Hypothesis / aims of study
Breast cancer is one of the pathologies with the highest incidence and prevalence that plagues the population of women worldwide, as a malignant, non-transmissible neoplasm with a chronic degenerative character. Fortunately, advances in science have made it possible to find more accurate diagnoses, which allow the early detection of cancer and increase the chance of cure and survival. However, the disease and its treatment, especially hormone therapy and surgical resection of the breast, generate physical and emotional repercussions in their patients, which reflect on their sexuality and functional capacity. The objective was to assess sexual function, functional capacity and quality of life in women undergoing breast cancer treatment.
Study design, materials and methods
: This is a cross-sectional study, conducted with patients from a reference hospital in the treatment of cancer diagnosed with breast cancer in the last two years. The capture of patients occurred from November 2019 to March 2020, and 170 volunteers participated in the study. They were instructed on the objectives of the study, which instruments would be used to conduct their assessment, its benefits and possible health risks. The women were subjected to an evaluation consisting of a form with sociodemographic and clinical information, through the questionnaires: Female Sexual Function Index (FSFI) and the Quality of Life Questionnaire Breast Cancer EORTC QLQ-C30 and its BR23 module, and the tests to assess the capacity functional: 6-minute walk test (6MWT), sit and reach test (TSA) and upper limb dynamometry.
Results
Seventeen sedentary women were evaluated, with an average age of 59.7 ± 9.53 years (ranging from 46 to 77 years), 47.05% were married and 35.29% were single, 41.17% graduated high school and 29.41% with elementary or higher education. The most prominent occupations were housewife (35.29%) and retired (29.41%), and all lived in the urban area of Campo Grande (100%).As for the clinical characteristics of the participants, 88.23% were in the post menopausal period, and the mean BMI for the group was 26.98% ± 4.96. All participants underwent a radical mastectomy procedure, 94.11% did not practice alcoholism or smoking. As for the manifestation of other comorbidities, 52.94% of the participants indicated that they had pathologies concomitant with cancer, while 88.23% did not develop metastasis or neoplastic recurrence after the treatment period. In the distribution of the means of the QLQ-C30 questionnaire, it was possible to notice that the items most affected correspond to the domains of emotional function (57.84 ± 29.23) and cognitive function (63.72 ± 29.01) of the functional scale (72 , 29 ± 14.98), 74.0 (18.0). While, from the symptom scale (23.17 ± 7.86), 15.4 (19.4), the most scored domains were pain (31.37 ± 30.55), insomnia (31.37 ± 36.26) and constipation (31.371 ± 39.91). In addition, the score for global health and quality of life scored (61.75 ± 20.84), 66.7 (25.0). In the QLQ-BR23, the domains on future perspectives (58.82 ± 34.41) and sexual satisfaction (35.29 ± 34.29) of the functional scale (32.35 ± 17.89), 33.3 (14 , 6), and symptoms of the arm (26.05 ± 22.19) and adverse effects (24.19 ± 16.08) of the symptomatic scale (22.72 ± 15.2), 17.8 (25.5) were the worst. In the FSFI, the most affected domains were orgasm, which obtained the lowest average (2.3 ± 2.28), meaning the worst result, followed by the lubrication domain (2.47 ± 2.09). The average of the total score was (16.42 ± 10.9) and median 17.4 (22.9). Regarding the variables of functional capacity, the Walk Test had an average of 194.3 ± 82.85, while the Sit and Reach Test was 21.91 ± 6.81 and the dynamometry on the right side obtained the best result (18, 52 ± 3.99) compared to the left (16.94 ± 5.65).
Interpretation of results
Sexual activity, from the perspective of women, involves the ability to achieve a healthy sexual function, both in psychological and physical aspects, which affect the female response cycle in its different moments: desire, excitement, orgasm and resolution.
Biopsychosocial problems associated with the diagnosis or treatment of cancer are complicated by the surgical removal of part or
all of the breast. Breast loss is usually associated with problems and difficulties such as depression, affective disorders, loss of
sexual interest, negative self-image, loss of femininity, and difficulties with clothing. These problems may persist for years after
the treatment of breast cancer.
The FSFI results, shown in Table 1, also refer to the tangent of sexuality, so it is necessary to correlate the questionnaires and their analyzed variables. Greater damage was observed in the areas of orgasm, lubrication, and arousal. Another study,of our research group, which evaluated female sexual function and quality of life, showed that participants reported sexual dysfunctions related to sexual desire, arousal, reduced pleasure during intercourse, difficulty in reaching orgasm, pain during and after activity sexual, and all contributed to making sex a less pleasurable experience.
The last item of the Functional Scale, the future perspectives, is one of the biggest limitations in the quality of life because it triggers frequently negative feelings, such as the fear of recurrence, the need to readjust life habits and daily routine practices due to the consequences left by the patient. cancer, the feeling of incapacity, among others.
A study carried out on the emotional experiences and perspectives of the future in women with breast cancer, pointed out that the uncertainty and fear that permeate the outcome of the treatment can make it impossible for the patient to see a life that goes beyond the disease and its consequences, to allow - to plan in the face of such an overwhelming situation. The results also showed that the emotional experiences and future perspectives of the patients have a strong relationship with the way they receive information about breast cancer, such as the news of the diagnosis.
Concluding message
The study showed that among women with breast cancer, sexual dysfunctions are very common and the complaints that stood out the most were the ability to achieve orgasm, vaginal lubrication and the degree of arousal regarding sexual intercourse. The quality of life of patients is negatively influenced by this aspect, combined with symptoms that include pain, insomnia, constipation and it was possible to determine deficits in the emotional sphere and in cognitive skills. The TSA proved to be an important predictor for functional capacity, ratified by the functional scale of the QLQ-C30 because they had a significant correlation. In addition to below-average performance in both the 6-minute walk test and dynamometry.
It is concluded that the prevalence of sexual dysfunction is high in women survivors of breast cancer, regardless of the type of surgical procedure performed. Regarding quality of life, functional capacity impairment was observed in young women.