RESUMO
OBJECTIVE: The aim of this study was to evaluate the effects of the relaxation technique with guided imagery by means of virtual reality on health-related quality of life in patients undergoing hematopoietic stem cell transplantation. METHODS: A quasi-experiment conducted in a Bone Marrow Transplantation Service of a public hospital in southern Brazil. From October 2019 to October 2020, forty-two adult participants who underwent transplantation were included, 35 in the intervention group and seven in the control group. A guided imagery intervention, with audio guiding the relaxation associated with nature images in 360º, was performed during the hospitalization period. Data were collected on the first day of hospitalization, on the transplantation day, during the neutropenia stage, and at pre-hospital discharge. The Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) were used to assess health-related quality of life, fatigue and neutropenia. Data were analyzed using the Generalized Linear Mixed Model for the evolution of the health-related quality of life assessments over time, considering the groups and stages. Pearson's correlation coefficient was adopted for the correlation analyses. RESULTS: Allogeneic transplantation was predominant: 28 (80%) in the intervention group and 5 (71.43%) in the control group. There were improvements in the health-related quality of life scores, although not significant. A significant difference was found among the stages (p <0.050) and a significant positive correlation (p <0.000) among the variables on general quality of life, additional concerns, fatigue and neutropenia in all stages. CONCLUSION: Patients undergoing hematopoietic stem cell transplantation suffer changes in their quality of life. Interventions based on integrative practices emerge as an option to minimize them.
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Assuntos
Fadiga/prevenção & controle , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Imagens, Psicoterapia/métodos , Neutropenia/prevenção & controle , Qualidade de Vida , Terapia de Relaxamento/métodos , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Fadiga/psicologia , Feminino , Seguimentos , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/psicologia , Ensaios Clínicos Controlados não Aleatórios como Assunto , Prognóstico , Inquéritos e Questionários , Taxa de Sobrevida , Transplante Homólogo , Adulto JovemRESUMO
Efficacy of therapeutic strategies relative to patient- and family-centered outcomes in pediatric oncology must be assessed. We sought to identify outcomes important to children with acute myeloid leukemia and their families related to inpatient versus at-home management of neutropenia. We conducted qualitative interviews with 32 children ≥8 years old and 54 parents. Analysis revealed the impact of neutropenia management strategy on siblings, parent anxiety, and child sleep quality as being outcomes of concern across respondents. These themes were used to inform the design of a questionnaire that is currently being used in a prospective, multiinstitutional comparative effectiveness trial.
Assuntos
Ansiedade , Pacientes Internados , Leucemia Mieloide Aguda , Neutropenia , Relações Pais-Filho , Irmãos , Adolescente , Adulto , Ansiedade/fisiopatologia , Ansiedade/psicologia , Ansiedade/terapia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/fisiopatologia , Leucemia Mieloide Aguda/psicologia , Leucemia Mieloide Aguda/terapia , Neutropenia/fisiopatologia , Neutropenia/psicologia , Neutropenia/terapia , Estudos ProspectivosRESUMO
CONTEXT: The Functional Assessment of Cancer Therapy-Neutropenia (FACT-N) is a neutropenia-specific questionnaire to assess patients' health-related quality of life. OBJECTIVES: This study aimed to examine the psychometric properties of FACT-N among cancer patients with chemotherapy-induced neutropenia (CIN). METHODS: This prospective, cross-sectional study included multiethnic Asian cancer patients. Patients completed the questionnaires within seven days after diagnosed with CIN. Eligible patients completed either the English or Chinese version of the EuroQol 5-Dimensions (EQ-5D) and the FACT-N once, according to their language preference. The reliability was evaluated by using Cronbach alpha (α). The known-group validity was assessed based on patient's Eastern Cooperative Oncology Group performance status, neutropenia grade, and experience of fever. The convergent validity was evaluated by contrasting the FACT-N subscales with the EQ-5D domains. Multiple linear regression models were performed to compare the FACT-N total scores between the two language versions. RESULTS: A total of 276 eligible patients (200 English speaking and 76 Chinese speaking) were included in this study. Internal consistencies within the FACT-N subscales were satisfactory (Cronbach α = 0.71-0.85), except for the flu-like symptoms subscale (Cronbach α = 0.67). For known-group validity, the FACT-N total score could differentiate patients according to their Eastern Cooperative Oncology Group performance status (P < 0.001), neutropenia grade (P = 0.028), and experience of fever (P < 0.001). The correlations between the FACT-N subscales and their hypothesized constructs in EQ-5D domains were weak to moderate (|r| = 0.15-0.44). The measurement equivalence between the English and Chinese versions was established for the FACT-N total scores. CONCLUSION: The FACT-N is a valid and reliable instrument to be used in clinical practice to evaluate the health-related quality of life among multiethnic Asian patients with CIN.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Neutropenia/diagnóstico , Neutropenia/etiologia , Inquéritos e Questionários , Antineoplásicos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/fisiopatologia , Neoplasias/psicologia , Neutropenia/fisiopatologia , Neutropenia/psicologia , Estudos Prospectivos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , SingapuraRESUMO
BACKGROUND: This is a report on the translation and cultural adaptation from English to Turkish languages of a standard HEALTH UTILITIES INDEX® (HUI®) questionnaire for interviewer-administration and proxy assessment of patients' health status, and its use for assessing 50 consecutive pediatric oncology patients during periods of and subsequent recovery from neutropenia. PROCEDURE: Preparation of the Turkish-language questionnaire was a collaborative effort by physician-researchers in Turkey, senior Health Utilities, Inc. staff with extensive experience in the development and translation of HUI questionnaires, and Turkish-born residents of Canada. Standard HUI questionnaires cover both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3). RESULTS: The mean improvement in overall health-related quality of life (HRQL) scores between neutropenic and non-neutropenic phases was clinically important according to both HUI2 and HUI3 instruments. Single-attribute utility scores showed clinically important size improvements between phases for HUI2 mobility, emotion, and HUI2 self-care. Significant reductions in disability rates between phases were also detected for pain (HUI2 and HUI3 rate decreases of 30%, P < 0.001) and HUI3 ambulation (rate decline of 14%, P = 0.020). CONCLUSIONS: The study results provide evidence that the Turkish-language questionnaire is acceptable, valid and useful for collecting parental assessments of health-status among young cancer patients in Turkey. Neutropenia was associated with important deficits in overall HRQL and disabilities in ambulation/mobility, emotion, self-care, and pain. Treatment plans should include strategies for addressing emotion and pain problems to improve the HRQL of neutropenic patients.
Assuntos
Cultura , Neutropenia/psicologia , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Lactente , Masculino , Oncologia , Neutropenia/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
Within the framework of systemic therapy with cytostatic agents and advanced stages of tumor diseases, therapy-induced and disease-related complications can severely impair the quality of life. This article gives a brief synopsis of the current literature on the diagnosis and therapy concerning anemia thrombotic events and tumor-related hypercalcemia as well as recommendations on treating therapy-associated neutropenia.
Assuntos
Cuidados Paliativos/métodos , Neoplasias Urogenitais/terapia , Anemia/psicologia , Anemia/terapia , Humanos , Hipercalcemia/psicologia , Hipercalcemia/terapia , Estadiamento de Neoplasias , Neutropenia/psicologia , Neutropenia/terapia , Qualidade de Vida/psicologia , Neoplasias Urogenitais/complicações , Neoplasias Urogenitais/patologia , Neoplasias Urogenitais/psicologiaRESUMO
OBJECTIVE: Dose delays and reductions in chemotherapy due to hematologic toxicities are common among patients with advanced non-small cell lung cancer (NSCLC). However, limited data on behavioral or psychological predictors of chemotherapy adherence exist. The goal of this study was to explore the frequency and clinical predictors of infusion dose delays and reductions in this patient population. METHODS: Fifty patients newly diagnosed with advanced NSCLC of high performance status (Eastern Cooperative Oncology Group Performance Status=0-1) completed baseline assessments on quality of life (Functional Assessment of Cancer Therapy - Lung) and mood (Hospital Anxiety and Depression Scale) within 8 weeks of diagnosis. Participants were followed prospectively for 6 months. Chemotherapy dosing data came from medical chart review. RESULTS: All patients received chemotherapy during the course of the study, beginning with a platinum-based doublet (74%), an oral epidermal growth factor receptor-tyrosine kinase inhibitor (14%), or a parenteral single agent (12%). Forty percent (n=20) of patients had a dose delay (38%) and/or reduction (16%) in their scheduled infusions. Fisher's Exact Tests and regression analyses showed that patients who experienced neutropenia, smoked at the time of diagnosis, or reported heightened baseline anxiety were significantly more likely to experience dose delays or reductions. There were no associations between chemotherapy adherence and patient demographics, performance status, or quality of life. CONCLUSION: In this sample, more than one third of patients with advanced NSCLC experienced either a dose delay or reduction in prescribed chemotherapy regimens. Behavioral and psychological factors, such as tobacco use and anxiety symptoms, appear to play an important role in chemotherapy adherence, though further study is required to confirm these findings.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Cooperação do Paciente/psicologia , Idoso , Antineoplásicos/uso terapêutico , Ansiedade/epidemiologia , Ansiedade/psicologia , Carcinoma Pulmonar de Células não Pequenas/psicologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Neutropenia/epidemiologia , Neutropenia/psicologia , Probabilidade , Qualidade de Vida , Fumar/epidemiologia , Fumar/psicologiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bacteriemia/diagnóstico , Febre/etiologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neutropenia/enfermagem , Infecções Estafilocócicas/diagnóstico , Idoso , Antibioticoprofilaxia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Cateterismo Venoso Central/efeitos adversos , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Filgrastim , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Controle de Infecções , Linfoma Difuso de Grandes Células B/enfermagem , Linfoma Difuso de Grandes Células B/radioterapia , Neutropenia/induzido quimicamente , Neutropenia/psicologia , Cooperação do Paciente , Educação de Pacientes como Assunto , Polietilenoglicóis , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Proteínas Recombinantes , Rituximab , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Vancomicina/uso terapêutico , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
OBJECTIVE: The present study established the psychometric properties of the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N), a self-report instrument to assess neutropenia-specific concerns and health-related quality of life (HRQL), in a sample of adults 65 years of age and older. MATERIALS AND METHODS: Participants were undergoing chemotherapy for lung, breast, or ovarian cancer or non-Hodgkin's lymphoma (n = 852) and were randomly assigned to receive pegfilgrastim beginning with cycle 1 (primary prophylaxis) or pegfilgrastim subsequent to cycle 1 at their clinicians' discretion (usual care). Participants completed a self-report assessment on day 1 of each cycle (up to six cycles) and at the expected nadir of the white blood cell count of each cycle. Using factor analysis, three subscales were identified in the 19-item FACT-N subscale: Malaise, Worry, and Flu-like symptoms. RESULTS AND DISCUSSIONS: The FACT-N and each of the subscales were sensitive to the presence of neutropenia although did not correlate with the absolute neutrophil count (ANC). While ANC is a marker of the impact of chemotherapy on the myeloid precursors of the bone marrow and is correlated with risk of febrile neutropenia, however the constellation of symptoms and patient experience vary throughout the period of neutropenia as the ANC first declines and then recovers. The 19-item neutropenia subscale can be used alone; however, evidence supporting reliability and validity was most robust for aggregate scores from the FACT-N and the Trial Outcome Index-Neutropenia (TOI-N). CONCLUSION: Understanding the impact of neutropenia on HRQL through the availability of a validated self-report measure will, ideally, lead to interventions to reduce the burden associated with cancer and its treatments.
Assuntos
Antineoplásicos/efeitos adversos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Neutropenia/psicologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Filgrastim , Humanos , Contagem de Leucócitos , Masculino , Neoplasias/tratamento farmacológico , Neutropenia/induzido quimicamente , Neutropenia/prevenção & controle , Neutrófilos/efeitos dos fármacos , Polietilenoglicóis , Psicometria , Proteínas Recombinantes , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de TempoRESUMO
This prospective study of chemotherapy-induced neutropenia (CIN) explored the association between the relative grade of neutropenia and symptom burden and quality of life (QOL). Eighty-four adult cancer patients from nine community oncology centers receiving 1 of 13 myelosuppressive chemotherapies were evaluated at days 0, 4, 7, 9, 11, 14, and 21 of their respective first cycle. Neutropenia grade (grade 3/4 vs grades 0 to 2) was determined by serial absolute neutrophil count (ANC) measures. Measures of patient-reported outcomes included the Rotterdam Symptom Checklist (RSCL), Hospital Anxiety and Depression Scale (HADS), Cancer Care Monitor-Medical Isolation Scale (CCM-MIS), and SF-36. Changes in outcomes from baseline to highest grade of neutropenia were evaluated using mixed model-repeated measures for each of 15 outcomes. Compared with grades 0-2, grade 3/4 neutropenia was associated with greater symptom burden and worse QOL for six measures (P < 0.05). The pattern of differences suggested that measures of symptom distress and social functioning were sensitive to patient changes associated with grade 3/4 neutropenia. Worsening of symptom burden and QOL appears to be associated with severe afebrile neutropenia. A causal relationship between neutropenia and worse symptoms and QOL remains difficult to establish due to the confounding of the effects of neutropenia with other adverse effects of chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neutropenia/induzido quimicamente , Qualidade de Vida , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Carboplatina/efeitos adversos , Cisplatino/efeitos adversos , Ciclofosfamida/efeitos adversos , Depressão/etiologia , Docetaxel , Doxorrubicina/efeitos adversos , Epirubicina/efeitos adversos , Feminino , Fluoruracila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/epidemiologia , Neutropenia/fisiopatologia , Neutropenia/psicologia , Prednisona/efeitos adversos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicometria , Análise de Regressão , Índice de Gravidade de Doença , Perfil de Impacto da Doença , Taxoides/efeitos adversos , Resultado do Tratamento , Estados Unidos/epidemiologia , Vincristina/efeitos adversosRESUMO
This report summarizes recent data on neutropenia-related quality of life (QOL), including measures and interventions. Neutropenia is a common adverse effect of cytotoxic chemotherapy. The clinical significance of QOL in patients with chemotherapy-induced neutropenia (CIN) remains largely unexplored, although recent studies have shown a correlation between severe CIN and impaired QOL. Neutropenia typically occurs at the same time as other adverse effects. Data indicate that other toxicities are worse in the presence of febrile neutropenia and that these concurrent events may have a greater effect on QOL. Precautions that are taken to minimize the incidence of infection in patients with neutropenia may also affect their QOL. Future research should focus on accurately defining and measuring QOL in patients with CIN as well as on assessing ways to manage CIN more effectively and thus improve QOL. A number of interventions may have a positive influence on QOL in patients with cancer and neutropenia. Hematopoietic growth factor support, for example, reduces the incidence and sequelae of neutropenia and may provide a QOL benefit. To assess the effect of such interventions, neutropenia-specific QOL instruments, such as the Functional Assessment of Cancer Therapy-Neutropenia (FACT-N), may be valuable tools.
Assuntos
Antineoplásicos/efeitos adversos , Neutropenia/induzido quimicamente , Neutropenia/psicologia , Qualidade de Vida/psicologia , Efeitos Psicossociais da Doença , Nível de Saúde , Fatores de Crescimento de Células Hematopoéticas/uso terapêutico , Humanos , Controle de Infecções , Neoplasias/tratamento farmacológico , Neutropenia/complicações , Neutropenia/terapia , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Pesquisa Metodológica em Enfermagem , Enfermagem Oncológica/métodos , Perfil de Impacto da Doença , Inquéritos e Questionários , Resultado do TratamentoRESUMO
PURPOSE: In this exploratory, prospective study evaluated quality of life (QoL) changes in patients with diverse cancers during the first cycle of myelosuppressive chemotherapy. PATIENTS AND METHODS: Of 80 patients enrolled, 71 were observed during one of five chemotherapy regimens: docetaxel; CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone); carboplatin-paclitaxel; carboplatin-docetaxel; and carboplatin-gemcitabine. Complete blood counts were taken weekly. QoL and symptom burden measures were administered at baseline and throughout the cycle, and included SF-36, Cancer Care Monitor (CCM), Hospital Anxiety and Depression Scale (HADS), and Psychosocial Adjustment to Illness Scale (PAIS). Using generalized estimating equations, we modeled the change in each measure from baseline to the end of each week using the following covariates: baseline QoL measure, baseline SF-36 Physical and Mental Health Summary scores, sex, age, cycle week, grade 4 neutropenia any time in the past 7 days (yes/no), and the interaction of the latter two covariates. RESULTS: Of the 71 patients observed, 33 developed grade 4 neutropenia during the first 2 weeks. Changes from baseline in SF-36 Bodily Pain, HADS Anxiety, and PAIS Social Environment scores were significantly less favorable (P<0.05) when patients experienced grade 4 neutropenia any time in the past 7 days compared to when they did not (grade 0-3). A similar, but non-significant, trend was also observed for 12 other QoL measures. CONCLUSION: QoL may be adversely affected up to 7 days after patients experience grade 4 (versus grade 0-3) neutropenia. Such findings need to be examined further in studies with adequate statistical power to test a priori hypotheses regarding specific QoL measures.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neutropenia/induzido quimicamente , Neutropenia/psicologia , Qualidade de Vida , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Ansiedade , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Prednisona/administração & dosagem , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Vincristina/administração & dosagemRESUMO
Parents asked to consent to a child's randomization in a pediatric cancer clinical trial are often unprepared to grasp the implications of this scientifically crucial but seemingly unfair process. Physicians must adopt specific communication skills to engage families in open dialogue from the outset in order to elicit truly shared informed consent. Starting from the case of a family with an only child affected by disseminated neuroblastoma, we wish to comment on the problems surfacing in the informed consent process for treatment and research in pediatric oncology that implicate an understanding of bioethical issues and psychological principles. Although the outcome of childhood cancer has improved dramatically over the last 30 years, with overall survival rates now exceeding 70%, there are regretfully still types and stages of cancer carrying a very high risk of death that urgently require new clinical strategies. The response to this need has been the design of experimental protocols that often entail randomized controlled trials (RCT). A large number of these trials concern stage IV neuroblastoma, acute leukemia, rhabdomyosarcoma, and other types of childhood cancers presenting great heterogeneity both in terms of localization and responsiveness to therapy. Most trials for disease relapses also include one or more randomizations. The scientific motivation justifying an RCT is the need to compare and evaluate an innovative protocol (or part thereof) with reference treatment modalities. Nevertheless, the process brings to bear the ethical dilemma of having to weigh the needs of the single afflicted child against the benefit which may ensue for a much larger patient community.
Assuntos
Comunicação , Consentimento Livre e Esclarecido , Neuroblastoma/terapia , Pais/psicologia , Relações Profissional-Família , Distribuição Aleatória , Pré-Escolar , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/psicologia , Masculino , Neutropenia/induzido quimicamente , Neutropenia/psicologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Neutropenia is a common and dangerous toxicity of cancer therapy that profoundly affects patients' lives. Neutropenia is typically defined by the numerical value of the absolute neutrophil count. However, considering neutropenia exclusively as the numerical value of the absolute neutrophil count limits its conceptualizations to physiologically related aspects, minimizes its complexities, and neglects dimensions of human response and the patient experience. This article offers a dimensional analysis of neutropenia derived from 42 research and clinical articles. Schatzman's dimensional analysis methods were applied to the literature to identify aspects of this phenomenon lying beyond its numerical boundaries. Dimensions of neutropenia that emerged were sorted into categories of perspective, context, conditions, processes, and consequences. The presence of the same dimension in more than 1 category and the circuitous relationships among categories begin to explicate the complexity and gravity of neutropenia. Articulation of these dimensions is necessary to assemble the beginnings of a theoretical understanding of neutropenia, which is crucial for the development and application of knowledge to research and practice. Limitations evident in the literature illuminate the urgent need for research into the psychosocial as well as physiologic dimensions of neutropenia.
Assuntos
Efeitos Psicossociais da Doença , Neoplasias/complicações , Neutropenia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Atitude Frente a Saúde , Febre/etiologia , Humanos , Controle de Infecções , Infecções/etiologia , Contagem de Leucócitos , Avaliação das Necessidades , Neutropenia/epidemiologia , Neutropenia/etiologia , Neutropenia/fisiopatologia , Neutropenia/psicologia , Qualidade de Vida , Projetos de Pesquisa , Fatores de RiscoAssuntos
Arte , Recursos Audiovisuais , Disseminação de Informação/métodos , Pesquisa Metodológica em Enfermagem/organização & administração , Enfermagem Oncológica/normas , Atitude Frente a Saúde , Benchmarking/métodos , Família/psicologia , Humanos , Neutropenia/induzido quimicamente , Neutropenia/psicologia , PensamentoAssuntos
Assistência Ambulatorial , Antineoplásicos/efeitos adversos , Febre de Causa Desconhecida/terapia , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias/tratamento farmacológico , Neutropenia/terapia , Infecções Oportunistas/terapia , Assistência Ambulatorial/psicologia , Antineoplásicos/uso terapêutico , Neoplasias Hematológicas/psicologia , Humanos , Neoplasias/psicologia , Neutropenia/induzido quimicamente , Neutropenia/psicologia , Infecções Oportunistas/induzido quimicamente , Infecções Oportunistas/psicologia , Fatores de RiscoRESUMO
Aggressive chemotherapy protocols result in neutropenia in approximately half of all patients receiving chemotherapy. Thus, neutropenia continues to be a significant and potentially life-threatening side effect of treatment, even with use of colony-stimulating factors. Families of patients with neutropenia often provide the primary healing environment because most chemotherapy protocols are managed on an outpatient basis. To learn about the family's experience of managing chemotherapy-induced neutropenia (CIN), a grounded-theory methodology was used to analyze data from seven families. The central theme revealed by these families was "turbulent waiting with intensified connections." This meant that when families had a sense of greater vulnerability in response to the waiting after diagnosis of CIN, they connected intensely with each other and healthcare providers. Families reported that connections with nurses became more significant when neutropenia interrupted chemotherapy. Families also developed family caring strategies to manage this period of waiting for the chemotherapy to resume. These strategies included family inquiry, family vigilance, and family balancing. Nurses need to be aware of approaches to support the family's ability to manage CIN. Interventions and approaches constructed from the perspective of a family-professional partnership will enhance the family cancer experience as well as ongoing family growth and function.
Assuntos
Adaptação Psicológica , Atitude Frente a Saúde , Cuidadores/psicologia , Família/psicologia , Neutropenia/psicologia , Assistência Ambulatorial , Antineoplásicos/efeitos adversos , Cuidadores/educação , Fatores Estimuladores de Colônias/uso terapêutico , Comportamento Cooperativo , Empatia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Controle Interno-Externo , Modelos Psicológicos , Neutropenia/induzido quimicamente , Neutropenia/enfermagem , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Pesquisa Metodológica em Enfermagem , Enfermagem Oncológica/organização & administração , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto , Relações Profissional-Família , Saúde da População Rural , Apoio Social , Inquéritos e QuestionáriosRESUMO
Neutropenia may be influenced by malignancy type, treatment, age extremes, inadequate nutrition, or psychological stress. Of these five factors, only nutrition and stress are amenable to nursing intervention and management. The increasing trend of providing treatment in the outpatient setting and managing the patient with neutropenia in the home challenges nurses to develop innovative methods of care. This article offers suggestions to assist nurses in the creative management of individuals at risk for neutropenia by maximizing nutrition and minimizing psychological stress. This discussion addresses the physiology of the inflammatory immune response; pathophysiology of neutropenia; factors that may influence the risk of infection, such as sustained stress, dietary fiber, antioxidant vitamins, and food-borne bacteria; and interventions that reduce the potential for neutropenic sepsis. Nursing implications that reduce the risk of neutropenic infection include patient education related to nutrition, stress management, and self-care.
Assuntos
Neutropenia/enfermagem , Fenômenos Fisiológicos da Nutrição , Estresse Psicológico , Infecções Bacterianas/prevenção & controle , Aconselhamento , Dieta , Humanos , Neoplasias/complicações , Neutropenia/etiologia , Neutropenia/psicologia , Autocuidado , Estresse Psicológico/prevenção & controleRESUMO
Quality of life (QOL) was assessed in 10 patients receiving treatment with recombinant methionyl human granulocyte colony-stimulating factor (r-met-GCSF). The Ferrans & Powers Quality of Life Index (Cancer II) was administered at three different time points to patients with severe chronic neutropenia. Mean overall QOL increased from time 1 to time 2 from a score of 23.72 to a score of 35.93 (p = 0.006). Overall QOL was maintained throughout the study with a mean score at time 3 of 36.96 (p = 0.002). Measures on all QOL subscales, including health and functioning and socioeconomic, improved significantly. Daily therapy with r-met-GCSF significantly improves the QOL of patients with severe chronic neutropenia.