O conceito de “survivorship” ou “sobreviventes” compreende o acompanhamento a longo prazo das pacientes diagnosticadas com tumores de mama e que foram submetidas a tratamento. Estimativas recentes dos Estados Unidos indicam que centenas de milhares de vidas de mulheres foram salvas pela mamografia e avanços no tratamento nos últimos anos.
Essas pacientes devem ser acompanhadas para monitorar o risco de recidiva da doença, manejo dos efeitos colaterais e das eventuais sequelas físicas e psicossociais relacionados ao tratamento, além da promoção à saúde. Com isso, surge uma consonância de que precisamos de um novo modelo de assistência para esse grupo de mulheres, que têm necessidades de acompanhamento e de vigilância bem definidas.
Quem pode ser considerada uma sobrevivente de câncer de mama?
De acordo com o Instituto Nacional do Câncer (INCA), uma pessoa é considerada uma sobrevivente no dia em que é diagnosticada e durante o resto da vida.
Se a paciente vai comemorar o aniversário de sobrevivência, o oncologista provavelmente irá sugerir como marco inicial o dia em que completou o primeiro tratamento – a realização de cirurgia e, possivelmente, quimioterapia e/ou radioterapia.
À medida que a detecção e os tratamentos melhoraram, as mulheres que foram diagnosticadas com a neoplasia estão vivendo mais. Enquanto no tratamento inicial, as pessoas referem a si mesmas como pacientes com câncer ou sobreviventes de câncer, após o tratamento, podem querer deixar a experiência para trás e seguir em frente sem autodefinições.
Como cuidar dessa população de pacientes em rápido crescimento com necessidades de cuidados de saúde tão específicas?
As pacientes enfrentam impactos potencialmente significativos do seu tratamento (por exemplo, fadiga, ondas de calor e alterações do humor decorrente da terapia hormonal; sintomas resultantes de alteração da função cardíaca por toxicidade da quimioterapia; e, eventualmente, restrições de amplitude à movimentação do braço relacionado com a cirurgia), e merecem cuidados de acompanhamento multidisciplinar de alta qualidade, abrangentes e coordenados.
Deve existir uma vigilância regular para a detecção precoce de uma eventual recidiva – reaparecimento da doença – o que inclui a realização de consulta médica e exames de imagem regularmente. Além disso, necessitam estar cientes da importância de manter um estilo de vida saudável, monitorar os sintomas pós-tratamento que podem afetar adversamente a qualidade de vida e eventual adesão à terapia endócrina.
Os médicos devem considerar o perfil de risco individual de cada paciente e as preferências de atendimento para abordar os impactos físicos e psicossociais. As sobreviventes devem receber apoio para tratar de depressão, ansiedade, comprometimento cognitivo, problemas de imagem corporal, preocupações sexuais, alterações funcionais e deficiências físicas, mudanças de relacionamento e outras dificuldades de função social.
Recomenda-se também a inclusão de cuidadores, parceiros e familiares nessa rede de apoio após o diagnóstico/tratamento. Compreender as preocupações particulares de cada mulher é essencial para intervenções eficazes.
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