What are the best terms in Portuguese to explain the concepts of "fatigue" and "depression" in cancer patients?

OBJECTIVE: Although "fatigue" and "depression" are well-accepted clinical terms in the English language, they are ill defined in many other languages, including Portuguese. We aimed to investigate the most appropriate words to describe cancer-related fatigue (CRF) and depression in Brazilian cancer patients. METHOD: The interviewers read to patients two clinical vignettes describing fatigued patients and two others describing depressed patients. Participants were asked to choose from among "fatigue," "tiredness," "weakness," "depression," and "sadness" the best and worst terms to explain the vignettes. In addition, they were administered an instrument containing numeric rating scales (NRSs), addressing common symptoms, including the aforementioned terms. Pearson correlation analysis and accuracy diagnostic tests were conducted using the Hospital Anxiety and Depression Scale (HADS) and the Functional Assessment of Cancer Treatment-Fatigue (FACIT-F) as references. RESULTS: Among the 80 participants, 40% reported that the best term to explain the concept of CRF was "tiredness," and 59% chose "sadness" as the best descriptor of depression. Regarding diagnostic accuracy, the areas under the curve (AUCs) for "fatigue," "weakness," and "tiredness" were 0.71, 0.81, and 0.76, respectively; the AUCs for "depression" and "sadness" ranged from 0.81 to 0.91 and 0.73 to 0.83, respectively. Negative correlations were found among FACIT-F fatigue subscale scores and NRS scores for "fatigue" (r = -0.58), "tiredness" (r = -0.67), and "weakness" (r = -0.62). Regarding depression, there were positive correlations between HADS-D scores and both NRS for "depression" (r = 0.61) and "sadness" (r = 0.54). SIGNIFICANCE OF RESULTS: "Tiredness" was considered the best descriptor of CRF. Taking into consideration the clinical correlation with depression scores, the term "depression" was accepted as the best term to explain the concept of depression.

Reclassification of risk in an emergency referral center: the need for a specific tool for the classification of onco-hematological patients. A cross-sectional study.

In emergency rooms, patients are usually classified using scales for predicting risk, resource usage, and the maximum time for receiving medical care. Emergency Severity Index (ESI) is a frequently used scale in this context. However, every patient with cancer is automatically classified as ESI level 3. In this study, patients with cancer seen at an emergency setting were reclassified using the ESI without the "cancer" parameter to verify whether there would be any change in the classification. Cross-sectional study. A convenience sample of all cancer patients who sought immediate care at a private center in Brazil during a 6-month period was included in the study. After receiving care according to the institution's standards, they were reclassified using the ESI scale without the "cancer" parameter. Times to receiving care and to reaching a diagnosis were recorded. In the study period, 360 patients were reclassified. They sought treatment for infection, pain, and gastrointestinal problems related to chemotherapy. The reclassification led to significant changes in the ESI risk level: 8.8% of the patients initially classified as level 4 had their level changed, as did 10.6% of those at level 3. The number of patients reclassified as level 1 was 3.2% higher than that of the initial classification (p < 0.001). There is a need to create a new scale for the classification of risk that takes the characteristics of patients receiving cancer treatment into account. Specific populations require specific classification scales for better evaluation of risk.

The Brazilian Version of the Edmonton Symptom Assessment System (ESAS) Is a Feasible, Valid and Reliable Instrument for the Measurement of Symptoms in Advanced Cancer Patients.

PURPOSES: To develop and validate a Portuguese version of the Edmonton Symptom Assessment System (ESAS) in Brazilian patients with advanced cancer. METHODS: The ESAS was translated and then back translated into Portuguese in accordance with international guidelines. The final version was approved by an Expert Committee after pilot testing on 24 advanced cancer patients. Subsequently, we evaluated the time to complete the assessment, the number of unanswered items, internal consistency, convergent validity, and known-group validity in a sample of 249 advanced cancer patients who completed the ESAS along with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), Hospital Anxiety and Depression Scale (HADS), and Epworth Sleepiness Scale (ESS). A total of 90 clinically stable patients were retested after 4 to 96 hours (test-retest reliability), and 80 patients answered the ESAS after 21 (± 7) days to measure scale responsiveness using an anchor-based method. RESULTS: The ESAS was completed in a mean time of only 2.2 minutes. The internal consistency was good (Cronbach's alpha = 0.861), and the removal of single items did not change the overall alpha value. For convergent validity, Spearman's correlation coefficients between the ESAS symptom scores and the corresponding EORTC QLQ-C30 and ESS symptom scores ranged between 0.520 (95% CI = 0.424-0.605) and 0.814 (95% CI = 0.760-0.856), indicating moderate to strong correlations. Test-retest reliability values were considered adequate, with intraclass correlation coefficients ranging from 0.758 (95% CI = 0.627-0.843) to 0.939 (95% CI = 0.905-0.960). CONCLUSIONS: ESAS is a feasible, valid and reliable multi-symptom assessment instrument for use in Brazil.