Alterações sensoriais e cognitivas do desempenho ocupacional em adultos e idosos submetidos a quimioterápicos neurotóxicos

Abstract

Brazil is in a demographic and epidemiological transition, marked by an increase in the number of elderly people and chronic non-communicable diseases (NCDs), such as cancer. Chemotherapy stands out for its effectiveness in the treatment of this disease, but due to its lack of specificity, it can cause adverse effects, among them, Chemotherapy-Induced Peripheral Neuropathy (NPIQ). The aim of this study was to evaluate changes in occupational performance, cognition and sensitivity caused by neurotoxicity in adults and the elderly undergoing potentially neurotoxic chemotherapy. The research was carried out in an adult oncology inpatient unit, located in a public hospital in the interior of Rio Grande do Sul and evaluated eight (n = 8) elderly and five (n = 5) adults. It is a research with a quantitative, longitudinal and descriptive approach. For data collection, a questionnaire about sociodemographic and clinical information was used; the Canadian Occupational Performance Measure (COPM) to assess possible changes as a result of the illness process; the Mini-Mental State Examination (MMSE), the Antineoplastic-Induced Neurotoxicity Questionnaire (QNIA) and the Semmes-Weinstein Monofilaments (MSW) to assess neurotoxicity. The COPM data went through the instrument's own analysis and the other data were plotted in Excel software tables. The descriptive analysis of the data was performed with presentation of mean and standard deviation, after checking the normality curve of the data. The variables assumed non-parametric distribution by the Shapiro- Wilk test, therefore it is necessary to choose non-parametric tests for the discrete variables. Fisher's exact test for categorical variables and the Mann-Whitney test for numerical variables were used for association. The results show that the occupational performance of adults and the elderly have undergone changes, with emphasis on the domains of productivity and leisure. Regarding performance satisfaction, changes occurred in the domains of self-care and productivity. As for cognition, the results show slight changes in mental status, with general improvement between the three phases of collection. However, when analyzing the scores by area, it is observed that the areas of remembering, recording and attention and calculation showed a decline in the score throughout the treatment. As for neurotoxicity, NPIQ affected the sensitivity of adults and the elderly, as all of them report symptoms already in the middle of the treatment, showing a tendency of aggravation in the elderly. The present study contributes to the understanding of changes in occupational performance that the process of illness and neurotoxicity resulting from chemotherapy treatment can cause in the lives of adults and the elderly, with a tendency of aggravation in the elderly. Neurotoxicity can cause disabilities in daily life, impacting quality of life in the short and long term. The novelty of this study in Brazil stands out and, as limiting factors, we highlight the small sample size and the suspension of collections due to the Covid-19 pandemic. The NPIQ presents aspects that have not yet been clarified, which need to be addressed in future research, such as differences in incidence, including after the completion of treatment, risk factors and pharmacological and non-pharmacological treatments.