Fabiana Paula de Andrade

Immediate Impact of Primary Surgery on Health-Related Quality of Life of Hospitalized Patients With Oral and Oropharyngeal Cancer

PURPOSE Oral and oropharyngeal tumor resection may be associated with disfigurement and dysfunctions that affect essential domains of life. This study aimed at assessing the immediate impact of primary surgery on the health-related quality of life for these patients. PATIENTS AND METHODS Forty-seven patients with squamous cell carcinoma of the lips, oral cavity, or oropharynx, and undergoing treatment in the head and neck surgery center of a large general hospital in the city of São Paulo, Brazil, from October 2005 to September 2006, completed the University of Washington Quality of Life questionnaire pre- and postoperatively (before hospital discharge). A paired t test evaluated differences between assessments; Poisson regression estimated ratios of ratings attributed to each domain (pain, appearance, activity, recreation, swallowing, chewing, speech, shoulder pain, taste, saliva, mood, and anxiety) per patient stratified by sociodemographic, clinical, and behavioral characteristics. RESULTS The immediate impact of surgery on health-related quality of life corresponded to a 31.1% reduction in the overall rating. The most affected domains were chewing (-73.5%), taste (-61.4%), swallowing (-57.3%), speech (-46.0%), and pain (-42.3%). Anxiety (+65.5%) was the sole domain that improved immediately after surgery. Comparisons involving subgroups of patients indicated that different clinical conditions (regional metastasis, tumor size, and location) were not associated with discrepant health-related quality of life immediately after surgery. CONCLUSIONS The routine pre- and postoperative assessment of health-related quality of life may contribute to evaluate treatment effectiveness, which would otherwise rely exclusively on assessing end-point results such as survival and tumor relapse. This information is relevant to attenuate the prejudicial impact of surgery on the physical and psychosocial functioning of patients.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection.

Objective This study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma. Material and Methods Forty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings. Results 1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95% confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95%CI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7). Conclusions The prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.

Validade discriminante do questionário de qualidade de vida da Universidade de Washington no contexto brasileiro

OBJETIVO: Avaliar a validade discriminante do questionario de qualidade de vida da Universidade de Washington para pacientes com câncer de cabeca e pescoco e identificar possiveis fatores sociodemograficos que modifiquem seus resultados. METODOS: Foram entrevistados 47 pacientes com câncer de boca e orofaringe em estagio pre-cirurgico em um hospital no sul do municipio de Sao Paulo em 2007, e 141 pacientes sem câncer, pareados por sexo e idade em uma proporcao de tres para um, que foram atendidos em ambulatorios do mesmo hospital em 2008. Os resultados obtidos para os dois grupos foram comparados pelo teste t de Student. Para os pacientes sem câncer utilizou-se analise de regressao de Poisson para avaliar possiveis fatores de modificacao da qualidade de vida. RESULTADOS: O escore geral de qualidade de vida foi significantemente mais elevado (p < 0,001) para os pacientes sem câncer (91,1) do que para os pacientes com câncer (80,6). Observacoes analogas foram efetuadas para oito dos doze dominios de qualidade de vida compreendidos no questionario (dor, aparencia, degluticao, mastigacao, fala, ombros, paladar e ansiedade). Como possiveis fatores de modificacao dos escores de qualidade de vida foram identificados renda familiar (com impacto nos dominios de recreacao, p = 0,017, e funcao dos ombros, p = 0,049), escolaridade (em ansiedade, p = 0,003), sexo (em funcao dos ombros, p = 0,038) e dor de dente (em mastigacao, p = 0,015). CONCLUSOES: O questionario tem validade discriminante, pois seus escores sao especificamente mais afetados para pacientes com câncer. Reforca-se a indicacao do questionario para monitorar o tratamento e recomenda-se avaliar os fatores que podem causar impacto nesses indicadores.

Consumo de alimentos de origem animal e câncer de boca e orofaringe

OBJETIVO: Avaliar a relacao entre alimentos de origem animal e câncer de boca e orofaringe. METODOS: Estudo caso-controle, de base hospitalar, pareado por sexo e idade (± 5 anos) com a coleta de dados realizada entre julho de 2006 e junho de 2008. A amostra foi composta por 296 pacientes com câncer de boca e orofaringe e 296 pacientes sem historico de câncer atendidos em quatro hospitais da cidade de Sao Paulo (SP), Brasil. Foi aplicado um questionario semiestruturado, para a coleta de dados relativos a condicao socioeconomica e aos habitos deleterios (tabaco e bebidas alcoolicas). Para avaliacao do consumo alimentar, utilizou-se um questionario de frequencia alimentar qualitativo. A analise se deu por meio de modelos de regressao logistica multivariada, que consideraram a hierarquia existente entre as caracteristicas estudadas. RESULTADOS: Entre os alimentos de origem animal, o consumo frequente de carne bovina (OR = 2,73; IC95% = 1,27-5,87; P < 0,001), bacon (OR = 2,48; IC95% = 1,30-4,74; P < 0,001) e ovos (OR = 3,04; IC95% = 1,51-6,15; P < 0,001) estava relacionado ao aumento no risco de câncer de boca e orofaringe, tanto na analise univariada quanto na multivariada. Entre os laticinios, o leite apresentou efeito protetor contra a doenca (OR = 0,41; IC95% = 0,21-0,82; P < 0,001). CONCLUSOES: O presente estudo sustenta a hipotese de que alimentos de origem animal podem estar relacionados a etiologia do câncer de boca e orofaringe. Essa informacao pode orientar politicas preventivas contra a doenca, gerando beneficios para a saude publica.