INTRODUCTION
Cancer and its treatment still involve a crucial factor, namely body image changes,
which are intensively experienced by women. Women with cancer may experience significant
emotional and psychosocial trauma. Cancer is a disease that is often associated with
death; hence, cancer patients develop a stigma toward the disease. Patients diagnosed
with malignant neoplasm experience various losses, extending from the diagnosis to
the treatment and prognosis of the disease. In women, body image changes are associated
with significant psychological trauma1.
The assessment of the quality of life (QOL) considers the subjective perception of
the patient, which is an important step toward a more comprehensive and humanistic
approach to cancer treatment. This trend is well documented in the literature due
to the increased number of breast cancer studies presenting results obtained through
the assessment of the QOL1.
Breast reconstruction can restore the patient’s physical form and integrity, among
other demonstrated benefits. In this scenario, psychological well-being plays a crucial
role since breast reconstruction can reduce the impact generated by stigmas and the
sequelae of cancer surgery. An increasing number of patients are being favored2 by the spread of this surgical technique and its advances.
Indicating immediate breast reconstruction not only optimizes body contour of women
but also, causes a positive impact on their QOL. Understanding this should increase
the awareness of the importance of this parameter because treatment of the disease
is not enough; it is necessary to provide QOL after treatment2.
This study aims to demonstrate, by assessing the QOL questionnaire, the importance
of QOL for all professionals involved in the treatment, which would ensure that this
parameter is prioritized in the choice of treatment of women with breast cancer at
the CECON Foundation (FCECON).
METHODS
This is an observational, cross-sectional, descriptive, quantitative study where we
assessed the QOL of women undergoing mastectomy with immediate breast reconstruction
through the administration of the WHOQOL-BREF questionnaire. It is a self-explanatory
and self-assessment instrument comprising 26 questions related to 4 domains: physical,
psychological, social relationships, and environment. Each of the questions was scored
on a scale from 1 to 5. The scores of the domains were calculated according to the
syntax proposed by the WHOQOL Group ranging from 0 to 100 and following a positive
direction, that is, higher scores represented a better assessment of QOL.
The study population comprised women registered at FCECON who underwent a mastectomy
and who wanted to undergo immediate breast reconstruction and who spontaneously agreed
to complete the WHOQOL-BREF questionnaire. Twenty-two patients were selected.
From January 2015 to June 2015, 51 mastectomies were performed at FCECON (6 in January,
5 in February, 10 in March, 11 in April, 12 in May, and 7 in June). Only 25 patients
were selected because the remaining 26 patients had advanced tumors, and the breast
service did not indicate immediate reconstruction for these patients (3 in January,
5 in March, 8 in April, 5 in May, and 5 in June). A total of three patients withdrew
from the study: one patient decided at the time of surgery not to undergo immediate
breast reconstruction after mastectomy (March, 15) and two patients did not undergo
breast reconstruction due to tumor growth and loss of surgical margin of safety (1
in March and 2 in May).
The patients answered the questionnaire during outpatient care 30 days after undergoing
the surgical procedure of immediate breast reconstruction after mastectomy. The questionnaire
was administered during this time because, at that time, patients have not yet received
adjuvant treatments, such as chemotherapy and radiotherapy, whose side effects could
interfere with QOL.
The study was assessed and approved by the Human Research Ethics Committee of the
FCECON (CAAE number: 39808514.4.0000.0004).
RESULTS
The age group with the highest incidence of breast reconstruction was 45–49 years,
corresponding to 27.27% of patients, and the age groups with the lowest incidence
of breast reconstruction were 60–64 years and 65–69 years, corresponding to 4.55%
of patients. High school was the most prevalent educational level, accounting for
63.64% of patients, and higher educational level and complete and incomplete elementary
education accounted for 22.73% and 4.55% of patients, respectively. Married, divorced,
and single women accounted for 72.73%, 18.18%, and 9.09% of the study sample, respectively.A
total of 90.91% of the patients were from Manaus City, and the rest were from the
countryside cities of Itacoatiara and Apuí.
A total of 41% of the patients defined their QOL as good, and 5% defined it as bad.
Approximately 50% of patients considered themselves very satisfied with their health,
while 4% reported dissatisfaction.
In the psychological domain, which assesses the acceptance of physical appearance,
55% of the patients reported being completely satisfied, and the rest was divided
between being very satisfied and moderately satisfied. None of the patients reported
being completely dissatisfied with their physical appearance. While 5% of patients
reported being dissatisfied with themselves, 50% reported being satisfied. A total
of 82% of women had negative feelings.
A total of 36%, 9%, and 14% of patients reported being satisfied, being very satisfied,
and being dissatisfied with their performance in daily activities, respectively.
Regarding social relationships, while 46% of patients reported being satisfied with
their sexual life, 13.5% reported being dissatisfied. In the subjective self-assessment
of personal relationships, 46% of patients reported being very satisfied, and only
9% reported being dissatisfied to some extent.
As shown in Table 1, although there was no significant difference between the domains, the scores for
personal relationships and self-assessment of QOL domains were slightly higher than
those of other domains.
Table 1 - Descriptive domain statistics.
| Domínio |
Mean |
Standard
Deviation
|
Coefficient Of
Variation
|
Minimum Value |
Maximum Value |
Extent |
| Physical |
15.01 |
2.36 |
15.72 |
10.86 |
18.86 |
8.00 |
| Psychological |
15.58 |
2.33 |
14.98 |
7.33 |
18.00 |
10.67 |
| Social relationships |
16.00 |
3.05 |
19.07 |
8.00 |
20.00 |
12.00 |
| Environment |
15.70 |
1.89 |
12.02 |
12.00 |
19.00 |
7.00 |
| Self-assessment of QOL |
16.73 |
3.30 |
19.71 |
8.00 |
20.00 |
12.00 |
| Total |
15.60 |
1.96 |
12.55 |
9.85 |
18.62 |
8.77 |
Table 1 - Descriptive domain statistics.
Figure 1 shows the means of the domains’ scores of the questionnaire for assessing the QOL
on a scale from 0 to 100. All domains had an approximate score of 72.51, with the
physical domain having the lowest score of 68.83.
Figure 1 - Distribution according to the general analysis of the WHOQOL-BREF domains.
Figure 1 - Distribution according to the general analysis of the WHOQOL-BREF domains.
Figure 2 shows the means of the scores of the 24 facets and the QOL self-assessment question
on a scale from 0 to 100. The mobility facet, which belongs to the physical domain,
had the best score, with 89.77. However, the environment domain, represented by the
recreation and leisure facet, had the lowest score, with 43.18. The score of self-assessment
of QOL was 79.55, showing that the patients had good QOL.
Figure 2 - Distribution according to the general analysis of the WHOQOL-BREF facets.
Figure 2 - Distribution according to the general analysis of the WHOQOL-BREF facets.
DISCUSSION
The predominant age group undergoing breast reconstruction was 45–49 years, corresponding
to 27.27% of patients. The age groups 40–44 years and 55–59 years corresponded to
22.73% of patients. Gomes et al., in 20153, conducted a cross-sectional study with 37 women and observed a mean age of 57 years
and a prevalence of 72% of women aged 50 years or higher. Similarly, Garcia et al.,
in 20184, conducted a cross-sectional study with 35 women and observed a mean age of 50 years.
High school was the predominant educational level, corresponding to 63.64% of the
patients assessed. Complete and incomplete elementary education corresponded to 4.55%
of patients. Seidel et al., in 20175, assessed 35 patients in the State of Santa Catarina and observed a prevalence of
53.1% of patients who had completed high school. Ferraz, in 20096, observed that 65% of patients had incomplete elementary education, and 16.7% had
completed high school, a result which is inconsistent to the results obtained in the
present study.
Married women were predominant, corresponding to 72.73% of the study sample; moreover,
18.18% and 9.09% of women were divorced and single, respectively. Hughet et al., in
20097, conducted a cross-sectional study with 110 women in Campinas (São Paulo) and observed
that 68% of them were married. Seidel et al., in 20175, found a similar result in their study conducted in 58 women in Santa Catarina with
a prevalence of 56.6% of married women, which is consistent with the results obtained
in the present study.
A total of 90.91% of patients were from the Manaus City, and the rest were from the
countryside cities of Amazonas. Pereira et al., in 2017,8, assessed 211 women from 2003 to 2013 at FCECON and observed that 21% were from countryside
cities different from those of the present study.
A total of 41% of patients defined their QOL as good. Our results were consistent
with the results obtained from the study of Paredes et al., in 20139, who assessed 27 women in Fortaleza and obtained a satisfaction level of 41%.
The physiological score was 72.35, which is close to the scores obtained by Gomes
et al., in 20153, 71.87, and by Fuga, in 201610, who assessed 18 patients in Rio Grande do Sul and found a mean age of 55.83 years
and a score of 75.17.
The physical domain had the lowest score, with 68.83. This finding is consistent with
the findings observed in the study of Garcia et al., in 20184, in which the physical domain score of the 35 women assessed was 65.09. Jorge e Silva,
in 201011, conducted a cross-sectional descriptive study with 50 patients in the region of
Triângulo Mineiro, from August 2007 to April 2009, and observed that the physical
domain was the most affected, with a score of 56.00.
Kluthcovsky and Urbanez, in 201212, conducted a cross-sectional study with 199 women in Paraná and observed that the
social relationships domain had the highest score, a result consistent with the results
obtained in the present study, with a social relationship score of 75.00. However,
in the study by Gomes et al., in 20153, comprising 37 patients, the social relationships domain had a score of 62.39.
Jorge e Silva, in 201011, and Garcia et al., in 20184, found low environment scores, 58.10 and 60.31, respectively. The present study had
different results, with a score of 73.15.
Paredes et al., in 20139, assessed 27 mastectomized women undergoing immediate or late breast reconstruction
using the WHOQOL-BREF questionnaire and found that women who underwent late reconstruction
were more satisfied compared to women who underwent immediate breast reconstruction.
CONCLUSION
When analyzing the criteria for QOL, negative feelings had an unfavorable outcome.
However, breast reconstruction had a positive impact on the physical, social relationships,
and environment domains.
The assessment of the QOL of women undergoing breast carcinoma treatment should be
prioritized in the choice of surgical treatment since body image directly influences
their QOL. In this way, breast reconstruction can provide this woman with an improved
body contour, which will directly impact her QOL.
QOL should be prioritized in the choice of treatment to be offered to women with breast
cancer. Further studies will certainly demonstrate the importance of this assessment.
COLLABORATIONS
|
RAP
|
Analysis and/or data interpretation, Conception and design study, Conceptualization,
Data Curation, Final manuscript approval, Formal Analysis, Funding Acquisition, Investigation,
Methodology, Project Administration, Realization of operations and/or trials, Resources,
Visualization, Writing - Original Draft Preparation, Writing - Review & Editing
|
|
HFBESAP
|
Writing - Original Draft Preparation, Writing - Review & Editing
|
|
GPSN
|
Data Curation
|
|
EOA
|
Writing - Review & Editing
|
|
VTA
|
Data Curation
|
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1. Fundação Centro de Controle de Oncologia do Amazonas, Manaus, AM, Brazil.
2. Universidade Nilton Lins, Faculdade de Medicina, Manaus, AM, Brazil.
3. Universidade Federal do Amazonas, Programa de Pós-Graduação Stricto Sensu, Manaus,
AM, Brazil.
Corresponding author: Roberto Alves Pereira Rua Acre, 12, Salas 519/520, Cemon Building, Manaus, AM, Brazil. Zip Code: 69053-130.
E-mail: robertopereiracp@me.com
Article received: June 19, 2019.
Article accepted: February 22, 2020.
Conflicts of interest: none.
