Utjecaj estetskih rezultata poštedne operacije karcinoma dojke na kvalitetu života i pojavu simptoma depresivnih poremećaja

doctoral thesis

• Author: Anto Dujmović
• Mentor: Davor Mijatović (mentor)
• Mentor: Darko Marčinko (komentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-12-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Karcinom dojke najčešća je maligna bolest ženske populacije u većini zemalja zapadnog svijeta pa tako i u Republici Hrvatskoj. Unazad dvadesetak godina umjesto do tada uobičajene metode liječenja karcinoma dojke kompletnim odstranjenjem tkiva dojke i limfnih čvorova iz pazuha, primat je zauzela poštedna operacija karcinoma dojke. Danas se u KBC Zagreb više od 60 % svih operacija karcinoma dojke učini poštednim načinom koji uglavnom podrazumijeva kvadrantektomiju i biopsiju sentinel limfnog čvora. Često se u kirurškom dijelu primjenjuju onkoplastična načela liječenja.
Osim kirurškog dijela, liječenje podrazumijeva i obveznu adjuvantnu terapiju zračenjem i, ovisno o patohistološkim obilježjima i proširenosti tumora, kemoterapiju ili hormonsku terapiju.
Pri pristupu bolesniku osim onkološkog dijela liječenja, koji je i dalje u središtu interesa kirurga, bolest se sagledava sa šireg motrišta i tu glavnu ulogu ima kvaliteta života.
Kvaliteta života ovisi izravno o načinu i rezultatu liječenja. Ovim je istraživanjem dokazano da bolji estetski rezultat rezultira višom razinom kvalitete života.
Kvaliteta života lošija je u bolesnika koji na testu ličnosti pokazuju veći broj bodova u dijelu za ispitivanje neuroticizma. Neuroticizam je usko povezan i s višim rezultatom na Beckovu testu depresije. Ekstrovertiranost nije povezana s pojavom depresije niti s rezultatom na upitniku kvalitete života. Od antropometrijskih mjerenja prije i poslije operacije ustanovili smo statistički značajnu povezanost s razlikom udaljenosti između bradavice i inframamarne brazde. Što je ta razlika veća, kvaliteta života je manja.
Rezultati istraživanja otkrivaju da se na osnovi provedenog testiranja i mjerenja mogu utvrditi pacijenti s povećanim rizikom za razvoj simptoma depresije i smanjenom kvalitetom života.
Rano psihološko liječenje u sklopu bolnice ili psihološkog konzultiranja kakvo nude udruge za oboljele od karcinoma dojke smanjilo bi mortalitet i poboljšalo kvalitetu života. Jednako je tako za očekivati i da bi pacijentice kod kojih se detektira i na vrijeme liječi problem nastao nezadovoljstvom estetskim rezultatom bile manje vremena na bolovanju i na taj način smanjile ukupan financijski trošak liječenja.

Abstract (english)

Breast cancer is the leading malignancy in females in the western world as well as in Croatia. In the last 20 years, the standard method of treatment disease was a complete mastectomy with lymphadenectomy of axillary lymph nodes. Modern treatment includes a conservative resection of the breast and is the standard choice at the Clinical Hospital Center Rebro where over 60% of all breast cancer operations are done with conservative methods including techniques such as quadrantectomy, and sentinel lymph node biopsy. Frequently during surgery oncoplastic techniques are used. Other than surgical treatment, mandatory adjuvant therapies such as radiotherapy, and depending on the histological features of the tumor and the extent of invasion and distant metastasis, chemotherapy and/or hormonal therapy is used. When approaching the patient, other than oncologic treatment which is the main concern for the surgeon, the disease is must be viewed from a wider perspective which includes the patient's quality of life. Quality of life depends directly on the method and outcome of treatment. Our observations and research has shown that better aesthetic results increases the patients quality of life. Quality of life is worse in patients who on the personality tests rank higher in the section for neuroticism. Neuroticism is closely associated with a higher score on the Beck depression test. Extroversion is not associated with the occurrence of depression, nor with the result of the quality of life questionnaire. From anthropometric measurements before and after surgery, we found a statistically significant association with the difference of the distance between the nipple and inframammary fold. The larger the distance, the lower quality of life. Research results suggest that based on the conducted testing and measurements, we can predict patients with an increased risk for developing symptoms of depression and reduced quality of life. Early psychological treatment and support within the hospital or psychological consultation which are offered by organisations for patients suffering from breast cancer could reduce morbidity and improve quality of life. It is also to be expected that patients who are recognized as high risk and treated earlier due to dissatisfaction of the aesthetic result would use less sick days and thus reduce the total financial cost of treatment.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:226072
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 85 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:21:55