IJCS | Volume 31, Nº4, July / August 2018

439 Not tired at all How tired did you feel during the past week? To what extent does the feeling of tiredness prevent you from doing what you want to do? A little tired Moderately tired Very tired Extremely tired I can do everything that I usually do I can do almost everything that I usually do I can do some of the things that I usually do I can only do what I have to do I can do very little Borges et al. Oncocardiology and the symptom fatigue Int J Cardiovasc Sci. 2018;31(4)433-442 Review Article Figure 2 - The Fatigue Pictogram (Mota, Pimenta, Fitch. 2009) 53 Table 3 - Pathophysiological triggers of coronary artery disease in cancer treatment Agent Pathophysiological mechanism Potential coronary events 5- fluorouracil, capecitabine, gemcitabine Endothelial lesion and vasospasm Up to 18% of myocardial ischemia and 10% of silent ischemia Platinum components - cisplatin Arterial thrombosis and procoagulant 20 years of absolute risk above 8% after testicular cancer Vascular endothelial growth factor (VEGF) inhibitors: bevacizumab, sorafenib, sunitinib Procoagulant, arterial thrombosis Endothelial injury Risk of arterial thrombosis: bevacizumab 3.8%, sorafenib 1.7%, and sunitinib 1.4% Radiotherapy Endothelial lesion, platelet rupture, and thrombosis A 2- to 7-fold increase in the relative risk of myocardial infarction 10% of coronary events in survivors of Hodgkin lymphoma The risk is proportional to the radiation dose Source: Adapted from the Guideline of the European Society of Cardiology 64 The Fatigue Pictogram, prepared for the evaluation of the intensity and impact of fatigue in patients with cancer, is a useful tool in clinical practice and research (Figure 2). It is described as a method that is fast, simple, valid, reliable, and applicable to patients with cancer and low educational level, although it requires adjustments for application to healthy individuals. This instrument was developed and validated in 2007 in four oncology outpatient clinics in the city of São Paulo, with the participation of 584 patients with