Hope and depression in Brazilian head and neck cancer patients during the COVID-19 pandemic.

Introduction: Head and neck cancer is characterised as traumatic, when compared to other types of cancer, due to the physical, physiological and social impact it has on the patient. Objective: To evaluate hope and severe depression in patients with head and neck cancer during the COVID-19 pandemic. Method: Quantitative, observational, and analytical; conducted in the outpatient department of the head and neck department of an oncological hospital in the city of Curitiba, Paraná, Brazil, with 60 patients with head and neck cancer being treated with chemotherapy and radiotherapy. Data collection took place between May and September 2020, with the application of three questionnaires: socio-demographic and clinical; Patient Health Questionnaire-9 (PHQ-9), to evaluate severe depression; and the Herth hope scale. Data analysis was through descriptive statistics and non-parametric Mann- Whitney, Kruskal-Wallis and Spearman correlation tests. Results: The age of participants ranged from 34 to 85 years, with 61.7% being male. The diagnosis of cancer occurred in the oral cavity (53.3%) and larynx (33.3%); 28.3% (n = 1 7) presented with a diagnosis of depression; 8.6% (n = 5) are in treatment with psychology; and 10.3% (n = 6) are in treatment with psychotropic drugs. The analysis of the association of the PHQ-9 score with sex showed a mean score of 7.7 ± 6.2, with a higher level of depression in women. The mean hope score was 41.3 ± 3.1; however, during the pandemic, 35% (n = 21) reported feelings of anguish, anxiety and fear, with the latter being predominant and in association with the PHQ-9 score showing a mean of 8.2 ± 6.2 (p = 0.123). The association of hope with the number of children was statistically significant (p = 0.034) and in the education variable with the PHQ-9 score (p = 0.019). Conclusion: The use of tools that assess both levels of hope and depression in patients undergoing chemotherapy and radiotherapy provides health professionals with support for the implementation of targeted actions to cope with the disease.

Significados da morte para adultos com câncer assistidos em um hospital oncológico do Brasil / Meanings of death for adults with cancer assisted in an oncological hospital in Brazil

Resumo Objetivo: Conhecer os significados da morte para adultos com câncer hospitalizados. Metodologia: Estudo qualitativo, descritivo, realizado com 27 pacientes em um hospital oncológico do Brasil. Os dados foram coletados no período de dezembro de 2019 a março de 2020, com dois instrumentos: perfil sociodemográfico e clínico do participante e roteiro de entrevista semiestruturada. Utilizou-se o método de análise de conteúdo de Creswell, após classificação dos dados por meio do software Iramuteq. Resultados: Emergiram seis classes, reagrupadas por conteúdo similar, que compuseram quatro categorias: a morte como mudança de vida e passagem; quando a morte é melhor que o sofrimento; a expectativa na intervenção divina; e a morte negada e distanciada. Conclusão: O significado da morte transita num processo de passagem, mudança de vida, que causa medo, insegurança e tem em Deus o suporte para o enfrentamento do adoecimento e do agravamento da doença; no cotidiano hospitalar, aproxima de sua experiência existencial.

Resumen Objetivo: Conocer el significado de la muerte para personas adultas con cáncer hospitalizadas. Método: Estudio cualitativo, descriptivo, realizado con 27 personas de un Hospital de Oncología de Brasil. Los datos fueron recolectados desde diciembre de 2019 a marzo de 2020, utilizando dos instrumentos: perfil sociodemográfico y clínico del participante y guion para entrevistas semiestructuradas. Se utilizó el método de análisis de contenido de Creswell, previa clasificación de los datos, mediante el software Iramuteq. Resultado: Emergieron seis clases, agrupadas por contenidos similares que conformaron cuatro categorías: muerte como cambio de vida y paso; cuando la muerte es mejor que el sufrimiento; la expectativa de la intervención divina y muerte negada y distanciada. Conclusión: El significado de la muerte pasa de un proceso pasajero, de un cambio de vida, que causa miedo e inseguridad. La persona tiene en Dios el apoyo para afrontar la enfermedad y su agravamiento, además, la rutina del hospital le acerca a su experiencia existencial.

Abstract Objective: To know the meaning of death for hospitalized cancer adults. Method: This is a qualitative, descriptive study carried out with 27 patients at an Oncology Hospital in Brazil. The data were collected from December 2019 to March 2020 using two instruments: the sociodemographic and clinical profile of the participant, and a script for semi-structured interviews. Creswell's content analysis method was used after classifying the data using the Iramuteq software. Results: Six classes emerged and were grouped by similar content, which made up four categories: death as a change of life and passage, death is better than suffering, the expectation of divine intervention, and death denied and distanced. Conclusion: The meaning of death moves from a passing process and a change in life to the origin of fear and insecurity. Patients have in God the support to face their illnesses and the worsening of the disease. In the hospital routine, death brings them closer to their existential experience.

Significados da morte para adultos com câncer assistidos em um hospital oncológico do Brasil

Objetivo: Conhecer os significados da morte para adultos com câncer hospitalizados. Metodologia: Estudo qualitativo, descritivo, realizado com 27 pacientes em um hospital oncológico do Brasil. Os dados foram coletados no período de dezembro de 2019 a março de 2020, com dois instrumentos: perfil sociodemográfico e clínico do participante e roteiro de entrevista semiestruturada. Utilizou-se o método de análise de conteúdo de Creswell, após classificação dos dados por meio do software Iramuteq. Resultados: Emergiram seis classes, reagrupadas por conteúdo similar, que compuseram quatro categorias: a morte como mudança de vida e passagem; quando a morte é melhor que o sofrimento; a expectativa na intervenção divina; e a morte negada e distanciada. Conclusão: O significado da morte transita num processo de passagem, mudança de vida, que causa medo, insegurança e tem em Deus o suporte para o enfrentamento do adoecimento e do agravamento da doença; no cotidiano hospitalar, aproxima de sua experiência existencial.

Objetivo: Conocer el significado de la muerte para personas adultas con cáncer hospitalizadas. Método: Estudio cualitativo, descriptivo, realizado con 27 personas de un Hospital de Oncología de Brasil. Los datos fueron recolectados desde diciembre de 2019 a marzo de 2020, utilizando dos instrumentos: perfil sociodemográfico y clínico del participante y guion para entrevistas semiestructuradas. Se utilizó el método de análisis de contenido de Creswell, previa clasificación de los datos, mediante el software Iramuteq. Resultado: Emergieron seis clases, agrupadas por contenidos similares que conformaron cuatro categorías: muerte como cambio de vida y paso; cuando la muerte es mejor que el sufrimiento; la expectativa de la intervención divina y muerte negada y distanciada. Conclusión: El significado de la muerte pasa de un proceso pasajero, de un cambio de vida, que causa miedo e inseguridad. La persona tiene en Dios el apoyo para afrontar la enfermedad y su agravamiento, además, la rutina del hospital le acerca a su experiencia existencial.

Objective: To know the meaning of death for hospitalized cancer adults. Method: This is a qualitative, descriptive study carried out with 27 patients at an Oncology Hospital in Brazil. The data were collected from December 2019 to March 2020 using two instruments: the sociodemographic and clinical profile of the participant, and a script for semi-structured interviews. Creswell's content analysis method was used after classifying the data using the Iramuteq software. Results: Six classes emerged and were grouped by similar content, which made up four categories: death as a change of life and passage, death is better than suffering, the expectation of divine intervention, and death denied and distanced. Conclusion: The meaning of death moves from a passing process and a change in life to the origin of fear and insecurity. Patients have in God the support to face their illnesses and the worsening of the disease. In the hospital routine, death brings them closer to their existential experience.

Death in the Hospital: The Witnessing of the Patient with Cancer.

OBJECTIVES: The aim of the study was to know the witnessing of death from the perspective of the cancer patient in the hospital environment. MATERIALS AND METHODS: This is a qualitative and descriptive study, which was carried out in a cancer hospital in southern Brazil, with 27 cancer patients, through semi-structured interview, after the institutional research ethics committee approval. For categorisation and data analysis, Iramuteq software and Creswell content analysis were used. RESULTS: Six classes emerged from the Iramuteq software and four categories were formed: (1) The reflection of the other itself; (2) feelings and emotions aroused; (3) the witnessing of a peaceful death and (4) death as a habitual event. CONCLUSION: Patients felt sad and distressed, and some perceived death as something natural, often necessary for the relief of suffering. They put themselves in the place of the dying patient and their family members, imagining their loved ones and the suffering they would experience. Participants considered peaceful deaths to be good, unlike those in which patients had some kind of discomfort, described as horrible, distressing, sad and bad.

Esperança e depressão em pacientes com câncer de cabeça e pescoço / Hope and depression in patients with head and neck câncer

Resumo: O objetivo deste trabalho foi avaliar a esperança e a depressão maior em pacientes com câncer de cabeça e pescoço em tratamento quimioterápico e/ou radioterápico. Trata-se de um estudo de natureza quantitativa, do tipo observacional e analítico, vinculado a um projeto maior denominado: construindo processos de cuidado na interface do cuidar em situações de enfermidade grave, da linha de pesquisa de Processo de Cuidar em Saúde e Enfermagem, conduzido no ambulatório do Serviço de Cabeça e Pescoço, de um hospital oncológico situado na cidade de Curitiba, Paraná, Brasil. A amostra por conveniência foi composta por 60 pacientes com câncer de cabeça e pescoço em tratamento quimioterápico e/ou radioterápico. A coleta de dados ocorreu entre maio e setembro de 2020, com a aplicação de questionário sociodemográfico e clínico elaborado pela autora, Patient Health Questionnaire-9, para avaliar a depressão maior e a Escala de Esperança de Hert. Utilizou-se para analisar os dados a estatística descritiva, teste não paramétrico de Mann-Whitney, Kruskal-Wallis e a Correlação de Spearman. Os resultados mostraram que 61,7% dos pacientes eram do sexo masculino, com idade variando de 34 a 80 anos; diagnóstico de câncer localizado na cavidade oral (53,3%), laringe (33,3%), orofaringe (5,0%) orofaringe e nasofaringe (8,3%); 28,3% relataram ter histórico de depressão. Na análise de correlação dos escores do Patient Health Questionnaire-9 com o sexo, obteve-se média de 7,7±6,2 com nível maior de depressão nas mulheres do que nos homens. A média do escore de esperança no sexo masculino foi de 41,6±2,4 e no sexo feminino 40,8±4,0, não apresentando significância estatística nesta correlação (p=0,662). Entretanto, durante a pandemia, 35% (n=21) dos participantes manifestaram sentimentos de angústia, ansiedade e medo, sendo este último predominante; ao associar o escore do Patient Health Questionnaire-9 com estes sentimentos, obteve-se média de 8,2±6,2 (p= 0,123). Houve significância estatística entre esperança e o número de filhos (p=0,034), verificou-se que os participantes com três filhos ou mais, obtiveram maior escore de esperança. Na associação das variáveis escolaridade com o escore do Patient Health Questionnaire-9, observou-se que a maior depressão estava presente nos participantes com maior nível de escolaridade, obtendo o valor de significância de p= 0,019. Conclui-se que a utilização de ferramentas que mensurem os níveis de esperança do paciente em tratamento quimioterápico e/ou radioterápico, fornecem as profissionais de saúde suporte para a implementação de ações direcionadas para o enfrentamento da doença e minimização de sintomas depressivos dessa população.

Abstract: The objective of this study was to evaluate hope and major depression in patients with head and neck cancer undergoing chemotherapy and/or radiation therapy. This is a quantitative, observational and analytical study, linked to a larger project called: building care processes at the interface of care in situations of serious illness, from the research line of the Care Process in Health and Nursing, conducted at the Head and Neck Service outpatient clinic of an oncology hospital located in the city of Curitiba, Paraná, Brazil. The convenience sample consisted of 60 patients with head and neck cancer undergoing chemotherapy and / or radiotherapy. Data collection took place between May and September 2020, with the application of a sociodemographic and clinical questionnaire prepared by the author, Patient Health Questionnaire-9, to assess major depression and the Hert Hope Scale. Descriptive statistics, non-parametric Mann-Whitney test, Kruskal-Wallis and Spearman's correlation were used to analyze the data. The results showed that 61.7% of the patients were male, with ages varying from 34 to 80 years old; diagnosis of cancer located in the oral cavity (53.3%), larynx (33.3%), oropharynx (5.0%) oropharynx and nasopharynx (8.3%); 28.3% reported having a history of depression. In the correlation analysis of the Patient Health Questionnaire-9 scores with sex, an average of 7.7 ± 6.2 was obtained with a higher level of depression in women than in men. The average hope score in males was 41.6 ± 2.4 and in females 40.8 ± 4.0, with no statistical significance in this correlation (p = 0.662). However, during the pandemic, 35% (n = 21) of the participants expressed feelings of anguish, anxiety and fear, being fear one of the predominant feelings expressed when associating the score of the patient health questionnaire-9; Obtaining an average of 8.2 + 6.2 (p= 0.123). There was statistical significance between hope and the number of children (p = 0.034), it was found that the participants with three children or more, obtained a higher hope score. In the association of the education variables with the score of the Patient Health Questionnaire-9,it was observed that larger sings of depresion were found in the participants with a higher level of education, obtaining the significant value of p = 0.019. It is concluded that the use of tools that measure the patient's hope levels in chemotherapy and / or radiotherapy treatment, provide health professionals with support for the implementation of actions aimed at coping with the disease and minimizing depressive symptoms in this population.