Neutropenia em pacientes com câncer de cólon e reto submetidos a tratamento quimioterápico adjuvante Ribeirão Preto 2018 1. Neutropenia. 2. Neoplasias Colorretais. 3.Incidência. 4.Epidemiologia. 5.Protocolos de Quimioterapia Combinada Antineoplásica. DEDICATÓRIAS A DEUS, por sua presença constante em minha vida, concedendo-me saúde, força e sabedoria nos momentos difíceis dessa jornada. Aos meus pais Francisco e Margarida, pelo dom de minha vida, sempre presentes nas horas de sufoco e

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... privando sempre de seus sonhos em favor dos meus. Aos meus irmãos Luciene e Raul, pelo apoio, incentivo e vibração a cada conquista de minha vida, por serem meus melhores amigos e companheiros fiéis. 5 AGRADECIMENTOS A minha orientadora, Profa. Dra. Namie Okino Sawada pelo apoio, paciência, por sua valiosa contribuição na construção e desenvolvimento deste estudo e por ter acreditado em mim desde o início dessa jornada, onde no início o desejo em cursar o Mestrado parecia algo distante e impossível de ser concretizado, tornando-se parte fundamental desta conquista. Aos meus familiares, pelo amor incondicional de cada um de vocês. Não trocaria nem escolheria viver em outra família por nada. Amo vocês! Aos amigos, pela ajuda e auxílio nos momentos de extrema necessidade e dúvidas na realização deste estudo e também da vida. Obrigado pelas palavras de conforto e incentivo. Aos meus amigos, Deise e Evandro, pelas alegrias, tristezas e dores compartilhadas. Obrigado pelo carinho, paciência e amizade. A convivência com vocês dia a dia foi uma das melhores experiências de minha vida. Que nossa amizade dure por muitos e muitos anos. Aos amigos do grupo de estudo e pesquisa Amanda, Bruna, Fernando, Juliana, Karina, Mayara, pela amizade, apoio, auxílio e incentivo. À Profa. Dra. Helena Megumi Sonobe e Profa. Dra. Thaís de Oliveira Gozzo, pela valiosa contribuição no exame de qualificação deste estudo. À Escola de Enfermagem de Ribeirão Preto, aos professores e funcionários dessa instituição que contribuíram direta e indiretamente com a construção deste estudo. Muito obrigado pelo conhecimento compartilhado. Ao Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, que permitiu a realização deste estudo, sendo um campo constante de aprendizagem, compreendendo a importância da ciência para o aperfeiçoamento no cuidado. 6 "Na minha vida nem tudo acontece Mas quanto mais a gente rala, mais a gente cresce A vida me ensinou a nunca desistir Nem ganhar, nem perder, mas procurar evoluir História, nossas histórias Dias de luta, dias de glória Histórias, nossas histórias Dias de luta, dias de glória..." Composição: Charlie Brown Jr. ABSTRACT BARBOSA, R.F. M. Neutropenia in patients with colon and rectal cancer who underwent adjuvant chemotherapeutic treatment. 2018. 86pp. Dissertation (Master Degree) -Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 2018. The chemotherapeutic treatment of colon and rectal cancer can entail adverse effects that limit the effectiveness of the therapy and have a great impact on the final results of the treatment, where neutropenia is the most common hematological toxicity resulting from the chemotherapeutic treatment. This study was aimed to identify the occurrence of neutropenia in patients with colon and rectal cancer who underwent adjuvant chemotherapeutic treatment at the Clinical Hospital of the Ribeirão Preto Medical School, which belongs to the University of São Paulo (HCFMRP-USP), and to assess the development of febrile neutropenia (FN), according to the risk index of the Multinational Association for Supportive Care in Cancer (MASCC), in patients who had neutropenia during the chemotherapeutic treatment. This is a descriptive and retrospective study, which was performed through the review of 60 medical charts of patients diagnosed with colon and rectal cancer who underwent chemotherapeutic treatment with 5-fluorouracil, folinic acid and oxaliplatin (FLOX) and were monitored at the outpatient clinic of Coloproctology of this hospital between 2010 and 2017. We performed the assessment of the laboratory results of the chemotherapeutic treatment in patients allowable for this study on a weekly basis. The average age of participants was 63.8 years. A total of 34 patients (56.7%) were male. Most, 50, (83.3%) were white. As for marital status, 37 (61.7%) were married. The most frequent type of neoplasm was rectal adenocarcinoma, represented by 38 (63.3%) patients, followed by colon adenocarcinoma with 22 (36.7%). The most observed clinical staging were IIIb, 18 (30%) patients, followed by IVa, 16 (26.7%). We analyzed a total of 146 chemotherapeutic cycles, with an average of 2.5 cycles per patient, and 876 weeks of chemotherapeutic treatment. Of the 60 patients participants in the study, 41.7% had neutropenia at some time over the chemotherapeutic treatment. Among these 60 patients 21.6% had one episode of neutropenia, two episodes were observed in 13.3%, four episodes in 3.4%, and 3.4% of the patients developed six episodes of neutropenia. Altogether, 49 episodes of neutropenia were identified. We noted 67 delays among the treatment weeks, with an average of 5.02 days. Dose reduction was used in 30 patients, with a total of 40 cycles and 218 weeks of treatment reduced, and treatment suspension happened to 21 patients, totaling 57 treatment weeks with 27 suspension cycles. In this study, neutropenia was among the main reasons for the delays, dose reductions, and suspension of chemotherapeutic treatment. As for the risk assessment for the development of FN, 23 patients (84%) showed low risk, 2 (8%) showed high risk and 2 (8%) showed low and/or high risk concomitantly. The results of this study highlight that neutropenia in patients with colon and rectal cancer undergoing chemotherapeutic treatment has a relatively low incidence in its different stages, has low risk for the development of FN, in addition to suggesting the preparation and implementation of instruments capable of providing the best record of information on the incidence of neutropenia in health services, thus avoiding its underreporting.