Integrative Oncology Approaches to Supporting Immune Checkpoint Inhibitor Treatment of Solid Tumours.

PURPOSE OF REVIEW: The goal of this review was to examine the role and practical applications of integrative oncology strategies in supporting immune checkpoint inhibitor (ICI) treatment of adult solid tumours. RECENT FINDINGS: Beyond tumour-intrinsic factors, several patient-associated factors affect ICI response, including germline genetics, systemic inflammation, the gut microbiota, and diet. Current promising supportive interventions include a Mediterranean-style diet with over 20 g of fibre, regular exercise, use of live biotherapeutics, minimisation of PPI and antibiotic use, and ensuring vitamin D repletion, with many other integrative oncology approaches under study. Caution around medical cannabis use in patients on ICIs is advised due to previously documented adverse impact on overall survival, while VAE (Viscum album extract) therapy studies have not highlighted any safety concerns so far. With expanding ICI use, it is important to investigate and apply low-cost integrative oncology strategies to support better treatment outcomes and minimise adverse events. Further research may lead to pre-treatment assessment of both tumour and patient-associated biomarkers and personalised multimodal prehabilitation care plans, as well as on-treatment support with targeted nutrition, physical activity, and supplementation regimes, including both systemic inflammation and gut microbiome modulating strategies. Given the emerging understanding of chronic stress impact on ICI treatment outcomes, mind-body approaches require further investigation.

Time is of the Essence: Why Goals-of-Care Conversations and Prognosis Documentation Matters in Advanced Cancer Patients in an Integrated Health System.

Background: Advanced cancer patients benefit less from aggressive therapies and more from goal-directed palliative management. Early and clearly documented goals-of-care discussions, including end-of-life decision making, are essential in this patient population. Integrated healthcare systems are comprehensive care models associated with improved quality of care and lower mortality compared to other healthcare models. The role of advance care planning within our system is understudied. Methods: Patients 18 years and older with a diagnosis of advanced-stage cancer were identified over a 6-month period. Expert panel review was performed to evaluate medical appropriateness of the selected diagnostic workup and management. The role and extent of care planning was reviewed in association with the clinical context. Results: In a cohort of 82 patients, evidence-based and individualized appropriateness of medical management was found to be consistent for all patients. Eighty-two percent of patients elected for oncologic-based treatment, 5% pursued active surveillance, and 11% did not receive treatment. Seventy-three percent of patients were referred to palliative care. Fifty-six percent of patients had a full goals-of-care conversation documented; yet only 9% of goals-of-care conversations were documented by an oncologist. Prognosis was documented fully for only 22% of patients. At the end of the study period, 43 patients were deceased (52%), further indicating the critical importance of documentation. Conclusions: Within our integrated health system, we found consistent guideline- and patient-directed diagnosis and management, along with frequent integration of palliative care services. Goals-of-care conversation and prognosis documentation, especially by the oncologist, remains an area of needed improvement.

Nurse-led interventions among older adults affected by cancer: An integrative review.

Objective: Aging can introduce significant changes in health, cognition, function, social status, and emotional status among older adults affected by cancer. Little is known about how existing nurse-led interventions address the needs of older adults. The objective was to identify existing nurse-led interventions among older adults to optimize recovery and survivorship needs. Methods: A integrative systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 Guidelines. Electronic databases (APA PsycINFO, CINAHL, MEDLINE, Scopus, and Google Scholar databases) were searched using key search terms. Articles were assessed for inclusion according to a pre-determined eligibility criterion. Data extraction and quality appraisal were conducted. Findings were integrated into a narrative synthesis. Results: Twenty-one studies were included, and a total of 4253 participants were represented. There were a range of study designs: quantitative (n â€‹= â€‹10), randomised controlled trials (n â€‹= â€‹6), mixed methods studies (n â€‹= â€‹3), qualitative (n â€‹= â€‹1), and a non-randomized controlled study (n â€‹= â€‹1). Most participants had prostate cancer, with some representation in colorectal, lung, head and neck, renal, esophageal, and mixed cancer patient populations. Conclusions: This review shows a lack of evidence on the inclusion of geriatric assessments for older people with cancer within existing nurse-led interventions. Further research is needed to test nurse-led interventions with the inclusion of geriatric assessments and their contribution to the multidisciplinary team across the cancer care continuum for various cancer patient populations.

Integrated dual training in palliative care and oncology.

Fellowship training in Hospice and Palliative Medicine (HPM) and Hematology/Oncology (Hem/Onc) share common themes and roots in the holistic care of people living with cancer. As of 2021, approximately 630 physicians in the United States were board-certified in both HPM and Hem/Onc. There is increasing demand for an integrated fellowship pathway, and the inaugural integrated fellowship Match took place in 2022. We present the historical context of the overlap in HPM and Hem/Onc fellowship training, limitations of the standard training paradigm, and an overview of the recently developed integrated training pathway accredited by the Accreditation Council for Graduate Medical Education (ACGME). We explore applications of dual training in clinical care, program development, and research at the intersection of HPM and Hem/Onc. Finally, we consider challenges to the success and how best to assess the outcomes of this program. Integrated fellowship training in HPM and Hem/Onc is 1 avenue to develop a cohort of dual-trained physicians poised to effect broad cultural change in this important and evolving space. A subset of physicians with dual training has the potential to fill unmet needs by promoting enhanced patient-centered care, developing infrastructure for heightened collaboration between these distinct but closely related fields, and prioritizing research focused on advanced communication skills and symptom management for patients with cancer.

Development and Testing of a Mobile App to Collect Social Determinants of Health Data in Cancer Settings: Interview Study.

BACKGROUND: Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems' current technological solutions for identifying and managing patients' SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify. OBJECTIVE: We developed and tested a patient-centric SDOH screening tool designed for use on patients' personal mobile phone that preserves patient privacy and confidentiality, collects information about the unmet social needs of patients with cancer, and communicates them to the provider. METHODS: We interviewed 22 patients with cancer, oncologists, and social workers associated with a US-based comprehensive cancer center to better understand how patients' SDOH information is collected and reported. After triangulating data obtained from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed an SDOH screening tool mobile app and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members at the same cancer center. We collected patient SDOH data using 36 survey items covering 7 SDOH domains and used validated scales and follow-up interviews to assess the app's usability and acceptability among patients and cancer care team members. RESULTS: Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources could be useful and valuable. In the pilot study, 25% (4/16) of app-using patients reported having at least one of the abovementioned social needs; the most common social need was social isolation (7/16, 44%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy but suggested that the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app. CONCLUSIONS: Use of a brief, patient-centric, mobile app-based SDOH screening tool can effectively capture SDOH of patients with cancer for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs.

Errors in prescribing injectable anticancer drugs: benefits of a pharmaceutical long-term monitoring to improve patient safety in a European comprehensive cancer centre.

OBJECTIVES: We aimed to assess the impact of pharmacist interventions on injectable chemotherapy prescription and the safety of early prescription practice in an adult daily care unit. METHODS: Prescription errors were recorded before and after implementing corrective measures. Errors identified from the pre-intervention period (i) were analysed to identify areas for improvement. During the post-intervention period (ii) we compared the errors in anticipated prescription (AP) with those in real-time prescriptions (RTP). We performed Chi-square statistical tests (α=0.05). RESULTS: Before implementing corrective measures (i), 377 errors were recorded (ie, 3.02% of prescriptions). After the implementation of corrective measures (ii), there was a significant decrease in errors, with 94 errors recorded (ie, 1.20% of prescriptions). The error rate in AP and RTP groups was 1.34% and 1.02%, respectively, without a significant difference between the two groups. CONCLUSIONS: This study highlights the importance of prescription review, as well as collaboration between pharmacists and physicians, in reducing prescription errors, whether these prescriptions were anticipated or not.

The chromatographic constitution of andiroba oil and his healing effects, compared to the LLLT outcomes, in oral mucositis induced in golden Syrian hamsters: a new treatment option.

The oral mucositis is a mucosal alteration that usually arises from oncological treatments, such as chemotherapy, and it is characterized as an inflammatory process. The aim of this study is to demonstrate the chromatographic constitution of Andiroba oil, comparing and evaluating Andiroba oil and laser scarring efficiency in treatments of oral mucositis in hamsters. These animals were submitted to 5-Fluorouracil. A total of 122 animals were used, randomized and divided into the following groups: (a) positive control; (b) laser associated to andiroba oil; (c) laser; (d) andiroba oil; (e) negative control; (f) cyclophosphamide (genotoxicity control). The induction of oral mucositis occurred by the administration of intraperitoneal Fluorouracila (60 mg/kg) and trauma to the mucosa. The laser protocol was performed once a day and the andiroba oil applied 3 times a day (1,5 ml/day). The mucosae were photographed and removed for clinical and histopathological analysis on day 4, 8, 12 and 15. The analysis was based in OM severity, in specific scoring for the clinical and histopathological aspect. Toxicity was evaluated on day 15 using comet assay and it was performed by variant DNA damage parameters. The data were analysed using analysis of variance (ANOVA) Tukey post-test and Kruskal-Wallis Dunn post-test. The "andiroba oil" and "laser" groups presented better results when compared to the control groups and the treatment associations. The andiroba oil presented the best scarring results, even considering its efficiency proximity to the laser treatment. Andiroba and laser, separately, did not present genotoxicity, however their association evidences damage to DNA.

The COVID-19 infection control response at a large stand-alone comprehensive cancer center in Los Angeles County.

BACKGROUND: The City of Hope National Medical Center (COH) is the only stand-alone comprehensive cancer center in Los Angeles, a county that was deemed a COVID-19 pandemic epicenter at the height of the 2020 winter surge. The immunocompromised patient population frequently experienced delays in infection control guidelines from local and government bodies due to minimal data available in comparison to the general population. This required COH to make swift, informed decisions for the best interest of the patient population. AIM: Here, we review the comprehensive COVID-19 infection control response conducted at COH within the context of a high-risk patient population, predominately comprised of patients with hematologic malignancies. METHODS AND RESULTS: This infection control response focused on prevention of COVID-19 transmission on campus, COVID-19 testing, and isolation management. These efforts consisted of COVID-19 screening, limitation of personnel on campus, source control, contact tracing, COVID-19 vaccination, establishment of in-house testing and implementation and management of COVID-19 testing. Between January 2020 and September 2021, COH implemented a robust in-house testing program, completed well over 1000 contact traces, ensured COVID-19 vaccinations were distributed to all eligible staff and patients, and established an algorithm for COVID-19 infection resolution, all without compromising the number of hematopoietic stem cell transplants (HCTs) performed, surgical volume, or healthcare-associated standardized infection ratios (SIR). CONCLUSION: Institutional collaboration and attention to infection control was pivotal to minimizing the burden of the COVID-19 pandemic.

Clinical applicability of the Polygenic Risk Score for breast cancer risk prediction in familial cases.

BACKGROUND: Common low-risk variants are presently not used to guide clinical management of familial breast cancer (BC). We explored the additive impact of a 313-variant-based Polygenic Risk Score (PRS313) relative to standard gene testing in non-BRCA1/2 Dutch BC families. METHODS: We included 3918 BC cases from 3492 Dutch non-BRCA1/2 BC families and 3474 Dutch population controls. The association of the standardised PRS313 with BC was estimated using a logistic regression model, adjusted for pedigree-based family history. Family history of the controls was imputed for this analysis. SEs were corrected to account for relatedness of individuals. Using the BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) V.5 model, lifetime risks were retrospectively calculated with and without individual PRS313. For 2586 cases and 2584 controls, the carrier status of pathogenic variants (PVs) in ATM, CHEK2 and PALB2 was known. RESULTS: The family history-adjusted PRS313 was significantly associated with BC (per SD OR=1.97, 95% CI 1.84 to 2.11). Including the PRS313 in BOADICEA family-based risk prediction would have changed screening recommendations in up to 27%, 36% and 34% of cases according to BC screening guidelines from the USA, UK and the Netherlands (National Comprehensive Cancer Network, National Institute for Health and Care Excellence, and Netherlands Comprehensive Cancer Organisation), respectively. For the population controls, without information on family history, this was up to 39%, 44% and 58%, respectively. Among carriers of PVs in known moderate BC susceptibility genes, the PRS313 had the largest impact for CHEK2 and ATM. CONCLUSIONS: Our results support the application of the PRS313 in risk prediction for genetically uninformative BC families and families with a PV in moderate BC risk genes.

Influência da religiosidade/espiritualidade em cuidadores informais de crianças com leucemia / Influence of religiosity/spirituality on informal caregivers of children with leukemia / Influencia de la religiosidad/espiritualidad en cuidadores informales de niños con leucemia

Resumo Perante diagnóstico e tratamento de doença grave em crianças, incluindo a oncológica, os pais, em especial as mães, tendem a assumir integralmente as demandas de cuidados, necessitando desenvolver estratégias de enfrentamento situacional. Nesse sentido, este estudo descritivo e transversal objetivou identificar o uso do coping religioso/espiritual em cuidadores informais de crianças com leucemia linfoide aguda mediante aplicação da escala de coping religioso/espiritual breve. Participaram 30 cuidadores informais, que apresentaram coping religioso/espiritual alto (média=3,90; Dp=0,34) na modalidade positiva (média=3,67; Dp=0,48). Por fim, identificou-se que as mães utilizam coping religioso/espiritual para lidar com a demanda de cuidados a elas imposta, vinculada à condição de saúde da criança. Com isso, reforça-se a possibilidade de utilizar a espiritualidade e/ou a religiosidade como indicadores de bem-estar físico e mental, visto que a qualidade dos cuidados prestados está intimamente relacionada à saúde de quem cuida.

Abstract Faced with diagnosis and treatment of serious illness in children, including oncology, parents, especially mothers, tend to fully assume the demands of care and, consequently, must develop situational coping strategies. In this regard, this descriptive and cross-sectional study sought to identify the use of religious/spiritual coping by informal caregivers of children with acute lymphoid leukemia via the Brief Religious/Spiritual Coping (SRCOPE) scale. A total of 30 informal caregivers participated in the study, presenting high religious/spiritual coping (mean=3.90; SD=0.34) regarding positive methods (mean=3.67; SD=0.48). Finally, results show that mothers use religious/spiritual coping deal with the imposed demands for care, linked to the child's health condition. This reinforces the possibility of using spirituality and or religiosity as indicators of physical and mental well-being, since the quality of care is closely related to the caregivers' health.

Resumen Ante el diagnóstico y tratamiento de una enfermedad grave en niños como el cáncer, los padres, sobre todo las madres, tienden a asumir plenamente las demandas de cuidado, por lo que necesitan desarrollar estrategias de afrontamiento de la situación. Este estudio descriptivo y transversal tuvo por objetivo identificar el uso de coping religioso/espiritual en los cuidadores informales de niños con leucemia linfocítica aguda mediante la aplicación de la escala de coping religioso/espiritual breve. Participaron 30 cuidadores informales, quienes presentaron un alto coping religioso/espiritual (media=3,90; DE=0,34) en la modalidad positiva (media=3,67; DE=0,48). Se identificó que las madres utilizan coping religioso/espiritual para hacer frente a la demanda de cuidados que realizan, relacionada al estado de salud del niño. Esto refuerza la posibilidad de utilizar la espiritualidad y/o la religiosidad como indicadores de bienestar físico y mental, ya que la calidad de la asistencia prestada está relacionada directamente con la salud del cuidador.

Optical diagnostic imaging and therapy for thyroid cancer.

Thyroid cancer, as one of the most common endocrine cancers, has seen a surge in incidence in recent years. This is most likely due to the lack of specificity and accuracy of its traditional diagnostic modalities, leading to the overdiagnosis of thyroid nodules. Although there are several treatment options available, they are limited to surgery and 131I radiation therapy that come with significant side effects and hence cannot meet the treatment needs of anaplastic thyroid carcinoma with very high malignancy. Optical imaging that utilizes optical absorption, refraction and scattering properties, not only observes the structure and function of cells, tissues, organs, or even the whole organism to assist in diagnosis, but can also be used to perform optical therapy to achieve targeted non-invasive and precise treatment of thyroid cancer. These applications of screening, diagnosis, and treatment, lend to optical imaging's promising potential within the realm of thyroid cancer surgical navigation. Over the past decade, research on optical imaging in the diagnosis and treatment of thyroid cancer has been growing year by year, but no comprehensive review on this topic has been published. Here, we review key advances in the application of optical imaging in the diagnosis and treatment of thyroid cancer and discuss the challenges and potential for clinical translation of this technology.

COVID-19 and Beyond: A Prototype for Remote/Virtual Social Work Field Placement.

The COVID-19 pandemic necessitated an abrupt conclusion of field placement for social work interns at a comprehensive cancer center. In response to social distancing requirements, social workers, but not interns, were granted access to work remotely. Virtual programming became necessary to meet the interns' remaining educational requirements and provided an opportunity for proper termination from the program. This article will delineate the program redesign for oncology social work interns using remote/virtual modalities. This melded approach involved creating simulated clinical interactions, based on selected points along the illness trajectory targeting specific clinical competencies, which were presented to interns by phone and/or videoconference. Examples will be provided related to developing clinical skills and critical thinking and preparing for professional responsibilities within a broad range of healthcare settings. Guidelines for working with individuals, couples/families, and groups will be included. Issues of individual and group supervision will be explored, with sensitivity to the parallel experience of existential uncertainty and mortality awareness among the interns in the context of the pandemic. Although in-person training is preferable, there are advantages to virtual learning for both supervisors and interns. This creative adaptation of field education provides an innovative programming model that can be used to enhance the experience for social work interns moving forward in various healthcare settings during ordinary or extraordinary circumstances.

Experience of Patients in a Consult Model versus an Integrated Palliative Care and Medical Oncology Co-Rounding Model: A Qualitative Study.

Background: Research on different models of palliative care should include evaluation of the patients' experience of care. Objectives: To understand the patients' experience regarding care received in a consult model versus an integrated palliative care and medical oncology co-rounding model during a hospital admission. Design: Qualitative study using thematic analysis. Setting/Subjects: Seventeen patients with stage 4 solid tumor admitted to a tertiary hospital in Singapore. Results: Although experiences of care during the hospital stay were similar in both models, patients in the integrated model were able to better articulate the benefits of palliative care involvement alongside oncologists-to facilitate better communication and a more holistic understanding of the clinical context, with a view to effectively addressing the patient's needs. Conclusions: An integrated co-rounding model may possibly smoothen the transition for advanced cancer patients to palliative care, and could perhaps be considered for implementation to foster reach of palliative care services and improve patient experience.

Factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil / Fatores associados à incapacidade funcional em idosos com câncer atendidos em ambulatórios de referência no estado de Mato Grosso, Brasil

ABSTRACT: Objective: To analyze factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil. Methods: This is a cross-sectional study of 463 older adults aged 60 years or older. The outcome variable was functional disability, evaluated by Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale. The independent variables were sociodemographic characteristics, lifestyle, social support, and health aspects. We performed bivariate and multivariate analyses and calculated prevalence ratios (PR) using Poisson regression with robust variance. Results: The prevalence of IADL functional disability was 55.3%. The variables associated with this disability in the multivariate analysis were: not working (PR=1.36; 95% confidence interval — 95%CI 1.03-1.78); low (PR=1.49; 95%CI 1.10-2.03) and moderate (PR=1.30; 95%CI 1.04-1.64) perceived affectionate support; depressive symptoms (PR=1.31; 95%CI 1.10-1.56); malnutrition (PR=1.28; 95%CI 1.03-1.59); having two or more comorbidities (PR=1.30; 95%CI 1.03-1.64), and having a companion to health services (PR=1.39; 95%CI 1.05-1.83). Conclusion: In addition to physical health aspects, comorbidities, and malnutrition, functional disability was associated with emotional, social support, and work issues, reinforcing the importance of comprehensive care and actions to maintain and recover functional capacity, promoting a better quality of life, the independence of older adults with cancer, and a reduced risk of adverse biopsychosocial outcomes.

RESUMO: Objetivo: Analisar os fatores associados à incapacidade funcional em idosos com câncer atendidos em ambulatórios de referência do estado de Mato Grosso, Brasil. Métodos: Estudo transversal, com 463 idosos de 60 anos ou mais. A variável desfecho foi a incapacidade funcional, avaliada por meio da Escala de Atividades Instrumentais de Vida Diária (AIVD) desenvolvida por Lawton e Brody. As variáveis independentes foram características sociodemográficas, estilo de vida, apoio social e condições de saúde. Foram realizadas análises bivariada e múltipla, calculando-se as razões de prevalência (RP), com o uso de regressão de Poisson com variância robusta. Resultados: A prevalência de incapacidade funcional para as AIVD foi de 55,3%. As variáveis que se associaram a essa incapacidade na análise múltipla foram: não trabalhar (RP=1,36, intervalo de confiança — IC95% 1,03-1,78); percepção de apoio afetivo baixo (RP=1,49; IC95% 1,10-2,03) e médio (RP=1,30; IC95% 1,04-1,64); sintomas depressivos (RP=1,31; IC95% 1,10-1,56); desnutrição (RP=1,28; IC95% 1,03-1,59); ter duas ou mais comorbidades (RP=1,30; IC95% 1,03-1,64) e ter acompanhante aos serviços de saúde (RP=1,39; IC95% 1,05-1,83). Conclusão: Além das condições de saúde física, comorbidade e desnutrição, as questões emocionais, de apoio social e trabalho associaram-se à incapacidade funcional, reforçando a importância de uma atenção integral e de ações de manutenção e recuperação da capacidade funcional, promovendo maior qualidade de vida, a independência do idoso com câncer e a redução do risco de desfechos adversos em âmbito biopsicossocial.

Current Attitudes toward Unfunded Cancer Therapies among Canadian Medical Oncologists.

BACKGROUND: Despite successes in the development of innovative anticancer therapies, the fiscal and capacity restraints of the Canadian public healthcare system result in challenges with drug access. A meaningful proportion of systemic therapies ultimately do not receive public funding despite supporting clinical evidence. In this study, we assessed Canadian medical oncologists' current attitudes toward discussing publicly unfunded cancer treatments with patients and predictors of different practices. METHODS: A web-based survey consisting of multiple choice and case-based scenarios was distributed to medical oncologists identified through the Royal College of Physicians and Surgeons of Canada directory. RESULTS: A total of 116 responses were received. Almost all respondents reported discussing publicly unfunded treatments, including those who did so for Health Canada (HC) approved treatments (50%) and those who discussed off-label treatments (i.e., not HC approved) as guided by national guidelines (48%). Respondents in practice for over 15 years versus less than 5 years (OR 0.14, 95% CI 0.04-0.50, p = 0.002) and those who worked in a community practice versus comprehensive cancer center (OR 0.17, 95% CI 0.03-0.91, p = 0.04) were significantly less likely to discuss off-label treatment options with their patients. Almost half of respondents (47%) indicated that their institution did not permit the administration of unfunded treatments. CONCLUSIONS: There is variability in medical oncologists' practices when it comes to discussing unfunded therapies. Given the limitations within Canada's publicly funded healthcare system, physicians are faced with the challenge of navigating an increasingly complex balance between patient care and available resources. Engagement of relevant stakeholders and policy makers is crucial in the continued evaluation of Canada's drug funding process.

Construção do significado de espiritualidade no processo de morte para a equipe de enfermagem oncológica / Constructing the meaning, to an oncological nursing team, of spirituality in the process of dying / Construcción del significado de la espiritualidad en el proceso de muerte para el equipo de enfermería oncológica

Objetivo: construir o significado de espiritualidade para a equipe de enfermagem diante do processo de morte de pacientes oncológicos. Método: estudo qualitativo, descritivo e exploratório, realizado em um hospital oncológico, referência na prevenção, diagnóstico e tratamento de câncer de Juiz de Fora, com a participação de 12 profissionais de enfermagem. O método se desenvolveu por entrevista estruturada na primeira etapa, e semiestruturada na terceira; entre elas, a segunda que se desenvolveu por leitura reflexiva sobre um texto com o tema da pesquisa. A análise foi de conteúdo temático. Resultados: o sentido da morte expressa descanso do corpo físico, um processo conflituoso e difícil de lidar; a espiritualidade confere sentido à vida; a integralidade da assistência abarca estratégias de cuidado associadas à espiritualidade. Considerações finais: o significado de espiritualidade a evidencia como única, sentida, vivencial, contributiva para o bem-estar humano; reflete em conforto, melhor aceitação da morte e em estratégia terapêutica humanística.

Objective: to construct the meaning of spirituality to a nursing team faced with the process of cancer patients' dying. Method: this exploratory, qualitative, descriptive study took place in a referral oncology hospital for the prevention, diagnosis, and treatment of cancer in Juiz de Fora with the participation of 12 nursing staff members. The method comprised a first stage of structured interviews, and a third of semi-structured interviews; between these, the second involved reflective reading of a text on the research theme. The data were subjected to thematic content analysis. Results: death means that the physical body rests, which is a conflictive process that is difficult to deal with; spirituality gives meaning to life; and comprehensive care includes care strategies associated with spirituality. Final Remarks: the meaning of spirituality shows it to be unique, felt, experiential, and contributing to human well-being; it reflects comfort, better acceptance of death, and humanistic therapeutic strategy.

Objetivo: construir el significado de la espiritualidad para el equipo de enfermería ante el proceso de muerte de pacientes oncológicos. Método: estudio cualitativo, descriptivo y exploratorio, realizado en un hospital de oncología, de referencia en la prevención, el diagnóstico y el tratamiento del cáncer, en Juiz de Fora. Participaron 12 profesionales de enfermería. El método se desarrolló mediante entrevista estructurada en la primera etapa y semiestructurada en la tercera. La segunda etapa se desarrolló mediante la lectura reflexiva de un texto del tema de la investigación. El análisis fue de contenido temático. Resultados: el sentido de la muerte expresa el reposo del cuerpo físico, un proceso conflictivo y difícil de afrontar; la espiritualidad da sentido a la vida; la atención integral incluye estrategias de cuidado asociadas a la espiritualidad. Consideraciones finales: el significado de la espiritualidad la pone en evidencia como única, sentida, vivencial, contribuyendo al bienestar humano; refleja comodidad, mejor aceptación de la muerte y estrategia terapéutica humanista.

Espiritualidade na concepção do paciente oncológico em tratamento antineoplásico / Conception of spirituality of cancer patients undergoing antineoplastic treatment / Espiritualidad en la concepción del paciente oncológico en tratamiento antineoplásico

Resumo Além de ser uma modalidade de enfrentamento, ressignificação do sofrimento e concepção de vida, a espiritualidade é fonte de esperança e confiança para pacientes oncológicos. Com base nessas premissas, objetivou-se desvelar a concepção de espiritualidade de pacientes oncológicos em tratamento antineoplásico a fim de compreender sua influência no enfrentamento da doença. Trata-se de estudo descritivo, de delineamento qualitativo, realizado no ambulatório de quimioterapia de um hospital público brasileiro. A amostra foi composta por 18 pacientes oncológicos submetidos a sessões de quimioterapia, em tratamento ambulatorial, maiores de 18 anos, de ambos os sexos. Para confecção dos resultados, utilizou-se a análise de conteúdo temática, que revelou duas categorias: 1) espiritualidade como fonte de esperança e confiança; e 2) espiritualidade como fonte de ressignificação do sofrimento e de uma renovada concepção de vida.

Abstract In addition to being a way of coping with and attributing new meanings to suffering and conceiving life, spirituality is a source of hope and confidence for cancer patients. From these premises, the aim of this study was to present the perception of spirituality of cancer patients undergoing antineoplastic treatment in order to understand its influence on how patients cope with the disease. This is a descriptive and qualitative study carried out in the outpatient chemotherapy clinic of a Brazilian public hospital. The study sample consisted of 18 cancer patients undergoing outpatient chemotherapy, over 18 years of age, of both genders. Thematic content analysis was used, which revealed two thematic categories: 1) spirituality as a source of hope and confidence; and 2) spirituality as a source of new meanings to suffering and of a renewed view of life.

Resumen Además de ser una modalidad de afrontamiento, resignificación del sufrimiento y concepción de la vida, la espiritualidad es una fuente de esperanza y confianza para los pacientes oncológicos. Partiendo de estas premisas, el objetivo de este trabajo fue desvelar la concepción de la espiritualidad de los pacientes con cáncer sometidos a tratamiento antineoplásico para comprender su influencia en el afrontamiento de la enfermedad. Se trata de un estudio descriptivo de diseño cualitativo, realizado en el ambulatorio de quimioterapia de un hospital público brasileño. La muestra se compuso de 18 pacientes oncológicos sometidos a sesiones de quimioterapia, en tratamiento ambulatorio, mayores de 18 años, de ambos sexos. Para confeccionar los resultados, se utilizó el análisis de contenido temático, que reveló dos categorías: 1) la espiritualidad como fuente de esperanza y confianza; y 2) la espiritualidad como fuente de resignificación del sufrimiento y de una concepción renovada de la vida.

Construção do significado de espiritualidade no processo de morte para a equipe de enfermagem oncológica / Construcción del significado de la espiritualidad en el proceso de muerte para el equipo de enfermería oncológica / Constructing the meaning, to an oncological nursing team, of spirituality in the process of dying

RESUMO Objetivo construir o significado de espiritualidade para a equipe de enfermagem diante do processo de morte de pacientes oncológicos. Método estudo qualitativo, descritivo e exploratório, realizado em um hospital oncológico, referência na prevenção, diagnóstico e tratamento de câncer de Juiz de Fora, com a participação de 12 profissionais de enfermagem. O método se desenvolveu por entrevista estruturada na primeira etapa, e semiestruturada na terceira; entre elas, a segunda que se desenvolveu por leitura reflexiva sobre um texto com o tema da pesquisa. A análise foi de conteúdo temático. Resultados o sentido da morte expressa descanso do corpo físico, um processo conflituoso e difícil de lidar; a espiritualidade confere sentido à vida; a integralidade da assistência abarca estratégias de cuidado associadas à espiritualidade. Considerações finais o significado de espiritualidade a evidencia como única, sentida, vivencial, contributiva para o bem-estar humano; reflete em conforto, melhor aceitação da morte e em estratégia terapêutica humanística.

RESUMEN Objetivo construir el significado de la espiritualidad para el equipo de enfermería ante el proceso de muerte de pacientes oncológicos. Método estudio cualitativo, descriptivo y exploratorio, realizado en un hospital de oncología, de referencia en la prevención, el diagnóstico y el tratamiento del cáncer, en Juiz de Fora. Participaron 12 profesionales de enfermería. El método se desarrolló mediante entrevista estructurada en la primera etapa y semiestructurada en la tercera. La segunda etapa se desarrolló mediante la lectura reflexiva de un texto del tema de la investigación. El análisis fue de contenido temático. Resultados el sentido de la muerte expresa el reposo del cuerpo físico, un proceso conflictivo y difícil de afrontar; la espiritualidad da sentido a la vida; la atención integral incluye estrategias de cuidado asociadas a la espiritualidad. Consideraciones finales el significado de la espiritualidad la pone en evidencia como única, sentida, vivencial, contribuyendo al bienestar humano; refleja comodidad, mejor aceptación de la muerte y estrategia terapéutica humanista.

ABSTRACT Objective to construct the meaning of spirituality to a nursing team faced with the process of cancer patients' dying. Method this exploratory, qualitative, descriptive study took place in a referral oncology hospital for the prevention, diagnosis, and treatment of cancer in Juiz de Fora with the participation of 12 nursing staff members. The method comprised a first stage of structured interviews, and a third of semi-structured interviews; between these, the second involved reflective reading of a text on the research theme. The data were subjected to thematic content analysis. Results death means that the physical body rests, which is a conflictive process that is difficult to deal with; spirituality gives meaning to life; and comprehensive care includes care strategies associated with spirituality. Final Remarks the meaning of spirituality shows it to be unique, felt, experiential, and contributing to human well-being; it reflects comfort, better acceptance of death, and humanistic therapeutic strategy.

Level of Anxiety Among Healthcare Workers at a Comprehensive Cancer Center During the Coronavirus Disease 2019 Pandemic.

Objective The recent coronavirus pandemic (SARS-CoV-2) has severely increased the burden on the field of oncology, leading to the implementation of new rules to overcome its negative impact. An important issue is the psychological impact of the pandemic on already vulnerable populations, such as oncology staff, as reported by oncology associations. This study assessed the anxiety level among oncology staff during the coronavirus disease 2019 pandemic and related it to its risk factors and the effectiveness of departmental interventions that seek to provide coping methods. Methods A cross-sectional survey was administered to the oncology staff at our oncology center. Generalized anxiety disorder scale "yes-or-no" questions were used to determine secondary objectives regarding the concern of infection and the impact of a departmental intervention on overcoming distress. Results Overall, 199 participants were included in the analysis; more than 60% were women, with a median age of 34 years. More than 50% had anxiety and the most significant risk factors were parenthood and contraction of infection (P-value 0.03 and 0.02, respectively). Most responders reported an increase in the workload during the pandemic, but coping methods applied by the administration had improved anxiety levels as reported by a majority of the responders. Conclusion Oncology staff members have been negatively affected by the pandemic, although coping methods helped to improve anxiety. In the future, attention must be focused on the most vulnerable groups.