RESUMO
Introduction: Breast cancer is a serious neoplasm that originates in mammary tissues whose treatment with chemotherapy seems to generate significant changes in the quality of life. Objective: To determine the risk factors associated with health-related quality of life in women with breast cancer under chemotherapy in Cali, Colombia. Materials and methods: We conducted an observational, cross-sectional study with analytical components in a sample of 80 female patients using the QLQ-C30 questionnaire for cancer, and the QLQ-BR23 for breast cancer, as well as sociodemographic and clinical information. We performed a logistic regression analysis to determine associated risk factors through adjusted OR and 95% CI; the quality of life was classified using the QLQ-BR23. Results: The most relevant symptoms were fatigue, insomnia, and hair loss. Physical functionality, feelings of pleasure, and sexual activity were reduced. The factors associated with low quality of life were mammary symptoms (adjusted OR= 5.5; 95% CI: 1.2-24.8; p = 0.038), systemic therapy side effects (adjusted OR = 7.3; IC95%: 2.6-22.1; p = 0.012), lower sexual pleasure (adjusted OR = 1.8; IC95%: 1.2-11.8; p = 0.027) and reduction of expectations about the future (adjusted OR = 4.2; IC95%: 1.1-17.8; p = 0.045). Conclusions: The quality of life in women with breast cancer and under chemotherapy was mainly affected by the side effects of the therapy; the most relevant signs and symptoms identified were hair loss, insomnia, and fatigue besides breast symptoms, lower physical functionality, and decreased sensation of sexual pleasure. We recommend intervention strategies aimed at improving the quality of life and the physical and emotional care of these patients.
Introducción. El cáncer de mama es una neoplasia grave que se origina en los tejidos mamarios y cuyo tratamiento demanda quimioterapia, con los consecuentes cambios en la calidad de vida. Objetivo. Determinar los factores de riesgo asociados con la calidad de vida relacionada con la salud en mujeres con cáncer de mama sometidas a quimioterapia en Cali, Colombia. Materiales y métodos. Se hizo un estudio observacional y transversal con componente analítico en una muestra de 80 mujeres, utilizando los cuestionarios QLQ-C30 para cáncer y QLQ-BR23 para cáncer de mama, así como información sociodemográfica y clínica. Se hizo un análisis de regresión logística para determinar los factores asociados con las razones de momios (odd ratios, OR) ajustadas y un intervalo de confianza (IC) de 95 %; la calidad de vida se clasificó mediante el cuestionario QLQ-BR23. Resultados. Los síntomas más relevantes fueron fatiga, insomnio y pérdida de cabello. Se redujeron la funcionalidad física, las sensaciones de placer y la actividad sexual. Los factores asociados con la baja calidad de vida fueron los síntomas mamarios (OR ajustada=5,5; IC95% 1,2-24,8; p=0,038), los efectos secundarios del tratamiento sistémico (OR ajustada=7,3; IC95% 2,6-22,1; p=0,012), un menor placer sexual (OR ajustada=1,8; IC95% 1,2-11,8; p=0,027) y la reducción de expectativas para el futuro (OR ajustada=4,2; IC95% 1,1-17,8; p=0,045). Conclusiones. En las mujeres con cáncer de mama sometidas a quimioterapia, la calidad de vida se vio afectada principalmente por los efectos secundarios del tratamiento, en tanto que los signos y los síntomas más relevantes fueron la pérdida del cabello, el insomnio y la fatiga, además de los síntomas mamarios, la menor funcionalidad física y la menor sensación de placer sexual. Se recomienda la implementación de estrategias de intervención destinadas a mejorar la calidad de vida, y el cuidado físico y emocional de las pacientes.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/psicologia , Qualidade de Vida , Adulto , Alopecia/induzido quimicamente , Alopecia/psicologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/psicologia , Colômbia , Intervalos de Confiança , Estudos Transversais , Fadiga/induzido quimicamente , Fadiga/psicologia , Feminino , Esperança , Humanos , Libido/efeitos dos fármacos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/psicologia , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: When evaluating a quality-of-life questionnaire (QLQ), many validation studies do not correlate quality-of-life scores with objective measurements of complications associated with treatment. PATIENTS AND METHODS: We performed a cross-sectional observational study with 300 patients submitted to breast-conserving therapy. The patients answered the European Organization for Research and Treatment of Cancer (EORTC) QLQs C-30 and BR23, as well as the Brazilian Portuguese version of the Breast Cancer Treatment Outcome Scale (BCTOS) questionnaire. Retest, internal consistency, factorial analysis, convergent/divergent analysis, and Rasch evaluation were performed. All patients underwent physical evaluations to assess lymphedema, handgrip strength, shoulder range of motion, breast cosmesis, and breast pain, and these groups were compared on the basis of BCTOS scores. Receiver operating characteristic curve determined the predictive value of BCTOS scores associated with clinical practice. RESULTS: The internal consistencies of the BCTOS domains ranged from 0.785 to 0.895. Factor analysis grouped according to the original questionnaire. Convergent validation showed differences in the sexual functioning and sexual enjoyment domains of the EORTC BR23. Analysis of known groups found that in most domains, the scores were higher in patients with lymphedema, strength deficit, shoulder range-of-motion alteration, poor breast cosmesis, breast pain, and axillary lymphadenectomy. Using a cutoff of 1.26, lymphedema was associated with the edema domain; using a cutoff of 1.33, Late Effects Normal Tissue Task Force/Subjective, Objective, Management, Analytic pain was associated with the pain domain; and using a cutoff of 2.37, the cosmetic domain was associated with subjective cosmesis. CONCLUSION: The association of objective measurements in a validation study of quality of life qualified the study and allowed us to develop better parameters for comparisons of results of breast-conserving therapy between populations.
Assuntos
Neoplasias da Mama/psicologia , Carcinoma Ductal de Mama/psicologia , Excisão de Linfonodo/métodos , Mastectomia Segmentar/métodos , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Estudos Transversais , Feminino , Seguimentos , Força da Mão , Humanos , Pessoa de Meia-Idade , Portugal , Psicometria , Curva ROC , Inquéritos e Questionários , Resultado do TratamentoRESUMO
OBJECTIVE: To correlate the perceptions related to dietary intake with the domains and subscales of health-related quality of life (HRQL) in women with breast neoplasms receiving chemotherapy. METHODS: In this prospective study, 55 women with breast cancer were followed up during chemotherapy at three different times (T0, T1, T2). Before chemotherapy, perceptions related to food consumption were evaluated. HRQL was analyzed with the EORTC QLQ-C30 and Br23 instruments 21 days after each investigated cycle. The differences (T2-T0) in the subscales and HRQL domains were correlated with the differences (T2-T0) in the appetite scores. Spearman's correlation was used to verify a possible correlation between differences in functional and overall HRQL domains (T2-T0) and differences in appetite scores for certain foods and between the differences in some subscales of EORTC QLQ-C30 and Br23 (T2-T0) and differences in appetite scores for certain food groups (T2-T0). RESULTS: Correlations between pain and appetite for bitter taste and between an increased appetite for juices and pain intensification or fatigue were identified, and pain was correlated with an appetite for starchy foods. An appetite for vegetables, legumes and meat/eggs was correlated with physical function. The only significant correlation with social functions occurred between the appetite for sweet foods and these functions. We found a correlation between overall health, emotional function, social function and physical function and the appetite for juices. CONCLUSION: Chemotherapy alters the individual's relationship with food and, consequently, the individual's HRQL.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Preferências Alimentares/efeitos dos fármacos , Qualidade de Vida , Adulto , Idoso , Análise de Variância , Apetite/efeitos dos fármacos , Neoplasias da Mama/psicologia , Carcinoma Ductal de Mama/psicologia , Carcinoma Lobular/psicologia , Feminino , Preferências Alimentares/psicologia , Humanos , Pessoa de Meia-Idade , Percepção/efeitos dos fármacos , Estudos Prospectivos , Qualidade de Vida/psicologia , Valores de Referência , Estatísticas não Paramétricas , Fatores de TempoRESUMO
OBJECTIVE: To correlate the perceptions related to dietary intake with the domains and subscales of health-related quality of life (HRQL) in women with breast neoplasms receiving chemotherapy. METHODS: In this prospective study, 55 women with breast cancer were followed up during chemotherapy at three different times (T0, T1, T2). Before chemotherapy, perceptions related to food consumption were evaluated. HRQL was analyzed with the EORTC QLQ-C30 and Br23 instruments 21 days after each investigated cycle. The differences (T2-T0) in the subscales and HRQL domains were correlated with the differences (T2-T0) in the appetite scores. Spearman's correlation was used to verify a possible correlation between differences in functional and overall HRQL domains (T2-T0) and differences in appetite scores for certain foods and between the differences in some subscales of EORTC QLQ-C30 and Br23 (T2-T0) and differences in appetite scores for certain food groups (T2-T0). RESULTS: Correlations between pain and appetite for bitter taste and between an increased appetite for juices and pain intensification or fatigue were identified, and pain was correlated with an appetite for starchy foods. An appetite for vegetables, legumes and meat/eggs was correlated with physical function. The only significant correlation with social functions occurred between the appetite for sweet foods and these functions. We found a correlation between overall health, emotional function, social function and physical function and the appetite for juices. CONCLUSION: Chemotherapy alters the individual's relationship with food and, consequently, the individual's HRQL.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Qualidade de Vida/psicologia , Neoplasias da Mama/tratamento farmacológico , Carcinoma Lobular/tratamento farmacológico , Carcinoma Ductal de Mama/tratamento farmacológico , Preferências Alimentares/efeitos dos fármacos , Antineoplásicos/efeitos adversos , Percepção/efeitos dos fármacos , Apetite/efeitos dos fármacos , Valores de Referência , Fatores de Tempo , Neoplasias da Mama/psicologia , Estudos Prospectivos , Análise de Variância , Carcinoma Lobular/psicologia , Carcinoma Ductal de Mama/psicologia , Estatísticas não Paramétricas , Preferências Alimentares/psicologiaRESUMO
Fundamentos: Ante la relevancia del cáncer de mama y su impacto en la salud pública, sumado a las pocas referencias bibliográficas sobre estudios psicosociales en la materia y la necesidad de comprender la situación desde una perspectiva cultural y situada de las personas, surgió la interrogante de conocer las vivencias en la sexualidad de las mujeres tratadas por carcinoma ductal invasor en la Unidad de Patología Mamaria (UPM) del Hospital Regional de Concepción, Chile. Método: Estudio cualitativo exploratorio con usuarias de una Unidad de Patología Mamaria y tratadas por carcinoma ductal invasor (noviembre 2014 junio 2015). Muestreo intencional con entrevista en profundidad semiestructurada, análisis de contenido semánticamente orientado. Resultados: Se encontraron principalmente dificultades en la interacción y comunicación con sus parejas debido a la transformación física como consecuencia de la cirugía de mamas y de la quimioterapia. Al mismo tiempo se evidenció distanciamiento entre las parejas debido al impacto que genera el tratamiento. Sin embargo, se observaron algunos casos en los cuales sus parejas manifestaron apoyo y compañía durante el proceso, lo cual impactó significativamente en las vidas de las usuarias y de éstas. Conclusión: Las mujeres manifiestan conflictos íntimos con sus parejas principalmente como consecuencia del estigma y cambio corporal que existe en el tratamiento de cáncer de mama, generando restricciones y limitaciones en la participación social que enfrentan en su vida personal y comunitaria, gatillando una emergente expresión de discapacidad.
Background: In light of the relevance of breast cancer and its impact on public health, along with the limited number of psychosocial studies on the subject and the need to understand the situation from a cultural perspective, focused on individuals' experiencse, an investigation of the sexual experiences of women treated for invasive ductal carcinoma in the Breast Pathology Unit (BPU) of the Hospital Regional de Concepción, Chile was conducted. Method: Qualitative exploratory study with users of the Breast Pathology Unit who were treated for invasive ductal carcinoma (November 2014 - June 2015). Purposive sampling with semi-structured in-depth interviews, with posterior semantically-oriented content analysis. Results: The principal difficulty expressed involved the interaction and communication with their partners, due to the physical transformation as a result of breast surgery and chemotherapy. Additionally, the woman exerienced distancing with their partner due to the impact of the treatment. However, there were some experiences in which the partners expressed support and companionship during the process, which significantly impacted the users' and their partners' lives. Conclusion: The women expressed intimate conflicts with their partners mainly due to stigma and body changes as a results of breast cancer treatment, which also leads to limited social participation their personal and community life, triggering an emerging type of disability.
Assuntos
Humanos , Feminino , Neoplasias da Mama/psicologia , Carcinoma Ductal de Mama/psicologia , Sexualidade/psicologia , Neoplasias da Mama/terapia , Parceiros Sexuais/psicologia , Entrevistas como Assunto , Carcinoma Ductal de Mama/terapia , Pesquisa Qualitativa , Avaliação da Deficiência , Tratamento Farmacológico/psicologia , Mastectomia/psicologiaRESUMO
OBJECTIVE: To investigate the clinicopathological findings of women diagnosed with breast cancer and study the impact of chronic psychological stress on the pathological characteristics of these tumors. METHODS: We investigated a cohort composed of women diagnosed with breast cancer and divided into two groups. One group was categorized as presenting with chronic psychological stress (by using the Self-Reporting Questionnaire - SRQ-20). Another group of women with breast cancer, but with no previous history of chronic psychological stress, comprised the Control Group. Clinical and pathological data were assessed. RESULTS: Women presenting with a history of chronic distress were significantly overweight when compared to the Control Group. Furthermore, it was observed that these stressed women also had a significant percentage of aggressive breast cancer subtype, the HER2 amplified tumor, which could be putatively associated with the loss of immunosurveillance. CONCLUSION: Our findings suggested an interaction among chronic psychological stress, overweight, and the development of more aggressive breast tumors.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Receptor ErbB-2/metabolismo , Estresse Psicológico/complicações , Índice de Massa Corporal , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Carcinoma Ductal de Mama/complicações , Carcinoma Ductal de Mama/psicologia , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Monitorização Imunológica , Sobrepeso/complicações , Inquéritos e QuestionáriosRESUMO
Objective To investigate the clinicopathological findings of women diagnosed with breast cancer and study the impact of chronic psychological stress on the pathological characteristics of these tumors.Methods We investigated a cohort composed of women diagnosed with breast cancer and divided into two groups. One group was categorized as presenting with chronic psychological stress (by using the Self-Reporting Questionnaire − SRQ-20). Another group of women with breast cancer, but with no previous history of chronic psychological stress, comprised the Control Group. Clinical and pathological data were assessed.Results Women presenting with a history of chronic distress were significantly overweight when compared to the Control Group. Furthermore, it was observed that these stressed women also had a significant percentage of aggressive breast cancer subtype, the HER2 amplified tumor, which could be putatively associated with the loss of immunosurveillance.Conclusion Our findings suggested an interaction among chronic psychological stress, overweight, and the development of more aggressive breast tumors.
Objetivo Investigar os achados clínico-patológicos de mulheres diagnosticadas com câncer de mama e estudar o impacto do estresse psicológico crônico nas características patológicas desses tumores.Métodos Investigamos uma coorte composta por mulheres diagnosticadas com câncer de mama divididas em dois grupos. O primeiro foi classificado pela apresentação de estresse psicológico crônico (por meio do Self-Reporting Questionnaire− SRQ-20). Outro grupo de mulheres com câncer de mama, mas sem história prévia de estresse psicológico crônico, foi denominado Grupo Controle. Os dados clínicos e patológicos foram avaliados.Resultados As mulheres com histórico de estresse crônico apresentaram-se significativamente acima do peso quando comparadas com o Grupo Controle. Além disso, verificou-se que estas mulheres estressadas apresentaram um porcentual significativo de um subtipo de câncer de mama agressivo, o HER2, o que poderia estar associado à possível perda da imunovigilância.Conclusão Nossos resultados sugeriram uma ligação entre o estresse psicológico crônico, o excesso de peso e o desenvolvimento de tumores de mama com maior agressividade.