RESUMO
PURPOSE: After therapy of cancer of the esophagus or the esophagogastric junction, patients often suffer from anxiety and depression. Some risk factors for elevated anxiety and depression are reported, but the influence of steatorrhea, the frequency of which has only recently been reported, has not yet been investigated. METHOD: Using the Hospital Anxiety and Depression Scale (HADS), we analyzed the correlation of anxiety and depression with steatorrhea, appetite, and weight loss in 72 patients with cancer of the esophagus or of the esophagogastric junction, who were treated at our rehabilitation clinic between January 2011 and December 2014. In addition, effectiveness of psychological interviews was analyzed. RESULTS: We have evaluable anxiety questionnaires from 51 patients showing a median anxiety value of 5 (range 0-13). As for the depression, results from evaluable questionnaires of 54 patients also showed a median value of 5 (range 0-15). Increased anxiety and depression values (> 7) were observed in 25.4% and 37.0% of the patients respectively. Patients who were admitted with steatorrhea for rehabilitation showed a statistically higher anxiety value (median 6.3 vs. 4.7, p < 0.05), reduced appetite, and a weight loss above 15 kg depicting a correlation to anxiety and depression. Psychological conversations helped lowering the depression but had no influence on anxiety. CONCLUSIONS: Impairments after cancer treatment, such as steatorrhea, appetite loss, and weight loss, should be interpreted as an alarm signal and should necessitate screening for increased anxiety and depression. Psychological therapy can help improving the extent of the depression.
Assuntos
Ansiedade/etiologia , Depressão/etiologia , Neoplasias Esofágicas/psicologia , Junção Esofagogástrica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS: We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS: Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS: We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.
Assuntos
Febre de Causa Desconhecida/epidemiologia , Neoplasias Hematológicas/reabilitação , Hospedeiro Imunocomprometido , Reinfecção/epidemiologia , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/imunologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Neutropenia Febril/epidemiologia , Neutropenia Febril/imunologia , Feminino , Febre de Causa Desconhecida/imunologia , Alemanha/epidemiologia , Neoplasias Hematológicas/imunologia , Hospitais de Reabilitação , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Pancitopenia/epidemiologia , Pancitopenia/imunologia , Centros de Reabilitação , Reinfecção/imunologia , Estudos Retrospectivos , Risco , Transplante de Células-Tronco , Fatores de Tempo , Transplante HomólogoRESUMO
After surgical treatment of cancer of the esophagus or the esophagogastric junction we observed steatorrhea, which is so far seldom reported. We analyzed all patients treated in our rehabilitation clinic between 2011 and 2014 and focused on the impact of surgery on digestion of fat. Reported steatorrhea was anamnestic, no pancreatic function test was made. Here we show the results from 51 patients. Twenty-three (45%) of the patients reported steatorrhea. Assuming decreased pancreatic function pancreatic enzyme replacement therapy (PERT) was started or modified during the rehabilitation stay (in the following called STEA+). These patients were compared with the patients without steatorrhea and without PERT (STEA-). Maximum weight loss between surgery and rehabilitation start was 18 kg in STEA+ patient and 15.3 kg in STEA- patients. STEA+ patients gained more weight under PERT during the rehabilitation phase (3 wk) than STEA- patients without PERT (+1.0 kg vs. -0.3 kg, P = 0.032). We report for the first time, that patients after cancer related esophageal surgery show anamnestic signs of exocrine pancreas insufficiency and need PERT to gain body weight.
Assuntos
Terapia de Reposição de Enzimas/métodos , Neoplasias Esofágicas/cirurgia , Esteatorreia/tratamento farmacológico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/patologia , Insuficiência Pancreática Exócrina/tratamento farmacológico , Insuficiência Pancreática Exócrina/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esteatorreia/etiologiaRESUMO
PURPOSE: This trial of the German High-Grade Non-Hodgkin's Lymphoma Study Group compares the use of high-dose therapy (HDT) as part of primary treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide followed by involved-field (IF) radiotherapy in a randomized, multicenter, phase III study. PATIENTS AND METHODS: Three hundred twelve patients with "aggressive" non-Hodgkin's lymphoma aged Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
, L-Lactato Desidrogenase/sangue
, Linfoma não Hodgkin/enzimologia
, Linfoma não Hodgkin/terapia
, Transplante de Células-Tronco
, Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
, Carmustina/administração & dosagem
, Quimioterapia Adjuvante
, Ciclofosfamida/administração & dosagem
, Citarabina/administração & dosagem
, Doxorrubicina/administração & dosagem
, Esquema de Medicação
, Etoposídeo/administração & dosagem
, Feminino
, Alemanha
, Humanos
, Linfoma não Hodgkin/tratamento farmacológico
, Linfoma não Hodgkin/radioterapia
, Masculino
, Melfalan/administração & dosagem
, Pessoa de Meia-Idade
, Prednisolona/administração & dosagem
, Prognóstico
, Estudos Prospectivos
, Radioterapia Adjuvante
, Risco
, Análise de Sobrevida
, Transplante Autólogo
, Resultado do Tratamento
, Vincristina/administração & dosagem