Publications by authors named "Carlos Eduardo Paiva"

103 Publications

Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers.

J Pain Symptom Manage 2022 Apr 7. Epub 2022 Apr 7.

Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil. Electronic address:

Context: Preferred place-of-death (PPoD) is considered an important outcome for the development of appropriate models of care and for improving health policies in countries with underdeveloped palliative care (PC) OBJECTIVES: To determine the concordance between the PPoD of a sample of Brazilian seriously-ill cancer patients and their caregivers, and its associated factors under four different end-of-life (EOL) scenarios: 1) health deterioration in the overall context; 2) health deterioration with severe and uncomfortable symptoms; 3) health deterioration receiving home-based visits as needed; 4) health deterioration receiving home-based visits as needed, when suffering severe and uncomfortable symptoms METHODS: Cross-sectional study at a large Brazilian cancer center, between February 2019 and July 2021. 190 adult cancer patients and their caregivers (n = 190) were analyzed RESULTS: Patient and/or caregiver PPoD concordance for EOL scenario one: 64% vs. 43% for death at home, 22% vs. 30% for death in a PC unit, 14% vs. 27% for death in hospital. Higher patient and/or caregiver PPoD concordance was found for death in hospital (41%; 49%) in EOL scenario two, and for death at home for scenario three (77%; 74%). Agreement coefficient was moderate for scenario two (k = 0.430; P < 0.001), and fair for EOL scenarios one, three and four (k = 0.237, P < 0.001; k = 0.296, P < 0.001; k = 0.307, P < 0.001, respectively). Associated disagreement factors were: performance status (OR:3.03), self-perceived health (OR: 6.99), marital status (OR:2.92), and hospital and/or emergency room proximity (OR:4.11). The presence of relevant persons (42.3% vs. 44.2%), followed by spirituality (38.5% vs. 27.9%) and the place-of-death (14.0% vs. 18.4%), were the most important factors in the EOL, when comparing patients and care givers opinions, respectively CONCLUSION: Low agreement between patients and caregivers on PPoD was identified. EOL clinical factors and deterioration, and PC support seem to influence PPoD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2022.03.015DOI Listing
April 2022

HAprog: A New Prognostic Application to Assist Oncologists in Routine Care.

J Pain Symptom Manage 2022 Feb 11. Epub 2022 Feb 11.

Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital (D.D.P., B.S.R.P., C.E.P.), Barretos, Sao Paulo, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital (D.D.P., C.E.P.), Barretos, Sao Paulo, Brazil; Researcher Support Centre, Learning and Research Institute, Barretos Cancer Hospital (B.S.R.P., C.E.P.), Barretos, Sao Paulo, Brazil. Electronic address:

Context: More patients are seeing palliative care (PC) earlier in the disease trajectory. The Barretos Prognostic Nomogram (BPN) was designed to fill the gap of survival prognostication for patients with advanced cancer and months of life expectancy. However, its routine use is limited by the common need for a ruler and calculator. Additionally, the BPN requires blood tests.

Objectives: The aim is to refine the BPN and to create a prognostic application (App) for use on smartphones.

Methods: This is a reanalysis of the two cohorts of advanced cancer patients (development, n=215 and validation, n=276). The variable 'metastasis' was revised (volume-site combinations) and 'KPS' replaced by 'ECOG-PS'. Prognostic variables were selected for multivariable Cox and Log-logistic parametric regression analyses; the most accurate final models were identified by backward variable elimination. Calibration and discrimination properties were evaluated in the validation sample.

Results: The 'full version' model is composed of 6 parameters: sex, locoregional disease, sites of metastasis, ECOG-PS, WBC and albumin. In the 'clinical version' model (5 variables), the variable 'antineoplastic treatment' was included and the laboratory variables were excluded. At validation, both models were well calibrated and presented adequate c-Index values (0.778 and 0.739). HAprog is a freely downloadable offline App that is used by clinicians to calculate prognosis in less than 1 minute.

Conclusion: The new models that integrate HAprog are refined prognostic tools with adequate calibration and discrimination properties. It has potential practical impact for the oncologist dealing with outpatients with advanced cancer during the decision-making process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2022.02.004DOI Listing
February 2022

Cross-cultural adaptation and translation of the Pediatric Intensive Care Unit-Quality of Dying and Death into Brazilian Portuguese.

Rev Bras Ter Intensiva 2022 24;33(4):592-599. Epub 2022 Jan 24.

Grupo de Pesquisas em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde, Hospital de Câncer de Barretos - Barretos (SP), Brasil.

Objectives: To translate and culturally adapt the Pediatric Intensive Care Unit-Quality of Dying and Death questionnaire into Brazilian Portuguese.

Methods: This was a cross-cultural adaptation process including conceptual, cultural, and semantic equivalence steps comprising three stages. Stage 1 involved authorization to perform the translation and cultural adaptation. Stage 2 entailed independent translation from English into Brazilian Portuguese, a synthesis of the translation, back-translation, and an expert panel. Stage 3 involved a pretest conducted with family caregivers and a multidisciplinary team.

Results: The evaluation by the expert panel resulted in an average agreement of 0.8 in relation to semantic, cultural, and conceptual equivalence. The pretests of both versions of the questionnaire showed that the participants had adequate comprehension regarding the ease of understanding the items and response options.

Conclusion: After going through the process of translation and cultural adaptation, the Pediatric Intensive Care Unit-Quality of Dying and Death caregiver and multidisciplinary team versions were considered culturally adapted, with both groups having a good understanding of the items. The questionnaires include relevant items to evaluate the process of death and dying in the intensive care setting, and suggest changes in care centered on patients and especially family caregivers, given the finitude of their children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0103-507X.20210086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8889588PMC
January 2022

Oncology palliative care: access barriers: bibliometric study.

BMJ Support Palliat Care 2021 Dec 31. Epub 2021 Dec 31.

Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil

Objective: To perform a bibliometric analysis of studies that evaluated the barriers to access to cancer palliative care (PC).

Methods: This was a bibliometric review using MEDLINE; EMBASE; Web Of Science; LILACS and the Cochrane Library. A search was conducted with the terms Barriers, Palliative Care and Cancer. Articles whose objectives targeted barriers to access to PC were considered, regardless of the year of publication. The setting is articles published from 1987 to 2020.

Results: A total of 6158 articles were identified, of which 217 were eligible for analysis. The USA and UK being the countries with the largest number of articles on the subject (n=101, n=18, respectively). After expert analysis, the barriers were grouped into nine categories.

Conclusions: Barriers related to symptom control were identified in 19% of the eligible articles, along with barriers related to health, which with 24% of occurrence in the articles, were the most frequently cited barriers. Countries which have implemented PC for some time were those with the greatest number of publications and in journals with the highest impact factors. Cross-sectional study design continues to be the most frequently used in publications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjspcare-2021-003387DOI Listing
December 2021

Predictors of happiness and satisfaction with life in individuals from the Brazilian general population who use social networks: a cross-sectional study.

Cad Saude Publica 2021 10;37(12):e00164020. Epub 2021 Dec 10.

Hospital de Câncer de Barretos, Barretos, Brasil.

This study aimed to identify possible conditions associated with the perception of happiness and satisfaction with life in a sample of the Brazilian population who use social networks. This was a cross-sectional study with participants recruited online in five regions of Brazil via Facebook and WhatsApp. Data were collected from October 2015 to October 2016. The instruments used were the Pemberton Happiness Index, the Satisfaction with Life Scale, and a questionnaire regarding sociodemographic and clinical characteristics and issues potentially associated with the feeling of happiness. In total, 2,151 participants were included. A total of five variables exerted the greatest influence on higher levels of happiness and satisfaction with life in the multiple linear regression model, in the multiple logistic regression analysis, and in the decision tree model. Being satisfied with financial circumstances, having a positive self-evaluation of health, having frequent family gatherings, engaging in physical activity ≥ 3 times a week, and having no previous psychological/psychiatric diagnosis are variables that "seem" to positively influence Brazilians' perception of happiness and satisfaction with life. We identified some predictors of happiness and satisfaction with life, which were mainly related to the social activities and personal satisfaction of the participating individuals. Encouraging people to seek strategies for increasing levels of happiness and life satisfaction based on modifiable variables, such as those found, can be helpful in this context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/0102-311X00164020DOI Listing
April 2022

Optimization of In Vivo Production of Spodoptera frugiperda multiple nucleopolyhedrovirus (SfMNPV).

Neotrop Entomol 2022 Feb 29;51(1):122-132. Epub 2021 Sep 29.

Federal University of Espírito Santo, Porto Alegre, ES, Brazil.

Insect viruses have been used to protect crops and forests worldwide for decades. Among insect viruses, isolates of Spodoptera frugiperda multiple nucleopolyhedrovirus (SfMNPV) have proven potential for the control of Spodoptera frugiperda (J. E. Smith) (FAW) (Lepidoptera: Noctuidae), a pest of many economically essential crops across several continents. Mass production of SfMNPV depends on an in vivo system using host insect rearing. However, many factors can limit its production, including abiotic factors and host characteristics, such as the stage of development and an antagonist intraspecific interaction. Thus, to improve in vivo production, we verified the most suitable larval age to inoculate the virus and the influence of incubation temperature on viral production. Subsequently, cannibal behavior was verified in FAW larvae reared at different densities, while reproducing the conditions of the best treatments. The highest viral yield occurred when FAW larvae were inoculated at 10 and 8 days old and incubated at 22 °C and 25 °C, respectively. Nonetheless, survival (lethal period in days) and cannibal behavior were positively influenced by larval development, which potentially increases the load of contamination and requires larval individualization for these production conditions. In contrast, 4-day-old larvae, which were inoculated and incubated at 31 °C, also demonstrated high viral production, with lower rates of cannibalism and death on the same day, thereby showing potential. The information presented in this study is useful for the optimization of the in vivo production systems of SfMNPV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13744-021-00917-8DOI Listing
February 2022

Oncoplastic Surgery in Breast-Conserving Treatment: Patient Profile and Impact on Quality of Life.

Breast Care (Basel) 2021 Jun 17;16(3):243-253. Epub 2020 Jul 17.

Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Sao Paulo, Brazil.

Background: Breast-conserving treatment (BCT) provides better quality of life (QL) than mastectomy without reconstruction. Oncoplastic surgery (OS) encompasses a series of surgical techniques, increasing the indications for BCT, but few studies have evaluated the impact on QL in patients who undergo BCT with OS.

Materials And Methods: A prospective, cross-sectional study was conducted in women who underwent BCT. We evaluated the characteristics of patients who underwent BCT with and without OS and the associated QL. QL was assessed through the EORTC QLQ-30, EORTC QLQ-BR23, and Breast Cancer Treatment Outcome Scale (BCTOS) questionnaires.

Results: A total of 300 patients underwent BCT, 72 underwent breast OS, and 37 underwent bilateral surgery. Patients who underwent OS were younger ( = 0.004), had a higher level of education ( = 0.01), had a smaller time interval since the end of treatment ( = 0.02), had tumours with greater dimensions ( = 0.003), and were more likely to receive neoadjuvant chemotherapy ( = 0.05). Based on the QL questionnaires, no difference was observed between the groups. Breast symmetry was not associated with high patient satisfaction ( = 0.55).

Conclusion: Despite the fact that OS was performed in patients with worse tumour conditions and in more demanding patients, OS allowed similar cosmetic results to classical BCT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248771PMC
June 2021

Prevalence of burnout and predictive factors among oncology nursing professionals: a cross-sectional study.

Sao Paulo Med J 2021 Jul-Aug;139(4):341-350

MD, PhD. Physician and Researcher, Postgraduation, Hospital de Câncer de Barretos, Barretos (SP), Brazil.

Background: Burnout is a syndrome that mostly affects professionals working in contact with patients and their caregivers. In oncology care, nursing professionals are constantly required to provide emotional support for patients and their caregivers, throughout the process of becoming ill, suffering and dying.

Objective: To evaluate the prevalence and factors associated with burnout in a sample of nursing professionals at a cancer hospital.

Design And Setting: Cross-sectional study conducted at Hospital de Câncer de Barretos.

Methods: The study population comprised 655 nursing professionals. Burnout syndrome was assessed using the Maslach Burnout Inventory Human Service Survey. Univariate analysis and binary logistic regression models were used to identify independent predictors associated with burnout.

Results: Among 304 nursing professionals included in the study, 27 (8.9%) were classified as presenting burnout according to the two-dimensional criteria, and four (1.3%) were classified based on the three-dimensional criteria. Workplace characteristics were not associated with burnout, while single marital status (odds ratio, OR = 2.695; P = 0.037), perceived workplace stressors, such as impatience with colleagues (OR = 3.996; P = 0.007) and melancholy (OR = 2.840; P = 0.021) were considered to be predictors of burnout. Nursing professionals who would choose the profession again (OR = 0.214; P = 0.001) were least likely to present burnout.

Conclusion: Perceived workplace stressors are strongly associated with burnout. Strategies focusing on restructuring of daily work processes and on activities that stimulate positive relationships are important for professionals' health because motivation to continue working in oncology nursing has a protective effect against burnout.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/1516-3180.2020.0606.R1.1202021DOI Listing
October 2021

The Impact of International Research Collaborations on the Citation Metrics and the Scientific Potential of South American Palliative Care Research: Bibliometric Analysis.

Ann Glob Health 2021 03 31;87(1):32. Epub 2021 Mar 31.

Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil.

Background: Progress in palliative care (PC) requires scientific advances which could potentially be catalyzed by international research collaboration (IRC). It is currently not known how often IRC occurs with PC investigators in South America.

Objectives: To evaluate the percentage of South America journal articles on PC involving IRCs and the impact of these collaborations on the scientific potential the studies and on their citations.

Methods: This was a bibliometric analysis of studies published between January 1, 1998, and December 31, 2017. A search of Pubmed, Embase, Lilacs, and Web of Science (WOS) was performed using the terms "palliative care," "hospice care," "hospices" and "terminal care," combined with the name of South America countries. The scientific potential was assessed by analyzing study design, characteristics of the journal and funding. IRCs were further subdivided in internal (within South America countries) and external (with countries outside South America).

Findings: Of the 641 articles, 117 (18.2%) involved IRCs (internal: 18, 2.8%; external: 110, 17.2%). Articles with IRCs had higher median two-year citations in WOS (2 vs. 1, p < 0.001), Scopus (3 vs. 1, p < 0.001) and Google Scholar (4.5 vs. 2, p < 0.001) compared to articles without IRC. Moreover, they were more often funded (40.7% vs. 9.7%, p < 0.001), published in Pubmed-indexed (76.1% vs. 41.6%; p < 0.001) and in WOS-indexed (70.1% vs. 29.6%; p < 0.001) journals, and with study designs most often classified as clinical trial (5.1% vs. 1.0%; p = 0.002) and cohort (10.3% vs. 2.9%; p < 0.001) compared to articles without IRC.

Conclusions: Studies with international research collaborations, both internal and external to South America, are more frequently cited and have characteristics with greater scientific potential than do studies without international collaborations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5334/aogh.3158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015710PMC
March 2021

Characteristics of Palliative Care Publications by South American Authors in the Last 20 Years: Systematic Literature Review With Bibliometric Analysis.

J Pain Symptom Manage 2021 09 2;62(3):e177-e185. Epub 2021 Apr 2.

Oncology Graduate Program, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. Electronic address:

Context: Research on palliative care (PC) can be used as a direct measure to assess the level of PC development in a country or region.

Objectives: To investigate the scientific production in the field of PC in South American countries over the last two decades.

Methods: The search was performed using the terms "palliative care," "hospice care," "hospices," and "terminal care" combined with the names of South American countries in several databases. The trend in publications over time was analyzed by linear equations (R) and by calculating the annual percentage change (APC). The article citations were extracted from Web of Science (WOS), Scopus and Google Scholar, and the countries' impact factors (IFc) were calculated.

Results: Of the 4259 identified articles, 641 were included in the analysis. There was a clear increase in the number of publications over the analyzed period (R = 0.8794, APC = 14.42%). Brazil was the country with the highest number of publications (n = 389); however, after adjustments by population, GDP and number of researchers, Chile was the country with the greatest prominence, including the highest IF in WOS (4.409). Only 8.3% of publications were systematic review, clinical trial or cohort studies; only 15.4% were funded.

Conclusion: This bibliometric review identified an annual increase of 14% in the number of scientific publications by researchers from South America over the last 20 years. Although Brazil produced the most articles, Chile, had the most efficient scientific production. In general, the articles had low potential for scientific impact.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2021.03.017DOI Listing
September 2021

The Importance of Prognostication: Impact of Prognostic Predictions, Disclosures, Awareness, and Acceptance on Patient Outcomes.

Curr Treat Options Oncol 2021 01 11;22(2):12. Epub 2021 Jan 11.

Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil.

Opinion Statement: In the advanced cancer setting, patients, families, and clinicians are often confronted with an uncertain future regarding treatment outcomes and survival. Greater certainty on what to expect can enhance decision-making for many personal and healthcare issues. Although 70-90% of patients with advanced cancer desire open and honest prognostic disclosure, a small proportion do not want to know. Approximately half of patients with advanced cancer have an inaccurate understanding of their illness, which could negatively impact their decision-making. In this review, we use a conceptual framework to highlight 5 key steps along the prognostic continuum, including (1) prognostic formulation, (2) prognostic disclosure, (3) prognostic awareness, (4) prognostic acceptance, and (5) prognosis-based decision-making. We shall summarize the impact of prognostic predictions, disclosure, awareness, and acceptance on various patient and caregiver outcomes, such as hope, trust, anxiety, depression, chemotherapy use, and care planning. Based on where the patient is at along the prognostic continuum, we propose 5 different subgroups (avoidance: "I don't want to know"; discordant, "I never wanted to know"; anxious, "I don't know what's happening"; concerned, "I don't like this"; acceptance, "I know how to plan ahead"). Although prognostication is not necessarily a linear process, recognizing where the patient is at cognitively and emotionally along the prognostic continuum may allow clinicians to provide personalized interventions, such as specialist palliative care and psychology referral, towards personalizing prognostic disclosure, enhancing prognostic awareness, increasing prognostic acceptance, and supporting decision-making and, ultimately, improving patient outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11864-020-00810-3DOI Listing
January 2021

Overweight Women with Breast Cancer on Chemotherapy Have More Unfavorable Inflammatory and Oxidative Stress Profiles.

Nutrients 2020 Oct 28;12(11). Epub 2020 Oct 28.

Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlândia, Uberlândia 38402-022, Brazil.

Chronic inflammation and redox imbalance are strongly influenced by diet and nutritional status, and both are risk factors for tumor development. This prospective study aimed to explore the associations between inflammatory and antioxidant markers and nutritional status in women with breast cancer undergoing chemotherapy. The women were evaluated at three times: T0, after the infusion of the first cycle; T1, after infusion of the intermediate cycle; and T2, after the infusion of the last chemotherapy cycle. The consumption of antioxidant nutrients and the Total Dietary Antioxidant Capacity reduced between T0 and T2 and the Dietary Inflammatory Index scores increased throughout the chemotherapy. Blood samples taken at the end of the chemotherapy showed lower levels of glutathione reductase and reduced glutathione, with greater quantification of the transcripts for Interleukin-6 and Tumor Necrosis Factor α. It should be emphasized that the Total Dietary Antioxidant Capacity is lower and the Dietary Inflammatory Index is higher in the group of overweight patients at the end of the follow-up, besides showing lower levels of the redox status, especially the plasma levels of glutathione reductase ( = 0.039). In addition, trends towards higher transcriptional levels of cytokines in peripheral blood were observed more often in overweight women than in non-overweight women. In this study of 55 women with breast cancer, nine (16%) with metastases, diet became more pro-inflammatory with fewer antioxidants during the chemotherapy. Briefly, we have shown that chemotherapy is critical for high-risk overweight women due to their reduced intake of antioxidant nutrients, generating greater inflammatory and oxidative stress profiles, suggesting the adoption of healthier dietary practices by women with breast cancer throughout their chemotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu12113303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692181PMC
October 2020

Health-related quality of life became worse in short-term during treatment in head and neck cancer patients: a prospective study.

Health Qual Life Outcomes 2020 Sep 16;18(1):307. Epub 2020 Sep 16.

School of Medicine; Nutrition Course, Federal University of Uberlandia, Pará Av, 1720 / 2U, Campus Umuarama, Uberlandia, Minas Gerais, 38400-902, Brazil.

Background: Quality of life (QoL) is influenced in head and neck cancer (HNC) patients by a set of factors related to diagnosis, treatment and tumor impacts. The aim of this study was to evaluate the Quality of Life (QoL) changes in Head and Neck cancer (HNC) patients during treatment (radiotherapy and/or chemoradiotherapy).

Methods: QoL was evaluated prospectively in 63 HNC patients during radiotherapy and/or chemoradiotherapy at three moments: before or at beginning (T0), in the middle (T1 ~ four weeks) and immediately at the end (T2 ~ eight weeks) of treatment. The differences between the scores at different time points was verified using Friedman's non-parametric test. Negative changes between time points were evaluated, with differences (delta) of ±10 points being considered to be clinically significant.

Results: The total mean age was 59.1 ± 9.5y, and 82.5% were male. The oral cavity and larynx were more frequent tumors. The functional score for 'role' was decreased at time points T1 and T2 as compared to T0, while an improvement in scores was observed for cognitive function. Several physical symptoms also worsened over time, such as: fatigue, nausea and vomiting, dry mouth and sticky saliva, swallowing and skin symptoms, senses and teeth problems. A high frequency of altered and clinically meaningful values were observed for most of domains, ranging from 6 to 74%.

Conclusions: The QoL became worse at approximately one month after treatment beginning in HNC patients, and this remained until the end of therapy. Protocols directing to early nutritional counseling and management of symptoms of nutritional impact are important to improve clinical outcomes. This is part of preventive actions aiming to make the exhausting treatment process less traumatic and easier to complete.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12955-020-01543-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493852PMC
September 2020

Validation of the Adolescent Barriers Questionnaire for use in Brazilian adolescents with cancer.

J Pediatr (Rio J) 2021 May-Jun;97(3):348-353. Epub 2020 Sep 6.

Hospital de Câncer de Barretos, Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual), Barretos, SP, Brazil. Electronic address:

Objective: To translate, culturally adapt, and evaluate the psychometric properties of Adolescent Barriers Questionnaire for use in Brazilian adolescents with cancer aged 12 to 18 years, based on the original American Adolescent Barriers Questionnaire which was designed to measure the extent to which adolescents with cancer have concerns about reporting pain and using analgesics.

Methods: The study analyzed the psychometric properties reliability (internal consistency and test-retest) and validity (known groups and convergent) of Adolescent Barriers Questionnaire in adolescents between 12 and 18 years of age with a diagnosis of cancer who were using or who had used analgesic medication (opioid or not) in a pediatric public health institution. It was estimated 64 adolescents as sample size and the research was conclude with 48.

Results: Results of pre-test suggest good understanding (content validity index >0.9). The internal consistency value Cronbach's α was 88%. The convergent validity values ranged between -0.400 and -0.450. Analysis of known groups showed that the instrument discriminated groups of patients with solid vs. hematologic tumors. The intraclass correlation coefficient obtained after retest was 0.863.

Conclusion: After the process of translations, validations and analysis of psychometric properties, the Brazilian Portuguese version of Adolescent Barriers Questionnaire could be considered culturally adapted, valid, and reliable for the Brazilian adolescent population with cancer aged 12 to 18 years and it can be useful in practical clinic, offering the health professionals the opportunity to understand which barriers the adolescent with cancer can encounter and offer, thus, all the support to overcome them.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jped.2020.06.008DOI Listing
May 2021

Influence of advance directives on reducing aggressive measures during end-of-life cancer care: A systematic review.

Palliat Support Care 2021 06;19(3):348-354

Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil.

Context: Although the literature recognizes the participation of patients in medical decisions as an important indicator of quality, there is a lack of consensus regarding the influence of advance directives (ADs) on reducing aggressive measures during end-of-life care involving cancer patients.

Objective: A systematic review was conducted to analyze the influence of ADs on reducing aggressive end-of-life care measures for cancer patients.

Method: We searched the Medline, Embase, Web of Science, and Lilacs databases for studies published until March 2018 using the following keywords, without language restrictions: "advance directives," "living wills," "terminal care," "palliative care," "hospice care," and "neoplasms." Article quality was assessed using study quality assessment tools from the Department of Health and Human Services (NHLBI).

Results: A total of 1,489 studies were identified; 7 met the inclusion criteria. The studies were recently published (after 2014, 71.4%). Patients with ADs were more likely to die at the site of choice (n = 3) and received less chemotherapy in the last 30 days (n = 1). ADs had no impact on intensive care unit admission (n = 1) or hospitalization (n = 1). One study found an association between ADs and referral to palliative care, but other did not find the same result.

Significance Of Results: Of the seven articles found, four demonstrated effects of ADs on the reduction in aggressive measures at the end of life of cancer patients. Heterogeneity regarding study design and results and poor methodological quality are challenges when drawing conclusions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1478951520000838DOI Listing
June 2021

An explorative analysis of the differences in levels of happiness between cancer patients, informal caregivers and the general population.

BMC Palliat Care 2020 Jul 11;19(1):106. Epub 2020 Jul 11.

Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.

Background: Although cancer patients experience distressing symptoms and health-related changes in their quality of life, they may report positive emotional states. The lives of informal caregivers of cancer patients may also be affected by the patient's cancer diagnosis; however, they may also find benefits in their experiences. Noticeable changes are reported in personal priorities after an oncologic diagnosis that can lead individuals to restructure their values and the way they perceive life. This study aims to assess happiness/satisfaction with life and positive and negative affect in cancer patients and informal caregivers compared with healthy people in the general population.

Methods: A cross-sectional study with participants recruited online in five regions of Brazil through the social network site Facebook® and the application WhatsApp®. Surveys were completed using the SurveyMonkey® platform. A different sample of cancer patients and informal caregivers that was personally interviewed with the same forms was also grouped in the present analysis. Variables with p-values < 0.05 in the univariate analysis were included in linear regression models (stepwise, backward).

Results: A total of 2580 participants were included, of whom 2112 were healthy representatives of the general population, 342 were cancer patients, and 126 were informal caregivers of cancer patients. In the multivariate analysis, the cancer patients and informal caregivers were happier than the healthy people in the general population, even after controlling for age, sex, educational level, and income. The patients and caregivers had lower scores for positive affect and higher scores for negative affect.

Conclusions: Overall, the conditions related to happiness, satisfaction with life and positive affect are similar for all groups. However, cancer patients and informal caregivers report increased rates of happiness and satisfaction with life compared with theoretically healthy people, although they have lower positive affect scores and higher negative affect scores. It is suggested that cancer patients and caregivers of cancer patients experience more difficulties (suffering) on ​​a daily basis. However, given the increased difficulties, they perceive life differently, reporting that they are happier.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12904-020-00594-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354680PMC
July 2020

Do different pedagogical conceptions result in different quality of life levels?

Rev Assoc Med Bras (1992) 2020 Mar;66(3):257-262

. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Brasil.

Objective: The present study aims to compare medical students' quality of life (QoL) at two Brazilian institutions with different pedagogical conceptions.

Methods: We studied students during the first four years of medical school at two institutions (one using active methodologies and small groups and the other using traditional lectures and large groups). We used a demographic questionnaire and the WHOQOL-BREF.

Results: 820 medical students were included. No significant differences in quality of life were found in general, nor while evaluating the course phase, except for the physical WHOQOL, which was lower for 2nd-year students at the institution with traditional lectures, even when adjusted for gender.

Conclusion: Our findings revealed that, despite having very distinct pedagogical conceptions and characteristics, there were no significant differences in medical students' QoL scores between both institutions. These results are surprising and differ from our initial hypothesis, which expected better QoL for those using more active and student-centered methods.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/1806-9282.66.3.257DOI Listing
March 2020

Happiness and satisfaction with life: potential social indicators for periodic measurement in Brasil?

Rev Assoc Med Bras (1992) 2020 Mar;66(3):245-247

. Grupo de Pesquisa em Cuidados Paliativos e Qualidade de Vida Relacionada à Saúde (GPQual),Instituto de Ensino e Pesquisa, Hospital de Câncer de Barretos, Barretos, SP, Brasil.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/1806-9282.66.3.245DOI Listing
March 2020

Association between multiple symptoms and quality of life of paediatric patients with cancer in Brazil: a cross-sectional study.

BMJ Open 2020 05 5;10(5):e035844. Epub 2020 May 5.

Learning and Research Institute, Barretos Cancer Hospital, Barretos, Brazil

Objectives: To identify the association of multiple symptoms and clinical characteristics on quality of life (QoL) of paediatric patients with cancer.

Design: A descriptive, cross-sectional study.

Setting: South American Children's Hospital for Cancer Treatment (Barretos, São Paulo, Brazil).

Participants: A total of 157 participants, 116 paediatric patients, diagnosed with cancer, undergoing chemotherapy treatment, between 7 and 18 years of age and 41 proxies for patients between 2 and 6 years of age.

Primary Outcome Measures: The severity and prevalence ofsymptoms were identified through the use of a culturally adapted multi-symptomscreening tool, and the influence these symptoms, in association with clinicalcharacteristics, had on the QOL of Brazilian pediatric cancer patients wasassessed.

Results: Prevalent symptoms identified by all participants were 'feeling tired' (98, 62.4%), 'feeling more or less hungry (do not feel like eating) than you usually do' (96, 61.1%), 'changes in taste (flavour of the food)' (89, 56.7%), 'throwing up or feeling like you may throw up' (77, 49%) and 'changes in how your body (visually) or face looks' (72, 45.9%). The multivariate analysis for symptom severity as reported by proxies showed that surgery (OR 0.20, 95% CI 0.04 to 0.98, p=0.047) and time of diagnosis (OR 0.14, 95% CI 0.03 to 0.66, p=0.012) were associated with a decreased OR of high severity symptoms.An analysis of the clinical characteristics associated with Pediatric Quality of Life Inventory (PedsQL) demonstrated no significant effect on QoL in any of the domains evaluated. The association between Symptom Screening in Pediatrics Tool and PedsQL in the self-report version demonstrated a significant negative influence of all symptoms on the QoL.

Conclusions: The prevalence of symptoms experienced among pediatric patients during treatment was high and significantly influenced all aspects of quality of life,especially in the emotional domain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-035844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223154PMC
May 2020

Development of a screening tool to improve the referral of patients with breast and gynecological cancer to outpatient palliative care.

Gynecol Oncol 2020 07 30;158(1):153-157. Epub 2020 Apr 30.

Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.

Objective: New strategies that allow timely referral to outpatient palliative care (PC) for cancer patients are sought. The authors developed a 16-item checklist tool with 3 categories of care priorities based on patients' physical functionality. To evaluate the potential clinical impact of the use of these criteria in patients with advanced breast and gynecological cancer (ABGC) seen at oncology clinics.

Methods: The study was divided into 2 phases. In Phase I, research nurse prospectively assessed the referral criteria among patients with ABGC who had not yet been referred to PC. The oncologists' (routine) referral rate was compared to the referral rate if the criteria were applied universally. In Phase II, we implemented routine screening with these referral criteria without automatic trigger. Patients not yet evaluated by PC were retrospectively evaluated regarding the rate of screening and how often they met criteria.

Results: Among the 120 patients evaluated in Phase I, oncologists referred 23 (19%) and the screening criteria identified another 82 (68%) who may benefit from PC, potentially increasing the PC referral rate by 3.2-fold. Patients would have been referred earlier using the criteria than based on oncologists' judgement (median survival 451 days vs. 178, p < 0.001). In Phase II, among the patients who were not yet receiving PC, 38.6% (97 of 251) met at least one criterion.

Conclusion: The use of referral criteria has the potential to significantly increase the number of timely palliative care referral. Further research is needed to test the implementation of these criteria.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ygyno.2020.04.701DOI Listing
July 2020

Missed Opportunities of Integration of Palliative Care: Frequency, Causes, and Profile of Missed Visits in an Oncologic Palliative Care Outpatient Unit.

J Pain Symptom Manage 2020 05 25;59(5):1067-1073.e1. Epub 2020 Jan 25.

Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.

Context: Many patients with cancer are referred to palliative care (PC) outpatient clinics but do not attend consultations, which increases the difficultly of integrating PC in a timely manner.

Objectives: To evaluate the frequency, causes, and profile of missing first-time consultations in a PC outpatient clinic.

Methods: Data from patients with advanced cancer who were scheduled for first-time visits to the PC outpatient clinic from September 2018 to August 2019 were analyzed. Missed consultation was defined as a nonperformed consultation with no prior notice of cancellation, and missed opportunity of palliative care (MOPC) was defined as a nonperformed consultation regardless of being notified in advance. The causes of the absence were identified by telephone using a standardized form. Logistic regression models were used to identify the profile of patients who have MOPC.

Results: About 1468 patients were scheduled for first-time visits to the PC outpatient clinic; missed consultation = 21.7% (n = 275) and MOPC = 32.5% (n = 478). Of the total number of patients who had MOPC, 86 (18%) were later seen in a median time (percentile p25-p75) of 29.5 days (range 7.0-66.5). The most common cause of MOPC was death before consultation (n = 92; 29.8%). Referral to PC using a standardized protocol (odds ratio 0.787; P = 0.044) and residence in distant cities (odds ratio 2.394; P < 0.001) were independently associated with MOPC.

Conclusion: Approximately one-third of patients eligible for PC miss the opportunity to be included earlier; only 18% of them are consulted later. Use of standardized referral protocols may help to reduce these absence rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2020.01.005DOI Listing
May 2020

Factors associated with return to work in breast cancer survivors treated at the Public Cancer Hospital in Brazil.

Support Care Cancer 2020 Sep 11;28(9):4445-4458. Epub 2020 Jan 11.

Postgraduate Oncology Program, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331, Bairro Dr Paulo Prata, Barretos, SP, 14784-400, Brazil.

Purpose: To evaluate the impact of return to work on the quality of life of breast cancer patients and to identify factors related to nonreturn to work.

Methods: An observational, cross-sectional study was performed in breast cancer survivors who had worked before their breast cancer diagnosis. We evaluated factors related to return to work (patient perspective, disease, and work), EORTC quality of life questionnaires (general: EORTC QLQ-C30; and breast cancer-specific: EORTC QLQ-BR23), the Shoulder Pain and Disability Index (SPADI), and the Anxiety and Depression Scale (HADS). Half of the patients underwent a physical therapy examination (shoulder goniometry, hand dynamometry, and limb volume). Univariate and multivariate analysis were performed.

Results: We included 304 patients, 163 of whom underwent physiotherapy evaluation. Approximately 54.0% (164) of the patients returned to work after treatment. The women who returned to work presented lower age, higher education levels, higher incomes, and smaller initial tumor size. The women who returned to work had higher scores related to body image and sexual function, lower scores in relation to disability and pain, and lower scores related to anxiety and depression. In the multivariate model to evaluate nonreturn to work, pretreatment variables were age, education level, and clinical staging. Sequelae related to loss of strength increased the risk of nonreturn to work.

Conclusion: Return to work was influenced by age, education level, previous activity types, axillary treatment, and physical sequelae related to loss of hand strength. Breast cancer treatment decreased the women's work capacity. Return to work improved the patients' quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-019-05164-7DOI Listing
September 2020

Prognostication, palliative care, and patient outcomes (reply to Rossi et al.).

Support Care Cancer 2020 Apr 6;28(4):1547-1548. Epub 2020 Jan 6.

Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-019-05264-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039736PMC
April 2020

Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: Systematic review and meta-analysis.

J Surg Oncol 2020 Apr 26;121(5):766-776. Epub 2019 Dec 26.

Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos, São Paulo, Brasil.

This systematic review with meta-analysis addressed late locoregional complications associated with adjuvant radiotherapy (RT) in breast cancer. Among 2120 titles, ten comparative studies in patients undergoing surgery vs surgery and radiotherapy reporting complications were evaluated. RT was associated with an increased risk of capsular contracture and decreased the mobility of the upper limb. A borderline association of lymphedema risk using RT was noted in the random-effects model but was significant in the fixed-effects model.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jso.25820DOI Listing
April 2020

Meaning in life in patients with advanced cancer: a multinational study.

Support Care Cancer 2020 Aug 19;28(8):3927-3934. Epub 2019 Dec 19.

Department of Palliative Care, Rehabilitation and Integrative Medicine, Unit 414, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.

Background: Few studies have examined meaning in life, a novel existential outcome, in patients with advanced cancer across countries.

Objectives: We examined differences in meaning in life across 5 countries and identified factors associated with meaning in life.

Methods: This is a pre-planned secondary analysis of a prospective longitudinal multicenter observational study of patients with advanced cancer. Meaning in life was assessed using a validated scale which examined four domains of meaning: values, purpose, goals, and reflection. The total score ranged from 8 to 32, with a higher score indicating greater meaning in life.

Results: Among 728 patients, the median meaning in life score was 25/32 (interquartile range 23, 28). There was no significant difference in the total meaning in life score among 5 countries (P = 0.11), though there were differences in domain sub-scores. In the univariate analysis, patients with higher intensity of physical symptoms by ESAS score (pain, fatigue, drowsiness, dyspnea, insomnia), depression, anxiety, spiritual pain, and financial distress had significantly lower meaning in life. However, patients with higher levels of education, who were married, and who had higher optimism had significantly higher meaning in life. In the multivariate analysis, higher total meaning in life scores were significantly associated with greater optimism (multivariate estimate = 0.33, p < 0.001), lower depression (- 0.26, < 0.001), spiritual pain (- 0.19, < 0.001), and financial distress (- 0.16, < 0.001).

Conclusion: Country of origin was not a determinant of meaning in life. However, meaning in life was significantly associated with optimism, depression, spiritual pain, and financial distress, underscoring the multidimensional nature of this construct and potential opportunities for improvement in addressing meaning in life of patients with advanced cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00520-019-05239-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8582319PMC
August 2020

The impact of a higher eating frequency on the diet quality and nutritional status of women with breast cancer undergoing chemotherapy.

Br J Nutr 2020 02 25;123(4):410-418. Epub 2019 Nov 25.

Federal University of Uberlandia, Uberlandia, Minas Gerais, CEP 38400-902, Brazil.

The present study investigated the association between eating frequency (EF), diet quality and nutritional status of fifty-five women with breast cancer (BC) undergoing chemotherapy (CT), with three follow-ups, before the first cycle (T0), after the intermediate cycle (T1) and after the last cycle of CT (T2). Dietary data were obtained by nine 24-h dietary recalls (24HR), and the Brazilian Healthy Eating Index Revised (BHEI-R) was used for qualitative analysis of diet. The average EF was established by adding the number of daily eating episodes in the three 24HR of each time. Anthropometric variables were obtained at three times. Women who reported higher EF (equal to or above median value (T0 and T1: 4·67; T2: 4·33 eating episodes)) presented better anthropometric parameters, in T0 and T1, as well as higher scores for BHEI-R specific groups and BHEI-R Total score in T1 and T2. In generalised linear models, the continuous variable EF was negatively associated with all the anthropometric variables in T0 and with the waist:height ratio in T1. There were positive associations for the BHEI-R groups at the three times: Total Fruit; Whole Fruit; Total Vegetables; Dark Green and Orange Vegetables and Legumes. At T1 and T2 the EF was positively associated with the BHEI-R Total score, and also with Whole Grains in T1. The results suggest that a higher EF was associated with a better diet quality during CT in women with BC. In contrast, an inverse association was observed between EF and anthropometric parameters before the first cycle of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0007114519002952DOI Listing
February 2020

Dealing with prognostic uncertainty: the role of prognostic models and websites for patients with advanced cancer.

Curr Opin Support Palliat Care 2019 12;13(4):360-368

Department of Medical Oncology, Barretos Cancer Hospital, Barretos, Brazil.

Purpose Of Review: To provide an updated overview of prognostic models in advanced cancer and highlight the role of prognostic calculators.

Recent Findings: In the advanced cancer setting, many important healthcare decisions are driven by a patient's prognosis. However, there is much uncertainty in formulating prognosis, particularly in the era of novel cancer therapeutics. Multiple prognostic models have been validated for patients seen by palliative care and have a life expectancy of a few months or less, such as the Palliative Performance Scale, Palliative Prognostic Score, Palliative Prognostic Index, Objective Prognostic Score, and Prognosis in Palliative Care Study Predictor. However, these models are seldom used in clinical practice because of challenges related to limited accuracy when applied individually and difficulties with model selection, computation, and interpretation. Online prognostic calculators emerge as tools to facilitate knowledge translation by overcoming the above challenges. For example, www.predictsurvival.com provides the output for seven prognostic indexes simultaneously based on 11 variables.

Summary: Prognostic models and prognostic websites are currently available to augment prognostication in the advanced cancer setting. Further studies are needed to examine their impact on prognostic accuracy, confidence, and clinical outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SPC.0000000000000459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034625PMC
December 2019

Prospective Analysis of Food Consumption and Nutritional Status and the Impact on the Dietary Inflammatory Index in Women with Breast Cancer during Chemotherapy.

Nutrients 2019 Nov 1;11(11). Epub 2019 Nov 1.

Graduate Program in Health Sciences, Federal University of Uberlandia, Uberlandia, 38405-320 Minas Gerais, Brazil.

Considering the implications of adverse effects of chemotherapy (CT) and the potential impact of diet on patients' recovery, this study aimed to prospectively evaluate the association between the consumption of food groups, patients' Dietary Inflammatory Index (DII) scores, and their nutritional status. Anthropometric and dietary assessments of 55 women with breast cancer (BC) were performed at three time points. T0 is the time point after the first CT cycle, T1 is the time point after the intermediate CT cycle, and T2 is the time point after the last CT cycle. We identified a significant increase in weight, body mass index, and waist circumference during CT. Consumption of poultry and eggs was higher in T1 when compared to T2, while consumption of total fruit and total vegetables was higher at T0 compared to T1 and T2. The diet became more pro-inflammatory over the course of treatment (X = 61.127), and was related to higher abdominal adiposity. Total fruit (T0: R = 0.208, T1: R = 0.095, T2: R = 0.120) and total vegetable consumption (T0: R = 0.284, T1: R = 0.365, T2: R = 0.580) predicted DII change at the three-time points. Meanwhile, consumption of total grains was significantly associated only with T1 (R = 0.084) and T2 (R = 0.118), and consumption of simple sugars was significantly associated only with T0 (R = 0.137) and T1 (R = 0.126). Changes in food consumption led to an increase in the inflammatory profile of the diet, suggesting the necessity to improve the guidelines during and after CT. These results reinforce the need to promote healthier eating practices in concert with maintaining a healthy nutritional status in women with BC treated with CT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/nu11112610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893533PMC
November 2019

Clinical Prediction of Survival in Advanced Cancer Outpatients: Do Experienced Physicians and With Prior Patient Evaluation Make More Accurate Predictions?

J Pain Symptom Manage 2020 01 1;59(1):e7-e10. Epub 2019 Oct 1.

Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Centre, Learning and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpainsymman.2019.09.019DOI Listing
January 2020
-->