Indicadores psicossociais da qualidade de vida no cancro de colo do útero

Abstract

O cancro de colo do útero (CCU) é a quarta patologia oncológica mais comum na mulher portuguesa, com uma incidência de 14.8 por cada 100 mil habitantes, acima da taxa europeia, 13.6/100 000 representando cerca de 33% das mortes anuais por cancro. Este é um tipo de cancro que atinge mulheres muito jovens, 1/3 dos diagnósticos ocorrerem em mulheres com idades abaixo dos 45 anos. Sendo uma patologia de elevada prevalência justifica-se o estudo dos fenómenos físicos, psicológicos e sociais associados de modo a promover um melhor ajustamento à doença. Foi nosso objetivo obter um maior conhecimento sobre esta população, explorar e identificar os fatores que contribuem para a qualidade de vida e ajustamento à doença. A amostra foi constituída por 140 mulheres com idades compreendidas entre os 23 e os 79 anos, com escolaridade média e maioritariamente residentes em meio urbano. Em termos clínicos, a maioria foi diagnosticada em idade fértil nos estádios iniciais do cancro de colo do útero, as mulheres encontram-se em follow-up, na Consulta de Ginecologia do Instituto Português de Oncologia de Lisboa. Os estudos apresentados permitiram-nos determinar quais as variáveis preditoras, mediadoras e moderadoras na qualidade de vida das doentes. Assim, os estudos 1 e 3 enfatizaram a importância da morbilidade psicológica, suporte social e imagem corporal na qualidade de vida, em mulheres sobreviventes de CCU. Por sua vez, os estudos 2 e 4 permitem-nos concluir que as relações diádicas são críticas quer para a satisfação sexual quer para a qualidade de vida. Do ponto de vista das políticas de saúde será importante averiguar o que pode ser implementado para minimizar o impacto financeiro do CCU, uma vez que as questões financeiras podem condicionar os próprios cuidados de saúde ou mesmo a adesão às recomendações médicas. Do ponto de vista psicológico, os programas de suporte e intervenção psicológica com o objetivo de promover a qualidade de vida devem focar-se na redução da morbilidade psicológica, no aumento do suporte social e, em particular, na imagem corporal e estilos de vinculação. Além disso, os resultados revelaram a importâncias das variáveis conjugais indicando a importância de tratar estas mulheres, no contexto da diada.

Cervical cancer (CC) is the fourth most common cancer pathology among Portuguese women, with an incidence of 14.8 per 100,000 inhabitants, above the European rate, 13.6 / 100 000 representing about 33% of annual cancer deaths. This is a type of cancer that affects very young women, one third of diagnoses occur in women under the age of 45 years. Being a condition of high prevalence it is justified the study of physical, psychological and social phenomena associated to the promotion of a better adjustment to the disease. This study is aimed to describe the psychosocial effects of the diagnosis of cervical cancer. It was our goal to get a better understanding of this population, explore and identify the factors that contribute to the quality of life and adjustment to illness. It was intended therefore, in addition to a socio-demographic and clinical description, describe and assess sexual satisfaction, physical and psychological morbidity, emotional expression, marital adjustment, attachment, social support, spirituality and quality of life of patients undergoing various therapeutic modalities for the treatment of cervical cancer. The sample of 140 women aged between 23 and 79 years, with an average education and mainly living in an urban environment. Clinically, most were diagnosed in childbearing age in the early stages of cervical cancer, women are in follow-up in Gynecology Consultation of the Portuguese Institute of Oncology of Lisbon, the elapsed time since the end of the treatment is on average higher than 18 months, 68% of patients underwent surgery, and in 23.6% the surgical treatment was combined with radiotherapy or chemoradiotherapy. When comparing the results with the European reference data, we have disclosed that, with the exception of cognitive functioning scale, there are no differences between the two groups. However, symptoms such as neuropathy and breathlessness show statistically significant differences (more neuropathy complaints and fewer complaints of breathlessness in this study). An important point regards the economic impact that the disease has on the lives of these women, being significantly higher in the present study. The presented studies have allowed us to determine which are the predictor mediating and moderating variables, in the quality of live of the patients. Thus, Study 1 focused on the predictors of the quality of life, having anxiety and social support emerged as important predictors. Study 2 intended to find an adjusted model to allow to know the role of the predictor and mediator of different variables in the quality of life of women, having shown that marital adjustment and anxiety are important mediators. Without visible changes in the body image, we assess to what extent the changes caused by the treatments had impact on women and, thus, Study 3 focused on moderating role of body image, factor that has demonstrated being a moderator in relation to the experience of symptoms / depression and quality of life. Being sexuality such an important area in these women, it was also possible to establish an explanatory model of sexual satisfaction. Thus, Study 4 sought to find an adjusted model to the data that revealed the role of attachment styles as a predictor variable as well as the mediating role of marital adjustment in sexual satisfaction. In short, studies 2 and 4 allow us to conclude that the dyadic relationships are critical both for sexual satisfaction and for the quality of life. On the other hand, studies 1 and 3 emphasize the importance of psychological morbidity, social support and body image in the quality of life in women survivors of cervical cancer. From the point of view of health policies it will be important to find out what can be done to minimize the financial impact of the cervical cancer, since financial issues can condition their own health care or even the adherence to medical recommendations. From a psychological point of view, support programs and psychological intervention in order to promote quality of life, should focus on reducing psychological morbidity, increasing social support and, in particular, on body image and attachment styles. In addition, the results have disclosed the importance of marital variables indicating the importance of treating these women, in the context of dyad.