Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil.

BACKGROUND: Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life. The objective of this study was to estimate the prevalence of lymphedema and associated factors in women treated for breast cancer in the municipality of Juiz de Fora. METHODS: We performed a cross-sectional study that evaluated 250 women who were being treated for breast cancer. Pre-screening of the sample by analysis of medical records was performed to select women who met the inclusion criteria as follows: women who had an operation more than 6 months ago; absence of active disease, locoregional or distant; the absence of functional change in the affected limb before surgery, which could lead to swelling of the limb; and simulating or masking symptoms of lymphedema, such as bursitis, tendonitis, and work-related musculoskeletal disorders. Women with bilateral breast cancer, absence of axillary intervention (partial or complete axillary dissection and/or SLN biopsy), active disease in the region, or lympho-venous alteration of the limb before surgery were excluded. Data were collected from the medical records of the selected cases, and they subsequently underwent an interview and a physical assessment. RESULTS: The prevalence of lymphedema was 44.8%. There were medical records on the presence of this condition in 5.4% of cases. With regard to shoulder joint mobility, restrictions on abduction movements, internal and external rotation, and anterior shoulder adduction were significantly associated with lymphedema. Variables, including the presence of seroma, vascular changes, time elapsed after surgery, episodes of redness in the extremities, and cuticle removal from the hand with pliers were considered as major associated factors for lymphedema (p<0.05). CONCLUSIONS: The prevalence of 44.8% for lymphedema found in this study is considered to be relevant because it is a morbidity that produces psychological, physical, and functional damage in patients with this condition. The planning of health programs and services appropriate for the immediate postoperative treatment of women with breast cancer, and increasing the awareness of health professionals regarding the early diagnosis of lymphedema, can help minimize the morbidity of this disease.

Quality of life in patients with dysphagia after radiation and chemotherapy treatment for head and neck tumors.

OBJECTIVE: The aim of this study is to analyze subjectively, using the SWAL-QOL questionnaire, swallowing dysfunction and associated factors after treatment with radiotherapy and chemotherapy in patients treated for head and neck cancer. MATERIAL AND METHODS: This is a cross-sectional study, based on the selection of patients with tumors of the head and neck area, treated with radiotherapy with or without chemotherapy during the years 2000 to 2006 at the Oncology Institute of Juiz de Fora. The data were analyzed using SPSS 15.0 software, and were evaluated using the chi-square test to compare differences in proportions between groups. The statistical significance level was set at 5%. RESULTS: It was observed that with respect to foods of solid consistency, there was a statistically significant difference for mouth tumors (p<0.01), with a tendency in this group to use softer foods, easier to chew (stews, boiled vegetables, creamy soups, canned fruit). With reference to the domains of the SWAL-QOL, the location of the tumor in the mouth was statistically associated with the lowest quality of life in the symptoms domain (p<0.05). The female gender variable was associated with the lowest perceived quality of life in several domains, namely swallowing (p=0.02); fatigue (p=0.008); symptoms (p=0.009). Age (split below and above 60 years) was not associated with differences in perceived quality of life in any domain. CONCLUSION: Tumor in the mouth and the total dose of radiation in the superior fossa were associated with the lowest quality of life in the symptoms domain. The female gender variable was associated with the lowest perceived quality of life in several domains This study shows that speech therapy should maintain a presence in the teams, to then guide the rehabilitation of organic dysphonia and mechanical dysphagia possibly afflicting patients after cancer treatment with radiation therapy and chemotherapy. Key words:Quality of life, dysphagia, head and neck neoplasms, rehabilitation.