Perfil da qualidade de vida três meses ou mais após o término da radioterapia adjuvante utilizada para o tratamento do câncer de cabeça e pescoço em um Centro de Assistência de Alta Complexidade em Oncologia
10.15343/0104-7809.202145308317
Palavras-chave:
Neoplasias de Cabeça e Pescoço. Qualidade de Vida Relacionada à Saúde. Perfil de Impacto da Doença. Efeitos adversos. Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos.Resumo
O tratamento do câncer de cabeça e pescoço (CCP) é multimodal e pode gerar diferentes comprometimentos físicos e psicológicos. O objetivo do estudo foi avaliar o perfil da qualidade de vida dos pacientes com CCP, em busca de possíveis alvos terapêuticos que possam ser reabilitados. Trata-se de um estudo descritivo do tipo observacional transversal, desenvolvido em um Centro de Assistência de Alta Complexidade em Oncologia. Os dados foram coletados através da anamnese e do questionário de qualidade de vida da University of Washington (UW-QOL). A amostra foi composta por 68 pacientes com câncer de cabeça pescoço que realizaram radioterapia adjuvante há no mínimo 90 dias. Houve predomínio do sexo masculino (89%) e acometimento da orofaringe (69%). Além da radioterapia, 53% dos indivíduos também realizaram cirurgia e 65% quimioterapia. As funções estomatognáticas foram as mais afetadas, seguido por implicações negativas relacionadas às atividades de vida diária e de aspectos de ordem psicológica. De acordo com a natureza dos domínios apurados no questionário de vida UW-QOL, a baixa pontuação observada nas questões referentes à atividade de vida diária e nos componentes de avaliação do estado psicológico, é pertinente supor que as complicações tardias impostas tanto pela fisiopatologia do CCP quanto pelo tratamento antineoplásico devam ser abordadas por uma equipe multidisciplinar alinhados no objetivo sinérgico de reabilitar as funções estomatognáticas, a alimentação e a capacidade física. Embora nossos dados não sugiram comprometimentos emocionais, o apoio adicional do psicólogo, poderia ser cogitado com o objetivo de fortalecer e motivar o engajamento na reabilitação do complexo quadro clínico intrínseco ao CCP.
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Referências
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2. Epidemiologia do Câncer de Cabeça e Pescoço no Brasil: estudo transversal de base populacional. Rev Bras Cir Cabeça Pescoço. 2012; 41 (4): 186-91.
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4. Caccelli EMN, Rapoport A. Para-efeitos das irradiações nas neoplasias de boca e orofaringe.Rev Bras Cir Cabeça Pescoço. 2008; 7(4):198-201.
5. Bragante KC, Nascimento DM, Motta NW. Evaluation of acute radiation effects on mandibular movements of patients with head and neck cancer. Rev Bras Fisioter. 2012;16(2):141-7.
6. Wang X, Lv Y, Li W, Gan C, Chen H, Liu Y, et al. Correlation between Psychosocial Distress and Quality of Life in Patients with Nasopharyngeal Carcinoma following Radiotherapy. J Oncol. 2018;2018:3625302.
7. Wranicz P, Herlofson BB, Evensen JF, Kongsgaard UE. Prevention and treatment of trismus in head and neck cancer: A case report and a systematic review of the literature. Scand J Pain. 2010;1(2):84-8.
8. Van der Geer SJ, van Rijn PV, Kamstra JI, Roodenburg JLN, Dijkstra PU. Criterion for trismus in head and neck cancer patients: a verification study. Support Care Cancer. 2019;27(3):1129-37.
9. Deng J, Murphy BA, Dietrich MS, Wells N, Wallston KA, Sinard RJ, et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013;35(7):1026-35.
10. Carvalho AP, Vital FM, Soares BG. Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer. Cochrane Database Syst Rev. 2012(4):CD008693.
11. Morton RP, Izzard ME. Quality-of-life outcomes in head and neck cancer patients. World J Surg. 2003;27(7):884-9. Available from: doi: 10.1007/s00268-003-7117-2.
12. Høxbroe Michaelsen S, Grønhøj C, Høxbroe Michaelsen J, Friborg J, von Buchwald C. Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer. 2017;78:91-102.
13. Nguyen NA, Ringash J. Head and Neck Cancer Survivorship Care: A Review of the Current Guidelines and Remaining Unmet Needs. Curr Treat Options Oncol. 2018;19(8):44.
14. Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev. 2015(6):CD011006.
15. Calver L, Tickle A, Moghaddam N, Biswas S. The effect of psychological interventions on quality of life in patients with head and neck cancer: A systematic review and meta-analysis. Eur J Cancer Care (Engl). 2018;27(1).
16.Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, et al. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology. 2018;27(4):1150-61.
17. Chow R, Bruera E, Temel JS, Krishnan M, Im J, Lock M. Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis. Support Care Cancer. 2020;28(5):2071-8.
18. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012(8):CD007566.
19. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91- 104.
20. Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, et al. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018;52(8):505-13.
21. Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770-6.
22. Argilés JM, Anker SD, Evans WJ, Morley JE, Fearon KC, Strasser F, et al. Consensus on cachexia definitions. J Am Med Dir Assoc. 2010;11(4):229-30. Available from: doi: 10.1016/j.jamda.2010.02.004.
23. Dias MV, Barreto APM, Coelho SC, Ferreira FMB, Vieira GBS, Cláudio MM, et al. O grau de interferência dos sintomas gastrointestinais no estado nutricional do paciente com câncer em tratamento quimioterápico. Rev Bras Nutr Clin. 2006; 21(3):211-8.
24. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-95. Available from: doi: 10.1016/S1470-2045(10)70218-7.
25. Moloney EC, Brunner M, Alexander AJ, Clark J. Quantifying fibrosis in head and neck cancer treatment: An overview. Head Neck. 2015;37(8):1225-31. Available from: doi: 10.1002/hed.23722.
26. Dijkstra PU, Sterken MW, Pater R, Spijkervet FK, Roodenburg JL. Exercise therapy for trismus in head and neck cancer. Oral Oncol. 2007;43(4):389-94. Available from: doi: 10.1016/j.oraloncology.2006.04.003.
27. Stubblefield MD, Manfield L, Riedel ER. A preliminary report on the efficacy of a dynamic jaw opening device (dynasplint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer. Arch Phys Med Rehabil. 2010;91(8):1278- 82. Available from: doi: 10.1016/j.apmr.2010.05.010.
28. Tang Y, Shen Q, Wang Y, Lu K, Peng Y. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol. 2011;187(1):39-44. Available from:doi: 10.1007/s00066-010-2151-0.
29. Pessôa GA, Fernandes JA, Matheus JPC, Matheus LB. Aumento da fadiga e redução da qualidade de vida após tratamento de câncer do colo do útero. Conscientia e Saúde. 2016;15(4):564-574. Available from: doi:10.5585/ConsSaude.v15n4.6767
30. Visacri MB, Pincinato EC, Ferrari GB, Quintanilha JCF, Mazzola PG, Lima CSP, et al. Adverse drug reactions and kinetics of cisplatin excretion in urine of patients undergoing cisplatin chemotherapy and radiotherapy for head and neck cancer: a prospective study. Daru. 2017;25(1):12.
31. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2018;20(1):124. Available from:doi: 10.1186/s13058-018-1051-6.
32. Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, et al. Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature. World J Clin Oncol. 2014;5(2):177-90. Available from: doi: 10.5306/wjco.v5.i2.177.
33. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017;3(7):961-8. Available from: doi: 10.1001/ jamaoncol.2016.6914.
34. Taylor D, Jenkins AR, Parrott K, Benham A, Targett S, Jones AW. Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis. Thorax. 2021. Available from: doi: 10.1136/thoraxjnl-2020-216007.
35. Hashibe M, Brennan P, Chuang SC, Boccia S, Castellsague X, Chen C, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2009;18(2):541-50. Available from: doi: 10.1158/1055-9965.EPI-08-0347.
36. Tamul PC, Peruzzi WT. Assessment and management of patients with pulmonary disease. Crit Care Med. 2004;32(4 Suppl):S137-45. Available from: doi:10.1097/01.ccm.0000121435.64057.cc.
37. Grønkjær M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52-71. Available from:doi:10 .1097/ SLA.0b013e3182911913 5.
38. Degani-Costa LH, Faresin SM, dos Reis Falcão LF. Preoperative evaluation of the patient with pulmonary disease. Braz J Anesthesiol. 2014;64(1):22-34.
39. Petrar S, Bartlett C, Hart RD, MacDougall P. Pulmonary complications after major head and neck surgery: A retrospective cohort study. Laryngoscope. 2012;122(5):1057-61.
40. Bentz BG, Snyderman CH. Pulmonary complications in patients with head and neck and lung neoplasms. Arch Otolaryngol Head Neck Surg. 2000;126(3):429-32. Available from: doi: 10.1001/archotol.126.3.429. PMID: 10722023.
41. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2018;20(1):124.
42. Guru K, Manoor UK, Supe SS. A comprehensive review of head and neck cancer rehabilitation: physical therapy perspectives. Indian J Palliat Care. 2012;18(2):87-97.
43. Kamstra JI, van Leeuwen M, Roodenburg JL, Dijkstra PU. Exercise therapy for trismus secondary to head and neck cancer: A systematic review. Head Neck. 2017;39(1):160-9. Available from: doi: 10.1002/hed.24366.
44. Pyszora A, Budzyński J, Wójcik A, Prokop A, Krajnik M. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial. Support Care Cancer. 2017;25(9):2899-908. Available from: doi:10.1007/s00520- 017-3742-4
45. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012(8):CD008465. Available from: doi: 10.1002/14651858. CD008465.pub2.
2. Epidemiologia do Câncer de Cabeça e Pescoço no Brasil: estudo transversal de base populacional. Rev Bras Cir Cabeça Pescoço. 2012; 41 (4): 186-91.
3. Melo Filho MR, Rocha BA, Pires MB, Fonseca ES, Freitas EM, Martelli Junior H, et al. Quality of life of patients with head and neck cancer. Braz J Otorhinolaryngol. 2013;79(1):82-8.
4. Caccelli EMN, Rapoport A. Para-efeitos das irradiações nas neoplasias de boca e orofaringe.Rev Bras Cir Cabeça Pescoço. 2008; 7(4):198-201.
5. Bragante KC, Nascimento DM, Motta NW. Evaluation of acute radiation effects on mandibular movements of patients with head and neck cancer. Rev Bras Fisioter. 2012;16(2):141-7.
6. Wang X, Lv Y, Li W, Gan C, Chen H, Liu Y, et al. Correlation between Psychosocial Distress and Quality of Life in Patients with Nasopharyngeal Carcinoma following Radiotherapy. J Oncol. 2018;2018:3625302.
7. Wranicz P, Herlofson BB, Evensen JF, Kongsgaard UE. Prevention and treatment of trismus in head and neck cancer: A case report and a systematic review of the literature. Scand J Pain. 2010;1(2):84-8.
8. Van der Geer SJ, van Rijn PV, Kamstra JI, Roodenburg JLN, Dijkstra PU. Criterion for trismus in head and neck cancer patients: a verification study. Support Care Cancer. 2019;27(3):1129-37.
9. Deng J, Murphy BA, Dietrich MS, Wells N, Wallston KA, Sinard RJ, et al. Impact of secondary lymphedema after head and neck cancer treatment on symptoms, functional status, and quality of life. Head Neck. 2013;35(7):1026-35.
10. Carvalho AP, Vital FM, Soares BG. Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer. Cochrane Database Syst Rev. 2012(4):CD008693.
11. Morton RP, Izzard ME. Quality-of-life outcomes in head and neck cancer patients. World J Surg. 2003;27(7):884-9. Available from: doi: 10.1007/s00268-003-7117-2.
12. Høxbroe Michaelsen S, Grønhøj C, Høxbroe Michaelsen J, Friborg J, von Buchwald C. Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer. 2017;78:91-102.
13. Nguyen NA, Ringash J. Head and Neck Cancer Survivorship Care: A Review of the Current Guidelines and Remaining Unmet Needs. Curr Treat Options Oncol. 2018;19(8):44.
14. Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev. 2015(6):CD011006.
15. Calver L, Tickle A, Moghaddam N, Biswas S. The effect of psychological interventions on quality of life in patients with head and neck cancer: A systematic review and meta-analysis. Eur J Cancer Care (Engl). 2018;27(1).
16.Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, et al. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology. 2018;27(4):1150-61.
17. Chow R, Bruera E, Temel JS, Krishnan M, Im J, Lock M. Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis. Support Care Cancer. 2020;28(5):2071-8.
18. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012(8):CD007566.
19. Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: An individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91- 104.
20. Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, et al. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2018;52(8):505-13.
21. Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770-6.
22. Argilés JM, Anker SD, Evans WJ, Morley JE, Fearon KC, Strasser F, et al. Consensus on cachexia definitions. J Am Med Dir Assoc. 2010;11(4):229-30. Available from: doi: 10.1016/j.jamda.2010.02.004.
23. Dias MV, Barreto APM, Coelho SC, Ferreira FMB, Vieira GBS, Cláudio MM, et al. O grau de interferência dos sintomas gastrointestinais no estado nutricional do paciente com câncer em tratamento quimioterápico. Rev Bras Nutr Clin. 2006; 21(3):211-8.
24. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-95. Available from: doi: 10.1016/S1470-2045(10)70218-7.
25. Moloney EC, Brunner M, Alexander AJ, Clark J. Quantifying fibrosis in head and neck cancer treatment: An overview. Head Neck. 2015;37(8):1225-31. Available from: doi: 10.1002/hed.23722.
26. Dijkstra PU, Sterken MW, Pater R, Spijkervet FK, Roodenburg JL. Exercise therapy for trismus in head and neck cancer. Oral Oncol. 2007;43(4):389-94. Available from: doi: 10.1016/j.oraloncology.2006.04.003.
27. Stubblefield MD, Manfield L, Riedel ER. A preliminary report on the efficacy of a dynamic jaw opening device (dynasplint trismus system) as part of the multimodal treatment of trismus in patients with head and neck cancer. Arch Phys Med Rehabil. 2010;91(8):1278- 82. Available from: doi: 10.1016/j.apmr.2010.05.010.
28. Tang Y, Shen Q, Wang Y, Lu K, Peng Y. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol. 2011;187(1):39-44. Available from:doi: 10.1007/s00066-010-2151-0.
29. Pessôa GA, Fernandes JA, Matheus JPC, Matheus LB. Aumento da fadiga e redução da qualidade de vida após tratamento de câncer do colo do útero. Conscientia e Saúde. 2016;15(4):564-574. Available from: doi:10.5585/ConsSaude.v15n4.6767
30. Visacri MB, Pincinato EC, Ferrari GB, Quintanilha JCF, Mazzola PG, Lima CSP, et al. Adverse drug reactions and kinetics of cisplatin excretion in urine of patients undergoing cisplatin chemotherapy and radiotherapy for head and neck cancer: a prospective study. Daru. 2017;25(1):12.
31. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2018;20(1):124. Available from:doi: 10.1186/s13058-018-1051-6.
32. Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, et al. Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature. World J Clin Oncol. 2014;5(2):177-90. Available from: doi: 10.5306/wjco.v5.i2.177.
33. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017;3(7):961-8. Available from: doi: 10.1001/ jamaoncol.2016.6914.
34. Taylor D, Jenkins AR, Parrott K, Benham A, Targett S, Jones AW. Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis. Thorax. 2021. Available from: doi: 10.1136/thoraxjnl-2020-216007.
35. Hashibe M, Brennan P, Chuang SC, Boccia S, Castellsague X, Chen C, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2009;18(2):541-50. Available from: doi: 10.1158/1055-9965.EPI-08-0347.
36. Tamul PC, Peruzzi WT. Assessment and management of patients with pulmonary disease. Crit Care Med. 2004;32(4 Suppl):S137-45. Available from: doi:10.1097/01.ccm.0000121435.64057.cc.
37. Grønkjær M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52-71. Available from:doi:10 .1097/ SLA.0b013e3182911913 5.
38. Degani-Costa LH, Faresin SM, dos Reis Falcão LF. Preoperative evaluation of the patient with pulmonary disease. Braz J Anesthesiol. 2014;64(1):22-34.
39. Petrar S, Bartlett C, Hart RD, MacDougall P. Pulmonary complications after major head and neck surgery: A retrospective cohort study. Laryngoscope. 2012;122(5):1057-61.
40. Bentz BG, Snyderman CH. Pulmonary complications in patients with head and neck and lung neoplasms. Arch Otolaryngol Head Neck Surg. 2000;126(3):429-32. Available from: doi: 10.1001/archotol.126.3.429. PMID: 10722023.
41. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2018;20(1):124.
42. Guru K, Manoor UK, Supe SS. A comprehensive review of head and neck cancer rehabilitation: physical therapy perspectives. Indian J Palliat Care. 2012;18(2):87-97.
43. Kamstra JI, van Leeuwen M, Roodenburg JL, Dijkstra PU. Exercise therapy for trismus secondary to head and neck cancer: A systematic review. Head Neck. 2017;39(1):160-9. Available from: doi: 10.1002/hed.24366.
44. Pyszora A, Budzyński J, Wójcik A, Prokop A, Krajnik M. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial. Support Care Cancer. 2017;25(9):2899-908. Available from: doi:10.1007/s00520- 017-3742-4
45. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012(8):CD008465. Available from: doi: 10.1002/14651858. CD008465.pub2.
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Publicado
2021-07-28
Como Citar
Batista Pires, M., Dalbem Paim, Émille, Ramos Wochnicki, G., & Macagnan, F. E. (2021). Perfil da qualidade de vida três meses ou mais após o término da radioterapia adjuvante utilizada para o tratamento do câncer de cabeça e pescoço em um Centro de Assistência de Alta Complexidade em Oncologia: 10.15343/0104-7809.202145308317. O Mundo Da Saúde, 45, 308–317. Recuperado de https://revistamundodasaude.emnuvens.com.br/mundodasaude/article/view/1129
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