Microsoft Word - 31-Sau_49902_review_quemrecomendou_semeditar 1771 Bioscience Journal Original Article Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 CERVICAL CANCER AND QUALITY OF LIFE: AN INTEGRATIVE REVIEW CÂNCER DE COLO DO ÚTERO E QUALIDADE DE VIDA: UMA REVISÃO INTEGRATIVA Ana Hélia de Lima SARDINHA¹; Thayane Costa FERREIRA²; Joelson dos Santos ALMEIDA²; Alynne Radoyk Silva LOPES3; Lívia Alessandra Gomes AROUCHA3; Cassandra Mirtes Andrade Rego BARROS4; Maria do Socorro Candeira COSTA5 1. Associate Professor, Doctor, Federal University of Maranhão - (PPGSA / UFMA), São Luís, MA, Brazil. anahsardinha@ibest.com.br; 2. Nurses. Master's students in Health and Environment from the Federal University of Maranhão – (PPGSA / UFMA), São Luís, MA, Brazil; 3. Nurses. Master's students in Nursing at the Federal University of Maranhão (PPGSA / UFMA), São Luís, MA, Brazil; 4. Nurses. Master in Biotechnology from the Federal University of Piauí (UFPI), Parnaíba, PI, Brazil; 5. Nurses. Master in Nursing from the Federal University of Ceará (UFCE), Parnaíba, PI, Brazil. ABSTRACT: Objective: To analyze the publications regarding the quality of life of women with cervical cancer. Method: This is an integrative review performed in the indexed LILACS, MEDLINE and SCIELO databases. The descriptors “Quality of Life” AND “Cervical Neoplasms”, “Quality of Life” AND “Woman's Health” and “Woman's Health” AND “Cervical Neoplasms” were used, in which articles published in the period from 2010-2018 that met the inclusion criteria were selected. Results: The research resulted in three articles in Lilacs, three in Medline, and five in Scielo, totaling 11 articles. The research used three questionnaires, such as EORTC QLQ-C30, WHOQOL-bref, and FACT-Cx. These instruments are the most widely used today to measure the quality of life and health conditions in broad aspects. It was observed that cervical cancer positively affects women's quality of life in social and emotional aspects. Conclusion: Quality of life, although with a positive evaluation, should encourage the formulation of public health policies aimed at improving this target audience's quality of life. The discovery of the disease brings several fears, including the thought of death. In addition, it has a physical and psychological impact on these women's lives. KEYWORDS: Quality of life. Cervical neoplasms. Woman's health. INTRODUCTION Cervical cancer develops slowly. Changes in cancer-stimulating cells are discovered on the Papanicolaou test. It is important to take this test every three years after two consecutive negative annual tests. Human papillomavirus (HPV) infection is a major risk factor for the development of cervical cancer (INCA, 2017a). This type of cancer is the third most common tumor in the female population, and it is the fourth leading cause of cancer death in women in Brazil. For Brazil's 2018-2019 biennium, 16,370 new cases of cervical cancer are expected, with an estimated risk of 15.43 cases per 100,000 women (INCA, 2017b). Cervical cancer is developed through a lesion preceding the epithelium at the squamous- columnar junction. Some risk factors are listed next: smoking, immunosuppressed system, Human papillomavirus (HPV) infection, socioeconomic conditions, early initiation of sexual activities, among others (SILVEIRA; MAIA; CARVALHO, 2018). Regarding treatment, it has some modalities, such as chemotherapy, radiotherapy, and surgery. This is the main modality, chosen most of the time. Neoplastic chemotherapy has been widely used, as drug purification and the elaboration of administration protocols allow the use of more than one compound, as well as contouring side effects through the application of symptomatic, salvage and protective therapy (FRIGO; ZAMBARDA, 2015). As for diagnosis, this is mostly done through routine cervical cytology or biopsy of the suspected area. Colposcopy is used in the presence of abnormal cytology, aiming to direct the biopsy. Conization, on the other hand, is recommended when the biopsy does not clearly define the existence or not of the invasion and when micro- invasive neoplasia is suspected (INCA, 2019). Cervical cancer staging adopts the FIGO or TNM classification system to define installed lesions. For the specification considers several factors, among them: the invasion or not of the lesion, macroscopic or microscopic changes of the disease, the stromal infiltration concavity, the lesion dimension, the range of associated structures, lymph node involvement, and the presence or absence of Received: 08/04/19 Accepted: 30/12/19 1772 Cervical cancer... SARDINHA, A. H. L. et al. Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 metastases in target organs (O'SULLIVAN et al. 2017; BHATLA et al. 2018; INCA, 2019). The need for treatment and diagnosis of cervical cancer reflects physically and psychologically in women's lives, as they are fearful of the prognosis, as well as the changes caused by the disease and its treatment, which may change their quality of life (DALLABRIDA et al., 2014). Given the above, the study was justified by the importance of knowing the quality of life of women with cervical cancer, to formulate public policies that improve these women's quality of life. Therefore, this study aims to analyze the publications regarding the quality of life of women with cervical cancer. METHODS This is an integrative literature review, consisting of six phases, such as: 1st phase: elaboration of the guiding question, 2nd phase: literature search or sampling, 3rd phase: data collection, 4th phase: critical analysis of the studies included, 5th phase: discussion of the results, and 6th phase: presentation of the integrative review (SOUZA; SILVA; CARVALHO, 2010). The integrative review is considered a tool of the Evidence-Based Practice (EBP) that aims to systematically condense knowledge, using evidence from clinical practice (SILVA; FARIAS, 2018). The guiding question was: How does cervical cancer affect women's quality of life? For the search of the articles, we used the descriptors and their combinations in the Portuguese and English languages: "Quality of Life", "Cervical Neoplasms" and "Woman's Health". The search was done in the following databases: LILACS (Literature in Health Sciences in Latin America and the Caribbean, in Portuguese), MEDLINE (Medical Literature Analysis and Retrieval System Online), and SciELO (Scientific Electronic Library Online). The descriptors were crossed as follows: “Quality of Life” AND “Cervical Neoplasms”, “Quality of Life” AND “Woman's Health”, and “Woman's Health” AND “Cervical Neoplasms”. The inclusion criteria that we established were: available articles published in Portuguese, English, and Spanish, between 2010 and 2018, and that met the objectives of the study, with full text available online. Among the exclusion criteria, we can mention: articles that did not fit the theme and that were not within the time frame, as well as double indexed articles in the databases and incomplete articles. RESULTS To streamline the understanding of data search, the flowchart was used to direct the databases used, the findings in the databases, as well as sample numbers and excluded works, as shown in Figure 1. Figure 01. Article selection flowchart 1773 Cervical cancer... SARDINHA, A. H. L. et al. Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 As shown, the research resulted in three articles in LILACS, three in MEDLINE, and five in SCIELO. Excluding the repeated ones, the total sample consisted of 11 articles, listed as shown in the flowchart and organized in table 1. Of these, five articles were in English and six in Portuguese. Table 1. Description of the articles regarding the quality of life of women with cervical cancer. Title of the article Authors Journal Year Objective: Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer Aredes MA, Garcez MR, Chaves GV. BRASPEN J 2017 Assess the influence of chemoradiotherapy on nutritional status, functional capacity and quality of life (QoL), associating these indicators with toxicity and interruption of cancer treatment in women with cervical cancer. Quality of life of breast and cervical cancer survivors Huang HY, Tsai WC, Chou WY, Hung YC, Liu LC, Huang KF, Wang WC, Kam-Wing Leung KW, Hsieh RK, Kung PT. BMC Women's Health 2017 Investigate the QoL of breast and cervical cancer survivors, their physical, psychological and social conditions. Qualidade de vida e toxicidade por radiação em pacientes com câncer ginecológico e mama (Quality of life and radiation toxicity in gynecological and breast cancer patients) Silveira CF, Regino PA, Soares MBO, Mendes LC, Thaís Cristina Elias TC, Silva SR. Escola Anna Nery 2016 Assess the quality of life and degree of acute radiation toxicity in patients with cervical, breast, and endometrial cancer, under radiotherapy. Avaliação da Qualidade de Vida de Mulheres com Carcinoma do Colo do Útero em Quimioterapia Paliativa (Quality of Life Assessment of Women with Cervical Carcinoma in Palliative Chemotherapy) Lofrano AD, Coura CPM, Silva MJS. Brazilian Journal of Cancerology 2016 Assess the impact of the carboplatin and paclitaxel palliative chemotherapy treatment on the health-related quality of life of women with cervical cancer. Quality of life for women with cancer cervical vulnerability Fialho AVM, Almeida NG, Pinheiro AKB, Oriá MOB, Leitão NMA, Almeida PC. Rev Enferm UFPI 2014 Identify the sociodemographic and gynecological profile and to assess the Quality of Life of women vulnerable to cervical cancer. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia (Health- related quality of life of cancer patients undergoing chemotherapy) Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Rev Rene 2014 Assess the health-related Quality of Life in cancer patients undergoing chemotherapy, identify affected domains and associate them with sociodemographic and clinical- therapeutic characteristics of the sample. 1774 Cervical cancer... SARDINHA, A. H. L. et al. Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 Qualidade de vida de mulheres tratadas por câncer do colo de útero (Quality of life of women treated for cervical cancer) Dallabrida FA, MM, Rosanelli CLSP, Souza MM, Gomes JS, Kolankiewicz ACB. Rev Rene 2014 Assess the Quality of Life of women with cervical cancer. Quality of life in cervical cancer patients treated with radiation therapy Pasek M, Suchocka L, Urba´nski K. Journal of Clinical Nursing 2013 Assess the quality of life of hospitalized patients with cervical cancer treated by radiotherapy. Avaliação da Qualidade de Vida Relacionada à Saúde em Pacientes com Câncer do Colo do Útero em Tratamento Radioterápico (Assessment of the Health- Related Quality of Life in Cervical Cancer Patients under Radiotherapy Treatment) Santos ALA, Moura JFP, Santos CAAL, Figueiroa JN, Souza AI. Brazilian Journal of Cancerology 2012 Assess the health-related quality of life (QoL) in women with cervical cancer undergoing radiotherapy, with an emphasis on the sexual function. Health-related quality of life women with cervical cancer Fernandes WC, Kimura M. Rev. Latino-Am. Nursing 2010 Assess the health-related quality of life (QoL) in women with cervical cancer and identify the predictors of quality of life. Avaliação da qualidade de vida de portadoras de câncer ginecológico, submetidas à quimioterapia antineoplásica (Quality of life assessment of gynecological cancer patients undergoing antineoplastic chemotherapy) Jorge LLR, Silva SR. Rev. Latino-Am. Nursing 2010 Assess the quality of life of women with gynecological cancer undergoing antineoplastic chemotherapy. Source: Research Data. DISCUSSION The findings found in the publications were: use of a quality of life questionnaire and domains with impacts on the health of women with cervical cancer. To outline the discussion process, after reading and carefully analyzing the selected studies, it was found that the research used three questionnaires, such as EORTC QLQ-C30, WHOQOL-bref, and FACT-Cx. These instruments are the most used today to measure the quality of life and health conditions in broad aspects of the community. The FACT-Cx questionnaire was used in two articles. The application of this questionnaire showed that cervical cancer positively affects the quality of life. The most affected domains were functional well-being, concerns and social/family welfare. In the article written by Santos et al., (2012), the most affected domains were functional well- being and concerns. On the other hand, in the study carried out by Fernandes, Kimura, (2010) the most affected domains were additional concerns, emotional well-being and social/family welfare. Pêssoa et al., (2016) shows in her study that physical and functional well-being were the most affected domains. This study shows a significant increase in fatigue, a significant reduction in quality of life, and a reduction in functional capacity. Fatigue is a subjective experience involving physical, psychological and cognitive aspects. It can be acute (extreme tiredness resulting from physical or mental stress, which can be improved by resting) or chronic (fatigue without improvement after resting, loss of functionality, limitation of daily activities, and reduced work capacity). 1775 Cervical cancer... SARDINHA, A. H. L. et al. Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 Two articles used the WHOQOL-bref questionnaire. The perception of the quality of life of the women followed in the studies was considered satisfactory. The most compromised domains were the physical and environmental ones. In the research described in the article by Fialho et al., (2014), the overall assessment of the quality of life was positive, even though the population had low economic conditions and educational levels. The article written by Jorge and Silva (2010), on the other hand, showed that the physical and environmental domains were the most affected. The perception of the quality of life of the women followed in the studies was considered satisfactory, even when given the recognition of the severity of the prognosis. The study by Correia et al., (2018) shows that the physical and environmental domains presented the worst scores. Regarding the physical domain, the facets with the lowest scores refer to pain, discomfort, energy and fatigue, sleep and rest, drug dependence, and treatment dependence. The lower scores in the environmental domain can be explained by the fact that most of the women surveyed live in poverty conditions. Seven articles used the EORTC QLQ-C30 questionnaire and, in all of them, the quality of life was considered satisfactory. The main domains of affected health-related quality of life were: emotional function, role performance, pain, fatigue, insomnia, and loss of appetite. For the authors Aredes; Garcez; Chaves (2017), the domains related to the functional scale and symptom scale were the most affected. Physical capacity, role performance, social function, and total functional scale are related to the functional scale, while nausea, vomiting, weight loss, and diarrhea refer to the symptom scale. The study by DALLABRIDA et al., (2014) showed that women with cervical cancer had a very satisfactory quality of life. According to the article written by HUANG et al., (2017), the women showed lower cognitive and emotional functioning, and also experienced very severe fatigue and insomnia. The article written by Lofrano; Coura; Silva (2016) pointed to a negative impact on diarrhea and peripheral neuropathy symptom. The study carried out by NICOLUSSI et al., (2014) states that the interviewees' quality of life was considered good. The main domains of affected health-related quality of life were: emotional function, role performance, pain, fatigue, insomnia, and loss of appetite. The article by SILVEIRA et al., (2016) shows that women's quality of life was classified as good. The emotional function was the most affected item, besides physical function, role performance, and symptoms such as pain, insomnia, and loss of appetite. PASEk; Suchocka; Urbask'ni, (2012) revealed in their article that cervical cancer patients are satisfied with their overall quality of life and its components. Following treatment, the greatest difficulties were the performance of strenuous activities, loss of appetite, concern, and fatigue. CONCLUSIONS Cervical cancer is a public health problem, as the number of women victims of this disease is increasing each year, and it is relevant to intensify preventive actions, health education, awareness on the search for prevention in health facilities, and early diagnosis. In all surveys, the interviewees rated their quality of life as satisfactory and were measured using the three most commonly used questionnaires: EORTC-QLC30, WHOQOL-bref, and FACT-Cx. Even with the positive quality of life assessment found in the publications, it is considered necessary to encourage the formulation of public policies that have better results in this target audience's quality of life. The discovery of this disease brings several fears, including the thought of death. In addition, it has a physical and psychological impact on these women's lives. The multi-professional team needs to work together to better assist these women. RESUMO: Analisar as publicações referentes à qualidade de vida das mulheres acometidas pelo câncer cervical. Trata-se de uma revisão integrativa realizada nas bases de dados indexadas LILACS, MEDLINE e SCIELO. Utilizou-se os descritores “Qualidade de vida” AND “Neoplasias do colo do útero”, “Qualidade de vida” AND “Saúde da Mulher” e “Saúde da Mulher” AND “Neoplasias do colo do útero”, na qual foram selecionados artigos publicados no período de 2010-2018 que atendessem aos critérios de inclusão. A pesquisa resultou em três artigos na Lilacs, três na Medline e cinco na Scielo, totalizando 11 artigos. As pesquisas utilizaram três questionários, tais como: EORTC QLQ-C30, WHOQOL-bref e FACT-Cx. Esses instrumentos são os mais utilizados na atualidade para mensurar a qualidade de vida e as condições de saúde em amplos aspectos. Observou-se que o câncer cervical afeta positivamente a qualidade de vida das mulheres 1776 Cervical cancer... SARDINHA, A. H. L. et al. Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 nos aspectos sociais e emocionais. A qualidade de vida embora com a avaliação positiva nas mulheres deva ser incentivada à formulação de políticas públicas de saúde que visem à melhora da qualidade de vida desse público-alvo. A descoberta da doença traz vários receios, entre eles, o pensamento de morte que repercute de forma física e psicológica na vida dessas mulheres. PALAVRAS-CHAVE: Qualidade de vida. Neoplasias do colo de útero. Saúde da mulher. REFERENCES AREDES, M.A.; GARCEZ, M.R.; CHAVES, G.V. Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical câncer. BRASPEN J v.32, n.4, p. 325-34, 2017. BHATLA, N.; AOKI, D.; SHARMA, D.N.; SANKARANARAYANAN, R. Cancer of the cervix uteri. Int J Gynecol Obstet, v. 143, sup. 2, p. 22-36, 2018. https://doi.org/10.1002/ijgo.12611 CORREIA,R.A;BONFIM,C.V;FERREIRA,D.K.S;SOUSA,B.M.A;FURTADO,M;COSTA,H.V.V;FEITOSA,K .M.A;SANTOS,S.L. Qualidade de vida após o tratamento do câncer do colo do útero. Escola Anna Nery v.22, n.4, 2018. https://doi.org/10.1590/2177-9465-ean-2018-0130 DALLABRIDA, F.A; LORO, M.M; ROSANELLI, C.L.S.P; SOUZA, M.M; GOMES, J.S; KOLANKIEWICZ. Qualidade de vida de mulheres tratadas por câncer do colo de útero. Revista da Rede de Enfermagem do Nordeste. v.15, n.1, p.116-22, 2014. https://doi.org/10.15253/2175-6783.2014000100015 FERNANDES, W.C.; KIMURA, M. Health related quality of life women with cervical cancer. Rev. Latino- Am. Enfermagem v.18, n. 3, 2010. https://doi.org/10.1590/S0104-11692010000300010 FIALHO, A.V.M; ALMEIDA, N.G; PINHEIRO, A.K.B; ORIÁ, M.O.B; LEITÃO, N.M.A; ALMEIDA, P.C. Quality of life for women with cancer cervical vulnerability. Rev Enferm UFPI. v.3, n.3, p.26-31, 2014. https://doi.org/10.26694/reufpi.v3i3.1558 FRIGO, L.F.; ZAMBARDA, S.O. Câncer do colo de útero: efeitos do tratamento. Cinergis, v.16, n.3, p. 164- 168, 2015. https://doi.org/10.17058/cinergis.v16i3.6211 HUANG,H.Y;TSAI,W.C;CHOU,W.Y;HUNG,Y.C;LIU,L.C;HUANG,K.F;WANG,W.C; LEUNG,K.W;HSIEH,R.K;KUNG,P.T. Quality of life of breast and cervical cancer survivors. BMC Women's Health. v.17 n. 1, p. 30.2017. https://doi.org/10.1186/s12905-017-0387-x Instituto Nacional de Câncer José Alencar Gomes da Silva. Parâmetros técnicos para o rastreamento do câncer do colo do útero / Instituto Nacional de Câncer José Alencar Gomes da Silva; Maria Beatriz Kneipp Dias; Caroline Madalena Ribeiro (organizadores). - Rio de Janeiro: Inca, 2019. Instituto Nacional de Câncer José Alencar Gomes da Silva. ABC do câncer: abordagens básicas para o controle do câncer. 3ªed. rev. atual. – Rio de Janeiro: Inca, 2017a.108 p. Instituto Nacional de Câncer José Alencar Gomes da Silva. ABC do câncer: abordagens básicas para o controle do câncer. 4ªed. rev. atual. – Rio de Janeiro: Inca, 2019.108 p. Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimativa 2018: incidência de câncer no Brasil. Rio de Janeiro: INCA. 2017b.128 p. JORGE, L.L.R.; SILVA, S.R. Avaliação da qualidade de vida de portadoras de câncer ginecológico, submetidas à quimioterapia antineoplásica. Rev. Latino-Am. Enfermagem, v.18, n.5, 2010. 1777 Cervical cancer... SARDINHA, A. H. L. et al. Biosci. J., Uberlândia, v. 36, n. 5, p. 1771-1777, Sept./Oct. 2020 http://dx.doi.org/10.14393/BJ-v36n5a2020-49902 LOFRANO, A.D.; COURA, C.P.M.; SILVA, M.J.S. Avaliação da Qualidade de Vida de Mulheres com Carcinoma do Colo do Útero em Quimioterapia Paliativa. Revista Brasileira de Cancerologia, v.62, n.3, p.203-213, 2016. https://doi.org/10.32635/2176-9745.RBC.2016v62n3.162 NICOLUSSI, A.C; SAWADA, N.O; CARDOZO, F.M.C; ANDRADE, V; PAULA, J.M. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene, v.15, n.1, p.132-40, 2014. O’SULLIVAN, B., BRIERLEY, J., BYRD, D., BOSMAN, F., KEHOE, S., KOSSARY, C., PIÑEROS, M; EYCKEN, E.V; WEIR, H.K; GOSPODAROWICZ, M. The TNM classification of malignant tumours— towards common understanding and reasonable expectations. The Lancet Oncology, v.18, n.7, p. 849– 851,2017. https://doi.org/10.1016/S1470-2045(17)30438-2 PASEK M, SUCHOCKA L, URBASK´NI K. Quality of life in cervical cancer patients treated with radiation therapy. Journal of Clinical Nursing, v.22, p. 690–697, 2012. https://doi.org/10.1111/j.1365-2702.2012.04350.x PESSÔA; G.A; FERNANDES; J.A; MATHEUSJ.P.C; MATHEUS, L.B.G. Aumento da fadiga e redução da qualidade de vida após tratamento de câncer do colo do útero. ConScientiae Saúde, v.15, n. 4, p.564-574, 2016. https://doi.org/10.5585/conssaude.v15n4.6767 SANTOS; A.L.A; MOURA; J.F.P; SANTOS, C.A.A.L; FIGUEIROA, J.N; SOUZA, A.I. Avaliação da Qualidade de Vida Relacionada à Saúde em Pacientes com Câncer do Colo do Útero em Tratamento Radioterápico. Revista Brasileira de Cancerologia, v.58, n.3, p. 507-515, 2012. SILVA, K.G.; FARIAS, S.N.P. Qualidade de vida e estresse dos enfermeiros. Rev enferm UFPE on line, Recife, v.12, n. 12, p.3378-85, 2018. https://doi.org/10.5205/1981-8963-v12i12a236158p3378-3385-2018 SILVEIRA, B.L.; MAIA, R.C.B.; CARVALHO, M.F.A. Câncer do colo do útero: papel do enfermeiro na estratégia e saúde da família. Revista Científica da Faculdade de Educação e Meio Ambiente. Ariquemes: FAEMA, v. 9, n. 1, 2018. https://doi.org/10.31072/rcf.v9i1.517 SILVEIRA, C.F; REGINO, P.A; SOARES, M.B.O; MENDES, L.C; ELIAS, T.C; SILVA, S.R. Qualidade de vida e toxicidade por radiação em pacientes com câncer ginecológico e mama. Escola Anna Nery, v.20, n.4, 2016. https://doi.org/10.5935/1414-8145.20160089 SOUZA, M.T.; SILVA, M.D.; CARVALHO, R. Revisão integrativa: o que é e como fazer. Einstein, v.8, n. 1 , p.102-6, 2010. https://doi.org/10.1590/s1679-45082010rw1134