Avaliação da qualidade de vida e impacto funcional em mulheres com câncer de mama pós intervenção cirúrgica na cidade de Juiz de Fora, Minas Gerais

Abstract

Breast cancer is the most common among women in Brazil, with great epidemiological importance and significant social impact, becoming the focus of attention given the health consequences that entail the diagnosis and treatment on quality of life of these women. Assessing quality of life related to health (HRQOL) in women treated surgically for breast CA in Maria José Baeta Reis-Asconcer Hospital in the city of Juiz de Fora, pole reference in cancer treatment. We evaluated 121 women attended at a cancer treatment referral unit in the public health system, collecting data from medical records and doing interviews and physical exams as part of the consultation. The interview included the application of quality of life measurements, the European Organization for Research and Treatment of Cancer, Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-C30 BR-23), and the morbidity of upper limb physical function and symptoms questionnaire, Disabilities of the Arm, Shoulder, and Hand (DASH), which characterized functionality in the present study. The EORTC QLQ-C30 BR-23 mean scores and DASH outcomes were considered as dependent variables, and the independent variables were socio-demographic, clinical, treatment, and tumor characteristics. The variables were expressed in terms of mean and standard deviation; and the statistical analysis consisted of Kruskal Wallis, Mann-Whitney, and Student's t tests, with a significance level of 5%, followed by the construction of a multiple linear regression model. SPSS 19 was used for database construction and analysis. Of the study population, 94.6% of the women were over 50 years of age, 52% lived without a partner, 66% had a low level of education, and 71.9% reported their current occupation as homemaker or retired; about 63.5% were overweight; 76% of the women had advanced clinical stages, III-IV, 65.3% had undergone conservative surgery, and on 31.5%, sentinel lymph node research had been conducted; 81.7% had received chemotherapy, 85% had undergone radiotherapy, and 87.5% were using hormone therapy. Lymphedema was diagnosed in 7.4% of the population. The mean values of the EORTC QLQ-C30 BR-23 showed a trend for good HRQOL, the functional scale being the most impaired, having the worst mean scores observed. The population had good upper limb functional performance, represented by low total DASH scores. There was statistical significance between the instrument's scale of symptoms and the women who were obese (p = 0.029 and p = 0.015, respectively), those who underwent adjuvant radiotherapy (p = 0.052), and those who had a higher number of lymph node dissections (p = 0.024). And between BMI ≥ 30 and functionality (p = 0.001). Subjective perceptions influenced all areas of the EORTC QLQ-C30 BR-23 (p < 0.01), as well as functionality (p < 0.01). After controlling for the variable, functional hand, what proved to explain HRQOL were the variables BMI, breast reconstruction, a heavy feeling in the arm, reduced range of motion in the shoulder, and a tight shirtsleeve sensation; and in turn, BMI, active work, limited shoulder range of motion, and a tight shirt-sleeve feeling, for functionality. In this sample, although the subjective perceptions were predictors of greater negative influence on HRQOL, the presence of lymphedema and self-reported complaints does not seem to influence the functionality of the upper limbs, which had good functional performance.