Cancer symptom clusters, cardiovascular risk, and quality of life of patients with cancer undergoing chemotherapy: A longitudinal pilot study.

Patients with cancer undergoing chemotherapy may have different cancer symptom clusters (CSC) that negatively impact their quality of life (QoL). These symptoms can sometimes arise from the disease itself or as a result of their cancer treatment. This study aimed to: examine the feasibility of longitudinal testing of CSC pattern and QoL in a sample of adult cancer patients undergoing outpatient chemotherapy; to identify the cardiovascular risk of patients with cancer undergoing outpatient chemotherapy; and to investigate the most prevalent CSC and their impact on the QoL of these patients. A longitudinal pilot study was conducted with eleven participants with a mean age of 56.09 years (range: 27-79) diagnosed with malignant neoplasm and undergoing outpatient chemotherapy treatment were evaluated during 6 cycles of chemotherapy. The CSC, cardiovascular risk, and QoL were assessed using the MSAS, FRS, and EQ-5D-3L™, respectively. Descriptive statistical and non-parametric bivariate analyses were performed. Patients who started chemotherapy treatment generally had a low to moderate cardiovascular risk and were likely to have a family history of hypertension, acute myocardial infarction, and stroke. Cardiovascular risk was found to be correlated with patient age (Rhos = 0.64; P = .033). In addition, the results showed a reduction in the QoL scoring over the 6 chemotherapy sessions. Regarding the most prevalent CSC, 2 clusters were identified: the neuropsychological symptom cluster (difficulty concentrating-sadness-worry) and the fatigue-difficulty sleeping cluster. Between the first and sixth chemotherapy sessions, there was a decrease in the perception of "mild" severity (P = .004) and an increase in the perception of "severe" and "very severe" (P = .003) for all symptoms. Adequate attention to CSC should be the basis for the accurate planning of effective interventions to manage the symptoms experienced by cancer patients.

Nutritional status of women with non-metastatic breast cancer receiving outpatient chemotherapy.

OBJECTIVES: The aim of this study was to evaluate and compare the nutritional status of women with stage I to III breast cancer in the first and third cycles of outpatient chemotherapy and to identify factors associated with it. METHODS: The prospective longitudinal study was conducted at a Reference Hospital for Cancer Care in Brazil and included women aged ≥18 y diagnosed with stage I to III breast cancer receiving outpatient chemotherapy. Assessments were performed during the 1st and 3rd cycles of chemotherapy, including anthropometric measurements, sociodemographic data, clinical information, and quality of life. Nutritional risk was assessed using the NRS-2002. RESULTS: Overweight was predominant in both chemotherapy cycles. Approximately 6.67% and 10% of patients were at nutritional risk in the 1st and 3rd chemotherapy cycles, respectively. Anxiety/depression was prevalent in the 1st chemotherapy cycle and was significantly associated with nutritional risk (P = 0.002). The variables age in cycle 3 and pain/discomfort in cycle 1 (P = 0.049 and P = 0.043, respectively) showed a significant association with nutritional risk. CONCLUSIONS: This study highlights the complex interaction between nutritional status, neuropsychological symptoms, and sociodemographic characteristics in breast cancer patients during chemotherapy, and underscores the need for personalized interventions to improve oncological care.

Dynamic Changes in Adiponectin and Resistin Drive Remission of Cardiometabolic Risk Biomarkers in Individuals with Obesity Following Bariatric Surgery.

The remission of obesity-related diseases following bariatric surgery appears to result from the reorganization of metabolic and hormonal pathways involving adipokines. This study aimed to investigate the relationship between changes in body adiposity and serum adipokine levels, as well as the association between variations in adiponectin or resistin levels and cardiometabolic risk blood biomarkers before and after Roux-en-Y gastric bypass. A longitudinal and prospective study was conducted with bariatric surgery patients. Anthropometric, body composition and blood biochemical parameters were measured before and at 2 and 6 months post-surgery. The data were analyzed using ANOVA, Pearson or Spearman correlation, and simple linear regression with a significance level of p < 0.05. Among 36 mostly female patients aged 30 to 39 years, significant reductions in body weight (-26.8%), fat mass (-50%), waist circumference (-18%) and waist-to-height ratio (-22%) were observed post-surgery. Serum adiponectin levels increased (+107%), while resistin (-12.2%), TNF-α (-35%), and PAI-1 (-11.1%) decreased. Glucose, insulin, CRP, cholesterol, LDL-c, triglycerides, and vitamin D also decreased. Waist circumference variation showed a positive correlation with PAI-1 and TNF-α and a negative correlation with adiponectin. The total fat mass showed a positive correlation with PAI-1. Adiponectin variation correlated negatively with glucose, resistin, and CRP but positively with HDL-c. Resistin showed a positive correlation with insulin and CRP. In conclusion, 6 months post-bariatric surgery, reducing abdominal adiposity had a more significant impact on serum adipokine levels than total fat mass. Adiponectin increase and resistin decrease acted as endocrine mediators driving the remission of cardiometabolic risk biomarkers in individuals with obesity following Roux-en-Y gastric bypass.

Reduction of vascular reactivity in rat aortas following pilocarpine-induced status epilepticus.

OBJECTIVE: The authors investigated changes in vascular reactivity in rats following pilocarpine-induced status epilepticus. METHOD: Male Wistar rats weighing between 250g and 300g were used. Status epilepticus was induced using 385 mg/kg i.p. pilocarpine. After 40 days the thoracic aorta was dissected and divided into 4 mm rings and the vascular smooth muscle reactivity to phenylephrine was evaluated. RESULTS: Epilepsy decreased the contractile responses of the aortic rings to phenylephrine (0.1 nM-300 mM). To investigate if this reduction was induced by increasing NO production with/or hydrogen peroxide L-NAME and Catalase were used. L-NAME (N-nitro-L arginine methyl ester) increased vascular reactivity but the contractile response to phenylephrine increased in the epileptic group. Catalase administration decreased the contractile responses only in the rings of rats with epilepsy. CONCLUSIONS: Our findings demonstrated for the first time that epilepsy is capable of causing a reduction of vascular reactivity in rat aortas. These results suggest that vascular reactivity reduction is associated with increased production of Nitric Oxide (NO) as an organic attempt to avoid hypertension produced by excessive sympathetic activation.

Reduction of vascular reactivity in rat aortas following pilocarpine-induced status epilepticus

Abstract Objective: The authors investigated changes in vascular reactivity in rats following pilocarpine-induced status epilepticus. Method: Male Wistar rats weighing between 250g and 300g were used. Status epilepticus was induced using 385 mg/kg i.p. pilocarpine. After 40 days the thoracic aorta was dissected and divided into 4 mm rings and the vascular smooth muscle reactivity to phenylephrine was evaluated. Results: Epilepsy decreased the contractile responses of the aortic rings to phenylephrine (0.1 nM-300 mM). To investigate if this reduction was induced by increasing NO production with/or hydrogen peroxide L-NAME and Catalase were used. L-NAME (N-nitro-L arginine methyl ester) increased vascular reactivity but the contractile response to phenylephrine increased in the epileptic group. Catalase administration decreased the contractile responses only in the rings of rats with epilepsy. Conclusions: Our findings demonstrated for the first time that epilepsy is capable of causing a reduction of vascular reactivity in rat aortas. These results suggest that vascular reactivity reduction is associated with increased production of Nitric Oxide (NO) as an organic attempt to avoid hypertension produced by excessive sympathetic activation.

Health Policies for Rare Disease Patients: A Scoping Review.

OBJECTIVE: To identify and map the available evidence on the implementation of public health policies directed at individuals with rare diseases, and to compare the implementation of these health policies between Brazil and other countries. METHOD: A scoping review guided by the PRISMA-ScR and JBI checklists. The search for articles was conducted in eight electronic databases, MEDLINE/Pubmed, Embase, Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, and LILACS, using controlled descriptors, synonyms, and keywords combined with Boolean operators. All steps of this review were independently conducted by two researchers. The selected studies were classified by evidence hierarchy, and a generic quantitative tool was used for the assessment of the studies. RESULTS: A total of 473 studies were identified, of which 13 which met all the inclusion criteria were selected and analyzed. Of these studies, 61.5% (n = 8) had final scores equal to or greater than 70%, i.e., they were classified by this tool as being well-reported. The comparative analysis of international rare diseases demonstrates that public authorities' priorities and recommendations regarding this topic also permeate and apply to the Brazilian context. CONCLUSIONS: The evaluation and monitoring of public policies directed at rare disease patients are urgent and necessary to improve and implement such policies with less bureaucracy and more determination for this unique population that requires timely and high-quality care.

Cancer symptom clusters in adult patients undergoing chemotherapy: A systematic review and meta-analysis protocol.

BACKGROUND: In oncology, the prevalence of symptoms is preferentially analyzed in isolation instead of being considered in clusters. However, clinical practice shows that symptoms rarely occur separately but rather form clusters that share common underlying mechanisms in terms of intensity and severity, creating a synergistic effect among them, which can even help predict the development of future symptoms. OBJECTIVE: To identify and gather evidence on the prevalence, composition, severity, and predictors of cancer symptom clusters in adult cancer patients undergoing chemotherapy. METHODS: This systematic review and meta-analysis protocol was developed in compliance with PRISMA-P. Observational and experimental study designs will be included. MEDLINE/PubMed, Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, Scopus, LILACS, clinical trials.gov-NIH, the British Library, Google Scholar, and preprints [medRXiv] will be searched with no restrictions on idioms, dates, or settings. Two investigators will independently select the studies, perform data extraction, and critically appraise the risk of bias of the included studies. Heterogeneity among the studies will be assessed using the I2 statistic. If meta-analysis was feasible, a random-effect model analysis will be carried out. For data analysis, the pooled effect will be estimated considering 95% confidence interval and α = 5%. In addition, the certainty of evidence will be rated based on Cochrane methods in accordance with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). DISCUSSION: To the best of our knowledge, this systematic review and meta-analysis will be the first to identify and critically assess evidence regarding the prevalence, composition, severity, and predictors of cancer symptom clusters in adult cancer patients undergoing chemotherapy. We intend to provide health professionals with subsidies to reflect on a better understanding of symptom clusters in adult cancer patients, with the aim of contributing to the development of evidence-based therapeutic interventions and success in clinical practice. PROSPERO REGISTRATION NUMBER: CRD42021248406.

Use of family history taking for hereditary neoplastic syndromes screening in primary health care: A systematic review protocol.

BACKGROUND: Although most neoplasms result from complex interactions between the individual's genome and the environment, a percentage of cases is particularly due to inherited alterations that confer a greater predisposition to the development of tumors. Hereditary Neoplastic Syndromes have a high psychosocial and economic burden, in addition to being characterized by an increased risk for one or more types of cancer, onset of malignancy at a young age, high risk of secondary malignancies, and occurrence in successive generations of the family. Personal and family history, as well as pedigree, may be useful resources to estimate the risk for developing cancer, especially in Primary Health Care settings. OBJECTIVE: To identify and evaluate the evidence regarding the impact of using family history as a genomic technology for Hereditary Neoplastic Syndromes screening at Primary Health Care. METHODS: This systematic review protocol was elaborated in compliance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will include all observational as well as experimental study designs published up to end of July 2022, and studies covering the impact of family history on screening for Hereditary Neoplastic Syndromes in primary health care. Qualitative studies, as well as guidelines, reviews, and studies undertaken in hospitals, outpatient clinic, or medical environments will be excluded. Five databases will be searched, including MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, and LILACS. Additional sources will also be retrieved, including Clinical trials.gov-NIH, The British Library, and Google Scholar. No restriction to language or date will be employed in the search strategy. Three investigators will select studies independently, perform data extraction, and conduct the critical appraisal of the risk of bias and overall quality of the selected studies according to their designs. Regarding data synthesis, the study characteristics will be summarized and presented in tables and results will be presented according to the study design. A qualitative synthesis of data will also be provided in this systematic review. DISCUSSION: To the best of our knowledge, this systematic review will be the first to identify and critically assess evidence regarding the impact of using family history as a genomic technology for Hereditary Neoplastic Syndromes screening in Primary Health Care settings worldwide. This study is expected to provide consistent evidence that will aid the primary care decision-makers regarding hereditary cancer screening, thus helping individuals and families at risk for cancer. PROSPERO REGISTRATION NUMBER: CRD42020166211.

Efficacy of the complementary therapies in the management of cancer pain in palliative care: A systematic review.

OBJECTIVE: to synthesize the knowledge and to critically evaluate the evidences arising from randomized controlled trials on the efficacy of the complementary therapies in the management of cancer pain in adult patients with cancer in palliative care. METHOD: a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search for articles in the MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane, and PsycINFO databases, as well as the manual search, selection of studies, data extraction, and methodological assessment using the Cochrane Bias Risk tool were performed independently by two reviewers. RESULTS: eight hundred and fifteen (815) studies were identified, six of them being selected and analyzed, of which three used massage therapy, one study used a combination of progressive muscle relaxation and guided imaging, and another two studies used acupuncture. Most of the studies had an uncertain risk of bias (n=4; 67%). CONCLUSION: while the evidence from the studies evaluating the use of massage therapy or the use of progressive muscle relaxation and guided imaging for the management of cancer pain in these patients demonstrated significant benefits, the other two studies that evaluated the use of acupuncture as a complementary therapy showed contradictory results, therefore, needing more research studies to elucidate such findings.

Efficacy of the complementary therapies in the management of cancer pain in palliative care: A systematic review / Eficácia das terapias complementares no manejo da dor oncológica em cuidados paliativos: revisão sistemática / Eficacia de las terapias complementarias en el manejo del dolor oncológico en los cuidados paliativos: revisión sistemática

Objective: to synthesize the knowledge and to critically evaluate the evidences arising from randomized controlled trials on the efficacy of the complementary therapies in the management of cancer pain in adult patients with cancer in palliative care. Method: a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search for articles in the MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane, and PsycINFO databases, as well as the manual search, selection of studies, data extraction, and methodological assessment using the Cochrane Bias Risk tool were performed independently by two reviewers. Results: eight hundred and fifteen (815) studies were identified, six of them being selected and analyzed, of which three used massage therapy, one study used a combination of progressive muscle relaxation and guided imaging, and another two studies used acupuncture. Most of the studies had an uncertain risk of bias (n=4; 67%). Conclusion: while the evidence from the studies evaluating the use of massage therapy or the use of progressive muscle relaxation and guided imaging for the management of cancer pain in these patients demonstrated significant benefits, the other two studies that evaluated the use of acupuncture as a complementary therapy showed contradictory results, therefore, needing more research studies to elucidate such findings.

Objetivo: sintetizar o conhecimento e avaliar criticamente as evidências provenientes de ensaios clínicos controlados randomizados sobre a eficácia das terapias complementares no manejo da dor oncológica em pacientes adultos com câncer em cuidados paliativos. Método: revisão sistemática guiada pelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A busca dos artigos nas bases de dados MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane e PsycINFO, bem como a busca manual, seleção dos estudos, extração dos dados e avaliação metodológica pela ferramenta do Risco de Viés da Cochrane foram realizadas por dois revisores de forma independente. Resultados: foram identificados 815 estudos, sendo seis selecionados e analisados, dos quais três utilizaram a massagem terapêutica, um estudo usou uma combinação de relaxamento muscular progressivo e imagem guiada, e outros dois estudos a acupuntura. A maioria dos estudos apresentou risco de viés incerto (n=4; 67%). Conclusão: enquanto as evidências dos estudos que avaliaram o uso da massagem terapêutica ou o uso de relaxamento muscular progressivo e imagem guiada para manejo da dor oncológica nesses pacientes mostraram benefícios significativos, os outros dois estudos que avaliaram o uso da acupuntura como terapia complementar exibiram resultados divergentes, necessitando, portanto, de mais pesquisas para elucidar tais achados.

Objetivo: sintetizar conocimiento y realizar el análisis crítico de las evidencias procedentes de ensayos clínicos controlados aleatorios sobre la eficacia de las terapias complementarias en el manejo del dolor oncológico en pacientes adultos con cáncer en cuidados paliativos. Método: revisión sistemática guiada por el Preferred Reporting Items for Systematic Reviews and Meta-Analyses. La búsqueda de artículos en las bases de datos MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane y PsycINFO, así como la búsqueda manual, selección de estudios, extracción de datos y evaluación metodológica con la utilización de la herramienta Riesgo de Sesgo de Cochrane se realizaron por dos revisores de forma independiente. Resultados: se identificaron 815 estudios, de los cuales, seis fueron seleccionados y analizados, siendo que tres utilizaron masaje terapéutico, un estudio utilizó una combinación de relajación muscular progresiva e imagen guiada, y otros dos estudios la acupuntura. La mayor parte de los estudios presentaron riesgo de sesgo incierto (n=4; 67%) Conclusión: mientras las evidencias de los estudios que evalúan el uso de la del masaje terapéutico o el uso de la relajación muscular progresiva y las imágenes guiadas para el manejo del dolor oncológico en estos pacientes demostraron beneficios significativos, los otros dos estudios que evaluaron el uso de la acupuntura como terapia complementaria mostraron resultados divergentes, razón por la cual se requiere de más investigación para dilucidar tales hallazgos.

Acute copper overload induces vascular dysfunction in aortic rings due to endothelial oxidative stress and increased nitric oxide production.

The mechanisms involved in vascular reactivity alterations promoted by copper (Cu) overload were investigated. Thoracic aorta obtained from male Wistar rats were cut into rings and exposed for 1 h to 10 µg/ml Cu. Exposure to Cu decreased the contractile responses of aortic rings to phenylephrine (PHE). Removal of endothelium and subsequent administration of N-nitro-L arginine methyl ester (L-NAME), tetrahydrobiopterin, aminoguanidine, diethyldithiocarbamic acid, catalase, or tetraethylammonium increased contractile responses. Incubation with apocinyn and tiron enhanced the sensitivity to PHE. Data demonstrated that high concentrations of Cu reduced PHE-mediated vascular reactivity which was associated with elevated production of nitric oxide (NO), which was attributed to activation of inducible NO synthase, and elevated levels of hydrogen peroxide probably related to a rise in superoxide dismutase activity and reactive oxygen species generation.

Intervenção educativa de enfermagem ao cliente submetido à cirurgia cardíaca / Intervención educativa de enfermería al cliente sometido a la cirugía cardiaca / Nursing educational intervention to the client subjected to cardiac surgery

Objetivo analisar se um programa educativo de enfermagem favorece o conhecimento e orienta as condutas adotadas pelos clientes no pós-operatório de cirurgia cardíaca. Método estudo de intervenção realizado com 51 pacientes. A coleta de dados foi realizada através da aplicação de um formulário estruturado. Análise estatística: foram usados os testes qui-quadrado, exato de Fisher, Mann-Whitney ou coeficiente de correlação de Spearman, quando apropriados. Resultados o programa educativo foi considerado importante para garantir tranquilidade, adesão ao tratamento e auxílio na recuperação. Entretanto, os clientes apresentaram compreensão limitada quanto a alguns procedimentos comuns do pós-operatório. As respostas inadequadas foram relacionadas à baixa escolaridade (p < 0,05). Houve correlação moderada e negativa (ρ = −0,314; p < 0,05) entre a coerência das respostas e o tempo entre a orientação e a cirurgia. Conclusão o programa educativo favoreceu o conhecimento e orientou as condutas adotadas pelos clientes na fase pós-operatória.

Objetivo analisar se um programa educativo de enfermagem favorece o conhecimento e orienta as condutas adotadas pelos clientes no pós-operatório de cirurgia cardíaca. Método estudo de intervenção realizado com 51 pacientes. A coleta de dados foi realizada através da aplicação de um formulário estruturado. Análise estatística: foram usados os testes qui-quadrado, exato de Fisher, Mann-Whitney ou coeficiente de correlação de Spearman, quando apropriados. Resultados o programa educativo foi considerado importante para garantir tranquilidade, adesão ao tratamento e auxílio na recuperação. Entretanto, os clientes apresentaram compreensão limitada quanto a alguns procedimentos comuns do pós-operatório. As respostas inadequadas foram relacionadas à baixa escolaridade (p < 0,05). Houve correlação moderada e negativa (ρ = −0,314; p < 0,05) entre a coerência das respostas e o tempo entre a orientação e a cirurgia. Conclusão o programa educativo favoreceu o conhecimento e orientou as condutas adotadas pelos clientes na fase pós-operatória.

Objective to analyze if a nursing educational program favors knowledge and guides the adopted conduct by clients in the cardiac surgery postoperative. Method intervention study carried out with 51 patients. Data collection was done by applying a structured form. Statistical analysis: chi-squared test, Fisher's exact test, Mann-Whitney or Spearman's correlation coefficient, when appropriate. Results nursing educational program was considered important to ensure tranquility, treatment adherence and recovery support. However, clients presented limited comprehension regarding some regular postoperative procedures. Inadequate answers were associated to low education (p < 0.05). There was moderate and negative correlation (ρ = −0.314; p < 0.05) between answer coherence and time within guidance and surgery. Conclusion the educational program favor the knowledge and guided the adopted conducts by the clients in postoperative phase.

Chronic lead exposure decreases the vascular reactivity of rat aortas: the role of hydrogen peroxide.

We investigated whether exposure to small concentrations of lead alters blood pressure and vascular reactivity. Male Wistar rats were sorted randomly into the following two groups: control (Ct) and treatment with 100 ppm of lead (Pb), which was added to drinking water, for 30 days. Systolic blood pressure (BP) was measured weekly. Following treatment, aortic ring vascular reactivity was assessed. Tissue samples were properly stored for further biochemical investigation. The lead concentration in the blood reached approximately 8 µg/dL. Treatment increased blood pressure and decreased the contractile responses of the aortic rings to phenylephrine (1 nM-100 mM). Following N-nitro-L arginine methyl ester (L-NAME) administration, contractile responses increased in both groups but did not differ significantly between them. Lead effects on Rmax were decreased compared to control subjects following superoxide dismutase (SOD) administration. Catalase, diethyldithiocarbamic acid (DETCA), and apocynin increased the vasoconstrictor response induced by phenylephrine in the aortas of lead-treated rats but did not increase the vasoconstrictor response in the aortas of untreated rats. Tetraethylammonium (TEA) potentiated the vasoconstrictor response induced by phenylephrine in aortic segments in both groups, but these effects were greater in lead-treated rats. The co-incubation of TEA and catalase abolished the vasodilatory effect noted in the lead group. The present study is the first to demonstrate that blood lead concentrations well below the values established by international legislation increased blood pressure and decreased phenylephrine-induced vascular reactivity. The latter effect was associated with oxidative stress, specifically oxidative stress induced via increases in hydrogen peroxide levels and the subsequent effects of hydrogen peroxide on potassium channels.