Adherence and urinary symptoms in women with breast cancer being treated with oral hormone therapy

Orientadores: Priscila Gava Mazzola, Cassia Raquel Teatin JuliatoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O uso de hormonioterapia oral como tratamento adjuvante em mulheres com câncer de mama tem benefícios provados relacionados com a diminuição de recidivas e metástases, contudo, adesão ao tratamento é essencial para sua eficácia. Apesar da sua conveniência, sintomas urogenitais são comuns em mulheres em hormonioterapia devido à diminuição dos níveis de estrógeno, podendo afetar a adesão ao tratamento e a qualidade de vida dessas mulheres. Identificar a prevalência desses sintomas e sua relação com a adesão ao tratamento pode ajudar na melhor orientação de uso da hormonioterapia com tamoxifeno ou inibidores de aromatase. O tratamento oral do câncer tem como propósito a diminuição de recidiva e mortalidade, com qualidade de vida, e algumas reações adversas ao tratamento podem diminuir a percepção da mulher na sua posição de vida. O objetivo desse estudo é realizar o acompanhamento farmacoterapêutico para verificar adesão, qualidade de vida e sintomas urinários, em mulheres com câncer de mama em tratamento com hormonioterapia. É um estudo corte transversal realizado no Hospital da Mulher Prof. Dr. José Aristodemo Pinotti. Mulheres com câncer de mama em hormonioterapia que foram tratadas nesse hospital e que retiraram seus medicamentos pessoalmente durante o período de coleta de dados de junho a outubro de 2016, que cumpriram com os critérios de inclusão e aceitaram participar desse estudo através da assinatura de termo de consentimento livre e esclarecido, foram incluídas. As mulheres foram divididas em dois grupos: em tratamento com tamoxifeno, e em tratamento com inibidor de aromatase. Foram aplicados os questionários de Qualidade de Vida (EORTC-QLQ30/BR23) e de eventos urinários (ICIQ-SF/OAB). Adesão ao tratamento foi avaliada pelo método Morisky Green. Foram entrevistadas 58 mulheres: 42 em tratamento com tamoxifeno, e 16 em tratamento com inibidor de aromatase. A média de idade foi de 58 ? 12 anos. Trinta e cinco mulheres (59,0%) apresentaram alguma comorbidade, sendo a hipertensão a mais prevalente. Nove mulheres necessitaram a troca de tratamento de tamoxifeno por anastrozol: três por evento adverso, cinco por progressão da doença e uma após ablação ovariana. Vinte e três mulheres (39,6%) apresentaram sintomas de perda de urina, com escores de 11 a 17 (máximo de 21). A condição global avaliada pelo questionário EORTC-QLQ30 teve uma média superior a 77,0%. Sintomas e eventos adversos avaliados pelo questionário EORTC-BR23 tem médias em torno de 20,0%, com fogacho como o mais comum e com extensão de "muito". Quarenta e quatro por cento das mulheres eram completamente aderentes ao tratamento. A adesão ao tratamento e sintomas foram autodeclarados. Nesse estudo observou-se uma grande quantidade de mulheres com sintomas de perda de urina dentro da amostra, mas que apresentaram bons resultados de qualidade de vida e menos da metade estiveram completamente aderidas ao tratamentoAbstract: The use of oral hormone therapy as adjuvant treatment in women with breast cancer has proven benefits relating to decrease in relapse and metastasis, however treatment adherence is essential to its effectiveness. Despite its convenience, genitourinary symptoms are common in hormone therapy patients due to decreased levels of estrogen, affecting adherence to treatment and quality of life of these women. Identifying these symptoms prevalence and its relation to treatment adherence would allow a better orientation as to use of hormone therapy with tamoxifen and aromatase inhibitors. The endpoint of oral hormone therapy is the decrease of recurrence and mortality, with quality of life, and some adverse reactions to the treatment can diminish how the woman sees her position in life. The objective of this study is to perform pharmaceutical follow-up to evaluate adherence, quality of life and urinary events, in women with breast cancer using hormone therapy. This was a case-control study at Women¿s Hospital Prof. Dr. José Aristodemo Pinotti. Women with breast cancer using hormone therapy that were treated at this hospital and picked up their medication in person during the data collection period from June to October 2016, fulfill the inclusion criteria and accept to participate in the study by signing the consent form, were included. Women were divided into two groups: treated with tamoxifen and treated with aromatase inhibitor. Quality of life (EORTC-QLQ30/BR23) and urinary events (ICIQ-SF/OAB) questionnaires were applied. Treatment adherence was evaluated by Morisky Green method. Were interviewed 58 women: 42 being treated with tamoxifen and 16 with aromatase inhibitor. Average age was 58 ? 12 years. Thirty-five women (59.0%) had some comorbidity, hypertension being the most prevalent. Nine women had switch in therapy from tamoxifen to anastrozole: three due to adverse events, five due to disease progression and one after ovarian ablation. For the overactive bladder and urinary incontinence, twenty-three women (39.6%) presented with scores of 11-17 (maximum score of 21). Women¿s global condition evaluated by the questionnaire EORTC-QLQ30 had an average above 77.0%. Symptoms and adverse events evaluated by the questionnaire EORTC-BR23 have averages around 20.0%, with hot flashes being the most common and with an extent of "very much". Forty-four point eight percent were completely adherent to the treatment. Adhesion to treatment and symptoms are all self-proclaimed. In this study it was possible to observe a great number of women within the sample with urinary incontinence, however they have good quality of life scores and less than half were completely adherent to treatmentMestradoPesquisa ClínicaMestra em Ciências130466/2016-6CAPE

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for >; 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results

Clinical relevancy and risks of potential drug–drug interactions in intensive therapy

AbstractPurposeEvaluate the potential Drug–Drug Interactions (pDDI) found in prescription orders of adult Intensive Care Unit (ICU) of a Brazilian public health system hospital; quantify and qualify the pDDI regarding their severity and risks to the critical patient, using the database from Micromedex®.MethodsProspective study (January–December of 2011) collecting and evaluating 369 prescription orders (convenient sampling), one per patient.ResultsDuring the study 1844 pDDIs were identified and distributed in 405 pairs (medication A×medication B combination). There was an average of 5.00±5.06 pDDIs per prescription order, the most prevalent being moderate and important interactions, present in 74% and 67% of prescription orders, respectively. In total, there were 9 contraindicated, 129 important and 204 moderate pDDIs. Among them 52 had as management recommendation to “avoid concomitant use” or “suspension of medication”, while 306 had as recommendation “continuous and adequate monitoring”.ConclusionThe high number of pDDIs found in the study combined with the evaluation of the clinical relevancy of the most frequent pDDIs in the ICU shows that moderate and important interactions are highly incident. As the majority of them demand monitoring and adequate management, being aware of these interactions is major information for the safe and individualized risk management

Analysis of information received during treatment and adherence to tamoxifen in breast cancer patients

This study examines whether women with breast cancer, who are adherent and non-adherent to tamoxifen, differ in their perceptions of information received during treatment. This cross-sectional study included women receiving tamoxifen as adjuvant treatment for breast cancer recruited from a teaching hospital specialised in women’s health in the state of São Paulo (Brazil). Women were interviewed and their records were reviewed for socio demographic data and clinical characteristics. We assessed tamoxifen adherence using the Morisky-Green Test, and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire – Information module (EORTC QLQ-INFO25) was used to evaluate the information received by the women. The sample contained 31 women (mean age = 55.4; SD = 11.6 years). According to the Morisky-Green Test, 74.2% of the women had suboptimal tamoxifen adherence. The global score for women’s perceptions of information they received about the treatment and disease was 57.0 ±19.1 on a scale of 0 to 100, and no significant differences in scores were observed between adherents and non-adherents. A high prevalence of suboptimal tamoxifen adherence was observed. We found no significant differences between women with breast cancer who were adherent and non-adherent to tamoxifen

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Abstract Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for > 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results

Adherence and quality of life in women with breast cancer being treated with oral hormone therapy

To evaluate adherence to oral hormone therapy (HT) and which factors impact in incomplete adherence and quality of life. Methods This was a cross-sectional study. Setting: Women's Hospital Prof. Dr. Jose Aristodemo Pinotti. Participants: women with breast cancer under treatment with oral HT. Main outcome measures: interview and performed an adherence questionnaire (Morisky-Green) and two questionnaires of quality of life (EORTC-QLQ30/BR23). The interviews were done once in a 5-month period. Fifty-eight women were interviewed: 42 under treatment with tamoxifen (TX) and 16 under treatment with aromatase inhibitor (AI). Twenty-six women (44%) showed high adherence to the treatment, 31 (54%) medium adherence, and 1 (2%) low adherence. Statistical analysis showed a relation between incomplete adherence and systemic therapy side effects as well as higher stages of disease, with no difference between the two drugs. When treatments were compared, this study showed treatment with AI presented less breast symptoms and better role functioning. Quality of life score was high, compared to the reference value. A low percentage of women with breast cancer were highly adherent to HT treatment. Low/medium adherence was associated with higher stages of disease and systemic side effects. Quality of life had high scores, with better role function and less breast symptoms in women being treated with an AI271037993804CAPES - Coordenação de Aperfeiçoamento de Pessoal e Nível Superior130466/2016-

Prevented prescribing errors in an ICU of a Brazilian teaching hospital specializing in women’s health

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