Juliana Franceschini

Pressões respiratórias máximas e capacidade vital: comparação entre avaliações através de bocal e de máscara facial

INTRODUCAO: A medida das pressoes respiratorias maximas e a capacidade vital sao importantes na avaliacao da funcao pulmonar, no entanto, variacoes metodologicas podem interferir na interpretacao dos resultados obtidos. OBJETIVO: Comparar os valores das pressoes respiratorias maximas e da capacidade vital, obtidos atraves de bocal e de mascara facial. METODO: Foram estudados 30 pacientes (16 homens), com idade de 55,9 ± 15,7 anos, em periodo pre-operatorio de cirurgia abdominal. As variaveis pressao inspiratoria maxima, pressao expiratoria maxima e capacidade vital foram avaliadas atraves de um bocal rigido achatado e de uma mascara facial, em ordem randomizada. RESULTADOS: A avaliacao com mascara facial nao alterou de forma significativa os valores de capacidade vital e pressao inspiratoria maxima, porem a pressao expiratoria maxima foi significantemente menor do que quando avaliado com bocal rigido. A presenca de escape aereo ao redor da mascara durante a medida da pressao expiratoria maxima foi observada em 60% das avaliacoes. Quando consideradas apenas as medidas de pressao expiratoria maxima avaliadas sem a presenca de escape de ar, os valores com o uso da mascara foram maiores do que os com o bocal. CONCLUSAO: A avaliacao da pressao inspiratoria maxima e capacidade vital pode ser realizada com uso de mascara facial, sem interferencia nos resultados obtidos. A avaliacao da pressao expiratoria maxima atraves de mascara facial mostrou-se adequado quando foi possivel evitar o escape de ar ao redor da mascara, porem a grande prevalencia de vazamentos e a consequente reducao dos valores obtidos na avaliacao tornam seu uso limitado.

Reprodutibilidade da versão em português do Brasil do European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire em conjunto com seu módulo específico para câncer de pulmão

OBJECTIVE: The assessment of the quality of life in patients with lung cancer has become one of the main goals in current clinical trials. To assess the quality of life of these patients, the most widely used instrument is the 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) in conjunction with its supplemental 13-item lung cancer-specific module (QLQ-LC13). The objective of this study was to assess the reproducibility of the Brazilian Portuguese version of these questionnaires. METHODS: A prospective study involving 30 stable outpatients with lung cancer who completed the instruments on the first day of the study and two weeks later. RESULTS: The test-retest reproducibility using the intraclass correlation coefficient for the EORTC QLQ-C30 and the QLQ-LC13 ranged from 0.64 to 1.00 and from 0.64 to 0.95, respectively. No correlations were found between the domains of the instruments and clinical parameters. CONCLUSIONS: Our findings show that these instruments were reproducible in this sample of patients with lung cancer in Brazil.

Non-small cell lung cancer in never smokers: a clinical entity to be identified

OBJECTIVES: It has been recognized that patients with non-small cell lung cancer who are lifelong never-smokers constitute a distinct clinical entity. The aim of this study was to assess clinical risk factors for survival among never-smokers with non-small cell lung cancer. METHODS: All consecutive non-small cell lung cancer patients diagnosed (n = 285) between May 2005 and May 2009 were included. The clinical characteristics of never-smokers and ever-smokers (former and current) were compared using chi-squared or Students t tests. Survival curves were calculated using the Kaplan-Meier method, and log-rank tests were used for survival comparisons. A Cox proportional hazards regression analysis was evaluated by adjusting for age (continuous variable), gender (female vs. male), smoking status (never- vs. ever-smoker), the Karnofsky Performance Status Scale (continuous variable), histological type (adenocarcinoma vs. non-adenocarcinoma), AJCC staging (early vs. advanced staging), and treatment (chemotherapy and/or radiotherapy vs. the best treatment support). RESULTS: Of the 285 non-small cell lung cancer patients, 56 patients were never-smokers. Univariate analyses indicated that the never-smoker patients were more likely to be female (68% vs. 32%) and have adenocarcinoma (70% vs. 51%). Overall median survival was 15.7 months (95% CI: 13.2 to 18.2). The never-smoker patients had a better survival rate than their counterpart, the ever-smokers. Never-smoker status, higher Karnofsky Performance Status, early staging, and treatment were independent and favorable prognostic factors for survival after adjusting for age, gender, and adenocarcinoma in multivariate analysis. CONCLUSIONS: Epidemiological differences exist between never- and ever-smokers with lung cancer. Overall survival among never-smokers was found to be higher and independent of gender and histological type.

Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil

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.OBJETIVO: Muitas vezes pacientes com câncer de pulmao vivenciam mudancas fisicas e psicossociais profundas que resultam da progressao da doenca ou dos efeitos colaterais do tratamento. Fadiga, dor, dispneia, depressao e disturbios do sono parecem ser os sintomas mais comuns nesses pacientes. O objetivo deste estudo foi examinar a prevalencia de sintomas em pacientes com câncer de pulmao a fim de identificar subgrupos (clusters) de pacientes, agrupados de acordo com a magnitude dos sintomas, bem como comparar os subgrupos quanto a qualidade de vida. METODOS: Estudo transversal utilizando agrupamento hierarquico aglomerativo. Foram avaliadas as caracteristicas demograficas de 50 pacientes com câncer de pulmao, bem como sua pontuacao em tres questionarios de qualidade de vida: o 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), o Functional Assessment of Cancer Therapy-Lung e o Medical Outcomes Study 36-item Short-form Survey. A analise de agrupamentos (clusters) levou em conta a magnitude dos sintomas de maior prevalencia de acordo com as escalas de sintomas do EORTC QLQC-30; esses sintomas foram fadiga, dor, dispneia e insonia. RESULTADOS: Foram identificados tres agrupamentos (subgrupos) de pacientes, baseados na magnitude dos quatro sintomas mais prevalentes. Os tres subgrupos de pacientes foram os seguintes: pacientes com sintomas leves (n = 30; 60%); pacientes com sintomas moderados (n = 14; 28%) e pacientes com sintomas graves (n = 6; 12%). O subgrupo de pacientes com sintomas graves apresentou a pior qualidade de vida, conforme mensurada pelos escores totais e pelas dimensoes integradas dos tres instrumentos. CONCLUSOES: Este estudo destaca a importância da avaliacao de agrupamentos de sintomas como uma ferramenta relevante para medir a qualidade de vida de pacientes com doencas cronicas, como o câncer de pulmao.

Do Current Lung Cancer Screening Guidelines Apply for Populations With High Prevalence of Granulomatous Disease? Results From the First Brazilian Lung Cancer Screening Trial (BRELT1)

BACKGROUND Low-dose computed tomography (LDCT) screening for lung cancer has been demonstrated to be effective in reducing cancer mortality. However, these studies have not been undertaken in countries where the incidence of granulomatous disease is high. The First Brazilian Lung Cancer Screening Trial (BRELT1) has completed initial accrual and is now in the follow-up phase. We present results from the initial prevalence round of screening. METHODS The inclusion criteria were the same as those for the National Lung Cancer Screening Trial (NLST). Pulmonary nodules larger than 4 mm were considered positive and required evaluation by a multidisciplinary team. Indeterminate nodules were evaluated with fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) or biopsy when indicated. Statistical analysis was performed with Fishers exact test to compare our positive findings with those of the NLST. RESULTS From January 2013 to July 2014, 790 participants were enrolled. Positive LDCT scans were reported in 312 (39.4%) participants, with a total of 552 nodules larger than 4 mm. The comparison between positive findings in the NLST (7,191 of 26,722 cases) and those in the BRELT1 (312 of 790 cases) showed a significant difference (p < 0.001). The positive predictive value was lower in BRELT1 than in the NLST (3.2% versus 3.8%, respectively). Follow-up imaging was indicated in 278 of 312 (89.1%) participants; 35 procedures were performed in 25 participants. In 15 cases, benign lesions were diagnosed. Non-small-cell lung cancer (NSCLC) was diagnosed in 10 patients (prevalence of 1.3%). In 8 patients (stage IA/IB disease), treatment was by resection only, in 1 patient neoadjuvant chemotherapy was used (stage IIIA), and in 1 patient advanced disease was diagnosed (stage IV). CONCLUSIONS Using NSLT criteria, a larger number of patients had positive scans (nodules), compared with previous lung cancer screening studies. However, the number of participants requiring surgical biopsy procedures and who were ultimately identified as having cancer was similar to other reports. This supports the role of screening in patient populations with a high incidence of granulomatous inflammation.

Challenges in Lung Cancer Screening in Latin America

Lung cancer is the deadliest cancer worldwide and is of particular concern for Latin America. Its rising incidence in this area of the world poses myriad challenges for the region’s economies, which are already struggling with limited resources to meet the health care needs of low- and middle-income populations. In this environment, we are concerned that regional governments are relatively unaware of the pressing need to implement effective strategies for the near future. Low-dose chest computed tomography (LDCT) for screening, and routine use of minimally invasive techniques for diagnosis and staging remain uncommon. According to results of the National Lung Screening Trial, LDCT lung cancer screening provided a 20% relative reduction in mortality rates among at-risk individuals. Nevertheless, this issue is still a matter of debate, particularly in developing countries, and it is not fully embraced in developing countries. The aim of this article is to provide an overview of what the standard of care is for lung cancer computed tomography screening around the world and to aid understanding of the challenges and potential solutions that can help with the implementation of LDCT in Latin America.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions

❚ RESUMO Objetivo: Descrever os resultados da utilização de punção aspirativa por agulha guiada por ultrassom endobrônquico na definição do diagnóstico em casos de lesões mediastinais por diferentes causas. Métodos: Estudo transversal retrospectivo de pacientes submetidos à punção aspirativa por agulha guiada por ultrassom endobrônquico em instituição privada, entre junho de 2013 e outubro de 2016. Foram incluídos todos os casos referenciados para coleta de materiais de linfonodos ou massas peritraqueais/peribrônquicas por punção aspirativa por agulha guiada por ultrassom endobrônquico, estudados com tomografia ou PET-CT. Os procedimentos foram realizados por pneumologistas intervencionistas e cirurgiões torácicos com experiência no método. Rapid on-site evaluation da punção aspirativa por agulha fina foi realizada por patologista experiente. A análise do material incluiu citologia dos esfregaços em lâminas e análise citopatológica do emblocado celular. Outras análises específicas (imunocitoquímica, pesquisas e culturas de agentes infecciosos) foram realizadas se necessárias. Resultados: Foram incluídos 72 pacientes; destes, 6 foram excluídos por apresentarem lesões endobrônquicas passíveis de biópsia broncoscópica convencional ou lesões intratorácicas não acessíveis a punção aspirativa por agulha guiada por ultrassom endobrônquico. Assim, a média de idade dos 66 pacientes incluídos para análise foi 61,17 anos (±14,67 anos), com predomínio do sexo masculino (64%). A punção aspirativa por agulha guiada por ultrassom endobrônquico foi definitivo para o diagnóstico em 60 casos (91%). Três casos (4,5%) foram inconclusivos. Não houve complicações maiores relacionadas ao procedimento. Conclusão: A punção aspirativa por agulha guiada por ultrassom endobrônquico teve elevado rendimento diagnóstico, com mínima morbidade, constituindo excelente opção na abordagem diagnóstica de pacientes com linfadenopatia ou lesões intratorácicas e no estadiamento de neoplasias.

Punção aspirativa por agulha guiada por ultrassom endobrônquico (EBUS-TBNA) no diagnóstico de lesões do mediastino

ABSTRACT Objective To describe the results of endobronchial ultrasound-guided transbronchial needle aspiration in making diagnosis of mediastinal injuries associated to different causes. Methods A retrospective cross-sectional study of patients submitted to Endobronchial ultrasound-guided transbronchial needle aspiration at a private organization, between June 2013 and October 2016. All cases referred for collection of lymph nodes or peritracheal/peribronchial masses by endobronchial ultrasound-guided transbronchial needle aspiration, and evaluated through tomography or PET-CT were included. Interventional pulmonologists and thoracic surgeons with experience in the method did the procedures. Rapid on-site evaluation of fine needle aspiration was performed by an experienced pathologist. Material analysis included cytological smear and cytopathological analysis of paraffin-embedded cell blocks. Other specific analyses (immunocytochemistry, tests and cultures of infectious agents) were performed whenever necessary. Results We included 72 patients; 6 were excluded for presenting endobronchial lesions in which bronchoscopic biopsy could be performed, or intrathoracic lesions that were not accessible by endobronchial ultrasound-guided transbronchial needle aspiration. The mean age of 66 patients included for analysis was 61.17 years (±14.67 years), with a predominance of males (64%). Endobronchial ultrasound-guided transbronchial needle aspiration was definitive for diagnosis in 60 cases (91%). Three cases (4.5%) had inconclusive test results. There were no major complications related to the procedure. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration had a high diagnosis yield, with minimal morbidity, being an excellent option for diagnostic approach of patients with lymphadenopathy or intrathoracic lesions, and for neoplasm staging.

Burnout syndrome: prevalence in health professionals working in the area of oncology

Healthcare professionals who work in the area of caregiving are responsible for the ongoing care of patients and therefore are more vulnerable to burnout. The objective of this study is to evaluate the levels of stress in health professionals, and to analyze the quality of life, and the level of anxiety and depression among these individuals. A cross-sectional study was carried out with professionals working in the oncology unit, both men and women, over 18 years of age, who agreed to participate in the study and signed an informed consent form. Participants completed the evaluation form and completed the SF-36 Quality of Life, Hospital Anxiety and Depression Scale (HADS), and Maslach Burnout Inventory (MBI) questionnaire. We evaluated 54 professionals, predominantly female and young. When comparing quality of life and level of anxiety or depression among the different subgroups of employees, it was possible to observe that, in the dimensions of emotional exhaustion and low professional achievement, individuals with higher stress had worse quality of life and higher level of anxiety and depression. For the dimension of depersonalization, only anxiety was higher in subjects with moderate stress. This study demonstrated that many professionals have moderate or high degree of professional stress and that this was associated with greater anxiety and depression and poorer quality of life. These results may provide useful insights to improve the physical and mental health of health care professionals.

Low-dose CT screening for lung cancer in Brazil: a study protocol

Devido a ausencia de estudos para o rastreamento do câncer de pulmao (CP) na populacao brasileira, foi iniciado um projeto com o intuito de avaliar a capacidade de rastreamento populacional do CP por meio de TC de baixa dosagem (TCBD) de torax, integrado ao Programa de Apoio ao Desenvolvimento Institucional do Sistema Unico de Saude do Ministerio da Saude. O objetivo da presente carta foi descrever o delineamento e os metodos do Projeto de Deteccao Precoce do Câncer de Pulmao (ProPulmao), o qual foi aprovado pelo Comite de Etica em Pesquisa do Instituto Israelita de Ensino e Pesquisa do Hospital Albert Einstein (CAAE 02087012.1.0000.0071).Para o desenvolvimento do projeto, a amostra final sera composta por 1.000 individuos, os quais estao sendo recrutados desde 2013, a partir de chamadas publicas em veiculos de comunicacao da regiao metropolitana de Sao Paulo e de parcerias com outros servicos de atendimento a comunidade. O tamanho da amostra foi calculado com base em estudos internacionais previos que abordaram o mesmo tema.Because of the lack of studies aimed at screening for lung cancer (LC) in the Brazilian population, a project that is integrated into the Program for the Support of the Institutional Development of the Brazilian National Ministry of Health Unified Health Care System and whose objective is to evaluate the efficacy of low-dose CT (LDCT) scans of the chest in screening for LC was launched. The objective of the present letter was to describe the design and methods of the Projeto de Detecção Precoce do Câncer de Pulmão For the development of the project, the final sample will comprise 1,000 individuals recruited as of 2013 via public calls in vehicles of communication in the greater metropolitan area of São Paulo, as well as via partnerships with other community care services. The sample size was calculated on the basis of previous international studies addressing this issue. The inclusion criteria are as follows (2) : having no respiratory symptoms; being in the 55-74 year age bracket; being a smoker with a smoking history of at least 30 pack-years or having been a former smoker for 15 years at most; and agreeing to participate in the study by giving written informed consent. The exclusion criteria are as follows: being unable to undergo CT scans; being pregnant; having previously undergone radiation therapy to the chest; and having severe chronic disease, such as cardiovascular disease, lung disease, liver disease, kidney disease, and metabolic disease. The primary outcome measure is early diagnosis of LC. Nevertheless, participants will undergo a multidisciplinary evaluation for smoking-related diseases and infectious diseases that are common in Brazil, such as tuberculosis. At the initial visit, demographic and smoking history data will be collected; health-related quality of life will be assessed by the Medical Outcomes Study 36-item Short-form Health Survey (3) ; the presence of anxiety or depression will be determined by the hospital anxiety and depression scale (4) ; and the presence of nicotine dependence in current smokers will be determined by the Fagerström test. After the initial evaluation, individuals will be referred for LDCT screening, the scans being analyzed by two radiologists with experience in thoracic diseases. Indeterminate pulmonary nodules ≥ 4 mm in size will be evaluated by a medical team comprising radiologists, pulmonologists, and thoracic surgeons, who will decide on the follow-up strategy (Chart 1). In cases of solid nodules > 8 mm in size, radiological features alone are …