Prevalência de clusters de sintomas oncológicos e correlações com estado nutricional e a qualidade de vida de mulheres com câncer de mama hospitalizadas

Abstract

Introduction: Women with breast cancer experience multiple symptoms that can cooccur simultaneously during antineoplastic treatment, constituting clusters. Objective: To analyze the prevalence of cancer symptom clusters and to correlate with the nutritional status and quality of life of hospitalized women with breast cancer. Methods: A cross-sectional observational study was undertaken at Hospital Santa Rita de Cássia - reference in oncological treatment in the state of Espírito Santo. Women aged >18 years were included; with an anatomopathological diagnosis of breast cancer in stage I, II or III; and who were in any phase of antineoplastic treatment as well as hospitalized at the hospital. For data collection, a sociodemographic and clinical questionnaire was used; the Memorial Symptom Assessment Scale was used for detection and monitoring of multiple symptoms in cancer patients; and the EQ-5D3L – a generic instrument for measuring quality of life. For the assessment of nutritional status, subjective and objective methods were used. The subjective method was considering the Subjective Global Assessment Produced by the Patient (ASG-PPP) and Nutritional Risk Screening (NRS-2002). Objective methods included BMI (kg/m2), triceps skinfold (mm), arm perimeter (cm) and calf perimeter (cm), and hand grip (kg). In addition, we have used the Neutrophil-Lymphocyte Ratio (NLR) and the Platelet-Lymphocyte Ratio (PLR) for prognostic evaluation. Descriptive, bivariate and multivariate analyzes were conducted with alpha set at 5%. Results: The most prevalent cancer symptoms were, respectively: pain (67%), fatigue (63%), worries (62%), and sleep disturbances (57%), constituting a neuropsychological symptom cluster. Patients with non-metastatic breast cancer present with multiple symptoms that differ according to the stage of the disease and tend to occur in 4 clusters for stage I (i.e., neuropsychological cluster, gastrointestinal cluster, neurocognitive cluster and psychological cluster) and in 4 clusters for stage III (i.e., psychoneurocognitive; gastrointestinal; chemotherapy-related; neurocognitive clusters) with distinct conformations in terms of intensity and severity. Our study revealed a high risk for participants, with high mean values of NLR and PLR, indicating low antitumor activity and worse prognosis. The binary logistic regression model showed that there was a significant association of the NLR marker and marital status (OR=3.1; 95%CI=1.06-8.57; p =0.03) and, in relation to PLR, a trend was shown for a higher chance in women of black ethnicity to have increased PLR compared to white women (OR=4.13; 95%CI=0.96-17.70; p=0.05). However, the inflammatory markers (NLR and PLR) did not show any significant association with nutritional factors. The average quality of life score presented by the patients was 71.53, indicating a self-reported quality of life as moderate at the time of collection, however, there were no statistically significant correlations between inflammatory markers (RNL and RPL) with the quality of life of these patients. patients. Significant associations were found between nutritional risk and educational level (p=0.03) and BMI (p=0.01). Binary logistic regression analysis revealed a significant association between educational level and nutritional risk, indicating that lower educational level was associated with higher odds of nutritional risk (OR=4.59; 95% CI=1.01-21.04; p=0.049). In addition, regarding BMI, it was observed that a BMI above 20.5 kg/m2 was associated with a higher likelihood of nutritional risk (OR=0.09; 95% CI=0.01-0.89; p=0.039). Conclusion: This study presents a specific profile of women with non-metastatic breast cancer, with a higher proportion for those of advanced age, low socioeconomic status, with reduced risk behaviors in relation to alcohol and tobacco and with moderate quality of life. In addition, most of them have an inadequate nutritional status, and high prevalence of excess of weigh. The findings shown here are relevant to guide future research, introducing new clusters by tumor staging for personalized assessments and interventions, considering nutritional status as a key variable in this process.