Psycho-oncology

Disponilbe en Revista Argentina de Terapia Ocupacional:
http://www.revista.terapia-ocupacional.org.ar/descargas/volumen2/Rev2%20Rese%C3%B1a2.pdf

Se trata de la reseña de un libro de autoria de la terapista ocupacional Silvina Ousdhoorn, publicado en 2015, por Ed. Martin, Mar del Plata.
El  libro,  anunciado  como  el  primero  de  una  trilogía,  tiene  como  uno  de  sus  propósitos cuestionar aquellos supuestos  que  consideran  a  la  oncología  en  pediatría  como  un  escenario  frecuentemente  temido  y  evitado  por  los  profesionales  de  la  salud,  para  describirlo 
como un campo pleno de posibilidades y desafíos, sobre todo si se considera la dimensión  de  esta  enfermedad  como  un  problema  de  salud  pública  de  relevancia.

This study explores the relationship between spiritual well-being (SWB) (meaning/ peace & faith), depression, and quality of life (QOL). Cancer survivors often use their spirituality as a way of coping. Among a sample of 97 Latina breast cancer survivors (LBCS), SWB was assessed with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale, QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G), and depression was measured with the Patient Health Questionnaire. Study findings revealed that SWB, specifically the meaning/peace factor, is the main predictor of an increase in QOL and a reduction in depression among LBCS.

Edição eletrônica em http://psicorporal.emnuvens.com.br/rbpc Revista Latino-americana de Psicologia Corporal De corpo e alma: a Análise Bioenergética na Promoção da Saúde do Paciente Oncológico 1 Resumo: O rompimento com a visão dualista de tradição cartesiana mente-corpo, associado à superação do modelo biomédico de saúde como ausência de doença, nos ajuda a trazer o sujeito da patologia para o centro do processo, valorizando-o como indivíduo para além do quadro sintomatológico. Nesta perspectiva, entender a psicodinâmica do paciente oncológico auxilia no trato mais humanizado, na medida em que tal quadro o afeta nas dimensões física, psíquica e social. Os estudos de Reich e outros pesquisadores (Edwing e Foque; Peller e Greene; Iker e Schmale) apontam uma interação profunda entre estados psíquicos e o surgimento do câncer como: contração respiratória ocorrida via resignação caracterológica que afeta o funcionamento vital, a presença de sentimentos como desesperança ou vivência patológica da perda (morte ou separação), abandono, culpa, solidão, condenação, repressão de sentimentos e distresse (Leschan). A partir desse contexto, o presente trabalho visa discutir as contribuições da Análise Bionergética no auxilio ao paciente oncológico, no que se refere ao tratamento de comorbidades como a depressão, no auxílio à auto-estima e no desbloqueio de tensões afetivo-musculares que podem piorar o quadro. Nesse sentido, a proposta de uma intervenção em grupo que permita um espaço de trocas simbólicas ligadas ao quadro de sofrimento psíquico compartilhado, agregada ao trabalho psicocorporal utilizando-se os exercícios da bioenergética desenvolvidos por Lowen e os Exercícios de Liberação do Trauma de Berceli, entram como importante ferramenta de desbloqueio das contrações vegetativas, melhoramento da respiração e favorecimento grounding no enfrentamento da doença, o que proporciona a redução da ansiedade e dos sintomas do tratamento agressivo da quimio e da radioterapia. Palavras-chave: Psicodinâmica do Câncer, Análise Bioenergética, Grounding. Abstract: The break with the dualistic view of mind-body Cartesian tradition, associated with overcoming of the biomedical model of health as absence of disease, helps to bring the subject of pathology to the center of the process, valuing them as individuals beyond the symptomatology. In this perspective, to understand the psychodynamics of cancer patients helps in more humane treatment, to the extent that such a framework affects the physical, psychological and social dimensions. Studies by other researchers and Reich (Edwing and Foque; Peller and Greene; Schmale and Iker) indicate a deep interaction between mental states and the emergence of cancer as: respiratory contraction occurred by resignation that affects the vital functioning, the presence of feelings as hopelessness or pathological experience of loss (death or separation), abandonment, guilt, loneliness, condemnation, repression of feelings and distress (Leschan). From this context, this paper aims to discuss the contributions of bioenergetic analysis in help to cancer patients, in relation to the treatment of comorbidities such as depression, self-esteem and aid in the release of muscle-affective tensions that can worsen them. In this sense, the proposal of a group intervention to allow a space of symbolic exchanges connected to the frame of psychological distress shared aggregate psycho-body to work, using the exercises developed by Lowen Bioenergetics and Trauma Releasing Exercises of Berceli, that come as an important tool to unlock the vegetative contractions, improving breathing and favoring grounding in fighting the disease, provides the reduction of anxiety and symptoms of aggressive treatment of chemotherapy and radiotherapy.

This practical manual presents the main drugs and protocols currently used in the psychopharmacological treatment of psychiatric disorders in cancer and palliative care settings and explores the principal issues involved in such treatment. Significant clinical challenges encountered in the psychopharmacological management of various psychiatric conditions are discussed, covering aspects such as side-effects and drug-drug interactions. Attention is also paid to the emerging theme of adjuvant use of psychotropic drugs for the treatment of symptoms or syndromes not primarily related to psychiatric disorders. In addition, practical suggestions are provided for dealing with special populations, including children and the elderly. The book is designed to be easy to read and to reference, with helpful concise tables and boxes. The authors include some of the most renowned clinicians working in the field of psycho-oncology.

Cancer is a sensitive topic that still causes a lot of suffering. When it comes to children, adults sometimes decide not to reveal the diagnosis or the prognosis, in order to protect the young patients. As far as caregivers are concerned, those who would like to openly communicate with children are hindered by a limiting legislation. Others are hindered by a lowering of empathy that prevents them from using proper communication skills. Nevertheless, not to explain the situation to pediatric patients would mean to give up on doctor-patient relationship, which may affect compliance, treatment result and public health system. In order to help caregivers and parents to announce the diagnosis and the prognosis to pediatric patients, we made a scientific literature review and created a semi-structured model of diagnosis announcement in four phases, and in case of terminal stage we added two more phases. As we have seen in a survey conducted in several Swiss hospitals, there is still a lack of written guidelines. This leaves an opening for research in the field of communication with pediatric patients and teaching programs development as well as for the intervention of psychologists.

There is little evidence on how telephone interviews are used in qualitative psychological research compared to
face-to-face interviews. This reflective methodological exercise explores the use of telephone interviews as a method
in relation to interviewing prostate cancer patients about their dietary changes in a recent study. In conclusion,
both methods of collecting data are qualitatively different and can offer a range of advantages. The decision
must be based on the aims of the study, the population studied, the interviewer’s experience and the decisive
balance between cost-effectiveness and wider demographics on the one hand and richer data on the other.

Egypt is a young nation with a growing oncology health sector. It is faced with many challenges, such as the endemicity of HCV and schistosomiasis causing the high prevalence rates of hepatocellular carcinoma and bladder cancer respectively. In recognition of their tremendous health and economic burden, the Egyptian government established the “100 Million Healthy Lives” campaign in September 2018 for the screening of HBV, HCV, hypertension, and diabetes mellitus patients. MoH also founded the National Committee for Control of Viral Hepatitis to implement an integrated national strategy to contain the situation. More oncology-specialized hospitals and units are built every year to cope with the increased demand, such as the New National Cancer Institute, Shefaa El-Orman hospital, and Baheya hospital. Non-Communicable Diseases (NCDs), especially neoplasms, are the twenty-first century’s biggest challenge after significant control of communicable ones with the advancement of antimicrobial and progression of community health and epidemiology knowledge. Hence, we believe more light should be shed on their burden in society to increase public awareness and encourage investment in the health care sector.

In questa relazione l’autrice a partire dal “mito di cura” indica tre orizzonti clinici nella prospettiva fenomenologica e relazionale della Gestalt Therapy: il senso del limite che il dolore ci rimanda e la sua funzione etica; il senso del sacro dell’arte medica e la sua funzione terapeutica; la “donazione di senso” e la sua funzione relazionale. Un processo relazionale curativo che l’autrice ha definito “palingenesi terapeutica” per indicare, in campo psicoterapico, il processo che dall’ascolto dell’inudibile ed indicibile esperienza esistenziale del paziente, ripercorrendo tramite la “memoria”, il racconto del romanzo della sua vita, prima e dopo l’evento “tragico” (sviluppo ontogenetico), conduce alla re-integrazione delle parti frantumate del sé (fase anatettica) e diventa esperienza di crescita e di arricchimento reciproco.

Quando si parla di assistenza socio-sanitaria sembra ormai impossibile non fare riferimento a quello che è considerato uno degli aspetti fondamentali del contesto di cura: la dignità. L’Organizzazione Mondiale della Sanità (WHO), a tal proposito, sottolinea il bisogno di strutturare interventi sanitari sempre più mirati che abbiano il focus incentrato sul paziente e sulla necessità di preservare il suo senso di dignità, ma la complessità nella definizione di tale costrutto rende ostico non soltanto il portare avanti studi sistematici, ma inevitabilmente anche lo strutturare piani di cura adeguati a ogni categoria di paziente. Nel presente lavoro ci siamo concentrati in modo particolare sui pazienti a termine, per i quali il mantenere la dignità personale è un obiettivo critico che non può non essere tenuto ampiamente in considerazione durante il trattamento e la pratica clinica. A causa della sua natura multidimensionale, il concetto di dignità può essere indagato a partire da diverse prospettive e con diversi approcci; studi recenti nell’ambito delle cure palliative hanno fatto ampio uso di metodi d’indagine qualitativi, utilizzando strumenti come le interviste semi strutturate e i focus group. Questo perché, rispetto ad un approccio quantitativo, quello qualitativo consente di giungere ad una più ampia riflessione sul tema trattato, e di raccogliere una quantità di informazioni significativamente maggiore.
Partendo da tali premesse, questo lavoro si propone come riflessione sul tema della dignità contestualizzata nell’ambito del fine vita.
Il primo capitolo consisterà in una trattazione storica e strutturale sui contesti delle cure palliative. Dopo aver fornito una definizione di cosa siano le cure palliative e di come siano nate, si andrà a descrivere nel particolare i due ambiti principali nei quali esse vengono applicate, ossia l’assistenza domiciliare e l’Hospice. In entrambi, il paziente e la famiglia vengono seguiti da un’équipe multiprofessionale allo scopo di garantirgli, per quanto possibile, la miglior qualità di vita.
Nel secondo capitolo verrà approfondito il concetto di dignità nel contesto delle cure palliative, facendo specialmente riferimento all’impostazione operativa delineata da Chochinov in un modello teorico e nei relativi strumenti che verranno ampiamente descritti.
Nel terzo capitolo viene descritto lo stato dell’arte riscontrato nella letteratura riguardo al senso di dignità nei contesti di cura. Nel particolare, gli studi riportati presentano approfondimenti nelle differenze tra il senso di dignità per come lo intendono pazienti ed operatori, e conseguentemente come diversi orientamenti professionali possano avere diverse modalità di raffrontarsi alla stessa tematica.
Il quarto capitolo presenta i contributi sperimentali del presente lavoro. La ricerca è stata condotta mediante l’utilizzo di focus group al fine di acquisire informazioni riguardo alla percezione della dignità del paziente a termine da parte degli operatori, con lo scopo di effettuare un confronto con l’attuale stato dell’arte rilevato in letteratura descritto nel capitolo precedente.
L’obiettivo ultimo del presente lavoro è quello di ampliare il dibattito rispetto al concetto di dignità nell’ambito di cura, per favorire una presa di coscienza rispetto alla centralità che questo tema dovrebbe trovare nell’ambito dei processi terapeutici e educativi.

Keywords: dignità, cure palliative, focus group, content analysis.

La ansiedad es un constructo que ha recibo muchas acepciones,
tanto en el lenguaje formal como en el coloquial. Esto quizá es
debido a que la vida de las sociedades industriales es cada vez
más caotica y acelerada, haciendo parte de la vida a los transtornos de la emoción. Por lo que en este artículo comenzaremos por
definir a la ansiedad como: “un estado desagradable de agitación
e inquietud, cuya principal característica es la anticipación del peligro, y que presenta tanto síntomas físicos, cognitivos y emocionales” (Sierra, Ortega & Zubeidat, 2003). Definir y entender la ansiedad es de gran importancia, ya que de acuerdo con Oblitas y Becoña (2000) cualquier trastorno físico u orgánico implica alteraciones psicológicas y viceversa. Esto cobra relevancia ya que la vida acelerada en las ciudades ha generado que las personas se encuentren cada vez con más frecuencia en períodos de mucho estrés, desequilibrando al organismo y generando diversas reacciones emocionales negativas, lo que conlleva al desarrollo
de diversas enfermedades o realizar conductas poco saludables
(Piqueras et al., 2008; Tabala, Wrzesinska, Stecz & Kocur, 2016).

Site: www.valcapelli.com WhatsApp 11 9 9471-3490 Resumo: Esse artigo objetiva apontar as causas psicoemocionais do câncer, que figuram como causas metafísicas da doença. O estudo foi baseado na larga experiência de investigação da interface entre a mente, a emoção e o corpo; no trabalho de atendimentos individuais de psicoterapias; bem como, por meio dos atendimentos de ambulatório (de práticas integrativas) realizados no Espaço Integração Ananda; fundamentado na bibliografia consultada. Os dois casos relatados apontam as causas emocionais associadas ao câncer. No primeiro caso a pessoa demorou para se conscientizar da gravidade da doença e promover as consequentes transformações interiores. O segundo caso a pessoa buscava se trabalhar interiormente enquanto tratava a doença. Os cuidados com o corpo repercutem positivamente na mudança das causas metafísicas do câncer. Encarar os eventos traumáticos e se libertar dos sentimentos nocivos, contribui significativamente nos resultados dos tratamentos do câncer. Summary: This article focus on pointing out the psychoemotional causes of cancer, which appears as metaphysical causes of the disease. The study was based on a large experience investigation of the interface between mind, emotion and body; in the work of individual psychotherapy sessions, as well as attendance trough chromotherapy ambulatory (integrative practices) performed at Espaço Integração Ananda; based on consulted bibliography. Both related cases point to the emocional causes associated to cancer. In the first case, the person took a time to raise awareness of the gravity of the disease and to promote the consequent inner transformation. In the second case the individual was trying to work internally while treating the disease. Body care has a positive impact in the change of the metaphysical causes of cancer. Facing traumatic events and getting rid of harmful feelings, contributes significantly to the results of cancer treatments.

Background: Lung cancer is one of the most appalling diagnoses, associated with significant patient distress, poured quality of life and often limited survival. Moreover, the current literature emphasizes the effect of distress level on survival rates. The purpose of this study was to explore the survival curve, considering the distress level reported by patients with advanced NSCLC cancer at the beginning of the treatment. Methods: A sample of 24 patients with newly diagnosed stage IV NSCLC, answered the Distress Thermometer (DT) and the Problem List (PL) before start the first chemotherapy infusion. They treated at a private cancer center, located at Brasília, Brazil. Survival was calculated from time of the histopathological diagnosis. The data was analyzed with descriptive evaluation, followed by Kaplan-Meier models, to test associations with survival and distress. Results: Of those patients, 58.3% were male. They were between 54-81 years old (M = 66.2; SD = 6.6); 62.5% were married; 54.2% had at least college degree. The NSCLC were 87.5% adenocarcinoma and 12.5% epidermoid. The survival rate was 10.7 months for all patients (range from 1 to 50 months; SD = 10.7); being 6.4 months for moderate to severe distress and 14.2 for mild distress. Seven types of chemotherapy regimen were prescribed: Cisplatin+Gemcitabine (45.8%); Alimta+Carboplatin (16.7%); Carboplatin+Taxol+Avastin (8.3%); Erlotinib (8.3%); Taxol+Carboplatin (8.3%); Cisplatin+Alimta (8.3%); Cisplatin+Gemcitabine+Avastin (4.2%). Half of patients (54.2%) reported moderate to severe distress (DT ≥ 4). The most problems reported at PL were worry (70.8%), sadness (66.7%), fears (45.8%), sleep (70.8%), fatigue (66.7%), pain (58.3%), eating (50%) and breathing (50%). Considering the survival curves, patients with mild distress showed better survival rate than patients with moderate to severe distress (x2 = 4.16; p = .04). Conclusion: Despite the limited sample size, the data suggest that mild distress is a prognostic factor in survival rate. The high prevalence of patients with moderate to severe distress, as well as, the problems-related distress, highlighted the importance of the distress screening and also to create an advanced care planning for patients with lung cancer, from the time of diagnosis until the last phase of illness, helping them to cope with this reality. More studies are thus needed to investigate the implication of distress level at diagnosis as a prognostic factor, increasing and diversifying the sample in order to make the data more generalizable.

Introduction: Lorsqu’un être humain est atteint du cancer mortel, c’est non seulement la personne malade elle-même qui est touchée mais également plus largement son entourage proche qui accompagne le patient jusqu’aux derniers instants. Plus particulièrement, les études actuelles démontrent que le soutien de la part du partenaire remplit une fonction primordiale dans une situation de cancer. Au sein des familles, la femme occupe une place particulière au sens où cette dernière est la principale figure de soins mais également garante de la gestion des émotions de l’ensemble des membres de la famille. Dès lors, certaines questions semblent intéressantes à investiguer dans le cadre de ce travail: «Quels mécanismes de protection la femme atteinte de cancer mortel met-elle en place afin de protéger son partenaire mais également elle-même?»; «Quels mécanismes de protection la femme met-elle en place face au cancer mortel de son partenaire?»; «Face à l’approche de la mort consécutive au cancer, comment la femme communique et interagit au sein du couple durant ce temps éprouvant?». La littérature souligne que la relation conjugale a une influence considérable sur l’adaptation au cancer. Toutefois, aucune étude n’aborde les interactions concrètes et les comportements de protection d’une telle situation auprès des couples concernés par la fin de vie suite au cancer.

Méthodes: Seize femmes tout-venantes et en bonne santé entre vingt-quatre et soixante-cinq ans sont invitées à se projeter dans deux scénarii présentant une situation de l'approche de leur fin de vie suite à un cancer et une autre situation de l'approche de la fin de vie de leur partenaire suite à un cancer également. Finalement, des questions semi-directives construites au préalable leur sont posées après chaque mise en situation. Le contenu des réponses des participantes est analysé afin d'approcher comment opèrent les comportements de protection des femmes au sein du couple.
Il s'agit donc d'une méthode projective, qualitative et comparative.

Résultats: La révélation de soi et la retenue ont pu être identifiées auprès les participantes de l’étude comme poursuivant des objectifs de protection de soi et du partenaire. Une observation intéressante réside dans les différences relevées entre les deux scénarii. Les comportements de protection sont différents selon qu'il s'agisse de la fin de vie de la femme ou de son partenaire. En effet, il apparaît que dans la mise en situation relative à la mort d’elles-mêmes, les femmes s’imaginent se révéler davantage que dans la mort de l’autre, l'objectif principal étant d'obtenir du soutien de la part de leur partenaire. Bien que des comportements de retenue ont pu être repérés dans les deux scénarii, il s’avère que dans la mise en situation se référant à la fin de vie du partenaire, la retenue est plus présente, la principale préoccupation des femmes étant de ne pas surcharger le partenaire.

Conclusion: Cette recherche élucide sur la manière comment opèrent les comportements de protection chez des femmes en couple face au contexte de fin de vie. Les comportements de protection semblent varier considérablement selon que les femmes sont confrontées à leur fin de vie ou à celle de leur partenaire. Ce travail pourrait
conceptualisations ayant entre autre comme objectif la réduction de la détresse individuelle et
guider vers une amélioration des interventions et
  relationnelle lors des interactions.

Background: Defense mechanisms defined as
unconscious process, cognitive operations alter by
developmental periods for protective function, and that
can be assessment of personality and experimental
schedules. Defense Style Questionnaire (DSQ-60) is a
self-report instrument designed to measuredefensive
functioning and coping styles. The aim of this study was
to adaptive theDSQ-60 in a sample of cancer patients
in Iran using exploratory and confirmatory factor
analytic procedures.
Method:The DSQ-60 was used to measure the
conscious derivatives of three factors defense styles
includeimage.distorting, affect.regulating and adaptive
in a sample of 200 cancer patients.
Result: Cronbach's coefficient alpha for
image.distorting (ex = 0.54),affect.regulating (ex =
0.53) and adaptive (ex = 0.5) were found to be poor in
terms of potential clinical significance,internal
consistency for all components was acceptable (.68).
Conclusion:Our results were consistent with the
previous research on the DSQ-60 indicating that the
psychometric features need to be improved before the
wider use of the scale. Further, DSQ-60 is a suitable
tool to assess cancer patients psychological defense
styles and that may be used for psychological
interventions to improve the care of these patients.
Keyword: defense styles, adaptation, DSQ-60,
confirmatory factor analysis

Breast cancer is one of the most frequent reasons for death among women and it is also the most feared one, mainly for its psychological effects that affect the perception of the sexuality, identity, self-esteem and body image. The current study aimed at checking the satisfaction of 44 women in regard to the breast reconstruction dividing them in two groups: immediate reconstruction (24 patients) and late reconstruction (20 patients). It also evaluated changes in the quality of life and in anxiety and depression levels, in these patients at that moment and at the time of the diagnosis/treatment (retrospective
evaluation). Moreover, it was such a goal three questionnaires were used: one related to satisfaction at breast reconstruction, the Hospital
Anxiety and Depression Scale (HAD) and the WHOQOL}Bref. It was verified that the patients who went under late reconstruction were more satisfied than the ones who went under immediate reconstruction, which shows the importance of the psychological work of the loss and mourning of the breast before mastectomy. Furthermore, changes were verified in the levels of depression and anxiety, as well as in the quality of life of the patients during
the diagnosis/treatment.

BACKGROUND: Distress, anxiety and depression are common emotional complications of cancer that deserve clinicians attention, as well as, the ways patients choose to cope with this difficult moment and the implications associated with disease and treatment in their quality of life (QoL). We examined the correlation between symptoms of distress, anxiety and depression, coping and quality of life among cancer patients from a Brazilian Cancer Center. METHOD: 44 patients participated in this pilot study, 27.3% were male and 72.7% female, average age was 57 (SD513.8), most of patients were married (70.5%), and 45.5% had college degree. The Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy-General and the Ways of Coping Checklist were used to evaluate the psychosocial aspects, followed by a multidisciplinary discussion to define the best intervention for each case. This research was authorized by the ethics committee and the data were analyzed according to criteria defined in literature and with help of the software SPSS 17.0. RESULTS: In the beginning of treatment, 40.9% of patients had a clinically significant level of distress, 29.5% had anxiety and 25% depression, the average QoL was 89.3. At the midcycle assessment, 14% presented with distress, 4% anxiety and depression, the average QoL was 94.1. On the last day of chemotherapy 7.1% still scored above 4 on the DT, 4% showed anxiety and depression, and the average QoL was 98.7. The most common forms of coping used in all stages of evaluation was seeking social support; the second one was planful problem-solving in the beginning and distancing at middle and last day. CONCLUSIONS: This study shows that patients with high distress have worse QoL (74.8% with QoL o85) than patients without it (30% with QoL o85). Considering that coping is a major factor in the relation between distress (depression and anxiety) and cancer adaptation, patients tend to emotional support (seeking for social support) and to make efforts to seek informational. The progressive decrease of distress, anxiety and depression was attributed to screening and monitoring routine for identifying the level and nature of distress as well as the multidisciplinary intervention tailored to each case. RESEARCH IMPLICATIONS: This result supports the importance of these analyses, and the multidisciplinary discussion as a method of understanding the relations between distress, mood disorder, coping and QoL, as well as of understanding coping process and the mechanisms through which they come to affect patient’s well-being over the treatment. Furthermore, it is important to identify intersection points between patient’s psychological adjustment to cancer to know more about our patients and to offer a quality cancer care. CLINICAL IMPLICATIONS: In this journey patients have to appraisal and reappraisal to revise the meaning of events in ways that were more consistent with their new situation in an attempt to find a tolerable meaning to the event. It is important to know how is this patients process to propose the appropriate intervention strategies. Such knowledge, can favor the adequate assistance to patients because of the understanding of suffering and doubts present in the phases of disease. ACKNOWLEDGEMENT OF FUNDING: None.

Coping refers to the cognitive and behavioral activities by which a person attempts to manage a potentially stressful situation. This study sims to investigate the association between distress level and coping styles in 161 patients from a private cancer center, located in Brasília, the capital of Brazil. They were between 19 and 84 years of age (M = 56; SD = 14.9), of both gender (29.8% male and 70.2% female), most of them married (61.5%), 61.5% had at least the college degree, with several types of cancer (gastrointestinal, breast and hematological were the main diagnosis). All patients answered the Distress Thermometer and the Ways of Coping Checklist 20 days after receive the diagnosis, on the day of the beginning of chemotherapy treatment. A signifi cant proportion of patients (42.9%) reported high level of distress (DT ≥ 4), of these patients the main coping strategy used to deal with diagnosis/treatment was seeking social support (27.5%) and painful problem solving (27.5%), followed by escape-avoidance (13%), confrontive coping, distancing and self-control (8.7% for each one). Those patients (57.1%) with low level of distress (DT ≤ 3) chose the social support (28.3%), problem solving (25%), distancing (23.9%), positive reappraisal (8.7%) and self-control (7.6%). There were similarities and diferences between group of patients with high and low of distress level. For both social support and problem solving were the most strategy used. The third one could be considered a similar construct of avoidance/denial (escapeavoidance and distancing). This preliminary fi ndings suggest that individuals who appraise their cancer illness as a threat are likely to use more social support and planful problem solving coping strategies. We suggest future studies to evaluate the relationship between coping and demographic and disease characteristics.

BACKGROUND: Based on scientific evidence, it is undeniable the importance to recognize distress in cancer patients. The routine screening for distress can orient the clinical care to provide adequate support, providing feedback to oncologists on the quality of their psychosocial care, being helpful to identify the need for improvement efforts. We investigate the course and prevalence of distress over the treatment, verifying the correlation with quality of life (QoL), and examine the effectiveness of psychosocial program. METHOD: Two hundred patients answered: (1) Distress Thermometer (DT) and Problem-List (PL) and (2) Functional Assessment of Chronic Illness Therapy-General (FACT-G) at baseline (T1), halfway time point (T2) and at completion of chemotherapy (T3). After each assessment, all results were discussed with the patients’ physician, to establish the best conduct. The conducts ranged from psycho-education, manage the side effects, to referrals. Descriptive analyses were calculated for sociodemographic, illness-related variables, DT, PL and FACT-G prevalence; chi-square and correlation were conducted to explore the effect of the distress course on PL and QoL. RESULTS: Proportion of patients experiencing moderate to severe distress (MSD) decreased (T1. 41.5%; T2. 9.1%; T3. 4.4%), being emotional and physical the most problems reported. The QoL mean scores slightly increased (T1. 85.6; T2. 90.4; T3. 92). There were a main effect of distress decreasing overtime (p = 0.000), of drop in problems reported (p < 0.05), and of QoL increase (p = 0.000). MSD were significant related (p = 0.000) to PL (T1. x2 = 77.5; T2. x2 = 79.1; T3. x2 = 158.5) and poor QoL (T1. x2 = 93.4; T2. x2 = 311.6; T3. x2 = 278.4). CONCLUSIONS: Routine screening for distress followed by personalized discussion between psychologist and oncologist (psychosocial program) resulted in reduction of MSD incidence and of problems-related distress reported, as well as, QoL increased, even under chemotherapy side effects. We observed that this kind of supportive feedback helps not only in identifying problems contributing to MSD, as offering appropriate practical and psychological assistance. This routine offers a viable strategy for ensuring that distress is identified and managed in a timely way. Moreover, we could provide more opportunities for connecting patients to adequate support, resulting in more appropriate referrals. RESEARCH IMPLICATIONS: Systematic screening for distress and multidisciplinary discussion was a good way to improve uptake of resources, rather than simplify focusing on screening alone. This routine maybe a key to reduce distress and to improve quality of life, providing equal access to psychological services. Future studies should be conducted to replicate and extend the current finding. As this study recruited patients just from a single cancer center, the study’s generalizability to other settings can be reduced. CLINICAL IMPLICATIONS: Understanding na individual’s level of distress related to their symptoms and illness-related concerns was fundamental to screening, referral, assessment and treatment. Moreover, this routine helped to determine the severity of distress and the appropriate intervention; let patients know more about the psychosocial services and the program available to take care of them, and mainly to encouraged those distressed patients without sufficient motivation for seek help and adequate active treatment. ACKNOWLEDGEMENT OF FUNDING: None.

BACKGROUND: For a long time, giving the diagnosis of cancer was considered something cruel and inhuman. Many times, doctors would prefer that patient should not know the name of the disease, in order that, they would not lose hope. Doctors believed that there was no treatment available for cancer. Having in mind such social representation, the present study main goal was to know the influence of such representation in the reaction to diagnosis during the treatment. METHOD: Participated in this study 100 patients, of booth genders (39% male and 61% female), with the age between 17 and 86 years (median of 55 years), with 17 types of cancer. Those patients were accompanied in a specialized center in cancer, in the capital of Brazil. The research project was authorized by an ethics committee. The procedures of gathering data included in the consent of the patient and application of a structured interview during treatment. A content analysis of answers was made, with help of the software SPSS 16.0 and ALCESTE. RESULTS: The content analysis of reports identified three categories of representation of cancer, that maintained themselves during the treatment: serious and fatal disease (88%), serious disease, but treatable (9%) and disease similar to any other one (3%). In relation to reaction to diagnosis; 40% of the patients became afraid and worried; 24% became desperate; 16% had a pessimist attitude; 10% were discontented; 7% denied; 3% became frustrated. The analysis of the ALCESTE showed a relation between the cancer concept and the way patient react to diagnosis. This relationship is influenced by the history and personality of each patient. CONCLUSIONS: The fact that the increase of survival may change the cancer into a chronic disease did not diminish the stigma imposed by the historic perspective. Till today, this disease is connected to death, which compromises the coping of patients. The social representation favored negative reactions to diagnosis, similar to those related by the patients. Thus, we can infer that the initial concept of cancer does not change independent of chances of being cured. This concept is latent while the situation is favorable and it manifests itself when an expected event appears and that confirms the initial representation of this disease. RESEARCH IMPLICATIONS: The relationship between cancer and death brings up the need of new educational programs that may soothe the historic stigma and negative appeal of the midia. Furthermore, it asks for studies that investigate the influence of that relationship in the behavior, as for example: early diagnosis—fear of the disease inhibits the looking for medical assistance; coping with a diagnosis and treatment; hyper precaution with health, obsessive thoughts and hypochondria patients in remission. CLINICAL IMPLICATIONS: Knowing the patient’s concept about his own disease favors a minimization of possible negative or positive fantasies that may compromise the coping of patient and adherences to treatment. Such perception may be related with distress, anxiety and depression - answers expected from the person who has cancer. Such knowledge, can favor the adequate assistance to patients because of the understanding of suffering and doubts present in the phases of disease. ACKNOWLEDGEMENT OF FUNDING: None.

BACKGROUND: In recent decades there has been a growing interest in medical science to study the relationship between gender and health status. This relation is influenced by biological, psychological, social and cultural characteristics. In the cancer context, women feel safer in sharing their sorrows and fears with others as a way of dealing with vulnerability feeling. While, men tend to choose fight-or-flight response, with a penchant for introspection to resolve problem, seeking internal resources. METHOD: This study aims to investigate the difference between distress and gender in 58 patients with lymphoma, 51.7% of whom were males (Group 1) and 48.3% were females (Group 2). In Group 1, the average mean age was 50 (SD515.8), most of patients were married (62%) and 51.7% had college degree. In Group 2, the average age was 56 (SD514.3), 48.1% were married and 59.3% had college degree. The investigation was authorized by the ethics committee. The Distress Thermometer (DT) was used to evaluate distress in three different stages of treatment: beginning, middle and end of chemotherapy. RESULTS: There was a significant difference between the two groups, observed in all three stages of evaluation (po0.01). In the beginning of treatment, the incidence of distress was 34.5% for male and 40.7% for female. During treatment, there was a progressive decline at middle (7.7% male and 25% female) and on the last stage of evaluation (4.5% male and 19% female). CONCLUSIONS: The results showed that women had a higher incidence of distress than men. This difference can be observed in all stages of evaluation, suggesting that gender is an important fator to be considered in the assessment of distress, with different implications for the ability to cope with the diagnosis and treatment. However, men’s tendency to minimize and somatize their vulnerabilities through nonverbal and, the impersonal way and short emotional expression can influence the sample data in this methodology. RESEARCH IMPLICATIONS: According to the literature, there is not a distress assessment strategy that is most efficient for detection of genders differences. We emphasize the importance of conducting more research to determine the gender influence on the distress incidence. Since gender is one of the most basic biological and psycho-social characteristics of individuals, knowledge of gender can be the first step toward understanding the complexity of cancer patients. CLINICAL IMPLICATIONS: Gender has been shown to be an important component in doctor patients’ communication/relationship, treatments’ efficacy, side effects management, and mood disorder intervention. For a better health care program and to choose appropriate intervention it is important to understand how to best support women and men in their experience of cancer treatment. ACKNOWLEDGEMENT OF FUNDING: None.

The quality of life (QoL) evaluation can better contextualize the psychosocial problems experienced by patients over the disease trajectory, as well as, monitor the quality of cancer care and the effi cacy of psychosocial intervention/treatment. Moreover, elevated level of distress have been linked with reduced health-related QoL. A longitudinal study was carried out to investigate the relationship between high level of distress (DT ≥ 4) and QoL, throughout the chemotherapy. For this assessment was considered three points in the treatment protocol, with an average interval of two and a half months between them (fi rst day – T1; middle – T2; last day – T3). A sample of 161 patients, completed the Distress Thermometer and the Functional Assessment of Cancer Therapy – General. Of those, 29.8% were male and 70.2% female, with a mean age of 56 years (SD = 14.9; range 19–84 years). The main forms of cancer were gastrointestinal (33.4%), breast (29.8%) and hematological (21.7%). About 36.4% had early stage (I and II) disease and 63.6% late stage (III and IV). At T1 distress level was signifi cant related to QoL score (r = −0.73, p < 0.001) and QoL to disease stage (r = −0.16, p < 0.05). At T2 and T3 distress was related to QoL (r = −0.65, p < 0.001; r = −0.59, p < 0.001). Accordingly with this preliminary data distress was related to QoL over all treatment phases: fear of the unknown (T1), adaptation to side effects and the cancer reality (T2) and apprehension with the end of treatment (T3); and the disease stage just with QoL at T1. This results suggest the importance of distress and QoL screening routine, since this allows an in-depth look at the patient’s psychosocial health care needs, improving not only the psychosocial service as the quality of cancer care.

OBJECTIVES: Men and women create different structures in their caregivers roles. Women are more socio-centric and assembled, and the experimental content of their relationship with others are basic relevant. As men enter the world of instrumental and emotional care giving, all known rules change. The current study aimed to investigate the relation between gender and distress among patients in chemotherapy. METHOD: This study was developed in an oncology center, located in Brasilia, Brazil. The data of 267 patients, of median age 56 (14 to 86 years old), were assessed with the Distress Thermometer during three different stages of the chemotherapy protocol: beginning, middle and last day. This sample was shared according to the gender of the patients. Thus, two groups were formed: Men group, with 35.6% of the sample and the Women group corresponding to 64.4%. RESULTS: There were significant differences between groups in all stages of evaluation: beginning (po0.05), middle (po0.01) and last day (po0.05). The men group reported 50.5% of severe distress at the beginning, 20.5% middle and 12.7% last day of treatment. By the time, the incidence of distress in the women group was higher: 66.9% at the beginning, 35.5% middle and 20.9% last day of chemotherapy. CONCLUSIONS: The findings showed that the women group had a higher incidence compared to the men group. The gender proved to be an important moderate factor, with effects on the ability to cope. Furthermore, it does not exist a sole determinant factor and neither one strategy that is the most efficient. The coping strategies chosen are related to the characteristic of the disease, reaction to the treatment, patient’s dynamic and cultural and social context.

BACKGROUND: Cancer diagnosis and treatment promote a sense of vulnerability, sadness, and fear for patients, often resulting in distress. When this happen quality of life, satisfaction with care and treatment adherence can be greatly affected.Managing this situation may require to use a variety of coping strategies for psychosocial adjustment. The present purpose was to identify variables (sociode- mographic, problem list, quality of life and coping) that predict moderate to severe distress (MSD) and mild distress (MD). METHOD: Two hundred patients from a brazilian cancer patients participate, answering before start chemotherapy (T1), halfway time point (T2) and at completion of treatment (T3): Distress Thermometer (DT) and Problem List (PL); Functional Assessment of Chronic Illness Therapy - General (FACT-G); Ways of Coping (WAYS). They were between 18–89 years old (M = 56.8; SD = 15), being 69.5% women, 63% married, and 55% had at least college degree. The main diagnosis were breast (30%), hematology (22%) and gastrointestinal (17.5%), being 59.5% with advanced disease stage. Logistic regression were used to identify predictors of distress. RESULTS: At T1, predictors for MSD were married/divorced (x2 = 15.4; p = 0.05), housing (x2 = 19.2; p = 0.002), family (x2 = 11.5; p = 0.003) and emotional problems (x2 = 99.9; p = 0.000; R2 N = 53%); for MD: distancing/positive reappraisal (x2 = 42.1; p = 0.000). At T2, spiritual problems (x2 = 7.56; p = 0.006) and nausea (x2 = 52.9; p = 0.000; R2 N = 54%) for MSD; distancing, problem solving and positive reappraisal (x2 = 24.9; p = 0.001) for MD. At T3, only family problem [x2 = 5.5; p = 0.05] for MSD. CONCLUSIONS : There was a statistically significant reduction in distress and a increased on quality of life over assessments. Our observation linking MSD to marital status (T1) and some problems at PL, and MD predicts coping strategies. This findings have a impressive prediction success, mainly for emotional (T1), and nausea (T2). Quality of life did not appear as a predictor. The same occur for age, gender, education, diagnostic and staging. Moreover, patients with MSD at T1 have an increase probability to present MSD at T2 and T3, which reinforces the literature data - the best predictors of later distress is early distress. RESEARCH IMPLICATIONS: Continued research is needed to understand how distress relates to quality of life, gender, age, cancer type and severity, treatment and symptom burden throughout the continuum of care. CLINICAL IMPLICATIONS: There is no doubt about the importance of detecting distress in cancer patients as early as possible, in order to facilitate rapid and tar- geted intervention for those who will need it most, as well as the importance of the follow-up. But, understand the predictors of distress during the treatment could be a key to improve cancer care, given more indicators to direct psychosocial care. ACKNOWLEDGEMENT OF FUNDING: None

OBJECTIVES: The NCCN guidelines of Distress Management specify the standards of care and recommend intervention modalities. The aim of this research was to make a retrospective and comparative study between two different moments of the routine (Before and After changes) of an oncology center, in Brasilia, Brazil. Thus, the changes correspond to a monthly meeting between psychologist and assistant doctor to discuss level of distress and interventions, as well as changes in the technical/administrative management. METHOD: The incidence of distress was recognized through the use of the Distress Thermometer in three stages: beginning, middle and last day of chemotherapy; relating them to two diferente moments of routine. The first group (Before) consisted of 100 patients, between 17 and 86 years, 39% male and 61% female, from July 2007 to April 2008. The second (After) comprised 100 patients, 18 and 86 years, 35% male and 65% female, from January to October 2009. RESULTS: Before: In the first stage of evaluation most participants (82%) presented a severe distress; that percentage progressively decreased to 36.4%at the middle, and to 18.2% at the last day. After: The incidence of distress at the beginning (52%) decreased over the first moment of routine evaluation; these decrease trends were maintained in the middle (25%) and in the last day of chemotherapy (16.7%). CONCLUSIONS: The high incidence of distress showed in the first group (Before) brought the need for changes in the health team routine and the technical/administrative management. Thereafter, the distress management becomes an integral part of cancer care. After changes, the low incidence of distress was attributed to screening and monitoring routine for identifying the level and nature of distress; medical and psychological intervention tailored to each case. A humane practice was observed from this comprehensive assistance.

BACKGROUND: Patients with gastrointestinal (GI) cancer are often diagnosed with locally advanced disease or distant metastases. Accordingly, this patient have to cope with limited on the possibility of curative treatment and the impact on quality of life due to the severe physical symptoms, which results in emotional distress. Special problems in psychosocial adjustment are posed when tumors develop in GI tract. The current study aimed to evaluate distress, anxiety and depression in patients with GI cancer. METHOD: This study was developed in an oncology center, located in Brasilia, Brazil. 93 patients, were assessed with the Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS) during three different stages of the chemotherapy protocol: beginning, middle and last day. This research was authorized by the ethics committee. The data were analyzed according to criteria defined in literature and with help of the software SPSS 17.0. RESULTS: At the beginning of chemotherapy, patients mean scores were distress (53.8%), anxiety (39.8%) and depression (42%). In the middle of treatment, the percentages of distress, anxiety, and depression decreased to 33.8%, 24.3%, and 27%, respectively. On the last day, the levels were 11.3% for distress, and 14.5% for anxiety and 13% for depression. CONCLUSIONS: A significant proportion of these patients shows symptoms of distress, anxiety and depression. In the beginning of therapy, the high incidence demonstrates the importance of screening and effective management of emotional disturbance related to the diagnosis and cancer treatment. Sometimes, we note, that the problem of physical and psychological dysfunction are so intertwined that they are difficult to separate. Because of that, we introduce a multidisciplinary discussion to facilitate the management of emotional disturbs related to patients’ experience in order to improve quality of life and to offer a better adaptation to this reality. RESEARCH IMPLICATIONS: There is great amount of distress associated with GI cancer. It is important to establish a routine of distress and emotional disturbance assessment as well as a multidisciplinary discussion, to open up the opportunity to work before the symptoms appear and to choose the best intervention tailored to each case. The multidisciplinary efforts to implement goals of psycho-oncology, palliative care and quality of life into routine care should also be the perspective for further research. CLINICAL IMPLICATIONS: Considering the generally poor prognosis in advanced GI tumors, supportive care intervention should be included in patients’ treatment. A consequent integration of psychosocial concerns into clinical practice and research is of particular importance in those cases with poor survival prognosis. ACKNOWLEDGEMENT OF FUNDING: None.

Even though loss and grief are common experiences, literatures informing counselling psychology illustrate some of the varied and problematic ways in which grief is talked about in psychological therapies. This study aimed to investigate and critique how counselling psychologists (CoPs) discursively construct grief in the context of their practice. Ten semi-structured interviews were conducted with accredited, practising CoPs who identified themselves as having worked with bereaved clients. The data was analysed, informed by a post-structuralist epistemological approach and a Foucauldian Discourse Analysis (FDA) was applied.

The rationale for this approach resulted from these participants’ accounts being resourced by diverse and power laden knowledges. Their multiple, conflicting and contrasting ways of talking about grief and bereavement counselling practices seemed to warrant closer attention. Specifically, the findings of this analysis identified three distinct subject positions; “The Expert Practitioner,” “The Human to Human Practitioner” and “The Reflexive Practitioner.” These subjectivities highlighted the multiple, mutable and contradictory spaces within which these CoP participants were located in their talk about grief work. Overall, these subject positions illustrate the heterogeneity and opacity in the language of grief work for counselling psychology. It is argued that these findings propose that CoPs working with multiple knowledges can cultivate a meta-perspective to appreciate the diverse, discursive power games in particular therapeutic accounts of grief work, as this research makes visible.

PURPOSE: A longitudinal study was conducted to investigate changes in the incidence of distress level and predictive factors, as problems reported, mood disorder, and quality of life. METHODS: A total of 113 patients, recruited from a private cancer center in Brazil’s Federal District (Centro de Cancer de Brasilia - CETTRO), answered the Distress Thermometer, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-General. Three points of evaluation were chosen considering the chemotherapy protocol: before the initial treatment (beginning), two and a half months after start chemotherapy (middle), and five months after start chemotherapy (last day), followed by a technical discussion between psychologist and assistant doctor. RESULTS: Ages ranged from 22 to 84 years (Mean = 56.9; SD = 14.9), being 27.4% male and 72.6% female, 62.8% were married, and 63.7% had at least college degree. In this sample we had 20 different types of cancer, whereas 64.7% were late stage disease. The incidence of distress (DT ‡ 4) at the beginning was 45.1%, 12.1% in the middle and 7.9% on the last day. For all points of evaluations distress level was significantly related (p < 0.001) to anxiety (r = 0.63; r = 0.54; r = 0.61), depression (r = 0.79; r = 0.74; r = 0.69) and quality of life (r = )0.74; r = )0.63; r = )0.54). In general there was a gradual decrease on the frequencies of problem-related distress reported by those patients, being emotional and physical the most common problem reported. CONCLUSIONS: The findings indicate that a significant proportion of patients shows high level of distress distress, which is related with anxiety, depression and quality of life throughout all points of evaluation. These findings also suggest that initial level of distress (beginning) is the most predictor for subsequent distress. The multidisciplinary discussion facilitated the symptom management related to cancer patients’ experience in order to improve quality of life. RESEARCH IMPLICATIONS: These findings supports the importance of the longitudinal investigation as a way to prevent and/or reduce the level of distress throughout the cancer treatment experience. Moreover, the DT could be used as a indirect measure for assessing quality of care in oncology. CLINICAL IMPLICATIONS: These results demonstrated the importance of distress screening and effective management of emotional disturbance related to the diagnosis and cancer treatment, to establish the level of assistance the patients needs and the strategy we have to adopt during the treatment. FUNDING: None.

Adults diagnosed with primary brain tumours often experience physical, cognitive and neuropsychiatric impairments and decline in quality of life. Although disease and treatment-related information is commonly provided to cancer patients and carers, newly diagnosed brain tumour patients and their carers report unmet information needs. Few interventions have been designed or proven to address these information needs. Accordingly, a three-study research program, that incorporated both qualitative and quantitative research methods, was designed to: 1) identify and select an intervention to improve the provision of information, and meet the needs of patients with a brain tumour; 2) use an evidence-based approach to establish the content, language and format for the intervention; and 3) assess the acceptability of the intervention, and the feasibility of evaluation, with newly diagnosed brain tumour patients.

Objectives: Over the last few years several offers in-and outpatient creative therapy interventions for cancer patients have been developed, implemented and researched. This article describes the content, concept and structure of art therapy interventions based on painting or drawing as well as some further methodical procedures and research results of art therapy in the field of psycho-oncology. Methods: We searched electronic databases for papers published between 1987 and March 2009 on painting or drawing based art therapy interventions in oncology. The papers were selected using the inclusion criteria detailed below. Results: Of 56 retrieved manuscripts, 17 papers reporting 12 research projects were included. The art therapy interventions differ from each other considerably in their content and structure. The variance in the study design of the papers was also high. More females than males participated in the interventions. The papers dealt with a variety of questions. A total of seven quantitative papers focused on mental health. A decrease in anxiety and depression was noted in six of these. Three papers documented an increase in quality of life. Moreover, four qualitative papers indicated positive effects on personal growth, coping, the development of new form of self-expression, and social interaction. Three papers with qualitative methods investigated participants' mechanisms for coping with their disease. Conclusion: Published papers show that art therapy benefits cancer patients in various ways including improving their mental health. Nevertheless, more studies with an evidencebased design are necessary for reaching further conclusions on efficacy of art therapy. This research should include a focus on gender differences, and controlling possible influencing factors.

BACKGROUND: Breast cancer (BC) is the most commonly diagnosed cancer in women. It is known that the number of survivors is increasing because of recent advances in screening and treatment therefore it is necessary to give them adequate support. Currently, technological devices may be useful to deliver an exercise program and to give support to these patients. The goal was to evaluate the feasibility of receiving a telerehabilitation and its psychophysical social implications in BC patients. METHOD: Our sample consisted of thirty-seven BC patients who were recruited for a randomized clinical trial (NCT01801527). The e-cuidate training was delivered through a telerehabilitation system where cancer-related symptoms were assessed. After that, patients received a tailored physical training for their specific needs (HD-image sequence and videoconferencing system to monitor their improvements were used during exercise program). The global health status/QoL, emotional, cognitive and social functionings were assessed at baseline and 8 weeks after intervention. All these scales were assessed with The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). RESULTS: A total of twenty-three patients received the e-cuidate telerehabilitation whereas fourteen patients only received usual care. The mean age was 46.11 AE 8.44 years and most of BC survivors (91.9%) received both radiation and chemotherapy as adjuvant treatment and 48.6% of them were taken Tamoxifen as hormonal therapy. The analysis of the study results showed significant improvement in global health status and cognition in patients receiving e-cuidate system compared with control group after 8 weeks of intervention: global health status/QoL (p = 0.007) and cognitive functioning (p = 0.040). There were no significant results neither for emotional functioning (p = 0.220) nor social functioning (p = 0.268). CONCLUSIONS: These preliminary findings suggest that an 8-week program of e-cuidate telerehabilitation is feasible and improves global quality of life and cognitive functioning in BC survivors. RESEARCH IMPLICATIONS: This pilot study provides scientific evidence about telehealth systems in BC survivors. Nowadays, the use of the technological advances is an interesting and promising strategy to help patients in their recovery. On the other hand, this type of study (randomized controlled trial) gives the findings an important scientific strength. CLINICAL IMPLICATIONS: Breast cancer patients suffer functional and cognitive changes following adjuvant therapy (for example chemotherapy). According to our preliminary results, a telerehabilitation system could be an important choice of treatment not only to improve physical problems but also cognitive function.

In this research we go more deeply into EVD, studying the Etiology and realizing a Differentiation of Syndromes according to the systems: Wen Bing, San Jiao and Han Shan Lun. Later, a Treatment for Prevention, Symptomatic/Acute, and Remission phases is proposed. Finally, we study the economic effects of the epidemic in the most affected countries by stressing the importance of preventive health care and international aid, looking at the usefulness of Medical Matter for its low cost especially in the affected societies (that probably they will return to be).