CC BY
6з В1Л-шфекщею. Вюник проблем бюлогп i меди-цини. 2019. Вип.4. Т. 2(154). - С. 168-171. https://doi.org/ 10.29254/2077-4214-2019-4-2-154168-171
5. Огоренко В.В., Гненна О.М Аналiз ефектив-носп впливу комплексного л^вання на психолоп-чну адаптацiю у пащенпв з вiрусом iмунодефiциту людини. Вiсник проблем бюлогп i медицини. 2021. Вип.1(159). - С. 101-105.
https://doi.org/10.29254/2077-4214-2021-1-159-101-105
6. Психологическая диагностика отношения к болезни: пособие для врачей. / Л. И. Вассерман i др. СПб.: СПб НИПНИ им. В.М. Бехтерева, 2005. - 32с.
7. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2020. URL: https://www.R-project.org/ (appeal date: 15.09.2021).
INTEGRATED INDIEX "QUALITY OF LIFE" IN WOMEN WITH BREAST CANCER
Savenkov O.
Oncologist, graduate student of the Department of Surgery 1 of the
Dnieper State Medical University
Abstract
The aim of the study was to determine an integrated indicator of quality of life in women who underwent surgery for breast cancer.
Research methods. In our study, we consider quality of life as a criterion for evaluating the effectiveness of treatment. In cases where radical interventions are used (eg surgery), an important result is the patient's subjective assessment of their condition, which can vary widely depending on the side effects of the intervention (emotional state of the woman after radical mastectomy). The study involved 77 women, who were divided into II groups: the main group (34) and control group (43).
This result suggests that patients who used intraoperative ICG-technology lymph node imaging, both primary (food, income, medical care, sexual pleasure) and secondary needs (maintaining social contacts, self-esteem, self-expression) [9] are generally rated higher than women after radical surgery with full regional lymph node dissection, although no statistically significant differences in the assessment of quality of life in the main and control groups were found.
At the same time, priority is given to the restoration of social and labor activity, taking into account the individual characteristics of the person and the course of the disease.
Keywords: "quality of life", intraoperative ICG-technology, breast cancer.
The concept of quality of life assessment involves finding and applying the optimal combination of informative (including social) markers to analyze both the course of the disease and the effectiveness of therapeutic and rehabilitation measures. Social indicators of quality of life should not be considered arbitrary formulations, but a hypothesis that needs to be corrected to determine the degree of well-being and social functioning of a particular person in a particular society in a particular sociological context [4].
Quality of life indicators, which are determined by health status, usually reflect the level of functioning of the subject and his subjective perception of his health and / or well-being, which characterizes two fundamental properties of quality of life - multicomponentity and subjectivity of its assessment [3]. In this regard, the concept of quality of life can be involved in a number of factors, in particular, physical, mental and social aspects of human life. On the other hand, quality of life is a certain integrated outcome indicator, which depends on the severity of the disease and the impact of therapeutic measures, so its important aspect is the ability to quantify the deterioration or improvement of patients as a result of treatment or rehabilitation [7].
Quality of life is an index of the effectiveness of rehabilitation programs. The study of the patient's quality of life allows to monitor the patient's condition during rehabilitation, to distinguish between complications
in the course of the disease and side effects of treatment. Based on data on quality of life, comprehensive rehabilitation programs for various diseases can be developed. The possibility of recovery of the patient and effective socialization are largely determined by the quality of life of the patient in the stages of rehabilitation [1, 2].
The value of quality of life assessment in clinical practice is determined by two circumstances. First, a direct link between the course of the disease and quality of life does not always exist, because it is largely determined by the patient's subjective perceptions of the severity of his disease, as well as its possible consequences. At the same time, the need to reduce labor activity, the threat of disability and changes in life habits are important. Secondly, quite often the assessment of the effectiveness of therapy by the doctor and his patient may not coincide. Thus, for a doctor, a successful operation in cancer is considered evidence of a good treatment effect, while patients report improvement in less than half of cases [8].
Thus, the aim of the study was to determine an integrated indicator of quality of life in women who underwent surgery for breast cancer.
Research methods. The method of assessing the quality of life associated with health has a wide range of possibilities. In our study, we consider quality of life as a criterion for evaluating the effectiveness of treatment. In international clinical practice, a lot of research
is devoted to the analysis of the quality of life of patients by assessing the effectiveness of treatment - numerous drug therapy programs and combination therapies. In cases where radical interventions are used (eg surgery), an important result is the patient's subjective assessment of their condition, which can vary widely depending on the side effects of the intervention (emotional state of the woman after radical mastectomy). In this regard, quality of life is one of the main indicators of successful treatment [5]. The study involved 77 women, who were divided into II groups: the main group (34) and control group (43).
Research results. According to research, the main disabling effect is caused not by breast cancer itself, but
Table 1
Quality of life indexes of patients after treatment of early forms of breast cancer on the scales of the questionnaire SF-36, points (M ± m)
by radical treatment, which leads to the development of persistent psychosocial maladaptation, which is larger and different in nature and significantly different from disability in many other cancers. In a detailed study of the most constructive mechanisms of psychological protection in women after radical treatment of breast cancer, it was found that mental disorders in the form of complicated reactions of grief and severe loss occur in 96.1% of cases [6].
The average quality of life on the scales of the questionnaire SF-36 in the main and control groups, obtained in our study, are presented in table 1 and in Fig. 1.
Index Main group (n=34) Control group (n=43)
Physical functioning (PF) 48,9 ± 4,83 40,9 ± 4,92
Role-functioning (RP) 32,6 ± 3,14 23,7 ± 2,74
Bodily pain (BP) 62,5 ± 6,38 56,0 ± 6,03
General health (GH) 66,5 ± 6,82 61,0 ± 6,28
Vitality (VT) 50,2 ± 5,16 43,5 ± 4,31
Social functioning (SF) 79,1 ± 8,14 67,3 ± 6,84
Role-Emotional (RE) 46,5 ± 4,76 41,0 ± 4,43
Mental health (MH) 58,7 ± 6,13 52,4 ± 5,38
Physical Functioning (PF) is defined by the respondents' subjective assessment of the amount of their daily physical activity as heavy (running, lifting heavy objects, etc.), moderate (moving a chair, working with a vacuum cleaner, etc.) or light (leaning, dress, etc.), ie expressed in the willingness to engage in active motor activity. Low scores on this scale indicate that the respondent's physical activity is limited by his health.
Our results show that the PF of patients who used the technology of intraoperative ICG-imaging of the sentinel lymph node, 15.7% higher (p> 0.05) than women with early forms of breast cancer, who, along with radical surgery performed full regional lymph dissection (Table and Fig. 1), ie patients of the main group are more physically resilient than women in the control group.
Fig. 1. Indicators of quality of life ofpatients after treatment of early forms of breast cancer on the scales of the
questionnaire SF-36, points
Role-functioning due to the physical condition of the Russian Federation (RP - Role-Physical Functioning) is a subjective assessment by respondents of the degree of limitation of their daily activities (the amount of time spent on work; limitation of any activity, etc.). Low scores on this scale indicate that daily activity is limited by the physical condition of the respondent. It is shown that the RF of the main group of patients is 27.3% higher (p> 0.05) than women of the control group (Table and Fig. 1), although this difference is a trend.
Pain is an integrative function of the body that mobilizes its various physiological systems to protect against the effects of aggressive environmental factors. Low scores on the scale of pain intensity (BP - Bodily Pain) indicate that pain significantly limits the activity of the respondent. It is noted that the value of the BP index in the group of women after radical surgery with a full volume of regional lymph dissection is 6.5 points (10.4%, p> 0.05) lower than in patients who used intraoperative ICG technology: 56.0 and 62.5 points, respectively
The General Health (GH) questionnaire of the SF-36 questionnaire suggests that respondents subjectively rate it as "excellent", "very good", "good", "mediocre" and "bad". In addition, respondents should make an evaluation judgment based on the phrase "My health is not worse than most of my acquaintances" in five grades and indicate whether their physical (emotional) state during the last month prevented them from spending free time with family, friends or with the colleagues. The lower the score on this scale, the lower the subjective assessment of the health of the respondent. We found that the subjective assessment of their GH by patients of the main and control groups in the age range of 27-69 years did not have a statistically significant difference (Table and Fig. 1). We believe that a key factor in this approach to assessing one's health is the statement "My health is not worse than that of most of my acquaintances", according to which respondents expressed their opinion.
Viability - the degree of human adaptation to life, to fluctuations in living conditions. According to the SF-36 questionnaire, the vital activity (VT-Vitality) involves a feeling of inspiration and energy or, conversely, exhaustion. Low scores on this scale indicate the respondent's fatigue, decreased vital activity. The results of our study found that the viability of patients who used intraoperative ICG-technology, 6.7 points (13.3%, p> 0.05) higher than in the group of women after radical surgery with full volume regional lymph dissection (Table and Fig. 1), which are more difficult to adapt to changes in living conditions.
Social functioning (SF) is determined by the degree of restriction of social activity of the respondent by his physical or emotional state, which interferes with communication with family, friends, neighbors or in the team. Low SF scores indicate a significant limitation of social contacts (communication). It is shown
that the level of SF of women in the control group is 6.5 points (10.4%, p> 0.05) lower than in patients of the main group, ie their physical and emotional state to a greater extent interferes with communication. Given that the scales "physical functioning", "role functioning due to physical condition" and "pain" in women with full regional lymph node dissection are also lower than in the group of patients using intraoperative ICG technology, it is possible predict their lower social activity. The decrease in social activity indicates a prolonged effect of traumatic experiences and changes in the internal perception of their social status.
Role-emotional functioning (RE - Role-Emotional) involves a subjective assessment of the degree to which the emotional state causes difficulty in performing work or other daily activities. Low scores on this scale are interpreted as restrictions on daily activities due to the emotional state of the respondent. According to our results, the index of RF in the group of patients using the technique of intraoperative visualization of the signal lymph node is 11.8% (p> 0.05) higher (46.5 points) than in the control group (41.0 points) table and Fig. 1.
According to the WHO, Mental Health is positioned as a state of well-being in which a person can realize his or her own potential, cope with normal life stresses, work productively and productively, and contribute to the life of his or her community. Software is a very important part of a person's quality of life related to health. This is primarily due to the fact that in the human body all systems and organs are interconnected, act on each other and are largely under the control of the central nervous system, so the software affects the work of each of the functional systems, and the state of the latter, in turn, affects mental health. MH (self-assessment of a person's psychological status) respondents rated the concepts of peaceful and happy. The first means that the person is calm, not confused and does not feel anxiety, the second - the respondent is in a state of emotional comfort when his basic needs (physical and spiritual) are met. We found that the rate of assessment of their mental health in patients of the main group was 6.3 points higher (10.7%, p> 0.05) than in women of the control group: 58.7 and 52.4 points.
This result suggests that patients who used intraoperative ICG-technology lymph node imaging, both primary (food, income, medical care, sexual pleasure) and secondary needs (maintaining social contacts, self-esteem, self-expression) [9] are generally rated higher than women after radical surgery with full regional lymph node dissection, although no statistically significant differences in the assessment of quality of life in the main and control groups were found.
Conclusion. The current concept of quality of life, relevant to health, for women with breast cancer is based on a comprehensive study and assessment of key clinical, psychological and social indexes. At the same time, priority is given to the restoration of social and labor activity, taking into account the individual characteristics of the person and the course of the disease.
References
1. Анохина И.В., Зикиряходжаев Д.З. Мест-нораспространённый рак молочной железы - современное состояние вопроса. Вестник Авиценны. -2016. - № 3 (68). - С. 104-110.
2. Букейханов Н.Р., Гвоздкова С.И., Ники-шечкин А.П. Иерархия потребностей А. Маслоу и потребность в управлении. Российские регионы: взгляд в будущее. 2017;4(4):15-28.
3. Евсина О.В. Качество жизни в медицине -важный показатель состояния здоровья пациента (обзор литературы). Личность в меняющемся мире: здоровье, адаптация, развитие. 2013. № 1. С. 119133.
4. Лобанов Ю.Ф., Скударнов Е.В., Строзенко Л.А., Прокудина М.П., Каракасекова М.К., Печкина К.Г. Качество жизни как проблема в здравоохранении: современные тенденции // Международный журнал прикладных и фундаментальных исследований. - 2018. - № 5-1. - С. 235-239.
5. Сперанский Д.Л., Ткаченко Л.В., Вдовин С.В., Андреева М.В., Селихова М.С., Жаркин Н.А. Анализ показателей качества жизни больных раком молочной железы на этапах противоопухолевой терапии. Медицинский вестник Северного Кавказа. 2015;4(38):438-440.
6. Хетагурова А.К., Мирюсупова Г.Ф. Организация реабилитации больных после мастэкто-мии. Проблемы стандартизации в здравоохранении. 2018;5-6:31-35.
7. Chopra I, Kamal KM. A systematic review of quality of life instruments in long-term breast cancer survivors. Health Qual Life Outcomes. 2012;10:14. doi: 10.1186/1477-7525-10-14.
8. Ho PJ, Gernaat SAM, Hartman M, Verkooijen HM. Health-related quality of life in Asian patients with breast cancer: a systematic review. BMJ Open. 2018;8(4):e020512. doi: 10.1136/bmjopen-2017-020512.
