Qualidade de vida relacionada à saúde de sobreviventes de câncer de mama: revisão de escopo e modelo para orientar discussões clínicas

Abstract

Women who survive breast cancer face several challenges that can affect their health-related quality of life (HRQoL). The aim was to map the available evidence on HRQoL in women who are breast cancer survivors, considering the three phases of survival; to describe the experience of transition in breast cancer; and to propose a model for clinical discussions on HRQoL in breast cancer survivors, in light of Afaf Meleis9 Theory of Transitions. This is a scoping review with a consultation exercise. In the first phase, a scoping review was performed based on the Joanna Briggs Institute methodology, including all types of studies, with no restrictions on date or language. The report of this review was conducted in accordance with PRISMA guidelines. Seven databases and one electronic repository were consulted, in addition to gray literature. The search, selection, and extraction of data were conducted independently by two reviewers using Rayyan software. In the second phase, the consultation exercise was conducted through qualitative research, using the Authors and Consumers Together Impacting on Evidence framework. The report of this study followed the COREQ criteria. This phase was divided into two stages, involving consultations with experts, survivors, and health professionals. The experts formed the review team, participating continuously throughout the process. Data collection took place between September 2024 and March 2025 at the Mastology Clinic of the Assis Chateaubriand Maternity School of the Federal University of Ceará (MEAC/UFC). Twelve breast cancer survivors and four health professionals were interviewed, with the interviews being recorded, transcribed, and analyzed from the perspective of Meleis9 Theory of Transitions. Based on the findings in the literature and the data from the interviews, a model was designed to aid clinical discussions, which was presented to stakeholders for analysis. The study was approved by the MEAC/UFC Research Ethics Committee. The results were compiled in the form of a collection, including two scientific articles. A total of 134 articles and 12 records from the gray literature were included. The studies were carried out in 38 countries, with the majority conducted in Brazil (21.2%) and the United States (17.1%). After content analysis, four categories were identified that reflect the HRQoL of breast cancer survivors. The survivors were between 38 and 76 years old, and the health professionals were between 40 and 52 years old, with an average of 19 years of training. The study critically analyzed the transitions experienced by these women, highlighting that their experience evolves throughout the three phases of survival. Meleis9 Theory of Transitions allowed us to understand the factors that influence HRQoL at each stage. The proposed model is structured around these three phases, addressing specific symptoms, challenges, and needs. The literature shows that breast cancer survival is a complex and individualized process. HRQoL tends to improve after an initial decline, although some survivors face persistent difficulties. Diagnosis and treatment represent interconnected transitions that affect HRQoL at different points in the journey.