Conservative treatment of breast cancer: validation of tools for qualitative and quantitative evaluation

Abstract

Breast cancer is the main cancer in the female population. Despite advances in diagnosis and treatment, in Brazil the diagnosis is frequent made at advanced stages, making treatment more complex with is associate to a high morbidity and mortality. Likewise, the increase in the therapeutic arsenal determined the increase of the survival as well as the sequelae related to the treatment. There is an increase of the conservative treatment of breast and the oncoplastic techniques, since it is associated with radiotherapy. Although the sentinel lymph node technique is more used, the high number of advanced tumors determines the high incidence of axillary lymph node dissection. The high incidence of breast cancer associated with the increase rate of cure, let to an increase number of survival, a fact that makes us reflect about the careful assessment of treatment-related sequelae. The main complications are: 1) Changes due to axillary lymphadenectomy, i.g., paresthesia, paresis , lymphedema and changes in shoulder mobility ; 2) Changes in the breast, i.g., the deformities resulting from conservative surgical treatment , the radiodermatitis, the breast pain, and asymmetries in mastectomies, 3) Emotional and sexual changes. Besides all these factors described, the time is a factor associated with changes in body aesthetics, since over time, the cosmetic results for conservative surgery may be worsen. Another fact that comes to the worse surgical outcomes is radiotherapy, as it causes chronic changes in breast tissue, and irradiated sites such as the brachial plexus, which are accentuated over the years. Some of these consequences can be alleviated, making it necessary the association of physical therapy. Likewise, the oncoplastic techniques increase its space, allowing new approach in the treatment of early breast cancer, associated with correction of asymmetries determined by treatment. The identification and quantification of these changes is of fundamental importance, improving our knowledge, associated with the enhancement of the discussion forward the quality of life, rehabilitation and need for surgical enhancement. From a qualitative point of view, the quality of life questionnaires EORTC- QLQ -30 and QLQ -23 are frequent used, but a lack of studies evaluating exclusively conservative surgical treatment. The BCTOS questionnaire (Breast Cancer Treatment Outcomes Scale) is not validated for the Portuguese language, making a qualitative evaluation. For quantitative evaluation, there are different methods of evaluation and high discrepancy related to the results. Clinical evaluation can be subjective, making necessary a global standard of measurement. In the assessment of lymphedema, we have the volumetry, the circular simple measurement, the calculation of circular or elliptical frustrum and bioimpedance spectroscopy. In the assessment of shoulder joint motion, and we electromyography (EMG), in assessing the strength we have the dynamometer and electromyography (EMG), and to evaluate the sensitivity esthesiometer. As auxiliary software's we have the BCCT.core® (Breast Cancer Conservative Treatment. Cosmetic Results) and the Fisimetrix®. There are limited studies combining qualitative and quantitative methodologies, primarily in Brazilian population. Quantitative and qualitative assessment by a single researcher using high sample (n = 280), associated with the correlation of findings will aid the evaluating and quantification of treatment-related sequelae, and it will organize parameters for the evaluation of treatment-related sequelae of cancer breast. (AU)