Uticaj edukacije bolesnica sa karcinomom dojke tokom primene antineoplastične terapije na anksioznost, depresivnost i stres Tadić, Dušanka, 1975-, 9903207 Uvod: Karcinom je kompleksno oboljenje sa visokim rizikom za nastanak komorbiditeta, uključujući i mentalne poremećaje, i značajan je javnozdravstveni problem na globalnom nivou. Oboleli od karcinoma, posebno u toku lečenja, imaju povećan rizik za razvoj mentalnih poremećaja u poređenju sa osobama koje su izlečene ili nemaju dijagnozu karcinoma. Savremena epidemiološka istraživanja su pokazala da, u proseku, 1/3 obolelih od karcinoma na hospitalnom lečenju ima neki mentalni poremećaj koji zahteva dalju pažnju i adekvatan tretman. Klinička procena i praćenje obolelih od karcinoma sa mentalnim poremećajima zahteva sistematski pristup i pružanje psihoonkoloških intervencija, uključujući i specifičnu edukaciju bolesnika od strane zdravstvenih radnika. To je od velikog značaja za bolesnike na peroralnoj hemioterapiji, s obzirom na činjenicu da mentalni poremećaji imaju negativan uticaj na komplijantnost/adherentnost bolesnika i ishode njihovog lečenja. Iz tog razloga, postoji potreba za identifikacijom najbolje prakse u ovoj oblasti. Ciljevi ovog istraživanja su bili da se proceni uticaj strukturisane edukacije bolesnica sa karcinomom dojke na peroralnoj antineoplastičnoj terapiji na anksioznost, depresivnost i stres, da se utvrdi prisustvo anksioznosti, depresivnosti i stresa pre početka hemioterapije (edukacije) i u toku terapije (jedna i tri nedelje nakon edukacije), kao i da se utvrdi njihova povezanost sa sociodemografskim karakteristikama bolesnica. Bolesnici i metode: U istraživanje je uključeno 142 bolesnice sa karcinomom dojke koje se primale peroralnu antineoplastičnu terapiju (kapecitabin) u Institutu za onkologiju i radiologiju Srbije u 2016. i 2017. godini. Bolesnice su randomizovane u dve studijske grupe: eksperimentalna grupa je imala dodatnu, individualnu, strukturisanu, specifičnu edukaciju, pre hemioterapije, prema srpskoj verziji priručnika Multinacionalne asocijacije za suportivnu terapiju karcinoma (Multinational Association of Supportive Care in Cancer-MASCC) za edukaciju bolesnika na oralnoj antineoplastičnoj terapiji (Oral Agent Teaching Tool-OATT)-MOATT V1.0, a kontrolna grupa je imala uobičajenu, standardnu edukaciju. Bolesnice su praćene 3 nedelje, u toku prvog ciklusa hemioterapije. Korišćena su dva instrumenta za prikupljanje podataka: posebno kreiran, za potrebe ovog istraživanja, sociodemografski upitnik i srpska verzija DASS-21 skale(Depression Anxiety Stress Scales-DASS-21) za samoprocenu simptoma depresivnosti, anksioznosti i stresa. Rezultati: Pre početka hemioterapije kapecitabinom i edukacije, bolesnice sa karcinomom dojke su imale simptome depresivnosti (29.58%), anksioznosti (35.92%) i stresa (21.13%), najviše blage i umerene. Ovi simptomi su se smanjili u celoj grupi bolesnica posle prve i treće nedelje od edukacije, sa značajnom razlikom u promeni statusa skora depresivnosti i anksioznosti. Depresivnost, anksioznost i stres značajno su se smanjili u eksperimentalnoj grupi bolesnica od inicijalnog merenja (pre edukacije) do merenja nakon prve i nakon treće nedelje od edukacije, u odnosu na kontrolnu grupu bolesnica. Konstatovana je i značajna povezanost anksioznosti, i/ili depresivnosti, i/ili stresa i životnog doba bolesnica, njihovog nivoa obrazovanja, radnog, bračnog i statusa roditeljstva, samoće, materijalnog stanja, porodičnih odnosa, podrške supruga, kontakata sa rođacima i prijateljima, kao i organizovanja slobodnog vremena. Zaključci: Strukturisana edukacija ima značajan uticaj na smanjenje simptoma depresivnosti, anksioznosti i stresa kod bolesnica sa karcinomom dojke na peroralnoj antineoplastičnoj terapiji. Rutinska klinička procena simptoma depresivnosti, anksioznosti i stresa kod obolelih od karcinoma dojke poželjna je na početku i u toku hemioterapijskog tretmana. Značajna je identifikacija bolesnica kojima je potrebno dalje stručno praćenje i psihoedukativna podrška. Organizovana, strukturisana, individualna edukacija može imati i javnozdravstveni značaj kroz uvođenje strukturisane edukacije obolelih od karcinoma dojke kao standardne intervencije i posebne zdravstvene usluge, a koja utiče na kvalitet zdravstvene zaštite, bezbednost bolesnika i jačanje zdravstvenog sistema u celini. Introduction: Cancer is a complex disease with a high risk of developing comorbidities, including mental disorders, and is a significant public health problem globally. Cancer patients, especially those who are undergoing treatment, have an elevated risk of developing mental disorders compared to cancer survivors and persons without cancer. Contemporary epidemiological studies showed that, on average, 1/3 of the cancer patients in hospitals develop some mental disorders which requires further attention and adequate treatment. Clinical assesment and follow up of cancer patients with mental disorders needs a sistematic approach and providing psycho-oncological interventions, including specific patient education by healthcare professionals as well. It is of major importance for patients receiving oral chemotherapy due to the fact that mental disorders have a negative impact on patients compliance/adherence and treatment outcomes. Thus, there is a need for identification the best practice in this area. The aims of this study were to assess the impact of structured education of breast cancer patients receiving oral antineoplastic therapy on anxiety, depression and stress, to identify the presence of anxiety, depression and stress before the start of chemotherapy (education) and during treatment (one and three weeks after education), as well as to determine their association with sociodemographic characteristics of the patients. Patients and methods: The study included 142 breast cancer patients who were receiving oral antineoplastic therapy (capecitabine) at the Institute of Oncology and Radiology of Serbia in 2016 and 2017. Patients were randomized into two study groups: experimental group had additional individual, structured, specific education, before chemotherapy, by using a Serbian version of the Multinational Association of Supportive Care in Cancer (MASCC) Oral Agent Teaching Tool (MOATT V1.0) and the control group had usual, standard education. Patients were followed up for 3 weeks, during their first chemotherapy cycle. Two instruments were used for data collection: specifically designed, for the purpose of this study, sociodemographic questionnaire and the Serbian version of the Depression Anxiety Stress Scales-21 (DASS 21), self-report questionnaire for depression, anxiety and stress symptoms assessment. Results: Before starting capecitabine chemotherapy and education, breast cancer patients had symptoms of depression (29.58%), anxiety (35.92%) and stress (21.13%), mostly mild and moderate. These symptoms were decreased in the whole group of patients after the first and the third week from education, with significant difference in the status ofdepression and anxiety. Depression, anxiety and stress were decreased significantly in the experimental group of patients from the initial measurement (before education) to the oneweek and three-week follow-up measurements after education, comparing to the control group of patients. A significant association of anxiety and/or depression and/or stress and age of patients, their level of education, employment, marital and parenthood status, loneliness, economic status, family relationships, support from husband, contacts with relatives and friends, as well as the organization of free-time was found. Conclusions: Structured education has a significant impact on decreasing depression, anxiety and stress symptoms of breast cancer patients receiving oral antineoplastic therapy. Routine clinical assessment of depression, anxiety and stress in patients suffering from breast cancer is desirable at the beginning and during a chemotherapy treatment. Identification of patients who need further professional monitoring and psychoeducational support is important. Organized, structured, individual education can have a public health importance through the introduction of structured education of breast cancer patients as standard intervention and specific health service, which have an impact on the quality of the health care, patient safety and strengthening the entire health system. Janjić, Vladimir, 1971-, 13585767 Milovanović, Dragan, 1967-, 13570919 Đonović, Nela, 1968-, 13584743 Milovanović, Srđan, 1967-, 12743783 2020 2020 2020 2020 2020 2020 baccalaureate Dissertation 170 listova 5140768 bytes o:1263 ID=19825929 ; D-3351 thesis:7550 cobiss:19825929 https://phaidrakg.kg.ac.rs/o:1263 Thesis:7550 Cobiss:19825929 srp CC BY-NC-ND 2.0 AT http://creativecommons.org/licenses/by-nc-nd/2.0/at/