Influencia de un programa de educación al esfuerzo en la mejora de la calidad de vida de los pacientes oncológicos con astenia / Effectiveness of educational program on quality of life of fatigue reported by the oncologic disease

Justificación: La revisión de la literatura pone de manifiesto el impacto negativo que la astenia tumoral tiene sobre la calidad de vida y recomienda utilizar además del tratamiento farmacológico para controlar el síntoma, otras terapias centradas en aumentar la autonomía. Nuestro objetivo ha sido comprobar la eficacia del "Programa de entrenamiento en la realización de las actividades de la vida diaria", en la mejora de la Calidad de Vida Relacionada con la Salud (CVRS) de los pacientes oncológicos con astenia. Metodología: Estudio experimental, prospectivo, longitudinal, aleatorizado mediante un esquema paralelo de asignación fija con grupo experimental y grupo control. El instrumento de evaluación para medir la variable dependiente fue el cuestionario SF-12 v2. El estudio se realizó con 180 sujetos reclutados entre diciembre de 2013 y septiembre de 2015. Resultados: Después de la intervención encontramos diferencias estadísticamente significativas (p<0,01) en todos los ítems de calidad de vida en los pacientes incluidos en el grupo experimental, exceptuando el ítem "dolor corporal" (p>0,05). Sin embargo no hemos encontrado relación entre la edad y la mejora de la calidad de vida. Conclusiones: La utilización sistemática y controlada del "Programa de entrenamiento en la realización de las actividades de la vida diaria" mejora todos los niveles de CVRS de los pacientes oncológicos por lo que después de estos resultados nuestro último objetivo será la implementación de este programa y su utilización en nuestra práctica clínica diaria

Background: The review of the literature show a negative impact of the fatigue on quality of life and recommend, in addition of the use of traditional drug treatment to control symptoms, other therapies focused into improve the autonomy. Our aim is to test the efficacy of improving the levels of quality of life related to health (HRQOL) of cancer patients using a "daily activity training program" to control fatigue reported by the oncological disease. Methods/design: experimental, prospective, longitudinal and randomized study using a parallel fixed allocation scheme with experimental and control group. We used the SF-12 v2 questionnaire to measure HRQL .The study was conducted in 180 subjects recruited between December 2013 and September 2015. Results: We found statistically significant differences after intervention (p <0.001) in all items related to quality of life in the experimental group patients, except for the item "bodily pain"(p>0, 05). However, we found no relationship between age and improving of the quality of life. In summary systematic and controlled use of our "daily activity training program" improve all levels of quality of life related to health (HRQOL) of cancer patients. Therefore after these results our ultimate goal will be the implementation of this program and its use in our daily practice

[Implementation of a nurse-driven educational program improves management of sorafenib's toxicities in hepatocellular carcinoma]. / Les infirmières cliniciennes améliorent la gestion des toxicités des patients traités par sorafénib pour carcinome hépatocellulaire.

BACKGROUND: Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC). Due to its peculiar toxicities, improving patient's tolerance may need close follow-up. Nurses can play a crucial role, by driving a patient education program (EP). We aimed to prove that adding EP to usual care (UC) improves patient's care. METHODS: Since 2011, oncologists referred patients treated by sorafenib to the EP, driven by clinical nurses. It consisted in a visit before first administration, weekly telephone calls and a visit before each oncologist consultation. We retrospectively compared patients followed by the EP to those followed by oncologist in usual care (UC) and patients included in a clinical trial (CT). RESULTS: Since 2005, 129 patients were treated with sorafenib for HCC, 31 (24%) in the EP, 22 (17%) in CT and 76 (59%) with UC. Seventy-one percent of patients in the EP had toxicities identified during a telephone call, which prompted symptomatic measures in 65% of patients, leading to treatment modification before the planned on-site visit in 29% of patients. EP patients required less dose reductions (39% vs. 61% for UC, P=0.04), and median time to first dose reduction was shorter with EP than with UC (25 days vs. 45 days, P=0.036). CONCLUSION: This study suggests a clinical benefit of EP, with a better toxicity's management of sorafenib, leading to less dose reduction. Different types of EP should be compared prospectively, focusing on quality of life.