Quality of life of patients with lung cancer: A scoping review

Rafael Turano Mota Helder Márcio Ferreira Júnior Fabiane Silva Pereira Maria Aparecida Vieira Simone de Melo Costa About the authors

Abstract

Objective:

To characterize scientific publications on the quality of life of people with lung cancer in order to explore current knowledge of the subject, with emphasis on assessment instruments and methodological aspects.

Method:

A scoping type literature review was performed. Articles were sought in the databases of the Virtual Health Library, in an integrative manner, with the descriptors: Quality of life and Lung Neoplasms, with no date of publication or language restrictions (n=138). The selection of articles was based on inclusion and exclusion criteria defined in the study proposal.

Results:

We included 18 publications published between 2006 and 2017, the majority (n = 10) of which had a cross-sectional design. Eight different instruments were used to evaluate the quality of life of patients with lung cancer, four of which were specific for people with cancer. There was a prevalence of the use of the European Organization for Research and Treatment of Cancer Care Quality of Life Questionnaire - EORTC QLQ-C30 (n=8). Prospective studies (n=8) assessed quality of life before and after chemotherapy, physical therapy or pulmonary resection. The studies adopted different methodologies and provided conflicting results of quality of life. Cross-sectional studies with comparatively healthy subjects found an inferior quality of life for people with lung cancer.

Conclusion:

The scoping review contributed to the identification of the multiple evaluated instruments, both generic and specific. It found a lack of homogeneity in the methodological approaches of the studies. Further prospective studies with a specific instrument and methodological standardization to evaluate the quality of life of people with lung cancer are recommended.

Keywords:
Quality of Life; Lung Neoplasms; Bibliometrics; Health of the Elderly; Aged, 80 and over

Resumo

Objetivo:

Caracterizar a publicação científica para explorar o conhecimento atual sobre qualidade de vida de pessoas com câncer de pulmão, com ênfase nos instrumentos avaliativos e aspectos metodológicos.

Método:

Revisão de literatura, do tipo scoping review, com busca nas bases de dados da Biblioteca Virtual em Saúde, com os descritores: Qualidade de Vida and Neoplasias Pulmonares, sem limites para ano e idioma (n=138). A seleção dos artigos deu-se por critérios de inclusão e exclusão propostos no estudo.

Resultados:

Incluíram-se 18 publicações 2006 a 2017, a maioria (n=10) de delineamento transversal. Oito instrumentos foram utilizados para avaliar qualidade de vida de pacientes com câncer de pulmão, sendo quatro específicos para pessoas com câncer. Entre esses, prevaleceu o European Organization for Research and Treatment of Cancer Care Quality of Life Questionnaire - EORTC QLQ-C30 (n=8). Os estudos prospectivos (n=8) avaliaram qualidade de vida antes e após quimioterapia, fisioterapia ou ressecção pulmonar. Adotaram diferente abordagem metodológica e apresentam resultados contraditórios acerca da qualidade de vida. Os estudos transversais comparativos com pessoas saudáveis descrevem pior qualidade de vida para pessoas com câncer.

Conclusão:

A scoping review identificou múltiplos instrumentos avaliativos, genéricos e específicos. Constatou falta de homogeneidade nos aspectos metodológicos dos estudos. Recomendam-se estudos prospectivos com instrumento específico e padronização metodológica para avaliar qualidade de vida entre pessoas com câncer de pulmão.

Palavras-chave:
Qualidade de Vida; Neoplasias Pulmonares; Bibliometria; Saúde do Idoso; Idoso de 80 Anos ou mais

INTRODUCTION

Lung cancer became a frequently detected condition among the global population in the 20th century, and as a result, a significant cause of mortality around the world11 Cardoso RC, Carlo MMRP. Fadiga em Pacientes com Câncer de Pulmão: uma Revisão Sistemática de Literatura. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(4):575-82. Disponível em: http://www1.inca.gov.br/rbc/n_59/v04/pdf/12-revisao-literatura-fadiga-em-pacientes-com-cancer-pulmao-uma-revisao-sistematica-de-literatura.pdf
http://www1.inca.gov.br/rbc/n_59/v04/pdf...
. The disease mainly affects the elderly, with most cases diagnosed in people 65 years of age or older22 American Cancer Society. Key Statistics for Lung Cancer [Internet]. [S.local]: ACS; 2019 [acesso em 05 abril 2019]. Disponível em: https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html
https://www.cancer.org/cancer/non-small-...
, while around half of patients are over 7033 Centro Cochrane do Brasil e Liga de Saúde Baseada em Evidências da Universidade Federal de Medicina (EPM-Unifesp). Quimioterapia para o câncer de pulmão de células não pequenas avançado em idosos. Diagn Tratamento [Internet]. 2017 [acesso em 11 dez. 2018];22(1):49-50. Disponível em: http://docs.bvsalud.org/biblioref/2017/03/832451/rdt_v22n1_49-50.pdf
http://docs.bvsalud.org/biblioref/2017/0...
. In Brazil, it is estimated that there will be 18,740 new cases in men and 12,530 cases in women in 2018-201944 Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. Estimativa 2018: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2017..

Lung cancer carries considerable weight in the main cancer-related statistics. It is a significant tumor due to its high mortality rate in every country. In addition, the quality of life (QoL) of patients may be affected by different factors, such as the stage of the disease and the type of treatment, as well as individual aspects, causing a negative impact on disease outcomes. Hence the importance of evaluating the QoL of this target group55 Franceschini J, dos Santos AA, El Mouallem I, Jamnik S, Uehara C, Fernandes ALG, et al. Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey. J Bras Pneumol. 2008 [acesso em 10 set. 2017];34(6):387-93. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000600009&lng=en
http://www.scielo.br/scielo.php?script=s...
, preferably using specific instruments for the disease, taking into account aspects related to cancer such as coughing, fatigue and tobacco use.

Among the specific instruments cited are the Functional Assessment of Cancer Therapy-Lung (FACT-L), which contains questions about symptoms, cognitive function and smoking habits66 American Thoracic Society: Quality of Life Resource [Internet]. [Sem local]: ATS; 2007. Functional Assessment of Cancer Therapy-Lung (FACT-L). 199 [acesso em 6 abr. 2019]; [1 tela]. Disponível em: http://qol.thoracic.org/sections/instruments/fj/pages/fact-l.html
http://qol.thoracic.org/sections/instrum...
. Also worthy of note is the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire and Lung Cancer Module (QLQ-LC13), which supplements QLQ-C30, both of which have been developed and validated for people with lung cancer and for use in an international context. QLQ-LC13 assesses aspects related to symptoms and the side effects of treatment77 American Thoracic Society [Internet]. [Sem local]: ATS; 2007. European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire and Lung Cancer Module (QLQ-LC13). 1999; [1 tela]. [acesso em 06 abr. 2019]; Disponível em: http://qol.thoracic.org/sections/instruments/ae/pages/qlq-lc13.html
http://qol.thoracic.org/sections/instrum...
.

QoL is a broad concept and was developed through the initiative of the World Health Organization (WHO), in the development of the generic World Health Organization Quality of Life (WHOQoL) instrument. The WHO defined QoL as the “individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns88 The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;10:1403-9.. Therefore, the concept is subjective and relates to different aspects of life, degree of satisfaction, whether in one’s family, love, social and environmental life, and the existential esthetic99 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
.

When this broad concept is transferred to health, it becomes health-related QoL. It can be affected by alterations caused by damage to one’s functional state, perceptions and social factors, influenced by diseases/harm, treatments and health policies. Thus, the concept can also be delimited by the interference of disease in the lives of individuals99 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
, which justifies the need for specific instruments for a particular disease.

A greater understanding of quality of life and lung cancer will support professionals in managing the clinical care of these patients, as well as future studies. The present study aimed to characterize relevant scientific publications to explore current knowledge about the quality of life of people with lung cancer, with an emphasis on assessment instruments and methodological aspects.

METHOD

A scoping review study was carried out. This type of study recognizes a topic that has not yet been addressed by a systematic review, or that has a complex and heterogeneous nature, making it difficult to more accurately review the evidence. This method helps to identify gaps in knowledge and to propose recommendations for future research. The study followed the following projected steps: (1) identification of the research question; (2) identification of relevant studies; (3) selection of studies; (4) data mapping; (5) comparison, summary and reporting of results1010 Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc [Internet]. 2015 [acesso em 10 set. 2017];13(3):141-6. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26134548
https://www.ncbi.nlm.nih.gov/pubmed/2613...
. The following question was defined: What is the current knowledge about the QoL of patients with lung cancer, the evaluative instruments and the methodological aspects of the studies?

The search for references was performed in the regional Virtual Health Library (VHL), as it integrates content on a specific theme from different countries. The databases were consulted in an integrative manner (patients with lung cancer AND quality of life) AND (instance: “regional”), without date of publication or language restrictions. The 14 bases of the VHL (international and Brazilian) in the area of Health Sciences include Lilacs (Latin American and Caribbean Literature in Health Sciences), Medline (Medical Literature Analysis and Retrieval System Online), SciELO (Scientific Electronic Library Online), the Cochrane Library, BDENF (Nursing Database) and IBECS (Spanish Bibliographical Index of Health Sciences). The search took place in December 2017 and was updated on August 29, 2018. Portuguese descriptors were used. The VHL retrieves publications in any language, in addition to that used, in Portuguese, English or Spanish. Even with Medline, in which most of the texts are in English, the use of any of the three languages mentioned is recommended when searching by subject descriptor (https://bvsalud.org/como-pesquisar/).

The inclusion criterion for selection by title/abstract was: Theme of QoL in people with lung cancer. The exclusion criteria were literature/theoretical review articles, duplicity in different databases, articles taken from the same research, studies with the principal objective of validating instruments by correlations of items/domains; case/experience reports; research and study protocols with the central purpose of comparing treatment modalities, with QoL a background variable.

The selection of the material was performed by two researchers, individually and independently (Figure 1), without disagreement between evaluators (kappa=1).

Figure 1
Flowchart of search process of study carried out in Universidade Estadual de Montes Claros, Minas Gerais, Brazil. 2018.

Qualitative analysis was carried out through the characterization of the publications. The data of interest were: author(s)/year; journal; language; population (age), place of recruitment; state/country; study design; assessment instruments and synthesis of results. Comparative cross-sectional and longitudinal studies were assessed for methodological quality by the Newcastle-Ottawa Scale (NOS) scale, which provides scores up to nine points and where a higher score reflects better quality. This scale considers three methodological questions: Participant selection, statistical comparability between groups and exposure/outcome items1111 Ottawa Hospital Research Institute [Internet]. Ottawa: OHRI; 2019. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses [acesso em 10 set. 2018]; [1 tela]. Disponível em: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
http://www.ohri.ca/programs/clinical_epi...
. For comparative cross-sectional studies the case-control scale was adapted, and for prospective studies, the cohort scale.

RESULTS

As shown in Figure 1, 18 articles55 Franceschini J, dos Santos AA, El Mouallem I, Jamnik S, Uehara C, Fernandes ALG, et al. Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey. J Bras Pneumol. 2008 [acesso em 10 set. 2017];34(6):387-93. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000600009&lng=en
http://www.scielo.br/scielo.php?script=s...
,99 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,1212 Nai-Wen C, Kuan- Chia L, Wen-Hu H, Shih-Chun L, Yi-Hsin JC, Kwua-Yun W. The effect of gender on health-related quality of life and related factorsin post-lobectomy lung-cancer patients. Eur J Oncol Nurs [Internet]. 2015 [acesso em 10 set. 2017];19(3):292-300. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25432210
https://www.ncbi.nlm.nih.gov/pubmed/2543...

13 Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene [Internet]. 2014 [acesso em 10 set. 2017];15(1):132-40. Disponível em: http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
http://repositorio.ufc.br/bitstream/riuf...

14 de Oliveira PI, Pereira CAC, Belasco AGS, Bettencourt ARC. Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico. Rev Latinoam Enferm [Internet]. 2013 [acesso em 10 set. 2017];21(3):787-94. Disponível em: http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
http://www.scielo.br/pdf/rlae/v21n3/pt_0...

15 Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2013 [acesso em 10 set. 2017];39(1):23-31. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
http://www.scielo.br/scielo.php?script=s...

16 Pastore CA, Oehlschlaeger MHK, Gonzalez MC. Impacto do estado nutricional e da força muscular sobre o estado de saúde geral e qualidade de vida em pacientes com câncer de trato gastrintestinal e de pulmão. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(1):43-9. Disponível em: https://rbc.inca.gov.br/site/arquivos/n_59/v01/pdf/07-impacto-do-estado-nutricional-e-da-for%C3%A7a-muscular.pdf
https://rbc.inca.gov.br/site/arquivos/n_...

17 Floyd A, Dedert E, Ghate S, Studts JL, Stetson B, Sephton SE, et al. Depression may mediate the relationship between sense of coherence and quality of life in lung cancer patients. J Health Psychol [Internet]. 2011 [acesso em 10 set. 2017];16(2):249-57. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20929943
https://www.ncbi.nlm.nih.gov/pubmed/2092...

18 Lee LJ, Chung CW, Chang YY, Lee YC, Yang CH, Liou SH, et al. Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls. Qual Life Res [Internet]. 2010 [acesso em 10 set. 2017];20(3):415-23. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20953907
https://www.ncbi.nlm.nih.gov/pubmed/2095...

19 Weaver KE, Rowland JH, Augustson E, Atienza AA. Smoking concordance in lung and colorectal cancer patient-caregiver dyads and quality of life. Cancer Epidemiol Biomark Prev [Internet]. 2011 [acesso em 10 set. 2017];20(2):239-48. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035926/
https://www.ncbi.nlm.nih.gov/pmc/article...

20 Ozalevli S, Ilgin D, Karaali HK, Bulac S, Akkoclu A. The effect of in-patient chest physiotherapy in lung cancer patients. Support Care Cancer [Internet]. 2010 [acesso em 10 set. 2017];18(3):351-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19471973
https://www.ncbi.nlm.nih.gov/pubmed/1947...

21 Lima LNT, da Silva RA, Gross JL, Deheinzelin D, Negri EM. Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2009 [acesso em 10 set. 2017];35(6):521-8. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...

22 Saad IAB, Botega NJ, Toro IFC. Avaliação da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2006 [acesso em 10 set. 2017];32(1):10-5. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
http://www.scielo.br/scielo.php?script=s...

23 Fiteni F, Vernerey D, Bonnetain F, Vaylet F, Sennélart H, Trédaniel J, et al. Prognostic value of health-related quality of life for overall survival in elderly non-small-cell lung cancer patients. Eur J Cancer [Internet]. 2016 [acesso em 10 set. 2017];52:120-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26682871
https://www.ncbi.nlm.nih.gov/pubmed/2668...

24 Borges EL, Franceschini J, Costa LHD, Fernandes ALG, Jamnik S, Santoro IL. Sobrecarga do cuidador familiar: a sobrecarga de cuidar de pacientes com câncer de pulmão, de acordo com o estágio do câncer e a qualidade de vida do paciente. J Bras Pneumol [Internet]. 2017 [acesso em 10 set. 2017];43(1):18-23. Disponível em: http://www.scielo.br/pdf/jbpneu/v43n1/pt_1806-3713-jbpneu-2016000000177.pdf
http://www.scielo.br/pdf/jbpneu/v43n1/pt...

25 Frio CC, Pretto ADB, Gonzalez MC, Pastore CA. Influência da composição corporal sobre a qualidade de vida de pacientes com câncer. Rev Bras Cancerol [Internet]. 2015 [acesso em 10 set. 2017];61(4):351-6. Disponível em: http://www1.inca.gov.br/rbc/n_61/v04/pdf/06-artigo-influencia-da-composicao-corporal-sobre-a-qualidade-de-vida-de-pacientes-com-cancer.pdf
http://www1.inca.gov.br/rbc/n_61/v04/pdf...

26 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
-2727 Müller AM, Silva DR, Xavier RG. Avaliação da qualidade de vida e função pulmonar em pacientes com câncer de pulmão. Clin Biomed Res [Internet]. 2014 [acesso em 10 set. 2017];34(4):347-56. Disponível em: https://seer.ufrgs.br/hcpa/article/view/48568
https://seer.ufrgs.br/hcpa/article/view/...
were selected for review.

Chart 1 characterizes the studies published between 2006 and 2017. A total of 44.4% were published in English and 55.6% in Portuguese.

Chart 1
Description of studies included in scoping review in descending chronological order based on year of publication, 2017-2006.

Five studies1313 Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene [Internet]. 2014 [acesso em 10 set. 2017];15(1):132-40. Disponível em: http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
http://repositorio.ufc.br/bitstream/riuf...
,1616 Pastore CA, Oehlschlaeger MHK, Gonzalez MC. Impacto do estado nutricional e da força muscular sobre o estado de saúde geral e qualidade de vida em pacientes com câncer de trato gastrintestinal e de pulmão. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(1):43-9. Disponível em: https://rbc.inca.gov.br/site/arquivos/n_59/v01/pdf/07-impacto-do-estado-nutricional-e-da-for%C3%A7a-muscular.pdf
https://rbc.inca.gov.br/site/arquivos/n_...
,1919 Weaver KE, Rowland JH, Augustson E, Atienza AA. Smoking concordance in lung and colorectal cancer patient-caregiver dyads and quality of life. Cancer Epidemiol Biomark Prev [Internet]. 2011 [acesso em 10 set. 2017];20(2):239-48. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035926/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2525 Frio CC, Pretto ADB, Gonzalez MC, Pastore CA. Influência da composição corporal sobre a qualidade de vida de pacientes com câncer. Rev Bras Cancerol [Internet]. 2015 [acesso em 10 set. 2017];61(4):351-6. Disponível em: http://www1.inca.gov.br/rbc/n_61/v04/pdf/06-artigo-influencia-da-composicao-corporal-sobre-a-qualidade-de-vida-de-pacientes-com-cancer.pdf
http://www1.inca.gov.br/rbc/n_61/v04/pdf...
included individuals with other types of cancer. In 94.4% (n=17), the samples were convenience based, recruited in hospitals or cancer centers. A cross-sectional design was adopted in 55.6% (n=10) of the studies. Non-controlled prospective, “before and after” studies assessed QoL before and after chemotherapy99 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,1414 de Oliveira PI, Pereira CAC, Belasco AGS, Bettencourt ARC. Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico. Rev Latinoam Enferm [Internet]. 2013 [acesso em 10 set. 2017];21(3):787-94. Disponível em: http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
http://www.scielo.br/pdf/rlae/v21n3/pt_0...
, before three cycles of chemotherapy2626 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
, before and after lung resectioning2121 Lima LNT, da Silva RA, Gross JL, Deheinzelin D, Negri EM. Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2009 [acesso em 10 set. 2017];35(6):521-8. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,2222 Saad IAB, Botega NJ, Toro IFC. Avaliação da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2006 [acesso em 10 set. 2017];32(1):10-5. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
http://www.scielo.br/scielo.php?script=s...
, before and after physiotherapy2020 Ozalevli S, Ilgin D, Karaali HK, Bulac S, Akkoclu A. The effect of in-patient chest physiotherapy in lung cancer patients. Support Care Cancer [Internet]. 2010 [acesso em 10 set. 2017];18(3):351-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19471973
https://www.ncbi.nlm.nih.gov/pubmed/1947...
, before starting treatment and two and four months after the first evaluation and/or the beginning of treatment2727 Müller AM, Silva DR, Xavier RG. Avaliação da qualidade de vida e função pulmonar em pacientes com câncer de pulmão. Clin Biomed Res [Internet]. 2014 [acesso em 10 set. 2017];34(4):347-56. Disponível em: https://seer.ufrgs.br/hcpa/article/view/48568
https://seer.ufrgs.br/hcpa/article/view/...
.

The researchers used eight instruments (Chart 2).

Chart 2
Instruments used to assess quality of life according to functions and items.

Chart 3 describes concurrent (n=7) and cross-sectional (n=2) prospective studies in terms of QoL instrument, affected domains, and assessment of methodological quality. The loss of quality of the studies, in general, is due to convenience sampling; self-reported information; disease already established at the beginning of recruitment and lack of multivariate analysis.

Chart 3
Description of prospective and cross-sectional comparative studies according to quality of life (QoL) instrument, affected domains and evaluation of methodological quality.

Comparative cross-sectional studies55 Franceschini J, dos Santos AA, El Mouallem I, Jamnik S, Uehara C, Fernandes ALG, et al. Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey. J Bras Pneumol. 2008 [acesso em 10 set. 2017];34(6):387-93. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000600009&lng=en
http://www.scielo.br/scielo.php?script=s...
,1818 Lee LJ, Chung CW, Chang YY, Lee YC, Yang CH, Liou SH, et al. Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls. Qual Life Res [Internet]. 2010 [acesso em 10 set. 2017];20(3):415-23. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20953907
https://www.ncbi.nlm.nih.gov/pubmed/2095...
with individuals without cancer revealed a worse QoL among cancer patients.

QoL was evaluated before and after chemotherapy99 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,1414 de Oliveira PI, Pereira CAC, Belasco AGS, Bettencourt ARC. Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico. Rev Latinoam Enferm [Internet]. 2013 [acesso em 10 set. 2017];21(3):787-94. Disponível em: http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
http://www.scielo.br/pdf/rlae/v21n3/pt_0...
,2626 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,2727 Müller AM, Silva DR, Xavier RG. Avaliação da qualidade de vida e função pulmonar em pacientes com câncer de pulmão. Clin Biomed Res [Internet]. 2014 [acesso em 10 set. 2017];34(4):347-56. Disponível em: https://seer.ufrgs.br/hcpa/article/view/48568
https://seer.ufrgs.br/hcpa/article/view/...
with varying assessment frequencies in patients with cancer stages I to IV.

A study by Saad, Botega and Toro2222 Saad IAB, Botega NJ, Toro IFC. Avaliação da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2006 [acesso em 10 set. 2017];32(1):10-5. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
http://www.scielo.br/scielo.php?script=s...
evaluated QoL before surgery and 30, 90 and 180 days later. In the prospective cohort study by Lima et al.2121 Lima LNT, da Silva RA, Gross JL, Deheinzelin D, Negri EM. Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2009 [acesso em 10 set. 2017];35(6):521-8. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
, QoL was evaluated only six months after pulmonary resection.

The evaluation of patients before and after physical therapy2020 Ozalevli S, Ilgin D, Karaali HK, Bulac S, Akkoclu A. The effect of in-patient chest physiotherapy in lung cancer patients. Support Care Cancer [Internet]. 2010 [acesso em 10 set. 2017];18(3):351-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19471973
https://www.ncbi.nlm.nih.gov/pubmed/1947...
involved advanced stages of cancer (III B or IV).

DISCUSSION

This review described the characteristics of studies of the QoL of patients with lung cancer, identified the QoL instruments used and explored the methodological aspects of the research, as well as evaluating its quality. The elderly are more affected by lung cancer22 American Cancer Society. Key Statistics for Lung Cancer [Internet]. [S.local]: ACS; 2019 [acesso em 05 abril 2019]. Disponível em: https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html
https://www.cancer.org/cancer/non-small-...
,33 Centro Cochrane do Brasil e Liga de Saúde Baseada em Evidências da Universidade Federal de Medicina (EPM-Unifesp). Quimioterapia para o câncer de pulmão de células não pequenas avançado em idosos. Diagn Tratamento [Internet]. 2017 [acesso em 11 dez. 2018];22(1):49-50. Disponível em: http://docs.bvsalud.org/biblioref/2017/03/832451/rdt_v22n1_49-50.pdf
http://docs.bvsalud.org/biblioref/2017/0...
, which explains the age of the patients, which was generally over 60 years. Being elderly is a risk factor for lung cancer, with such individuals having a 4.33 times greater chance of having the disease than those at other ages2828 Saldías PF, Elola AJM, Uribe MJ, Morales AS, Díaz PO. Predictores clínicos y funcionales del riesgo de cáncer pulmonar en el seguimiento de una cohorte de adultos fumadores. Rev Méd Chile [Internet]. 2016 [acesso em 06 abr. 2019];144(11):1382-90. Disponível em: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001100003&lng=pt
https://scielo.conicyt.cl/scielo.php?scr...
. Greater life expectancy allows sufficient time to develop the disease2929 Tsukazan MTR, Vigo A, Silva VD, Barrios CH, Rios JO, Pinto JAF. Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil. J Bras Pneumol [Internet]. 2017 [acesso em 06 abr. 2019];43(5):363-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132017000500363
http://www.scielo.br/scielo.php?script=s...
.

The QoL instruments were generic and specific. The generic studies evaluate QoL irrespective of the presence of the pathology. The specific studies analyzed patients with cancer of any type, with lung cancer and with chronic obstructive pulmonary disease.

Eight different instruments evaluated the QoL of patients. The most frequently adopted was specific for people with cancer, EORTC QLQ-C30, although it was used in less than half of the articles. Its LC-13 complementary module was used in two studies1515 Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2013 [acesso em 10 set. 2017];39(1):23-31. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
http://www.scielo.br/scielo.php?script=s...
,2626 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
because it is specific for lung cancer, evaluating QoL for the particular symptoms of this disease. It is therefore recommended to combine these scales.

These instruments are potentially useful because they are based on life and health symptoms and impairments which affect patients. An instrument such as the EORTC QLQ-C3099 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,1313 Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene [Internet]. 2014 [acesso em 10 set. 2017];15(1):132-40. Disponível em: http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
http://repositorio.ufc.br/bitstream/riuf...

14 de Oliveira PI, Pereira CAC, Belasco AGS, Bettencourt ARC. Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico. Rev Latinoam Enferm [Internet]. 2013 [acesso em 10 set. 2017];21(3):787-94. Disponível em: http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
http://www.scielo.br/pdf/rlae/v21n3/pt_0...

15 Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2013 [acesso em 10 set. 2017];39(1):23-31. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
http://www.scielo.br/scielo.php?script=s...

16 Pastore CA, Oehlschlaeger MHK, Gonzalez MC. Impacto do estado nutricional e da força muscular sobre o estado de saúde geral e qualidade de vida em pacientes com câncer de trato gastrintestinal e de pulmão. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(1):43-9. Disponível em: https://rbc.inca.gov.br/site/arquivos/n_59/v01/pdf/07-impacto-do-estado-nutricional-e-da-for%C3%A7a-muscular.pdf
https://rbc.inca.gov.br/site/arquivos/n_...
-1717 Floyd A, Dedert E, Ghate S, Studts JL, Stetson B, Sephton SE, et al. Depression may mediate the relationship between sense of coherence and quality of life in lung cancer patients. J Health Psychol [Internet]. 2011 [acesso em 10 set. 2017];16(2):249-57. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20929943
https://www.ncbi.nlm.nih.gov/pubmed/2092...
,2323 Fiteni F, Vernerey D, Bonnetain F, Vaylet F, Sennélart H, Trédaniel J, et al. Prognostic value of health-related quality of life for overall survival in elderly non-small-cell lung cancer patients. Eur J Cancer [Internet]. 2016 [acesso em 10 set. 2017];52:120-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26682871
https://www.ncbi.nlm.nih.gov/pubmed/2668...
,2525 Frio CC, Pretto ADB, Gonzalez MC, Pastore CA. Influência da composição corporal sobre a qualidade de vida de pacientes com câncer. Rev Bras Cancerol [Internet]. 2015 [acesso em 10 set. 2017];61(4):351-6. Disponível em: http://www1.inca.gov.br/rbc/n_61/v04/pdf/06-artigo-influencia-da-composicao-corporal-sobre-a-qualidade-de-vida-de-pacientes-com-cancer.pdf
http://www1.inca.gov.br/rbc/n_61/v04/pdf...
,2626 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
evaluates fatigue among the symptoms of patients with cancer. In a literature review it was observed that fatigue impacts the QoL of patients with lung cancer. It influences the execution of activities of daily living, relapse of the disease, the reduction of survival and emergency care and hospital admissions. It is highly prevalent and needs to be better evaluated through studies with high levels of scientific evidence11 Cardoso RC, Carlo MMRP. Fadiga em Pacientes com Câncer de Pulmão: uma Revisão Sistemática de Literatura. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(4):575-82. Disponível em: http://www1.inca.gov.br/rbc/n_59/v04/pdf/12-revisao-literatura-fadiga-em-pacientes-com-cancer-pulmao-uma-revisao-sistematica-de-literatura.pdf
http://www1.inca.gov.br/rbc/n_59/v04/pdf...
. It should be considered that elderly patients usually suffer reduced functional capacity3030 Cesari M, Calvani R, Marzetii E. Frailty in older persons. Clin Geriatr Med [Internet]. 2017 [acesso em 06 abr. 2019];33(3):293-303. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28689563
https://www.ncbi.nlm.nih.gov/pubmed/2868...

31 Fhon JRS, Rodrigues RAP, Santos JLF, Diniz MA, Santos EB, Almeida VC, et al. Factors associated with frailty in older adults: a longitudinal study. Rev Saúde Pública [Internet]. 2018 [acesso em 06 abr. 2019];52:1-8. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102018000100266
http://www.scielo.br/scielo.php?script=s...

32 Diez-Ruiz A, Bueno-Errandonea A, Nuñez-Barrio J, Sanchez-Martín I, Vrotsou K, Vergara E. Factors associated with frailty in primary care: a prospective cohort study. BMC Geriatr [Internet]. 2016 [acesso em 06 abr. 2019];16(91):1-8. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850657/pdf/12877_2016_Article_263
https://www.ncbi.nlm.nih.gov/pmc/article...
-3333 Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Ciênc Saúde Colet [Internet]. 2016 [acesso em 06 abr. 2019];21(11):3377-86. Disponível em: http://www.scielo.br/pdf/csc/v21n11/1413-8123-csc-21-11-3377
http://www.scielo.br/pdf/csc/v21n11/1413...
, which, added to the fatigue caused by the disease3434 Mansano-Schlosser TC, Ceolin MF. Fadiga em idosos em tratamento quimioterápico. Rev Bras Enferm [Internet]. 2014 [acesso em 06 abr. 2019];67(4):623-9. Disponível em: http://www.scielo.br/scielo.php?pid=S0034-71672014000400623&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S003...
, may result in greater impairment of activities of daily living and interference in QoL3535 Carneiro J, Ramos GCF, Barbosa ATF, Mendonça JMG, Costa FM, Caldeira AP. Prevalência e fatores associados à fragilidade em idosos não institucionalizados. Rev Bras Enferm [Internet]. 2016 [acesso em 06 abr. 2019];69(3):435-42. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672016000300435&lng=en
http://www.scielo.br/scielo.php?script=s...

36 Ribeiro EG, Matozinhos FP, Guimarães GL, Couto AM, Azevedo RS, Mendoza IYQ. Self-perceived health and clinical-functional vulnerability of the elderly in Belo Horizonte/Minas Gerais. Rev Bras Enferm [Internet]. 2018 [acesso em 06 abr. 2019];71(2):860-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000800860
http://www.scielo.br/scielo.php?script=s...
-3737 Freitas CV, Sarges ESNF, Moreira KECS, Carneiro SR. Avaliação de fragilidade, capacidade funcional e qualidade de vida dos idosos atendidos no ambulatório de geriatria de um hospital universitário. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 06 abr. 2019];19(1):119-28. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232016000100119&lng=pt
http://www.scielo.br/scielo.php?script=s...
.

Specific instruments with varying purposes were noted, for example, the evaluation of chemotherapy (Quality of Life Questionnaire for Cancer Patients Treated with Anti-Cancer Drugs (QoL-ACD) and those which featured treatment side effect items. However, it should be emphasized that this instrument would not be suitable for individuals at the initial stage of the disease who are treated by surgical resection. In this situation, generic instruments or those specific for respiratory diseases are recommended. It is the responsibility of researchers to choose the best instrument or to use more than one. In Brazil and in developed countries, about 70% of patients have advanced (stage III) or metastatic (stage IV) lung cancer3939 Araujo LH, Baldotto C, Castro Jr G, Katz A, Ferreira CG, Mathias C, et al. Câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2018 [acesso em 06 abr. 2019];44(1):55-64. Disponível em: http://www.scielo.br/pdf/jbpneu/v44n1/pt_1806-3713-jbpneu-44-01-00055.pdf
http://www.scielo.br/pdf/jbpneu/v44n1/pt...
and it can be inferred that for most studies specific instruments are recommended, since the patients diagnosed would already be living with symptoms and their implications for QoL.

Among the non-specific instruments, the SF-36, used in six studies, is worthy of note. It assesses both the negative (illness/infirmity) and positive (well-being) aspects of health1515 Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2013 [acesso em 10 set. 2017];39(1):23-31. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
http://www.scielo.br/scielo.php?script=s...
. Generic instruments perform multidimensional health assessment, identifying the ability to perform activities of daily living. Applied at different times, they assess improvement or worsening in physical and emotional aspects. In this sense, generic instruments can be useful for evaluating a certain intervention4040 Ciconelli RM, Ferra MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol.1999;39(3):143-50.. However, assessment involves general aspects of life and does not consider disease specificities, such as in the QLQ-LC13, with items for symptoms and the adverse effects of treatment such as coughs, mucositis, alopecia and chest pain1515 Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2013 [acesso em 10 set. 2017];39(1):23-31. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
http://www.scielo.br/scielo.php?script=s...
,2626 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
.

The prospective studies assessed QoL, before and after: chemotherapy, physiotherapy or pulmonary resection. They adopted generic and specific instruments. In one study, antineoplastic chemotherapy worsened the physical performance of patients99 Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
. Also, in the study by Nicolussi et al.1313 Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene [Internet]. 2014 [acesso em 10 set. 2017];15(1):132-40. Disponível em: http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
http://repositorio.ufc.br/bitstream/riuf...
, cancer and its treatment affected patients in some way, causing deterioration in the functions performed and the presence of more symptoms, impairing QoL. However, improvement in QoL may occur if the side effects of treatments can be avoided and controlled and there is adherence to effective complementary treatments that can assist in coping with the disease and treatment1313 Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene [Internet]. 2014 [acesso em 10 set. 2017];15(1):132-40. Disponível em: http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
http://repositorio.ufc.br/bitstream/riuf...
.

However, Oliveira et al.1414 de Oliveira PI, Pereira CAC, Belasco AGS, Bettencourt ARC. Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico. Rev Latinoam Enferm [Internet]. 2013 [acesso em 10 set. 2017];21(3):787-94. Disponível em: http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
http://www.scielo.br/pdf/rlae/v21n3/pt_0...
found an improvement in QoL and symptoms of dyspnea and hemoptysis after chemotherapy. In the study by Avelino et al.2626 Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
, the authors found differences in QoL regarding physical and cognitive capacity during chemotherapy, with improvement and deterioration, respectively. They also observed improvement in pain and loss of appetite. The study by Muller, Silva and Xavier2727 Müller AM, Silva DR, Xavier RG. Avaliação da qualidade de vida e função pulmonar em pacientes com câncer de pulmão. Clin Biomed Res [Internet]. 2014 [acesso em 10 set. 2017];34(4):347-56. Disponível em: https://seer.ufrgs.br/hcpa/article/view/48568
https://seer.ufrgs.br/hcpa/article/view/...
showed no difference in QoL before chemotherapy and 60 and 120 days later. The negative effects of adjuvant chemotherapy on QoL appear to be temporary and improvements are common in most patients4141 Bezjak A, Lee CW, Ding K, Brundage M, Winton T, Graham B, et al. Quality-of-life outcomes for adjuvant chemotherapy in early-stage non-small-cell lung cancer: results from a randomized trial, JBR.10. J Clin Oncol [Internet]. 2008 [acesso em 10 set. 2017];26(31):5052-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/18809617
https://www.ncbi.nlm.nih.gov/pubmed/1880...
.

The evaluation of QoL after physical therapy was described in one study, with improvement in physical mobility, pain, energy, emotional aspects and sleep2020 Ozalevli S, Ilgin D, Karaali HK, Bulac S, Akkoclu A. The effect of in-patient chest physiotherapy in lung cancer patients. Support Care Cancer [Internet]. 2010 [acesso em 10 set. 2017];18(3):351-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19471973
https://www.ncbi.nlm.nih.gov/pubmed/1947...
. The results after pulmonary resection are contradictory2121 Lima LNT, da Silva RA, Gross JL, Deheinzelin D, Negri EM. Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2009 [acesso em 10 set. 2017];35(6):521-8. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
,2222 Saad IAB, Botega NJ, Toro IFC. Avaliação da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2006 [acesso em 10 set. 2017];32(1):10-5. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
http://www.scielo.br/scielo.php?script=s...
, with both deterioration2121 Lima LNT, da Silva RA, Gross JL, Deheinzelin D, Negri EM. Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2009 [acesso em 10 set. 2017];35(6):521-8. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
http://www.scielo.br/scielo.php?pid=S180...
and improvement in QoL2222 Saad IAB, Botega NJ, Toro IFC. Avaliação da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2006 [acesso em 10 set. 2017];32(1):10-5. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
http://www.scielo.br/scielo.php?script=s...
. Studies comparing the QoL of people with cancer with healthy individuals55 Franceschini J, dos Santos AA, El Mouallem I, Jamnik S, Uehara C, Fernandes ALG, et al. Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey. J Bras Pneumol. 2008 [acesso em 10 set. 2017];34(6):387-93. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000600009&lng=en
http://www.scielo.br/scielo.php?script=s...
,1818 Lee LJ, Chung CW, Chang YY, Lee YC, Yang CH, Liou SH, et al. Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls. Qual Life Res [Internet]. 2010 [acesso em 10 set. 2017];20(3):415-23. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20953907
https://www.ncbi.nlm.nih.gov/pubmed/2095...
found a worse overall QoL score for cancer patients in the SF-365 and WHOQoL-BREF1818 Lee LJ, Chung CW, Chang YY, Lee YC, Yang CH, Liou SH, et al. Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls. Qual Life Res [Internet]. 2010 [acesso em 10 set. 2017];20(3):415-23. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20953907
https://www.ncbi.nlm.nih.gov/pubmed/2095...
. In the latter study1818 Lee LJ, Chung CW, Chang YY, Lee YC, Yang CH, Liou SH, et al. Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls. Qual Life Res [Internet]. 2010 [acesso em 10 set. 2017];20(3):415-23. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20953907
https://www.ncbi.nlm.nih.gov/pubmed/2095...
there were worse scores in the physical and psychological domains.

Despite the lack of consensus on the type of instrument adopted, evaluations of QoL can be an important tool for guiding health interventions in the affected QoL domains, according to the chosen therapy and clinical evolution of the patient, in a given context.

Regarding the losses in quality of the articles, given the severity of the disease, the most practical way to recruit participants is in the hospital environment, explaining the use of convenience samples. Quality of life is subjective in nature, and it is therefore feasible that the responses to the instruments should be provided by self-assessment. It should be noted that the instruments provide quantitative data in different domains, which is useful in comparing procedures and population groups, supporting decision-making in health care and future investigations.

Limitations of the present study include the fact that the search was carried out only in the VHL and in Portuguese. However, the importance of the regional VHL is highlighted, as it incorporates more than 30 databases, including 14 from Health Sciences, such as Lilacs and Medline. It is important to emphasize that in the VHL, even with descriptors in Portuguese, searches are made for publications in other languages and in other countries. In addition, the VHL is supported by the technical cooperation of the Pan-American Health Organization.

CONCLUSION

This scoping review identified discrepancies between the prospective studies evaluating quality of life after chemotherapy and pulmonary resection, which found both deterioration and improvement in QoL. The probable causes of this are methodological diversity, with different questionnaires applied across varying treatments and frequency reapplications, and the use of convenience samples of different ages and stages of disease. This does not help when grouping results in meta-analysis, which justifies the use of the scoping review method when exploring publications in terms of the methodological aspects and instruments used.

The results of the comparative cross-sectional studies should be evaluated with caution. They compare diseased and healthy populations and use generic questionnaires, such as the WHOQoL-BREF and SF36. They identified a worse quality of life in the overall score of the instruments for people with cancer. A study with the WHOQoL-BREF also found worse results in the physical and psychological domains, with no differences in the social and environmental domains. This is most likely due to the lack of disease specificity in the questionnaire, which includes domains that evaluate sexual activity and aspects of health care, such as the availability and quality of care, which are commonly affected by the disease; especially in studies with patients in advanced stages.

The choice of generic instruments to evaluate quality of life in patients diagnosed with cancer should not be encouraged, as the disease carries particularities that impact the life of the patients, and this theme can be better evaluated by specific instruments. Such assessment should preferably be complemented with evaluation by specific instruments for people with lung cancer, which consider, in addition to functional, emotional and social aspects, the symptoms associated with lung disease. These instruments better evaluate the impact of lung cancer on the quality of life of the individual.

Further studies with a specific instrument for people with lung cancer are therefore recommended. Prospective studies should also be encouraged, as they allow the evaluation of quality of life at different times. Different cancer modalities should not be grouped together, due to their specificities and possible impairment in different aspects. Methodological homogeneity should be applied, analyzing groups by age, disease stage and treatment modalities, while consensus should be sought among experts regarding the best timing/frequency of the application and reapplication of the instruments.

It is also recommended, where possible, that respondents are randomly selected, as the convenience sample method limits generalizations of the results by restricting the participation of those with advanced physical disability or cognitive impairment, resulting in an overestimation of the quality of life. The exclusion of comorbidities that can influence quality of life should also be considered in future studies.

REFERENCES

  • 1
    Cardoso RC, Carlo MMRP. Fadiga em Pacientes com Câncer de Pulmão: uma Revisão Sistemática de Literatura. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(4):575-82. Disponível em: http://www1.inca.gov.br/rbc/n_59/v04/pdf/12-revisao-literatura-fadiga-em-pacientes-com-cancer-pulmao-uma-revisao-sistematica-de-literatura.pdf
    » http://www1.inca.gov.br/rbc/n_59/v04/pdf/12-revisao-literatura-fadiga-em-pacientes-com-cancer-pulmao-uma-revisao-sistematica-de-literatura.pdf
  • 2
    American Cancer Society. Key Statistics for Lung Cancer [Internet]. [S.local]: ACS; 2019 [acesso em 05 abril 2019]. Disponível em: https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html
    » https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/key-statistics.html
  • 3
    Centro Cochrane do Brasil e Liga de Saúde Baseada em Evidências da Universidade Federal de Medicina (EPM-Unifesp). Quimioterapia para o câncer de pulmão de células não pequenas avançado em idosos. Diagn Tratamento [Internet]. 2017 [acesso em 11 dez. 2018];22(1):49-50. Disponível em: http://docs.bvsalud.org/biblioref/2017/03/832451/rdt_v22n1_49-50.pdf
    » http://docs.bvsalud.org/biblioref/2017/03/832451/rdt_v22n1_49-50.pdf
  • 4
    Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. Estimativa 2018: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2017.
  • 5
    Franceschini J, dos Santos AA, El Mouallem I, Jamnik S, Uehara C, Fernandes ALG, et al. Avaliação da qualidade de vida em pacientes com câncer de pulmão através da aplicação do questionário Medical Outcomes Study 36-item Short-Form Health Survey. J Bras Pneumol. 2008 [acesso em 10 set. 2017];34(6):387-93. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000600009&lng=en
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008000600009&lng=en
  • 6
    American Thoracic Society: Quality of Life Resource [Internet]. [Sem local]: ATS; 2007. Functional Assessment of Cancer Therapy-Lung (FACT-L). 199 [acesso em 6 abr. 2019]; [1 tela]. Disponível em: http://qol.thoracic.org/sections/instruments/fj/pages/fact-l.html
    » http://qol.thoracic.org/sections/instruments/fj/pages/fact-l.html
  • 7
    American Thoracic Society [Internet]. [Sem local]: ATS; 2007. European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire and Lung Cancer Module (QLQ-LC13). 1999; [1 tela]. [acesso em 06 abr. 2019]; Disponível em: http://qol.thoracic.org/sections/instruments/ae/pages/qlq-lc13.html
    » http://qol.thoracic.org/sections/instruments/ae/pages/qlq-lc13.html
  • 8
    The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;10:1403-9.
  • 9
    Ferreira MLL, de Souza AI, Ferreira LOC, Moura JFP, Costa Junior José I. Qualidade de vida relacionada à saúde de idosos em tratamento quimioterápico. Rev Bras Geriatr Gerontol [Internet]. 2015 [acesso em 10 set. 2017];18(1):165-77. Disponível em: http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
    » http://www.scielo.br/scielo.php?pid=S1809-98232015000100165&script=sci_abstract&tlng=pt
  • 10
    Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc [Internet]. 2015 [acesso em 10 set. 2017];13(3):141-6. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26134548
    » https://www.ncbi.nlm.nih.gov/pubmed/26134548
  • 11
    Ottawa Hospital Research Institute [Internet]. Ottawa: OHRI; 2019. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses [acesso em 10 set. 2018]; [1 tela]. Disponível em: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    » http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
  • 12
    Nai-Wen C, Kuan- Chia L, Wen-Hu H, Shih-Chun L, Yi-Hsin JC, Kwua-Yun W. The effect of gender on health-related quality of life and related factorsin post-lobectomy lung-cancer patients. Eur J Oncol Nurs [Internet]. 2015 [acesso em 10 set. 2017];19(3):292-300. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/25432210
    » https://www.ncbi.nlm.nih.gov/pubmed/25432210
  • 13
    Nicolussi AC, Sawada NO, Cardozo FMC, Andrade V, Paula JM. Qualidade de vida relacionada à saúde de pacientes com câncer em quimioterapia. Rev Rene [Internet]. 2014 [acesso em 10 set. 2017];15(1):132-40. Disponível em: http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
    » http://repositorio.ufc.br/bitstream/riufc/11658/1/2014_art_acnicolussi.pdf
  • 14
    de Oliveira PI, Pereira CAC, Belasco AGS, Bettencourt ARC. Comparação da qualidade de vida de portadores de câncer de pulmão antes e após o tratamento quimioterápico. Rev Latinoam Enferm [Internet]. 2013 [acesso em 10 set. 2017];21(3):787-94. Disponível em: http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
    » http://www.scielo.br/pdf/rlae/v21n3/pt_0104-1169-rlae-21-03-0787.pdf
  • 15
    Franceschini J, Jardim JR, Fernandes ALG, Jamnik S, Santoro IL. Relação entre a magnitude de sintomas e a qualidade de vida: análise de agrupamentos de pacientes com câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2013 [acesso em 10 set. 2017];39(1):23-31. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132013000100004
  • 16
    Pastore CA, Oehlschlaeger MHK, Gonzalez MC. Impacto do estado nutricional e da força muscular sobre o estado de saúde geral e qualidade de vida em pacientes com câncer de trato gastrintestinal e de pulmão. Rev Bras Cancerol [Internet]. 2013 [acesso em 10 set. 2017];59(1):43-9. Disponível em: https://rbc.inca.gov.br/site/arquivos/n_59/v01/pdf/07-impacto-do-estado-nutricional-e-da-for%C3%A7a-muscular.pdf
    » https://rbc.inca.gov.br/site/arquivos/n_59/v01/pdf/07-impacto-do-estado-nutricional-e-da-for%C3%A7a-muscular.pdf
  • 17
    Floyd A, Dedert E, Ghate S, Studts JL, Stetson B, Sephton SE, et al. Depression may mediate the relationship between sense of coherence and quality of life in lung cancer patients. J Health Psychol [Internet]. 2011 [acesso em 10 set. 2017];16(2):249-57. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20929943
    » https://www.ncbi.nlm.nih.gov/pubmed/20929943
  • 18
    Lee LJ, Chung CW, Chang YY, Lee YC, Yang CH, Liou SH, et al. Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls. Qual Life Res [Internet]. 2010 [acesso em 10 set. 2017];20(3):415-23. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/20953907
    » https://www.ncbi.nlm.nih.gov/pubmed/20953907
  • 19
    Weaver KE, Rowland JH, Augustson E, Atienza AA. Smoking concordance in lung and colorectal cancer patient-caregiver dyads and quality of life. Cancer Epidemiol Biomark Prev [Internet]. 2011 [acesso em 10 set. 2017];20(2):239-48. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035926/
    » https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3035926
  • 20
    Ozalevli S, Ilgin D, Karaali HK, Bulac S, Akkoclu A. The effect of in-patient chest physiotherapy in lung cancer patients. Support Care Cancer [Internet]. 2010 [acesso em 10 set. 2017];18(3):351-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/19471973
    » https://www.ncbi.nlm.nih.gov/pubmed/19471973
  • 21
    Lima LNT, da Silva RA, Gross JL, Deheinzelin D, Negri EM. Avaliação da função pulmonar e da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2009 [acesso em 10 set. 2017];35(6):521-8. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
    » http://www.scielo.br/scielo.php?pid=S1806-37132009000600005&script=sci_abstract&tlng=pt
  • 22
    Saad IAB, Botega NJ, Toro IFC. Avaliação da qualidade de vida em pacientes submetidos à ressecção pulmonar por neoplasia. J Bras Pneumol [Internet]. 2006 [acesso em 10 set. 2017];32(1):10-5. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132006000100005
  • 23
    Fiteni F, Vernerey D, Bonnetain F, Vaylet F, Sennélart H, Trédaniel J, et al. Prognostic value of health-related quality of life for overall survival in elderly non-small-cell lung cancer patients. Eur J Cancer [Internet]. 2016 [acesso em 10 set. 2017];52:120-8. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26682871
    » https://www.ncbi.nlm.nih.gov/pubmed/26682871
  • 24
    Borges EL, Franceschini J, Costa LHD, Fernandes ALG, Jamnik S, Santoro IL. Sobrecarga do cuidador familiar: a sobrecarga de cuidar de pacientes com câncer de pulmão, de acordo com o estágio do câncer e a qualidade de vida do paciente. J Bras Pneumol [Internet]. 2017 [acesso em 10 set. 2017];43(1):18-23. Disponível em: http://www.scielo.br/pdf/jbpneu/v43n1/pt_1806-3713-jbpneu-2016000000177.pdf
    » http://www.scielo.br/pdf/jbpneu/v43n1/pt_1806-3713-jbpneu-2016000000177.pdf
  • 25
    Frio CC, Pretto ADB, Gonzalez MC, Pastore CA. Influência da composição corporal sobre a qualidade de vida de pacientes com câncer. Rev Bras Cancerol [Internet]. 2015 [acesso em 10 set. 2017];61(4):351-6. Disponível em: http://www1.inca.gov.br/rbc/n_61/v04/pdf/06-artigo-influencia-da-composicao-corporal-sobre-a-qualidade-de-vida-de-pacientes-com-cancer.pdf
    » http://www1.inca.gov.br/rbc/n_61/v04/pdf/06-artigo-influencia-da-composicao-corporal-sobre-a-qualidade-de-vida-de-pacientes-com-cancer.pdf
  • 26
    Avelino CUR, Cardoso RM, Aguiar SS, Silva MJS. Assessment of quality of life in patients with advanced non-small cell lung carcinoma treated with a combination of carboplatin and paclitaxel. J Bras Pneumol [Internet]. 2015 [acesso em 10 set. 2017];41(2):133-42. Disponível em: http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
    » http://www.scielo.br/scielo.php?pid=S1806-37132015000200133&script=sci_arttext&tlng=pt
  • 27
    Müller AM, Silva DR, Xavier RG. Avaliação da qualidade de vida e função pulmonar em pacientes com câncer de pulmão. Clin Biomed Res [Internet]. 2014 [acesso em 10 set. 2017];34(4):347-56. Disponível em: https://seer.ufrgs.br/hcpa/article/view/48568
    » https://seer.ufrgs.br/hcpa/article/view/48568
  • 28
    Saldías PF, Elola AJM, Uribe MJ, Morales AS, Díaz PO. Predictores clínicos y funcionales del riesgo de cáncer pulmonar en el seguimiento de una cohorte de adultos fumadores. Rev Méd Chile [Internet]. 2016 [acesso em 06 abr. 2019];144(11):1382-90. Disponível em: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001100003&lng=pt
    » https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001100003&lng=pt
  • 29
    Tsukazan MTR, Vigo A, Silva VD, Barrios CH, Rios JO, Pinto JAF. Lung cancer: changes in histology, gender, and age over the last 30 years in Brazil. J Bras Pneumol [Internet]. 2017 [acesso em 06 abr. 2019];43(5):363-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132017000500363
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132017000500363
  • 30
    Cesari M, Calvani R, Marzetii E. Frailty in older persons. Clin Geriatr Med [Internet]. 2017 [acesso em 06 abr. 2019];33(3):293-303. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28689563
    » https://www.ncbi.nlm.nih.gov/pubmed/28689563
  • 31
    Fhon JRS, Rodrigues RAP, Santos JLF, Diniz MA, Santos EB, Almeida VC, et al. Factors associated with frailty in older adults: a longitudinal study. Rev Saúde Pública [Internet]. 2018 [acesso em 06 abr. 2019];52:1-8. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102018000100266
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102018000100266
  • 32
    Diez-Ruiz A, Bueno-Errandonea A, Nuñez-Barrio J, Sanchez-Martín I, Vrotsou K, Vergara E. Factors associated with frailty in primary care: a prospective cohort study. BMC Geriatr [Internet]. 2016 [acesso em 06 abr. 2019];16(91):1-8. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850657/pdf/12877_2016_Article_263
    » https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850657/pdf/12877_2016_Article_263
  • 33
    Medeiros SM, Silva LSR, Carneiro JA, Ramos GCF, Barbosa ATF, Caldeira AP. Fatores associados à autopercepção negativa da saúde entre idosos não institucionalizados de Montes Claros, Brasil. Ciênc Saúde Colet [Internet]. 2016 [acesso em 06 abr. 2019];21(11):3377-86. Disponível em: http://www.scielo.br/pdf/csc/v21n11/1413-8123-csc-21-11-3377
    » http://www.scielo.br/pdf/csc/v21n11/1413-8123-csc-21-11-3377
  • 34
    Mansano-Schlosser TC, Ceolin MF. Fadiga em idosos em tratamento quimioterápico. Rev Bras Enferm [Internet]. 2014 [acesso em 06 abr. 2019];67(4):623-9. Disponível em: http://www.scielo.br/scielo.php?pid=S0034-71672014000400623&script=sci_abstract&tlng=pt
    » http://www.scielo.br/scielo.php?pid=S0034-71672014000400623&script=sci_abstract&tlng=pt
  • 35
    Carneiro J, Ramos GCF, Barbosa ATF, Mendonça JMG, Costa FM, Caldeira AP. Prevalência e fatores associados à fragilidade em idosos não institucionalizados. Rev Bras Enferm [Internet]. 2016 [acesso em 06 abr. 2019];69(3):435-42. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672016000300435&lng=en
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672016000300435&lng=en
  • 36
    Ribeiro EG, Matozinhos FP, Guimarães GL, Couto AM, Azevedo RS, Mendoza IYQ. Self-perceived health and clinical-functional vulnerability of the elderly in Belo Horizonte/Minas Gerais. Rev Bras Enferm [Internet]. 2018 [acesso em 06 abr. 2019];71(2):860-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000800860
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672018000800860
  • 37
    Freitas CV, Sarges ESNF, Moreira KECS, Carneiro SR. Avaliação de fragilidade, capacidade funcional e qualidade de vida dos idosos atendidos no ambulatório de geriatria de um hospital universitário. Rev Bras Geriatr Gerontol [Internet]. 2016 [acesso em 06 abr. 2019];19(1):119-28. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232016000100119&lng=pt
    » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232016000100119&lng=pt
  • 38
    American Thoracic Society: Quality of Life Resource [Internet]. [Sem local]: ATS; [200-]. Lung Cancer; [Sem data] [acesso em 06 abr. 2019]; [1 tela]. Disponível em: http://qol.thoracic.org/sections/specific-diseases/lung-cancer.html
    » http://qol.thoracic.org/sections/specific-diseases/lung-cancer.html
  • 39
    Araujo LH, Baldotto C, Castro Jr G, Katz A, Ferreira CG, Mathias C, et al. Câncer de pulmão no Brasil. J Bras Pneumol [Internet]. 2018 [acesso em 06 abr. 2019];44(1):55-64. Disponível em: http://www.scielo.br/pdf/jbpneu/v44n1/pt_1806-3713-jbpneu-44-01-00055.pdf
    » http://www.scielo.br/pdf/jbpneu/v44n1/pt_1806-3713-jbpneu-44-01-00055.pdf
  • 40
    Ciconelli RM, Ferra MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol.1999;39(3):143-50.
  • 41
    Bezjak A, Lee CW, Ding K, Brundage M, Winton T, Graham B, et al. Quality-of-life outcomes for adjuvant chemotherapy in early-stage non-small-cell lung cancer: results from a randomized trial, JBR.10. J Clin Oncol [Internet]. 2008 [acesso em 10 set. 2017];26(31):5052-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/18809617
    » https://www.ncbi.nlm.nih.gov/pubmed/18809617

  • Financiamento:

    Fundação de Amparo à Pesquisa de MG- FAPEMIG, processo N:CDS-BIP00128-18 e Conselho Nacional de Desenvolvimento Científico e Tecnológico- CNPq, bolsa de iniciação científica.

Publication Dates

  • Publication in this collection
    19 Aug 2019
  • Date of issue
    2019

History

  • Received
    01 Sept 2018
  • Accepted
    13 May 2019
Universidade do Estado do Rio Janeiro Rua São Francisco Xavier, 524 - Bloco F, 20559-900 Rio de Janeiro - RJ Brasil, Tel.: (55 21) 2334-0168 - Rio de Janeiro - RJ - Brazil
E-mail: revistabgg@gmail.com
Accessibility / Report Error