The purpose of this phase II randomised trial was to determine which of two schemes, raltitrexed-irinotecan or raltitrexed-oxaliplatin, offered better activity and less toxicity in patients with advanced colorectal cancer (CRC). A total of 94 patients with previously untreated metastatic CRC were included and randomised to receive raltitrexed 3 mg m À2 followed by oxaliplatin 130 mg m À2 on day 1 (arm A), or CPT-11 350 mg m À2 followed by raltitrexed 3 mg m À2 (arm B). In both arms treatment was repeated every 3 weeks. Intent-to-treat (ITT) analysis showed an overall response rate of 46% (95% CI, 29.5 -57.7%) for arm A, and 34% (95% CI, 19.8 -48.4%) for arm B. Median time to progression was 8.2 months for arm A and 8.8 months for arm B. After a median follow-up of 14 months, 69% of patients included in arm A were still alive, compared to 59% of those included in arm B. Overall, 31 patients (65%) experienced some episode of toxicity in arm A and 32 patients (70%) in arm B, usually grade 1 -2. The most common toxicity was hepatic, with 29 patients (60%) in arm A and 24 patients (62%) in arm B, and was grade 3 -4 in four (8%) and four (9%) patients, respectively. In all, 14 patients (29%) from arm A and 24 patients (52%) from arm B had some grade of diarrhoea (Po0.03). Neurologic toxicity was observed in 31 patients (64%) in arm A, and was grade 3 -4 in five patients (10%), while a cholinergic syndrome was detected in nine patients (19%) in arm B. There were no differences in haematologic toxicity. One toxic death (2%) occurred in arm A and three (6.5%) in arm B. In conclusion, both schemes have high efficacy as first-line treatment in metastatic CRC and their total toxicity levels are similar. Regimens with raltitrexed seem a reasonable alternative to fluoropyrimidines.

The evaluation of quality of life (QOL) faced with chronic ischemic pain involves the clients in their subjectivity and multidimensionality. This descriptive study aimed to evaluate the quality of life of clients who presented chronic ischemic pain. A total of 100 clients of hospital institutes participated in the study. The instrument used to assess pain was an 11 point numerical scale, and to assess Evaluación de la calidad de vida en clientes con dolor crónico isquémicoLa evaluación de la calidad de vida (CV) frente al dolor crónico isquémico debe considerar la subjetividad del cliente y las múltiples dimensiones envueltas. Este estudio descriptivo tuvo como objetivo evaluar la calidad de vida de clientes que manifestaron dolor crónico isquémico. Participaron de la investigación 100 clientes de instituciones hospitalarias. El instrumento aplicado para evaluar el dolor fue la escala numérica de 11 puntos y para la calidad de vida, el cuestionario World Health Organization Quality of Life abreviado. El promedio aritmético para el dolor crónico fue de 5,59±3,16 puntos. Los promedios para la calidad de vida fueron: en el dominio físico, 44,75±16,98; en el global, 50,0±22,40; en el ambiental, 55,06±13,51; en el psicológico, 56,21±17,19 y en el social, 68,33±21,84.Así, el dominio físico fue, entre los dominios analizados, el que presentó un mayor impacto sobre la calidad de vida de los clientes con dolor crónico isquémico.

The purpose of the present study was to evaluate pain in the aging process in long-term care institutions. The study included 46 elderly subjects of both genders and with chronic pain. Descriptors of chronic pain were analyzed using psychophysical category estimation methods, and the thematic content of semi-structured interviews was analyzed. Chronic pain was perceived in 33.33% of the elderly subjects. For the descriptors of pain, the results showed higher scores for "painful." In the interview, the thematic units were time, start of symptoms, coping, pain-related causes, current situation, and other perceptions about pain. Pain was related to physical, emotional, and cognitive factors. The present results shed light on "pain" and "aging" phenomena and may contribute to improving the management of pain symptoms in long-term institution residents.

Percepción del Dolor en Adolescentes con Cáncer: Investigación Fenomenológica hiLze BeniGno de oLiveira Moura siqueira andressa Karina aMaraL PLá PeLeGrin rodriGo raMon FaLConi GoMez taLita de Cássia raMineLLi da siLva FátiMa aPareCida eMM FaLeiros sousa resumo: A adolescência é um período da vida desafiador, principalmente, quando se vivencia uma doença como o câncer. Este estudo exploratório descritivo desenvolvido no Hospital de uma cidade do interior de São Paulo teve o objetivo de compreender como os adolescentes com câncer percebiam a vivência de dor. Para isso, a pesquisa foi desenvolvida no período de janeiro a dezembro de 2010 por meio de entrevistas fenomenológicas com 19 pré-adolescentes e adolescentes de ambos os sexos, com idade entre 10 e 19 anos, submetidos a tratamento de câncer. Os resultados mostraram a percepção da dor associada à vivência de situações existenciais significativas, os quais podem ser descritos nos temas seguintes: (1) percebendo a dor em conexão com os fatores emocionais; (2) apegando-se à memória dolorosa de hospitalização; (3) coexistindo com a dor; (4) percebendo a dor negativamente. Os adolescentes com câncer compreenderam sua experiência de dor em múltiplas dimensões. Diante disso, sugere-se que psicólogos, enfermeiros e médicos atentem à história de vida, ao tempo de hospitalização e a expressão dolorosa nessa fase da vida, para que, a partir dos relatos, os profissionais de saúde possam pensar em tratamentos e manejos que possam aliviar suas dores.

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