[Bioethics and nutrition in adult patients with cancer in palliative care]

Survival of patients with advanced cancer in Enteral Nutritional Therapy: a comparison between caloric estimates

ABSTRACT Objective To assess factors related to the achievement of the caloric estimates of enteral nutritional therapy and the survival of patients with advanced cancer in exclusively palliative care. Methods Retrospective study, where patients using enteral nutrition admitted from March 2019 to February 2020 were divided into two groups: Group 1 included patients who reached 75% of the estimated caloric goals, and Group 2 included those who did not. The data were extracted from the patients’ electronic medical records. Logistic regression analyzes were performed to assess associations between the studied sociodemographic, clinical, and nutritional variables, and the Kaplan-Meier curve and Cox regression were used to assess the survival of the groups. Results A total of 158 patients participated in the study, with a median age of 63 (IIQ: 55-70) years. 57% reached the caloric goal (Group 1). In the logistic regression, the functional capacity (OR: 5.82; CI: 2.28-14.84; p<0.001) and symptoms of nausea or vomiting (OR: 0.050; CI: 0.005-0.455; p=0.008) were independent variables for achieving the caloric goal. Cox regression showed Karnofsky Performance Status as an independent predictor for survival (HR: 1.85; CI: 1.13-3.04). Conclusion Patients with better functionality have longer survival and are potential candidates for reaching the caloric goals proposed by national and international guidelines for cancer patients.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: children and adolescents

The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Children and Adolescents was developed by dietitians, physicians, and pediatric hematologists from 10 Brazilian reference centers in hematopoietic stem cell transplantation. The aim was to emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to patient´s nutritional assessment. This consensus is intended to improve and standardize nutrition therapy during hematopoietic stem cell transplantation. The consensus was approved by the Brazilian Society of Bone Marrow Transplantation.

Speech therapy aspects in patients’ palliative care

ABSTRACT Purpose: to describe the speech therapy aspects of patients treated by the palliative care team in a hospital. Methods: an observational and cross-sectional study, performed from medical records of patients treated under Palliative Care Program, in a hospital, from July to September 2018. Information from the anamnesis and speech-language assessments, which were analyzed by frequency measures, were collected. Results: the sample was composed by 41 medical records, including 25 males and 16 females, with an average age of 61.2 years and hospitalization average time of 20.7 days. Oral feeding was present in 73% of the sample. It was observed that 24% of the patients had impaired expressive language, 56% had reduced maximum phonation times and 34% showed altered mobility phonoarticulatory organs. For swallowing, 22% showed difficulty in some consistency. A nutritional feeding was verified in 74% of the sample and the remaining was making use of comfort feeding. In relation to assistance, 46% of the sample was under management, 7% in therapy, and the remaining did not have follow-up indication. Conclusion: relevant alterations to orofacial motricity, voice, language and swallowing were found in patients under palliative care.

GLOBAL Leukemia in Children 0-14 Statistics 2018, Incidence and Mortality and Human Development Index (HDI): GLOBOCAN Sources and Methods

OBJECTIVE

Cancer is the second leading cause of death in children under 15 and leukemia is the most common type of cancer in this age group.  The aim of the present study is to investigate the incidence and mortality of leukemia in children aged 0-14 years and its relationship with Human Development Index (HDI in different countries of the world.  Methods: Incidence and mortality rates were obtained from GLOBOCAN and Country's income from World Bank. The data analysis was conducted using correlation analysis. The association of incidence and mortality rates with HDI was investigated using linear regression models.

RESULTS

The results revealed a significant positive correlation between the incidence rate and Gross National Income per capita (r = 0.464, P <0.0001), mean years of schooling (r = 0.566, P <0.0001), life expectancy at birth (r = 0.712, P <0.0001) and expected years of schooling (r = 0.604, P <0.0001). The results also demonstrated a positive and significant correlation between mortality rate and life expectancy at birth (r = 0.199, P <0.0001). An improvement in HDI [Beta = 7.7, CI95% (0.1, 15.3)] and life Expectancy at birth [Beta = 0.1, CI95% (0.03, 0.1)] caused a significantly rise in the incidence of leukemia. Moreover, the improved HDI [Beta = 6.2, CI95% (1.9, 10.5)] was associated with increased mean years of schooling [Beta = -0.1, CI95% (-0.2, -0.01)] and expected years of schooling [Beta = -0.1, CI95% (-0.3, -0.08).

CONCLUSION

As the HDI increases, incidence and mortality from of leukemia increases indicating a change in factors that affects leukemia incidences.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly

The Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly was elaborated by nutritionists, nutrologists and hematologists physicians from 15 Brazilians reference centers in hematopoietic stem cell transplantation, in order to emphasize the importancy of nutritional status and the body composition during the treatment, as well as the main characteristics related to patient's nutritional assessment. Establishing the consensus, we intended to improve and standardize the nutritional therapy during the hematopoietic stem cell transplantation. The Consensus was approved by the Brazilian Society of Bone Marrow Transplantation.

Incidence and management of chemotherapy-induced nausea and vomiting in women with breast cancer

The objective of this study was to analyze the incidence of chemotherapy-induced nausea and vomiting in women with breast cancer and identify strategies used by them to control these signs and symptoms. Data for this cross-sectional study were collected through interviews during the last cycle of chemotherapy, between August 2011 and March 2012, in a university hospital in the State of São Paulo. The sample consisted of 22 women between the ages of 31 and 70, of whom 77.3% reported nausea and 50% vomiting during treatment. Regarding symptom management, 82% of the women reported having received some information centered on the use of prescribed medication. However, 27.3% did not know what medication they had taken. We concluded that there is a lack of systematic care and institutional protocol to guide professionals in providing standardized information to women so they can better control nausea and vomiting.

Cuidados paliativos na assistência hospitalar: a vivência de uma equipe multiprofissional

Trata-se de um estudo qualitativo, exploratório e descritivo, que objetivou conhecer a vivência de uma equipe multiprofissional no cuidado paliativo no contexto hospitalar. Participaram do estudo seis membros de uma equipe multiprofissional de saúde, que atende pacientes em cuidados paliativos, de um Hospital Escola no Sul do Brasil. Identificou-se que os profissionais, ao iniciarem sua trajetória de cuidado na terminalidade, referiram frustração e impotência. Contudo, a experiência fez com que encontrassem novos significados para o cuidado prestado, passando a entender a morte como evento natural da vida e a importância de garantir qualidade de vida e conforto ao paciente. Os participantes relataram a necessidade do fortalecimento da comunicação, do trabalho em equipe e de um espaço para discutirem a terminalidade. Assim, a atenção hospitalar deve atender as necessidades do paciente em cuidados paliativos e família, articulando e promovendo ações que garantam o alívio dos sofrimentos e uma sobrevida digna.