Health-related quality of life of cancer patients undergoing chemotherapy*

It is a cross-sectional study to evaluate the health-related quality of life in cancer patients undergoing chemotherapy, to identify the domains affected and associate them with sociodemographic and clinical-therapeutic features of the sample. It was performed with 152 patients between 2009 and 2011 in two centers of chemotherapy, in Ribeirão Preto, SP, Brazil. The instrument Quality of Life Questionnaire Core-30 was used. The general Quality of Life was considered good, the domains affected were: emotional and role function, pain, fatigue, insomnia and loss of appetite. Female patients, between 40 and 60 years, economically active, with gastric, lung, neurological and skin cancer, with metastasis, and patients who underwentsurgery and/or radiotherapy showed concomitant deficitsin several areasand the presence of more symptoms. We concluded that the cancer and its treatment somehow affected patients, causing more symptoms and deficits of the performed functions, jeopardizing their health-related quality of life. insomnio y pérdida de apetito. Pacientes del sexo femenino, entre 40-60 años, económicamente activos, con cáncer gástrico, pulmón, neurológico y piel, con metástasis y los pacientes que se sometieron a cirugía y/o radioterapia concomitante presentaran déficit en varias áreas y presencia de más síntomas. El cáncer y su tratamiento afectaran de alguna manera los pacientes, causando déficits en las funciones desarrolladas e más síntomas, perjudicando la Calidad de Vida Relacionada con la Salud.


Introduction
In the last decades, cancer acquired a broader dimension, being converted in an evident world public health problem. The estimates of incidence of cancer in Brazil for the year 2013 is 518,510 new cases, including skin cancer of the non melanoma type. The most frequent are the following cancers: non melanoma skin, prostate, lung, colon, rectum and stomach for the male sex; and for the female sex: non melanoma skin, breast, uterine cervical, colon, rectum and thyroid glandule (1) .
The objective of the treatment of cancer is the cure, to prolong life when there is no cure and to provide palliative care. When the treatment does not result in cure, it must lead to an improvement of the welfare and the quality of life (2) . Life (QL) of the patients with cancer (4) .
The technological advancement, in the scope of medical science, has provided a greater optimism in the treatment of cancer and an increase of the rate of surviving patients; therefore, it is necessary to evaluate the quality of life of these patients, while this is an important indicator of welfare (3) .
Health-related quality of life (HRQL) and its  (6) .
The QLQ-C30 is specific instrument of quality of life for patients with cancer, dully validated for the Brazilian population (8) . The instrument has 30 questions which make a scale of the General Council (HNC) (9) .

Result
The sample was composed of 152 patients with cancer. As to the socio-demographic characteristic,

Health-related quality of life
Regarding the psychometric characteristics of the instrument for the sample studied, Cronbach´s Alpha coefficient was 0.84, showing reliability of the instrument for this sample.  Association of the socio-demographic variables were made: sex, age, marital status, profession/ occupation and religion with each scale of the QLQ-C30 and the following statistically significant associations were found (p≤0,05): the female sex presented a worse score for the cognitive function than the male one; patients in the age range of 40 and 60 years old obtained higher scores meaning they presented more diarrhea and more financial difficulties than those of the other age ranges; retired and housewives presented a better (GCH/QL) and fewer symptoms of nausea and vomit than the economically active patients, as shown in Table 2.  who underwent radiotherapy had more symptoms of pain than the ones who did not undergo such therapy.

Discussion
The average of 74.91 for the GCH/QL showed that the patient with cancer undergoing chemotherapy, despite facing the diverse modifications in their lives due to the disease and the treatment, considered that their HRQL was good. They also reported as good their physical, cognitive and social functions and obtained a satisfactory result for the role and emotional functions; but still were attacked with symptoms of pain, fatigue, insomnia and loss of appetite and they also reported some financial difficulty.
The HRQL was analyzed in women with breast cancer undergone chemotherapy and average of 71.43 for the GCH/QL was found, which was also considered good, as well as the physical and social functions and they also presented deficits in the emotional function and more symptoms of nausea and vomit, fatigue, constipation and pain, besides reporting financial difficulties (3) . Another evaluation of HRQL of patients with cancer undergoing chemotherapy, also found a relatively good HRQL in the beginning of chemotherapy, however, after three to six months of treatment, it was observed that it was significantly worse and impairment in the sexual and physical functions was detected (2) . This research found that the women had the worse scores for the cognitive function. Literature shows that the highest impacts perceived by the women were in the sexual and emotional function, financial difficulties, besides the emerging of pain, fatigue, nausea and vomits (3) ; women with colorectal cancer presented the worse scores for the emotional and cognitive functions and with more symptoms of pain, insomnia, fatigue, constipation and loss of appetite than men (10) . Falta a referência 9Women with depression and fatigue after one year or more of chemotherapy and radiotherapy showed jeopardizing in their QL, with lower scores for sexual function and satisfaction and future perspectives (11) .
Regarding the age range, significant differences were found among the groups of age (3) , especially in the women (12) .
In the present study, the patients with gastric, lung, neurological and skin cancer presented more fatigue and the ones with neurological and lung cancer had more dyspnea. In another research made with oncological patients, the gastrointestinal cancer was the most common and the patients presented problems related to fear concerning the future, thought about the disease and its consequences, impatience and depression; HRQL was favorable in most patients and this study also found relation between fatigue and HRQL in the patients with chemotherapy treatment, that is, the more intense the fatigue was, the worse the HRQL was reported by the patients (4) . In another study which evaluated the HRQL of patients with the gliomas shows that this patients presented deficits in five functions of QLQ-C30 (emotional, social, cognitive, physical and functional), besides the presence of the symptoms of fatigue, pain, loss of appetite, insomnia and nausea and vomit (13) .
Studies evaluated that the HRQL of the patients with colorectal cancer undergoing chemotherapy found significant changes in the course of the treatment, with deficits in the cognitive, dyspnea, insomnia, constipation and diarrhea functions (14) , emotional, pain, insomnia and fatigue functions and the general QL as satisfactory (average = 79.13) (10) .
Factors which contributed for the decrease of HRQL were evaluated in women with gynecological cancer and they were divided into four subgroups (quartiles) according to the result of HRQL, it was found that, for the women whose total QL was in the inferior quartile (Q1), the result showed that the falls are due to the considerable differences in specific questions, including nauseas, pains sensation of malaise and being bothered by the side effects of the treatment.
they believe that the fact that practically there are no differences in the welfare among those subgroups of women, confirms the main hypothesis that harms in HRQL are specific for the disease and the treatment and they do not reflect a generalized deficiency of QL and that simple interventions that improve the physical symptoms can have great effects, thus improving other aspects of physical and functional welfar (15) .
The HRQL was evaluated in patients with non small cells lung cancer undergoing adjunctive chemotherapy and the alterations in the HRQL during chemotherapy were relatively small, with the worsening of the symptoms of fatigue, nausea and vomit, however there was a reduction in the pain and no change in the general HRQL. These results indicated that the negative effects of adjunctive chemotherapy in HRQL seem to be temporary and that the improvement is common in most patients (16) .  (19) .
Patients with cancer of head and neck who underwent radiotherapy treatment were affected with symptoms as fatigue and insomnia, besides reporting financial difficulties (5) . Women with cervical uterine cancer presented sexual disorder after radiotherapy (20) . In this research, the patients who underwent radiotherapy reported more pain than the others.

Conclusion
This study provided the evaluation of the