The impact of the oncological treatment on the quality of life of elderly with breast cancer assisted by the brazilian Public Health System

Keywords: aged, breast câncer, quality of life, medication adherence, drug interactions

Abstract

Aims: to evaluate the quality of life (QV), drug interactions and adherence to treatment in elderly patients with breast cancer who did cancer treatment through the brazilian Public Health System (SUS).
Methods: prospective cohort, with six months of follow-up, which included elderly patients with breast cancer treated at the University Hospital of Porto Alegre and assisted by the SUS. Women aged ≥ 60 years were selected, divided into two groups (60-69 years and ≥ 70 years).
Results: thirty-eight patients were included in the QV and treatment adherence analysis. Within the molecular classification, the most diagnosed subtypes were Luminal B/Her2- (34,2%), Luminal A (26,3%), Luminal B/HER2+ (21,1%). Physical symptoms most related to the disease, at the time of the diagnosis, were insomnia, musculoskeletal stiffness, concerns regarding other people and the future. In contrast, six months later the less favorable results were fatigue, nausea and vomit, dyspnea, pain, inappetence, constipation, diarrhea, financial issues, systemic treatment adverse events, symptoms in the breasts and arms, and alopecia. Low treatment adherence was identified in 67.6% of patients. Polypharmacy was evidenced in 60.6%, and at least one potential drug interaction was observed in 78.8% of the sample. The average of medicines used was 7.24 (SD= 3.77). 
Conclusions: this study demonstrated the importance of monitoring the elderly population with breast cancer that uses chemotherapy, in order to understand the implications of senescence, as well as improve the rates of adherence to therapy and the quality of life of this population.

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Author Biographies

Bárbara Zanesco Moehlecke, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Graduanda em Medicina pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil.

Renan Oliveira de Melo, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Graduando em Medicina pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil.

Daiana Renck, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Doutora em Biologia Celular e Molecular pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil; mestre em Biologia Celular e Molecular pela PUCRS, em Porto Alegre, RS, Brasil. Farmacêutica no Centro de Pesquisa Clínica do Hospital São Lucas da PUCRS, em Porto Alegre, RS, Brasil.

Victoria Aumann, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Mestranda em Medicina e Ciências da Saúde pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil; farmacêutica pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS.

Mathias André Kunde, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Médico pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil.

Angélica Regina Cappellari, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Doutora em Ciências Biológicas: Bioquímica pela Universidade Federal do Rio Grande do Sul (UFRGS), em Porto Alegre, RS, Brasil; mestre em Ciências Biológicas: Bioquímica pela UFRGS, em Porto Alegre, RS, Brasil. Bióloga supervisora de Pesquisa & Desenvolvimento no Biovel - Laboratório de Análises e Pesquisa Clínica, em Cascavel, PR, Brasil. 

Paula Engroff, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Doutora em Gerontologia Biomédica pela Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), em Porto Alegre, RS, Brasil. Farmacêutica no Laboratório de Bioquímica e Genética Molecular do Instituto de Geriatria e Gerontologia da PUCRS, em Porto Alegre, RS, Brasil.

Fernanda Bueno Morrone, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.

Doutora em Ciências Biológicas: Bioquímica pela Universidade Federal do Rio Grande do Sul (UFRGS), em Porto Alegre, RS, Brasil; mestre em Ciências Biológicas: Bioquímica pela UFRGS, em Porto Alegre, RS, Brasil. Professora titular da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) em Porto Alegre, RS, Brasil. 

References

Momenimovahed Z, Salehiniva H. Epidemiological characteristics of and risk factors for breast cancer in the world. Breast Cancer (Dove Med Press). 2019;11:151-64.

Koo MM, von Wagner C, Abel GA, McPhail S, Rubin GP, Lvratzopoulos G. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer Epidemiol. 2017;48:140-146.

Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Poortmans P, et al. Breast cancer. Nat Rev Dis Primers. 2019;5(1):66

Bidoli E, Virdone S, Hamdi-Cherif M, Toffolutti F, Taborelli M, Panato C, et al. Worldwide Age at Onset of Female Breast Cancer: A 25-Year Population-Based Cancer Registry Study. Sci Rep. 2019; 9(1):14111.

International Agency for Research on Cancer. Estimated number of incident cases and deaths worldwide, both sexes, all ages [Internet]; 2020 [citado em 27 set. 2021]. Disponível em: https://gco.iarc.fr/today/online-analysis-map.

International Agency For Research on Cancer. Estimated number of incident cases from 2018 to 2040, breast, females, all ages [Internet]. Global Cancer Observatory: Cancer Tomorrow. Lyon, France; 2020 [citado em 27 set. 2021]. Disponível em: https://gco.iarc.fr/tomorrow/graphicisotype?type=0&type_sex=0&mode=population&sex=2&populations=76&cancers=20&age_group=value&apc_male=0&apc_female=0&single_unit=500000&print=0.

Gragnolati M, Jorgensen OH, Rocha R, Fruttero A. Growing old in an older Brazil: implications of population aging on growth, poverty, public finance, and service delivery (English) [Internet]; 2011. Directions in development; human development Washington, D.C.: World Bank Group. [citado em 10 nov. 2021]. Disponível em: http://documents.worldbank.org/curated/en/906761468226151861/Growing-old-in-an-older-Brazil-implications-of-population-aging-on-growth-poverty-public-finance-and-service-delivery.

Ince Yenilmez, M. Economic and Social Consequences of Population Aging the Dilemmas and Opportunities in the Twenty-First Century. Appl Res Qual Life. 2015;10:735-52.

Instituto Nacional de Câncer José Alencar Gomes da Silva. A situação do câncer de mama no Brasil: síntese de dados dos sistemas de informação. Instituto Nacional de Câncer José Alencar Gomes da Silva. Rio de Janeiro: INCA; 2019. 85 p.

Benz CC. Impact of aging on the biology of breast cancer. Crit Rev Oncol Hematol. 2008;66(1):65-74.

Heer E, Harper A, Escandor N, Sung H, McCormack V, Fidler-Benaoudia MM. Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. Lancet Glob Health. 2020;8(8):E1027-37.

Purushotham A, Bains S, Lewison G, Szmukler G, Sullivan R. Cancer and mental health-a clinical and research unmet need. Ann Oncol. 2013;24(9):2274-78.

World Health Organization. WHOQOL: Measuring Quality of Life [Internet]; 2012 [citado em 30 set. 2021]. Disponível em: https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/#:~:text=WHO%20defines%20Quality%20of%20Life,%2C%20expectations%2C%20standards%20and%20concerns.

Beltrán-Sánchez H, Soneji S, Crimmins EM. Past, Present, and Future of Healthy Life Expectancy. Cold Spring Harb Perspect Med. 2015;5(11):a025957.

Institutional Repository for Information Sharing. Health Indicators: Conceptual and operational considerations [Internet]. Pan American Health Organization: Washington, DC; 2018 [citado em 30 set. 2021]. Disponível em:

https://www.paho.org/hq/index.php?option=com_content&view=article&id=14401:health-indicators-conceptual-and-operational-considerations-section-1&Itemid=0&lang=pt.

Gal O, Catherine Terret. Early Breast Cancer in the Elderly: Characteristics, Therapy, and Long-Term Outcome. Oncology 2018;94(1):35-45.

Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I, et al. Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics (Sao Paulo). 2011;66(11):1867-72.

Michels FAS, Latorre M, Maciel MDS. Validity, reliability and understanding of the EORTC-C30 and EORTC-BR23, quality of life questionnaires specific for breast cancer. Rev Bras Epidemiol. 2013;16(2):352-63.

Luvisaro BMO, Menezes JR, Rodrigues CF, Soares ALAG, Muzi CD, Guimarães RM. Conceptual equivalence of items and semantic equivalence of the Brazilian version of the EORTC QLQ-ELD14 instrument to evaluate the quality of life of elderly people with cancer. Rev Bras Geriatr Gerontol. 2017;20(1):20-33.

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. MedCare. 1986;24(1):67-74.

United Nations. World Population Prospects 2019 [Internet]; 2019 [citado em 17 nov. 2021]. Disponível em: https://population.un.org/wpp.

Tesarova P. Breast cancer in the elderly: Should it be treated differently? Rep Pract Oncol Radiother. 2013;18(1):26-33.

Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Prz Menopauzalny.2015;14(3):196-202.

Cronin KA, Harlan LC, Dodd KW, Abrams JS, Ballard-Barbash R. Population-based Estimate of the Prevalence of HER-2 Positive Breast Cancer Tumors for Early Stage Patients in the US. Cancer Invest. 2010;28(9):963-8.

Li CI, Malone KE, Daling JR. Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomarkers Prev. 2002;11(7):601-7.

Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, et al. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015 Mar 30;107(6):djv048.

Chu WO, Dialla PO, Roignot P, Bone-Lepinoy MC, Poillot ML, Coutant C, et al. Determinants of quality of life among long-term breast cancer survivors. Qual Life Res. 2016; 25(8):1981-90.

Ng CG, Mohamed S, See MH, Harun F, Dahlui M, Sulaiman AH, et al. Anxiety, depression, perceived social support and quality of life in Malaysian breast cancer patients: a 1-year prospective study. Health Qual Life Outcomes. 2015 Dec 30;13:205.

Arraras JI, Manterola A, Asin G, Illarramendi JJ, Cruz Sde L, Ibañez B, et al. Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study. Breast. 2016;26:46-53.

Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10(3).

Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D. Predictors of quality of life of breast cancer patients. Acta Oncol.2003;42(7):710-18.

Jorge LL, da Silva SR. Evaluation of the quality of life of gynecological cancer patients submitted to antineoplastic chemotherapy. Rev Latino-Am Enfermagem. 2010;18(5):849-55.

Salonen P, Kellokumpu-Lehtinen PL, Tarkka MT, Koivisto AM, Kaunonen M. Changes in quality of life in patients with breast cancer. J Clin Nurs. 2010;20(1-2):255-66.

Villar RR, Fernández SP, Garea CC, Pillado MTS, Barreiro VB, Martín CG. Quality of life and anxiety in women with breast cancer before and after treatment. Rev Lat Am Enfermagem. 2017 Dec 21;25:e2958.

Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011 Apr;126(2):529-37.

Díaz-Carrasco MS, Almanchel-Rivadeneyra M, Tomás-Luiz A, Pelegrín-Montesinos S, Ramírez-Roig C, Fernández-Ávila JJ. Observational study of drug-drug interactions in oncological inpatients. Farm Hosp. 2018 Jan 1;42(1):10-5.

Fernández de Palencia Espinosa MÁ, Díaz Carrasco MS, Sánchez Salinas A, de la Rubia Nieto A, Miró AE. Potential drug-drug interactions in hospitalised haematological patients. J Oncol Pharm Pract. 2017 Sep;23(6):443-53.

Nightingale G, Pizzi LT, Barlow A, Barlow B, Jacisin T, McGuire M, Swartz K, Chapman A. The prevalence of major drug-drug interactions in older adults with cancer and the role of clinical decision support software. J Geriatr Oncol. 2018 Sep;9(5):526-33.

Published
2022-06-23
How to Cite
Moehlecke, B. Z. ., Melo, R. O. de, Renck, D., Aumann, V., Kunde, M. A., Cappellari, A. R., Engroff, P., & Morrone, F. B. (2022). The impact of the oncological treatment on the quality of life of elderly with breast cancer assisted by the brazilian Public Health System. PAJAR - Pan American Journal of Aging Research, 10(1), e43014. https://doi.org/10.15448/2357-9641.2022.1.43014