Quality of life in dysphagia and functional performance of oncological patients in palliative care
deglutition disorders; quality of life; palliative care; medical oncology; neoplasms; functional status.
Introduction: Functionality in cancer patients is affected both by the progression of the disease and by the treatment itself, whether or not patients are in palliative care. It is known that the progression of cancer can cause dysphagia and have a negative impact on quality of life. The hypothesis of this study is that the degree of functionality correlates with the perception of how dysphagia impacts on quality of life. Objective: To correlate functional performance and the impact of dysphagia on the quality of life of cancer patients in palliative care. Method: Analytical, observational and cross-sectional study, approved by the CEP under opinion no. 6.169.276. The data was collected in the outpatient clinic and oncology ward of a university hospital. Inclusion criteria: cancer diagnosis, age 18 or over and a positive answer to the question: "Do you have difficulty or problems swallowing?". Exclusion criteria: diagnosis of head and neck cancer, inability to answer questionnaires due to uncontrolled symptoms and/or drowsiness, individuals in the active process of dying and those who did not completely fill in the collection instruments. Two instruments were used in their Brazilian Portuguese versions. The Palliative Performance Scale (PPS) for assessing functional performance, which evaluates walking, activity and evidence of illness, self-care, eating and level of consciousness, with a maximum score of 100 (subject with no evidence of illness) and a minimum score of 0 (indicating death). The M. D. Anderson Dysphagia Inventory (MDADI) has global, physical, emotional and functional domains to identify the effect of dysphagia on quality of life. Its score is from 0 to 100 and the lower the value, the greater the degree of limitation. The variables were analyzed using descriptive and inferential statistics, using Pearson's correlation at a 5% significance level. Results: The sample included 39 participants aged between 45 and 88 years (mean 65.36 years; ±10.89), 24 of whom were women. The most frequent neoplasm locations were: pancreas (n=7; 13.7%), liver (n=5; 9.8%) and stomach (n=4; 7.8%). The mean PPS and MDADI scores were 66.15 (±15.15) and 61.90 points (±12.62), respectively. The results of the PPS indicated that the average patient had reduced ambulation, was unable to work, but was independent in terms of self-care, and had a full level of swallowing and consciousness. The MDADI indicated a medium degree of limitation. Outpatients showed a moderate correlation (r=0.397; p=0.033) between the MDADI score and the level of functionality according to the PPS. Women showed a decrease in the total MDADI score and in the emotional domain as age increased (r= -0.435; p=0.034) and (r= -0.491; p=0.015), respectively. Women also showed a decrease in the emotional and physical domains as the PPS score decreased (r= 0.408; p= 0.048) and (r= 0.424; p= 0.039). There was a negative and moderate correlation between the PPS score and age (r = -0.358; p=0.025), which was more evident among women (r = -0.566; p=.004). Conclusion: There was a correlation between functional performance and the impact of dysphagia on quality of life in outpatient cancer patients under palliative care.