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- ItemAcesso aberto (Open Access)Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Franceschini, Juliana [UNIFESP]; Santos, Alecssandra Aparecida dos; El Mouallem, Inás; Jamnik, Sergio [UNIFESP]; Uehara, Cesar [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro Universitário São CamiloOBJECTIVE: To assess the quality of life of patients with lung cancer and to compare it with that of individuals without cancer. METHODS: The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was administered to 57 patients diagnosed with lung cancer, treated at the Lung Cancer Outpatient Clinic of the Hospital São Paulo, and to a control group of 57 individuals recruited from the Extra Penha workout group. The Mann-Whitney test was used to compare the groups, domain by domain. The first model of logistic regression was adjusted for male gender, nonsurgical treatment, Karnofsky performance status and smoking, which were included as predictors. The second model was adjusted for each SF-36 domain in order to identify increases in the proportions of patients in stage IIIB or IV. RESULTS: The lung cancer group and the control group presented the following mean scores, respectively, for the SF-36 domains: role limitations due to physical health problems, 29.39 ± 36.94 and 82.89 ± 28.80; role limitations due to emotional problems, 42.78 ± 44.78 and 86.55 ± 28.77; physical function, 56.49 ± 28.39 and 89.00 ± 13.80; vitality, 61.61 ± 23.82 and 79.12 ± 17.68; bodily pain, 62.72 ± 28.72 and 81.54 ± 19.07; general health, 62.51 ± 25.57 and 84.47 ± 13.47; emotional well-being, 68.28 ± 23.46 and 82.63 ± 17.44; and social functioning, 72.87 ± 29.20 and 91.67 ± 17.44. The logistic regression model showed that role limitations due to physical health problems, physical function and emotional well-being were predictors of stages IIIB and IV. CONCLUSIONS: The patients with lung cancer had a poorer quality of life, especially regarding physical aspects, than did the control subjects.
- ItemSomente MetadadadosAvaliação da reprodutibilidade e da validade de critério das versões em português do Brasil dos questionários: European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) associado ao Quality of Life Questionnaire Lung Cancer (QLQ-LC13) e Functional Assessment of Cancer Therapy-Lung (FACT-L) com o FACT-L Symptom Index (FLSI)(Universidade Federal de São Paulo (UNIFESP), 2010-02-24) Pereira, Juliana Franceschini [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The assessment of quality of life in patients with lung cancer has become one of the main goal in current clinical trials. For lung cancer patients, the most common quality of life tools available are the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) + Quality of Life Questionnaire Lung Cancer (QLQ-LC13) and the Functional Assessment of Cancer Therapy-Lung (FACT-L). Despite the amount of data available about these questionnaires, there are no data on its performance in the Brazilian patients with lung cancer. The purpose of this study was to assess the reliability and the criterion validity of the Brazilian version of the EORTC QLQ-C30 + QLQ-LC13 and the FACT-L with the FACT-L Symptom Index (FLSI) questionnaires. Methods: The EORTC QLQ-C30 + QLQ-LC13 and FACT-L with the FLSI questionnaires were administered prospectively to 50 consecutive-stable-lung cancer outpatients. For the reliability study, the questionnaires were applied at baseline and 2 weeks. The criterion validity of the questionnaires was examined through correlation with clinical and functional parameters, Karnofsky scale and similar domains of SF-36. Results: The intraclass correlation coefficient between test and retest ranged from 0,64 to 1,0 for the QLQ-C30 and from 0,64 to 0,95 for the QLQ-LC13. For the FACT-L, it ranged from 0,79 to 0,96 and for the FLSI, it was 0,87. There was no correlation between these questionnaires dimensions and clinical or functional parameters. Several scores of the study questionnaires correlated well with Karnofsky scale. The EORTC QLQ-C30 + QLQ-LC13, and the FACT-L with the FLSI scales showed good correlation among their similar dimensions, moreover they had as well good correlation with the homologous SF-36 domains. Conclusions: The Brazilian version of the questionnaires EORTC QLQ-C30 + QLQ-LC13 and FACT-L with FLSI have good reliability, are simple, and have good correlation with the SF-36. These instruments can now be used to properly evaluate the quality of life of the Brazilian lung cancer patients.
- ItemSomente MetadadadosAvaliação nutricional em portadores de carcinoma broncogênico(Universidade Federal de São Paulo (UNIFESP), 1995) Jamnik, Sergio [UNIFESP]; Ratto, Octavio Ribeiro [UNIFESP]; Ratto, Octavio Ribeiro [UNIFESP]
- ItemAcesso aberto (Open Access)Câncer de pulmão: comparação entre os sexos(Sociedade Brasileira de Pneumologia e Tisiologia, 2000-12-01) Uehara, Cesar [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Jamnik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The importance of prognostic factors in the analysis of lung cancer clinical trials has long been recognized. In this paper, many prognostic factors were considered and their comparison between male and female group results were evaluated. The presence of symptoms at the time of diagnosis of lung cancer was not found to be different between women and men in this study. The women had a lower smoking incidence (45.7%) than men (90.6%). Squamous cell carcinoma represented the most common lung malignancy among men (40.6%), whereas adenocarcinoma represented the most frequently diagnosed lung cancer among women (57.1%). On the average, 45% of the patients had advanced disease at the moment of diagnosis. Compared with women, men had a higher prevalence of cachexia (40%).
- ItemSomente MetadadadosCancer de pulmão: correlação de aspectos clínicos, tomográficos e broncoscópicos(Universidade Federal de São Paulo (UNIFESP), 2000) Santoro, Ilka Lopes [UNIFESP]; Uehara, Cesar [UNIFESP]A neoplasia de pulmao e a principal causa de morte por cancer, independentemente da raca ou grupo etnico. As tendencias da taxa de incidencia do cancer de pulmao para cada grupo racial ou etnico varia, conforme sexo e idade, no momento do diagnostico. Consequentemente, nos decidimos estudar, atraves do modelo de risco proporcional de Cox, a importancia relativa de fatores potenciais de prognostico em uma amostra de 1013 pacientes portadores de cancer de pulmao. Como resultado, o Carcinoma Indiferenciado de Pequenas Celulas e indice de Karnofsky menor que 70 foram os mais importantes determinantes prospectivos de prognostico para diagnostico em menor espaco de tempo. Adicionalmente, pacientes do sexo masculino portadores de Carcinoma Indiferenciado de Pequenas Celulas, com idade inferior a 62 anos, indice de massa corporea menor que 18, indice de Karnofsky menor que 70 e sem nenhuma modalidade de tratamento, apresentaram o mais alto nivel de risco de obito. Nos selecionamos 180 pacientes portadores de neoplasia de pulmao, para o estudo das correlacoes. Era imperativo que eles tivessem a descricao broncoscopica original e os filmes da tomografia computadorizada de torax para acurado estadiamento da doenca. A maioria dos pacientes com Carcinoma Espinocelular apresentou tosse, expectoracao e indice de Karnofsky maior que 70. Eles tinham tumores localmente avancados (T4) e o envolvimento metastatico foi frequente. Eram tumores centrais. Em adicao, nos encontros broncoscopicos foram classificados como tumor nodular e apresentaram obstrucao do lume bronquico. Pacientes portadores de Adenocarcinoma tambem apresentaram indice de Karnofsky maior que 70. Tinham localizacao periferica, e metastases a distancia foram comumente encontradas. Tiveram tumor localmente avancado (T4) e, quando havia derrame pleural, este era frequentemente classe V de Papanicolaou. Os principais sintomas presentes em pacientes portadores de Carcinoma Indiferenciado de Pequenas Celulas foram dispneia e tosse. Sua localizacao mais frequente foi em lobo superior direito e classificado como tumor central. Eram localmente avancados, sem superficie de corte com o mediastino, e o derrame pleural foi frequente. Os achados broncoscopicos foram infiltracao com irregularidade de mucosa e estenose pelo infiltrado. Noventa por cento dos Carcinomas de Nao-Pequenas Celulas foram classificados como estadio 111 e IV, enquanto setenta e sete por cento dos
- ItemSomente MetadadadosCromofibrobroncoscopia com azul de toluidina para o diagnóstico de lesões pré-neoplásicas, neoplásicas e metaneoplásicas em brônquios centrais de tabagistas(Universidade Federal de São Paulo (UNIFESP), 1999) Goncalves, José Julio Saraiva [UNIFESP]; Leão, Luiz Eduardo Villaça [UNIFESP]Todo ano, morrem cerca de 3,5 milhoes de pessoas de doencas relacionadas ao cigarro, cerca de 10 mil/dia no mundo. Estima-se que o fumo mate 80 mil ao ano no pais e seja responsavel por 90 por cento das mortes por cancer de pulmao. Os fumantes, de maneira generica, tem uma probabilidade de apresentar cancer do pulmao 22 vezes maior do que os nao-fumantes, sendo que 90 por cento dos portadores de cancer de pulmao morre como consequencia. Latu sensu no cancer de pulmao, no momento do diagnostico, apenas 25 a 40 por cento sao ressecaveis e apenas 20 por cento dos casos tem doenca localizada sendo que 25 por cento ja apresentam disseminacao linfatica e 55 por cento tem metastases a distancia. Nos pacientes assintomaticos ha uma sobrevida de cinco anos de 45 por cento, ao passo que quando sintomatico, cai para menos de lO por cento. A sobrevida para cancer precoce central e de aproximadamente 100 por cento, sendo imperiosa a deteccao precoce do cancer de pulmao. Em pacientes grandes fumantes assintomaticos o rastreamento de cancer pode diagnosticar 20 por cento dos casos por citologia de escarro, 72 por cento por radiografia de torax e 6 por cento por ambos. As tecnicas de diagnostico precoce, via broncoscopia pareciam promissoras mas, LAM et ai. (l 993) demonstraram que a broncoscopia convencional detecta apenas lO-20 por cento das lesoes precoces (48,4 por cento de sensibilidade), isto devido as caracteristicas das lesoes, pois apresentam minimas diferencas em relacao ao epitelio normal e, na maioria dos casos, poucos milimetros de diametro com uma espessura de O,2 a l mm. Os corantes vitais sao amplamente utilizados no incremento diagnostico de lesoes superficiais, sendo o mais conhecido em uso o teste de SCHILLER (l933), para o diagnostico precoce do cancer de colo uterino com lugol. Estes corantes mostraram ser seguros e de extremo baixo custo; sua utilizacao na endoscopia convencional, foi uma evolucao natural, com grande sucesso, sendo utilizado em praticamente todas as endoscopias do tubo digestivo. Com o uso do corante vital na via aerea por TARKKANEN et al. (l972), e VAROLI et al. (l986) A.T., tambem SINEV et al. (l980) e OUCHINNIKOV et al. (l980) A.M. pode-se observar que os tecidos neoplasicos coravam em azul intenso. Estes ultimos foram os primeiros a utilizarem o termo cromobroncoscopia. Neste estudo utilizou-se o azul de toluidina em 57 pacientes, fumantes ou ex-fumantes, que quando submetidos a broncoscopia diagnostica ...(au)
- ItemSomente MetadadadosDerrame pleural em portadores de carcinoma broncogênico(Universidade Federal de São Paulo (UNIFESP), 1993) Jamnik, Sergio [UNIFESP]; Ratto, Octavio Ribeiro [UNIFESP]; Ratto, Octavio Ribeiro [UNIFESP]
- ItemAcesso aberto (Open Access)O diagnóstico do carcinoma metastático de coróide pela biópsia aspirativa com agulha fina (BAAF): relato de caso(Conselho Brasileiro de Oftalmologia, 2003-01-01) Corrêa, Zélia Maria da Silva [UNIFESP]; Irion, Luciane Cristina Dreher; Marcon, Ítalo Mundialino; Goldhardt, Raquel; Travi, Giovanni Marcos; Universidade Federal de São Paulo (UNIFESP); Fundação Faculdade Federal de Ciências Médicas de Porto Alegre; Serviço de Oftalmologia da Santa Casa de Porto Alegre; Santa Casa de Porto AlegrePURPOSE: To report a case of a patient with lung carcinoma in which the first detected metastasis was to the choroid, how it was diagnosed and confirmed. METHODS: A 35 year-old white male, while being treated for a solitary pulmonary condensation, reported sudden loss of vision, pain, discharge and red eye (right eye) for 10 days. During the ophthalmic examination a nonregmatogenous retinal detachment as well as multiple choroidal tumors were confirmed by diagnostic ocular ultrasound. Fine-needle aspiration biopsy (FNAB) was suggested to diagnose a possible metastatic disease. Fine-needle aspiration biopsy was performed under peribulbar anesthesia with sedation. A transvitreous route was chosen through a sclerotomy 4 mm from the limbus. The procedure was monitored via binocular indirect ophthalmoscopy. Two sample aspirates were obtained from different tumour foci. After fine-needle aspiration biopsy, the aspirates were sent for processing, fixation and stained with Papanicolaou and HE. RESULTS: Cytology confirmed the diagnosis of multiple metastatic tumors. Immunocytochemistry of ocular and lung aspirates revealed a common cell origin by a pankeratin (AE1/AE3) positive test. Regardless of systemic treatment with chemotherapy and improvement of the ocular status, the patient died 4 months after cytological diagnosis of metastatic carcinoma of the choroid. CONCLUSIONS: Fine-needle aspiration biopsy was efficient to diagnose and correlate ocular cytology with the primary tumor by imunohistochemical methods in this case. Fine-needle aspiration biopsy should still be used only in selected cases and further research will be necessary for it to become a standard diagnostic procedure in ophthalmology.
- ItemAcesso aberto (Open Access)Dirofilariose pulmonar humana: relato de sete casos(Sociedade Brasileira de Pneumologia e Tisiologia, 2002-04-01) Cavallazzi, Rodrigo Silva [UNIFESP]; Cavallazzi, Antônio César; Souza, Irene Vieira; Cardoso, João José de Deus; Universidade Federal de São Paulo (UNIFESP)Human pulmonary dirofilariasis is a rare disease caused by the parasite Dirofilaria immitis. It is usually seen as a solitary pulmonary nodule that mimics lung cancer. Although this disease is considered benign, its diagnosis often requires an excisional lung biopsy. Herein we report the epidemiological, clinical and radiological features observed in seven cases of human pulmonary dirofilariasis from Florianópolis. Six of our seven patients, showed a radiological finding of pulmonary nodule and underwent excisional lung biopsy for diagnosis. In one case, the radiological image was unavailable for review. Therefore, it was not described in this work, and the diagnosis was established through transbronchial biopsy.
- ItemAcesso aberto (Open Access)Doenças asbesto-relacionadas(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-05-01) Terra Filho, Mário; Freitas, Jefferson Benedito Pires De; Nery, Luiz Eduardo [UNIFESP]; Universidade de São Paulo (USP); Santa Casa de São Paulo Faculdade de Ciências Médicas Departamento de Medicina Social; Universidade Federal de São Paulo (UNIFESP)This chapter presents a bibliographic review of asbestos-related diseases. The latest diagnostic, radiological, computed tomography and lung function aspects of benign pleural disease, asbestosis, occupational lung cancer and mesothelioma are discussed.
- ItemAcesso aberto (Open Access)Escalas de risco de Torrington e Henderson e de Epstein: aplicabilidade e efetividade nas ressecções pulmonares(Sociedade Brasileira de Pneumologia e Tisiologia, 2005-08-01) Stanzani, Fabiana [UNIFESP]; Oliveira, Maria Alenita De [UNIFESP]; Forte, Vicente [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To compare the incidences of pulmonary and cardiopulmonary postoperative complications estimated using, respectively, the scoring systems devised by Torrington and Henderson and by Epstein in a populational sample undergoing lung resection for the treatment of lung cancer. METHODS: Prospective data from patients submitted to resection of one or more pulmonary lobes were selected from the databases of two tertiary-care hospitals. The outcome measures were pulmonary complications, cardiac complications and mortality rates. Fisher's exact test was used to evaluate the concordance between the predicted and observed complications. RESULTS: The Torrington and Henderson scoring system was applied to 50 patients, in which the risk was found to be mild in 12, moderate in 32, and high in 6. Although accurately identifying patients at high risk, the Torrington and Henderson scale underestimated the rate of postoperative cardiopulmonary complications in the mild and moderate risk categories (p = 0.0003 and p = 0.0006, respectively). The Epstein scoring system was applied to 38 patients, 4 of which were found to be at high risk, and 34 of which were found to be at mild risk. The Epstein scale also underestimated the risk in the patients (the majority) that were classified as being at mild risk (p < 0.0001) and yet, like the Torrington and Henderson scale, accurately identified those at high risk. CONCLUSION: Neither of the two scoring systems analyzed were found to be appropriate for predicting the risk of pulmonary and cardiopulmonary complications in most cases.
- ItemAcesso aberto (Open Access)Estudo comparativo dos fatores prognósticos entre os pacientes com maior e menor sobrevida em portadores de carcinoma broncogênico(Sociedade Brasileira de Pneumologia e Tisiologia, 2002-09-01) Jamnik, Sergio [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Uehara, Cesar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Despite the improvements seen in the treatment of lung cancer, little has improved in the survival of these patients, and a great importance is attributed to the factors that have a role to play in such survival. Purpose: To check for possible prognostic factor differences in two populations of lung cancer patients, one of them with short survival (less than six months), and the other with longer survival (more than 24 months). Methods: From 1997 to 1999, 52 patients with histopathologic diagnosis of homogenous carcinoma were studied, and demographics, clinical parameters, smoking pattern, Karnofsky's index, disease staging, and laboratory dosing of lactic dehydrogenase, alkaline phosphatase, carcinoembryonic antigen, and calcium data were surveyed. Results: 29 patients had less than six month survival, and 23 had more than 24 month survival. The three most important factors for short survival were the low initial Karnofsky's index, loss of appetite, and high serum LDH levels. Conclusion: The three prognosis components are: current physical status, prior physical status, and current status of the disease.
- ItemSomente MetadadadosExtração de antígeno tumoral de câncer de pulmão humano e avaliação pelo teste de inibição de migração de leucócitos(Universidade Federal de São Paulo (UNIFESP), 1986) Mattar, Rejane [UNIFESP]; Mendes, Nelson Figueiredo [UNIFESP]
- ItemAcesso aberto (Open Access)Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life(Soc Brasileira Pneumologia Tisiologia, 2017) Borges, Eliana Lourenco [UNIFESP]; Franceschini, Juliana [UNIFESP]; Costa, Luiza Helena Degani [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Jamnik, Sergio [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.
- ItemAcesso aberto (Open Access)Localização do carcinoma pulmonar em relação ao vício tabágico e ao sexo(Sociedade Brasileira de Pneumologia e Tisiologia, 2006-12-01) Jamnik, Sergio [UNIFESP]; Uehara, Cesar [UNIFESP]; Silva, Vilmer Vieira da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To analyze the locations of lung carcinomas in relation to patient gender and smoking status. METHODS: In order to test the hypothesis that lung carcinoma location (upper or lower lobe; left or right side) is correlated with smoking status and gender, we conducted a retrospective study of 697 patients with bronchogenic carcinoma treated at the Pulmonology-Oncology Outpatient Clinic of the Federal University of São Paulo. RESULTS: We found that the bronchogenic carcinomas occurring in smokers were more frequently located in the upper lobes, whereas those occurring in nonsmokers were more frequently located in the lower lobes. In women, the neoplasms were more often seen in the lower lobes, especially in nonsmokers. Based on the available data, there were no differences in terms of the side affected (left or right). CONCLUSION: Overall, bronchogenic carcinomas are predominantly found in the upper lobes. However, in nonsmokers, they occur more frequently in the lower lobes. In females, bronchogenic carcinomas present a tendency to occur more often in the lower lobes.
- ItemAcesso aberto (Open Access)Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients(Sociedade Brasileira de Pneumologia e Tisiologia, 2014-01-01) Stanzani, Fabiana; Paisani, Denise de Moraes [UNIFESP]; Oliveira, Anderson de; Souza, Rodrigo Caetano de; Perfeito, João Aléssio Juliano [UNIFESP]; Faresin, Sonia Maria; Universidade Federal de São Paulo (UNIFESP); Arnaldo Vieira de Carvalho Cancer InstituteOBJECTIVE:To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs).METHODS:This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010.RESULTS:Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs.CONCLUSIONS:Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies.
- ItemAcesso aberto (Open Access)Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil(Sociedade Brasileira de Pneumologia e Tisiologia, 2013-02-01) Franceschini, Juliana [UNIFESP]; Jardim, José Roberto [UNIFESP]; Fernandes, Ana Luisa Godoy [UNIFESP]; Jamnik, Sergio [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Lung cancer patients often experience profound physical and psychosocial changes as a result of disease progression or treatment side effects. Fatigue, pain, dyspnea, depression, and sleep disturbances appear to be the most common symptoms in such patients. The objective of the present study was to examine the prevalence of symptoms in lung cancer patients in order to identify subgroups (clusters) of patients, grouped according to the magnitude of the symptoms, as well as to compare the quality of life among the identified subgroups. METHODS: A cross-sectional study involving agglomerative hierarchical clustering. A total of 50 lung cancer patients were evaluated in terms of their demographic characteristics and their scores on three quality of life questionnaires, namely the 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the Functional Assessment of Cancer Therapy-Lung, and the Medical Outcomes Study 36-item Short-form Survey. The cluster analysis took into account the magnitude of the most prevalent symptoms as assessed by the EORTC QLQ-C30 symptom scale scores; those symptoms were fatigue, pain, dyspnea, and insomnia. RESULTS: Three clusters (subgroups)_of patients were identified on the basis of the magnitude of the four most prevalent symptoms. The three subgroups of patients were as follows: patients with mild symptoms (n = 30; 60%); patients with moderate symptoms (n = 14; 28%); and patients with severe symptoms (n = 6; 12%). The subgroup of patients with severe symptoms had the worst quality of life, as assessed by the total scores and by the integrated domains of all three instruments. CONCLUSIONS: This study highlights the importance of symptom cluster assessment as an important tool to assess the quality of life of patients with chronic diseases, such as lung cancer.
- ItemAcesso aberto (Open Access)Síndrome mascarada como primeira manifestação de adenocarcinoma pulmonar: relato de caso e revisão de literatura(Conselho Brasileiro de Oftalmologia, 2003-01-01) Farias, Charles Costa De; Garcia, Claudio Renato; Muccioli, Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To describe a case of masquerade syndrome as the first manifestation of lung adenocarcinoma. METHODS: A 57- year-old female was referred with a 6-month history of blurred vision in her right eye. She was treated for relapsing uveitis but signs and symptons remained despite treatment with topical steroids. On physical examination she had conjuctival hyperemia, moderate cilliary injection and choroidal peripapillary lesion. Ancillary examinations were requested. RESULTS: A lung adenocacirnoma was diagnosed as the primary lesion. The choroidal peripapillary lesion in her right eye was consistent with the appearance of a choroidal metastatic lesion. CONCLUSIONS: The incidence of uveal metastasis ranges from 0.7 to 12% in patients with pulmonary tumors. Treatment depends on characteristics such as size of the lesion, number of metastases, visual acuity, bilaterality and the patient´s general health. As confirmed by this case, ocular involvement may be the first clinical manifestation of lung adenocarcinoma.
- ItemAcesso aberto (Open Access)Survival in a cohort of patients with lung cancer: the role of age and gender in prognosis(Soc Brasileira Pneumologia Tisiologia, 2017) Franceschini, Juliana Pereira [UNIFESP]; Jamnik, Sergio [UNIFESP]; Santoro, Ilka Lopes [UNIFESP]Objective: To determine the demographic and clinical characteristics of patients with non-small cell lung cancer (NSCLC), as well as their disease course, by age group and gender. Methods: This was a retrospective cohort study of patients diagnosed with NSCLC from 2000 to 2012 and followed until July 2015 in a tertiary referral hospital in the city of Sao Paulo, Brazil. Based on the 25th and 75th percentiles of the age distribution, patients were stratified into three age groups: < 55 years; >= 55 and < 72 years; and >= 72 years. Survival time was evaluated during the follow-up period of the study. Functions of overall and gender-specific survival stratified by age groups (event: all-cause mortality) were calculated using the Kaplan-Meier method. Differences among survival curves were assessed via the log-rank test. Results: We included 790 patients with the following age distribution: < 55 years, 165 patients; >= 55 and < 72 years, 423; and >= 72 years, 202. In the entire sample, there were 493 men (62.4%). Adenocarcinoma was the most common histological pattern in the < 72-year age groups; 575 patients (73%) presented with advanced disease (stages IIIB-IV). The median 5-year survival was 12 months (95% CI: 4-46 months), with no significant differences among the age groups studied. Conclusions: NSCLC remains more common in men, although we found an increase in the proportion of the disease in women in the < 55-year age group. Adenocarcinoma predominated in women. In men, squamous cell carcinoma predominated in the >= 72-year age group. Most patients presented with advanced-stage disease at diagnosis. There were no statistical differences in survival between genders or among age groups.
- ItemAcesso aberto (Open Access)Trabalho industrial e câncer de pulmão(Faculdade de Saúde Pública da Universidade de São Paulo, 1995-06-01) Wünsch Filho, Victor; Magaldi, Cecília; Nakao, Neusa; Moncau, José Eduardo Cajado [UNIFESP]; Secretária de Estado da Saúde Instituto de Saúde Núcleo de Investigação em Trabalho e Saúde; Universidade de São Paulo (USP); Universidade Estadual Paulista (UNESP); Universidade Federal de São Paulo (UNIFESP)In a hospital-based case-control study, 316 lung cancer cases and 536 controls were interviewed for their occupational, smoking, passive smoking, cancer in the family and residential histories as well as social economic status, by trained interviewers, using a standardized questionnaire. Cases and controls were matched by hospital, sex and age. The study was carried out between 1st July 1990 and 31st January 1991 in 14 hospitals in the Metropolitan Region of S. Paulo, the most highly industrialized and urbanized region in Brazil. Score criteria were developed for the ordering of the individuals of the study by occupational exposure to know carcinogens to the lung, in order to evaluate this exposure during the occupational life of each person. The criteria accumulated information on exposure to carcinogens as regards type, sector of work and time in each employment. The unconditional logistic regression analysis showed an odds ratio of 1.97 (95% IC: 1.52 to 2.55) for the highest exposure group. This result showed that workers linked to the production sectors of several industries have about twice the risk of developing lung cancer as workers involved in non-industrial activities.