Assistência oncológica a mulheres com câncer de mama: avaliação da qualidade de vida e dos tempos de espera para diagnóstico e tratamento

Abstract

Context: The prolonged waiting time for diagnosis and treatment initiation for breast cancer usually results in the diagnosis of the disease in advanced stages. Thus requires aggressive therapies that affect the patients’ quality of life. Objective: To evaluate breast cancer care based on the analysis of quality of life and waiting time for diagnosis and treatment initiation, as well as analyze the factors associated in an Oncology Reference Center in Minas Gerais, Brazil. Method: to assess waiting time - retrospective cohort with 477 women diagnosed with breast cancer between 2014 and 2016. Analyzes were performed using the Kaplan-Meier method and the Cox regression model. For the analysis of quality of life and the association between waiting time and quality of life - cross-sectional study with 101 women diagnosed with breast cancer between 2014 and 2016. Quality of life was assessed using the EORTC QLQ-C30 and BR-23 questionnaires. Analyzes were performed using the Student's T test, the Mann-Whitney test, the Kruskal–Wallis test and Dunn's post-hoc test. Results: the median time to diagnosis was 70 days, being shorter for those who discovered the disease by screening tests and diagnosed in early stages. The median time for treatment was 32 days, being shorter for women assisted by the private network, with high schooling and diagnosed in early stages. Regarding quality of life, in the QLQ – C30 questionnaire, there was a median score on the global health scale of 75.0 (IQ=33.33), a mean score on the functional scale of 75.99 (SD=19, 26) and a mean score on the symptom scale of 19.67 (SD=16.91). In the QLQ – BR23 questionnaire, there was a mean score on the functional scale of 61.89 (SD=17.21), and a mean score on the symptoms scale of 21.21 (SD=16.94). Better quality of life scores were identified among women over 50 years old, black race, with more than 8 years of schooling completed, who lived with a partner, who had a paid job, who were assisted by the private care, with per capita income above half the minimum wage, from economic classes A, B and C, who resided in the municipality where the service was provided, who did some type of physical activity, who did not use tobacco, with a higher score on the scale of religiosity, who had greater social support, who were not overweight, who did not have comorbidities and who underwent sectorectomy. Higher levels of quality of life were observed among women who had the diagnosis and treatment of the disease in a shorter time. Conclusions: there is a great influence of sociodemographic, behavioral and clinical factors on the waiting time and quality of life of women diagnosed with breast cancer. Interventions to promote health, reduce inequities in access to health services can contribute to reducing the waiting time for cancer care, and consequently, improve quality of life even three years after diagnosis.