Cirurgia oncoplástica e reconstrução mamária imediata em pacientes com câncer de mama: avaliação da satisfação e qualidade de vida de pacientes operadas em um serviço de mastologia do Distrito Federal

Abstract

Introduction: Breast cancer is an important public health problem, being the second most common type of cancer in the world and the most common among women. High mortality indicators and the psychological impact caused by changes in body image make it a disease feared by women. Advances in surgical treatment made it possible to associate oncological treatment with good aesthetic results, positively impacting the quality of life of these patients. Objective: To evaluate the satisfaction and the quality of life of the patients submitted to the surgical treatment of breast cancer through the oncoplastic and reconstructive surgery of the breast. Products: This masters dissertation consisted of two scientific articles: 1) original article "Oncoplastic surgery and immediate breast reconstruction in patients with breast cancer: evaluation of the satisfaction and quality of life of patients submitted to surgical interventions in mastology service of the Federal District ". This article was submitted to JAMA on April 11, 2018; 2) Systematic review article with meta-analysis entitled "Satisfaction with breast reconstruction in women with cancer: systematic review with meta-analysis". It was decided to carry out the systematic review due to the scarcity of review studies about the subject until the present moment, which can corroborate for the decision making on the therapy of breast cancer. Methods: 1) Original article: this is a cross-sectional study with women attended at the mastology service of a reference hospital in the Federal District and submitted to the surgical treatment of breast cancer from December 2016 to May 2017. Satisfaction with surgical outcome and quality of life were assessed through the postoperative breast reconstruction module of BREAST-Q. 2) Systematic review: The search of the studies was carried out in the main databases (Medline, Embase, Scopus, Lilacs, Scielo, Web of Science and science direct) as well as in the reference lists of the selected articles. Cohort, case-control, and randomized clinical trials that investigated improvement in quality of life and patient satisfaction after immediate breast reconstruction in women treated with breast cancer were included in the review. There was no limitation on the language or date of publication. The selection of articles and data extraction were performed by two reviewers independently. Meta-analyzes with random effects and sensitivity analyzes were performed. Results: 1) Original article: The overall mean score in BREAST-Q was higher than 54.2 for satisfaction and quality of life indicators. It was observed that for each year of age there was an increase of 0.15 in the sexual well-being score (p <0.02), 0.83 points in the satisfaction score with the medical team (p <0.02) and 0.23 points in the satisfaction score with the care received (p <0.04). 2) Systematic review and meta-analysis: We included 77 studies that met the criteria for eligibility of the review and published until 2017. The meta-analysis showed that the domains satisfaction with the breasts, psychological and sexual presented a higher average in the group of women who underwent breast reconstruction. Conclusion: Studies indicate that breast reconstruction immediate can improve the satisfaction and quality of life of women with cancer who underwent surgical treatment. Still, it is necessary to carry out more robust studies to qualify the scientific evidence on the subject.