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Oncological Wounds: Meanings and Emerging Feelings of Patients Undergoing Treatment
Adriana Rodrigues dos Anjos Mendonça1*, Thiago Marques Camargo2, Sandiego Phelip Sthefan Palhares2, Taynan Bruno Ramos Izidoro2 and Dénia Amélia Novato Castelli Von Atzingen1
1Professor, Sapucaí Valley University, Brazil
2Academic of the Medicine Course of the Sapucaí Valley University, Brazil
Submission: January 16, 2018; Published: February 05, 2019
*Corresponding author: Adriana Rodrigues dos Anjos Mendonça, Professor at the Sapucaí Valley University, Pouso Alegre, MG. Avenue Prefeito Tuany Toledo, 470, Fátima, Pouso Alegre, MG, zip code 37550-000, Brazil
How to cite this article: Adriana R d A M, Thiago M C, Sandiego P S P, Taynan B R I, Dénia A N C V A. Oncological Wounds: Meanings and Emerging
Feelings of Patients Undergoing Treatment. Palliat Med Care Int J. 2019; 1(5): 555575. 10.19080/PMCIJ.2019.01.555575
Study design: Qualitative, exploratory, observational, transversal approach, with intentional sampling.
Objectives: to know the meanings and feelings about the wounds, emerging from patients on cancer treatment.
Methods: 30 patients with oncological wounds were interviewed using a semi-structured interview instrument containing questions about the meaning and feelings of the patients regarding their oncological wounds. The responses were analyzed through the Collective Subject Discourse. Therefore final discourses were produced from reunion of patients speeches with the same central ideas.
Results: Substantial central ideas for cancer wound meaning was: “constant concern in my life”. Feeling about other people: “I’m worried”, “I’m embarrassed”. When it was asked if the wounds influenced the relationship with their relatives: “yes, it took me away from my family”.
Conclusion: Patients present different meanings and feelings about their oncological wounds
Keywords: Neoplasms; Wounds and injuries; Quality of life; Oncology nursing
Abbrevations: HCSL: Samuel Libânio Clinical Hospital; DSC: Collective Subject Discourse; ECH: Composed of Key Expressions; CI: Central Ideas; AC: Same Anchorage
Among patients with neoplasias 5 to 10% present the development of cutaneous metastasis . Neoplastic wounds constitute deformities, ulcerations in the most varied and most intrusive places, still bothering with their odors, bleeding and exudation, exposing oneself and others. Neoplastic wounds are formed by the infiltration of malignant tumor cells into the skin structures. What is the energy of government and the origin of cell proliferation that triggers the production of induced oncogenesis, there is an exophytic wound . The formation of oncological wounds is linked to the growth of the tumor, which will cause the impact of the skin; a neovascularization, an important substrate for tumor growth and an invasion of the basal membrane of healthy cells, a process suitable for the expansive growth of the wound on the affected surface . Skin wounds affect people throughout the life cycle to recover tissue damage, the body using an intrinsic, dynamic, organized and complex biological process that can be rapid when a clinical activity is favorable and extensive in the degree of loss tissues are smaller. This fact causes a series of problems that affect
the life of the individual in all its spheres, generating negative impact on the quality of life .
Quality of life can be conditioned as a sensation of comfort, well-being or happiness, in the performance of their domains, intellectual and psychic within the reality of their family, their work and their values of community to quality . Interest in concepts such as “standard of living” and “quality of life” was initially shared by social media and philosophers. The next technological meeting in the area of health brought, as a consequence, the current situation and the prevalence of patient survival [5,6]. Measurements of quality of sleep were generated and used, since the identification of problems as the general emotional state, social interaction, enabling the reduction of variables that can interfere in a negative way in the multidisciplinary follow-up of cancer patients .
Oncology was the specialty that was confronted with the needs of evaluating the Quality of Life of its patients . The Quality of Life evaluation has been used within the health area as an important outcome in order to evaluate the impact of the disease felt by the patient, to create indicators of the severity
and progression of the disease and to predict the influence of the
treatments on the condition . Thus this research aims to know
the meaning, for patients, of their oncological wounds and the
implications of these wounds on the quality of life.
A qualitative, exploratory, observational, cross-sectional
study. Data collection was performed at the Samuel Libânio
Clinical Hospital (HCSL), located in Pouso Alegre, MG. This
hospital serves the population of 54 neighboring municipalities
Thirty (30) patients with oncological wounds who attended
the dressing room of the HCSL participated in the study. Sampling
was intentional. The following inclusion criteria were used:
patients older than 18 years, who had an oncological wound.
As criteria of non-inclusion: patient with other types of wound.
Exclusion criteria: patient who gave up voluntary participation
in the study, withdrawing their free and informed consent
For data collection, a semi-structured interview script was
used containing three questions:
i. Are oncological wounds constant concern in your life?
ii. What feelings arise when people look or perceive their
iii. If someone asked you if the neoplastic wound affects
your relationship with family members, what would you
Before the interview, each patient was informed and clarified
about the objectives of the study, signing the Informed Consent
Term. The answers to the questions were recorded and later
transcribed and analyzed using the Collective Subject Discourse
The DSC is a methodological strategy with the purpose
of clarifying a certain social representation and the set of
representations that constitute an imaginary die . It consists
in the meeting, in a single discourse-synthesis, of several
individual discourses issued in response to the same question of
research by social subject, and institutionally equivalent or that
are part of the same organizational culture and of a homogeneous
social group, insofar as the individuals who belong to this group
occupy the same or neighboring positions in a given social field.
DSC is thus a way of directly expressing the social representation
of a given subject .
The DSC is written in the first person singular, composed of
key expressions (ECH) that of the speeches of participants who
presented the same central ideas (IC) and the same anchorage
(AC), obeying the order of the following steps:
1st stage: The answers were heard several times, and only
after a better understanding of the general idea and the discourse
is it was transcribed literally.
2nd stage: Total reading of the answers of each of the
interviewees, followed by a separate reading of all the answers
to the analyzed question.
3rd stage: Transcription of the answers to question 1, with
the ECH in italics, and the CIs, which represent the description of
the ECHs and not their interpretation, were marked.
4th stage: Individual transcription of each central idea with
its respective ECH.
5th stage: Extraction of the theme from each of the questions,
grouping with their respective CI, the subjects, represented by
the number of interviewed, and the frequencies of ideas through
tables. Finally, construction of DSCs separately from each central
idea, with their respective ECH.
The study complied with the criteria required by Resolution
466/12 of the National Health Council, and the project was
previously approved by the Ethics Committee of the Sapucaí
Valley University, under the opinion 393.830 of 09/14/2013.
With regard to the first question: “Are oncological wounds a
constant concern in your life?”, 3 central ideas (CIs) have been
i. Do not know if the wound is a constant concern in my
ii. Wound is a big concern in my life;
iii. In some way the wound is a constant concern in my life
Second question: “What feelings arise when people look or
perceive their wound?”, 7 ICs were observed:
i. I do not care when people look at my wound;
ii. When people look at my wound, this makes me happy;
iii. I feel worried, without being when people look at my
iv. Fico envergonhado when people look at my wound;
v. I feel nude when people look at my wound;
vi. I do not feel sick when people look at my wound;
vii. I’m sad as the people look at my wound.
Third question: “If someone asked you if the neoplastic
wound affects your relationship with family members, what
would you say?”, 3 ICs were found:
i. The wound does not affect at all my relationship with
ii. The wound distanced my relationship with my
iii. I do not know my relationship with my familiars.
The body is a reflection of society, and it is not possible
to conceive processes exclusively biological, instrumental
or aesthetic in human behavior. The body applies feelings,
discourses and practices that are the basis of life in society. In
turn, the body is emblematic of social processes .
Some discourses of the collective subject (DSC) obtained
highlight this discussion:
“We do not get this problem because I’ve never had it. We have
never seen each other and now, suddenly, this little thing comes
out in me. I’m afraid to get this injury here and not fade, not heal.
Well, it bothers, because soon another wound comes out, and she
has to do another surgery .... “
“...the injury is releasing a little water, blood, it gets wet shirt,
burning, and has to pass a cloth or paper. She bothers. It hurts too
much and is too bloated. Therefore, I am afraid of dying of cancer “
The French philosopher and psychologist Michael Foucault,
in his book “The Birth of the Clinic”, discusses how the body,
being a space of disease, becomes a text capable of different
readings in search of meanings both for the patient in the process
of unchaining symptoms, as for the clinician, when he pursues
signs, signs, when examining the body of the other, the patient,
and thus finds the visible forms of disease . The integrative
vision between Being and body, shown by Foucault, susceptible
of different readings, significantly influences the quality of life.
Its influence can be both positively and negatively depending on
how the patient sees his or her reality. The rupture of the physical
integrity of the body through the manifestation of the neoplastic
wound and its subsequent biopsychosocial decharacterization is
associated with the cultural and functional aspects of the body
in our society. It is not the approach focused on cancer wound,
but the person carrying the injury. And this approach comprises
the physical, psychological, social and spiritual dimensions .
“It’s worrying. But, people are accustomed, right? I’m more
than there. If I was younger I worried more “ The externalized
tumor lesion causes a change in the patient’s image, which
depresses their self-esteem and makes it difficult to perform
everyday tasks. Oncological wounds affect patients also because
they have a continuous view of their clinical condition, because
they still know that their appearance may mean ineffective
treatment, incurable disease progression, or even the end of life
. At the same time, most patients are stigmatized, isolated
and emotionally shaken, considerably reducing the chances and
prospects of living together in a dignified manner in society
. “In the beginning, my ex-wife started calling me cancerous,
my face would turn into a monster. I was afraid after I became
defective, I cried and just listening to her speak. That’s when I
Yeah, with my family a little. Because they, I do not know,
seem to pity. With my sister and my children, it has messed up a
bit, and I’m kind of like that, I do not play with them like I used to.
I get a little away from them. There are people who have prejudice,
who do not go near us, who can not mix with us”
In the daily life of people with wounds there is suffering, and
this happens due to doubts and anguishes about the treatment
and, mainly, the anxiety in seeing the evolution of the wound
for an improvement. From this perspective, it can be seen that
for these people a wound may not only be a physical injury,
but something that hurts without necessarily needing sensory
stimuli, a mark, an irreparable loss, that is, something beyond an
incurable disease. It weakens and often incapacitates the human
being for various activities, especially those of labor .
“The little girl messes up, sometimes I think about doing more
things, and it comes at a time when I can not do more things for
my children or myself, it bothers me to sit down. I just want to take
Satisfy health needs goes back to several interpretations.
What can be quality for a given population may be non-quality
in other sectors of the population, the coverage of the needs
of individuals and the degree of satisfaction that this coverage
reaches among individuals. This thinking leads us to a broader
view of quality, which depends not only on the type of activity,
how it is performed and the resources available, but the
subjectivity of how the recipient, that is, the population receiving
it, will assess the quality of that activity. health service [18-20].
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