The quality of life of disease-free Brazilian breast cancer survivors

Health-Related Quality of Life in Patients with Breast Cancer in Latin America and the Caribbean: A Systematic Review and Meta-Analysis

Background and Objectives

Breast cancer (BC) is the most common cancer in women. It imposes a huge disease burden and a significant impact on health‐related quality of life (HRQoL). Our study focused on HRQoL of patients with BC in Latin America and the Caribbean (LAC). We conducted a systematic review to identify relevant articles published between 2008 and August 2018. We conducted several meta‐analyses and subgroup analyses by country, disease stage, and instrument used (Prospective Register Of Systematic Reviews registration number: CRD42018106835).

Results

From 2,265 initial references, we finally included 75 articles (8,806 participants) that assessed HRQoL. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 and B23 modules (34 studies; 8 countries; 4,866 participants) were the most used instruments, followed by the Short Form 36‐item, the abbreviated version of the World Health Organization Quality of Life instrument, and the Functional Assessment of Cancer Therapy – Breast instrument. Only four studies reported specific HRQoL data of patients with metastatic disease. Half the studies were rated as having moderate quality (38/75), and 38% (29/75) as high quality. We identified substantial heterogeneity. As expected, the meta‐analyses revealed that patients with metastatic disease reported lower HRQoL values and high symptom burden compared with patients at earlier stages. Similar results can be observed when we compared patients with early breast cancer in active treatment phases versus those in follow‐up.

Conclusion

This study provides a synthesis of breast cancer HRQoL reported in LAC and exposes existing evidence gaps. Patients with BC in active treatment or with metastatic disease had worse HRQoL compared with survivors during the follow‐up period.

Implications for Practice

This systematic review provides an exhaustive synthesis of breast cancer health‐related quality of life in women in the Latin American and Caribbean region. Patients with breast cancer in active treatment or with metastatic disease had worse health‐related quality of life compared with survivors during the different follow‐up periods. This study also shows important evidence and methods gaps that can help inform future research.

This review reports the health‐related quality of life for patients with breast cancer living in Latin American countries and explores relationships with disease stage and treatment in real‐world settings.

Benefits of belly dance on quality of life, fatigue, and depressive symptoms in women with breast cancer - A pilot study of a non-randomised clinical trial

OBJECTIVE

To analyse the influence of belly dance on the quality of life, fatigue, and depressive symptoms in women with breast cancer.

METHODS

Pilot study, with a design of non-randomised clinical trial study, analysing 19 women, with 8 allocated in the experimental group and 11 in the control group. The experimental group underwent 12 weeks of belly dance classes, with a frequency of twice a week and duration of 60 min for each lesson. Data collection was made through the use of questionnaires containing general information, quality of life (EORTC QLQ-BR23), fatigue (Piper Fatigue Scale) and depressive symptoms (BECK's Depression Inventory) applied on baseline and after intervention.

RESULTS

The experimental group presented significant improvements after the intervention, with an increase in scores of the functional scale (p = 0.002): body image (p = 0.037) and sexual function (p = 0.027); and a decrease in scores of the symptomatic scale (p = 0.001): systemic therapy side effects (p = 0.005) and arm symptoms (p = 0.001) of quality of life, as well the decrease of fatigue (p = 0.036) and depressive symptoms (p = 0.002). No significant differences were observed in clinical and demographic information at baseline between the experimental and control groups. Also, there was no significant difference on quality of life, fatigue, and depressive symptoms between the two groups.

CONCLUSION

Belly dance can be a viable form of physical activity for women with breast cancer. It was associated with benefits for quality of life, fatigue, and depressive symptoms. Even though there were significant pre-post treatment differences, there was no significance difference between the experimental and control group; and therefore, treatment could have been due to natural history.

TEMPO SENTADO, IMAGEM CORPORAL E QUALIDADE DE VIDA EM MULHERES APÓS A CIRURGIA DO CÂNCER DE MAMA

RESUMO Introdução: A cirurgia é uma das modalidades de tratamento do câncer de mama e pode ser conservadora ou radical. Esse tipo de tratamento pode trazer alterações físicas e psicológicas para a vida das pacientes. Objetivo: Analisar a influência da cirurgia radical e conservadora sobre o tempo sentado, a imagem corporal e a qualidade de vida de mulheres após diagnóstico do câncer de mama. Métodos: Participaram 172 mulheres que foram submetidas à cirurgia radical ou conservadora do câncer de mama. Aplicou-se um questionário contemplando características pessoais, medidas antropométricas, nível econômico (IBGE), características da doença, tempo sentado (IPAQ - versão curta), imagem corporal (BIBCQ) e qualidade de vida (EORTC QLQ-C30 + QLQ BR - 23). Para a análise estatística, utilizou-se o teste do Qui-quadrado ou o teste exato de Fisher e o teste t de Student para amostras independentes e o teste U de Mann-Whitney. Resultados: As mulheres que foram submetidas à cirurgia radical apresentaram maior tempo sentado nos finais de semana, mais relatos de linfedema, piores escores de qualidade de vida (função física, dor, escala funcional, imagem corporal e sintomas no braço) e pior imagem corporal (vulnerabilidade, estigma, limitações, transparência e preocupações com o braço). Conclusão: O tipo de cirurgia pode influenciar o tempo sentado e aspectos da imagem corporal e da qualidade de vida, com piores escores para as mulheres submetidas à cirurgia radical.

I survived cancer: phenomenological analysis of the survivors' language

The study attempted to understand the feelings of people who have survived cancer, through qualitative research with Heidegger's phenomenological approach. The study subjects were five cancer survivors, followed up during 2004 and 2005 through a university extension project in the northwestern region of the state of Paraná. Phenomenological interviews were held to capture the survivors' feelings, at their homes, during January and February 2013. "How is it for you to have survived cancer?" was the orienting question. Four ontological issues emerged from the analysis of their discourses: (re-) remembering the vigor of having been; (re-) encountering spirituality; fear of the disease's recurrence; forgetting the temporality of living with cancer. We conclude that, in their being-healed, patients live with anxiety, that throws them into a distressing state for fear of recurrence, as well as enabling them to find a new meaning to life.

Assessment of the measurement properties of quality of life questionnaires in Brazilian women with breast cancer

BACKGROUND

There are several questionnaires available to assess quality of life in breast cancer, however the choice of the best questionnaire often does not take into account the adequacy of these questionnaires' measurement properties.

OBJECTIVE

To test the measurement properties of two generic quality of life questionnaires and one quality of life questionnaire specific for women with breast cancer.

METHOD

We assessed 106 women after surgery for breast cancer. The assessment included application of the SF-36, WHOQOL-bref, and FACT-B+4 questionnaires as well as the Global Perceived Effect and Pain Numerical Rating scales. The participants were interviewed on three occasions to investigate internal consistency, floor and ceiling effects, construct validity, reproducibility, and responsiveness.

RESULTS

Most of the instruments' domains showed adequate internal consistency (Cronbach's alpha varying from 0.66 to 0.91). Reliability varied from poor to substantial (ICC2,1 between 0.39 and 0.87) and agreement varied from negative to very good. The SF-36 presented doubtful agreement and showed floor and ceiling effects in three domains. The domains of the generic questionnaires presented moderate to good correlation with the FACT-B+4 (Pearson varying from 0.31 to 0.69). The internal responsiveness varied from small to large (ES varying from -0.26 to 0.98) and external responsiveness was found in only some of the instruments' domains.

CONCLUSIONS

Most of the measurement properties tested for the WHOQOL-bref and FACT-B+4 were adequate as was their ability to assess quality of life in women with breast cancer. The SF-36 showed inadequacy in agreement and floor and ceiling effects and should not be used in women with breast cancer.

Quality of life as a predictor of overall survival after breast cancer treatment

PURPOSE

To describe quality of life (QoL) in a cohort of surviving women 4 years after breast cancer treatment and to analyze its role as a predictor of mortality within 2 years.

METHODS

This is a prospective cohort study of 544 women who have undergone surgical treatment, from 2001 to 2002 and who answered a questionnaire about QoL in 2006. After, we conducted a survival study to evaluate the association between QoL and mortality within 2 years with the same population. We conducted factor analysis between the variables of the scales of function and symptoms. Survival analysis was conducted by Kaplan-Meier, and differences in survival curves were assessed with the log-rank test, assuming significant statistical level of 5 %. The Cox proportional hazards regression model was used to explore the relationship between QoL variables (functional scales) and prognostic value for survival.

RESULTS

The mean age of the women was 59.1 years (SD 11.66). The mean of overall QoL score was 75.16 (SD 20.93). Using factor analysis, we identified three conditions that made up the construct of QoL in this group of patients: social, psycho-emotional, and physical. Social condition was the most important factor. After assessment of QoL, the mean survival was 23 months (SD 3.90). Women who reported worse future perspective had higher chance of death compared with women better prospect of future (HR = 3.46; 95 % CI 1.36-8.79; p value = 0.009).

CONCLUSION

Future perspectives were predictors of mortality, which reinforce the relevance of social support and psychological aspects for these women.