{"id":1383,"date":"2016-11-29T19:28:16","date_gmt":"2016-11-29T18:28:16","guid":{"rendered":"http:\/\/www.ipsi.cat\/elfil\/?p=1383"},"modified":"2017-06-12T10:31:32","modified_gmt":"2017-06-12T08:31:32","slug":"despres-dun-cancer-de-mama","status":"publish","type":"post","link":"https:\/\/www.ipsi.cat\/elfil\/despres-dun-cancer-de-mama\/","title":{"rendered":"Despr\u00e9s d&#8217;un c\u00e0ncer de mama, qu\u00e8 ve? Estudi d&#8217;una onc\u00f2loga"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Qu\u00e8 ve despr\u00e9s d&#8217;un c\u00e0ncer de mama? Mai es pot generalitzar, per\u00f2 d\u2019entrada&#8230;molts canvis i moltes inc\u00f2gnites:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Pron\u00f2stic<\/span><span style=\"font-weight: 400;\">?\u00a0<\/span><span style=\"font-weight: 400;\">Tractament?\u00a0<\/span><span style=\"font-weight: 400;\">P\u00e8rdues<\/span><span style=\"font-weight: 400;\">?\u00a0<\/span><span style=\"font-weight: 400;\">Fills<\/span><span style=\"font-weight: 400;\">?\u00a0<\/span><span style=\"font-weight: 400;\">Parella<\/span><span style=\"font-weight: 400;\">?\u00a0<\/span><span style=\"font-weight: 400;\">Feina\u2026<\/span><span style=\"font-weight: 400;\">?<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">El c\u00e0ncer de mama \u00e9s un problema de salut p\u00fablica a nivell mundial<\/span><span style=\"font-weight: 400;\">1<\/span><span style=\"font-weight: 400;\">. A Catalunya es diagnostiquen 4675 casos nous\/any (2)<\/span><span style=\"font-weight: 400;\">. Tot i que avui en dia, gr\u00e0cies al diagn\u00f2stic preco\u00e7, els aven\u00e7os en els tractaments i el treball en equips multidisciplinaris, la superviv\u00e8ncia de les pacients amb c\u00e0ncer de mama ha augmentat del 65% al 82.5% en els darrers 15 anys, encara som lluny de curar totes les pacients diagnosticades. Per la persona que pateix la malaltia en concret, encara \u00e9s insuficient, perqu\u00e8 hi ha un 15-20% de les nostres pacients que tot i fer els tractaments correctament poden recaure amb el temps.<\/span><\/p>\n<blockquote><p>Els tractaments que utilitzem avui en dia s\u00f3n m\u00e9s efica\u00e7os que els que ten\u00edem pr\u00e8viament per\u00f2 tamb\u00e9 m\u00e9s t\u00f2xics. I cal saber que la toxicitat que generen va m\u00e9s enll\u00e0 de la duraci\u00f3 estricta del tractament.<\/p><\/blockquote>\n<p><span style=\"font-weight: 400;\">Davant d\u2019aquest risc de recaiguda de la malaltia, els onc\u00f2legs tractem i tractem. Per\u00f2 a quin preu? Els tractaments que utilitzem avui en dia s\u00f3n m\u00e9s efica\u00e7os que els que ten\u00edem pr\u00e8viament per\u00f2 tamb\u00e9 m\u00e9s t\u00f2xics. I cal saber que la toxicitat que generen va m\u00e9s enll\u00e0 de la duraci\u00f3 estricta del tractament. Les pacients sovint refereixen trobar-se pitjor f\u00edsica i an\u00edmicament l\u2019any seg\u00fcent a finalitzar els tractaments oncoespec\u00edfics que durant la fase aguda del tractament. De fet hi ha estudis que reporten que les dones que han passat un c\u00e0ncer de mama presenten puntuacions pitjors en qualitat de vida que les de la poblaci\u00f3 general ajustada per edat fins i tot m\u00e9s enll\u00e0 dels 10 anys, especialment aquelles que han rebut quimioter\u00e0pia (<\/span><span style=\"font-weight: 400;\">3,4)<\/span><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A qu\u00e8 \u00e9s degut to aix\u00f2? Aix\u00ed com els tractaments locals, tant la cirurgia com la radioter\u00e0pia, tendeixen a ser cada vegada menys agressius: hem passat de les grans mastectomies de Halstead i les limfadenectomies axil\u00b7lars completes (5)<\/span><span style=\"font-weight: 400;\">\u00a0a les tumorectomies amb bi\u00f2psia selectiva del gangli sentinella amb radioter\u00e0pia millorant l\u2019est\u00e8tica i disminuint el risc de limfedema (<\/span><span style=\"font-weight: 400;\">6)<\/span><span style=\"font-weight: 400;\">; els tractaments sist\u00e8mics, tant la quimioter\u00e0pia com la hormonoter\u00e0pia, han ampliat la duraci\u00f3 i la intensitat. Per exemple en el camp de la quimioter\u00e0pia hem passat d\u2019esquemes tipus CMF amb molta toxicitat aguda com les n\u00e0usees i els v\u00f2mits, per\u00f2 que es recuperaven en deixar el tractament, a quimioter\u00e0pics com les antraciclines i els taxans que produeixen certes toxicitats que perduren m\u00e9s en el temps com la cardiopatia, la neuropatia perif\u00e8rica o l\u2019ast\u00e8nia (<\/span><span style=\"font-weight: 400;\">7)<\/span><span style=\"font-weight: 400;\">. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">En paraules de les pacients: \u201c <\/span><i><span style=\"font-weight: 400;\">Mai hagu\u00e9s imaginat que hauria de viure amb aquesta manca d\u2019energia<\/span><\/i><span style=\"font-weight: 400;\">\u201d; \u201c<\/span><i><span style=\"font-weight: 400;\">ja no soc la que era abans<\/span><\/i><span style=\"font-weight: 400;\">\u201d. Molt sovint els tractaments de quimioter\u00e0pia tamb\u00e9 produeixen alteracions cognitives (<\/span><span style=\"font-weight: 400;\">8)<\/span><span style=\"font-weight: 400;\">, un fenomen anomenat \u201cchemobrain\u201d i que les pacients descriuen com que no tenen l\u2019agilitat mental que tenien abans, manca de concentraci\u00f3 i de mem\u00f2ria, retornar a la feina se\u2019ls fa una muntanya perqu\u00e8 creuen que no tindran la capacitat d\u2019assumir aquesta responsabilitat. I no \u00e9s un problema local \u00e9s un problema generalitzat que afecta totes les pacients d\u2019arreu del mon, textualment: \u201c<\/span><i><span style=\"font-weight: 400;\">My mind is not as sharp as it was<\/span><\/i><span style=\"font-weight: 400;\">\u201d or \u201c<\/span><i><span style=\"font-weight: 400;\">I get mad because I never knew I would have to learn to live with the loss of energy<\/span><\/i><span style=\"font-weight: 400;\">\u201d. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">A tot aix\u00f2 cal afegir que sovint els tractaments de quimioter\u00e0pia provoquen una menopausa preco\u00e7 amb tot el que comporta: sufocacions, alteracions de l\u2019humor, irritabilitat, p\u00e8rdua de la libido, insomni, increment de pes. I aquests s\u00edmptomes empitjoren si la pacient ha de rebre tractament hormonal que actualment en certs casos s\u2019allarga m\u00e9s enll\u00e0 dels 10 anys (<\/span><span style=\"font-weight: 400;\">9)<\/span><span style=\"font-weight: 400;\">. Podeu imaginar els sentiments que es generen: soledat, incomprensi\u00f3, canvi en la vida de parella, sentiments de culpabilitat.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Un altre factor a tenir en compte \u00e9s la \u201cpor\u201d. Quan a una persona se li diagnostica un c\u00e0ncer de mama sempre hi \u00e9s present la por<\/span><span style=\"font-weight: 400;\">10<\/span><span style=\"font-weight: 400;\">: por al tractament, por al futur, por a no veure cr\u00e9ixer els teus fills, por a la mort. Textualment (<\/span><span style=\"font-weight: 400;\">11)<\/span><span style=\"font-weight: 400;\">: \u201c<\/span><i><span style=\"font-weight: 400;\">Cada s\u00edmptoma penses que \u00e9s c\u00e0ncer un altre cop<\/span><\/i><span style=\"font-weight: 400;\">\u201d; altres pacients remarquen la por envers la fam\u00edlia (<\/span><span style=\"font-weight: 400;\">12)<\/span><span style=\"font-weight: 400;\">: \u201c<\/span><i><span style=\"font-weight: 400;\">A mi no em fa por morir-me, pateixo pels meus<\/span><\/i><span style=\"font-weight: 400;\">\u201d.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Davant d\u2019aquest escenari, com podem ajudar a alg\u00fa que est\u00e0 passant per aquest proc\u00e9s? Com he dit al principi, mai es pot generalitzar, per\u00f2&#8230; acompanyar i escoltar s\u00f3n bons consells. Voler treure ferro a una situaci\u00f3 que \u201ccrema\u201d no ajuda. Es fa amb la millor intenci\u00f3, per\u00f2 a voltes no fa m\u00e9s que augmentar la sensaci\u00f3 de solitud i d\u2019incomprensi\u00f3 que senten les pacients. Cal pensar que les dones que estan passant per aquests proc\u00e9s s\u00f3n fortes, valentes, generoses, que pensen m\u00e9s en els altres que en elles mateixes, que han desenvolupat unes estrat\u00e8gies d\u2019afrontament davant l\u2019adversitat que s\u00f3n dignes d\u2019admiraci\u00f3. Per aix\u00f2 &#8230; quin consell podem donar que no s\u00e0piguen? Potser \u00e9s millor escoltar-les i aprendre de la seva lli\u00e7\u00f3 de Vida.<\/span><\/p>\n<div id=\"attachment_1440\" style=\"width: 310px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1440\" class=\"wp-image-1440 size-medium\" src=\"http:\/\/www.ipsi.cat\/elfil\/wp-content\/uploads\/2016\/11\/577-300x292.jpg\" alt=\"Doctora Catalina Falo autora de l'article: Despr\u00e9s d'un c\u00e0ncer de mama\" width=\"300\" height=\"292\" srcset=\"https:\/\/www.ipsi.cat\/elfil\/wp-content\/uploads\/2016\/11\/577-300x292.jpg 300w, https:\/\/www.ipsi.cat\/elfil\/wp-content\/uploads\/2016\/11\/577-768x747.jpg 768w, https:\/\/www.ipsi.cat\/elfil\/wp-content\/uploads\/2016\/11\/577.jpg 980w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><p id=\"caption-attachment-1440\" class=\"wp-caption-text\">Doctora Catalina Falo autora de l&#8217;article: Despr\u00e9s d&#8217;un c\u00e0ncer de mama<\/p><\/div>\n<p style=\"text-align: right;\"><em>La doctora Catalina Falo Zamora \u00e9s metge adjunta al servei d&#8217;Oncologia M\u00e8dica de l&#8217;Institut Catal\u00e0 d&#8217;Oncologia (ICO-Hospitalet) i mare d&#8217;una alumna de 3r d&#8217;ESO<\/em><\/p>\n<div style=\"font-weight: 400; font-size: 8pt;\">\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><i><span style=\"font-weight: 400;\">Refer\u00e8ncies:<\/span><\/i><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><i><i><span style=\"font-weight: 400;\">Ferlay J, <\/span><\/i><i><span style=\"font-weight: 400;\">Soerjomataram I, Ervik M, Dikshit R, Esec S, Mathers C, et al. <\/span><\/i><i><span style=\"font-weight: 400;\">GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer <\/span><\/i> <i><span style=\"font-weight: 400;\">Base No. 11 [Internet]. Lyon, France: International Agency for <\/span><\/i> <i><span style=\"font-weight: 400;\">Research on Cancer; 2013. (Acc\u00e9s 25 juliol, 2016). Available from: <\/span><\/i> <i><span style=\"font-weight: 400;\">http:\/\/ http:\/\/globocan.iarc.fr <\/span><\/i><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Izquierdo A, Gispert R, Saladie F, Espin\u00e0s JA. An\u00e1lisis de la incidencia, la supervivencia y la mortalidad seg\u00fan las principales localizaciones tumorales, 1985-2019: c\u00e1ncer de mama. Med Clin (Barcelona) <\/span><\/i> <i><span style=\"font-weight: 400;\">2008;131(supl.1):50-52.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">L.Koch, H Bertram, A Eberle et al. Fear of recurrence in long-term breast cancer survivors\u2014still an issue. Results on prevalence, <\/span><\/i> <i><span style=\"font-weight: 400;\">determinants, and the association with quality of life and <\/span><\/i> <i><span style=\"font-weight: 400;\">depression from the Cancer Survivorship\u2014a multi-regional <\/span><\/i> <i><span style=\"font-weight: 400;\">population based study.Psycho-Oncology 23: 547\u2013554 (2014). <\/span><\/i> <i><span style=\"font-weight: 400;\">DOI:10.1002\/pon.3452<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Ganz <\/span><\/i> <i><span style=\"font-weight: 400;\">PA, Desmond KA, Leedham B, Rowland J, Meyerowitz B,Belin T. Quality <\/span><\/i> <i><span style=\"font-weight: 400;\">of Life in Long-Term, Disease-Free Survivors of Breast Cancer: a <\/span><\/i> <i><span style=\"font-weight: 400;\">Follow-up Study. J Natl Cancer Inst 2002; 94: 39-49.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Fisher <\/span><\/i> <i><span style=\"font-weight: 400;\">B, Jeong, JH., Anderson S et al. Twenty-Five-Year Follow-up of a Randomized Trial Comparing Radical Mastectomy, Total Mastectomy, and Total Mastectomy Followed by Irradiation. N Engl J Med 2002; <\/span><\/i> <i><span style=\"font-weight: 400;\">347:567-575\u00a0<\/span><\/i><a href=\"http:\/\/www.nejm.org.sire.ub.edu\/toc\/nejm\/347\/8\/\"><i><span style=\"font-weight: 400;\">August <\/span><\/i> <i><span style=\"font-weight: 400;\">22, 2002<\/span><\/i><\/a>\u00a0<i><span style=\"font-weight: 400;\">DOI: 10.1056\/NEJMoa020128.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Krag, <\/span><\/i> <i><span style=\"font-weight: 400;\">David N; Anderson, Stewart J; Julian, Thomas B; Brown, Ann M; <\/span><\/i> <i><span style=\"font-weight: 400;\">Harlow, Seth P; et al.<\/span><\/i><a href=\"http:\/\/search.proquest.com.sire.ub.edu\/docview\/758826762\/785115CF1F2E4946PQ\/1?accountid=15293\"> <i><span style=\"font-weight: 400;\">Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall <\/span><\/i> <i><span style=\"font-weight: 400;\">survival findings from the NSABP B-32 randomised phase 3 trial<\/span><\/i><\/a><i><span style=\"font-weight: 400;\">. Lancet <\/span><\/i> <i><span style=\"font-weight: 400;\">Oncology 11.10 (Oct 2010): 927-33.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Early Breast Cancer Trialists\u2019 Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;365:1687-1717.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Christine D. Craig&amp;Bradley J. Monk&amp;John H. Farley&amp;<\/span><\/i><i><span style=\"font-weight: 400;\">Dana M. Chase. <\/span><\/i><i><span style=\"font-weight: 400;\">Cognitive <\/span><\/i> <i><span style=\"font-weight: 400;\">impairment in gynecologic cancers: a systematic review of current approaches to diagnosis and treatment. <\/span><\/i><i><span style=\"font-weight: 400;\">Support Care Cancer (2014) 22:279<\/span><\/i><i><span style=\"font-weight: 400;\">\u2013<\/span><\/i><i><span style=\"font-weight: 400;\">287. DOI 10.1007\/s00520-013-2029-7.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">P.E. Goss, J.N. Ingle, K.I. Pritchard, N.J. Robert, H. Muss et al. <\/span><\/i> <i><span style=\"font-weight: 400;\">Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years. <\/span><\/i><i><span style=\"font-weight: 400;\">N Engl J Med 2016. <\/span><\/i><i><span style=\"font-weight: 400;\">DOI: <\/span><\/i> <i><span style=\"font-weight: 400;\">10.1056\/NEJMoa1604700<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Koch L, Jansen L, Brenner H, et al. Fear of recurrence and disease progression in long-term (&gt;\/=5 years) cancer survivors-a systematic review of quantitative studies. Psycho-Oncology 2013;22(1):1\u201311.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">M.Rosedale, <\/span><\/i> <i><span style=\"font-weight: 400;\">PhD. Confronting the Unexpected: Temporal, Situational, and <\/span><\/i> <i><span style=\"font-weight: 400;\">Attributive Dimensions of Distressing Symptom Experience for Breast Cancer Survivors. Oncology Nursing Forum Vol. 37, No. 1, January 2010.doi: 10.1188\/10.ONF.E28-E33.<\/span><\/i><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><i><span style=\"font-weight: 400;\">Falo C, Villar H, Rodr\u00edguez E, Mena M, Font A. Calidad de vida en c\u00e1ncer de mama metast\u00e1sico de larga evoluci\u00f3n: La opini\u00f3n de las pacientes. Psicooncolog\u00eda 2014;11(2-3):313 -331<\/span><\/i><\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<!-- AddThis Advanced Settings generic via filter on the_content --><!-- AddThis Share Buttons generic via filter on the_content -->","protected":false},"excerpt":{"rendered":"<p>Experi\u00e8ncies recollides  de les pacients explicades per una onc\u00f2loga per apropar-nos a una situaci\u00f3 que \u00e9s dif\u00edcil d\u2019entendre si no es coneix de prop. Intent de posar-nos a la pell de qui est\u00e0 passant per aquesta malaltia en general, des del reconeixement.<\/p>\n<p><a class=\"more-link\" href=\"https:\/\/www.ipsi.cat\/elfil\/despres-dun-cancer-de-mama\/\">Read More<\/a><\/p>","protected":false},"author":3,"featured_media":1441,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"wpupg_custom_link":[],"wpupg_custom_link_behaviour":[],"wpupg_custom_link_nofollow":[],"wpupg_custom_image":[],"wpupg_custom_image_id":[],"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[60,1],"tags":[83,86,91],"class_list":{"0":"post-1383","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-articles","8":"category-general","9":"tag-el-fil","10":"tag-escola","11":"tag-ampa","12":"entry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Despr\u00e9s d&#039;un c\u00e0ncer de mama, qu\u00e8 ve? 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