Assessing burden, risk factors, and perceived impact of uterine fibroids on women's lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study.

BACKGROUND: Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women's lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women's quality of life. METHODS: A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH's (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. RESULTS: Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication- 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1-10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6-12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6-13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1-0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1-0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women's lives. The poverty cycle of uterine fibroids emerged. CONCLUSIONS: A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

Improvement in parameters of quality of life and uterine volume reduction after uterine fibroid embolization.

OBJECTIVE: To evaluate improvement in quality of life, reduction of uterine volume, and the correlation between these two variables after uterine fibroid embolization. METHODS: Data on quality of life before and after uterine fibroid embolization were collected from 60 patients using the Uterine Fibroid Symptom - Quality of Life questionnaire. In 40 of these patients, uterine volume information on magnetic resonance imaging examinations performed before and after uterine fibroid embolization was collected, and compared using the nonparametric Wilcoxon test for paired data. Correlation between quality of life and uterine volume before and after procedure was measured using Spearman's correlation coefficient. RESULTS: There was significant improvement in quality of life after uterine fibroid embolization on Uterine Fibroid Symptom - Quality of Life questionnaire, in both subscales scores and the total score. There was a significant median reduction of -37.4% after uterine fibroid embolization, but no correlations between uterine volume and quality of life scores were found before or after embolization. CONCLUSION: Uterine embolization is an alternative to treat uterine fibroids, resulting in relief of symptoms and better quality of life. Although reduction in uterine volume plays an important role in the evaluation of therapeutic success, it does not necessarily have a definitive correlation with relief of symptoms.

A systematic review of the psychosocial impact of fibroids before and after treatment.

OBJECTIVE: Despite the high prevalence of uterine fibroids, the psychosocial impact of fibroids has not been evaluated across different quality of life indicators and compared with other chronic conditions. Here, we rigorously analyzed available evidence pertaining to the psychosocial burden of uterine fibroids in premenopausal women and compared validated quality of life and symptom scores before and after treatment. DATA SOURCES: We searched PubMed, PsycINFO, ClinicalTrials.gov, Embase, and Cochrane Library for publications from January 1990 to January 2020. STUDY ELIGIBILITY CRITERIA: We considered English-language publications that evaluated the association between uterine fibroids diagnosed by imaging studies in premenopausal women and quality of life by standardized and validated questionnaires at baseline and after treatment. We used a detailed list of terms related to quality of life, questionnaires, and uterine fibroids to conduct the search. METHODS: Three reviewers screened titles and abstracts and then obtained full-text articles for further analysis. The reviewers assessed risk of bias using established Cochrane and Newcastle-Ottawa Scale guidelines. The quality of life scores of premenopausal women with fibroids were reviewed at baseline and compared with those of published quality of life scores in other disease populations in addition to after fibroid treatment. RESULTS: A total of 57 studies were included in the review: 18 randomized controlled trials and 39 observational studies. Of note, the 36-Item Short Form Survey and European Quality of Life Five-Dimension Scale questionnaires both indicated a diagnosis of uterine fibroids to have a disability score that was similar to or exceeded (was a greater psychosocial stressor) a diagnosis of heart disease, diabetes mellitus, or breast cancer. Quality of life scores were lower at baseline than after treatment in all instruments measuring these variables in women with uterine fibroids, indicating significantly impaired psychosocial functioning. Uterine fibroids were associated with significant patient-reported health disabilities related to bodily pain, mental health, social functioning, and satisfaction with sex life. CONCLUSION: A diagnosis of uterine fibroids was a significant psychosocial stressor among women at baseline and relative to other diseases. Validated quality of life instruments indicated therapeutic success and the improvement of both physical and emotional symptoms after treatment.

Improvement in parameters of quality of life and uterine volume reduction after uterine fibroid embolization / Melhora em parâmetros de qualidade de vida e redução do volume uterino após embolização de artérias uterinas

ABSTRACT Objective To evaluate improvement in quality of life, reduction of uterine volume, and the correlation between these two variables after uterine fibroid embolization. Methods Data on quality of life before and after uterine fibroid embolization were collected from 60 patients using the Uterine Fibroid Symptom - Quality of Life questionnaire. In 40 of these patients, uterine volume information on magnetic resonance imaging examinations performed before and after uterine fibroid embolization was collected, and compared using the nonparametric Wilcoxon test for paired data. Correlation between quality of life and uterine volume before and after procedure was measured using Spearman's correlation coefficient. Results There was significant improvement in quality of life after uterine fibroid embolization on Uterine Fibroid Symptom - Quality of Life questionnaire, in both subscales scores and the total score. There was a significant median reduction of -37.4% after uterine fibroid embolization, but no correlations between uterine volume and quality of life scores were found before or after embolization. Conclusion Uterine embolization is an alternative to treat uterine fibroids, resulting in relief of symptoms and better quality of life. Although reduction in uterine volume plays an important role in the evaluation of therapeutic success, it does not necessarily have a definitive correlation with relief of symptoms.

RESUMO Objetivo Avaliar a melhora na qualidade de vida e a redução do volume uterino, além da correlação entre essas duas variáveis, após a embolização de artérias uterinas. Métodos Foram coletados dados de 60 pacientes sobre qualidade de vida antes e depois da embolização de artérias uterinas com a aplicação do questionário Uterine Fibroid Symptom - Quality of Life. Informações sobre o volume uterino em exames de ressonância magnética realizada antes e depois do procedimento foram coletadas em 40 dessas pacientes e comparadas por meio de teste não paramétrico de Wilcoxon para dados pareados. A correlação entre qualidade de vida e volume uterino antes e depois do procedimento foi determinada pelo coeficiente de Spearman. Resultados Houve melhora significativa na qualidade de vida das pacientes após embolização de artérias uterinas nos escores do questionário Uterine Fibroid Symptom - Quality of Life, tanto das subescalas como do total. Houve redução mediana significativa (-37,4%) no volume uterino após embolização de artérias uterinas, embora não tenha sido estabelecida qualquer correlação entre volume uterino e escores de qualidade de vida antes e depois da embolização. Conclusão A embolização de artérias uterinas é alternativa para o tratamento de fibroide uterina, resultando na melhora dos sintomas e da qualidade de vida. Embora a redução do volume uterino seja fator importante na avaliação do sucesso terapêutico, não está necessariamente correlacionada com melhora de sintomas.

An uncommon response to metronomic therapy in a heavily pretreated patient with metastatic carcinosarcoma: a case report.

BACKGROUND: Uterine carcinosarcoma is well known for its aggressive behavior. There is little evidence regarding the gold standard combination chemotherapy in metastatic or locally advanced carcinosarcoma, due to poor survival outcomes obtained with conventional scheduled chemotherapy. This case report represents the first-ever reported objective response to a metronomic chemotherapy regimen and adds to the current literature. CASE PRESENTATION: We describe a case of a Caucasian woman diagnosed with metastatic carcinosarcoma that had already been treated with multiple lines of conventional chemotherapy, with progressive disease. This patient had a surprising clinical and imaging response when treated with oral metronomic cyclophosphamide. CONCLUSIONS: We reviewed the mechanism of action implicated in metronomic chemotherapy, and correlated it with the biology of disease in carcinosarcoma. This information may add to the current literature, providing important insights to future clinical trials in this patient population.

Aspectos psicológicos dos pacientes com câncer de colo de útero, relacionado à prática radioterápica / Psychological Aspects of Patients with Cervical Cancer Radiotherapy – Related Practice

Radioterapia é um dos tratamentos instituídos para o combate ao câncer de colo uterino e provoca um forte impacto orgânico e psicológico nos pacientes. Ao destacar a importância do acompanhamento psicológico, realizou-se uma pesquisa com o objetivo de investigar as percepções e estratégias de enfrentamento à radioterapia. Trata-se de uma pesquisa qualitativa, com sujeitos encontrados a partir do método “Bola de Neve”, aos quais se aplicou uma entrevista aberta, posteriormente realizada sua Análise de Conteúdo. A Análise de Conteúdo compreendeu que a informação e a acolhida são fatores inerentes a melhoria da qualidade de vida do paciente. Percebeu-se que o apoio das redes sociais e equipe de saúde influencia positivamente no enfrentamento da enfermidade e auxilia a elaborar as idéias de finitude e a passividade quanto ao tratamento e o curso da doença. Assim, o estar informado e sentir-se acolhido e apoiado em seu sofrimento são situações que podem auxiliar o paciente no tratamento, reabilitação e convívio social.(AU)

Radiotherapy is a treatment instituted to combat uterine cancer and causes a strong physical and psychological impact on patients. Highlighting the importance of monitoring psychological, research was done in order to investigate the perceptions and strategies of confrontation to radiotherapy. It is a qualitative research with individuals found by the method “Snowball”, who participated in an open interview, which had its analysis of content performed before. The analysis of content understood that the information and the reception are inherent factors that improve the patient quality of life. It was realized that the support of social networks and health team have a positive influence in combating the disease and help to develop the ideas of finitude and passivity in relation to the treatment and course of the disease. Thus, to be informed and feel welcome and supported in their grief are situations that can assist the patient in treatment, rehabilitation and social life.(AU)

Aspectos psicológicos dos pacientes com câncer de colo de útero, relacionado à prática radioterápica / Psychological aspects of patients with cervical cancer radiotherapy: related practice

Radioterapia é um dos tratamentos instituídos para o combate ao câncer de colo uterino e provoca um forte impacto orgânico e psicológico nos pacientes. Ao destacar a importância do acompanhamento psicológico, realizou-se uma pesquisa com o objetivo de investigar as percepções e estratégias de enfrentamento à radioterapia. Trata-se de uma pesquisa qualitativa, com sujeitos encontrados a partir do método “Bola de Neve”, aos quais se aplicou uma entrevista aberta, posteriormente realizada sua Análise de Conteúdo. A Análise de Conteúdo compreendeu que a informação e a acolhida são fatores inerentes a melhoria da qualidade de vida do paciente. Percebeu-se que o apoio das redes sociais e equipe de saúde influencia positivamente no enfrentamento da enfermidade e auxilia a elaborar as idéias de finitude e a passividade quanto ao tratamento e o curso da doença. Assim, o estar informado e sentir-se acolhido e apoiado em seu sofrimento são situações que podem auxiliar o paciente no tratamento, reabilitação e convívio social.

Radiotherapy is a treatment instituted to combat uterine cancer and causes a strong physical and psychological impact on patients. Highlighting the importance of monitoring psychological, research was done in order to investigate the perceptions and strategies of confrontation to radiotherapy. It is a qualitative research with individuals found by the method “Snowball”, who participated in an open interview, which had its analysis of content performed before. The analysis of content understood that the information and the reception are inherent factors that improve the patient quality of life. It was realized that the support of social networks and health team have a positive influence in combating the disease and help to develop the ideas of finitude and passivity in relation to the treatment and course of the disease. Thus, to be informed and feel welcome and supported in their grief are situations that can assist the patient in treatment, rehabilitation and social life.

[Radiotherapy: perception of women with uterine-cervical cancer]. / Radioterapia: percepção de mulheres com câncer cérvico-uterino.

This is a qualitiative study that aimed to know the perception of women with uterine-cervical cancer on the radiotherapy, describing the physical and daily alterations they suffered and evidencing the their coping to face these adversities and their expectations about the treatment. 20 women in a specialized hospital had been interviewed, located in the city of Teresina-PI. The results showed that they perceive the radiotherapy as a good treatment, although the fear ahead of the stranger and the limitations in the daily one, had to the side-effects, that are faced with support in the religious and the social-familiar scope, increasing the cure expectation. The importance of the orientation to these women for the multiprofessional team showed, especially the Nurse, in all the phases of the treatment.

Radioterapia: percepção de mulheres com câncer cérvico-uterino / Radioterapia: percepción de mujeres con cáncer cérvico-uterino / Radiotherapy: perception of women with uterine-cervical cancer

Realizou-se um estudo qualitaitvo com objetivo de conhecer a percepção das mulheres com câncer cérvico-uterino sobre a radioterapia, descrevendo as alterações físicas e cotidianas sofridas e evidenciando meios de enfrentamento e expectativas em relação ao tratamento. Foram entrevistadas 20 mulheres em um hospital especializado, localizado na cidade de Teresina-PI. Os resultados mostraram que elas percebem a radioterapia como um bom tratamento, apesar do medo diante do desconhecido e das limitações no cotidiano, devido aos efeitos colaterais, que são enfrentados com suporte na religiosidade e no âmbito sócio-familiar, aumentando a expectativa de cura. Revelou-se a importância da orientação a essas mulheres pela equipe multiprofissional, especialmente o Enfermeiro, em todas as fases do tratamento.

This is a qualitiative study that aimed to know the perception of women with uterine-cervical cancer on the radiotherapy, describing the physical and daily alterations they suffered and evidencing the their coping to face these adversities and their expectations about the treatment. 20 women in a specialized hospital had been interviewed, located in the city of Teresina-PI. The results showed that they perceive the radiotherapy as a good treatment, although the fear ahead of the stranger and the limitations in the daily one, had to the side-effects, that are faced with support in the religious and the social-familiar scope, increasing the cure expectation. The importance of the orientation to these women for the multiprofessional team showed, especially the Nurse, in all the phases of the treatment.

Se realizó un estudio con abordaje cualitativo objetivando conocer la percepción de las mujeres con cáncer cérvico-uterino sobre la radioterapia, describiendo las alteraciones físicas y cotidianas sufridas y evidenciando el medio utilizado para que enfrenten esas adversidades y sus expectativas con relación al tratamiento. Fueron entrevistadas 20 mujeres en un hospital especializado, localizado en la ciudad de Teresina-PI. Los resultados mostraron que ellas perciben la radioterapia como un buen tratamiento, a pesar del miedo delante de lo desconocido y de las limitaciones en el cotidiano, debido a los efectos colaterales, que son enfrentados con base en la religiosidad y en el ámbito socio-familiar, aumentando la expectativa de cura. Se reveló la importancia de la orientación a esas mujeres por el equipo multiprofesional, especialmente el Enfermero, en todas las fases del tratamiento.

Qualidade de vida e aspectos psicológicos em pacientes com doença trofoblástica gestacional / Quality of life and psychological aspects in pacients with gestational trophoblastic disease

Doença trofoblástica gestacional (DTG) é um grupo de anomalias proliferativas em células trofoblásticas placentárias que levam a diferentes quadros evolutivos: remissão espontânea, invasão miometrial, metástase e recorrência. O medo da doença, da quimioterapia e da recorrência, bem como a incerteza quanto a futuras gestações são fatores de estresse que afetam consideravelmente a qualidade de vida das pacientes com DTG. Todos esses transtornos resultam em estresse psicológico, social e sexual no momento do diagnóstico, ao longo do seguimento e até mesmo após a cura. A fim de aperfeiçoar a assistência, a qualidade de vida tem sido avaliada em pacientes com diferentes doenças. Entretanto, poucos estudos têm como foco a influência da DTG sobre aspectos psicológicos, sociais e sexuais. Este trabalho tem como objetivo a revisão de estudos sobre qualidade de vida e aspectos psicológicos em pacientes com doença trofoblástica gestacional.

Vivências de mulheres submetidas à braquiterapia: compreensão existencial / Experiences of women submited to braquitherapy: existencial comprehension

Neste estudo, busquei compreender as vivências de mulheres portadoras de câncer uterino antes de submeterem ao tratamento braquiterápico. Trata-se de uma pesquisa qualitativa embasada na fenomenologia existencial de Martin Heidegger que possibilitou a apreensão dos momentos vividos por esses seres. Para participar dessa pesquisa, procurei por mulheres que haviam iniciado algum tipo de tratamento para câncer uterino. Selecionei aquelas que se submeteram à radioterapia em uma clínica de radioterapia situada no noroeste do Paraná, e, a posteriori, seriam submetidas à braquiterapia no período compreendido entre os meses de abril a maio de 2006. Foram entrevistadas quatro mulheres em um hospital especialista em oncologia no norte do Paraná, antes de iniciarem a braquiterapia. Para buscar os discursos dos sujeitos, utilizei a seguinte questão norteadora: “O que você sente antes de vivenciar a braquiterapia”? Da interpretação emergiram três temáticas: O ser-com-o-outro inautêntico no convívio do hospital; angústia ante o desconhecimento do tratamento;religiosidade: o caminho da esperança. Os resultados obtidos revelam a importância do cuidado holístico ao Ser que vivencia esta, facticidade, pois, muitas vezes, a subjetividade do cuidado fica absorvida pela massificação das regras e normas institucionais...

Experiences of females with uterine cancer have been analyzed prior to brachytherapy treatment. The qualitative research has been foregrounded on Martin Heidegger’s existential phenomenology which favors the understanding of instances experienced by the patients. Females who had already initiated some type of treatment for uterine cancer were investigated, although only those undertaken radiotherapy in a specific radiotherapy clinic in the northwestern section of the state of Paraná/Brazil, have been selected. They would later have to undergo brachytherapy treatment which occurred between April and May 2006. Four females were interviewed in an oncology hospital in the north of the state of Paraná, Brazil, prior to brachytherapy treatment. The following question was asked to elicit the subjects’ discourse: “What are your feelings prior to brachytherapy?” Three themes were categorized: the non-authentic being-with-the other in the hospital; anxiety in the face of the unknown therapy; religiosity or the way to hope. Results show the importance of holistic care to the person experiencing the facts since the subjectivity of care is absorbed by the huge number of rules and institutional norms...

A mulher japonesa vivenciando o câncer cérvico-uterino: um estudo de caso com abordagem da fenomenologia social / A japanese woman going through cervical uterine cancer: a case study with the social phenomenology approach

Trata-se de estudo sobre a experiência de uma mulher japonesa, com câncer cérvico-uterino, realizado em um hospital da cidade de Osaka-Japão, no qual se utilizou o "estudo de caso" com abordagem da Fenomenologia Social de Alfred Schütz. Objetivou-se conhecer o significado da doença e da hospitalização para essa mulher, buscando compreender os motivos que envolvem a sua ação. Por meio da análise dos dados, foi possível compreender que o processo da hospitalização deve ser visto respeitando, além da característica individual, o mundo cultural que nos remete às ações humanas e que exerce influência importante no comportamento e atitude em relação à doença e hospitalização.

Depression before and after uterine cervix and breast cancer neoadjuvant chemotherapy.

Depression in cancer patients is common and may affect treatment outcome either directly (by lowering defenses) or indirectly (by lowering compliance). Neoadjuvant chemotherapy for advanced uterine cervix or breast cancer is a strenuous undertaking and may lead to depression and impair patients' willingness to comply with the rest of the treatment (eg, surgery or radiotherapy). We compare Beck Depression Inventory (BDI) scores both before and after neoadjuvant chemotherapy in order to verify if depression influences treatment outcome. We studied 22 advanced uterine cervix and 20 breast cancer patients submitted to three courses of neoadjuvant chemotherapy. We used cisplatin and ifosfamide for cervix, and fluorouracil, adriamycin, and cyclophosphamide for breast cancer. We did not identify significant differences in the number of depressed patients, before and after treatment. Cognitive affective, somatic-performance, and total BDI scores were not significantly different from before to after chemotherapy for both breast and uterine cervix cancer. After treatment, the number of depressive breast cancer patients increased while the number of uterine cervix cancer patients decreased. This trend to depression was found more often in less responsive breast cancer patients than in the more responsive cervix cancer patients. We were not able to link depression to treatment failure or success, but patients who responded to treatment were less depressed at the end of treatment.

[Knowledge of the motives that lead a woman from Vargem Grande Paulista to undergo a Papanicolaou smear--I]. / Conhecimento dos motivos que levaram a mulher de Vargem Grande Paulista a realizar o Papanicolau--parte I.

In this first approach the authors discusses the state of the Program for Integral Assistance por Woman's Health in São Paulo and emphasize the deficit of information on social epidemiology of women's behaviors related to health practices. They focus on the preventive Pap smear and associate the motives that yeld women of Vargem Grande Paulista to have it made. They analyse this knowledge from criterian proposed by KULBOK for posteriory apply it in practice.