Impactos Psicossociais e na Qualidade de Vida do Tratamento Oncológico em Crianças e Adolescentes / Psychosocial and Quality-of-Life Impacts of Cancer Treatment in Children and Adolescents / Impactos Psicosociales y en la Calidad de Vida del Tratamiento del Cáncer en Niños y Adolescentes

Introdução: Tão importante quanto o diagnóstico e o tratamento do câncer pediátrico são os cuidados relacionados ao impacto psicossocial, educacional e emocional. Objetivo: Avaliar em crianças e adolescentes com diagnóstico de câncer os impactos psicossociais, de qualidade de vida e da presença de acompanhante durante os procedimentos. Método: Estudo transversal, descritivo, com pacientes de 8 a 18 anos e diagnóstico de neoplasia maligna. Os pacientes responderam aos questionários: PedsQL 4.0 Qualidade de Vida (8 a 12 anos), PedsQL 3.0 Módulo de Câncer (8 a 12 anos), PedsQL 4.0 Qualidade de Vida (13 a 18 anos), PedsQL 3.0 Módulo de Câncer (13 a 18 anos) e outro sobre acompanhantes elaborado pelos autores. Resultados: Foram incluídos 25 pacientes pediátricos oncológicos que se sentiam mais felizes na presença de um acompanhante e menos ansiosos durante os procedimentos. Foi percebido grande impacto na qualidade de vida. No questionário Qualidade de Vida, não houve diferença significativa (p=0,627) entre os grupos de pacientes com 8 a 12 anos e 13 a 18 anos, porém o grupo com 8 a 12 anos teve impacto significativamente maior no questionário Módulo de Câncer (p=0,0094). Conclusão: O impacto psicossocial e na qualidade de vida é razoavelmente grande em pacientes pediátricos oncológicos. Além disso, os mais jovens parecem sofrer um impacto psicossocial maior. Os pacientes se dizem mais felizes com a presença de acompanhante, e mais ansiosos na sua ausência.

Introduction: As important as the diagnosis and treatment of pediatric cancer are the care related to psychosocial, educational, and emotional impact. Objective: To evaluate in children and adolescents diagnosed with cancer the psychosocial and quality-of-life impacts and the presence of a companion during the procedures. Method: Cross-sectional descriptive study of patients aged 8 to 18 years of age diagnosed with malignant neoplasms. Patients responded the questionnaires PedsQL 4.0 Quality of Life (8 to 12 years), PedsQL 3.0 Cancer Module (8 to 12 years), PedsQL 4.0 Quality of Life (13 to 18 years), PedsQL 3.0 Cancer Module (13 to 18 years) and another about companions created by the authors. Results: There were 25 pediatric oncology patients included who felt happier in the presence of a companion, and less anxious during the procedures. A great impact on quality of life was perceived. In the Quality-of-Life questionnaire, no significant difference (p=0.627) between the groups of patients aged 8 to 12 years and 13 to 18 years were found, but the group aged 8 to 12 years had a significantly higher impact on the Cancer Module questionnaire (p= 0.0094). Conclusion: The impact on quality of life and psychosocial is fairly large in pediatric oncology patients. The youngest appear to suffer great psychosocial impact. Patients claim they are happier in the presence of a companion, and more anxious in its absence

Introducción: Tan importante como el diagnóstico y tratamiento del cáncer pediátrico, son los cuidados sobre el impacto psicosocial, educativo y emocional. Objetivo: Evaluar en niños y adolescentes diagnosticados de cáncer el impacto psicosocial y en la calidad de vida y la presencia de un acompañante durante los procedimientos. Método: Estudio transversal descriptivo de pacientes de 8 a 18 años con diagnóstico de neoplasia maligna. Los pacientes respondieron a los cuestionarios: PedsQL 4.0 Calidad de Vida (8 a 12 años), PedsQL 3.0 Módulo de Cáncer (8 a 12 años), PedsQL 4.0 Calidad de Vida (13 a 18 años), PedsQL 3.0 Módulo de Cáncer (13 a 18 años) y otro sobre cuidadores elaborado por los autores. Resultados: Se incluyeron 25 pacientes de oncología pediátrica que se sentían más felices con la presencia de un acompañante y menos ansiosos al realizar procedimientos. Se percibió un gran impacto en la calidad de vida. En el cuestionario de Calidad de Vida, no hubo diferencia significativa (p=0,627) entre los grupos de pacientes de 8 a 12 años y de 13 a 18 años, pero el grupo de 8 a 12 años tuvo un impacto significativamente mayor en el cuestionario del Módulo de Cáncer (p=0,0094). Conclusión: El impacto en la calidad de vida y psicosocial es razonablemente grande en los pacientes oncológicos pediátricos. Los de menor edad parecen sufrir un mayor impacto psicosocial. Los pacientes dicen sentirse más felices con la presencia de un acompañante, y más ansiosos en su ausencia.

Newborn Screening for the Detection of the TP53 R337H Variant and Surveillance for Early Diagnosis of Pediatric Adrenocortical Tumors: Lessons Learned and Way Forward.

The incidence of pediatric adrenocortical tumors (ACT) is high in southern Brazil due to the founder TP53 R337H variant. Neonatal screening/surveillance (NSS) for this variant resulted in early ACT detection and improved outcomes. The medical records of children with ACT who did not participate in newborn screening (non-NSS) were reviewed (2012-2018). We compared known prognostic factors between the NSS and non-NSS cohorts and estimated surveillance and treatment costs. Of the 16 non-NSS children with ACT carrying the R337H variant, the disease stages I, II, III, and IV were observed in five, five, one, and five children, respectively. The tumor weight ranged from 22 to 608 g. The 11 NSS children with ACT all had disease stage I and were alive. The median tumor weight, age of diagnosis, and interval between symptoms and diagnosis were 21 g, 1.9 years, and two weeks, respectively, for the NSS cohort and 210 g, 5.2 years, and 15 weeks, respectively, for the non-NSS cohort. The estimated surveillance/screening cost per year of life saved is US$623/patient. NSS is critical for improving the outcome of pediatric ACT in this region. Hence, we strongly advocate for the inclusion of R337H in the state-mandated universal screening and surveillance.

Impact of the COVID-19 pandemic in patient admission to a high-complexity cancer center in Southern Brasil.

OBJECTIVE: The aim of our study was to investigate whether there has been a reduction in patient admission to a high-complexity cancer care center in Brasil during the COVID-19 pandemic, similar to what was reported in Europe. METHODS: We reviewed the cancer tracking database of the largest cancer center in southern Brasil and performed statistical tests to compare first-time appointments from the onset of the outbreak until the end of June to those of the equivalent period in 2019. RESULTS: We observed a dramatic reduction (-42%) in first-time appointments during the pandemic compared to the same period in the previous year (P <0.001). This reduction was observed among all medical specialties (P <0.001). CONCLUSION: The onset of COVID-19 was correlated with a reduction in admission to a high-complexity cancer care center in Brasil. Since a delay in diagnosis and treatment may influence prognosis, it is important that cancer centers and public health strategies reinforce care for non-COVID-19 patients to prevent potentially unnecessary deaths.

Impact of the COVID-19 pandemic in patient admission to a high-complexity cancer center in Southern Brasil

SUMMARY OBJECTIVE: The aim of our study was to investigate whether there has been a reduction in patient admission to a high-complexity cancer care center in Brasil during the COVID-19 pandemic, similar to what was reported in Europe. METHODS: We reviewed the cancer tracking database of the largest cancer center in southern Brasil and performed statistical tests to compare first-time appointments from the onset of the outbreak until the end of June to those of the equivalent period in 2019. RESULTS: We observed a dramatic reduction (-42%) in first-time appointments during the pandemic compared to the same period in the previous year (P <0.001). This reduction was observed among all medical specialties (P <0.001). CONCLUSION: The onset of COVID-19 was correlated with a reduction in admission to a high-complexity cancer care center in Brasil. Since a delay in diagnosis and treatment may influence prognosis, it is important that cancer centers and public health strategies reinforce care for non-COVID-19 patients to prevent potentially unnecessary deaths.

Penetrance of the TP53 R337H Mutation and Pediatric Adrenocortical Carcinoma Incidence Associated with Environmental Influences in a 12-Year Observational Cohort in Southern Brazil.

The TP53 R337H mutation is associated with increased incidence of pediatric adrenocortical tumor (ACT). The different environmental conditions where R337H carriers live have not been systematically analyzed. Here, the R337H frequencies, ACT incidences, and R337H penetrance for ACT were calculated using the 2006 cohort with 4165 R337H carriers living in Paraná state (PR) subregions. The effectiveness of a second surveillance for R337H probands selected from 42,438 tested newborns in PR (2016 cohort) was tested to detect early stage I tumor among educated families without periodical exams. Estimation of R337H frequencies and ACT incidence in Santa Catarina state (SC) used data from 50,115 tested newborns without surveillance, ACT cases from a SC hospital, and a public cancer registry. R337H carrier frequencies in the population were 0.245% (SC) and 0.306% (PR), and 87% and 95% in ACTs, respectively. The ACT incidence was calculated as ~6.4/million children younger than 10 years per year in PR (95% CI: 5.28; 7.65) and 4.15/million in SC (CI 95%: 2.95; 5.67). The ACT penetrance in PR for probands followed from birth to 12 years was 3.9%. R337H carriers living in an agricultural subregion (C1) had a lower risk of developing pediatric ACT than those living in industrial and large urban subregion (relative risk = 2.4). One small ACT (21g) without recurrence (1/112) was detected by the parents in the 2016 cohort. ACT incidence follows R337H frequency in each population, but remarkably environmental factors modify these rates.