O Impacto dos Sintomas Orais Gerados por Quimioterapia e Radioterapia / The Impact of Oral Symptoms Generated by Chemotherapy and Radiotherapy

Os primeiros efeitos da radioterapia e da quimioterapia antineoplásica acontecem sobre as células do epitélio oral, as quais sofrem rápida proliferação. O tamanho destes efeitos depende de muitos fatores ligados ao tratamento, ao paciente e ao tumor. No que se trata do paciente, interferem nesse processo o seu estado geral de saúde, presença de comorbidades, sexo, estado nutricional, idade, fatores sociais e psicológicos, além de hábitos deletérios e patologias orofaciais preexistentes. Esses adoecimentos na integridade bucal devem-se a veracidade de que a radioterapia e quimioterapia não são capazes de destruir as células tumorais sem lesionar células normais. O tratamento oncológico pode provocar reações adversas na cavidade oral, e é comum, em pacientes oncológicos submetidos ao tratamento antineoplásico, o desenvolvimento de agravamentos orais agudos ou tardios.---The first effects of radiotherapy and antineoplastic chemotherapy happen on the cells of the oral epithelium, which quickly notice proliferation. The size of these effects depends on many factors related to the treatment, the patient, and the tumor. With regard to the patient, this process interferes with their general health status, presence of comorbidities, gender, nutritional status, age, social and psychological factors, in addition to deleterious habits and pre-existing orofacial pathologies. These illnesses in the oral integrity are due to the veracity that radiotherapy and chemotherapy are not capable of destroying tumor cells without normal cells. Oncological treatment can cause adverse reactions in the oral cavity, and it is common, in cancer patients, to antineoplastic treatment, to develop acute or late oral aggravations.

Defining cytotoxic drugs – you know it when you see it?

Safe handling precautions are an important measure used to prevent occupational exposure to hazardous antineoplastic drugs. Historically, the terms ‘antineoplastic’, ‘chemotherapy’ and ‘cytotoxic’ are frequently conflated. However, many current antineoplastic drugs do not have cytotoxic mechanisms of actions, leading to confusion when developing safe handling policies. Based on the mechanistic criteria outlined in this review, we have compiled a list of the most commonly used antineoplastic drugs with their cytotoxic or non-cytotoxic designations. We propose that this list can be used when discussing drug-specific safe handling precaution measures.

Occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy

ABSTRACT Objective To analyze the occurrence of occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy. Method Retrospective cohort, with 156 medical records of patients aged 0-19 years who underwent outpatient chemotherapy between 2013 and 2017 by this catheter, in a hospital in the city of Rio de Janeiro. Descriptive and inferential statistics were applied. Results 219 catheters were registered. Occlusion occurred in 141 (64.4%) catheters; 63 (44.7%) were removed because of occlusion, either alone or associated with another factor. Total occlusion alone led to the removal of 27 (12.3%) catheters. Occlusion was associated with: catheter dwell time, cyclophosphamide, neuroblastoma, bone metastasis and number of chemotherapy sessions. Conclusion Occlusion is an important complication because it occurred in more than half of the catheters and was one of the main reasons for withdrawal. The identified risk factors may guide the care to prevent this complication.

Ability for self-care in clients undergoing antineoplastic chemotherapy treatment

To identify the self-care capacity of cancer clients treated at the chemotherapy service of a university hospital in Minas Gerais/Brazil. This is a cross-sectional study conducted with 79 adult and elderly participants diagnosed with primary cancer on antineoplastic chemotherapy treatment. Two instruments were used to achieve the proposed objective, one created by the authors for sociodemographic characterization and another translated, adapted and validated to Brazilian Portuguese to assess the capacity of self-care, namely, the Appraisal of Self Care Agency Scale-Revised, the ASAS-R. Most respondents were female (50.6%), married (58.2%), had between five and nine years of schooling (43.0%), had a family income of one to three minimum wages (86.1%) and were predominantly elderly (54.4%). The mean score obtained for self-care capacity was 57.8. A dichotomy between the patients' usual chores and their diagnoses was observed, but the participants also stated that they dedicate time and were willing to take care of their health. They also stated that they looked for the best ways to take care of themselves and sought updated information whenever necessary, although no statistically significant association was found between self-care scores and sociodemographic variables. This study allowed to show that sociodemographic variables such as education, income, religion and cohabitation should be taken into account by health professionals to favor the client's engagement in self-care actions.

Prevention and conduct against the Extravasation of antineoplastic chemotherapy: a scoping review

ABSTRACT Objectives: to identify and synthesize scientific evidence on prevention and management of extravasation of antineoplastic agents in adult patients by nurses. Methods: scoping review, according to Joanna Briggs Institute and PRISMA-ScR. Research was conducted in five electronic databases, Cochrane Library and eight catalogs of theses and dissertations. Data collection occurred from April to July 2018, with no time limit. The extracted data were analyzed and synthesized in a narrative way. Results: a total of 3,110 records were retrieved and 18 studies were kept for review. Most publications (66.6%) had a qualitative approach and addressed both aspects, i.e., prevention and management of extravasation of chemotherapy in adult patients. Conclusions: the implementation of protocols based on scientific evidence on prevention and management of extravasation of antineoplastic agents is paramount in order to provide patient safety and support to the nursing staff.

Educational technology for fatigue management related to antineoplastic chemotherapy

ABSTRACT Objective: To construct and validate an educational technology (ET) on fatigue and non-pharmacological strategies for the management of this symptom in people with cancer undergoing outpatient antineoplastic chemotherapy. Method: This is a methodological study composed of three stages: 1) elaboration of the ET using the theoretical-methodological model of Doak, Doak and Root; 2) validation of content and appearance by seven nurses via the content validity index (CVI); and 3) a pilot test with 10 patients. Results: The ET “Knowing and coping with fatigue” contemplates the definition of fatigue, its causes and the interventions of physical exercise practice, sleep hygiene, energy conservation and behavioral intervention. The overall CVI obtained with the judges was 0.95. Conclusion: The ET presented content and appearance validity for health education regarding fatigue related to antineoplastic chemotherapy in outpatient cancer patients.