RESUMO
BACKGROUND: Lymphoma is the second most prevalent cancer treated with autologous stem cell transplantation (ASCT). Additional resources are required to enhance the provision of care for these patients. OBJECTIVE: To explore the complications and economic costs of home versus hospital care models for ASCT in patients diagnosed with lymphoma and to describe the experience of home care patients. METHODS: This was an observational pilot case-control study with 1:1 matching, in which all patients assisted at home were included. Data were obtained by reviewing medical records and data from the hospital's financial and resource management service. The IEXPAC scale version 11 + 4 was used to assess the care process experience as perceived by home care patients. RESULTS: The study included 34 patients, in which there was a significant decrease in neutropenic fever, both in frequency and duration (P = .001 and P < .001, respectively), in mucositis days (P = .038), and the rate of red cell concentrate transfusion (P < .001); however, there was a longer neutrophil recovery time (P = .044) in home care versus hospitalized patients. The overall cost was higher in the hospital care model (P = .001). Home care patients obtained high scores on the perceived experience of the care process scale. CONCLUSIONS: The home ASCT model is associated with fewer complications, shorter hospital stays, and more significant cost savings. The experience of the home care process was rated satisfactorily. IMPLICATIONS FOR PRACTICE: This study provides evidence for a model that offers high-quality care and a comfortable experience for ASCT patients. Preparing more nurses for this home care model is imperative.
RESUMO
Despite progress in breast cancer treatment, a significant portion of patients still relapse because of drug resistance. The involvement of microRNAs in cancer progression and chemotherapy response is well established. Therefore, this study aimed to elucidate the dysregulation of the microRNA-449 family (specifically, microRNA-449a, microRNA-449b-5p, and microRNA-449c-5p) and its impact on resistance to doxorubicin, a commonly used chemotherapeutic drug for the treatment of triple-negative breast cancer. We found that the microRNA-449 family is downregulated in triple-negative breast cancer and demonstrated its potential as a diagnostic biomarker. Besides, our findings indicate that the downregulation of the microRNA-449 family is mediated by the microRNAs-449/SIRT1-HDAC1 negative feedback loop. Moreover, it was found that the microRNA-449 family dysregulates the fatty acid metabolism by targeting ACSL4, which is a potential prognostic biomarker that mediates doxorubicin response through regulation of the drug extrusion pump ABCG2. Altogether, our results suggest that the microRNA-449 family might be a potential therapeutic target for the treatment of triple-negative breast cancer since it is implicated in doxorubicin response through ACSL4/ABCG2 axis regulation. Ultimately, our results also highlight the value of microRNAs-449 and ACSL4 as diagnostic and prognostic biomarkers in triple-negative breast cancer. Proposed model of miRNAs-449 downregulation in TNBC and doxorubicin response. MiRNAs-449 are downregulated in TNBC through a negative feedback loop with SIRT1 and HDAC1. Moreover, ACSL4 increases ABCG2 expression, thus diminishing the intracellular doxorubicin concentration and promoting doxorubicin resistance. MiRNAs-449 overexpression downregulates the ACSL4/ABCG2 axis and sensitizes doxorubicin-resistant cells to doxorubicin. Created with BioRender. TNBC: triple-negative breast cancer; DOX: doxorubicin; SIRT1: Sirtuin 1; HDAC1: Histone deacetylase 1; ACSL4: Acyl-CoA Synthetase Long-Chain Family Member 4; ABCG2: ATP-binding cassette superfamily G member 2.