Câncer de mama metastático
a abordagem atual melhora a qualidade de vida? Um estudo prospectivo
Palavras-chave:
Neoplasias mamárias, Metástase neoplásica, Qualidade de vida, Depressão, Avaliação de estado de KarnofskyResumo
CONTEXTO E OBJETIVO: As abordagens terapêuticas atuais para o câncer de mama metastático não as- seguram aumento na sobrevida. Sendo assim, qualidade de vida passa a ser um dos principais objetivos do tratamento. Apesar disso, desconhecemos a influência dos tratamentos atualmente utilizados na qualidade de vida dessa população. O objetivo do estudo foi avaliar a influência do tratamento oncológico na qualidade de vida de portadoras de câncer de mama metastático. TIPO DE ESTUDO E LOCAL: Estudo prospectivo da variação da qualidade de vida de portadoras de câncer de mama metastático tratadas em um centro médico terciário. MÉTODOS: Realizamos um levantamento prospectivo da influência dos tratamentos oncológicos, incluindo quimioterapia, tratamento hormonal, radioterapia, cirurgia e suporte clínico, na qualidade de vida de pacientes tratadas no Centro de Tratamento e Pesquisa Hospital do Câncer, em São Paulo. Utilizamos para isso o Medical Outcomes Study’s Short Form-36 (SF-36) e o Inventário de Depressão de Beck (IDB), aplicados em três ocasiões: antes do início, na 6a e na 12a semanas após o início do tratamento. RESULTADOS: Encontramos melhora de qualidade de vida na amostra avaliada (n = 40), expressa pela variação dos índices do SF-36 (p = 0,002) e do IDB (p = 0,004). Os componentes do SF-36 que apresen- taram ganhos mais significativos foram dor, aspecto social e saúde mental. Como esperado, as pacientes com piores Performance Status (PS) e com sintomas secundários presentes apresentaram maiores ganhos em sua qualidade de vida que as de bom PS e as assintomáticas (p < 0,001). Da mesma forma, aquelas que receberam mais de uma modalidade terapêutica em comparação com as que só receberam um tipo de tratamento (p = 0,038). CONCLUSÕES: Em nosso meio, a abordagem atual para o câncer de mama metastático mostrou-se capaz de melhorar a qualidade de vida das pacientes, especialmente das que se apresentam com sintomas secundários à doença de base ou com baixo PS.
Downloads
Referências
McPherson K, Steel CM, Dixon JM. ABC of breast diseases. Breast cancer-epidemiology, risk factors, and genetics. BMJ. 2000;321(7261):624-8.
Feuer EJ, Wun LM, Boring CC, Flanders WD, Timmel MJ, Tong T. The lifetime risk of developing breast cancer. J Natl Cancer Inst. 1993;85(11):892-7.
Carlson RW. Quality of life issues in the treatment of metastatic breast cancer. Oncology (Williston Park). 1998;12(3 suppl 4):27-31.
Cardoso F, Di LA, Lohrisch C, Bernard C, Ferreira F, Piccart MJ. Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann Oncol. 2002;13(2):197-207.
Fossati R, Confalonieri C, Torri V, et al. Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women. J Clin Oncol. 1998;16(10):3439-60.
Ghersi D, Wilcken N, Simes J, Donoghue E. Taxane containing regimens for metastatic breast cancer. Cochrane Database Syst Rev. 2005;(2):CD003366.
Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974-86.
Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. American Society of Clinical Oncology. J Clin Oncol. 1996;14(2):671-9.
Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B. Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Clin Oncol. 1999;17(9):2659-69.
Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res. 1998;152:396-411.
Geels P, Eisenhauer E, Bezjak A, Zee B, Day A. Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol. 2000;18(12):2395-405.
Norris B, Pritchard KI, James K, et al. Phase III comparative study of vinorelbine combined with doxorubicin versus doxoru- bicin alone in disseminated metastatic/recurrent breast cancer: National Cancer Institute of Canada Clinical Trials Group Study MA8. J Clin Oncol. 2000;18(12):2385-94.
Fallowfield L. Quality of life: a new perspective for cancer patients. Nat Rev Cancer. 2002;2(11):873-9.
Langenhoff BS, Krabbe PF, Wobbes T, Ruers TJ. Quality of life as an outcome measure in surgical oncology. Br J Surg. 2001;88(5):643-52.
Essink-Bot ML, Krabbe PF, Bonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/ WONCA charts, and the EuroQol instrument. Med Care. 1997;35(5):522-37.
Cooley ME, McCorkle R, Knafl GJ, et al. Comparison of health- related quality of life questionnaires in ambulatory oncology. Qual Life Res. 2005;14(5):1239-49.
Okamoto T, Shimozuma K, Katsumata N, et al. Measuring qual- ity of life in patients with breast cancer: a systematic review of reliable and valid instruments available in Japan. Breast Cancer. 2003;10(3):204-13.
Mosconi P, Apolone G, Barni S, Secondino S, Sbanotto A, Filiberti A. Quality of life in breast and colon cancer long-term survivors: an assessment with the EORTC QLQ-C30 and SF-36 questionnaires. Tumori. 2002;88(2):110-6.
Yost KJ, Haan MN, Levine RA, Gold EB. Comparing SF-36 scores across three groups of women with different health profiles. Qual Life Res. 2005;14(5):1251-61.
Ware JE Jr. SF-36 health survey update. Spine. 2000; 25(24):3130-9.
Mosconi P, Colozza M, De Laurentiis M, De Placido S, Maltoni M. Survival, quality of life and breast cancer. Ann Oncol. 2001;12 (Suppl 3):S15-9.
Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF- 36). [Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure]. Rev Bras Reumatol. 1999;39(3):143-50.
Gorenstein C, Andrade L. Validation of a Portuguese ver- sion of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects. Braz J Med Biol Res. 1996;29(4):453-7.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
Conill C, Verger E, Salamero M. Performance status assessment in cancer patients. Cancer. 1990;65(8):1864-6.
Wang XS, Cleeland CS, Mendoza TR, et al. The effects of pain severity on health-related quality of life: a study of Chinese cancer patients. Cancer. 1999;86(9):1848-55.
Handy JR Jr, Asaph JW, Skokan L, et al. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest. 2002;122(1):21-30.
Bottomley A. Depression in cancer patients: a literature review. Eur J Cancer Care (Engl). 1998;7(3):181-91.
Osoba D. Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol. 1994;12(3):608-16.
Pivot X, Asmar L, Hortobagyi GN, Theriault R, Pastorini F, Buzdar A. A retrospective study of first indicators of breast cancer recurrence. Oncology. 2000;58(3):185-90.
Rojas MP, Telaro E, Russo A, et al. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev. 2005;(1):CD001768.
Mollick JA, Carlson RW. Rational surveillance programs for early stage breast cancer patients after primary treatment. Breast Dis. 2004;21:47-54.
Coates A, Gebski V, Signorini D, et al. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group. J Clin Oncol. 1992;10(12):1833-8.
Hann DM, Jacobsen PB, Martin SC, Kronish LE, Azzarello LM, Fields KK. Quality of life following bone marrow transplantation for breast cancer: a comparative study. Bone Marrow Transplant. 1997;19(3):257-64.
Murray KJ, Nelson DF, Scott C, et al. Quality-adjusted survival analysis of malignant glioma. Patients treated with twice-daily radiation (RT) and carmustine: a report of Radiation Therapy Oncology Group (RTOG) 83-02. Int J Radiat Oncol Biol Phys. 1995;31(3):453-9.
Sprangers MA, Groenvold M, Arraras JI, et al. The Euro- pean Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol. 1996;14(10):2756-68.
Greimel E, Thiel I, Peintinger F, Cegnar I, Pongratz E. Pro- spective assessment of quality of life of female cancer patients. Gynecol Oncol. 2002;85(1):140-7.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
