Prospective Quality of Life Study of South African Women Undergoing Treatment for Advanced-stage Cervical Cancer

Abstract

PurposeThe majority of South African cervical cancer patients present with advanced-stage disease. Chemoradiation therapy, in comparison with radiation therapy, results in marginally improved survival in women with advanced cervical cancer. The impact on the quality of life due to the addition of a chemosensitizer in a situation of limited survival benefits warrants objective assessment. This prospective study compares the quality of life for women with cervical cancer and treated with radiation or chemoradiation therapy at Tygerberg Hospital, South Africa. MethodsA prospective study was done in a population with a high incidence of advanced cervical cancer. Quality of life measurements were done at pretreatment, post treatment, and follow-up. The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire and the Cervix Cancer Module were used. FindingsThe study included 219 women. Forty-four women were treated with primary surgery. A total of 102 women completed primary radiation therapy and 73 women completed primary chemoradiation therapy. The demographic characteristics of the last 2 treatment groups were different. Women receiving chemoradiation therapy had a higher educational level (P < 0.01) and had less advanced stage (III or IV) cervical cancer (P < 0.01). Radiation therapy was used significantly more in HIV-positive women. The presiding clinicians chose treatment options based on clinical factors unrelated to quality of life. Chemoradiation therapy resulted in statistically more improvement in the pain (P < 0.05), fatigue (P < 0.05), appetite loss (P < 0.01), and nausea and vomiting (P < 0.05) quality of life domains. In these domains, pretreatment quality of life scores were significantly higher in the radiation therapy group, implying a poorer quality of life status at the initiation of treatment. In post hoc analysis, the global health domain was significantly more improved (P = 0.03) by chemoradiation. Peripheral neuropathy was not increased by chemoradiation. ImplicationsChemoradiation therapy improved quality of life more than radiation therapy in certain domains. This allows for selection of chemoradiation as a treatment option in situations where quality of life is the end point of treatment.