Abstract
BackgroundA long-term prospective assessment of QoL in cervical cancer patients is still lacking. Here, we provide the first 2-years prospective, longitudinal study evaluating emotional distress and QoL in early stage (ECC) and locally advanced (LACC) cervical cancer patients who remained disease-free 2-years from diagnosis.MethodsThe questionnaires: Hospital Anxiety and Depression Scale (HADS), Global Health Status items of EORTC QLQ-C30 (GHS), and EORTC QLQ-CX24 (CX24) have been administered by a dedicated team of psycho-oncologists, administered at baseline, and after 3, 6, 12 and 24 months from surgery The Generalized Linear Model for repeated measure was used to analyze modifications of QoL measures over time.ResultsIn both groups, an early reduction of the percentage of patients with anxiety levels ≥11 was observed at the 3-month evaluation (ECC: 25.7% at baseline Vs 14.7% after 3 months, p value=0.001; LACC: 22.2% at baseline Vs 15.4% after 3 months, p value=0.001). Despite this favorable trend, after 2 years from diagnosis, 11.9% of ECC and 15.6% of LACC patients still showed an anxiety score ≥11. No significant changes over time were observed in term of Depression levels. Focusing on QoL issues, mean GHS and Sexual Activity scores showed an improvement over time in both groups compared to baseline (GHS: 5.7% difference for ECC, p value=0.001, and 11.0% in LACC, p value=0.001; SXA: 13.9% difference for ECC, p value=0.001; and 6.1% in LACC, p value=0.008). On the other hand, Body Image mean scores were significantly impaired by chemoradiation administration in LACC patients, without long-term recovery (7.5% difference, p value=0.001). Finally, in both groups, lymphedema (LY) and menopausal symptoms (MS) showed an early worsening which persisted 2-year after surgery (LY: 19.5% difference for ECC, p value=0.014, and 27.3% in LACC, p value=0.001; MS: 14.4% difference for ECC, p value=0.004, and 16.0% in LACC, p value=0.002).ConclusionsDespite a significant improvement over time, elevated anxiety levels are still detectable at 24 months after surgery in approximately 10% of cervical cancer patients. Much more attention should be focused on surgical/medical approaches able to minimize the negative impact of lymphedema and menopausal symptoms on QoL.
Highlights
A long-term prospective assessment of quality of life (QoL) in cervical cancer patients is still lacking
No statistically significant differences were detected in the distribution of clinico-pathological and socio demographics features between eligible patients and women excluded from the final analysis due to refusal or recurrence/progressive disease
We reported for the first time a long-term, prospective, longitudinal evaluation of emotional distress and QoL in a large series of women with ECC and LACC
Summary
A long-term prospective assessment of QoL in cervical cancer patients is still lacking. Over the last decade, increasing attention has been focused on the issues of emotional distress and quality of life (QoL) in women with gynecological cancer [1,2] This renewed attention comes from the growing awareness that cancer diagnosis and the consequences of multimodal treatments deeply affect woman’s self-identity, impairing her social/intimate relationships, as well as her overall self-perception as mother and wife [3,4,5]. The available literature on this specific field shows a large variability, and it can be justified by the retrospective nature of the studies, which are often cross-sectional, performed at different time intervals from treatment and lacking of baseline evaluations For these reasons, we have performed a prospective and longitudinal collection of data on QoL levels in early (ECC) and locally advanced (LACC) cervical cancer patients treated with radical surgery (RS) or chemoradiation (CT/RT) followed by RS, respectively [16]
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