgeusia and anosmia in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and these manifestations should be considered a potential indication of coronavirus disease 19 (COVID-19). As potential contributors to these symptoms, dentists should perform careful oral and oropharyngeal examinations and document suspicious oral lesions in patients with COVID-19, especially in those who complain of loss of taste and smell. The study's objective was to assess the prevalence of oral manifestations among ambulatory unvaccinated symptomatic patients with suspected COVID-19 during the acute phase of the disease. METHODS: This cross-sectional study evaluated oral manifestations in adults (aged ≥ 18 years) with suspected and confirmed SARS-CoV-2 infection. Chi-square and Fisher's exact tests were used to compare data between the groups (rRT-PCR-positive and rRT-PCR-negative patients). RESULTS: One hundred thirty-six participants were included. Most were female (n = 79; 58.1%), with a mean age of 39.53 (± 14.17) years. Of these, 54 (39.7%) had a positive rRT-PCR test, and 82 (60.3%) had negative rRT-PCR results. Oral manifestations were observed in 40 participants (74.1%) in the rRT-PCR-positive group and 67 participants (81.7%) in the rRT-PCR-negative group. The most common oral manifestations were xerostomia (n = 85; 62.5%) and dysgeusia/ageusia (n = 57; 41.9%). Different rates of gingivitis (n = 12; 22.2% vs. n = 5; 6.1%; p = 0.005) and halitosis (n = 7; 13.0% vs. n = 1; 1.2%; p = 0.007) were observed between the rRT-PCR-positive and -negative groups, respectively. Mouth ulcers, glossitis, tongue coating, and petechiae were reported in both groups without significant differences. CONCLUSIONS: A high prevalence of oral manifestations was observed in symptomatic patients with suspected or confirmed COVID-19. CLINICAL RELEVANCE: This study highlights the importance of routine oral examinations by dentists as part of the multidisciplinary care of COVID-19 patients.
Assuntos
COVID-19 , Adulto , Humanos , Feminino , Masculino , COVID-19/complicações , SARS-CoV-2 , Estudos Transversais , Disgeusia/epidemiologia , Disgeusia/etiologia , Disgeusia/diagnóstico , Reação em Cadeia da PolimeraseRESUMO
Xerostomia is defined as the perception of dry mouth, and dysgeusia, as a change in taste. Both are common complaints in the elderly, especially among those making use of polypharmacy drug combinations. Aim: This study aimed to determine the prevalence of xerostomia and dysgeusia and to investigate their association with polypharmacy in the elderly. Methods: older people under follow-up at the Multidisciplinary Elderly Center of the University Hospital of Brasília were interviewed and asked about health problems, medications used, presence of xerostomia and dysgeusia. Descriptive statistics were used to determine the prevalence of the symptoms surveyed. The chi-square test was used to investigate the relationship between xerostomia and dysgeusia and polypharmacy. Secondary associations were performed using binomial logistic regression. Results: Ninety-six older people were evaluated and of these, 62.5% had xerostomia and 21.1%, had dysgeusia. The average number of medications used was 4±3 medications per individual. Polypharmacy was associated with xerostomia but not dysgeusia. It was possible to associate xerostomia with the use of antihypertensive drugs. Conclusion: Xerostomia was a frequent complaint among elderly people making use of polypharmacy, especially those using antihypertensives. Antihypertensives and antidepressants were used most drugs by the elderly and exhibited interactions with drugs most prescribed in Dentistry. Two contraindications were found between fluconazole and mirtazapine; and between erythromycin and simvastatin
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Xerostomia/epidemiologia , Assistência Odontológica para Idosos , Polimedicação , Interações Medicamentosas , Disgeusia/epidemiologiaRESUMO
OBJECTIVES: During the COVID-19 pandemic, several cases of changes in olfaction and taste associated with the infection have been reported. Therefore, otolaryngologists are frequently the first medical professionals sought by patients. The aim of this study was to evaluate the frequency of olfaction and taste disorders in patients hospitalized with COVID-19, and their association with other clinical manifestations and patient evolution during hospitalization. METHODS: 248 patients, admitted to three public hospitals in Belo Horizonte, Minas Gerais, Brazil, were prospectively included: Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), Hospital Júlia Kubitschek (HJK) and Hospital Eduardo de Menezes (HEM), who, upon admission to hospital, presented with Severe Acute Respiratory Syndrome due to COVID-19. Clinical and laboratory variables and outcomes during hospitalization were prospectively collected from the electronic medical records. The collection of sociodemographic and symptomatology data during the acute phase was carried out prospectively in electronic medical records and confirmed with the patients at a subsequent outpatient visit. RESULTS: The most frequently reported symptoms were dyspnea (77.4%), cough (69.8%) and fever (55.2%). During the acute phase of the disease, 95 (38.3%) and 87 (35.1%) patients reported taste and olfaction disorders, respectively. There was a lower prevalence of dysosmia among patients with previous comorbidities (pâ¯<â¯0.05). Both symptoms were associated with less need for intensive care admission (pâ¯=â¯0.001 for dysgeusia and pâ¯=â¯0.021 for dysosmia) and a negative correlation with length of hospital stay (dysosmia: râ¯=â¯-0.175, pâ¯<â¯0.05; dysgeusia: râ¯=â¯-0.29, pâ¯<â¯0.001) and length of stay in the ICU (dysosmia: râ¯=â¯-0.136, pâ¯<â¯0.05; dysgeusia: râ¯=â¯-0.215, pâ¯<â¯0.05). The absence of taste disorders was also associated with a greater need for mechanical ventilation (pâ¯<â¯0.001). CONCLUSION: Changes in taste and olfaction were reported by a large number of patients in the acute phase of COVID-19. In this study, both were markers of better clinical patient evolution. LEVEL OF EVIDENCE: 1B.
Assuntos
COVID-19 , Transtornos do Olfato , Humanos , COVID-19/epidemiologia , Pandemias , Disgeusia/epidemiologia , Disgeusia/etiologia , Olfato , SARS-CoV-2 , Paladar , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/etiologia , Transtornos do Olfato/diagnóstico , Distúrbios do Paladar/epidemiologia , Distúrbios do Paladar/etiologia , HospitalizaçãoRESUMO
PURPOSE: To evaluate the effectiveness of photobiomodulation (PBMT) in preventing dysgeusia in breast cancer patients treated with doxorubicin-cyclophosphamide (AC). METHODS: This is a phase II, randomized, triple-blind, placebo-controlled clinical trial involving 112 breast cancer patients treated with AC. The patients were divided equally into two groups: a test group treated with 2 J red laser and 3 J infrared laser on 21 points that were symmetrically distributed on the tongue on day 0 of four cycles of AC, and an equal placebo group treated with simulated PBMT to blind the patient, evaluator, and statistician. The clinicopathological and sociodemographic data, results of taste test, and subjective taste analysis, and the QoL, ECOG performance status, body mass index, and other side effects were recorded. The data were analyzed using ANOVA-RM/Bonferroni, Friedman/Dunn, and chi-square/Fisher's exact tests. RESULTS: PBMT patients showed less objective and subjective taste loss (p<0.05). On the other hand, the placebo group showed a higher ECOG status (p=0.037) and more significant weight loss (p<0.001) after four cycles of AC. The QoL was significantly higher in the PBMT group (p<0.05) at all assessment periods, and PBMT treatment also reduced the incidence of cachexia (p=0.020), anorexia (p<0.001), diarrhea (p=0.040), oral mucositis (p=0.020), and vomiting (p=0.008). CONCLUSION: PBMT reduced the taste loss and improved the overall health status and QoL of patients with breast cancer treated with AC. TRIAL REGISTRATION: Brazilian Clinical Trials Registry ( www.ensaiosclinicos.gov.br ) approval number RBR-9qnm34y, registered on 01/05/2021.
Assuntos
Antineoplásicos , Neoplasias da Mama , Terapia com Luz de Baixa Intensidade , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Doxorrubicina/efeitos adversos , Disgeusia/induzido quimicamente , Disgeusia/epidemiologia , Feminino , Humanos , Qualidade de VidaRESUMO
PURPOSE: This study retrospectively analyzed the risk factors for transchemotherapy dysgeusia. METHODS: Before each chemotherapy cycle, patients were routinely evaluated for the presence/severity of dysgeusia based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 scale for adverse effects and graded as follows: 0, no change in taste; 1, altered taste with no impact on eating habits; or 2, altered taste with an impact on eating habits. Information from 2 years of evaluations was collected and patient medical records were reviewed to obtain data on chemotherapy cycle, sex, age, body mass index, body surface area, primary tumor, chemotherapy protocol, and history of head and neck radiotherapy. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). RESULTS: Among 7425 total patients, 3047, 2447, and 1931 were evaluated after the first, second, and third chemotherapy cycles, respectively. One-fifth of the patients (19.0%) presented a significant loss of taste, with 1118 (15.0%) showing grade 1 dysgeusia and 442 (6.0%) showing grade 2 dysgeusia. The chemotherapy duration (p < 0.001), female sex (p < 0.001), location of the primary tumor in the uterus (p = 0.008), head and neck (p = 0.012), and testicles (p = 0.011), and use of ifosfamide (p = 0.009), docetaxel (p = 0.001), paclitaxel (p < 0.001), pertuzumab (p = 0.005), bevacizumab (p < 0.001), and dacarbazine (p = 0.002) independently increased the risk of dysgeusia. In head and neck tumors, a previous history of radiotherapy significantly increased the prevalence of dysgeusia (p = 0.017), and the use of cisplatin (p = 0.001) increased this prevalence. CONCLUSION: Cycles of chemotherapy, sex, uterine cancer, head and neck tumors, testicular cancer, ifosfamide, docetaxel, paclitaxel, pertuzumab, bevacizumab, and dacarbazine increase the risk of dysgeusia.
Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Testiculares , Protocolos de Quimioterapia Combinada Antineoplásica , Estudos Transversais , Disgeusia/induzido quimicamente , Disgeusia/epidemiologia , Feminino , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Humanos , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND & AIMS: The symptoms of xerostomia and taste alteration are adverse effects which frequently occur in patients under chemotherapy and once associated they can potentially impair their nutritional status. The aim of this study was to investigate the association of xerostomia and taste alterations in patients being treated by neoplastic chemotherapy. METHODS: Fifty patients scheduled to receive neoplastic chemotherapy were followed for their first two chemotherapy cycles for solid tumors and the Chemotherapy-Induced Taste Alteration Scale (CiTAS) was adopted. Xerostomia was defined by the presence of dry mouth complaints reported by the patients and signs of hyposalivation identified during the intraoral examination. RESULTS: Of the 50 patients, 33 were women, mean age; 61,48 ± 9,07 years, and 17 were men, mean age; 57,35 ± 11,50 years. The most common tumor was located in the breast affecting 15 patients (30%). The Mann-Whitney test showed that the mean scores of CiTAS were significantly higher for those patients who reported having xerostomia when compared with those without xerostomia after the first two chemotherapy cycles. The cofounding variables such as age, smoking habits and use of antidepressants were not statistically associated with taste alterations (p > 0.05). CONCLUSIONS: Taste alterations were worse for patients who complained of xerostomia during the first two cycles of antineoplastic chemotherapy and the association of both symptoms can potentially impair their nutritional status and quality of life.
Assuntos
Antineoplásicos , Xerostomia , Antineoplásicos/efeitos adversos , Disgeusia/induzido quimicamente , Disgeusia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Paladar , Xerostomia/induzido quimicamente , Xerostomia/epidemiologiaRESUMO
Despite its effectiveness, radiochemotherapy treatment in the head and neck region is accompanied by acute oral complications such as oral mucositis, dysphagia, xerostomia, and dysgeusia. The aim of this study was to analyze and prospectively assess the frequency and evolution of acute oral complications during radiochemotherapy in patients diagnosed with squamous cell carcinoma in the head and neck region. We have analyzed oral complications of 20 patients during 6 weeks of radiochemotherapy treatment for squamous cell carcinoma. Oral mucositis was evaluated according to the World Health Organization criteria, dysphagia, and dysgeusia according to the National Cancer Institute Common Toxicity Criteria, and xerostomia according to parameters set by the Seminars in Radiation Oncology. Mucositis was first observed in the second week and all patients presented some degree of mucositis in the fourth week of radiotherapy. Xerostomia and dysphagia were initially reported already in the first week of radiotherapy. All patients presented xerostomia in the fourth week; however, dysphagia was observed in all patients, only in the sixth week. Dysgeusia was first observed in the second week, becoming more severe in the third week. Acute oral complications can be observed throughout the treatment, but the third week of radiotherapy seems to represent a critical week, regardless of the grade of the complication. The sixth week presents the worst grades of these complications. Knowledge about the natural course of oral complications during radiotherapy is important to develop better strategies for treatment and improve the patients' quality of life.
Assuntos
Quimiorradioterapia/efeitos adversos , Transtornos de Deglutição/epidemiologia , Neoplasias de Cabeça e Pescoço/terapia , Doenças da Boca/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Doença Aguda , Transtornos de Deglutição/etiologia , Disgeusia/epidemiologia , Disgeusia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/etiologia , Estudos Prospectivos , Estomatite/epidemiologia , Estomatite/etiologia , Xerostomia/epidemiologia , Xerostomia/etiologiaRESUMO
INTRODUCTION: Health personnel, including physicians, are a fundamental part of the first line of defense against the SARS-CoV-2 pandemic. OBJECTIVE: To characterize the clinical manifestations and course of the first cases of contagion by SARS-CoV-2 in doctors of Peru. METHODOLOGY: We present a series of six cases of doctors infected by SARS-CoV-2, with confirmed positivity for COVID-19, showing the daily evolution from the diagnosis of the disease, its main signs and symptoms, evolution, and until the outcome in each case. RESULTS: Five were men. The median age was 28 years (interquartile range: 27 to 33). In three cases the physician worked more than 12 hours a day in emergency and hospitalization services and not wear a mask at all times. The most frequent symptoms were axillary temperature above 38°C, malaise, dry cough, and odynophagia (the latter in three of the cases). The diagnosis was made at a median of 3 days (interquartile range: 3 to 4 days). The symptoms that persisted the most were dry cough (present during ten days in four doctors). Dysgeusia was the only symptom with the most extended duration (15 days in only one doctor). In the six cases, the course was favorable. However, these doctors found it difficult to return to functions in their hospital centers adequately. DISCUSSION: Despite a small number of cases, it is the first report detailing the evolution of symptoms day by day, which can help for occupational health and even for case surveillance and monitoring.
INTRODUCCIÓN: El personal de salud, entre ellos los médicos, es parte fundamental en primera línea de defensa ante la pandemia de COVID-19, causada por SARS-Cov-2. OBJETIVO: Caracterizar la clínica y evolución de los primeros casos de contagio por coronavirus en médicos de Perú. METODOLOGÍA: Se presentan una serie de seis casos de médicos infectados por coronavirus, con positividad confirmada para COVID-19, mostrando la evolución diaria desde el diagnóstico de la enfermedad, sus principales signos y síntomas, la evolución de los mismos y hasta el desenlace en cada caso. RESULTADOS: De los casos estudiados, cinco fueron hombres, tenían una mediana de edad de 28 años (rango intercuartílico: 27 a 33). Tres de ellos trabajaban más de 12 horas al día en servicios de hospitalización y emergencia; y tres no contaban con mascarilla como método de protección personal. Los síntomas más frecuentes fueron la temperatura axilar superior a 38 grados Celsius, el malestar general, la tos seca y la odinofagia (este último en tres pacientes). En cuanto al diagnóstico con la prueba molecular, tuvo una mediana de tres días de demora (con rango: de 2 a 6 días). Los síntomas que más persistieron fueron la tos seca (presente durante 10 días en cuatro médicos), y la disgeusia como síntoma único, que tuvo la mayor duración (15 días en un solo médico). En los seis casos la evolución fue favorable. Sin embargo, aún se tienen deficiencias para la definición de reincorporación laboral a sus centros hospitalarios. DISCUSIÓN: A pesar de ser un número pequeño de casos, es el primer reporte en personal de salud y que detalla día a día la evolución de los síntomas de COVID-19. Esto puede servir para la salud ocupacional, e incluso como base para la vigilancia y monitorización de los casos en una población mayor.
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Técnicas de Laboratório Clínico , Infecções por Coronavirus/fisiopatologia , Transmissão de Doença Infecciosa do Paciente para o Profissional , Médicos , Pneumonia Viral/fisiopatologia , Adulto , COVID-19 , Teste para COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Tosse/epidemiologia , Tosse/virologia , Disgeusia/epidemiologia , Disgeusia/virologia , Feminino , Febre/epidemiologia , Febre/virologia , Humanos , Masculino , Máscaras/estatística & dados numéricos , Pandemias , Peru , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissãoRESUMO
INTRODUCTION AND OBJECTIVES: Vismodegib (Erivedge® ), a hedgehog pathway inhibitor, is approved to treat metastatic or locally advanced basal cell carcinoma (BCC) not suitable for surgery or radiotherapy. Our main objectives were to study the objective response rate (ORR) assessed by treating physicians and safety of vismodegib in a real-world practice setting in Argentina. MATERIAL AND METHODS: This is a prospective cohort study in real-world practice. We included consecutive adult patients treated in Argentina with locally advanced or metastatic BCC not suitable for surgery or radiotherapy. Patients were followed until the end of the study, death, or loss to follow-up, whichever occurred first. Patients received 150 mg vismodegib PO daily. RESULT: We included in the analysis 63 patients who received treatment. Locally advanced BCC was present in 57 (90.4%) and metastatic disease in two (3.2%). ORR was observed in 46 patients (73%; 95% CI: 60.3-83.4), with partial response in 36 (57%; 95% CI: 44-69.5) and complete response in 10 (16%; 95% CI: 7.8-27.2). As to safety, 48 (76.2%) patients had at least one adverse event (AE). The most frequently observed AEs were muscular spasms in 25 (39.6%); dysgeusia in 23 (36.5%); alopecia in nine (14.2%); weight loss in seven (11.1%); and ageusia in (9.5%) patients. Serious AEs were observed in 11 (17%) patients with one episode of deep vein thrombosis and pulmonary embolism resulting in death. CONCLUSION: Our study provides additional evidence of the efficacy and tolerability of vismodegib in patients with locally advanced or metastatic BCC in a real-world practice.