Calidad de vida en mujeres con cáncer de mama

Abstract

Objectives: To determine characteristics of women diagnosed with breast cancer during the study period, the quality of life and state-trait anxiety at the time of diagnosis and after completion of treatments for breast cancer. Determine the variables associated to quality of life and anxiety at baseline. Material and Methods: Prospective observational follow-up study. Incidental cases of breast cancer diagnosed in the health area of A Coruña were included (period: 2013-2015; n=339; security=95%; accuracy=±5,32%). Descriptive and multivariate analysis to identify variables associated with quality of life and state-trait anxiety at baseline. Authorized by the CAEI Galicia (code 2013/253). Results: The average age is 59 years, 51% are living in A Coruña council, 64,9% are married women and 62,2% of them have basic studies 62,2%. Most common location is in the upper outer quadrant (40,7%). Most common histological type is invasive ductal cancer (76,9%). Most patients are diagnosed by screening (41,9%) and the most frequent first symptom is palpable mass (43,4%). High scores are achieved in most items of quality of life (>80/100), except for Global Health Status (66,7/100), emotional functioning (61,72/100), sexual enjoyment (54,6/100) and future perspectives (44,95/100). The most disturbing symptoms of quality of life include insomnia, fatigue and upset by hair loss. Quality of life at baseline is associated with level of education, the higher level of education increased quality of life (OR=0,48); comorbidity, the greater previous comorbidity decreases quality of life (OR=2,07); women taking anxiolytic drugs reported poorer quality of life (OR=1,61); having been pregnant previously is associated with worse quality of life (OR=1,99) and the presence of nipple-areola complex is also associated with a poorer quality of life (OR=4,5). By the end of breast cancer treatments, they have significantly improved emotional functioning and future perspectives and have worsened physical functioning and role functioning, body image, financial difficulties, and symptoms like fatigue, pain, dyspnoea, breast symptoms, arm symptoms and systemic therapy side effects. At the time of diagnosis, almost half of women have severe levels of state anxiety and nearly 20% severe levels of trait anxiety. At baseline, severe levels of state anxiety are associated with marital status and anxiolytic drugs, reporting worst state anxiety levels married women (OR=2,28) and women taking anxiolytic drugs (OR=2,13). Trait anxiety is associated with employment status, anxiolytic drugs, breast swelling and stage at diagnosis, presenting higher levels of trait anxiety women who are unemployed (inactive OR=3,79 or housewives Calidad de vida en mujeres con cáncer de mama 18 OR=4,12), those taking anxiolytic drugs, women with breast swelling (OR=5,32) and those found in stage III and IV (OR=2,6). At the end of treatments for breast cancer severe levels of state anxiety have been reduced from almost 50% to less than 20%. No significant differences were found in the variation of trait anxiety levels. Conclusions: Socials, psychological and physical factors are determinants of overall quality of life and anxiety in women diagnosed with breast cancer in Spain. The final regression model suggests that the strongest predictors of quality of life are the level of education, comorbidity, anxiolytic drugs, having had previous pregnancies and retraction of the nippleareola complex. The most important predictors for anxiety are marital status, employment status, anxiolytic drugs, breast swelling and stage at diagnosis.