Funcionalidade de mulheres no pré e pós-operatório de cirurgias por câncer de mama

Abstract

Introduction: Breast cancer is the most common cancer among women, with breast surgery being the primary therapeutic option in most cases. These surgeries, along with adjuvant therapies, can induce physical, functional, and emotional alterations that negatively impact women's lives. The World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire assesses functionality across various populations and health conditions; however, its psychometric properties have not been tested for women with breast cancer undergoing surgeries. Furthermore, understanding functionality before and after surgeries is essential for better clinical decision- making and follow-up care for these women. Objectives: To evaluate the functionality of women with breast cancer by comparing functionality indicators in the pre- and post-operative phases and to test the psychometric properties of WHODAS 2.0 as a tool for assessing functionality/disability in women after breast cancer surgeries. Methods: A longitudinal observational study, concurrently with a validation study, was conducted. Sociodemographic and clinical data were collected, physical examinations were performed, and specific questionnaires were administered to analyze functionality (WHODAS) and quality of life (FACT-B+4). The research was carried out at three breast cancer patient care centers in Fortaleza/Brazil. Women aged 18 to 80 years with a diagnosis of breast cancer requiring mastectomy or quadrantectomy or who were 3 to 12 months post- surgery were included. Non-parametric hypothesis tests were used to compare functionality before and after surgeries. For WHODAS validation, psychometric properties were considered: internal reliability (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient - ICC), construct validity, and convergent validity (Spearman's correlation test). Results: Forty-seven women were included in the pre-operative phase and 95 in the post-operative phase, with a mean age of 53.12 (±11.10) years. Regarding functionality comparison, no significant differences were observed in WHODAS scores between pre-operative (20.94 ± 13.19) and post-operative (22.31 ± 14.67) phases, with the "mobility," "life activities" and "participation" domains showing higher levels of disability. Concerning WHODAS validation, results indicated satisfactory internal consistency for all domains and excellent test-retest reliability (ICC=0.87). Regarding construct validity, a strong negative correlation was observed between WHODAS and FACT-B+4 (ρ=−0.75). Convergent validity analysis showed correlations (between WHODAS and FACT-B+4 domains) ranging from weak to moderate, except for the "mobility" domain of WHODAS, which showed a strong correlation with the "physical well-being" domain of FACT-B+4. Conclusion: Significant variability in WHODAS scores was observed both before and during the first year after surgical treatment. The "mobility," "life activities" and "participation" domains are the ones showing higher levels of disability, especially after surgery, and should therefore be relevant outcomes for rehabilitation. WHODAS is a reliable and valid instrument for assessing functioning/disability in women with breast cancer after surgeries.