Burnout syndrome is frequent among Brazilian cancer physicians and further studies should be conducted to evaluate its prevalence and prevention among other sub specialists.

SUMMARY INTRODUCTION.Burnout syndrome which is prevalent among oncologists is characterized by three aspects: emotional exhaustion, depersonalization and low personal accomplishment. The purpose was to evaluate prevalence of the burnout syndrome among Brazilian medical oncologists and the variables that correlate with its presence. METHODS. A survey was conducted with members of the Brazilian Society of Medical Oncology (SBOC) who received three questionnaires (general, Maslach burnout questionnaire and an opinion survey) mailed to all 458 members. RESULTS. Response rate was of 22.3%. According to the criteria proposed by Grunfeld, which consider burnout present when at least one of the aspects is severely abnormal, prevalence of this syndrome was 68.6% (95% confidence interval, CI: 58.68% to 77.45%). By multivariate analysis having a hobby/physical activity, a religious affiliation, older age, living with a companion and rating vacation time as sufficient were correlated significantly and independently with burnout syndrome. CONCLUSIONS. The burnout syndrome is prevalent among Brazilian oncologists. Oncologists having sufficient personal and social resources to engage in a hobby, physical activity, have enough vacation time and religious activities are at lower risk of developing burnout.

Astaxanthin (ASTA) is a pinkish-orange carotenoid commonly found in marine organisms, especially salmon. ASTA is a powerful antioxidant and suggested to provide benefits for human health, including the inhibition of LDL oxidation, UV-photoprotection, and prophylaxis of bacterial stomach ulcers. Exercise is associated to overproduction of free radicals in muscles and plasma, with pivotal participation of iron ions and glutathione (GSH). Thus, ASTA was studied here as an auxiliary supplement to improve antioxidant defenses in soleus muscles and plasma against oxidative damage induced by exhaustive exercise. Long-term 1 mg ASTA/kg body weight (BW) supplementation in Wistar rats (for 45 days) significantly delayed time to exhaustion by 29% in a swimming test. ASTA supplementation increased scavenging/iron-chelating capacities (TEAC/FRAP) and limited exercise-induced iron overload and its related pro-oxidant effects in plasma of exercising animals. On the other hand, ASTA induced significant mitochondrial Mn-dependent superoxide dismutase and cytosolic glutathione peroxidase antioxidant responses in soleus muscles that, in turn, increased GSH content during exercise, limited oxidative stress, and delayed exhaustion. We also provided significant discussion about a putative “mitochondrial-targeted” action of ASTA based on previous publications and on the positive results found in the highly mitochondrial populated (oxidative-type) soleus muscles here.

INTRODUÇÃOO câncer é uma doença que está entre as principais causas de morte, constituindo atualmente no Brasil a segunda causa de mortalidade, sendo superado apenas pelas doenças cardiovasculares 1 . Segundo o Instituto Nacional de Câncer, a incidência no Brasil é de aproximadamente 400.000 novos casos por ano, sendo que destes cerca de 127.000 evoluem a óbito 1 . Nos EUA, esses números são ainda maiores, sendo que para o ano de 2004 a estimativa foi de 1.368.000 novos casos e 563.700 óbitos 2 . Apesar dos grandes avanços no tratamento oncológico, nem sempre é possível obter a cura; com isso, muitos pacientes passam a necessitar de cuidados que visam, além do controle da dor e de outros sintomas diversos, interferir nos aspectos psicológicos, sociais e espirituais, no intuito de investir na melhora de sua qualidade de vida 3 . O termo "palliare" tem origem no latim e significa proteger, amparar, cobrir, abrigar, ou seja, a perspectiva do cuidar e não somente curar 4 . De acordo com a Organização Mundial da Saúde (OMS), cuidados paliativos são definidos como cuidados ativos e totais aos pacientes quando a doença não responde aos tratamentos curativos, e o controle de sintomas torna-se prioridade, objetivando melhor qualidade de vida para pacientes e familiares 5 . Já o conceito de qualidade de vida pode ser definido como uma avaliação global que o sujeito faz da sua vida, e depende tanto das características do sujeito (demográficas, personalidade, valores, etc) como de moduladores externos, como a doença, seus sintomas e o tratamento que esta requer 5 . A depressão é comum em pacientes com câncer em estágio terminal e pode ser uma importante fonte de angústia tanto para o paciente como para seus parentes 6,7 . A importância de se diagnosticar a depressão em pacientes sob cuidados paliativos deve-se ao fato de que, além do comprometimento emocional, os pacientes deprimidos também apresentam sintomas físicos que são difíceis de "paliar" e que podem ser facilmente aliviados quando a depressão é tratada adequadamente, com a conseqüente melhora da qualidade de vida deste indivíduo 7 . Apesar dos benefícios observados com o tratamento da depressão, esta ainda permanece freqüentemente subdiagnosticada 8,9,10 . De fato, Maguire (1985) mostrou que mais de 80% das comorbidades psicoló-gicas e psiquiátricas presentes nos pacientes oncológicos passam despercebidas e não são tratadas 11 . Acredita-se que uma explicação para esta baixa taxa de detecção dever-se-ia a não comunicação efetiva do paciente com seu médico, por achar que, de alguma forma, seria o culpado pela sua angústia ou que estaria desperdiçando o tempo do profissional e, portanto, optaria por esconder seus verdadeiros sentimentos 12 . Na literatura brasileira, ainda são poucos os estudos que enfocam o paciente oncológico em cuidados paliativos, suas necessidades, sua qualidade de vida e a presença de depressão nesta fase de sua vida.

CONTEXT AND OBJECTIVE: Intravenous amphotericin B deoxycholate (AmB-D) infusions, usually given over 4 hours, frequently induce nephrotoxicity and undesirable infusion-related side effects such as rigors and chills. There is evidence in the literature that the use of AmB-D in the form of continuous 24-hour infusion is less toxic than the usual four-hour infusion of this drug. Our objective was to evaluate the efficacy and safety of continuous infusion of AmB-D for the treatment of persistent fever in neutropenic patients with hematological malignancies after chemotherapy. DESIGN AND SETTING: Observational retrospective analysis of our experience with continuous infusion of AmB-D, at Faculdade de Medicina da Fundação ABC and Hospital Estadual Mário Covas in Santo André. METHODS: From October 2003 to May 2004, 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous infusion of AmB-D. RESULTS: The median dose of AmB-D was 0.84 mg/kg/day (0.33 to 2.30 mg/kg/day). Concomitant use of nephrotoxic medications occurred in 92% of the cycles. Nephrotoxicity occurred in 30.76% of the cycles, hypokalemia in 16.67%, hepatotoxicity in 30% and adverse infusion-related events in 23%. All patients survived for at least seven days after starting continuous infusion of AmB-D, and clinical resolution occurred in 76% of the cycles. CONCLUSIONS: Continuous infusion of AmB-D can be used in our Institution as an alternative to the more toxic four-hour infusion of AmB-D and possibly also as an alternative to the more expensive liposomal formulations of the drug.