O câncer de colo do útero é o segundo tumor mais frequente entre as mulheres brasileiras, os tratamentos disponíveis trazem complicações de curto a longo prazo e estudos que avaliam a qualidade de vida destas mulheres ainda são escassos no Brasil. Isto é justificado pela falta de instrumentos específicos e validados para esta finalidade em língua portuguesa (Brasil). Neste estudo objetivou-se testar as propriedades psicométricas dos questionários EORTC QLQ-CX24 e FACT-CX em uma amostra de mulheres brasileiras com câncer do colo do útero. O estudo é metodológico e foi realizado com 100 mulheres tratadas no Hospital de Câncer de Barretos, por meio de três avaliações (no início do estudo, 15 dias e 18 a 24 meses após o início). Foi testada a consistência interna (alfa de Cronbach), reprodutibilidade (coeficiente de correlação intraclasse), validade convergente (correlação com o questionário SF-36 e com o questionário EORTC QLQ-C30), a validade discriminante pelo estadiamento, tipo de tratamento e autoclassificação de saúde e a responsividade pelo método de distribuição dos dados, além da análise da facilidade de compreensão das questões e dos questionários. Confirmou-se a confiabilidade do questionário EORTC QLQ-CX24, a reprodutibilidade foi baixa nas escalas de preocupação sexual, atividade sexual e prazer sexual, bons resultados observou-se ao avaliar a validade convergente e discriminante. A análise da responsividade não confirmou todas as hipóteses. Ao avaliar o questionário FACT-CX, por meio da consistência interna, exceto pela escala de bem-estar emocional, as demais apresentaram valores de Alpha de Cronbach superiores a 0,70. A reprodutibilidade foi satisfatória nas cinco escalas que compõem o FACT- CX. Na análise da validade convergente, somente as escalas de bem-estar físico e bem-estar emocional mostrou boa correlação com as escalas do SF-36. Em geral, o questionário revelou boa validade discriminante, principalmente em relação a autoclassificação da saúde. Resultado satisfatório encontrou-se na análise da responsividade. Em geral observou-se um bom grau de entendimento das questões e dos questionário. Concluindo os questionários desenvolvidos para medir a QVRS em mulheres com câncer de colo do útero EORTC QLQ-CX24 e FACT-CX obtiveram resultados aceitáveis recomendando-se que outros estudos testem a responsividade por outros métodos / Cervical cancer is the second most common tumor among Brazilian women. Available treatments bring short and long-term complications, and studies assessing the quality of life of these women are still rare in Brazil. Such situation is warranted by the lack of specific and validated tools in (Brazilian) Portuguese for such a purpose. The goal of this study was to test the psychometric properties of EORTC QLQ-CX24 and FACT-CX questionnaires in a sample of Brazilian women affected by cervical cancer. This is a methodological study and it was conducted on 100 women treated at the Barretos Cancer Hospital by way of three assessments (at baseline, 15 days and 18 to 24 months after the onset). We tested the internal consistency (Cronbach\'s alpha), reproducibility (intraclass correlation coefficient), convergent validity (correlation with the SF-36 questionnaire and the EORTC QLQ-C30 questionnaire), the discriminant validity by way of staging, type of treatment and health self-classification and responsiveness by the method of data distribution, as well as the analysis of how easy it was their understanding of questions and questionnaires. The reliability of the EORTC QLQ-CX24 questionnaire was confirmed, reproducibility was low in the scales of sexual worry, sexual activity and sexual enjoyment, and good results were observed when evaluating the convergent and discriminant validity. The analysis of responsiveness did not confirm all hypotheses. Upon evaluation of the FACT-CX questionnaire through internal consistency, except for the scale of emotional well-being, the others showed Cronbach\'s alpha values above 0.70. Reproducibility was satisfactory in the five scales comprising FACT-CX. In convergent validity analysis, only the scales of physical well-being and emotional well-being showed good correlation with the scales of the SF-36. In general, the questionnaire demonstrated good discriminant validity, especially in relation to the self-ratings of health. Satisfactory result was found in the analysis of responsiveness. In general there was a good degree of understanding of questions and questionnaires. In conclusion, questionnaires developed to measure HRQOL in women with cervical cancer such as EORTC QLQ-CX24 and FACT-CX achieved acceptable results, and we do recommended that further studies are performed to assess responsiveness by other methods

In den letzten Jahren wurde die Sentinel Node Biopsie in Studien zur Diagnostik und Behandlung des N0-Halses als Stagingverfahren untersucht. Ziel der vorliegenden Studie war der Vergleich der postoperativen Lebensqualität und des funktionellen Status bei Patienten mit oralen und oropharyngealen Karzinomen, die sich einer Sentinelbiopsie, bzw. einer selektiven Neck Dissection bei N0-Hals unterzogen haben. 57 Patienten mit primär operativ behandeltem Karzinom wurden im Rahmen der Studie untersucht, 29 nach Sentinel Node Biopsie und 28 nach selektiver Neck Dissection. Es wurde die postoperative gesundheitsbezogene (EORTC QLQ-C30) und krankheitsspezifische Lebensqualität (EORTC QLQ-H&N35) erfasst. Patientenbezogene psychosoziale Variablen wurden anhand der „Hospital Anxiety and Depression Scale“ (HADS) und der Kurzform des „Progredienzangst-Fragebogens“ (PA-F-KF) ermittelt. Die Erhebung des klinischen Gesundheitszustandes erfolgte unter besonderer Berücksichtigung des funktionellen Status nach zervikaler Lymphknotendissektion. Bezüglich der gesundheitsbezogenen Lebensqualität sowie der Angst und Depression existierten keine signifikanten Unterschiede. Hinsichtlich der krankheitsspezifischen Lebensqualität zeigte sich, dass die Patienten nach Sentinel Node Biopsie weniger Schluckbeschwerden angaben (p=0,037). Ebenso zeigte sich bei der klinischen Untersuchung eine geringere Beeinträchtigung durch die zervikalen Narben. Die Sentinel Node Biopsie bietet, neben dem geringeren operativen Aufwand, der schnelleren Rekonvaleszenz und der geringeren funktionellen Minderung der Patienten, eine tendenzielle Verbesserung der krankheitsspezifischen Lebensqualität. Als Grund für die subjektiv weniger beeinträchtigte Schluckfunktion kann die fehlende Präparation der suprahyoidalen Muskulatur und der entsprechend innervierenden Nerven in Erwägung gezogen werden.

O câncer de colo do útero é o segundo tumor mais frequente entre as mulheres brasileiras, os tratamentos disponíveis trazem complicações de curto a longo prazo e estudos que avaliam a qualidade de vida destas mulheres ainda são escassos no Brasil. Isto é justificado pela falta de instrumentos específicos e validados para esta finalidade em língua portuguesa (Brasil). Neste estudo objetivou-se testar as propriedades psicométricas dos questionários EORTC QLQ-CX24 e FACT-CX em uma amostra de mulheres brasileiras com câncer do colo do útero. O estudo é metodológico e foi realizado com 100 mulheres tratadas no Hospital de Câncer de Barretos, por meio de três avaliações (no início do estudo, 15 dias e 18 a 24 meses após o início). Foi testada a consistência interna (alfa de Cronbach), reprodutibilidade (coeficiente de correlação intraclasse), validade convergente (correlação com o questionário SF-36 e com o questionário EORTC QLQ-C30), a validade discriminante pelo estadiamento, tipo de tratamento e autoclassificação de saúde e a responsividade pelo método de distribuição dos dados, além da análise da facilidade de compreensão das questões e dos questionários. Confirmou-se a confiabilidade do questionário EORTC QLQ-CX24, a reprodutibilidade foi baixa nas escalas de preocupação sexual, atividade sexual e prazer sexual, bons resultados observou-se ao avaliar a validade convergente e discriminante. A análise da responsividade não confirmou todas as hipóteses. Ao avaliar o questionário FACT-CX, por meio da consistência interna, exceto pela escala de bem-estar emocional, as demais apresentaram valores de Alpha de Cronbach superiores a 0,70. A reprodutibilidade foi satisfatória nas cinco escalas que compõem o FACT- CX. Na análise da validade convergente, somente as escalas de bem-estar físico e bem-estar emocional mostrou boa correlação com as escalas do SF-36. Em geral, o questionário revelou boa validade discriminante, principalmente em relação a autoclassificação da saúde. Resultado satisfatório encontrou-se na análise da responsividade. Em geral observou-se um bom grau de entendimento das questões e dos questionário. Concluindo os questionários desenvolvidos para medir a QVRS em mulheres com câncer de colo do útero EORTC QLQ-CX24 e FACT-CX obtiveram resultados aceitáveis recomendando-se que outros estudos testem a responsividade por outros métodos / Cervical cancer is the second most common tumor among Brazilian women. Available treatments bring short and long-term complications, and studies assessing the quality of life of these women are still rare in Brazil. Such situation is warranted by the lack of specific and validated tools in (Brazilian) Portuguese for such a purpose. The goal of this study was to test the psychometric properties of EORTC QLQ-CX24 and FACT-CX questionnaires in a sample of Brazilian women affected by cervical cancer. This is a methodological study and it was conducted on 100 women treated at the Barretos Cancer Hospital by way of three assessments (at baseline, 15 days and 18 to 24 months after the onset). We tested the internal consistency (Cronbach\'s alpha), reproducibility (intraclass correlation coefficient), convergent validity (correlation with the SF-36 questionnaire and the EORTC QLQ-C30 questionnaire), the discriminant validity by way of staging, type of treatment and health self-classification and responsiveness by the method of data distribution, as well as the analysis of how easy it was their understanding of questions and questionnaires. The reliability of the EORTC QLQ-CX24 questionnaire was confirmed, reproducibility was low in the scales of sexual worry, sexual activity and sexual enjoyment, and good results were observed when evaluating the convergent and discriminant validity. The analysis of responsiveness did not confirm all hypotheses. Upon evaluation of the FACT-CX questionnaire through internal consistency, except for the scale of emotional well-being, the others showed Cronbach\'s alpha values above 0.70. Reproducibility was satisfactory in the five scales comprising FACT-CX. In convergent validity analysis, only the scales of physical well-being and emotional well-being showed good correlation with the scales of the SF-36. In general, the questionnaire demonstrated good discriminant validity, especially in relation to the self-ratings of health. Satisfactory result was found in the analysis of responsiveness. In general there was a good degree of understanding of questions and questionnaires. In conclusion, questionnaires developed to measure HRQOL in women with cervical cancer such as EORTC QLQ-CX24 and FACT-CX achieved acceptable results, and we do recommended that further studies are performed to assess responsiveness by other methods

Bakgrund: Cancer är en sjukdom som omfattar tumörsjukdomar med onaturlig och okontrollerad cellväxt. Sjukdomen drabbar tiotusentals personer i Sverige varje år. Hälsorelaterad livskvalitet är ett begrepp som använts för att beskriva individers uppfattning av sitt välmående i relation till sin hälsa. Livskvaliteten kan användas som ett verktyg för att förstå patientgruppen och de förändringar de genomgår i samband med sjukdomsprogression och behandling. Onkologisk rehabilitering erbjuds vissa patientgrupper. Syftet med rehabiliteringen är främst att genom patientundervisning och träning återge patienten kontroll över sitt liv. Syfte: Att undersöka hälsorelaterad livskvalitet över tid hos patienter som genomgått onkologisk rehabilitering. Metod: Studien har en prospektiv design. Samtliga patienter som remitterades till en onkologisk rehabiliteringsverksamhet i Sverige under ett år tillfrågades. För att utvärdera livskvaliteten användes enkäten EORTC QLQ-C30. Enkäten lämnades ut till patienterna vid baseline, efter tre och sex månader. Deskriptiv statistik. Resultat: Studiens resultat visar att livskvaliteten var låg och oförändrad vid de tre mätningarna. Deltagarnas uppvisar goda funktioner i samtliga mätningar, högst vid tre månader. Symtomen minskar överlag vid varje mätning. Kraftigast minskar sömnsvårigheterna. Slutsats: Sammanfattningsvis visar studien att livskvaliteten var opåverkad de sex första månaderna efter rehabiliteringen. Dock förbättrades deltagarnas sömn, vilket kan ses som en positiv effekt av rehabiliteringen. Viss skillnad mellan kön, cancerdiagnoser samt svenskfödda och utlandsfödda finns; men dessa kan även bero på skillnader inom normalpopulationen. Funktionsskalornas maxvärde efter tre månader kan visa på behov av uppföljande rehabilitering. Klinisk betydelse: Studiens resultat ska användas i ett kvalitetsgranskningsarbete. / Background: Cancer is a diagnosis which encompasses diseases with abnormal and uncontrolled cellular growth. Tens of thousands of people are affected by cancer every year in Sweden. Health-related quality of life (HRQoL) is a concept used to describe people’s perception of well-being in relation to their health. HRQoL can also be used as a tool to understand the patients and the changes they go through during progression of disease and treatment. Oncological rehabilitation is offered to some patient groups. The goal with the rehabilitation is to give the patients control back over their lives through education and training. Aim: To study the oncological rehabilitations effect on HRQoL over time. Method: All patients remitted to a certain rehabilitation facility in Sweden during one year were asked to participate. To evaluate the HRQoL the EORTC QLQ-C30 questionnaire was used. The questionnaire was sent out to the respondents at baseline and after three and six months. Descriptive statistics. Result: The results of the study showed that quality of life was low and unaffected at the three measurements. The functions reached their highest value after three months. The symptoms overall decreased at each measurement. The most positive change was seen with insomnia. Conclusion: In conclusion, the quality of life was unaffected during the first six months after the rehabilitation. The improvement of the participants’ insomnia might be a positive outcome of the rehabilitation. The results points to some differences between gender, cancerdiagnose and people born in Sweden or abroad; but these might as well depend on differences in the population. The functions higher value after three months might show a need for follow-up rehabilitation. Clinical implication: The result of the study is to be used in a quality audit.

In den letzten Jahren wurde die Sentinel Node Biopsie in Studien zur Diagnostik und Behandlung des N0-Halses als Stagingverfahren untersucht. Ziel der vorliegenden Studie war der Vergleich der postoperativen Lebensqualität und des funktionellen Status bei Patienten mit oralen und oropharyngealen Karzinomen, die sich einer Sentinelbiopsie, bzw. einer selektiven Neck Dissection bei N0-Hals unterzogen haben. 57 Patienten mit primär operativ behandeltem Karzinom wurden im Rahmen der Studie untersucht, 29 nach Sentinel Node Biopsie und 28 nach selektiver Neck Dissection. Es wurde die postoperative gesundheitsbezogene (EORTC QLQ-C30) und krankheitsspezifische Lebensqualität (EORTC QLQ-H&N35) erfasst. Patientenbezogene psychosoziale Variablen wurden anhand der „Hospital Anxiety and Depression Scale“ (HADS) und der Kurzform des „Progredienzangst-Fragebogens“ (PA-F-KF) ermittelt. Die Erhebung des klinischen Gesundheitszustandes erfolgte unter besonderer Berücksichtigung des funktionellen Status nach zervikaler Lymphknotendissektion. Bezüglich der gesundheitsbezogenen Lebensqualität sowie der Angst und Depression existierten keine signifikanten Unterschiede. Hinsichtlich der krankheitsspezifischen Lebensqualität zeigte sich, dass die Patienten nach Sentinel Node Biopsie weniger Schluckbeschwerden angaben (p=0,037). Ebenso zeigte sich bei der klinischen Untersuchung eine geringere Beeinträchtigung durch die zervikalen Narben. Die Sentinel Node Biopsie bietet, neben dem geringeren operativen Aufwand, der schnelleren Rekonvaleszenz und der geringeren funktionellen Minderung der Patienten, eine tendenzielle Verbesserung der krankheitsspezifischen Lebensqualität. Als Grund für die subjektiv weniger beeinträchtigte Schluckfunktion kann die fehlende Präparation der suprahyoidalen Muskulatur und der entsprechend innervierenden Nerven in Erwägung gezogen werden.

Die Anlage eines Hautstomas nach exenterativen Beckeneingriffen stellt für Betroffene einen drastischen Einschnitt in die körperliche Integrität dar. Vielfach führen ästhetische und funktionelle Bedenken dazu, dass wasserbezogene Angebote zur Rehabilitation nicht genutzt werden. Fragestellung: Ziel war es, im Rahmen des Pilotprojekts „UROAquaFIT“ die Möglichkeit einer wasserbezogenen Rehabilitationsmaßnahme für Patienten nach Zystektomie mit inkontinenter Harnableitung zu evaluieren. Methode: Im Rahmen des Pilotkurses „UROAquaFIT“ wurde Patienten nach radikaler Zystektomie mit inkontinenter Harnableitung die Möglichkeit einer wasserbezogenen Rehabilitationsmaßnahme angeboten. Aufgeteilt in Kleingruppen erfolgte ein Wassergymnastikkurs unter Anleitung einer Physiotherapeutin und einer Stomatherapeutin unter ärztlicher Aufsicht. Daten zur Lebensqualität und der persönlichen Beurteilung des Kurses mittels Fragebögen wurden vor Beginn und 6 Monate nach Kursende erhoben und qualitativ ausgewertet. Darüber hinaus erfolgte eine Literaturrecherche (MEDLINE) zum Thema Aquagymnastik in der Onkologie. Ergebnis und Diskussion: Das Kursangebot wurde von allen Teilnehmern als durchweg positiv und bereichernd empfunden. Wohlbefinden und Selbstwertgefühl der Probanden konnten gesteigert werden. Wassergymnastik unter gezielter physio- und stomatherapeutischer Anleitung kann somit eine höchst effektive Rehabilitationsmaßnahme für Patienten nach inkontinenter Harnableitung darstellen. Darüber hinaus stärkt sie die körperliche Integrität der Betroffenen und erweitert somit die Möglichkeiten der sozialen Reintegration. Diese Form der Therapie sollte als fester Baustein in der Rehabilitation nach exenterativen Beckeneingriffen mit Stomaanlage verankert werden.

PURPOSE: To compare the characteristics of cancer patients in Taiwan who use complementary and alternative medicine (CAM) to cancer patients who do not use CAM and determine the predictors of quality of life (QoL) among cancer patients who use CAM. PATIENTS AND METHODS: Face-to-face interviews were conducted with and 3 questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire, the Brief Fatigue Inventory, and the Pittsburgh Sleep Quality Index) were administered to 216 cancer patients being treated at the Nuclear Medicine Department in southern Taiwan. Chi-square testing for categorical variables and t-testing for continuous variables were conducted to determine the correlation between sociodemographic and clinical data and CAM use. Analysis of variance was performed to conduct within-group comparison of QoL scales and CAM use. Linear regression models were established to predict QoL score. RESULTS: A total of 216 cancer patients were interviewed. The prevalence of CAM use was found to be 69.4% (150 of 216 subjects). Among the CAM users, 91.6% had used traditional Chinese medicine (TCM), dietary supplementation (vitamin, herbal, mineral, glucosamine, mushroom, and/or fish oil supplementation), or detoxification therapy. A greater percentage (49.5%) of CAM users had breast cancer than any other type of cancer, and a very large percentage (74.7%) did not inform their primary caregiver of their CAM use, whereas 52.7% used CAM after initiation of diagnosis and 26.7% increased the original frequency of their CAM use during the course of their treatment. Overall QoL was not found to be significantly different between CAM users and nonusers. Predictors of poor QoL were female gender, breast or liver cancer patient, younger age, lower education, chemotherapy, increased frequency of CAM use, non-vitamin/TCM use, and having received CAM information from primary caregiver. The factors of CAM use, number of CAM modalities used, frequency of CAM use, duration of cancer diagnosis, mineral/algae supplementation, and detoxification therapy were not found to be significant in this population. CONCLUSION: Cancer patients in Taiwan have a high rate of CAM use but a low rate of disclosure of CAM use to their primary caregivers. Multiple factors appear to have a significant correlation with poor QoL. Clinical physicians should emphasize the QoL of cancer survivors, providing more accurate CAM information and endeavoring to address their unmet needs.

Introduction: Each year 1200-1300 patients are diagnosed with head neck cancer. Treatment that involves radiotherapy can cause severe side effects for example trismus that affects quality of life. Purpose: To study health-related quality of life in patients who have undergone radiation treatment for head and neck cancer and participated in a intervention group who received training intended to prevent trismus or in a control group who received standard treatment. Method: This is a prospective study in which data is collected from 66 patients participating in a randomized study aiming to evaluate a training program to prevent trismus. Thirty three participated in the intervention group and thirty three in the control group. Both patient groups assessed health related quality of life (HRQOL) with EORTC QLQ C30 and QLQ-H&N35, at start and end of the radiation treatment, and at 3 and 6-months after completing radiation treatment. Results: There is no difference between the intervention and control groups regarding symptoms, functional status and global health, except for intake of nutritional supplements.  For both groups almost all scales measuring HRQOL deteriorated under the radiation treatment. However, 3 and 6 months after end of radiotherapy HRQOL had improved and had returned to the baseline values. The only exceptions were dry mouth, sticky saliva, problems with social eating, senses and physical ability. Conclusion: Radiation therapy for head and neck cancer affects patients HRQOL both in the short and long term. Medical staff needs strategies to manage patients ' functional and symptomatic deterioration throughout the treatment period and try to prevent or relieve the symptoms that may still remain several months after radiotherapy.

Submitted by Sandra Mendonça (sandra.mendonca@unioeste.br) on 2019-03-11T13:44:56Z No. of bitstreams: 2 Cinthya_Raquel_2018.pdf: 1923643 bytes, checksum: aee0d6b6e9ac7931be835a7558cfe622 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2019-03-11T13:44:56Z (GMT). No. of bitstreams: 2 Cinthya_Raquel_2018.pdf: 1923643 bytes, checksum: aee0d6b6e9ac7931be835a7558cfe622 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-11-27 / Clinical management of cancer patients involves primarialy the recovering of their biological health. This process is accompained by a psycosocial context, since cancer patients undergoing treatment fight profound bad feelings as pain, suffering, mutilation, destruction and death. Therefore, it is necessary to profoundly understand this patient, especially regarding the caracteristics that contribute to the mainentance and improvement of their quality of life. In this context, few instruments have been associated to evaluate the quality of life of patients ongoing chemotherapy, as well as it is not clear which specific component of such instruments influence the global health status of such patients.In the present study, we evaluated the relationship between the functional capacity and quality of life of cancer patients submitted to chemotherapy in a public health hospital from Brazil. To reach this goal, we used the Karnofsky performance scale and the EORTC QLQ-30 questionnaire as predictors of global health in patients with cancer. A total of 101 patients were enrolled in the study, from June to December 2017. All data were categorized accordingly and analyzed in SPSS 22.0.0 software for possible association among parameters. Patients presented a mean age of 59,6±13 years, and were predominatly female. Breast cancer was the most common neoplasia (43.56%), and most of patients exhibited advanced disease (73%) and distant metastasis (66.33%) at diagnosis. The global health score evaluated by EORTC QLQ-30 was 67.5%, and about 63% of patients presented a Karnofsky status of 80%. The most positive influent factor on the functional capacity was the working function (R = 0.515, p<0.05). Further, emotional and social functions were strongly associated with the global health status of patients (R = 0,960, p<0,05). Our data showed that the Karnofsky performance scale is a great tool for evaluating the quality of life in cancer patients undergoing chemotherapy, which correlates positively with their global health scores and is affected by emotional and social functions of patients. / O manejo clínico de pacientes com câncer envolve primariamente a recuperação de sua saúde biológica. Esse processo é acompanhado por um contexto psicossocial, uma vez que os pacientes oncológicos em tratamento combatem sentimentos ruins como dor, sofrimento, mutilação, destruição e morte. Portanto, é necessário entender profundamente esse paciente, principalmente no que se refere às características que contribuem para a manutenção e melhora da qualidade de vida. Nesse contexto, poucos instrumentos têm sido associados para avaliar a qualidade de vida dos pacientes em tratamento quimioterápico, assim como não está claro qual componente específico de tais instrumentos influencia o estado global de saúde desses pacientes. No presente estudo, avaliamos relação entre a capacidade funcional e a qualidade de vida de pacientes com câncer submetidos à quimioterapia em um hospital público de saúde do Brasil. Para atingir esse objetivo, utilizamos a escala de desempenho de Karnofsky e o questionário EORTC QLQ-30 como preditores de saúde global em pacientes com câncer. Um total de 101 pacientes foram incluídos no estudo, de junho a dezembro de 2017. Todos os dados foram categorizados de acordo e analisados no software SPSS 22.0.0 para possível associação entre os parâmetros. Os pacientes apresentavam idade média de 59,6 ± 13 anos e eram predominantemente do sexo feminino. O câncer de mama foi a neoplasia mais comum (43,56%) e a maioria dos pacientes apresentou doença avançada (73%) e metástase à distância (66,33%) ao diagnóstico. O escore global de saúde avaliado pelo EORTC QLQ-30 foi de 67,5% e cerca de 63% dos pacientes apresentaram um status de Karnofsky de 80%. O fator influente mais positivo na capacidade funcional foi a função de trabalho (R = 0,515, p <0,05). Além disso, funções emocionais e sociais estavam fortemente associadas ao estado global de saúde dos pacientes (R = 0,960, p <0,05). Nossos dados mostraram que a escala de desempenho de Karnofsky é uma ótima ferramenta para avaliar a qualidade de vida em pacientes com câncer submetidos a quimioterapia, que se correlaciona positivamente com seus escores globais de saúde e é afetada pelas funções emocionais e sociais dos pacientes.

The overall aims of this thesis are to describe women’s experiences of breast cancer from a gender perspective, describe women’s experiences of an art therapy intervention and the effects of an art therapy intervention on self-rated coping resources and quality of life. The thesis presents results from a study with 42 women with primary breast cancer without distance metastasis who participated in a randomized intervention study with art therapy carried out between 2001 and 2004. All women were recruited as they were referred to the Department of Oncology at Umeå University Hospital in northern Sweden for postoperative radiotherapy. They were randomized to an intervention group (n = 20) with individual art therapy for 1 hour/week during postoperative radiotherapy, or to a control group (n = 22). The women were between 37–69 years old and had a range of educational and socioeconomic backgrounds. All 42 women completed questionnaires in connection with three interview occasions during six months: at baseline (start of radiotherapy), two and six months later. The questionnaires assessed coping resources, quality of life, symptoms, and self-image. In addition, all women were interviewed about their experiences, and were asked to write a weekly diary about their experiences of breast cancer during the six months of participation. All women signed a written consent form in which they were assured voluntariness and that ending their participation would not affect the care or medical treatment in any way. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). In this thesis, part of results from the study is reported. The results presented in the first study show an overall increase in coping resources as measured by the Coping Resources Inventory (CRI) among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study group and the control group in the total score on the second occasion and in the social domain on the second and third occasions. The second study reports results of the art therapy intervention, with regard to quality of life aspects as measured by the instruments WHOQOL-BREF and EORTC QLQ-BR23, at baseline (start of radiotherapy) and two and six months later. Significant increases in total health, total quality of life, physical health and psychological health were found in the art therapy group compared to the control group. A significant positive difference was also found within the intervention group, concerning future perspectives, body image and systemic therapy side effects. The third study builds on previous quantitative results, drawing on gender theories and, taking a discursive approach in analyzing the women’s use of interpretative repertoires in diaries and interviews. The results show a connection between participation in art therapy, talking about protecting one’s own boundaries, and scoring higher on the CRI compared to the control group. A connection between the control group, repertoire conflicts, and lower scores on the CRI was also found. The fourth study presents further knowledge about women’s trajectories, in art therapy, towards helpful management of restraining boundaries. We were inspired by discursive psychology and the analytic concept of subject position. The result shows that art therapy helped women to get access to subject positions that enabled them to protect and strengthen their boundaries and put forward their own needs. Taken together, the results from all four studies support art therapy as a valuable complement in oncology care and rehabilitation of women with primary breast cancer in similar contexts.