ABSTRACT Background: Diarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments. Methods: The role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria. Results: Thirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (p-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarrhea (p-value = 0.06). Conclusions: The high frequency of diarrhea caused by coccidia shows the importance of investigating and correctly identifying etiological agents and highlights the possible varieties of intestinal infections in patients who undergo autologous stem cell transplantation.

OBJETIVO: Avaliar o nível de informação e as atitudes preventivas em uso corrente pelos médicos ligados à FMABC. MÉTODOS: Foram entregues questionários para 120 médicos não oncologistas que lidam diretamente com pacientes adultos. RESULTADOS: A taxa de resposta foi de 58,3%. A idade média dos médicos foi de 33,9 anos, sendo 57,1% mulheres e 10% tabagistas. As práticas preventivas para os cânceres mais comuns (mama, colo de útero, próstata, colorretal e pele não-melanoma) foram analisadas e comparadas com as recomendadas pelos consensos adotados (INCA, Sociedade Americana de Cancerologia e Força-Tarefa Canadense). Observou-se que a maioria das práticas (45,72% a 100%) não se adequou a nenhum deles. Sobre possíveis barreiras para o adequado exercício da prevenção do câncer, 82,86% considerou falta de agentes educadores em saúde para a população, 77,14% poucos conhecimento ou treinamento e 70,15% falta de verba para custear exames. Houve uma tendência ao excesso de pedidos de exames de rastreamento. CONCLUSÕES: As práticas preventivas utilizadas pelos médicos entrevistados são heterogêneas e, em sua maioria, não preconizadas pelos consensos de condutas preventivas consultados, o que pode ser relacionado tanto à sua falta de conhecimento em relação a estes consensos como às divergências entre eles. Dessa forma, faz-se necessário um esforço educativo enfatizando a importância da prevenção do câncer no aprendizado e na prática médica.

BACKGOUND: New cancer cases are most often diagnosed by non-oncologist physicians. It is therefore essential for all physicians to be aware of cancer preventive practices and use them appropriately with their patients. METHODS: Questionnaires were administered to 120 non-oncologist physicians of various specialties attending the "Faculdade de Medicina do ABC" who deal directly with adult patients. Replies were collected and classified as appropriate or not according to one of these three cancer prevention guidelines: INCA, American Cancer Society and Canadian Task Force. RESULTS: The percentage of replied questionnaires was 58.3% (70 questionnaires). Mean age of physicians was 33.9 years; 57.1% were women and 10% smokers. Most of the current preventive practices adopted by the participating physicians (45.72% to 100%) regarding the most common and preventable tumors (breast, cervix, prostate, colon and rectum and non-melanoma skin cancer) did not agree with any of the guidelines mentioned above. When questioned about possible impediments for the appropriate practice of cancer prevention, 82.86% reported absence of health education agents working with the population, 77.14% scarceness of knowledge or training concerning prevention, and 70.15% lack of financial support for ordering tests. Frequently, whenever there was disagreement between the guidelines and the physician's current practices, preventive tests were ordered in excess of those recommended by the guidelines. CONCLUSIONS: Physicians had a tendency to order excessive laboratory tests, an action which can be related to lack of knowledge and to divergence among guidelines. A more intensive educational effort regarding cancer prevention, directed towards teaching physicians in training, seems to be warranted.

CONTEXTO: Pacientes recebendo quimioterapia adjuvante por câncer de mama têm tendência a ganhar peso. Esta tendência tem fatores determinantes não completamente definidos e seu significado prognóstico é incerto. OBJETIVO: Avaliar a variação de peso durante tratamento quimioterápico por câncer de mama em uma população definida, identificar fatores predisponentes e seu possível significado prognóstico. TIPO DE ESTUDO: Observacional, de coorte retrospectiva. LOCAL: Serviço privado de oncologia clínica. PARTICIPANTES: Cento e seis pacientes consecutivas com câncer de mama tratadas entre junho de 1994 e abril de 2000 e que receberam quimioterapia neoadjuvante (n = 8), adjuvante (n = 74) ou paliativa (n = 24). PROCEDIMENTOS: Revisão de prontuários médicos com coleta de dados clínicos incluindo peso corporal das pacientes antes do tratamento e nas avaliações subseqüentes. VRIÁVEIS ESTUDADAS: Variação de peso corporal expresso em percentual do peso corporal por mês em tratamento, influência de variáveis clínicas nesta variação de peso e influência da variação de peso na sobrevida global e sobrevida livre de doença. RESULTADOS: Houve um ganho de peso médio de 0,50 ± 1,42% (p = 0,21) do peso corpóreo por mês de tratamento. Constatamos uma correlação negativa entre presença de doença metastática e ganho de peso (r = -0,447, p < 0,0001). No grupo em quimioterapia adjuvante e neoadjuvante, houve um ganho de peso médio de 0,91 ± 1,19 % (p < 0,00001) do peso corpóreo por mês de tratamento, enquanto que, no grupo com doença metastática (paliativo), observamos uma perda de peso média de 0,52 ± 1,21% (p = 0,11) do peso corpóreo por mês de tratamento. Não observamos correlação estatisticamente significante entre variação de peso e sobrevida livre de doença ou sobrevida global. CONCLUSÕES: Mulheres com câncer de mama recebendo tratamento quimioterápico adjuvante e neo-adjuvante ganham peso, enquanto mulheres com câncer de mama metastático possivelmente perdem peso durante quimioterapia paliativa. Estudos subseqüentes são necessários para avaliar o valor prognóstico da variação de peso durante quimioterapia.

CONTEXT: Patients receiving adjuvant chemotherapy for breast cancer have a tendency to gain weight. This tendency has determining factors not completely defined and an unknown prognostic impact. OBJECTIVE: To evaluate weight change during chemotherapy for breast cancer in a defined population and to identify its predisposing factors and possible prognostic significance. DESIGN: Observational, retrospective cohort study. SETTING: Private clinical oncology service. PARTICIPANTS: 106 consecutive patients with breast cancer treated between June 1994 and April 2000, who received neoadjuvant (n = 8), adjuvant (n = 74) or palliative (n = 24) chemotherapy. INTERVETION: Review of medical records and gathering of clinical information, including patients’ body weights before treatment and at follow-up reviews. MAIN MEASUREMENTS: Body weight change, expressed as percentage of body weight per month in treatment; role of clinical data in weight change; and influence of weight change in overall survival and disease-free survival. RESULTS: There was a mean increase of 0.50 ± 1.42% (p = 0.21) of body weight per month of treatment. We noted a negative correlation between metastatic disease and weight gain (r = -0.447, p < 0.0001). In the adjuvant and neoadjuvant therapy groups there was a mean weight gain of 0.91 ± 1.19 % (p < 0.00001) per month, whereas in the metastatic (palliative) group, we observed a mean loss of 0.52 ± 1.21% (p = 0.11) of body weight per month during the treatment. We did not observe any statistically significant correlation between weight changes and disease-free survival or overall survival. CONCLUSIONS: Women with breast cancer undergoing adjuvant or neoadjuvant chemotherapy gain weight, whereas metastatic cancer patients will probably lose weight during palliative chemotherapy. Further studies are needed in order to evaluate the prognostic significance of weight changes during chemotherapy.