Qualidade de vida de pacientes com câncer avançado na terapêutica paliativa e no cuidado paliativo

Silva, Leonel dos Santos

Resumo:

O objetivo desta pesquisa foi avaliar a qualidade de vida de pacientes adultos com câncer avançado em terapêutica paliativa ou cuidado paliativo. Pesquisa quantitativa, observacional, transversal e analítica, conduzida em hospital público universitário localizado na região sul do Brasil. A amostra não probabilística foi de 126 pacientes divididos em dois grupos, 107 em terapêutica paliativa e 19 no cuidado paliativo exclusivo. A coleta de dados ocorreu no período de janeiro a junho de 2018 em unidade ambulatorial e internamento, com dados sociodemográficos, clínicos, terapêuticos, espiritual/religioso, apoio social, sintomas e qualidade de vida.

Para as variáveis relacionadas à qualidade de vida e sintomas foram utilizados os questionários:

Quality o f Life Questionnaire-Core 15-Palliative, Functional Assessment o f Chronic Illness Therapy-Palliative Care 14 e Edmonton Symptom Assessment System, ambos traduzidos e validados no Brasil. A análise dos dados observou a orientação da European Organization for Research and Treatment o f Cancer e Functional Assessment o f Chronic Illness Terapy, associado aos cálculos de média, mínimo, máximo, desvio padrão e do coeficiente não paramétrico de Spearman. Os resultados mostraram que o perfil sociodemográfico é semelhante entre os grupos, houve predomínio de mulheres, idosas, casadas ou em união estável, com filhos, baixa escolaridade e renda entre 1 a 3 salários mínimos. No tangente à espiritualidade/religiosidade e suporte social no enfrentamento da doença, estratégias como: crença, prática, comunidade religiosa, cuidador familiar, apoio familiar, de amigos e profissionais de saúde, foram relevantes em ambos os grupos. Nas variáveis clínicas o destaque é para o câncer de mama com diagnóstico metastático. Quanto aos escores do Quality o f Life Questionnaire-Core 15-Palliative dos grupos em terapêutica paliativa e cuidado paliativo os resultados respectivamente foram: qualidade de vida global (71,54/59,65), função física (17,95/53,67; p=0,000), função emocional (28,83/43,87), náuseas/vômitos (73,84/38,58; p=0,005) e fadiga (63,45/48,25; p=0,021). Quando analisados os dados do Functional Assessment of Chronic Illness Therapy-Palliative Care 14, o grupo em terapêutica paliativa apresentou melhor QV (p= 0,002). Na avaliação dos sintomas utilizando a Edmonton Symptom Assessment System, os pacientes que estavam em cuidados paliativos tiveram moderada perda de apetite (5,95; p=0,004) e bem-estar comprometido (5,58 p=0,014), com indicativo de escore total (39,3; p=0,014) mais elevado quando comparado aos que estavam recebendo a terapêutica paliativa. Quando correlacionado à qualidade de vida global do Quality of Life Questionnaire-Core 15- Palliative com o escore total do Functional Assessment o f Chronic Illness Therapy- Palliative Care 14 (p=0,001) e a Edmonton Symptom Assessment System (p=0,001) confirma a diferença significativa de melhor qualidade de vida na terapêutica paliativa. Esses resultados expressam o comprometimento em diferentes domínios na qualidade de vida dos pacientes nos grupos terapêutica paliativa ou cuidado paliativo, além da variabilidade de sintomas físicos. O conhecimento destes dados auxilia os profissionais para realização de intervenções com enfoque transdisciplinar para o paciente e sua família.

Abstract:

The purpose of this research was to evaluate the quality of life of adult patients with advanced cancer in palliative therapy care or palliative care. Quantitative, observational, transversal and analytical research conducted in a university public hospital located in the southern region of Brazil. The non-probabilistic sample consisted of 126 patients divided into two groups, 107 in palliative therapy care and 19 exclusive palliative care. Data were collected from January to June 2018 in outpatient and inpatient units, with sociodemographic, clinical, therapeutic, religious/spiritual, social support, symptoms and quality of life data. For the variables related to quality of life and symptoms, the following questionnaires were used: Quality of Life Questionnaire-Core 15-Palliative, Functional Assessment o f Chronic Illness Therapy- Palliative Care 14 and Edmonton Symptom Assessment System, both translated and validated in Brazil. The analysis of the data observed the orientation of the European Organization for Research and Treatment o f Cancer and Functional Assessment of Chronic Illness Therapy, associated with the mean, minimum, maximum, standard deviation calculations and nonparametric Spearman coefficients. The results showed that the socio-demographic profile is similar among the groups, there was a predominance of elderly, married or in stable union women, with children, low education and income between 1 and 3 minimum wages. Regarding the spirituality/religiosity and social support in coping with the disease, strategies such as: belief, practice, religious community, family caregiver, family support, of friends and health professionals, were relevant in both groups. In the clinical variables the highlight is for breast cancer with metastatic diagnosis. Regarding the Quality o f Life Questionnaire-Core 15-Palliative scores of the groups in palliative therapy and palliative care the results respectively were: overall quality of life (71.54/59.65), physical function (17.95/53.67; p=0.000), emotional function (28.83/43.87), nausea/vomiting (73.84/38.58; p=0.005) and fatigue (63.45/48.25; p=0.021). When the data from the Functional Assessment o f Chronic Illness Therapy-Palliative Care 14 report were analyzed, the group on palliative therapy presented better QV (p= 0.002). In the evaluation of symptoms using the Edmonton Symptom Assessment System, patients who were in palliative care had moderate loss of appetite (5.95; p=0.004) and compromised well-being (5.58 p=0.014), with indicative of total score (39.3; p=0.014) higher when compared to those receiving palliative therapy. When related to the global quality of life of the Quality o f Life Questionnaire-Core 15-Palliative with total score of Functional Assessment o f Chronic Illness Therapy-Palliative Care 14 (p=0.001) and Edmonton Symptom Assessment System (p=0.001) confirms significant difference in the better quality of life in palliative therapy. These results express the commitment in different domains in the patients' quality of life in the palliative therapy or palliative care groups, in addition to the variability of physical symptoms. The knowledge of these data helps the professionals to carry out interventions with a transdisciplinary approach for the patient and his family.