ABSTRACT
O câncer de mama é o tipo de neoplasia mais incidente na população eminina brasileira. Devido ao diagnóstico ainda ser realizado em estadiamentos avançados, os tratamentos precisam ser mais agressivos, o que aumenta o risco de morbidades. Dentre essas complicações, a mais frequente é o linfedema, caracterizado por insuficiência do sistema linfático decorrente da obstrução causada pelo tratamento. É uma afecção crônica que pode evoluir com importantes alterações físicas e psicossociais, afetando a qualidade de vida dessas pessoas. A fisioterapia dispõe de diferentes condutas que podem ser aplicadas em todas as fases do tratamento oncológico, potencializando as ações de prevenção primária, secundária e terciária do linfedema. O objetivo deste artigo foi divulgar ascondutas adotadas no Serviço de Fisioterapia do Hospital do Câncer III, do Instituto Nacional de Câncer (INCA), para prevenção, diagnóstico e tratamento do linfedema de membros superiores em pacientes submetidas ao tratamento para o câncer de mama. Por meio desta divulgação, uscamosproporcionar um objeto de discussão entre os profissionais de saúde dos diferentes níveis de atenção, com o intuito de colaborar para o controle do linfedema secundário ao câncer de mama.
Breast cancer is the most frequent type of cancer among women in Brazil. Because the diagnosis is still held in advanced staging, treatments need to be more aggressive, which increases the risk of morbidity. Among these complications, the most prevalent is the lymphedema, characterized by failure of the lymphatic system resulting from the obstruction caused by the treatment of breast cancer. It is a chronic disease that can evolve with significant physical changes and psychosocial affecting the quality of life of these people. Physical therapy has different behaviors that can be implemented at all stages of cancer treatment, boosting shares of primary, secondary and tertiary prevention of lymphedema. The aim of this paper is to disseminate the approaches adopted in the Department of Physical Therapy of Cancer Hospital III, in the National Cancer Institute, for prevention, diagnosis and treatment of lymphedema of the upper limbs in patients undergoing treatment for breast cancer. Through this publication, we seek to provide a subject of discussion among health professionals of different levels of care, with the goal of collaborating to control lymphedema secondary to breast cancer.
ABSTRACT
INTRODUCTION: Advanced breast cancer is a very frequent serious public health problem. OBJECTIVE: This study aimed to analyze the prevalence of arm symptoms and overall survival in affected patients. METHODOLOGY: A retrospective cohort study was accomplished in 196 women presenting with advanced breast cancer. A descriptive analysis was carried out by and overall survival probabilities were calculated according to Kaplan-Meier method and Cox regression. RESULTS: These included 196 woman had a medium age of 55.9 years, the majority being obese (71.3%) and having a IIIB clinical staging (52.3%). The most prevalent arm symptoms were pain (54.6%), paresthesia in upper limb (8.5%), lymphedema (> 200 ml) (6.6%), shoulder restriction (4.7%) and axillary web syndrome (0.6%). The median follow-up was 18.7 months (SD 7,33), 4.0% of the patients had metastasis and 31.6% were dead. The mean free disease survival was 20.4 months (95% CI 18.4-22.4), and the mean survival time was 26.3 months (95% CI 24.7-28.0). After adjusted the association with arm symptom and overall survival for clinical stage and presence of distant metastasis, the shoulder restriction was a predict variable, were represents the risk 2.59 for worse survival in compared with woman with no shoulder restriction (CI 95% 1.06-5.98). CONCLUSION: The population studied at this study presented high prevalence of complications earlier than neo adjuvant treatment. After controlling for effects of tumor variables, the shoulder restriction was statistically associated with poor overall survival after 2 years.
