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Doctoral Thesis
DOI
https://doi.org/10.11606/T.83.2008.tde-07072008-131358
Document
Author
Full name
Thais de Oliveira Gozzo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2008
Supervisor
Committee
Almeida, Ana Maria de (President)
Carrara, Helio Humberto Angotti
Panobianco, Marislei Sanches
Santos, Manoel Antonio dos
Sawada, Namie Okino
Title in Portuguese
Toxicidade ao tratamento quimioterápico em mulheres com câncer de mama
Keywords in Portuguese
Efeitos adversos
Enfermagem
Neoplasias mamárias
Protocolos de Quimioterapia Combinada Antineoplásica
Abstract in Portuguese
Foi realizado um estudo retrospectivo, por meio da revisão de 72 prontuários de mulheres com diagnóstico de câncer de mama, submetidas ao tratamento quimioterápico neoadjuvante com epirrubicina e docetaxel e no adjuvante, epirrubicina e ciclofosfamida . Os prontuários revisados foram de mulheres na faixa de 30 a 60, acompanhadas no Ambulatório de Mastologia do Departamento de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e que receberam o tratamento quimioterápico entre os anos de 2003 e 2006. Resultados: As participantes foram divididas em dois grupos, sendo um das 31 mulheres que apresentaram neutropenia e o outro das 41 que não apresentaram. A média de idade das participantes foi de 47,8 anos. Entre as toxicidades gastrointestinais durante a neoadjuvância e a adjuvância observouse a mucosite (8,4% e 2%), náusea (18,6% e 18%) e vômito (3,3% e 18%). Outra intercorrência observada foi o extravasamento durante o tratamento quimioterápico que ocorreu em 17 (23,6%) mulheres. Observou-se que 43% das mulheres apresentaram neutropenia, que analisadas entre os ciclos de quimioterapia foram estatisticamente significantes para os ciclos dois e três da neoadjuvância com valores de p de 0,0016 e 0,0009 respectivamente, para os ciclos dois e três da adjuvância com valores de p de 0.0014 e 0.0030 respectivamente, para o final do tratamento neoadjuvante, anterior ao tratamento cirúrgico sendo o p-valor=<0.0001 e para o final do tratamento adjuvante, com p-valor=<0.0004. Quanto à ocorrência de anemia, esta não esteve relacionada com a presença ou não de neutropenia, entretanto observou-se que houve uma queda nos valores de HB durante a neoadjuvância, com ligeira recuperação no período de adjuvância, porém, não houve recuperação aos valores médios anteriores ao tratamento quimioterápico. A redução da dose foi utilizada para seis mulheres em decorrência da toxicidade hematológica. Registrou-se 152 atrasos entre os ciclos de quimioterapia. Realizado o teste do Log-Rank para o tempo de tratamento e de sobrevida, concluiu-se que esta foi igual para os dois grupos de mulheres. Conclusão: Por meio dos resultados deste estudo demonstra-se a necessidade de elaboração e implementação de protocolos de cuidados de enfermagem para pacientes oncológicos com a finalidade de avaliação dos eventos adversos e manejo mais adequado dos mesmos
Title in English
Toxicity to chemotherapy treatment in women with breast cancer
Keywords in English
Adverse effects
Antineoplastic combined chemotherapy protocols
Neoplasias mammary
Nursing
Abstract in English
Method: Thais study data were collected retrospectively reviewing the chart of 72 women with breast cancer, underwent to chemotherapy for the first time, that used epirubicin and docetaxel to neoadjuvant treatment and epirubicin and ciclophosphamid to adjuvant treatment. The data collection was done with the charts of women, with 30 to 60 years, treated in 2003 to 2006 in followed in the onco-gynecology and mastology sector- Gynecology and Obstetric Department of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. Results: The participants had been divided in two groups, one with 31 women who had presented neutropenia and the other with 41 that had not presented. The average of age of the participants was of 47,8 years. The gastrointestinal toxicities during the neoadjuvant and adjuvant treatment observed mucositis (8.4% and 2%), nausea (18.6% and 18%) and vomiting (3.3% and 18%). Another observed toxicity was the extravasation during the chemotherapy treatment that occurred in 17 (23.6%) women. Was observed that 43% of the women had respectively presented neutropenia, who analyzed between the chemotherapy cycles had been statistical significant for cycles two and three of the neoadjuvant with values of p = 0,0016 and 0,0009 respectively, for cycles two and three of the adjuvant with values of p =0.0014 and 0.0030. And for the end of the neoadjuvant treatment, previous treatment to the surgical treatment being p-valor=< 0,0001 and for the end of the adjuvant treatment, with p-valor=< 0.0004. To anemia occurrence, this was not related with the presence or not of neutropenia, however it was observed that had a fall in the values of HB during the neoadjuvant, with fast recovery in the period of adjuvant. However, did not have recovery to previous the average values to the chemoterapy treatment. The reduction of the dose was used for six women in result of the hematologic toxicity. Was registered 152 doses delays between the chemotherapy cycles. The Log-Rank test for the time of treatment and survival, concluded that was equal for both groups. Conclusion: Through the results of this study demonstrates the necessity of develop and implement protocols for nursing care to women with breast cancer in order to assess the adverse events and most appropriate management of them
 
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Publishing Date
2009-03-10
 
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