Qualidade de vida, dependência funcional e estratégias de coping em pacientes oncológicos
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Data
2020-08-20
Autores
Camargo, Heloiza Thaís Felippe de
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Universidade Estadual Paulista (Unesp)
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Introdução: A percepção de qualidade de vida é considerada uma medida crítica em oncologia, uma vez que tanto o câncer quanto seu tratamento podem interferir negativamente na percepção do constructo, que pode ser influenciada pela funcionalidade e estratégias de coping. Objetivos: Comparar a qualidade de vida, as estratégias de coping e a funcionalidade em pacientes oncológicos em cuidados paliativos, sem evidência de doença e em tratamento modificador. E, mais especificamente, avaliar se a percepção de qualidade de vida se correlaciona às estratégias de enfrentamento e à funcionalidade, e identificar as variáveis clínicas e sociodemográficas relacionadas à qualidade de vida, ao coping e à funcionalidade dos participantes do estudo. Método: Estudo transversal realizado com pacientes oncológicos atendidos no Ambulatório de Oncologia, Hematologia e de Cuidados Paliativos do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Os pacientes foram divididos em três grupos: Grupo A - pacientes em cuidados paliativos; Grupo B - pacientes em fase pós-tratamento e sem sinais de neoplasia em atividade; Grupo C - pacientes em tratamento modificador de doença com quimioterapia e/ou hormonioterapia e/ou radioterapia. Foi utilizado formulário de dados sociodemográficos e clínicos, Escala de Performance Paliativa, o McGill Quality of Life Questionnaire e, por fim, o Inventário de Estratégias de Coping. Resultados: Foram entrevistados 300 participantes, idade média de 60,4 anos (±14,5), maioria do sexo feminino 51,3% (154), com companheiro 68% (204), católicos 62% (186), com nível fundamental ou analfabeto 61% (183). Em relação à qualidade de vida foi relativamente boa (mediana 8,0; p25=7,0-p75=9,0), porém o domínio psicológico foi o mais acometido pelos pacientes em cuidados paliativos (p<0,001), seguido do domínio físico (p<0,001). Qualidade de vida correlacionou-se positivamente com grupo B (p<0,001), C (p<0,001), nível de instrução (p<0,001), funcionalidade (p<0,001) e os fatores resolução de problemas (p<0,001), reavaliação positiva (p<0,001), afastamento e suporte social (p<0,005). No que se refere à performance paliativa predominaram pacientes estáveis (81,7%), em menor proporção no grupo A (p<0,001). Funcionalidade correlacionou-se positivamente com QV (p<0,001) e os fatores resolução de problemas (p<0,001), reavaliação positiva (p<0,001) e suporte social (p<0,005). As estratégias de coping foram pouco utilizadas (mediana total=1,4; p25=1-p75=1,95) e o fator resolução de problemas foi o fator mais utilizado pelos participantes do grupo C (p=0,006). Conclusão: Os resultados deste estudo indicam que a qualidade de vida dos participantes foi relativamente boa, porém os domínios sintomas físicos e bem-estar psicológico foram os mais comprometidos no grupo de pacientes em cuidados paliativos. Quando correlacionada às variáveis sociodemográficas e clínicas pacientes do grupo B, C, com maior funcionalidade, renda e nível de instrução tiveram melhor percepção deste constructo. Associou-se positivamente às estratégias de enfretamento resolução de problemas, reavaliação positiva, afastamento e superação. Em relação à funcionalidade prevaleceram pacientes estáveis, em menor proporção no grupo A, evidenciando o pior prognóstico e funcionalidade. Pacientes com maior escore de funcionalidade tiveram melhor qualidade de vida e utilizaram as estratégias de enfrentamento focadas na emoção e no problema. A utilização de estratégias de coping pelos participantes foi baixa e o fator suporte social foi o mais utilizado pelos participantes do estudo. Nos três grupos houve predomínio de modos de enfrentamento focados na emoção e nos problemas. Quando associada às variáveis do estudo indivíduos do sexo masculino utilizaram a estratégia aceitação de responsabilidade. Para as demais variáveis, tempo de diagnóstico, idade, renda e nível de instrução os enfrentamentos foram focados na emoção e nos problemas.
Introduction: The perception of quality of life is considered a critical measure in oncology, since both cancer and its treatment can negatively interfere with the perception of the construct, which can be influenced by the functionality and coping strategies. Objectives: To compare quality of life, coping strategies and functionality in cancer patients in palliative care, without evidence of disease and undergoing modifying treatment. And, more specifically, to assess whether the perception of quality of life correlates with coping strategies and functionality, and to identify the clinical and social demographic variables related to quality of life, coping and the functionality of the study participants. Method: Cross-sectional study carried out with oncology patients, hematology and palliative care outpatient clinics at the Hospital das Clínicas da Faculdade de Medicina de Botucatu. The patients were divided into three groups: Group A - patients on palliative care; Group B - patients in the post-treatment phase and without signs of active cancer; Group C - patients undergoing disease-modifying treatment with chemotherapy and/or hormone therapy and/or radiation therapy. We used a social demographic and clinical data form, Palliative Performance Scale, the McGill Quality of Life Questionnaire and, finally, the Coping Strategies Inventory. Results: 300 participants were interviewed, with an average age of 60.4 years (± 14.5), most women 51.3% (154), with a partner 68% (204), Catholics 62% (186), with primary or illiterate 61% (183). Regarding quality of life, it was relatively good (median 8.0; p25 = 7.0-p75 = 9.0), but the psychological domain was the most affected by patients in palliative care (p <0.001), followed by the physical domain (p <0.001). Quality of life was positively correlated with group B (p <0.001), C (p <0.001), education level (p <0.001), functionality (p <0.001) and problem solving factors (p <0.001), positive reassessment (p <0.001), removal and social support (p <0.005). Regarding palliative performance, stable patients predominated (81.7%), to a lesser extent in group A (p <0.001). Functionality was positively correlated with quality of life (p <0.001) and the factors problem solving (p <0.001), positive reassessment (p <0.001) and social support (p <0.005). Coping strategies were rarely used (total median = 1.4; p25 = 1-p75 = 1.95) and the problem solving factor was the factor most used by group C participants (p = 0.006). Conclusion: The study results indicate that the quality of life of the participants was relatively good, however the domains physical symptoms and psychological well-being were the most compromised in the group of patients in palliative care. When correlated with social demographic and clinical variables, patients in group B, C, with greater functionality, money income and level of education had a better perception of this construct. It was positively associated with coping strategies, problem solving, positive reassessment, clearence and overcoming. Regarding functionality, stable patients prevailed, to a lesser extent in group A, showing the worst prognosis and functionality. Patients with a higher functionality score had better quality of life and used coping strategies focused on emotion and the problem. The use of coping strategies by the participants was low and the social support factor was the most used by the study participants. In the three groups, there was a predominance of coping modes focused on emotion and problems. When associated with the study variables, male individuals used the responsibility acceptance strategy. For the other variables, time of diagnosis, age, money income and level of education, the confrontations were focused on emotion and problems.
Introduction: The perception of quality of life is considered a critical measure in oncology, since both cancer and its treatment can negatively interfere with the perception of the construct, which can be influenced by the functionality and coping strategies. Objectives: To compare quality of life, coping strategies and functionality in cancer patients in palliative care, without evidence of disease and undergoing modifying treatment. And, more specifically, to assess whether the perception of quality of life correlates with coping strategies and functionality, and to identify the clinical and social demographic variables related to quality of life, coping and the functionality of the study participants. Method: Cross-sectional study carried out with oncology patients, hematology and palliative care outpatient clinics at the Hospital das Clínicas da Faculdade de Medicina de Botucatu. The patients were divided into three groups: Group A - patients on palliative care; Group B - patients in the post-treatment phase and without signs of active cancer; Group C - patients undergoing disease-modifying treatment with chemotherapy and/or hormone therapy and/or radiation therapy. We used a social demographic and clinical data form, Palliative Performance Scale, the McGill Quality of Life Questionnaire and, finally, the Coping Strategies Inventory. Results: 300 participants were interviewed, with an average age of 60.4 years (± 14.5), most women 51.3% (154), with a partner 68% (204), Catholics 62% (186), with primary or illiterate 61% (183). Regarding quality of life, it was relatively good (median 8.0; p25 = 7.0-p75 = 9.0), but the psychological domain was the most affected by patients in palliative care (p <0.001), followed by the physical domain (p <0.001). Quality of life was positively correlated with group B (p <0.001), C (p <0.001), education level (p <0.001), functionality (p <0.001) and problem solving factors (p <0.001), positive reassessment (p <0.001), removal and social support (p <0.005). Regarding palliative performance, stable patients predominated (81.7%), to a lesser extent in group A (p <0.001). Functionality was positively correlated with quality of life (p <0.001) and the factors problem solving (p <0.001), positive reassessment (p <0.001) and social support (p <0.005). Coping strategies were rarely used (total median = 1.4; p25 = 1-p75 = 1.95) and the problem solving factor was the factor most used by group C participants (p = 0.006). Conclusion: The study results indicate that the quality of life of the participants was relatively good, however the domains physical symptoms and psychological well-being were the most compromised in the group of patients in palliative care. When correlated with social demographic and clinical variables, patients in group B, C, with greater functionality, money income and level of education had a better perception of this construct. It was positively associated with coping strategies, problem solving, positive reassessment, clearence and overcoming. Regarding functionality, stable patients prevailed, to a lesser extent in group A, showing the worst prognosis and functionality. Patients with a higher functionality score had better quality of life and used coping strategies focused on emotion and the problem. The use of coping strategies by the participants was low and the social support factor was the most used by the study participants. In the three groups, there was a predominance of coping modes focused on emotion and problems. When associated with the study variables, male individuals used the responsibility acceptance strategy. For the other variables, time of diagnosis, age, money income and level of education, the confrontations were focused on emotion and problems.
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Palavras-chave
Oncologia, Cuidados paliativos, Qualidade de vida, Palliative care, Quality of life, Oncology