Validade discriminante do questionário de qualidade de vida da Universidade de Washington no contexto brasileiro / Discriminant validity of the University of Washington quality of life questionnaire in the Brazilian context

OBJETIVO: Avaliar a validade discriminante do questionário de qualidade de vida da Universidade de Washington para pacientes com câncer de cabeça e pescoço e identificar possíveis fatores sociodemográficos que modifiquem seus resultados. MÉTODOS: Foram entrevistados 47 pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico em um hospital no sul do município de São Paulo em 2007, e 141 pacientes sem câncer, pareados por sexo e idade em uma proporção de três para um, que foram atendidos em ambulatórios do mesmo hospital em 2008. Os resultados obtidos para os dois grupos foram comparados pelo teste t de Student. Para os pacientes sem câncer utilizou-se análise de regressão de Poisson para avaliar possíveis fatores de modificação da qualidade de vida. RESULTADOS: O escore geral de qualidade de vida foi significantemente mais elevado (p < 0,001) para os pacientes sem câncer (91,1) do que para os pacientes com câncer (80,6). Observações análogas foram efetuadas para oito dos doze domínios de qualidade de vida compreendidos no questionário (dor, aparência, deglutição, mastigação, fala, ombros, paladar e ansiedade). Como possíveis fatores de modificação dos escores de qualidade de vida foram identificados renda familiar (com impacto nos domínios de recreação, p = 0,017, e função dos ombros, p = 0,049), escolaridade (em ansiedade, p = 0,003), sexo (em função dos ombros, p = 0,038) e dor de dente (em mastigação, p = 0,015). CONCLUSÕES: O questionário tem validade discriminante, pois seus escores são especificamente mais afetados para pacientes com câncer. Reforça-se a indicação do questionário para monitorar o tratamento e recomenda-se avaliar os fatores que podem causar impacto nesses indicadores.

OBJECTIVE: To assess discriminant validity of the University of Washington quality of life questionnaire for patients with head and neck cancer, and to identify socio-demographic factors that may modify its results. METHODS: We interviewed 47 patients with oral and oropharyngeal cancer in pre-surgical stage in a hospital located in the South region of the city of São Paulo, in 2007, and 141 patients without cancer, matched by sex and age in a ratio of three to one, who were attending outpatient clinics of the same hospital in 2008. The results for the two groups were compared by the Student t test. Poisson regression models to evaluate factors that may modify quality of life scores among patients without cancer. RESULTS: The overall quality of life score was significantly higher (p < 0.001) for patients without cancer (91.1) than for patients with cancer (80.6). Similar observations were made for eight of the twelve quality of life domains included in the questionnaire (pain, appearance, swallowing, chewing, speech, shoulder, taste, and anxiety). As factors that may modify the quality of life scores, we identified family income (which impacted in recreation, p = 0.017, and shoulder function, p = 0.049), schooling (in anxiety, p = 0.003), sex (in shoulder function, p = 0.038) and toothache (in chewing, p = 0.015). CONCLUSIONS: The questionnaire has discriminant validity, because its scores are specifically more reduced among cancer patients. The use of the questionnaire for monitoring the treatment of cancer patients is reinforced, and the assessment of factors that may impact in its results is recommended.

Consumo de alimentos de origem animal e câncer de boca e orofaringe / Consumption of animal Consumption of animalderived oropharyngeal cancer

Objetivo. Avaliar a relação entre alimentos de origem animal e câncer de boca e orofaringe.Métodos. Estudo caso-controle, de base hospitalar, pareado por sexo e idade (± 5 anos) coma coleta de dados realizada entre julho de 2006 e junho de 2008. A amostra foi composta por296 pacientes com câncer de boca e orofaringe e 296 pacientes sem histórico de câncer atendidosem quatro hospitais da cidade de São Paulo (SP), Brasil. Foi aplicado um questionário semiestruturado,para a coleta de dados relativos à condição socioeconômica e aos hábitos deletérios(tabaco e bebidas alcoólicas). Para avaliação do consumo alimentar, utilizou-se um questionáriode frequência alimentar qualitativo. A análise se deu por meio de modelos de regressão logísticamultivariada, que consideraram a hierarquia existente entre as características estudadas.Resultados. Entre os alimentos de origem animal, o consumo frequente de carne bovina(OR = 2,73; IC95% = 1,27–5,87; P < 0,001), bacon (OR = 2,48; IC95% = 1,30–4,74;P < 0,001) e ovos (OR = 3,04; IC95% = 1,51–6,15; P < 0,001) estava relacionado ao aumentono risco de câncer de boca e orofaringe, tanto na análise univariada quanto na multivariada.Entre os laticínios, o leite apresentou efeito protetor contra a doença (OR = 0,41; IC95% =0,21–0,82; P < 0,001).Conclusões. O presente estudo sustenta a hipótese de que alimentos de origem animalpodem estar relacionados à etiologia do câncer de boca e orofaringe. Essa informação podeorientar políticas preventivas contra a doença, gerando benefícios para a saúde pública.

Objective. Evaluate the relationship between animal-derived foods and mouth andoropharyngeal cancer.Methods. Hospital-based case-control study matched by sex and age (± 5 years) withdata collected between July of 2006 and June of 2008. The sample contained 296 patientswith mouth and oropharyngeal cancer and 296 patients without a cancer history who weretreated in four hospitals in the City of São Paulo, State of São Paulo, Brazil. A semistructuredquestionnaire was administered to collect data regarding socioeconomic condition andharmful habits (tobacco and alcoholic beverage consumption). To assess eating habits,a qualitative questionnaire that asked about the frequency of food consumption wasused. The analysis was rendered by means of multivariate logistic regression models thatconsidered the existing hierarchy among the characteristics studied.Results. Among foods of animal origin, frequent consumption of beef (OR = 2.73;CI95% = 1.27–5.87; P < 0.001), bacon (OR = 2.48; CI95% = 1.30–4.74; P < 0.001) andeggs (OR = 3.04; CI95% = 1.51–6.15; P < 0.001) was linked to an increased risk ofmouth and oropharyngeal cancer, in both the univariate and multivariate analyses.Among dairy products, milk showed a protective effect against the disease (OR =0.41; CI95% = 0.21–0.82; P < 0.001).Conclusions. This study affirms the hypothesis that animal-derived foods can beetiologically linked to mouth and oropharyngeal cancer. This information can guidepolicies to prevent these diseases, generating public health benefits.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection

OBJECTIVE: This study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma. MATERIAL AND METHODS: Forty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings. RESULTS: 1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95 percent confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95 percentCI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7). CONCLUSIONS: The prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.

Evaluation of the quality of life of patients with oral cancer in Brazil

This study performed a field trial of a Portuguese version of the University of Washington quality of life questionnaire (UW-QOL, 3rd version), aiming at appraising its ability to identify different patterns of health-related quality of life of patients with oral cancer in Brazil. Patients (N = 100) were interviewed as they were undergoing treatment for oral squamous cell carcinoma at a large Brazilian hospital ("Hospital das Clínicas", School of Medicine, University of São Paulo). The results were compared based on categories of socio-demographic and clinical characteristics of the patients. At a one-year follow-up, 20 patients had died, and 24 were considered dropouts. The remaining patients accounted for the longitudinal assessment of modifications in the self report of quality of life. Patients with larger tumours and neoplasms in the posterior part of the mouth presented significantly (p < 0.05) poorer indications of quality of life. Chewing was the poorest rated domain (35.0/100.0), and presented the highest proportion of complaints both at the baseline and at the follow-up assessments. The questionnaire allowed the identification of important contrasts (while comparing clinical characteristics) and similarities (while comparing socio-demographic status) among subsets of respondents, and it can contribute to reduce the impact of treatments and improve subsequent patient management.

O presente estudo realizou teste de campo para uma versão em Português do questionário de qualidade de vida da Universidade de Washington (UW-QOL, 3ª versão), com o intuito de avaliar sua capacidade em descrever padrões diferenciais de qualidade de vida de pacientes com câncer de boca no contexto brasileiro. Foram entrevistados 100 pacientes com carcinoma epidermóide oral no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os resultados foram comparados por características sócio-demográficas e clínicas dos pacientes. Após um ano, 20 pacientes haviam falecido e 24 não foram localizados. A re-entrevista dos demais permitiu o acompanhamento longitudinal de modificações na auto-avaliação de qualidade de vida. Pacientes com tumores maiores e neoplasia na porção posterior da boca apresentaram indicadores de pior qualidade de vida (p < 0.05). Mastigação foi o item com pior avaliação (35,0/100,0) e maior proporção de queixas, tanto na avaliação inicial como no seguimento longitudinal. O questionário permitiu identificar relevantes contrastes (na comparação de características clínicas) e similaridades (na comparação de características sócio-demográficas) entre os grupos de respondentes. Seu uso regular no hospital pode contribuir para reduzir o impacto das aplicações terapêuticas e aprimorar a gestão dos tratamentos.