Sérgio Jamnik

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.

Câncer de pulmão: comparação entre os sexos

A importância dos fatores de prognostico na analise de estudos clinicos de câncer de pulmao ja e bem definida. Neste artigo, varios fatores de prognostico foram avaliados, assim como a comparacao entre ambos os sexos foi realizada. Nao houve diferenca estatisticamente significante entre os dois sexos para a presenca de sintomas no momento do diagnostico. Os pacientes do sexo feminino apresentaram incidencia de tabagismo menor que os do masculino. O carcinoma espinocelular (40,6%) foi o tipo histologico mais comum entre os pacientes ao sexo masculino enquanto o adenocarcinoma (57,1%) foi o mais frequente no feminino. Em media, 45% dos pacientes apresentaram-se com doenca disseminada no momento do diagnostico. Pacientes do sexo masculino (40%) foram classificados como desnutridos mais frequentemente que as do feminino.

Estudo comparativo dos fatores prognósticos entre os pacientes com maior e menor sobrevida em portadores de carcinoma broncogênico

Apesar dos avancos no tratamento, ha pouca melhora na sobrevida dos pacientes com câncer do pulmao. Atualmente, e importante o conhecimento dos fatores que intervem na sobrevida. Objetivos: Verificar possiveis diferencas de fatores prognosticos em duas populacoes de pacientes com câncer de pulmao, uma com pequena sobrevida (menos de seis meses) e outra com maior sobrevida (acima de 24 meses). Metodos: De 1997 a 1999 foram estudados 52 pacientes com diagnostico histopatologico de carcinoma homogenico, sendo colhidos dados demograficos, clinicos, parametricos, habitos tabagicos, indice de Karnofsky, estadiamento da doenca e dosagem laboratorial de desidrogenase latica, fosfatase alcalina, antigeno carcinoembrionario e calcio. Resultados: 29 pacientes tiveram sobrevida menor do que seis meses e 23, superior a 24 meses. Os tres fatores mais importantes que influenciaram o tempo curto de sobrevida foram baixo indice de Karnofsky inicial, reducao do apetite e alto nivel serico de DHL. Conclusao: Os tres componentes do prognostico sao o estado fisico atual, o estado fisico previo e o estado atual da doenca. (J Pneumol 2002;28(5):245-9) Comparative study of prognostic factors among longer and shorter survival patients with bronchogenic carcinoma 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.

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.