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CC BY 4.0 · Brazilian Journal of Oncology 2017; 13(45): e-BJO20171345A92
DOI: 10.26790/BJO20171345A92
Artigo Original

Sintomas biopsicossociais em pacientes com câncer incurável no Brasil

Biopsychosocial symptoms in patients with incurable cancer in Brazil
Isadora Miranda de Azevedo
1   Universidade Federal de São Paulo São Paulo, SP Brasil
,
Carolina Gaue Zayat
1   Universidade Federal de São Paulo São Paulo, SP Brasil
,
Getúlio Yuzo Okuma
1   Universidade Federal de São Paulo São Paulo, SP Brasil
,
Edvane Birelo Lopes De Domenico
1   Universidade Federal de São Paulo São Paulo, SP Brasil
,
Cristiane Decat Bergerot
1   Universidade Federal de São Paulo São Paulo, SP Brasil
› Author Affiliations Recursos financeiros: Para a realização desse trabalho não houve auxílio ou recursos financeiros.
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RESUMO

Objetivo: Cuidado paliativo (CP) é essencial para a identificação e manejo dos sintomas reportados por pacientes com câncer metastático. Essa assistência promove uma maior qualidade de vida à pacientes e familiares ao longo do continuum da doença, por meio da antecipação, prevenção e alívio do sofrimento. No Brasil, o CP ainda é incipiente no âmbito da assistência oncológica. Sendo assim, o presente estudo objetiva caracterizar as principais demandas de pacientes com câncer em estadio IV, bem como, identificar os fatores associados aos sintomas a fim de determinar aqueles de maior risco psicológico.

Métodos: Trata-se de um estudo descritivo e prospectivo realizado com 253 pacientes diagnosticados com câncer metastático, em tratamento quimioterápico paliativo em um hospital público universitário, localizado em São Paulo. Para tanto, os pacientes foram avaliados quanto ao distress (Termômetro de Distress - TD), a ansiedade e a depressão (Escala de Ansiedade e Depressão - HADS) e a qualidade de vida (Functional Assessment of Chronic Illness Therapy - FACT-G). Os procedimentos de análise de dados incluíram na análise descritiva, correlação linear simples e regressão logística.

Resultados: A média da idade dos pacientes avaliados foi de 56,6 anos, sendo 64,4% do sexo feminino, 51% casados e 54,2% com Ensino Fundamental. Os cânceres de mama (29,2%) e gastrointestinal (28,9%) foram os mais frequentes. Quase metade dos pacientes (44,7%) reportou um distress moderado a severo, sendo que 21,7% apresentaram sintomas de ansiedade e 16,6% de depressão. A correlação foi significativa entre esses sintomas psicossociais (ps<0,001), sendo que maiores escores de distress estiveram associados a uma pior qualidade de vida global, com consequente impacto negativo no bem-estar físico, social/familiar, emocional e funcional (ps<0,001). Ademais, idade jovem, medo, preocupação, fadiga, dor, sono, ansiedade e depressão foram os fatores associados a um maior risco psicológico.

Conclusão: Pacientes com câncer metastático reportaram inúmeros sintomas físicos e psicossociais. Essa alta prevalência impactou significativamente na qualidade de vida desses pacientes, reforçando a relevância da inserção precoce do CP. Constata-se que a assistência precisa considerar a inserção de uma rotina de avaliação sistemática que auxilie na identificação dos sintomas, para proposição de tratamentos adequados e direcionados às necessidades dos pacientes, de maneira a reduzir, antecipar e prevenir o sofrimento desses pacientes.

ABSTRACT

Objective: Palliative Care (CP) is essential for the identification and management of symptoms reported by patients with metastatic cancer. Such assistance promotes higher quality of life for patients and families throughout the disease continuum, by anticipation, prevention and relief of suffering. In Brazil, the CP is still incipient in the context of Oncology care. Thus, the present study aims to characterize the main demands reported by cancer patients at stage IV, as well as to identify the factors associated with symptoms in order to determine those most at psychological risk.

Methods: This is a descriptive and prospective study conducted with 253 patients diagnosed with metastatic cancer, undergoing a palliative chemotherapy treatment in a public hospital, located in Sao Paulo. To this end, patients were evaluated regarding the distress (Distress Thermometer), anxiety and depression (Hospital Anxiety and Depression Scale), and the quality of life (Functional Assessment of Chronic Illness Therapy - General). The data analysis procedures included the descriptives analysis, simple linear correlation and logistic regression.

Results: The average age of patients was 56.6 years, 64.4% female, 51% married, and 54.2% had elementary school. Breast (29.2%) and gastrointestinal (28.9%) cancers were the most frequent. Almost half of patients (44.7%) reported a moderate and severe distress, and 21.7% showed symptoms of anxiety and 16.6% of depression. The correlation was significant among these psychosocial symptoms (ps<0.001), with higher scores of distress associated with a worse quality of life, with consequent negative impact on the physical, social/family, emotional and functional well-being (ps<0.001). In addition, young age, fear, worry, fatigue, pain, sleep, anxiety and depression were factors associated with a greater psychological risk.

Conclusion: Patients with metastatic cancer reported numerous physical and psychological symptoms. This high prevalence significantly impacted on the quality of life of these patients, highlighting the importance of early insertion of CP. We noted that the cancer care need to consider the screening routine that helps the identification of symptoms, to adequate propose a treatment targeted to the patients needs, in order to anticipate and prevent the suffering of these patients.

Descritores:

Cuidados paliativos - Psico-oncologia - Distress - Qualidade de vida - Serviço publico

Keywords:

Palliative care - Psycho-oncology - Distress - Quality of life - Public service


Publication History

Received: 29 May 2017

Accepted: 21 August 2017

Article published online:
07 March 2025

© 2017. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Isadora Miranda de Azevedo, Carolina Gaue Zayat, Getúlio Yuzo Okuma, Edvane Birelo Lopes De Domenico, Cristiane Decat Bergerot. Sintomas biopsicossociais em pacientes com câncer incurável no Brasil. Brazilian Journal of Oncology 2017; 13: e-BJO20171345A92.
DOI: 10.26790/BJO20171345A92
 

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