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Breast ; 36: 67-73, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28992556


PURPOSE: To evaluate the incidence and risk factors of lymphedema 10 years after surgical treatment for breast cancer. METHODS: Prospective observational hospital-based cohort of women undergoing axillary lymph node dissection. Lymphedema was assessed by indirect volume, measured by circumference, and diagnosed if there was a difference of 200 mL between the arms or if the patient was treated for it. Independent variables were patient, tumour and treatment characteristics. Descriptive statistics were conducted as survival analysis using the Kaplan-Meier estimate. Cox regression was performed, considering a 95% confidence interval (95%CI). RESULTS: The study evaluated 964 women. The cumulative incidence of lymphedema observed was 13.5% at two years of follow-up, 30.2% at five years and 41.1% at 10 years. Final model showed an increased risk for lymphedema among women that underwent radiotherapy (HR = 2.19; 95%CI 1.63-2.94), were obese (HR = 1.52; 95%CI 1.20-1.92), had seroma formation after surgery (HR = 1.46; 95%CI 1.14-1.87), underwent chemotherapy infusion in the affected limb (HR = 1.45; 95%CI 1.12-1.87) or advanced disease staging (HR = 1.41; 95%CI 1.11-1.80). CONCLUSIONS: Cumulative incidence of lymphedema was 41.1%. Women undergoing axillary radiotherapy, obese, who developed seroma, underwent chemotherapy infusion in the affected limb and with advanced disease had a higher risk of lymphedema.

Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Adulto , Idoso , Antineoplásicos/administração & dosagem , Braço , Axila , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Incidência , Infusões Intravenosas , Linfedema/etiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Prospectivos , Radioterapia Adjuvante , Fatores de Risco , Seroma/epidemiologia , Índice de Gravidade de Doença
Health Qual Life Outcomes ; 13: 119, 2015 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-26246238


BACKGROUND: Multiple sclerosis (MS) is a chronic disease associated with several impacts; especially regarding patients' health-related quality of life (HRQL). EuroQol 5 Dimensions questionnaire (EQ-5D) provides self-reported analysis of HRQL and utility scores. Although the British algorithm to convert EQ-5D responses into utility is the most used in the literature, national settings is more appropriate for health policy decision makers. A Brazilian algorithm is available, but not used in MS patients yet. Primarily, this study aimed to address potential differences in utility scores obtained through Brazilian and British value sets. Secondary objective was to determine the role of disability, fatigue and patients socio-demographic and clinical characteristics relevant to MS on the utility scores reported by Brazilian patients. METHODS: Cross-sectional study with MS patients treated in 8 Brazilian sites. Patients were interviewed about socio-demographic and clinical characteristics, self-reported disability level, HRQL and impact of fatigue on daily living. Disability level, HRQL and impact of fatigue were assessed using the Expanded Disability Status Scale (EDSS) and the Brazilian versions of EQ-5D-3 L and Modified Fatigue Impact Scale (MFIS-BR), respectively. Patients were classified in subgroups according to EDSS (mild: 0-3; moderate: 4-6.5; severe: >7) and the self-perceived impact of fatigue (absent: ≤ 38 points; low: 39-58; high: ≥ 59). EQ-5D-3 L data was converted into a utility index using an algorithm developed by a Brazilian research group (QALY Brazil) and also the UK algorithm. Differences between utility scores were analysed through Wilcoxon test. RESULTS: Two hundred and ten patients were included in the study. Utility index mean scores of 0.59 (SD = 0.22) and 0.56 (SD = 0.32) for the Brazilian and UK algorithms were observed, respectively, without statistically significant difference for the distribution of data (p = 0.586). However, when utility scores were lower than 0.5, Brazilian algorithm provided higher estimates than UK with a better agreement between the scores found closer to 1. The same trend was observed when data was stratified for EDSS and impact of fatigue, with statistically significant difference between scores in categories of mild/severe disabilities and absent/high impact of fatigue. CONCLUSIONS: Results suggest that Brazilian value set provided higher utility scores than the UK, particularly for measures below 0.5.

Esclerose Múltipla/psicologia , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Adaptação Psicológica , Adulto , Algoritmos , Brasil , Estudos Transversais , Fadiga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/terapia , Medição da Dor/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes