Annonaceae acetogenins: A potential treatment for gynecological and breast cancer.

Breast and gynecological cancers are major health concerns due to their increasing incidence rates, and in some cases, their low survival probability. In recent years, multiple compounds of natural origin have been analyzed as alternative treatments for this disease. For instance, Acetogenins are plant secondary metabolites from the Annonaceae family, and its potential anticancer activity has been reported against a wide range of cancer cells both in vitro and in vivo. Several studies have demonstrated promising results of Acetogenins' antitumor capacity, given their selective activity of cellular inhibition at low concentrations. This review outlines the origin, structure, and antineoplastic activities in vitro and in vivo of Acetogenins from Annonaceae against breast cancer and gynecological cancers reported to date. Here, we also provide a systematic summary of the activity and possible mechanisms of action of Acetogenins against these types of cancer and provide references for developing future therapies based on Acetogenins and nanotechnologies.

The incidence risk of gynecological cancer by antipsychotic use: a meta-analysis of 50,402 patients.

BACKGROUND: Female gynecological cancers represent a serious public health problem, with 1,398,601 new diagnoses and 671,875 deaths per year worldwide. Antipsychotics are often used in psychiatric disorders, including schizophrenia, bipolar disorder, and major depression. It is estimated that the prescription of these drugs is linked to 1,800 deaths a year in the United States, but their association with cancer remains controversial. METHODS: We searched PubMed, Scopus, and Web of Science databases for studies reporting the correlation in the incidence risk of gynecological cancer by antipsychotic use. We used DerSimonian and Laird random-effect models to compute logit transformed odds ratio (OR) for the primary binary endpoint with 95% confidence interval (CI). Heterogeneity was assessed through effect size width along with I-squared and Tau-squared statistics. Review Manager 5.4.1. was used for statistical analyses. A p-value of < 0.05 denoted statistically significant. RESULTS: 50,402 patients were included, of whom 778 (1,54%) took antipsychotic medication for at least 1 year. 1,086 (2,15%) with ovarian cancer and 49,316 (97,85%) with endometrial cancer. Antipsychotic use (OR 1.50; 1.06 to 2.13 95% CI; p-value 0.02), hypertension (OR 1.50; 95% CI 1.06 to 2.13; p-value < 0.01), nulliparity (OR 1.98; 95% CI 1.53 to 2.57; p-value < 0.01) and multiparity (OR 0.53; 95% CI 0.41 to 0.69; p-value < 0.01) showed significantly different distributions between groups of cancer and cancer-free patients. The primary endpoint of incidence risk of gynecological cancer by antipsychotic therapy showed a statistically significant difference (OR 1.67; 95% CI 1.02 to 2.73; p-value < 0.05) against the use of antipsychotic drugs. CONCLUSIONS: Our meta-analysis showed that the use of antipsychotic drugs increases the risk of gynecological cancers, particularly endometrial cancer. This result should be weighed against the potential effects of treatment for a balanced prescribing decision.

Ingestão Alimentar de Mulheres com Tumores Ginecológicos em Tratamento Oncológico: Revisão Integrativa da Literatura / Food Intake of Women with Gynecological Tumors Undergoing Cancer Treatment: Integrative Literature Review / Ingestión de Alimentos de Mujeres con Tumores Ginecológicos en Tratamiento Oncológico: Revisión Integradora de la Literatura

Introdução: Pacientes com câncer apresentam uma tendência à perda ponderal e à desnutrição energético-proteica. Isso ocorre em razão das modificações que o organismo sofre pelo desenvolvimento da doença e pelos efeitos adversos do tratamento oncológico que contribuem para a redução da ingestão alimentar. Objetivo: Identificar evidências disponíveis na literatura científica sobre a ingestão alimentar de mulheres com tumores ginecológicos em tratamento oncológico. Método: Revisão integrativa da literatura cujas buscas foram realizadas nas bases de dados Embase, MEDLINE e LILACS por meio da associação de termos descritores e palavras livres. Foram incluídos nas análises estudos observacionais que avaliaram a ingestão alimentar de mulheres adultas com tumores ginecológicos durante o tratamento oncológico, redigidos em português, inglês e espanhol. Resultados: Esta revisão analisou seis estudos que investigaram a mudança na ingestão alimentar dessa população. Identificou-se uma redução da ingestão em até 31% de energia, 39,9% de proteínas, 33,7% de lipídeos, 28,7% de carboidratos e uma inadequação da ingestão de determinados micronutrientes. Conclusão: Mulheres com tumores ginecológicos durante o tratamento oncológico apresentam redução significativa da ingestão de energia, proteínas, lipídeos, carboidratos e micronutrientes. Considerando que a perda de peso e a desnutrição em pacientes com câncer está associada a desfechos clínicos negativos, a avaliação e a análise da ingestão alimentar desses indivíduos são fundamentais para possibilitar uma intervenção nutricional precoce, boa resposta ao tratamento e consequente melhoria da qualidade de vida

Introduction: Cancer patients tend to lose weight and energy-protein malnutrition because of the changes the organism undergoes caused by the progression of the disease and treatment-related adverse effects that contribute for the reduction of food intake. Objective: To identify scientific literature-based evidences on food intake of women with gynecological tumors undergoing cancer treatment. Method: Integrative literature review through searches at the Embase, MEDLINE and LILACS databases with the association of descriptive terms and free words. Observational studies in Portuguese, English and Spanish that evaluated the food intake of this population were included in the analyzes. Results: This review identified 6 studies that investigated the change in food intake of women with gynecological cancer undergoing cancer treatment. A reduction in intake was identified in until 31% of energy, 39.9% of proteins, 33.7% of lipids, 28.7% of carbohydrates and inadequate intake of certain micronutrients. Conclusion: Women with gynecological tumors during cancer treatment present significant reduction of energy, proteins, lipids, carbohydrates and micronutrients intake. Considering that weight loss and malnutrition in cancer patients are associated with negative clinical outcomes, the evaluation and analysis of the food intake of this population individuals is essential for early nutritional intervention, good response to treatment and improvement of the quality of life

Introducción: Los pacientes con cáncer tienen tendencia a la pérdida de peso y a la desnutrición calórico-proteica. Esto ocurre debido a los cambios que sufre el organismo debido al desarrollo de la enfermedad y los efectos adversos del tratamiento del cáncer que contribuyen a la reducción de la ingesta alimentaria. Objetivo: Identificar la evidencia disponible en la literatura científica sobre la ingesta alimentaria de mujeres con tumores ginecológicos en tratamiento oncológico. Método: Revisión integrativa de la literatura cuyas búsquedas se realizaron en las bases de datos Embase, MEDLINE y LILACS mediante la asociación de términos descriptivos y palabras libres. Se incluyeron en los análisis estudios observacionales que evaluaron la ingesta de alimentos de mujeres adultas con tumores ginecológicos durante el tratamiento del cáncer, escritos en portugués, inglés y español. Resultados: Esta revisión analizó seis estudios que investigaron el cambio en la ingesta de alimentos en esta población. Cuantificamos una reducción de la ingesta de hasta un 31% en energía, 39,9% en proteínas, 33,7% en lípidos, 28,7% en carbohidratos y una ingesta inadecuada de determinados micronutrientes. Conclusión: Las mujeres con tumores ginecológicos durante el tratamiento del cáncer tienen una reducción significativa en la ingesta de energía, proteínas, lípidos, carbohidratos y micronutrientes. Teniendo en cuenta que la pérdida de peso en pacientes con cáncer se asocia con resultados clínicos negativos, la evaluación de la ingesta alimentaria de estos individuos es fundamental para permitir una intervención nutricional precoz, una buena respuesta al tratamiento y la consecuente mejora de la calidad de vida

ABCB1 and ERCC1 gene polymorphisms are associated with nephro- and hepatotoxicity to carboplatin/paclitaxel-based chemotherapy in patients with gynecologic cancers.

BACKGROUND: Paclitaxel/carboplatin combination is the standard chemotherapeutic protocol for gynecologic cancers, but severe toxicities may compromise treatment. There is great inter-individual variability regarding the incidence and severity of toxicities, which may be due to single-nucleotide polymorphisms (SNPs) affecting drug disposition or cellular sensitivity. Here we investigate the impact of selected SNPs in ERCC1, ABCB1, CYP2C8, and CYP3A5 genes on the incidence of severe toxicities, including nephro- and hepatotoxicity. METHODS: A cohort of 507 gynecological cancer patients receiving paclitaxel/carboplatin was recruited at the Brazilian National Cancer Institute (INCA-Brazil). Clinical data were obtained during routine consultations or from electronic medical records. Toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0). Genotyping was performed using real-time PCR. RESULTS: ABCB1 c.1236C>T was associated with moderate-to-severe (grades 2-4) nephrotoxicity (ORadjusted 2.40; 95% CI 1.39-4.15), even after adjustment for age (≥ 65) and diabetes. The risk association between ABCB1 c.1236C>T and moderate-to-severe nephrotoxicity following paclitaxel/carboplatin chemotherapy was also present among non-diabetic patients (ORadjusted 2.16; 95% CI 1.22-3.82). ERCC1 c.118C>T was the only individual variable associated with an increased risk for moderate-to-severe (grades 2-4) hepatotoxicity (OR 3.71; 95% CI 1.08-12.77), severe nausea (OR 4.18; 95% CI 1.59-10.95), and severe myalgia (OR 1.95; 95% CI 1.12-3.40). CONCLUSIONS: ABCB1 c.1236C>T and ERCC1 c.118C>T might serve as potential biomarkers for the risk of moderate-to-severe toxicities to carboplatin/paclitaxel chemotherapy of gynecological cancers.

Impact of gene polymorphisms on the systemic toxicity to paclitaxel/carboplatin chemotherapy for treatment of gynecologic cancers.

PURPOSE: Gynecologic malignancies are often detected in advanced stages, requiring chemotherapy with taxane/platinum combinations, which may cause severe toxicities, such as neutropenia and peripheral neuropathy. Gene polymorphisms are suspected as possible causes for the interindividual variability on chemotherapy toxicities. OBJECTIVE: To evaluate the role of ABCB1 1236C>T, 3435C>T; CYP2C8*3; CYP3A5*3C variants on paclitaxel/carboplatin toxicities. METHODS: A cohort of 503 gynecologic cancer patients treated with paclitaxel/carboplatin at the Brazilian National Cancer Institute (INCA-Brazil) was recruited (2013-2017). Polymorphisms were genotyped by real-time PCR, and toxicities were evaluated by patients' interviews at each chemotherapy cycle and by data collection from electronic records. The association of clinical features and genotypes with severe toxicities was estimated using Pearson's Chi square tests and multiple regression analyses, with calculation of adjusted odds ratios (ORadjusted), and respective 95% confidence intervals (95% CI). RESULTS: CYP2C8*3 was significantly associated with increased risks of severe (grades 3-4) neutropenia (ORadjusted 2.11; 95% CI 1.24-3.6; dominant model) and severe thrombocytopenia (ORadjusted 4.93; 95% CI 1.69-14.35; recessive model), whereas ABCB1 variant genotypes (ORadjusted 2.13; 95% CI 1.32-3.42), in association with CYP2C8*3 wild type (GG) (ORadjusted 1.93; 95% CI 1.17-3.19), were predictive of severe fatigue. CONCLUSIONS: The present study suggests that CYP2C8*3 is a potential predictor of hematological toxicities related to paclitaxel/carboplatin treatment. Since hematological toxicities, especially neutropenia, may lead to dose delay or treatment interruption, such prognostic evaluation may contribute to clinical management of selected patients with paclitaxel-based chemotherapy.

Suspeita de Reações Adversas Associadas a Quimioterapia com Paclitaxel e Carboplatina em Pacientes com Câncer Ginecológico Assistidas em um Hospital Oncológico do Rio de Janeiro / [Suspected Adverse Reactions Associated with Chemotherapy with Paclitaxel and Carboplatin in Gynecological Cancer Patients Assisted at an Oncology Hospital in Rio de Janeiro]

O protocolo de paclitaxel e carboplatina (CARBO-TAX) é capaz de induzir reações adversas a medicamentos (RAM), comprometendo a qualidade de vida das pacientes. Este estudo teve como objetivo detectarsuspeitas de RAM (sRAM) relacionadas ao CARBO-TAX, em pacientes com câncer ginecológico, identificando os desdobramentos clínicos e o efeito da adesão à Terapia de Suporte (TS). Foi realizado estudo transversal descritivo em hospital oncológico, com pacientes submetidas ao CARBO-TAX. Os dados clínicos, laboratoriais, sociodemográficos, medicamentos utilizados e relatos de sRAM, foram coletados através de entrevista estruturada e análise de prontuário. Das 79 pacientes avaliadas, 39% relataram sRAM agudas e 100% sRAM tardia. Dentre as sRAM tardias, as prevalentes foram fadiga (68% - Grau 1 à 3) e náuseas (66% - Grau 1 à 2). Os principais desdobramentos clínicos foram busca à emergência (45%) e alteração da dose do CARBO-TAX (20%). A adesão a TS (78%) foi relacionada a redução significativa (p<0,05) nas sRAM de maior gravidade (Grau 3). Em conclusão, as sRAM associadas ao CARBO-TAX, afetam o plano terapêutico (alteração de dose/interrupção de protocolo) das pacientes e, a adesão a TS, reduz a gravidade da RAM, interferindo na qualidade e segurança da terapia antineoplásica.

The paclitaxel and carboplatin protocol (CARBO-TAX) is capable of inducing adverse drug reactions (ADR), compromising patients' quality of life. This study aimed to detect CARBO-TAX-related suspected ADRs (sADR) in patients with gynecological cancer, identifying clinical outcomes and the effect of adherence to Supportive Therapy (TS). A descriptive cross-sectional study was carried out in an oncology hospital, with patients submitted to CARBO-TAX. The clinical, laboratorial, sociodemographic data, medicines used and sADR reports were collected through a structured interview and chart analysis. Of the 79 patients evaluated, 39% reported acute sADR and 100% late sADR. Among the late sADR, the prevalent were fatigue (68% - Grade 1 to 3) and nausea (66% - Grade 1 to 2). The main clinical outcomes were the emergence (45%) and modification of the dose of CARBO-TAX (20%). The adherence to TS (78%) was related to a significant reduction (p <0.05) in the most serious sADR (Grade 3). In conclusion, the CARBO-TAX-associated sADR affect the therapeutic plan (dose change / protocol interruption) of patients, and adherence to TS reduces the severity of ADR, interfering with the quality and safety of antineoplastic therapy.

Rivaroxaban Used in the Treatment Patients With Gynecologic Cancer and Venous Thromboembolism: The Experience of Instituto Nacional de Câncer-Rio de Janeiro, Brazil.

INTRODUCTION: Venous thromboembolism (VTE) is a major complication of malignant diseases and is a frequent cause of death in patients with cancer. Managing anticoagulation in these patients is challenging because of the high risk of recurrent VTE and bleeding events. Rivaroxaban is an oral anticoagulant that provides rapid onset of anticoagulation. OBJECTIVE: The aim of this study was to describe the complications of rivaroxaban and potentially associated factors in patients with gynecologic cancer and VTE. METHODS: This was an observational study in women with gynecological cancer who developed VTE and were treated with 15 and 20 mg rivaroxaban at Instituto Nacional de Câncer from July 2014 to July 2015. RESULTS: Forty-one patients were treated with rivaroxaban. Most patients were younger than 60 years and presented cervical cancer; 58.5% of women did not have complications, thus remaining at a dose of 20 mg/d. Because of complications, 12.2% had the dose reduced to 15 mg/d, 12.2% had the drug suspended, 7.3% had progressive worsening of the disease with suspension of anticoagulation, and 9.8% progressed to death because of progression of the disease. CONCLUSIONS: Rivaroxaban has been documented as a low-cost, easily controlled option compared with standard therapy. Most participants in this study had no complications. However, it was not possible to assess associations with statistical significance. Further analytical studies with larger samples are required to evaluate the safety and efficacy of this treatment in patients with gynecologic cancer.

A Review of mTOR Pathway Inhibitors in Gynecologic Cancer.

The treatment of advanced gynecologic cancers remains palliative in most of cases. Although systemic treatment has entered into the era of targeted drugs the antitumor efficacies of current therapies are still limited. In this context there is a great need for more active treatment and rationally designed targeted therapies. The PI3K/AKT/mTOR is a signaling pathway in mammal cells that coordinates important cell activities. It has a critical function in the survival, growth, and proliferation of malignant cells and was object of important research in the last two decades. The mTOR pathway emerges as an attractive therapeutic target in cancer because it serves as a convergence point for many growth stimuli and, through its downstream substrates, controls cellular processes that contribute to the initiation and maintenance of cancer. Aberrant PI3K-dependent signaling occurs frequently in a wide range of tumor types, including endometrial, cervical, and ovarian cancers. The present study reviewed the available evidence regarding the potential impact of some mTOR pathway inhibitors in the treatment of gynecological cancer. Few advances in medical management have occurred in recent years in the treatment of advanced or recurrent gynecological malignancies, and a poor prognosis remains. Rationally designed molecularly targeted therapy is an emerging and important option in this setting; then more investigation in PI3K/AKT/mTOR pathway-targeted therapies is warranted.

Characterization and functional capacity in women with breast cancer, gynaecological cancer and gestational trophoblastic disease / Caracterización y capacidad funcional de mujeres con cáncer mamario, cáncer ginecológico y enfermedad trofoblástica gestacional / Caracterização e capacidade funcional de mulheres com câncer ginecológico, câncer mamário e doença trofoblástica gestacional

Objective: to describe the social, demographic and clinical profile, and functional capacity of women diagnosed with gynecological cancer, breast cancer and gestational trophoblastic disease during chemotherapy. Method: longitudinal retrospective study that evaluated the records of women treated in hospital clinics from January 2000 to December 2012. Results: they evaluated the records of 438 women. The analysis showed that were not able to perform their daily activities, limited to the activities of self-care. Older patients had greater functional impairment during therapy. Conclusions: the sample was women 41 to 50 years, diagnosed with breast cancer (50.9%) and made use of anthracycline based protocols (47%); the scores of the functional capacity of the sample fell from 78.22 to 73.57. It is evident that nursing care should focus on the control of signs and symptoms that impact the functional capacity of women under chemotherapy.

Objetivo: describir el perfil socio demográfico, clínico y capacidad funcional de mujeres diagnosticadas con cáncer ginecológico, mamario y enfermedad trofoblástica gestacional en tratamiento quimioterápico. Método: estudio longitudinal retrospectivo, que evaluó los registros de mujeres en tratamiento en un hospital de clínicas en el período de enero/2000-diciembre/2012. Resultados: fueron evaluados los registros de 438 mujeres. El análisis mostró que las pacientes no eran capaces de realizar sus actividades cotidianas, limitándose a las actividades del autocuidado. Las pacientes mayores sufrieron más comprometimiento funcional durante la terapéutica. Conclusiones: la muestra estudiada era de mujeres con 41-50 años, diagnosticadas con cáncer de mama (50,9%) y hacían uso de protocolos basados en antracíclicos (47%); los escores de la capacidad funcional de la muestra decayeron de 78,22 para 73,57. Se evidencia que los cuidados de enfermería deben centrarse en el control de señales y síntomas que causan impacto en la capacidad funcional de las mujeres en quimioterapia.

Objetivo: descrever o perfil sociodemográfico e clínico e a capacidade funcional de mulheres diagnosticadas com câncer ginecológico, câncer mamário e doença trofoblástica gestacional em tratamento quimioterápico. Método: estudo longitudinal retrospectivo, que avaliou os registros de mulheres em tratamento em um hospital de clínicas no período de janeiro de 2000 a dezembro de 2012. Resultados: foram avaliados os registros de 438 mulheres. A análise mostrou que as pacientes não eram capazes de realizar suas atividades cotidianas, limitando-se àquelas do autocuidado. As pacientes idosas sofreram maior comprometimento funcional durante a terapêutica. Conclusões: a amostra estudada era de mulheres com 41 a 50 anos, diagnosticadas com câncer de mama (50,9%), que faziam uso de protocolos baseados em antracíclicos (47%); os escores da capacidade funcional da amostra decaíram de 78,22 para 73,57. Evidencia-se que os cuidados de enfermagem devem centrar-se no controle de sinais e sintomas que causam impacto na capacidade funcional das mulheres sob quimioterapia.

Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods.

BACKGROUND: Most contraceptive methods present benefits beyond contraception; however, despite a large body of evidence, many healthcare professionals (HCPs), users and potential users are unaware of those benefits. This review evaluates the evidence for non-contraceptive benefits of hormonal and non-hormonal contraceptive methods. METHODS: We searched the medical publications in PubMed, POPLINE, CENTRAL, EMBASE and LILACS for relevant articles, on non-contraceptive benefits of the use of hormonal and intrauterine reversible contraceptive methods, which were published in English between 1980 and July 2014. Articles were identified using the following search terms: 'contraceptive methods', 'benefits', 'cancer', 'anaemia', 'heavy menstrual bleeding (HMB)', 'endometrial hyperplasia', 'endometriosis' and 'leiomyoma'. RESULTS: We identified, through the literature search, evidence that some combined oral contraceptives have benefits in controlling HMB and anaemia, reducing the rate of endometrial, ovarian and colorectal cancer and ectopic pregnancy as well as alleviating symptoms of premenstrual dysphoric disorder. Furthermore, the use of the levonorgestrel-releasing intrauterine system also controls HMB and anaemia and endometrial hyperplasia and cancer, reduces rates of endometrial polyps in users of tamoxifen and alleviates pain associated with endometriosis and adenomyosis. Depot medroxyprogesterone acetate controls crises of pain associated with sickle cell disease and endometriosis. Users of the etonogestrel-releasing contraceptive implant have the benefits of a reduction of pain associated with endometriosis, and users of the copper intrauterine device have reduced rates of endometrial and cervical cancer. CONCLUSIONS: Despite the high contraceptive effectiveness of many hormonal and intrauterine reversible contraceptive methods, many HCPs, users and potential users are concerned mainly about side effects and safety of both hormonal and non-hormonal contraceptive methods, and there is scarce information about the many benefits that these methods offer beyond contraception.

Câncer ginecológico e gravidez: uma revisão sistematizada direcionada para obstetras / Gynecological cancer and pregnancy: a systematic review aimed to obstetricians

A estimativa de incidência de câncer em grávidas é baixa. Entretanto, com a procriação ocorrendo em idades mais avançadas nas últimas décadas, observou-se um aumento na incidência dos cânceres diagnosticados durante a gravidez. Neste artigo, foi realizada uma revisão sistemática sobre a ocorrência do câncer ginecológico concomitante à gravidez. O objetivo foi apresentar as evidências disponíveis sobre a triagem, diagnóstico, acompanhamento do tratamento oncológico, bem como a possibilidade de preservação da fertilidade nessas mulheres. A revisão de literatura foi realizada na base de dados Pubmed, de 2010 a 2014. Dos 352 artigos encontrados, 26 foram selecionados para leitura completa. Devido à baixa incidência de cânceres ginecológicos associado à gravidez a condução destas pacientes tem como base os relatos e séries de casos e poucas coortes históricas. Os cânceres ginecológicos mais frequentemente associados à gravidez são o câncer do colo do útero e o de ovário. Nestes grupos de pacientes, o obstetra desempenha papel fundamental na triagem, diagnóstico, avaliação inicial, e coordenação da equipe multidisciplinar de assistência. O tratamento deve ser individualizado, com o objetivo de alcançar as maiores taxas de cura. Entretanto, deve também vislumbrar a possibilidade de manter a gravidez, com mínimos danos ao feto e de preservar a fertilidade, se possível, o que é incentivado pela tendência de início tardio da vida reprodutiva.(AU)

Cancer incidence estimates during pregnancy are low. However, with procreation occurring at older ages in recent decades, an increased incidence of cancers diagnosed during pregnancy has been observed. In this article a systematic review on the occurrence of concomitant gynecological cancer to pregnancy was performed. The objective was to provide the available evidence on screening, diagnosis and monitoring of cancer treatment and preservation of pregnancy and fertility in these group of women. The literature review was performed in PubMed database from 2010 to 2014. Of the 352 reviewed articles, 26 were selected to complete reading. Due to the low incidence of gynecological cancers associated with pregnancy, the management of these patients is based on reports, case series, and a few historical cohorts. Gynecologic cancers most often associated with pregnancy are cervical cancer and the ovarian cancer. In these group, the obstetrician composes an important role in screening, diagnosis, initial evaluation, and coordination of the multidisciplinary team care. Treatment should be individualized in order to achieve the highest cure rates. However, it should also envisage the possibility to maintain the pregnancy, with minimal damage to the fetus and to preserve fertility, if possible, which is encouraged by the tendency of the late reproductive years.(AU)

Conhecimento da equipe de enfermagem acerca de eventos adversos do tratamento quimioterápico / Knowledge of a nursing team about chemotherapy adverse effects

Este estudo teve como objetivo identificar o conhecimento dos profissionais da equipe de enfermagem acerca dos eventos adversos decorrentes do tratamento quimioterápico. Estudo descritivo e transversal realizado entre março e maio de 2013 com 28 profissionais da equipe de enfermagem que trabalham no Ambulatório, na Unidade de Internação e na Central de Quimioterapia de um hospital universitário. Para a coleta dos dados foi utilizado um instrumento elaborado pelas autoras e validado por enfermeiras especialistas na área. Entre os participantes, 82,1% não possuem nenhum tipo de especialização na área de oncologia. As profissionais apresentaram dificuldades em classificar os eventos adversos em relação ao tempo de aparecimento, bem como ao manejo dos mesmos. Os eventos adversos relatados coincidem com os mais evidenciados na prática clínica. Diante da complexidade do tratamento quimioterápico, torna-se indiscutível a necessidade de capacitação dos profissionais de saúde que atuam na área quando consideramos uma prática assistencial em oncologia de qualidade.

This study aimed to identify the knowledge of the professional nursing team about the adverse events resulting from chemotherapy treatment. Descriptive cross-sectional study conducted between March and May 2013 with 28 professional nursing team working at the outpatient clinic, the inpatient unit and Chemotherapy Center of a university hospital. To collected data were used an instrument developed by the authors and validated by expertise nurses in this area. Among the participants, 82,1 % did not have any expertise in the area ofoncology. The professionals had difficulties in classifying adverse events in relation to time of onset, and their management. Reported adverse events coincide with the most evident in clinical practice. Given the complexity of chemotherapy becomes the indisputable need for training of health professionals working in the area when considering a care in oncology quality.

[Characterization and functional capacity in women with breast cancer, gynaecological cancer and gestational trophoblastic disease]. / Caracterização e capacidade funcional de mulheres com câncer ginecológico, câncer mamário e doença trofoblástica gestacional.

OBJECTIVE: To describe the social, demographic and clinical profile, and functional capacity of women diagnosed with gynecological cancer, breast cancer and gestational trophoblastic disease during chemotherapy. METHOD: Longitudinal retrospective study that evaluated the records of women treated in hospital clinics from January 2000 to December 2012. RESULTS: They evaluated the records of 438 women. The analysis showed that were not able to perform their daily activities, limited to the activities of self-care. Older patients had greater functional impairment during therapy. CONCLUSIONS: The sample was women 41 to 50 years, diagnosed with breast cancer (50.9%) and made use of anthracycline based protocols (47%); the scores of the functional capacity of the sample fell from 78.22 to 73.57. It is evident that nursing care should focus on the control of signs and symptoms that impact the functional capacity of women under chemotherapy.

2-methoxyestradiol and disorders of female reproductive tissues.

2-Methoxyestradiol (2ME) is an endogenous metabolite of 17ß-estradiol. Once thought of as a mere degradation product, 2ME has gained attention as an important component of reproductive physiology and as a therapeutic agent in reproductive pathologies such as preeclampsia, endometriosis, infertility, and cancer. In this review, we discuss the involvement of 2ME in reproductive pathophysiology and summarize its known mechanisms of action: microtubule disruption, inhibition of angiogenesis and stimulation of apoptosis. Currently, the clinical uses of 2ME as a single agent are limited due to its poor water solubility and thus low bioavailability; however, 2ME analogs and derivatives have been recently developed and tested as cancer treatments. Despite some isolated success stories and ongoing research, 2ME derivatives have not yet provided the expected results. The adjuvant use of 2ME derivatives with chemotherapeutic agents is hindered by their intrinsic toxicity confounding the unwanted secondary effects of chemotherapy. However, due to the well-tested tolerance of the body to high doses of native 2ME, it may the combination of native 2ME with conventional treatments that will offer novel clinically relevant regimens for cancer and other reproductive disorders.

Comprehensive management of diffuse leiomyomatosis in a patient with Alport syndrome.

Alport syndrome with diffuse leiomyomatosis (ASDL) is a complex combination that doesn't have a specific course of treatment. In this case report, we present a 44-year-old woman with ASDL and detail her treatment. The patient presented at the emergency room (ER) with symptoms of anemia, bronchial asthma, and abnormal uterine bleeding (AUB). The patient had diffuse myomas in different areas of her body, including the esophagus and genital tract. She was treated by a multidisciplinary team that included members from the hematology/oncology, pulmonary, interventional radiology, anesthesia, surgery, and gynecology services. A physician from interventional radiology performed an embolization of the uterine arteries to treat the patient's AUB. Surgery was done in May 2011 to remove the esophageal leiomyomas to improve her pulmonary function. Surgery included a distal esophagectomy, a proximal gastrostomy, and the resection of the leiomyomatous mass. In order to shrink the tumor in her genito pelvic region so that it could be extirpated with the highest likelihood of success, the patient was treated with gonadotropin-releasing hormone agonist (leuprolide acetate, 3.75 mg/month for 4 months). In May 2012, the patient had a total abdominal hysterectomy (TAH), with a bilateral salpingo-ophorectomy (BSO), the excision of a leiomyoma, and a posterior colporrhaphy.

Osteonecrosis maxilar: una problemática onco-odontológica / Maxillary osteonecrosis: an onco-odontologic problematic

Los bifosfonatos fueron sintetizados en el siglo XIX por químicos alemanes, los cuales buscaban prevenir el depósito industrial de carbonato de calcio en sus chimeneas. Más tarde se observó la gran afinidad de la droga con el tejido óseo y que además inhibía la conversión de fosfato de calcio amorfo a hidroxiapatita (HA), lo cual reducía la velocidad de disolución de los cristales óseos. Por lo antedicho, estos compuestos sintéticos son utilizados hace más de tres décadas para el tratamiento de desórdenes esqueletales: osteoporosis, enfermedad de Paget, hipercalcemia asociada a mieloma múltiple y metástasis óseas propias de cáncer de próstata y mama, osteogénesis imperfecta y displasia fibrosa. Recientemente se han descripto algunos casos de osteonecrosis maxilar a causa de tratamiento crónico con bifosfonatos, a altas dosis en la prescripción de dichas drogas utilizadas como terapéutica oncológica.

Biphosphonates, synthesized in the mid 19th century by German chemists, were initially used in industry due to their capacity to prevent the deposits of calcium carbonate, which made them especially useful in avoiding the deposit of calcium salt in pipes. Later it was shown that they had great affinity with osseous tissue, where they inhibitedthe conversion of amorphous calcium phosphate in hydroxyapatite and they reduced the dissolution speed o the later. Biphosphonates are synthetics compounds used in the treatment of various metabolic and malignant bone diseases: Osteoporosis, Paget Disease, Hypercalcemia, Multiple Mieloma, Metastatic breast cancer and Metastatic prostate cancer, Osteogenesis Imperfecta, Fibrous Dysplasia. Recently, have been described some cases of Osteonecrosis of the jaw because of biphosphonate treatment in high doses for oncology administration.

Evaluation of the quality of life of gynecological cancer patients submitted to antineoplastic chemotherapy.

This study aimed to evaluate the quality of life of female gynecological cancer patients submitted to antineoplastic chemotherapy Between August 2007 and April 2009, 50 patients who were undergoing chemotherapy at an outpatient chemotherapy unit in Uberaba-MG were interviewed, by applying the instrument of evaluation of Quality of Life of the World Health Organization, WHOQOL-BREF. The results showed that the domain most affected was the Physical and the more preserved, the Social, with the mean of the general quality of life above the means obtained in other studies. All domains correlated significantly with the general quality of life. It was evident then that the quality of life of these women is satisfactory, however it is suggested that the domains with lower scores be the targets of more accurate observations during multi-professional interventions in order to provide a better quality of life during the chemotherapy treatment.

Evaluation of the Quality of Life of Gynecological Cancer Patients Submitted to Antineoplastic Chemotherapy / Avaliação da qualidade de vida de portadoras de câncer ginecológico, submetidas à quimioterapia antineoplásica / Evaluación de la calidad de vida de portadoras de cáncer ginecológico, sometidas a quimioterapia antineoplásica

This study aimed to evaluate the quality of life of female gynecological cancer patients submitted to antineoplastic chemotherapy Between August 2007 and April 2009, 50 patients who were undergoing chemotherapy at an outpatient chemotherapy unit in Uberaba - MG were interviewed, by applying the instrument of evaluation of Quality of Life of the World Health Organization, WHOQOL-BREF. The results showed that the domain most affected was the Physical and the more preserved, the Social, with the mean of the general quality of life above the means obtained in other studies. All domains correlated significantly with the general quality of life. It was evident then that the quality of life of these women is satisfactory, however it is suggested that the domains with lower scores be the targets of more accurate observations during multi-professional interventions in order to provide a better quality of life during the chemotherapy treatment.

Este estudo teve como objetivo avaliar a qualidade de vida de mulheres portadoras de câncer ginecológico, submetidas à quimioterapia antineoplásica. Foram entrevistadas 50 pacientes, no período de agosto de 2007 a abril de 2009, que estavam em tratamento quimioterápico em um ambulatório de quimioterapia de Uberaba, MG, mediante aplicação do instrumento de avaliação de Qualidade de Vida da Organização Mundial da Saúde-WHOQOL-bref. Os resultados apontaram que o domínio mais comprometido foi o físico e o mais preservado, o social, sendo que a qualidade de vida geral obteve média acima da obtida em outros estudos. Todos os domínios correlacionaram-se significativamente com a qualidade de vida geral. Pode-se evidenciar, então, que a qualidade de vida dessas mulheres é satisfatória; entretanto, sugere-se que os domínios com escores mais baixos sejam alvo de observações mais acuradas, durante as intervenções multiprofissionais, a fim de se proporcionar melhor qualidade de vida durante o tratamento quimioterápico.

Este estudio tuvo como objetivo evaluar la calidad de vida de mujeres portadoras de cáncer ginecológico sometidas a quimioterapia antineoplásica. Fueron entrevistadas 50 pacientes en el período de agosto de 2007 a abril de 2009 que estaban en tratamiento quimioterapéutico en un ambulatorio de quimioterapia de Uberaba-MG, mediante la aplicación del instrumento de evaluación de Calidad de Vida de la Organización Mundial de la Salud-WHOQOL-bref. Los resultados apuntaron que el dominio más comprometido fue el físico y el más preservado, el social, siendo que la calidad de vida general obtuvo un promedio superior al obtenido en otros estudios. Todos los dominios se correlacionaron significativamente con la calidad de vida general. Se puede evidenciar, entonces, que la calidad de vida de esas mujeres fue satisfactoria; sin embargo se sugiere que los dominios con puntajes más bajos sean examinados con observaciones más exactas durante las intervenciones multiprofesionales, a fin de proporcionar una mejor calidad de vida durante el tratamiento quimioterapéutico.

[Profile of patients with gynecological cancer under chemotherapy]. / Perfil de pacientes com câncer ginecológico em tratamento quimioterápico.

A study of socio-epidemiological demographic profile of patients in chemotherapy for cancer in the Gynecology and Obstetrical Ward in HE- UFTM, presented in the period from 1998 to 2006. Retrospective study whose data collection was obtained from health records It was built a data base using Epi-Info. Data analysis considered simple distribution, mediacy with value between the maximum and the minimum and stand deviation. The sample was constituted of 321 health records; the more incident age group was 46 to 50 years-old; breast cancer was the most noticed cancer (45%); the chemotherapy most used was ciclofosfamida, in 173 treatments; had an increase in breast cancer. It was concluded that had a change in the patient's profile.