Qualidade de Vida Relacionada à Saúde e Risco de Comorbidade Cardiovascular ao Diagnóstico de Câncer de Mama / Health-Related Quality of Life and Cardiovascular Comorbidity Risk for Breast Cancer Diagnosis / Calidad de Vida Relacionada con la Salud y Riesgo de Comorbilidad Cardiovascular al Diagnóstico de Cáncer de Mama

INTRODUÇÃO: A literatura sugere que mulheres com doenças cardiovasculares apresentam pior qualidade de vida ao diagnóstico de câncer de mama. OBJETIVO: Avaliar a associação entre a qualidade de vida relacionada à saúde (QVRS) e as doenças cardiovasculares ao diagnóstico de câncer de mama. MÉTODO: Estudo transversal com mulheres diagnosticadas com câncer de mama. A QVRS foi avaliada pelos questionários European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Câncer Module (QLQ-BR23) e a comorbidade por meio da Cumulative Illness Rating Scale Geriatric (CIRS-G). Foram calculadas as diferenças entre as médias dos escores de QVRS e comorbidade. A associação foi avaliada por regressão logística múltipla. RESULTADOS: Foram incluídas 953 mulheres com média de idade de 54 anos (DP±11,7). Apresentavam alguma comorbidade ao diagnóstico de câncer de mama 84,1% das mulheres. O sistema coração foi afetado em 10,8% e o sistema vascular em 48,2%. Após ajuste, observou-se associação entre os escores das funções física e sexual e problemas nos sistemas coração e vascular. Foi ainda observada associação entre os piores escores de dor e dispneia e o sistema coração. Em relação à presença de doenças no sistema vascular, este esteve associado à melhor satisfação sexual, melhor perspectiva futura e piores sintomas na mama. CONCLUSÃO: A QVRS se mostrou associada a doenças cardiovasculares em pacientes com câncer de mama em relação à função física, sexual, satisfação sexual, a perspectivas futuras e às escalas de sintomas (dor, dispneia e sintomas na mama).

INTRODUCTION: The literature suggests that women with cardiovascular diseases have worse quality of life when diagnosed with breast cancer. OBJECTIVE: To evaluate the association between health-related quality of life (HRQoL) and cardiovascular disease at diagnosis of breast cancer. METHOD: Cross-sectional study with women diagnosed with breast cancer. HRQoL was assessed by the questionnaires of the European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Cancer Module (QLQ-BR23) and comorbidity was assessed by the Cumulative Illness Rating Scale Geriatric (CIRS-G). It were calculated the differences between mean HRQoL values and comorbidity. Logistic multiple regression was used to evaluate the association. RESULTS: 953 women with a mean age of 54 years (SD±11.7) were included. Comorbidity was presented at diagnosis of breast cancer in 84.1% of the women. The heart system was affected in 10.8% and the vascular system in 48.2%. After adjustment, an association between physical and sexual function scores and heart and vascular system problems was observed. An association between worse pain and dyspnea scores and the heart system was also noticed. Regarding the presence of diseases in the vascular system, this was associated with better sexual satisfaction, better future outcome and worse breast symptoms. CONCLUSION: HRQoL was associated with cardiovascular disease in breast cancer patients, in relation to physical and sexual function, sexual satisfaction, future perspectives and symptom scales (pain, dyspnea and breast symptoms).

INTRODUCCIÓN: La literatura sugiere que las mujeres con enfermedad cardiovascular tienen una peor calidad de vida cuando se les diagnostica cáncer de la mama. OBJETIVO: Evaluar la asociación entre la calidad de vida relacionada con la salud (CVRS) y la enfermedad cardiovascular en el diagnóstico de cáncer de mama. MÉTODO: Estudio transversal con mujeres diagnosticadas con cáncer de mama. La CVRS se evaluó mediante los cuestionarios European Organization for Research and Treatment of Cancer Quality of Life Questionnarie (EORTC QLQ-C30) and Breast Câncer Module (QLQ-BR23) y la comorbilidad se evaluó mediante Cumulative Illness Rating Scale Geriatric (CIRS-G). Se calcularon las diferencias entre las puntuaciones medias de CVRS y la comorbilidad. La asociación se evaluó mediante regresión logística múltiple. RESULTADOS: Se incluyeron 953 mujeres con una edad media de 54 años (DP±11,7). Algunas tenían comorbilidad en el diagnóstico de cáncer de mama 84,1% de las mujeres. El sistema cardíaco se vio afectado en 10,8% y el sistema vascular en 48,2%. Después del ajuste, se observó una asociación entre las puntuaciones de la función física y sexual y los problemas del corazón y del sistema vascular. También se observó una asociación entre puntajes de dolor y disnea peores y el sistema cardíaco. Con respecto a la presencia de enfermedades en el sistema vascular, esto se asoció con una mejor satisfacción sexual, una mejor perspectiva futura y peores síntomas mamarios. CONCLUSIÓN: La CVRS se asoció con la enfermedad cardiovascular en pacientes con cáncer de mama, con respecto a la función física, la función sexual, la satisfacción sexual, las perspectivas futuras y las escalas de síntomas (dolor, disnea y síntomas de mama).

Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women.

BACKGROUND: Breast cancer is commonly diagnosed at an advanced stage in Brazil. AIM: Analyze the determinants of advanced staging in Brazilian women with breast cancer. METHODS: Crosssectional study, including women diagnosed with breast cancer in Brazil, between 2000 and 2009. RESULTS: A total of 59,317 women were included, 53.5% being classified as advanced stage (≥IIB). Younger age (18 to 49 years old) (OR=1.61 95% CI 1.51 to 1.72) or between 40 and 49 years old (OR=1.08 95% CI 1.03 to 1.14), having low educational level (OR=1.53 95% CI 1.48 to 1.58), living in less developed geographical regions (OR=1.27 95% CI 1.21 to 1.33), having invasive ductal carcinoma (OR=2.70 95% CI 2.56 to 2.84) and invasive lobular carcinoma (OR=2.63 95% CI 2.42 to 2.86) were associated with advanced breast cancer. CONCLUSION: We conclude that future interventions should focus on these high risk groups.

Quality of Life and Volume Reduction in Women with Secondary Lymphoedema Related to Breast Cancer.

Purpose. To assess the quality of life (QOL) as a predictor of volume reduction in women undergoing complex physical therapy (CPT) for lymphoedema following breast cancer. Methods. Clinical trial in 57 women undergoing CPT. Results. At baseline, in measuring quality of life for the EORTC QLQ-C30 questionnaire subscale of functionality, the worst scores for emotional function (55 points) and better social function (89 points) were observed. The symptom scales showed the worst pain averaged (66 points). The overall quality of life showed a low score (40 points). In the BR 23 module, low scores were observed in the field of future perspective (47 points). After treatment of lymphoedema, absolute reduction of excess volume between the upper limbs of 282 mL was observed, representing a reduction of 15%. No association was observed between the domains of quality of life and response to treatment of lymphoedema. Conclusion. This study included 57 women with advanced and chronic lymphoedema in early treatment with CPT and low scores for quality of life. The lymphoedema therapeutic response was not influenced by the QOL at the beginning of treatment.

Fatores prognósticos em mulheres jovens com câncer de mama / [Prognostic factors in young women with breast cancer]

Introdução: O câncer de mama é a neoplasia mais comum entre as mulheres no mundo. Quando diagnosticado em idade jovem, é comum a presença de tumores mais agressivos, que podem estar relacionados à apresentação de subtipos moleculares de pior prognóstico, como o subtipo triplo negativo e com super expressão de HER2. Objetivos: Identificar a influência da idade e dos subtipos moleculares no estadiamento clínico do câncer de mama e avaliar a sobrevida de mulheres jovens com câncer de mama diagnosticadas em um hospital de referência no Rio de Janeiro, Brasil. Métodos: Foram selecionadas todas as mulheres com câncer de mama, diagnosticadas e tratadas entre os anos de 2008 e 2009, no Hospital do Câncer III/INCA. Inicialmente foi realizado um estudo transversal com mulheres com idade igual ou superior a 18 anos (artigo 1). Em um segundo momento, foi realizado um estudo de coorte com mulheres na faixa etária de 18 a 40 anos (artigo 2). Os dados clínico-tumorais foram coletados dos prontuários físicos e eletrônico. Foi realizada a análise descritiva da população utilizando medidas de tendência central e de dispersão, frequências absolutas e relativas, em ambos os estudos. Para o estudo transversal a associação entre variáveis independentes e os desfechos foi realizada por análise univariada, por meio de Odds Ratio (OR), assumindo-se intervalos de 95% de confiança. Os dados considerados clínica e estatisticamente relevantes nessa análise foram incluídos na análise de regressão logística. No estudo de sobrevida foi utilizado o método deKaplan-Meier. Para análise múltipla, foi utilizado o modelo de regressão de Cox, por meio do método Stepwise Forward, sendo incluídas todas as variáveis que apresentaram valor de p<0,20 na análise univariada. As análises foram realizadas no programa estatístico SPSS (Statistical Package for the Social Sciences) versão 21.0...

Backgroung: Breast cancer is the most common cancer among women worldwide. When diagnosed at a young age, it is common to have more aggressive tumors which can be related to presentation in aggressive molecular subtypes as the triple negative subtype and overexpressing HER2. The more aggressive behavior this age group leads to worse prognosis, reflected in the increase in relapse rates and poor survival. Objective: Identify the influence of age and molecular subtypes in clinical staging of breast cancer and to evaluate the survival of youngwomen with breast cancer diagnosed in a referral hospital in Rio de Janeiro, Brazil. Methods: Women with breast cancer, diagnosed and treated were selected between the years 2008 and2009, identified from the Hospital Cancer Registry of the Cancer Hospital III/INCA. A crosssectional study was conducted with women aged over 18 years (Article 1). In a second step, weconducted a cohort study of women aged 18-40 years (Article 2). Clinical and tumor data were collected from physical and electronic records. The descriptive analysis was performed using means ± standard deviation (SD) for continuous variables and percentages for categoricalvariables for both studies. For the cross-sectional study the association between independent variables and the outcome was assessed using odds ratio (OR) with 95% confidence intervals(95%CI). All variables clinically and statistically important were included in the logistic regression analysis. In the survival study used the Kaplan-Meier method. For multivariate analysis, we used the Cox regression model, using the stepwise forward method, and included all variables with p<0.20 in the univariate analysis. The analyzes were performed in SPSS (Statistical Package for Social Sciences) version 21.0...