Fatores associados ao atraso no diagnóstico e tratamento do câncer bucal: revisão integrativa de literatura
DOI:
https://doi.org/10.34019/1982-8047.2023.v49.39514Palabras clave:
Neoplasias Bucais, Carcinoma de Células Escamosas de Cabeça e Pescoço, Diagnóstico TardioResumen
Introdução: O câncer bucal é apontado como um problema de saúde relevante e apresenta alta taxa de incidência e mortalidade. O consumo de tabaco e álcool são considerados os principais fatores de risco para sua ocorrência. Apesar dos avanços relacionados a detecção, diagnóstico e tratamento, grande parte dos pacientes ainda é diagnosticada com a doença em estágio avançado. Objetivo: Estabelecer os principais fatores associados ao atraso no diagnóstico do câncer bucal. Material e Métodos: Foram pesquisados artigos nas bases de dados MEDLINE/PubMed, SciELO e Lilacs, com os descritores: delayed oral cancer; delayed diagnosis oral cancer; oral cancer young patients; e HPV oral cancer patients. Como critérios de inclusão, foram delimitados artigos completos e disponíveis integramente. Publicações não relacionadas a delimitação do tema e ao objetivo do estudo foram excluídas. Resultados: Foram encontrados 513 artigos, dos quais 118 foram lidos na íntegra e 96 por fim selecionados, conforme critérios de inclusão e exclusão. Os dados indicaram que o atraso no diagnóstico do câncer bucal é frequente e relacionado ao atraso pelo paciente, atraso pelo profissional de saúde e atraso no tratamento, com destaque ao atraso pelo paciente. Conclusão: O diagnóstico precoce é o meio mais eficaz de reduzir as taxas de mortalidade e melhorar o prognóstico e qualidade de vida de pacientes com câncer bucal. Dessa forma, estratégias que objetivam a redução de diagnósticos realizados tardiamente devem ser consideradas.
Descargas
Citas
Steele TO, Meyers A. Early detection of premalignant lesions and oral cancer. Otolaryngol Clin North Am. 2011; 44(1):221-9.
Güneri P, Epstein JB. Late stage diagnosis of oral cancer: components and possible solutions. Oral Oncol. 2014; 50(12):1131-6.
Souza LM, Michel-Crosato E, Biazevic MG, Antunes JL. Scheduling delay in suspected cases of oral cancer. Rev Bras Epidemiol. 2011; 14(4):642-50.
Llewellyn CD, Johnson NW, Warnakulasuriya S. Factors associated with delay in presentation among younger patients with oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004; 97(6):707-13.
Bandeira CM. Almeida AA, Lima CF, Almeida JD, KaminagaKura E. Como melhorar o diagnóstico precoce do câncer bucal? How to improve the early diagnosis of oral cancer. Braz Dent Sci. 2017; 20(4):25-31.
Joshi P, Nair S, Chaturvedi P, Nair D, Agarwal JP, D'Cruz AK. Delay in seeking specialized care for oral cancers: experience from a tertiary cancer center. Indian J Cancer. 2014; 51(2):95-7.
Seoane-Romero JM, Vázquez-Mahía I, Seoane J, Varela-Centelles P, Tomás I, López-Cedrún JL. Factors related to late stage diagnosis of oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal. 2012; 17(1):35-40.
Gigliotti J, Madathil S, Makhoul N. Delays in oral cavity cancer. Int J Oral Maxillofac Surg. 2019; 48(9):1131-7.
Thomas AS, Manchella K, Koo AT, Nastri D. The impact of delayed diagnosis on the outcomes of oral cancer patients: a retrospective cohort study. Int J Oral Maxillofac Surg. 2020; 50(5):585-90.
Naseer R, Naz I, Mahmood MK. Frequency of delayed diagnosis of oral squamous cell carcinoma in Pakistan. Asian Pac J Cancer Prev. 2016; 17(11):5037-40.
Zhang X, Liu D, Dong H, Li Y, Zhang Y, Wang X et al. Factors associated with delay in presentation among patients for oral cancer. J Comp Eff Res. 2019; 8(12):1003-71.
Baykul T, Yilmaz HH, Aydin U, Aydin MA, Aksoy M, Yildirim D. Early diagnosis of oral cancer. J Int Med Res. 2010; 38(3):737-49.
Azhar N, Doss JG. Health-seeking behaviour and delayed presentation of oral cancer patients in a developing country: a qualitative study based on the self-regulatory model. Asian Pac J Cancer Prev. 2018; 19(10):2935-41.
Noonan B. Understanding the reasons why patients delay seeking treatment for oral cancer symptoms from a primary health care professional: an integrative literature review. Eur J Oncol Nurs. 2014; 18(1):118-24.
Epstein JB, Kish RV, Hallajian L, Sciubba J. Head and neck, oral, and oropharyngeal cancer: a review of medicolegal cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119(2):177-86.
Crossman T, Warburtonb F, Richardsc MA, Smitha H, Ramirez A, Forbes LJL. Role of general practice in the diagnosis of oral cancer. Br J Oral Maxillofac Surg. 2015; 54(2):208-12.
Santos LC, Batista OM, Cangussu MC. Caracterização do diagnóstico tardio do câncer de boca no estado de Alagoas. Brazilian Journal of Otorhinolaryngology. 2010; 76(4):416-22. doi: 10.1590/S1808-86942010000400002
Alami AY, El Sabbagh RF, Hamdan A. Knowledge of oral cancer among recently graduated medical and dental professionals in Amman, Jordan. J Dent Educ. 2013; 77(10):1356-64.
Esmaelbeigi F, Hadji M, Harirchi I, Omranipour R, Vand Rajabpour M, Zendehdel K. Factors affecting professional delay in diagnosis and treatment of oral cancer in Iran. Arch Iran Med. 2014; 17(4):253-7.
Lombardo EM, da Cunha AR, Carrard VC, Bavaresco CS. Atrasos nos encaminhamentos de pacientes com câncer bucal: avaliação qualitativa da percepção dos cirurgiões-dentistas. Cien Saude Colet. 2014; 19(4):1223-32.
Pitiphat W, Diehl SR, Laskaris G, Cartsos V, Douglass CW, Zavras AI. Factors associated with delay in the diagnosis of oral cancer. J Dent Res. 2002; 81(3):192-7.
Le Campion ACOV, Santos KCB, Carmo ES, Silva FF, Peixoto FB, Ribeiro CMB et al. Caracterização do atraso no diagnóstico do câncer de boca e orofaringe em dois centros de referência. Cad Saúde Colet. 2016; 24(2):178-84. doi: VV10.1590/1414-462X201600020004
Abdo EN, Garrocho AA, Barbosa AA, Oliveira EL, França-Filho L, Negri SL et al. Time elapsed between the first symptoms, diagnosis and treatment of oral cancer patients in Belo Horizonte, Brazil. Med Oral Patol Oral Cir Bucal. 2007; 12(7):469-73.
Lopez-Cedrún JL, Otero-Rico A, Vázquez-Mahía I, Seoane J, García-Caballero L, Seoane-Romero JM et al. Association between hospital interval and survival in patients with oral cancer: a waiting time paradox. PLoS One. 2019; 14(10).
Xu T, Wang DC, Shan XF, Cai ZG. Delayed diagnosis of oral squamous cell neoplasms at different sites. Beijing Da Xue Xue Bao Yi Xue Ban. 2019; 18; 51(4):748-52. doi: 10.19723/j.issn.1671-167X.2019.04.027.
Farquhar DR, Masood MM, Lenze NR, McDaniel P, Mazul A, Sheth S et al. Travel time to provider is associated with advanced stage at diagnosis among low income head and neck squamous cell carcinoma patients in North Carolina. Oral Oncol. 2019; 89:115-20.
Galvão-Moreira LV, da Cruz MCFN. Screening and early detection of oral cancer: current controversies. Acta Odontol Scand. 2017; 75(5):361-5.
Scott S, McGurk M, Grunfeld E. Patient delay for potentially malignant oral symptoms. Eur J Oral Sci. 2008; 116(2):141-7.
Grafton-Clarke C, Chen KW, Wilcock J. Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review. Br J Gen Pract. 2019; 69(679):112-6.
Mascitti M, Tempesta A, Togni L, Capodiferro S, Troiano G, Rubini C et al. Histological features and survival in young patients with HPV-negative oral squamous cell carcinoma. Oral Dis. 2020; 26(8):1640-8. doi: 10.1111/odi.13479
Mneimneh WS, Xu B, Ghossein C, Alzumaili B, Sethi S, Ganly I, Khimraj A et al. Clinicopathologic characteristics of young patients with oral squamous cell carcinoma. Head Neck Pathol. 2021; 15(4):1099-108. doi: 10.1007/s12105-021-01320-w
Grant E, Silver K, Bauld L, Day R, Warnakulasuriya S. The experiences of young oral cancer patients in Scotland: symptom recognition and delays in seeking professional help. Br Dent J. 2010; 208(10):465-71. doi: 10.1038/sj.bdj.2010.450
Melo BAC, Vilar LG, Oliveira NR, Lima PO, Pinheiro MB, Domingueti CP et al. Human papillomavirus infection and oral squamous cell carcinoma: a systematic review. Braz J Otorhinolaryngol. 2021; 87(3):346-52. doi: 10.1016/j.bjorl.2020.10.017
Hübbers CU, Akgül B. HPV and cancer of the oral cavity. Virulence. 2015; 6(3):244-8.
Taberna M, Mena M, Pavón MA, Alemany L, Gillison ML, Mesía R. Human papillomavirus-related oropharyngeal cancer. Ann Oncol. 2017; 28(10):2386-98. doi: 10.1093/annonc/mdx304
Jiang S, Dong Y. Human papillomavirus and oral squamous cell carcinoma: a review of HPV-positive oral squamous cell carcinoma and possible strategies for future. Curr Probl Cancer. 2017; 41(5):323-7.
Santos VC, Assis AM, Silva LE, Ferreira, SM, Dias EP. Câncer de boca: análise do tempo decorrido da detecção ao início do tratamento em centro de Oncologia de Maceió. Rev Bras Odontol. 2012; 69(2):159-64.
Seoane J, Pita-Fernández S, Gómez I, et al. Proliferative activity and diagnostic delay in oral cancer. Head Neck. 2010; 32(10):1377-84. doi:10.1002/hed.21338
Onyango JF, Macharia IM. Delays in diagnosis, referral and management of head and neck cancer presenting at Kenyatta National Hospital, Nairobi. East Afr Med J. 2006; 83(4):85-91. doi: 10.4314/eamj.v83i4.9421
Sargeran K, Murtomaa H, Safavi SM, Teronen O. Delayed diagnosis of oral cancer in Iran: challenge for prevention. Oral Health Prev Dent. 2009; 7(1):69-76.
Buelva SAR, Agudelo SA. Gradiente social, envejecimiento y diagnóstico tardío del cáncer oral. Rev Fac Nac Salud Pública. 2011; 29(3):320-8.
Groome PA, Rohland SL, Hall SF, Irish J, Mackillop WJ, O'Sullivan B. A population-based study of factors associated with early versus late stage oral cavity cancer diagnoses. Oral Oncol. 2011; 47(7):642-7. doi: 10.1016/j.oraloncology.2011.04.018
Vilela LD, Allison PJ. An investigation of the correlates of sense of coherence in a sample of Brazilians with head and neck cancer. Oral Oncol. 2010; 46(5):360-5. doi: 10.1016/j.oraloncology.2010.02.009
Varela-Centelles P, Seoane J, Lopez-Cedrun JL et al. The length of patient and primary care time interval in the pathways to treatment in symptomatic oral cancer: a quantitative systematic review. Clin Otolaryngol. 2018; 43(1):164-71. doi:10.1111/coa.12919
Graboyes EM, Kompelli AR, Neskey DM et al. Association of treatment delays with survival for patients with head and neck cancer: a systematic review. JAMA Otolaryngol Head Neck Surg. 2019; 145(2):166-77. doi: 10.1001/jamaoto.2018.2716
Souxa LM, Michel-Crosato E, Biazevic MGH, Antunes JLF. Atraso de agendamento em casos suspeitos de câncer bucal. Revista Brasileira de Epidemiologia. 2011; 14(2):642-50.
Lopez-Cedrún JL, Varela-Centelles P, Otero-Rico A et al. Overall time interval ("total diagnostic delay") and mortality in symptomatic oral cancer: a u-shaped association. Oral Oncol. 2020; 104:104626. doi: 10.1016/j.oraloncology.2020.104626
Khoo SP, Shanmuhasuntharam P, Mahadzir WM, Tay KK, Latif A, Nair S. Factors involved in the diagnosis of oral squamous cell carcinoma in Malaysia. Asia Pac J Public Health. 1998; 10(1):49-51. doi: 10.1177/101053959801000111
Yu T, Wood RE, Tenenbaum HC. Delays in diagnosis of head and neck cancers. J Can Dent Assoc. 2008; 74(1):61.
Rutkowska M, Hnitecka S, Nahajowski M, Dominiak M, Gerber H. Oral cancer: the first symptoms and reasons for delaying correct diagnosis and appropriate treatment. Adv Clin Exp Med. 2020; 29(6):735-43. doi: 10.17219/acem/116753
McLeod NM, Saeed NR, Ali EA. Oral cancer: delays in referral and diagnosis persist. Br Dent J. 2005; 198(11):681-4. doi: 10.1038/sj.bdj.4812381
Jafari A, Najafi Sh, Moradi F, Kharazifard M, Khami M. Delay in the diagnosis and treatment of oral cancer. J Dent. 2013; 14(3):146-50.
Le Campion ACOV, Santos K, Carmo ES, et al.Caracterização do atraso no diagnóstico do câncer de boca e orofaringe em dois centros de referência. Cadernos Saúde Coletiva. 2016; 24(2).
Mahl C, Melo LR, Almeida MH, et al. Delay in head and neck cancer care during the COVID-19 pandemic and its impact on health outcomes. Brazilian oral research. 2020; 34(126).
Scott SE, Grunfeld EA, McGurk M. Patient's delay in oral cancer: a systematic review. Community Dent Oral Epidemiol. 2006; 34(5):337-43. doi: 10.1111/j.1600-0528.2006.00290.x
Scott SE, Grunfeld EA, Main J, McGurk M. Patient delay in oral cancer: a qualitative study of patients' experiences. Psycho Oncology. 2006; 15(6):474-85. doi: 10.1002/pon.976
Friedrich RE. Delay in diagnosis and referral patterns of 646 patients with oral and maxillofacial cancer: a report from a single institution in Hamburg, Germany. Anticancer Res. 2010; 30(5):1833-6.
Kumar S, Heller RF, Pandey U, Tewari V, Bala N, Oanh KT. Delay in presentation of oral cancer: a multifactor analytical study. Natl Med J India. 2001; 14(1):13-7.
Singh T, Schenberg M. Delayed diagnosis of oral squamous cell carcinoma following dental treatment. Ann R Coll Surg Engl. 2013; 95(5):369-73. doi: 10.1308/003588413X13629960045599
Onizawa K, Nishihara K, Yamagata K, Yusa H, Yanagawa T, Yoshida H. Factors associated with diagnostic delay of oral squamous cell carcinoma. Oral Oncol. 2003; 39(8):781-8. doi: 10.1016/s1368-8375(03)00075-7
Chiou SJ, Lin W, Hsieh CJ. Assessment of duration until initial treatment and its determining factors among newly diagnosed oral cancer patients: a population-based retrospective cohort study. Medicine. 2016; 95(50):e5632. doi: 10.1097/MD.0000000000005632
Varela-Centelles P, Seoane J, Bilbao A, Seoane-Romero J. Covid-19 pandemic: a new contributing factor to diagnostic and treatment delay in oral cancer patients. Oral Oncol. 2021; 116:105176. doi: 10.1016/j.oraloncology.2020.105176
Van Harten MC, de Ridder M, Hamming-Vrieze O, Smeele LE, Balm AJ, van den Brekel MW. The association of treatment delay and prognosis in head and neck squamous cell carcinoma (HNSCC) patients in a Dutch comprehensive cancer center. Oral Oncol. 2014; 50(4):282-90. doi: 10.1016/j.oraloncology.2013.12.018
Guggenheimer J, Verbin RS, Johnson JT, Horkowitz CA, Myers EN. Factors delaying the diagnosis of oral and oropharyngeal carcinomas. Cancer. 1989; 64(4):932-5. doi: 10.1002/1097-0142(19890815).
Joseph BK, Sundaram DB, Ellepola AN. Assessing oral cancer knowledge among undergraduate dental students in Kuwait University. J Cancer Educ. 2015; 30(3):415-20. doi: 10.1007/s13187-014-0734-7
Seoane J, Alvarez–Novoa P, Gomez I, et al. Early oral cancer diagnosis: the Aarhus statement perspective: a systematic review and meta-analysis. Head Neck. 2016; 38:2182-9. doi: 10.1002/hed.24050
Varela-Centelles P, López-Cedrún JL, Fernández-Santromán J et al. Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain: relative contribution of patient interval. Med Oral Patol Oral Cir Bucal. 2017; 22(4):478-83. doi: 10.4317/medoral.21676
Lee NV, Kang ETB, Senger C, Poh CF. Oral cancer in a 5-year-old boy: a rare case report and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020; 130(1):10-9. doi: 10.1016/j.oooo.2019.12.005
Tucci R, Borges FT, Castro PHS, Aburad A, Carvalhosa AA. Avaliação de 14 casos de carcinoma epidermoide de boca com diagnóstico tardio. Revista Sul-Brasileira de Odontologia. 2010; 7:231-8.
Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol. 2015; 8(9):11884-94.
Paré A, Joly A. Cancers de la cavité buccale: facteurs de risque et prise en charge. La Presse Médicale. 2017; 46(3):320-30. doi: 10.1016/j.lpm.2017.01.004.
Kerdpon D, Jantharapattana K, Sriplung H. Factors related to diagnostic delay of oral squamous cell carcinoma in southern Thailand: revisited. Oral Dis. 2018; 24(3):347-54. doi: 10.1111/odi.12757
Tevetoğlu F, Kara S, Aliyeva C, Yıldırım R, Yener HM. Delayed presentation of head and neck cancer patients during COVID-19 pandemic. Eur Arch Otorhinolaryngol. 2021; 278(12):5081-5. doi: 10.1007/s00405-021-06728-2
Seoane J, Otero-Rico A, López-Cedrún JL, Varela-Centelles P. Shorter specialist time intervals are associated with advanced stage on symptomatic oral cancer. Oral Dis. 2018; 24(1-2):112-4. doi: 10.1111/odi.12754
Epstein JB, Sciubba JJ, Banasek TE, Hay LJ. Failure to diagnose and delayed diagnosis of cancer: medicolegal issues. J Am Dent Assoc. 2009; 140(12):1494-503. doi: 10.14219/jada.archive.2009.0100
Schnetler JF. Oral cancer diagnosis and delays in referral. Br J Oral Maxillofac Surg. 1992; 30(4):210-3. doi: 10.1016/0266-4356(92)90262-h
Gómez I, Warnakulasuriya S, Varela-Centelles PI et al. Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay? Oral Dis. 2010; 16(4):333-42. doi: 10.1111/j.1601-0825.2009.01642.x
Langton S, Cousin GCS, Plüddemann A, Bankhead CR. Comparison of primary care doctors and dentists in the referral of oral cancer: a systematic review. Br J Oral Maxillofac Surg. 2020; 58(8):898-917. doi: 10.1016/j.bjoms.2020.06.009
Santos IV, Alves TD, Falcão MM, Freitas VS. O papel do cirurgião-dentista em relação ao câncer de boca. Odontol Clín Cient. 2011; 10(3).
McGurk M, Scott SE. The reality of identifying early oral cancer in the general dental practice. Br Dent J. 2010; 208(8):347-51. doi: 10.1038/sj.bdj.2010.345
Lopez J, Pia & Camacho-AF. New barriers in oral cancer: patient accessibitity to dental examination: a pilot study. Oral Oncology. 2006; 42:1022-5. doi: 10.1016/j.oraloncology.2005.12.025.
Grimes D, Patel J, Avery C. New NICE referral guidance for oral cancer: does it risk delay in diagnosis? Br J Oral Maxillofac Surg. 2017; 55(4):404-6. doi: 10.1016/j.bjoms.2016.09.022
Webster JD, Batstone M, Farah CS. Missed opportunities for oral cancer screening in Australia. J Oral Pathol Med. 2019; 48(7):595-603. doi: 10.1111/jop.12915
Rath H, Shah S, Sharma G, Mishra E. Exploring determinants of care-seeking behaviour of oral cancer patients in India: a qualitative content analysis. Cancer Epidemiol. 2018; 53:141-8. doi: 10.1016/j.canep.2018.01.019
Gilligan G, Lazos J, Piemonte E, Criado E, Pánico R. Delays in the diagnosis of oral cancer due to the quarantine of COVID-19 in Córdoba, Argentina. Spec Care Dentist. 2020; 40(6):618-20. doi: 10.1111/scd.12524
Macpherson LMD. Raising awareness of oral cancer from a public and health professional perspective. Br Dent J. 2018; 225(9):809-14. doi: 10.1038/sj.bdj.2018.919
Stoykova M. Delayed diagnosis of cancer with emphasis on oral cavity cancers. Folia Med. 1999; 41(1):132-5.
Allison P, Locker D, Feine JS. The role of diagnostic delays in the prognosis of oral cancer: a review of the literature. Oral Oncol. 1998; 34(3):161-70. doi: 10.1016/s1368-8375(97)00071-7
van der Waal I, Bree R, Brakenhoff R, Coebergh JW. Early diagnosis in primary oral cancer: is it possible? Med Oral Patol Oral Cir Bucal. 2011; 16(3):e300-e305. doi: 10.4317/medoral.16.e300Rhodus
Rhodus NL, Kerr AR, Patel K. Oral cancer: leukoplakia, premalignancy, and squamous cell carcinoma. Dent Clin North Am. 2014; 58(2):315-40. doi: 10.1016/j.cden.2013.12.004
Dionne KR, Warnakulasuriya S, Zain RB, Cheong SC. Potentially malignant disorders of the oral cavity: current practice and future directions in the clinic and laboratory. Int J Cancer. 2015; 136(3):503-15. doi: 10.1002/ijc.28754
Madhura MG, Rao RS, Patil S, Fageeh HN, Alhazmi A, Awan KH. Advanced diagnostic aids for oral cancer. Dis Mon. 2020; 66(12):101034. doi: 10.1016/j.disamonth.2020.101034
Dave B. Why do GDPs fail to recognise oral cancer? The argument for an oral cancer checklist. Br Dent J. 2013; 214(5):223-5. doi: 10.1038/sj.bdj.2013.214
Razavi SM, Zolfaghari B, Foroohandeh M, Doost ME, Tahani B. Dentists' knowledge, attitude, and practice regarding oral cancer in Iran. J Cancer Educ. 2013; 28(2):335-41. doi: 10.1007/s13187-013-0460-6
Nagao T, Warnakulasuriya S. Screening for oral cancer: future prospects, research and policy development for Asia. Oral Oncol. 2020; 105:104632. doi: 10.1016/j.oraloncology.2020.104632
Gómez I, Seoane J, Varela-Centelles P, Diz P, Takkouche B. Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis. Eur J Oral Sci. 2009; 117(5):541-6. doi: 10.1111/j.1600-0722.2009.00672.x
Al-Dakkak I. Diagnostic delay broadly associated with more advanced stage oral cancer. Evid Based Dent. 2010; 11(1):24. doi: 10.1038/sj.ebd.6400708
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2024 Regina Mara Antunes dos Santos, Rose Mara Ortega, Francielle Silvestre Verner, Denis Talis Reis, Larissa Stefhanne Damasceno de Amorim Póvoa, Sibele Nascimento de Aquino
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Cessão de Primeira Publicação à HU Revista
Os autores mantém todos os direitos autorais sobre a publicação, sem restrições, e concedem à HU Revista o direito de primeira publicação, com o trabalho licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento irrestrito do trabalho, com reconhecimento da autoria e crédito pela citação de publicação inicial nesta revista, referenciando inclusive seu DOI.
