Preparación psicológica para radioterapia en paciente con tumor en SNC: presentación de un caso / Psychological preparation for radiotherapy on a patient with a brain tumor: case report

Introducción: los meningiomas forman el 27% de los tumores de encéfalo en población adulta. La radioterapia es uno de los tratamientos para tumores primarios del SNC más efectivos, en el cual se administran altas dosis de radiación que destruye el ADN de las células cancerosas para detener su multiplicación o lentificar su crecimiento. Para este tratamiento es necesaria la inmovilización del paciente, que se asegura por medio de máscaras termoplásticas que fijan al paciente a la camilla del acelerador lineal. Este tipo de inmovilización ha representado una incidencia de ansiedad significativa previa al tratamiento y durante el mismo, puede causar niveles altos de estrés, miedo, malestar físico, dolor e incluso claustrofobia. Tomando en cuenta estos aspectos, como preparación psicológica para el tratamiento se sugiere ofrecer información clara previa y durante la simulación, identificar a los pacientes con niveles altos de ansiedad, y brindar estrategias cognitivas y conductuales para regular la misma. Objetivo: Describir un reporte de caso de preparación para radioterapia en SNC. Método: Se presenta el caso de una mujer de 61 años de edad que fue referida a psico-oncología con el objetivo de la preparación psicológica para radioterapia en SNC. El motivo de la referencia a psico-oncología fue evitar la sedación durante la radioterapia debido a los altos niveles de ansiedad que presentaba la paciente. Se realizaron dos sesiones de preparación psicológica en donde se incluyeron estrategias psicoeducativas, de desensibilización sistemática y respiración diafragmática. Resultados: La paciente disminuyó el reporte subjetivo de ansiedad, logró terminar las 25 sesiones de radioterapia sin necesidad de sedación. Conclusión: La preparación psicológica utilizada en esta paciente fue efectiva para disminuir ansiedad. Es importante realizar estudios aleatorizados y controlados para conocer realmente la efectividad.(AU)

Introduction:Meningiomas represent 27% of brain tumors in adults. Radiotherapy is one of the most frequent treatments for CNS tumors, in which high radiation doses destroy cancer cell’s DNA in order to stop their multiplication or to slow their growth. Patient’s inmovilization is necessary in this treatment, so he has to be attached to treatment bed with a thermogenic mask. This inmovilization has represented significant anxiety prior and during treatment, it can also represent a trigger for stress, fears, physical symptoms, pain and even claustrophobia. Considering this, a psychological preparation is suggested before radiotherapy. It is suggested o include clear information before and during simulation, and to identify patients with high levels of anxiety, and to deliver cognitive and behavioral strategies to regulate it. Aim: to describe a case report of a psychological preparation for CNS radiotherapy. Method: A case of a 61 year old woman who was referred to psycho-oncology service with the aim of psychological preparation for CNS radiation. The reason this patient was referred was to avoid sedation during treatment due to high levels of anxiety. Psychologic preparation consisted in two sessions that included psychoeducational, systematic desensibilization and diaphragmatic breathing strategies. Results: Subjective anxiety report was reduced with psychologic preparation, and the patient finished 25 sessions of radiotherapy without sedation. Conclusion: Psychological preparation in this patient was efective in anxiety reduction. It is important to design randomized controled studies in order to know the effectiveness of these strategies.(AU)

Assessing the implementation of a comprehensive quality management system for cross-sectoral psycho-oncology in Germany.

INTRODUCTION: Quality management in healthcare is essential for safe, effective, and patient-centered services. Quality management systems (QMS) monitor and improve healthcare quality. Integrating QMS is crucial for optimal quality of care, but previous studies show gaps in integration. This study aims to assess program adherence to a QMS in cross-sectoral psycho-oncological care and to develop strategies for better integration, ultimately improving healthcare quality. MATERIALS AND METHODS: The study used a utility analysis to assess the program adherence of a cross-sectoral psycho-oncology care program using a 5-point scale. The evaluation process involved breaking down the program into distinct areas, and used key figures and developed indicators to assess adherence. Descriptive statistics were used. RESULTS: The study conducted a comprehensive assessment of program adherence in a complex care program, analysing 4460 evaluation cases based on 128 quality indicators. The results showed a score of 4.2 out of 5 points (84%), indicating a highly effective implementation of the QMS. Notably, the study observed successful implementation of top-down elements, while encountering more challenges in integrating bottom-up aspects. CONCLUSION: The study demonstrates effective implementation of a comprehensive QMS. Successful integration was observed in areas such as care concept, care management, quality assurance, and IT-based documentation, while challenges remain in quality development and indicators. Active leadership involvement, staff training, data collection, and a learning culture are essential for successful implementation. Future research should assess the impact and cost-effectiveness of QMSs and develop tailored approaches to sustain healthcare professionals' motivation in quality improvement efforts.

Malestar psicológico y preocupaciones psicosociales durante la tercera ola de la pandemia en pacientes oncológicos y familiares: Un análisis exploratorio / Distress and pychosocial concers during the third wave of the pandemic among oncological patients and family caregivers: an exploratory análisis

Objetivo: Describir el malestar psicológico y las preocupaciones psicosociales durante la tercera ola de la pandemia de los pacientes oncológicos y sus familiares y analizar la evolución de estas variables teniendo como referencia los meses de abril y diciembre de 2020. Método. Se utilizó un cuestionario autoadministrado que estaba compuesto por ítems elaborados ad hoc para evaluar las características sociodemográficas y las preocupaciones psicosociales y la escala Kessler K-6 para evaluar el malestar psicológico. Resultados. La proporción de pacientes y familiares que presentaban niveles clínicos de malestar era mayor que la de la población general. El porcentaje de personas con cáncer que mostraba malestar psicológico en niveles clínicos se incrementó significativamente durante el mes de diciembre de 2020, en comparación con el mes de abril. Este aumento fue especialmente significativo entre las mujeres y los pacientes más jóvenes, siendo también estas poblaciones las más afectadas en el primer momento de medida. Las preocupaciones más frecuentes en la población oncológica (pacientes y familiares) durante el mes de diciembre de 2020 fueron: el miedo a contraer la COVID-19, la inquietud y el miedo al futuro, la suspensión de los contactos y la ausencia del contacto cara a cara y la inactividad en las calles y comercios. Conclusiones. Los resultados de este estudio destacan la necesidad de desarrollar intervenciones específicas que permitan cubrir las secuelas psicológicas y las preocupaciones psicosociales derivadas de la COVID-19 en los pacientes oncológicos y sus familiares (AU)

Aim: Describe the psychological distress and the psychosocial concerns during the third wave of the pandemic in oncological patients and family caregivers and analyze the evolution of these variables in cancer patients taking as references April and December of 2020. Method. The researchers developed a self-administered questionnaire. It was composed by items developed ad hoc to assess sociodemographic characteristics and social concerns and the Kessler K-6 scale to measure psychological distress. Results.The proportion of oncological patients and family caregivers who showed clinical levels of distress was higher than that the ones of non-oncological population during December 2020. Clinical distress was higher in oncological patients during the December 2020, compared to April levels. This increase was especially significant among women and younger patients in both assessment moments. The main social concerns at the third wave for oncological patients and family caregivers were: the fear of contracting COVID-19, restlessness and fear of the future, suspension of the social contacts, the absence of face-to-face contact and inactivity in the streets and shops. Conclusions.The results of this study highlight the need to provide the proper care to oncological patients and family caregivers due to the presence of socio-emotional needs, and to develop strategies that allow them to be covered from psychological impact of COVID-19 (AU)

How physicians respond to the emotional expressions of people with cancer / Cómo responden los médicos a las expresiones emocionales de las personas con cancer

The aim of this study is to examine patient emotional cues to oncologists’ responses and explore the association between the concerns and emotional cues during the consultation and the physicians’ response to them throughout treatment, satisfaction, and the assessment of the patients’ perception of the established communication. Method: Cross-sectional design, involved 12 adults patients undergoing cancer treatment and eight physicians in the study. The twelve video-recorded medical consultations were coded (349 cues/concern) using the Verona coding definitions of emotional sequences (VR-CoDES). Results: A strong association between explicit with reducing space responses and the physiological symptoms cues (x²=6.029; p=0.014), and related to the repetition cue of the content by the patient (x²=5.599; p=0.018) was observed. Patients expressed fewer non-verbal behaviors (for example, crying, silence, silent pauses), as they had been undergoing treatment for a longer time, therefore, provided with more empathic responses from physicians. Conclusion: The identification of emotions can help physicians to further explore patients’ underlying cues that reveal emotional distress concerning illness and treatment in a less explicit way. There is a need for improvement in the physician’s ability to recognize patients’ concerns and to provide space for patients to have comprehensive health care, considering the severity of cancer disease and its negative emotional impacts for patients (AU)

El objetivo de este estudio es examinar cómo los oncólogos responden a las preocupaciones emocionales de las personas con cáncer durante el tratamiento, relacionarlas con la satisfacción y evaluar las percepciones de comunicación de los pacientes. Diseño transversal, en el que participaron 12 pacientes adultos en tratamiento oncológico y ocho médicos en el estudio. Las doce consultas médicas grabadas en vídeo se codificaron (349 pistas/inquietudes) utilizando las definiciones de codificación de secuencias emocionales de Verona (VR-CoDES). Hubo fuerte asociación entre respuestas explícitas con reducción de espacio y claves de síntomas fisiológicos (x²=6,029; p=0,014), y relacionada con la repetición de claves de contenido por parte del paciente (x²=5,599; p=0,018). Los pacientes expresaron menos comportamientos no verbales (por ejemplo, llanto, silencio, pausas silenciosas) ya que habían estado en tratamiento por más tiempo y, por lo tanto, tenían respuestas más empáticas por parte de los médicos. La identificación de las emociones puede ayudar a los médicos a explorar más a fondo las pistas subyacentes de los pacientes que revelan angustia emocional por la enfermedad y el tratamiento de una manera menos abierta. Existe la necesidad de mejorar la capacidad del médico para reconocer las preocupaciones de los pacientes y hacer espacio para que los pacientes tengan una atención integral en salud, considerando la gravedad de la enfermedad oncológica y sus impactos emocionales negativos para los pacientes (AU)

Necesidad de intervención psicosocial en un menor no acompañadodiagnosticado de linfoma: a propósito de un caso / Need for psychosocial intervention in an unaccompanied minor diagnosed with lymphoma: A case report

Objetivo: Caso de un menor no acompañado que tras su llegada a España, le es diagnosticado un linfoma y como es necesaria una intervención a nivel psicosocial, para garantizar primero la cobertura de necesidades básicas para después abordar toda la sintomatología psicológica propia de su situación. Método: Una intervención por parte del área de Trabajo Social y Psicooncología para el manejo de toda la problemática asociada a la situación de migrante y adaptación al proceso oncológico. Resultado: Se inicia la cobertura de necesidades básicas (alojamiento y alimentación) y garantizar el acceso a los servicios sociosanitarios, para luego proceder a intervenir a nivel psicológico. Se consigue la reducción de la sintomatología ansiosa, gestionando la ideación suicida y la reducción de pensamientos negativos y depresivos, mejorando la gestión emocional y potenciando el autocontrol, así como una mejor adaptación a la situación de enfermedad. Conclusión: El abordaje psicosocial se convierte en una herramienta indispensable para la intervención en personas que se encuentras en una situación de extrema vulnerabilidad social, que son diagnosticadas de enfermedad oncológica (AU)

Objective: Case of an unaccompanied minor who, after his arrival in Spain, is diagnosed with lymphoma and how an intervention at a psychosocial level is necessary, to first ensure the coverage of basic needs and then address all the psychological symptoms of his situation. Method: An intervention by the area of Social Work and Psycho-Oncology for the management of all the problems associated with the migrant situation and adaptation to the oncological process. Results: At the begginning basic needs (accommodation and food) were coveres and it was ensured access to social and health services, and then psychological intervention started. There is a reduction of anxious symptomatology, managing suicidal ideation and the reduction of negative and depressive thoughts, improving emotional management and enhancing self-control, as well as a better adaptation to the disease situation. Conclusion: The psychosocial approach becomes an indispensable tool for the intervention in people who are in a situation of extreme social vulnerability, who are diagnosed with oncological disease (AU)

Repercussões psicossociais do tratamento radioterápico para o câncer do colo uterino: uma abordagem qualitativa / Psychosocial repercussions of radiotherapy treatment for cervical cancer: a qualitative approach / Repercusiones psicosociales del tratamiento de radioterapia para el cáncer de cuello uterino: un enfoque cualitativo

RESUMO Objetivo: compreender as repercussões psicossociais do pós-tratamento radioterápico para o câncer do colo uterino. Método: estudo qualitativo, com a participação de pacientes em pós-tratamento radioterápico para o câncer do colo uterino em um ambulatório de enfermagem oncoginecológica, localizado no Município do Rio de Janeiro - Brasil. Os dados foram coletados durante os meses de março e abril de 2019 por meio de entrevista aberta e submetidos à análise de conteúdo. Resultados: definiram-se quatro categorias: o constructo de papéis sociais: a perda da identidade feminina; a sexualidade da mulher pós-tratamento para o câncer do colo uterino: repercussões conjugais; dificuldades de adaptação à nova condição de vida: reconstruindo a imagem corporal; convivendo com o câncer do colo uterino: repensando a vida e reconstruindo valores através da rede de apoio. Considerações finais: os resultados contribuem para o direcionamento do cuidado, aumentando a qualidade de vida e auxiliando a reorganização da vida profissional, social e familiar dessas mulheres.

ABSTRACT Objective: to understand the psychosocial repercussions of post radiotherapy treatment for cervical cancer. Method: qualitative study, with the participation of patients in post radiotherapy treatment for cervical cancer in an onco-gynecologic nursing outpatient clinic, located in the Municipality of Rio de Janeiro - Brazil. Data were collected during the months of March and April 2019 by means of open interview and submitted to content analysis. Results: four categories were defined: the construct of social roles: the loss of female identity; the sexuality of post-treated women for cervical cancer: marital repercussions; difficulties in adapting to the new life condition: rebuilding the body image; living with cervical cancer: rethinking life and rebuilding values through the support network. Final considerations: the results contribute to the direction of care, increasing the quality of life and helping these women reorganize their professional, social, and family lives.

RESUMEN Objetivo: conocer las repercusiones psicosociales del tratamiento post-radioterapia del cáncer de cuello de útero. Método: estudio cualitativo, con la participación de pacientes en tratamiento post radioterapia para cáncer de cuello uterino en una consulta externa de enfermería oncoginecológica, ubicada en el Municipio de Río de Janeiro - Brasil. Los datos fueron recolectados durante los meses de marzo y abril de 2019 a través de una entrevista abierta y fueron sometidos a un análisis de contenido. Resultados: se definieron cuatro categorías: la construcción de los roles sociales: la pérdida de la identidad femenina; la sexualidad de las mujeres después del tratamiento del cáncer de cuello uterino: las repercusiones conyugales; las dificultades de adaptación a la nueva condición de vida: la reconstrucción de la imagen corporal; la convivencia con el cáncer de cuello uterino: el replanteamiento de la vida y la reconstrucción de los valores a través de la red de apoyo. Consideraciones finales: los resultados contribuyen a la orientación de los cuidados, aumentando la calidad de vida y ayudando a la reorganización de la vida profesional, social y familiar de estas mujeres.

O mundo privado na UTI: análise da internação de pacientes oncológicos / The private world in the ICU: analysis of the hospitalization of oncology patientes / El mundo privado en la UCI: análisis de la hospitalización de pacientes oncológicos

O presente estudo buscou investigar a percepção que pacientes adultos de uma unidade de terapia intensiva (UTI) oncológica têm acerca da experiência de internação nesse setor. Trata-se de uma pesquisa de abordagem qualitativa e de compreensão. Sete pacientes de um hospital de câncer na região Sul do país foram pesquisados. Eles responderam a uma entrevista semiestruturada, a qual foi gravada e posteriormente transcrita, o que possibilitou o acesso às concepções prévias desses sujeitos acerca da UTI, aspectos psicológicos presentes durante a internação e concepções posteriores à experiência de internamento na unidade. Tais informações foram interpretadas por meio da análise de conteúdo. A partir dos resultados, foi possível verificar que a experiência de internação em contextos de terapia intensiva pode ser afetada, favorável ou desfavoravelmente, pelo conjunto de regras que o paciente traz consigo acerca do que é a UTI. Além disso, foi possível compreender também que os estímulos aversivos existentes nesse ambiente podem ser atenuados pela presença da família e por uma relação acolhedora e sensível com a equipe de saúde, favorecendo, assim, o repertório de enfrentamento do paciente frente a esse momento crítico de saúde.(AU)

This study aims to investigate the perception of adult patients in an oncology intensive care unit (ICU) regarding the experience of hospitalization in this sector. This is a research with a qualitative approach and understanding. Seven patients from a cancer hospital in the southern region of the country were surveyed. They answered a semi-structured interview, which was recorded and later transcribed, on the subjects' previous conceptions about the ICU, psychological aspects present during hospitalization, and conceptions subsequent to the hospitalization experience in the Unit. Such information was interpreted through content analysis. From the results, it was possible to verify that the experience of hospitalization in intensive care contexts can be affected, favorably or unfavorably, by the set of rules that the patient brings with them about what the ICU is. In addition, it was also possible to understand that the aversive stimulus existing in this environment can be attenuated by the presence of the family and by a welcoming and sensitive relationship with the health team, thus favoring the patient's coping repertoire when facing a critical moment of health.(AU)

Este estudio pretendió investigar la percepción que tienen los pacientes adultos sobre la experiencia de hospitalización en una Unidad de Cuidados Intensivos (UCI) de oncología. Se trata de una investigación con enfoque cualitativo y de comprensión. Participaron siete pacientes de un hospital oncológico en la región Sur de Brasil. Se aplicó una entrevista semiestructurada, que fue grabada y, posteriormente, transcrita, lo que permitió acceder a las concepciones previas de los sujetos sobre la UCI, los aspectos psicológicos presentes durante la hospitalización y las concepciones posteriores a la experiencia de internación en la Unidad. Dicha información se interpretó mediante análisis de contenido. A partir de los resultados, fue posible constatar que la experiencia de hospitalización en cuidados intensivos puede ser afectada favorable o desfavorablemente por el conjunto de normas que el paciente trae consigo sobre qué es la UTI. Además, se constató que los estímulos adversos existentes en este ambiente pueden mitigarse mediante la presencia de la familia y la relación acogedora y sensible con el equipo de salud, lo que favorece así el repertorio de afrontamiento del paciente ante este momento crítico de salud.(AU)

Standards for psychosocial care in pediatric cancer: adapted proposal for Latin American and Caribbean countries / Normas para la atención psicosocial en el cáncer pediátrico: una propuesta adaptada para los países de América Latina y el Caribe / Padrões de atendimento psicossocial em câncer pediátrico: proposta adaptada para países da América Latina e do Caribe

ABSTRACT Objective. To highlight the objectives, achievements, challenges, and next steps for the World Health Organization's Global Initiative for Childhood Cancer (GICC) framework, a project designed to improve psychosocial care (PSC) in pediatric cancer centers across Latin America and the Caribbean (LAC). Methods. The project was launched in Peru, the first GICC focal country, in November 2020. The diagnosis phase included a survey and a semistructured interview with health professionals to assess PSC practices in institutions, and a needs assessment survey for caregivers. In the second phase, a strategic plan was developed to address the identified needs, including the adaptation of PSC standards, the establishment of multicenter working groups, the expansion of the proposal, and the development of materials. Results. The study found that PSC was not being adequately provided in accordance with international standards. Six adapted standards were proposed and validated, and more than 50 regional health professionals participated in online activities to support the project. The implementation process is currently ongoing, with the establishment of five multidisciplinary working groups, one regional committee, and the production of 16 technical outputs. Conclusion. This project represents a substantial step forward to improve PSC for pediatric patients with cancer and their families in LAC countries. The establishment of working groups and evidence-based interventions strengthen the proposal and its implementation. Development of health policies that include PSC according to standards is needed to achieve sustainable results in the quality of life of children with cancer and their families.

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RESUMO Objetivo. Destacar os objetivos, as conquistas, os desafios e as próximas etapas da Iniciativa Global para o Câncer Infantil (GICC), um projeto criado pela Organização Mundial da Saúde para melhorar a atenção psicossocial em centros de câncer pediátrico na América Latina e no Caribe. Métodos. O projeto foi lançado no Peru, o primeiro país focal da GICC, em novembro de 2020. A fase de diagnóstico incluiu uma pesquisa e uma entrevista semiestruturada com profissionais de saúde para avaliar as práticas de atenção psicossocial nas instituições, bem como uma pesquisa para avaliar as necessidades dos cuidadores. Na segunda fase, foi desenvolvido um plano estratégico para atender às necessidades identificadas, incluindo uma adaptação de padrões de atenção psicossocial, o estabelecimento de grupos de trabalho multicêntricos, a expansão da proposta e o desenvolvimento de materiais. Resultados. O estudo constatou que, de acordo com padrões internacionais, a atenção psicossocial não estava sendo adequadamente oferecida. Seis padrões adaptados foram propostos e validados, e mais de 50 profissionais de saúde da região participaram de atividades on-line para apoiar o projeto. O processo de implementação está em andamento, com a formação de cinco grupos de trabalho multidisciplinares e um comitê regional e a produção de 16 relatórios técnicos. Conclusão. Este projeto representa um avanço substancial para melhorar a atenção psicossocial para pacientes pediátricos com câncer e suas famílias nos países da América Latina e do Caribe. A criação de grupos de trabalho e intervenções baseadas em evidências fortalecem a proposta e sua implementação. É preciso desenvolver políticas de saúde que incluam atenção psicossocial segundo padrões estabelecidos para alcançar resultados sustentáveis na qualidade de vida das crianças com câncer e de suas famílias.

Análisis de las respuestas cognitivas relacionadas con el diagnóstico de cáncer en pacientes mexicanos / Cognitive response related to cancer diagnosis in Mexican patients

Resumen La evaluación subjetiva ha sido descripta como una variable mediadora para la respuesta emocional. Se presenta con diferentes contenidos y estilos. El estilo cognitivo se refiere a la manera en que se piensa sobre el estresor, por ejemplo: la rumiación (pensamientos intrusivos, repetitivos, que generan malestar emocional), la evitación (intentos por no pensar en el estresor) y el compromiso cognitivo (enfocados en búsqueda de sentido o solución). En base a esta respuesta emocional, se busca explorar y describir los pensamientos relacionados con el cáncer en un grupo de diez pacientes con la enfermedad. En un estudio cualitativo, se les pidió a diez pacientes con cáncer que indicaran los cinco pensamientos más frecuentes desde su diagnóstico. Se analizó el contenido mediante la técnica top down (teoría a contenido) y, a partir de los estilos de respuestas cognitivas, se clasificó el contenido de los pensamientos reportados por estilo de pensamiento (rumiación, compromiso cognitivo o evitación), por temporalidad (pasado, presente y futuro) y por valencia (positiva o negativa). Posteriormente, se hizo el análisis bottom up (contenido a teoría). Se hicieron tablas cruzadas para identificar los contenidos según el estilo de pensamiento, la temporalidad y la valencia. En los pensamientos con estilo rumiativo, el enfoque temporal se dirigía en su mayoría al futuro y al pasado, mientras que el compromiso cognitivo se enfocaba en el presente. Esta diferencia fue estadísticamente significativa mediante una prueba de chi cuadrado. Dentro de los temas relacionados con la incertidumbre, se refirieron a la muerte, al pronóstico de la enfermedad, a la respuesta de la familia y a las finanzas (en el futuro) y a las causas y culpa (en el pasado).

Abstract Cancer has been defined by the World Health Organization as "a disease caused by abnormal cells growing uncontrollably in the body, going beyond their usual boundaries, invading adjoining parts of the body and spreading to other organs". Being diagnosed with cancer has been described as an experience with diverse emotional reactions and difficulties in adaptation, having psychological consequences, being most common depression, anxiety and psychological distress; but also, some patients present positive consequences after having a cancer diagnosis, such as post traumatic growth, which includes positive changes presented after the disease experience. Subjective appraisal about cancer has been defined as a mediating variable for the emotional response presented after a stressor, such as cancer diagnosis, treatment, or important changes during disease process (initiating and finalizing treatment, presenting relapse or remission, as well as when having control studies). The subjective appraisal can be presented with different thought content and styles. Thought style is referred as the way thoughts about the stressor are presented, it has been classified as rumination (thoughts that are intrusive and repetitive that also increase psychological distress), cognitive engagement (thoughts associated with problem solving and meaning finding) or avoidance (aiming to stop thinking about stressor or feeling associated with it). Depending on the thought style presented at a stressor, could be the emotional response (anxiety, depression, distress, post-traumatic growth). The aim of the present study was to describe the thoughts (style, content, valence and temporality) related to cancer diagnosis in a group of ten oncologic patients. To identify if differences between thought style, valence and temporality were presented. The study design is qualitative from a phenomenological point of view. Ten oncologic (different cancer type, clinical stage and treatment) patients were asked to write the five more frequent thoughts since their cancer diagnosis. Each thought was classified by: thought style, valence, and temporality (top-down, classifying the thoughts according to theory). The same thoughts were also classified in semantic units (bottom-up, classifying the thoughts according to their own contents), generating concerns from the content. Cross tabs were made to identify contents and temporality for thought style and valence, which were analyzed by chi square to identify differences between thought style, temporality and valence. The most common thought style was cognitive engagement, followed by rumination (almost same frequency). On what respects to thought style and temporality, rumination was more focused on past (causes and attributions of cancer) and future (uncertainty about death and treatment effectiveness); meanwhile, cognitive engagement was focused on present (to enjoy present moment and focus on daily actions). Chi square was made to identify if this difference was significant, showing temporality was significantly different in cognitive engagement and rumination. The concerns identified in study participants were uncertainty about future and disease, family (communication and wellness of the family), finances (due to expensive treatments), causes and guilt about having cancer. Thoughts that were more centered in present, were more likely to be associated with cognitive engagement. Cognitive engagement has been described previously as an important variable associated with post traumatic growth. Thoughts centered in the past and present were more associated with rumination. Rumination has been associated with depression and post-traumatic stress disorder. Because of mediating role of thought style in disease adaptation, emotional response to the disease, and the relation of this adaptation with the perception of quality of life in cancer patients, the design of psychological interventions aiming on promoting cognitive engagement by problem solving skills, meaning finding, and focusing on present could be a research line derived from present studies results.

Guía para el abordaje del paciente oncológico por el farmacéutico comunitario / Guide for the community pharmacist's approach to the oncology patient

INTRODUCCIÓN: el aumento del número de pacientes oncológicos, la aparición de nuevos fármacos orales, así como la cronicidad de algunos tratamientos, hacen necesario ofrecer desde la farmacia comunitaria, una atención integral al paciente oncológico y a sus familias.OBJETIVOS. Principal: Establecer pautas de actuación profesional a pacientes oncológicos y a sus familias por el farmacéutico comunitario (FC). Secundarios: 1. Elaborar una guía que incluya apartados relativos a la comunicación, psicología, derivación a los servicios de la Asociación Contra el Cáncer en Barcelona (ACCB) y revisión de los tratamientos oncológicos, que minimice sus efectos adversos, interacciones y mejore la adherencia al tratamiento. 2. Difundir la guía a los FC de Barcelona y resto de España.MATERIALES Y MÉTODOS: la edición de los contenidos se realizó conjuntamente por dos FC de SEFAC y un psicólogo de la ACCB, llevando la coordinación la Fundación Sefac, mediante reuniones telemáticas y revisiones en línea. Se analizaron las principales estrategias psicológicas y terapéuticas actualmente empleadas en la clínica, revisando diversas fuentes de información (artículos originales, bases de datos como Pubmed/Medline o Cochrane Plus, libros, guías de práctica clínica y cursos de formación editados por sociedades científicas, boletines terapéuticos y fichas técnicas de medicamentos) publicadas especialmente en los últimos 10 años.RESULTADOS: la Guía fue publicada en noviembre del 2021 y presentada en una sesión webinar a los socios de SEFAC. Se encuentra disponible gratuitamente para socios de SEFAC en la dirección: https://www.sefac.org/documentos-para-profesionales- publicaciones-sefac/proyecto-del-abordaje-del-paciente-oncologico-porConsta de dos bloques diferenciados: Bloque 1. Orientado al acompañamiento del paciente oncológico y familiares por el FC. (AU)

Prácticas clínicas de comunicación del diagnóstico en oncologíapediátrica: una revisión sistemática / Clinical practices of communicating the diagnosis in pediatric oncology: a systematic review

La comunicación del diagnóstico en enfermedades crónicas ha sido poco estudiada en oncología pediátrica. Las prácticas clínicas para la revelación son al final de la vida, pero poco al inicio de la enfermedad, por lo que no parece haber claridad sobre cómo comunicar a las familias. Objetivo: conocer cuáles son las prácticas de comunicación del diagnóstico en niños y jóvenes con enfermedad oncológica. Método: revisión sistemática según lineamientos PRISMA. Resultados: se encontraron 17 estudios que cumplían con los criterios de inclusión. Se identificaron dos protocolos para comunicar el diagnóstico y varias recomendaciones para hacer la revelación según la edad del paciente, el derecho a estar informado y la importancia de involucrar a la familia. Discusión: se requieren prácticas de comunicación validadas que respondan a las necesidades de salud mental en oncología pediátrica, que incluyan la cultura y contexto de paciente y familia, así como las barreras que dificultan la comunicación.(AU)

Communication of diagnosis in chronic disease has been little studied in pediatric oncology. Clinical practices for disclosure are mainly carried out at the end of life, not at the onset of the disease, and there does not seem to be clarity on how to communicate to families. Objective: to understand the current communication practices of diagnosis in children and young people with oncologic disease. Method: systematic review according to PRISMA guidelines. Results: A total of 17 studies were obtained that met the inclusion criteria. Two protocols for communicating the diagnosis were identified and several recommendations were found for disclosure according to the patient’s age, the right to be informed, and the importance of involving the family. Discussion: validated communication practices are required that respond to the mental health needs in pediatric oncology, considering the culture and environment of patients and their families, and other barriers to effective communication.(AU)

Efectividad de la Realidad Virtual (RV) en la disminución del distrés de niños y adolescentes con cáncer: Revisión sistemática / Effectiveness of Virtual Reality (VR) in reducing distress in children and adolescents with cancer: A systematic review

Introducción: Aunque se han publicado muchos estudios que han intentado demostrar la eficacia de diferentes tratamientos psicológicos en pacientes con cáncer; hasta la fecha no se ha revisado la evidencia disponible sobre la eficacia de la Realidad Virtual (RV) para disminuir el distrés en niños y adolescentes con cáncer. Objetivo:El objetivo principal es evaluar la efectividad de la intervención con Realidad virtual en la disminución del distrés que padecen los niños y adolescentes con cáncer ante los procedimientos médicos, la hospitalización, o la propia enfermedad. Resultados:De los 22 artículos encontrados, se han seleccionado para la revisión un total de 8, que seguían un diseño experimental o cuasiexperimental en pacientes niños y jóvenes diagnosticados de cáncer tratados con RV. Conclusiones: Los resultados, aunque heterogéneos, sugieren mejorías a medio–largo plazo en las variables de ansiedad, depresión, aceptación, calidad de vida, distrés y flexibilidad psicológica. Además, la RV ha resultado ser más eficaz que otras técnicas. De este modo, a pesar de las limitaciones encontradas en este estudio, se han obtenido resultados prometedores para futuras revisiones y/ o metaanálisis (AU)

Introduction: Although many studies have been published that have attempted to demonstrate the efficacy of different psychological treatments in cancer patients, to date there has been no review of the available evidence on the efficacy of Virtual Reality (VR) in reducing distress in children and adolescents with cancer. Objective: The main aim is to evaluate the effectiveness of virtual reality intervention in reducing the distress suffered by children and adolescents with cancer in the face of medical procedures, hospitalization, or the disease itself. Results: Of the 22 articles found, a total of 8 were selected for the review, which followed an experimental or quasi-experimental design in children and young people diagnosed with cancer treated with VR. Conclusions: The results, although heterogeneous, suggest medium to long-term improvements in the variables of anxiety, depression, acceptance, quality of life, distress, and psychological flexibility. Moreover, VR has proved to be more effective than other techniques. Thus, despite the limitations found in this study, promising results have been obtained for future reviews and/or meta-analysis (AU)

¿Cuál es el impacto emocional de los resultados de estudios genéticos en pacientes oncológicos con sospecha de síndrome hereditario para cáncer? / What is the emotional impact of the genetic test results on oncologic patients with suspected hereditary cancer syndrome?

Objetivos: valorar el impacto emocional de recibir los resultados del estudio genético (EG) en pacientes con antecedente oncológico personal y sospecha de síndrome hereditario, aplicando el Cuestionario Multidimensional del Impacto de la evaluación de riesgo de cáncer (MICRA). Método: 219 pacientes con diagnóstico oncológico que concurrieron a la consulta de Asesoramiento Genético Oncológico en el Instituto Alexander Fleming entre 2014 y 2019, fueron evaluados aplicando el MICRA. Resultados: Edad promedio 49,84 (42,21; 62,02), 82,2% con diagnóstico de cáncer de mama. En un 16% se halló una variante patogénica (VP). La media de los puntajes obtenidos por cada subescala fue: 5,26 (DS=4,48, rango 0-22) para Malestar Emocional (ME); 12,31 (DS 7,42 rango 0-37) para Incertidumbre (I); 16,36 (DS 4.30 rango 2-20) para Experiencias Positivas (EP) y de 34,37 (DS 10,24 rango 8-62) para la puntuación global, lo que muestra un bajo nivel de ME e I y la presencia de EP entre los pacientes. Se hallaron diferencias significativas según tipo de resultado: los portadores de VP, mostraron una modesta elevación del nivel de ME y menor puntuación en EP, respecto de aquellos que tuvieron resultados no informativos o inciertos. Sin diferencias significativas según edad, pacientes con o sin hijos, o tiempo entre la realización del estudio y la aplicación del cuestionario. Conclusiones: Recibir resultados de estudio genético no produciría un impacto psicológico adverso. Las puntuaciones altas de esta escala podrían ser usadas para identificar a pacientes con malestar emocional y ofrecerles un seguimiento psicooncológico específico (AU)

Objective: The aim of our study is to assess the emotional impact of genetic test results disclosure to patients with a personal cancer history and suspected hereditary syndrome, applying the Multidimensional Impact of Cancer Risk Assessment (MICRA) Questionnaire. Methods: two hundred nineteen patients affected with cancer, referred to the Cancer Genetic Counseling department at the Alexander Fleming Institute, between 2014 and 2019, were evaluated using the MICRA questionnaire. Results: Average age 49.84 (42,21; 62,02), 82.2% presented breast cancer. In 16% a pathogenic variant (PV) was found. The mean of the scores obtained for each subscale in the questionnaire was 5.26 (0-22, SD 4.48) for Distress (D); 12.31 (0-37, DS 7.42) for Uncertainty (U); 16.36 (2-20 SD 4.30) for Positive Experiences (PE) and 34.37 (8-62 SD 10.24) for the global score, which shows a low level of D and U and the presence of PE among the patients. Significant differences were found according to the type of result: We found modestly increased distress in PV carriers compared to patients who received uninformative or negative test results. No significant differences according to age, patients with or without children, or time between the completion of the genetic test and the application of the questionnaire. Conclusion: Genetic test disclosure does not seem to produce an adverse psychological impact. High scores on this scale could be used to identify patients with emotional distress and offer them specific psycho-oncological follow-up (AU)

Aspectos psicológicos en las mastectomías reductoras de riesgo en mujeres portadoras de mutación patogénica BRCA1/2 / Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers

Las cirugías reductoras de riesgo descienden un 95% el riesgo de desarrollar cáncer de mama, pero traen consigo repercusiones psicológicas. Esta revisión sistemática tuvo como objetivo analizar la sintomatología ansiosa/depresiva, la imagen corporal y la calidad de vida de mujeres portadoras de una mutación BRCA1/2 con o sin antecedentes oncológicos personales que se habían sometido a una mastectomía reductora de riesgo. Para ello, se utilizó el método PRISMA. La búsqueda inicial identificó 234 estudios. Solo 7 investigaciones cumplieron los criterios de inclusión. No se encontraron diferencias en sintomatología ansiosa. Un estudio concluyó que la sintomatología depresiva aumentó significativamente en mujeres sin antecedentes oncológicos en el seguimiento a largo plazo. Las mujeres que optaron por una mastectomía bilateral reductora de riesgo y fueron reconstruidas mediante prótesis tendían a estar satisfechas con su imagen corporal/resultado cosmético. No se hallaron diferencias a largo plazo en la calidad de vida independientemente de la cirugía realizada(AU)

Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed(AU)

Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers.

Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.

Avaliação de Prejuízo Cognitivo em Sobreviventes de Câncer de Mama: Estudo Transversal / Assessment of Cognitive Impairment in Survivors of Breast Cancer: A Cross-sectional Study

Resumo Estudo prospectivo e transversal, para determinar a prevalência de prejuízo cognitivo decorrente da quimioterapia e explorar fatores preditores e mediadores em sobreviventes de câncer de mama. Utilizou-se o Termômetro de Distress, Escala de Ansiedade e Depressão, Functional Assessment of Chronic Illness Therapy-General e Cognitive Function. As sobreviventes (N = 62) reportaram uma alta prevalência de distress (46,8%) e de ansiedade (24,2%), com baixos escores nas subescalas déficit cognitivo e habilidades cognitivas percebidos. O funcionamento cognitivo esteve associado à idade (β = 1,42; p = 0,002), atuação profissional (β = -23,12; p = 0,004), depressão (β = -5,43; p = 0,001) e qualidade de vida (β = 1,24; p = 0,001). Prejuízo cognitivo deve ser considerado no serviço de Psico-Oncologia.

Abstract Prospective and cross-sectional study to determine the prevalence of cognitive impairment resulting from chemotherapy, and to explore predictors and mediators in survivors of breast cancer. We used the Distress Thermometer, Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy-General and Functional Assessment of Cancer Therapy-Cognitive Function. Survivors (N = 62) reported a high prevalence of distress (46.8%) and anxiety (24.2%), with low scores on cognitive deficit and cognitive skills perceived subscales. Cognitive functioning was associated with age (β = 1.42; p = 0.002), professional performance (β = -23.12; p = 0.004), depression (β = -5.43; p = 0.001), and quality of life (β = 1.24; p = 0.001). Cognitive impairment must be considered in Psycho-Oncology service.

Vínculos entre psicooncología y enfermería en el cuidado continuo de personas con cáncer de próstata / Links between Psycho-Oncology and Nursing in the Ongoing Care of Individuals with Prostate Cancer

Introducción: La enfermería en oncología ocupa un lugar preponderante dentro del equipo multidisciplinar, y el concepto de cuidado va más allá de actividades técnicas, donde toda relación terapéutica implica, de modo necesario, un proceso de relación interpersonal, para lo cual se deben desarrollar habilidades y destrezas comunicativas. Objetivo: Analizar los vínculos entre la psicooncología y la enfermería en el cuidado continuo de personas con cáncer de próstata. Métodos: Revisión bibliográfica sistemática de artículos publicados desde 2011 hasta 2020 en las bases de datos SciELO, Google académico y Dialnet. Se elaboró la pregunta guía a través del acrónimo PICo. La estrategia de búsqueda se realizó mediante los descriptores en Ciencias de la Salud (DeCS) "Psicooncología", "Enfermería", "Cuidados continuos", "Neoplasia de la próstata" y "Enfermedades crónicas" con los operadores booleanos AND y OR. Se utilizó el diagrama de flujo (PRISMA). Se accedió a interpretar los referentes teóricos y organización del conocimiento en las 16 bibliografías seleccionadas. Conclusiones: La revisión realizada permitió enfatizar la importancia de integrar técnicas y habilidades de la psicooncología, sus beneficios y aplicación desde las perspectivas de enfermería, con el propósito de favorecer el bienestar biopsicosocial de la persona con cáncer de próstata(AU)

Introduction: Nursing in oncology occupies a preponderant place within the multidisciplinary team, and the concept of care goes beyond technical activities, any therapeutic relationship necessarily implies an interpersonal relationship process, for which skills and communication skills must be developed. Objective: To analyze the links between psycho-oncology and nursing in the continuous care of individuals with prostate cancer. Methods: We develop a systematic bibliographic review of articles published from 2011 to 2020 in the SciELO, Google academic and Dialnet databases. The guiding question was developed through the acronym PICo. The search strategy was carried out using the Health Sciences (DeCS) descriptors "Psychooncology", "Nursing", "Continuous care", "Prostate neoplasia" and "Chronic diseases" with the Boolean operators AND and OR. PRISMA flow chart was used. It was agreed to interpret the theoretical references and organization of knowledge in the 16 selected bibliographies. Conclusions: The review carried out made it possible to emphasize the importance of integrating techniques and skills of psycho-oncology, their benefits and application from the nursing perspectives, with the purpose of favoring the bio psychosocial well-being of the person with prostate cancer(AU)

Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers. / Aspectos psicológicos en las mastectomías reductoras de riesgo en mujeres portadoras de mutación patogénica BRCA1/2.

Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.

Intervenções Psicológicas na Psico-Oncologia / Psychological Interventions in Psycho-Oncology

O objetivo deste trabalho é divulgar a Psico-Oncologia como uma área de conhecimento que ampliou as possibilidades de atendimento ao portador de câncer seu familiar e equipe de saúde. O surgimento da Psico-Oncologia é influenciado por diversos fatores relacionados ao desenvolvimento das ciências, mas não deixa de ser uma necessidade que responde a uma demanda dos últimos anos, quando o câncer não para de atingir cada vez mais pessoas, levando as pesquisas a descobertas intrigantes, mas que muitas vezes não explicam o surgimento e a evolução da doença. A Psico-Oncologia nasce enfatizando os fatores psicossociais, biológicos e psicológicos no atendimento ao portador de câncer, e busca também uma compreensão maior dos processos de adoecimento e desenvolvimento da moléstia bem como as implicações na vida familiar dos portadores de câncer.

This work aims at divulging the main concepts of Psycho-Oncology as a new area of knowledge, involving the attendance of cancer patients, their families and health teams. Psycho-Oncology's creation was influenced by many different factors related to scientific development, but also constitutes an answer for a contemporary demand in face of an unprecedented number of new cases. This situation has conducted research to important discoveries, notwithstanding in many cases not being able to explain the causes nor the evolution of the disease. The reasons justifying this work involve the need for a systematized account accompanied of some necessary critical reflections, since information on the area is still scarce.

Consenso sobre el estándar de atención psicooncológica, complejidad psicosocial y actividad asistencial en el Instituto Catalán de Oncología / Consensus on the standard of psycho-oncological care, psychosocial complexity and care activity at the Catalan Institute of Oncology

Introducción: La atención psicosocial de las personas con enfermedad oncológica y la familia debe formar parte de todo modelo integral de atención que pretenda reducir el impacto vital del cáncer. Las intervenciones psicosociales han probado su eficacia en la ayuda a pacientes y familiares para afrontar las situaciones de alta complejidad psicosocial emergentes a consecuencia de un diagnóstico de cáncer. Objetivo: Definir y explicar el modelo de Atención Psicosocial del Comité Psicosocial del Instituto Catalán de Oncología (ICO) utilizando criterios de vulnerabilidad, complejidad y derivación; enmarcado y basado en los valores del ICO (centrados en las necesidades de pacientes con cáncer y sus familias). Método: El modelo que se presenta en este documento consta de cinco pilares: 1) Principios de la Práctica Psicosocial en Oncología; 2) Áreas de actuación en la Atención Psicosocial del paciente con cáncer y la familia; 3) Cribado de malestar emocional y derivación del paciente con cáncer y la familia para una atención psicooncológica específica; 4) Comité Psicosocial: (objetivos; funciones; organización; composición; disciplinas participantes; criterios de derivación y niveles de complejidad; y procedimiento); y 5) Índice de productividad. Resultados: Pacientes y familiares atendidos por el CPS mostraron mejoría estadísticamente significativa en los niveles del malestar emocional, pasando de una media inicial de 8,12/10 (EVA/ENV) a una media 6,27/10 (EVA/ENV). Asimismo, se constata que las intervenciones derivadas del comité psicosocial redujeron el porcentaje de casos iniciales de alta complejidad, pasando de un 69,3% a un 49,3% (AU)

Introduction: Psychosocial care for cancer patients and their families should be part of all comprehensive model of care that aims to reduce the life impact of cancer. Psychosocial interventions have proven to be effective in helping patients and families to cope with the highly complex psychosocial situations that arise as a result of a cancer diagnosis. Aim: To define and explain the model of Psychosocial Care in the Psychosocial Committee of the Catalan Institute of Oncology (ICO) using criteria of vulnerability, complexity and referral; framed and based on the values of the ICO (focused on patients and family’s needs). Method: The model presented in this document consists of five pillars: 1) Principles of Psychosocial Practice in Oncology; 2) Areas of action in the Psychosocial Care of the cancer patient and family; 3) Screening for emotional distress and referral of the cancer patient and family for specific psycho-oncological care; 4) PsychosocialCommittee: (objectives; functions; organization; composition; participating disciplines; referral criteria and levels of complexity; and procedure); and 5) Productivity index. Results: Patients and relatives who were attended by the CPS showed statistically significant improvement in the levels of emotional distress, going from an initial mean of 8.12 / 10 (VAS / ENV) to a mean of 6.27 / 10 (VAS / ENV). It also shows that the interventions derived from the psychosocial committee reduced the percentage of initial cases of high complexity, from 69.3% to 49.3% (AU)