Women's Health-related Quality Research Articles

"I think my vagina is still there?": Women's perspectives on sexual function and dysfunction following radical cystectomy for bladder cancer, a qualitative study.

Women's sexual health after radical cystectomy is an important but poorly understood aspect of bladder cancer survivorship. Dedicated investigation is needed to elucidate patient perceptions on sexual function and dysfunction in this setting. In this study we sought to qualitatively examine women's perceptions and experiences of sexual health following radical cystectomy for bladder cancer. We conducted one-on-one qualitative telephone interviews with 40 women who underwent radical cystectomy in the past 6months to 5 years and signed a research consent form to be contacted for future studies. We examined women's experiences of engaging in sexual activity after surgery and their attitudes toward sex and body image. We audio recorded, transcribed, and coded the interviews using ATLAS.ti software and applied grounded theory methods for analysis. For data that emerged during the qualitative interviews that was related to lack of knowledge about how physical and psychological sexual health would be affected after surgery, we reviewed and discussed transcripts that enabled coding of the data into emerging topic areas. Our analysis yielded 4 main themes. (1) Women reported receiving little to no information from providers about female sexual dysfunction prior to or after radical cystectomy. Women wished they had been provided more information about female sexual dysfunction from their clinicians, including strategies for postoperative self-pleasure and nonintercourse methods of sexual pleasure with partners. (2) Women shared that they were not sexually active following surgery due to physical and mental barriers. (3) When women did try to engage in sex, they described feeling disappointed that it did not feel the same as prior to surgery. (4) Some women found that physical therapy helped them to physically and mentally recover their strength to engage in sexual activity again. Clinicians must directly address sexual health concerns with patients who undergo radical cystectomy. This study has several key strengths. Investigation into women's sexual function and dysfunction addresses a gap in understanding of this component of women's health-related quality of life after radical cystectomy, which represents an unmet need. The large number of interviews conducted as well as the in-depth information obtained through one-on-one interviews are additional strengths. This study also has limitations, including possible shortcomings of telephone interviews compared with in-person interviews. However, telephone interviews were beneficial because the interviews took place during the COVID-19 pandemic and spared patients from extra visits or from having to travel long distances to the respective medical centers. Other possible limitations were that patients may have been reluctant to share all of their experiences and that patients who underwent urostomies, also termed ileal conduits, were overrepresented in this study compared with women who underwent continent urine diversions, which allow greater control over urine output. Broadening the understanding of sexual health beyond sexual intercourse to encompass sexuality and self-pleasure can provide clinicians, patients, and their families with more effective preparation and strategies to care for an essential aspect of their wellbeing.

The Effects of Pregnancy and Childbirth on Women's Health-Related Quality of Life: A Scoping Review

Context: Although pregnancy and childbearing are the most natural processes for women, it is accompanied by significant life changes for the mother, who needs to adjust to parenting. Hormonal variables cause these changes, resulting in physiological and emotional consequences. Although the changes that pregnant women experience are only transitory, they might affect their quality of life.
 Aim: This scoping review highlight the effect of pregnancy and childbearing on women’s health-related quality of life.
 Methods: A scoping review was completed by searching data converging about pregnancy and childbirth's effects on women's health-related quality of life utilizing databases from 2015-2022 papers. The review was done via different database engines. The research selection procedure uses Mesh keywords to find the most relevant papers, and the PRISMA flowchart helped pick research papers. The search engines were picked from the Saudi digital library and Google Scholar. Three main themes and three subthemes were created in this scoping review. A total of 82 articles were initially retrieved. Twenty-four duplications were removed. Thirty-four articles that did not meet the aim were excluded. The remaining 26 were screened; the non-English, outdated articles, text articles, and more reasons were counted, so another ten articles were removed. So, 14 studies met the criteria and were eligible to be included in this review.
 Results: revealed a correlation between delayed first birth and better health-related quality of life. It is highlighted that physical quality of life-related to maternal age, gestational age, BMI before 12 weeks of pregnancy, mother's education and work, and spouse's education (p<0.05). Psychological quality of life-related to gestational age, mother's education and occupation, and spouse's education. The main characteristics related to greater quality of life were mean maternal age, primiparity, early gestational age, the lack of social and economic issues, having family and friends, exercising, being happy to be pregnant, and being hopeful. Early second-trimester pregnant women had the best health-related quality of life drops in the third trimester. More than half of the participants in the reviewed studies had urinary incontinence as a main pelvic floor disorder. Mothers showed lower gray matter (GM) volumes and higher white matter (WM) volumes in empathy and reward networks. Those who gave birth vaginally reported the highest HRQoL, whereas those who underwent cesareans reported the lowest.
 Conclusion: The study elucidates the fluctuations in quality of life throughout pregnancy, showing its dependence on various demographic and health-related aspects. The nuanced variations and pathological features emerging during pregnancy encompass the impact of morning sickness, sleep patterns, and pelvic floor disorders. The influence of the mode of delivery on women's health-related quality of life emphasizes differences in pain, physical functioning, and mental health between those who undergo cesarean sections and those who have vaginal births. Collectively, these findings underscore the complexity of the maternal experience, calling for a holistic approach to healthcare that addresses the diverse challenges women face during this pivotal life stage.

Patient-reported health-related quality of life outcomes following mastectomy for breast cancer, with immediate, delayed or no breast reconstruction: Four-year follow-up from a prospective cohort study.

Breast reconstruction (BR) improves women's health-related quality of life (HRQOL) following mastectomy for breast cancer, yet factors contributing to improved HRQOL remain unclear. This study aimed to explore the overall impact of mastectomy with or without BR on participants' perceptions of HRQOL over time in a cohort of women with high-risk breast cancer; to examine differences in mean HRQOL scores between immediate BR, delayed BR and no BR groups; to assess the influence of patient characteristics potentially associated with HRQOL scores; and to determine the feasibility of long-term collection of patient-reported outcome measures in clinical settings. A prospective, longitudinal study of 100 women with high-risk breast cancer who underwent mastectomy with or without breast reconstruction and were likely to require post-mastectomy radiotherapy. Four validated patient-reported questionnaires, comprising 21 outcome measures relating to HRQOL, administered at baseline and up to 4 years post-mastectomy. Demographic, clinical and surgical data extracted from patient medical records. Consistently significant declines in perceptions of future health and arm symptoms, consistently significant improvements in treatment side effects, breast symptoms and fatigue, as well as significant improvements, compared to baseline, in social functioning and financial difficulties at 48 months. No significant differences in mean HRQOL scores between women given a choice of reconstructive options. Similar trajectories of HRQOL scores were found in women with high-risk breast cancer who were offered a choice of BR. Informed choice may be an independent contributing factor in long-term maintenance of most HRQOL indicators at their pre-mastectomy levels.

Alexithymia and Loneliness in Women with Endometriosis. Testing the Factorial Structure of the Italian Endometriosis Health Profile (EHP-30) and a Mediation Model.

Endometriosis is a pathological condition characterized by endometrial-like tissue outside the uterus, chronic inflammatory reaction, and pelvic pain that dramatically decrease women's health-related quality of life (HRQoL). Furthermore, this invisible and difficultly diagnosable disease might lead women to experience alexithymia, loneliness, and consequent impairment of perceived quality of life. Firstly, the present study aimed at validating the Italian EHP-30 version which is the most used specific questionnaire for HRQoL measurement. Secondly, the present study aimed at exploring the still understudied relationship between alexithymia and HRQoL in endometriosis conditions, evaluating the mediating role of perceived loneliness. A total of 435 women with endometriosis (mean age=35.75 years) have been involved. All items were loaded on their own factors. The measure showed good internal consistency (Cronbach's α ranged between 0.60-0.95 for core and 0.74-0.94 for modular parts). The Italian EHP-30 is a psychometrically valid measure of HRQoL with endometriosis. The tested mediation model provided adequate goodness-of-fit indices (χ2 (51) = 206.071; p < 0.001; RMSEA = 0.084; 90%CI: 0.072, 0.096, CFI = .933, SRMR= 0.058), showing that alexithymia only indirectly affected women's perceived HRQoL, via the mediating effect of feelings of loneliness. The current study highlighted the pivotal role of perceived loneliness in directly affecting women's quality of life and mediating the effect of the alexithymic experiences.

Impact of endometriosis on women's health-related quality of life: A national prospective cohort study.

To examine the association between endometriosis and women's health-related quality of life (HRQoL). This study included 3728 women born in 1973-78 using data from the Australian Longitudinal Study on Women's Health. Women with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. A mixed effect model with only random intercept and generalised estimating equations with binary logistic regressions were used to examine the association between endometriosis and health-related quality of life over eight time points. Each HRQoL scale was analysed in terms of binary outcomes by comparing women who had a lower HRQoL (scoring below the 25th percentile) with those who had a higher HRQoL (scoring above the 25th percentile). Women's HRQoL was assessed using the 36-item Short Form Survey every 3years from 1996 to 2018. Endometriosis was associated with significantly worse reports of HRQoL over time. In the comparison against women without endometriosis, the following adjusted odds ratios (95% confidence intervals) were calculated for women with endometriosis having worse scores on the eight domains of the Short Form Survey: physical functioning 1.33 (1.19, 1.50), role physical 1.57 (1.41, 1.74), bodily pain 1.65 (1.48, 1.82), general health 1.61 (1.42, 1.81), vitality 1.38 (1.23, 1.55), social functioning 1.38 (1.25, 1.53), role emotion 1.19 (1.06, 1.33), mental health 1.32 (1.18, 1.48). Women with endometriosis also had significantly lower physical health 1.68 (1.51, 1.88) and mental health components scores 1.28 (1.14, 1.44). Endometriosis is associated with worse physical, mental, and social functioning and well-being. Bodily pain was the most affected HRQoL domain.

Urinary incontinence more than 15 years after premenopausal risk-reducing salpingo-oophorectomy: a multicentre cross-sectional study.

To study the impact of premenopausal risk-reducing salpingo-oophorectomy (RRSO), compared with postmenopausal RRSO, on urinary incontinence (UI) ≥10 years later. Cross-sectional study, nested in a nationwide cohort. Multicentre in the Netherlands. 750 women (68% BRCA1/2 pathogenic variant carriers) who underwent either premenopausal RRSO (≤45 years, n = 496) or postmenopausal RRSO (≥54 years, n = 254). All participants were ≥55 years at the time of the study. Urinary incontinence was assessed by the urinary distress inventory-6 (UDI-6); a score ≥33.3 indicated symptomatic UI. The incontinence impact questionnaire short form (IIQ-SF) was used to assess the impact on women's health-related quality of life (HR-QoL). Differences between groups were analysed using regression analyses adjusting for current age and other confounders. Differences in UDI-6 scores and IIQ-SF scores between women with a premenopausal and a postmenopausal RRSO. Women in the premenopausal RRSO group had slightly higher UDI-6 scores compared with women in the postmenopausal RRSO group (P = 0.053), and their risk of symptomatic UI was non-significantly increased (odds ratio [OR] 2.1, 95% confidence interval [95% CI] 0.93-4.78). A premenopausal RRSO was associated with a higher risk of stress UI (OR 3.5, 95% CI 1.2-10.0) but not with urge UI. The proportions of women with a significant impact of UI on HR-QoL were similar in the premenopausal and postmenopausal RRSO groups (10.4% and 13.0%, respectively; P = 0.46). More than 15 years after premenopausal RRSO, there were no significant differences in overall symptomatic UI between women with a premenopausal and those with a postmenopausal RRSO.

The association between Diastasis recti abdominis and pelvic floor dysfunction, sacroiliac joint dysfunction, and quality of life among postpartum women after Cesarean delivery

Abstract Purpose The goal of this study is to see if there's a predictive relationship between diastasis rectus abdominis and pelvic floor dysfunction, sacroiliac joint dysfunction, and postpartum women's health-related quality of life. Method This cross-sectional, correlative study focused on 32 postpartum mothers aged 18 to 45 years old. Real Ultrasound Sonographic Imaging (RUSI) was used to determine DRA. The Pelvic Floor Disability Index was used to assess pelvic floor dysfunction (PFDI). The Active Straight Leg Raise Test (ASLR), the Long Dorsal Sacral Ligament Test (LDL), and the Posterior Pelvic Provocation Test (P4) were also investigated. The Short Form-12 (SF-12) Survey was used to assess health-related quality of life (HRQoL). Results A negative correlation between DRA and postpartum period was recorded (ρ=0.0001). The following categories showed a significant positive correlation between DRA and Pelvic floor dysfunction: Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) corelated positively with DRA (ρ =0.01); Colorectal-Anal Distress Inventory-8 (CRAD-8) (ρ =0.02); Urinary Distress Inventory-6 (UDI-6) (ρ =0.00). There was no correlation between DRA and sacroiliac joint dysfunction (ρ =0.8). Conclusion DRA was discovered to be a strong predictor of pelvic floor dysfunction, such as prolapse, colorectal-anal dysfunction, and urine distress. There was no evidence of a link between DRA and sacroiliac joint dysfunction or HRQoL.

The Effect of Targeted Ultrasound as Primary Imaging Modality on Quality of Life in Women with Focal Breast Complaints: A Comparative Cohort Study.

Background: The high diagnostic performance of modern breast ultrasound (US) opens the possibility to shift toward targeted US as initial imaging test in women with breast complaints. This comparative cohort study investigates the effects of starting with US followed by digital breast tomosynthesis (DBT), as practiced in the breast ultrasound study (BUST), on women's health-related quality of life (QoL). Methods: Fifty BUST participants and 50 "controls" who underwent DBT and US in regular order filled out the EQ-5D-3L three times during their visit: BUST participants before US (T1), after US (T2), and after DBT (T3) and non-BUST participants before DBT (T1), after DBT (T2), and after US (T3). Changes in QoL from baseline to T2 and T3 were assessed using generalized least squares, also taking into account the effects of biopsy, age, and complaint type. Results: Participants' mean age was 50.6 years (BUST: SD = 12.1, controls: SD = 11.5). At T2 the overall QoL was higher [t(102.9) = 2.4, p = 0.017] and anxiety levels were lower [t(98.7) = -2.4, p = 0.020] in BUST participants compared with controls. However, from T2 to T3 these effects equalize, resulting in similar performances in QoL and anxiety at T3, respectively [t(97.6) = -2.3, p = 0.023] and [t(97.2) = 3.1, p = 0.002]. Compared with BUST participants, controls show a clear decrease in pain after US [t(106.5) = -2.8, p = 0.006]. Women undergoing biopsy had lower QoL [t(167.1) = -2.4, p = 0.017] and pain [t(154.1) = -2.1, p = 0.038], and more anxiety [t(187.4) = 4.3, p = 0.000]. Conclusions: The results suggest that changing the radiological order by starting with US has a short-term positive effect on overall QoL, anxiety, and DBT pain experience in symptomatic women. Owing to its negative impact, biopsies should be performed cautiously. In conclusion, the moment of reassurance for women advances by reversing the radiological order according to the BUST, showing the high importance of human interaction in diagnostic care in addition to the clinical performance of imaging modalities.

Women's Health-Related Quality of Life Substantially Improves With Tailored Cardiac Rehabilitation: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Exercise-based cardiac rehabilitation (EBCR) offers an opportunity to improve women's otherwise poorer outcomes from coronary heart disease compared with men. However, synthesized evidence for the benefits of EBCR for health-related quality of life (HRQL) is lacking for women. The current study addresses this gap. Four electronic databases (PubMed, CINAHL, SCOPUS, and Cochrane) were searched for studies reporting HRQL using validated questionnaires in women attending EBCR. Two reviewers independently screened articles and extracted data. A random effects model was used for meta-analysis, where possible. Eleven studies (1237 women) were included, with seven suitable for meta-analyses. Participation in EBCR improved multiple domains of HRQL, with greatest improvements in Role Physical (mean differences [MD] = 19.09: 95% CI, 2.37-35.81), Physical Functioning (MD = 10.43: 95% CI, 2.60-18.27), and Vitality (MD = 9.59: 95% CI, 0.31-18.86) domains of the 12-Item Short Form Health Survey and the 36-Item Short Form Health Survey. Adding psychosocial components tailored for women to traditional EBCR produced further gains in HRQL in Bodily Pain (MD = 9.82: 95% CI, 4.43-15.21), Role Physical (MD = 8.48: 95% CI, 1.31-9.97), Vitality (MD = 8.17: 95% CI, 3.79-12.55), General Health (MD = 5.64: 95% CI, 1.31-9.97), and Physical Functioning (MD = 5.61: 95% CI, 0.83-10.40) domains. Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, with added benefits when strategies were tailored to their needs. These benefits should be highlighted to promote EBCR uptake in women.

Impact of Adenomyosis on Women's Psychological Health and Work Productivity: A Comparative Cross-Sectional Study.

Background: Quality of life in adenomyosis (AD) patients has been poorly investigated. Previous data suggest that AD has negative impact on the quality of life in these women. Materials and Methods: From September 2018 to December 2019, all consecutive female premenopausal patients aged ≥18 years diagnosed with AD by transvaginal ultrasound (TVU) were invited to participate in a comparative cross-sectional study. The Short Form-36-item (SF-36) health questionnaire and the Hospital Anxiety and Depression Scale (HADS) were administered. Work productivity and activity impairment were assessed using the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH). Data obtained from these patients were compared with women with normal-appearing myometrium in the TVU recruited during routine gynecological visits. The study was approved by the Clinical Research Ethics Committee of the Hospital Clinic (reference HCB/2018/0919). Results: One hundred three patients with AD and 214 without AD were analyzed. Patients with AD compared to those without AD showed significantly lower scores in all domains of the SF-36 questionnaire and mean (SD) higher scores in the HADS questionnaire for anxiety (10.06 [3.04] vs. 6.92 [2.98], p < 0.001) and depression (6.39 [3.89] vs. 2.74 [2.01], p < 0.002). Significant differences (p < 0.001) were also found for the percentages of absenteeism (12.2% vs. 1.1%), presenteeism (31.1% vs. 11.4%), overall work productivity loss (38.2% vs. 12.4%), and activity impairment (55.7% vs. 9.9%). The presence of AD was associated with higher yearly estimated indirect costs of €5161.32 (€7928.0 vs. €2460.8, p < 0.001). Conclusions: AD negatively affects women's health-related quality of life, psychological health, and work productivity, with impairment at work and daily activities, and higher risk for anxiety and depression.

Dietary patterns during pregnancy and health-related quality of life: The Japan Environment and Children's Study.

BackgroundLimited research exists on how dietary pattern (DP) influences pregnant women’s health-related quality of life (HRQOL). This study aimed to identify DPs in a cohort of 92,448 pregnant Japanese women using fixed data from the Japan Environment and Children’s Study (JECS) to investigate the associations of DP with HRQOL.MethodsDuring the first trimester, DPs were assessed using the Food Frequency Questionnaire (FFQ), and HRQOL was assessed using the 8-Item Short-Form Health Survey (SF-8). DPs such as Western, Japanese and Unbalanced DP were identified through principal component analysis (PCA). Multivariable logistic model analysis was used to assess the associations between DP and HRQOL as good or poor.ResultsWe found a significant association between poor mental HRQOL in the univariate analysis for the Western DP (p = 0.014). However, this association was not significant in the multivariate analysis adjusted for basic confounders (p = 0.078). Western DP was not highly associated with poor physical HRQOL (from low-medium to high levels of intake; adjusted odds ratio [OR] 0.87–0.88, all p≤0.001, when comparing highest to lowest intake levels). A high intake of the Japanese DP was significantly associated with poor mental HRQOL and physical HRQOL (adjusted OR 1.20, p<0.0001 and adjusted OR 1.12, p = 0.005, respectively). A medium-high intake of the Unbalanced DP was not highly associated with poor physical HRQOL (adjusted OR 0.93, p = 0.048) but with poor mental HRQOL (adjusted OR 1.29, p<0.0001).ConclusionThis is the first known prospective study to establish an association between DP and HRQOL in pregnant women. We hope that our findings will help in the field of nutritional science.

A systematic review of the impact of contemporary treatment modalities for cervical cancer on women's self-reported health-related quality of life.

Given the high survival rate of cervical cancer patients, understanding women's health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women's HRQL, including symptoms, functioning, and global HRQL. We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized. We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter vagina, pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3-6months after treatment. In patients with metastatic or recurrent disease, pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time. Whereas most symptoms worsen during treatment and improve in the first 3months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs.

Swedish women's awareness of human papillomavirus, and health-related quality of life, anxiety, and depression after a notification of an abnormal Pap smear result: a cross-sectional study.

This study aims to assess (a) women's awareness of the human papillomavirus (HPV), (b) women's health-related quality of life (HRQoL) and levels of anxiety and depression symptoms, and (c) to compare the outcomes between women who are aware of the sexually transmitted nature of the HPV infection and women who are not. Swedish women who have been notified of an abnormal Pap smear result completed a questionnaire. This questionnaire consisted of sociodemographic characteristics, items on awareness of HPV, and how to cope with the Pap smear result and the instruments: the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using descriptive statistics, Student's t-test, χ-tests, Fisher's exact test, the Mann-Whitney U-test, and Fisher-Freeman-Halton exact test. In total, 122 women participated. The women reported a median (quartile 1-quartile 3) score of 87.6 on the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (81.8-107.0), compatible with a good HRQoL. The median (quartile 1-quartile 3) scores on HADS-anxiety and HADS-depression were 7.0 (4.0-10.0) and 3.0 (1.0-5.3), respectively; however, 48.4% of the women reported anxiety (compared with 20% in a normal population). There were no statistically significant differences in the median scores in any of the scales, including the prevalence of distress between the subgroups. Women with abnormal Pap smear results have a good HRQoL; they can become anxious, but not depressed. Awareness of HPV as a sexually transmitted infection is low, but being aware does not impact on women's HRQoL or on anxiety and depression.

Trajectories and predictors of women's health-related quality of life during pregnancy: A large longitudinal cohort study.

The objective of this study was to identify distinct trajectories and their predictors of health-related quality of life (HRQOL) of women during pregnancy in a prospective mother and child cohort. Analyses were based on 3936 Dutch pregnant women in Rotterdam area, the Netherlands. Information on potential predictors was collected in early pregnancy by questionnaire. Latent Class Mixture Modelling and Multinomial Logistic Regression were applied to assess the trajectory and predictors of HRQOL during pregnancy. HRQOL was measured by SF-12 in early, mid- and late pregnancy; physical and mental component summary (PCS-12/MCS-12) scores were calculated. Four physical HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 63.3%, consistently low (‘vulnerable’) in 10.8%; a small increase (‘recovering’) in 12.8% and a large decrease (‘at risk’) in 13.1%. Three mental HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 86.1%; a large increase (‘recovering’) in 7.5%; and a large decrease (‘at risk’) in 6.4%. Compared with healthy trajectories, the likelihood of following the ‘vulnerable’ physical HRQOL trajectory rather than a healthy trajectory was increased by daily fatigue(OR: 4.82[2.76, 8.40]), pelvic pain (OR:4.76[2.91, 7.78]) and back pain (OR:5.29[3.21, 8.70]); pregnancy-specific anxiety increased the likelihood of following the ‘at risk’ mental HRQOL trajectory (OR:7.95[4.84, 13.05]). Healthy physical and mental HRQOL trajectories during pregnancy were most common. Predictors indicative of poor HRQOL trajectories included pregnancy-related symptoms and anxiety.

Abstract P5-19-04: Psychosocial impact of a multi-modality surveillance program for women at high-risk for breast cancer

Abstract Purpose: To evaluate the psychosocial impact of semi-annual dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) screening in women at high-risk for breast cancer. Background: For women with BRCA1 and BRCA2 mutations and/or a personal or family history of breast cancer, annual breast MRI has shown improved sensitivity and cancer detection compared to mammography. However, MRI's heightened sensitivity may lead to increased: false positives requiring additional follow-up biopsy/imaging; iatrogenic risk; and psychosocial distress, which all may negatively impact women's overall health-related quality of life. Methods: Between 2004 and 2016, we assembled a prospective cohort of high-risk women undergoing semi-annual DCE-MRI and annual mammography. We reviewed a subset of this group. Participants completed psychosocial assessments at baseline and 6-month visits using the following measures: coping (MBSS); state/trait anxiety (STAI-S/T); depression (BDI-II); risk perception; and mental health (SF-36). Participants were classified according to Monitor or Blunter coping style. Mixed-effects logistic regressions models examined effects of demographics on psychosocial changes over time. Results: 295 women were recruited to the study; 44% of the study participants had pathogenic mutations in BRCA1 or BRCA2 genes. 232 of 295 enrolled participants (78.6%) completed psychosocial assessments. For the total population: median age 44y (range: 21-73), 71% ≥college/post-graduate education; 84% Caucasian; 8% African American; 2% Latino; 99% with health insurance; 72% annual income of &amp;gt;$60,000. One third of women had a personal cancer history. Participants were evenly split between baseline Monitoring and Blunting coping style (49% and 51%, respectively). No significant differences were found between demographics (age, race, income, mutation, cancer type, cancer history) or psychosocial factors (baseline trait anxiety (p =0.64), depression (p =0.65), SF36 global health (p=0.66). After adjusting for education, race, cancer history and coping, women with ≥$60,000 income had lower trait anxiety (p&amp;lt;0.000) and greater mental health (p&amp;lt;0.001) than those with &amp;lt;$60,000 income. Over time, change in trait anxiety varied by coping (p=0.0006): Blunters did not experience significant changes in trait anxiety (p=0.072) while Monitors had significant diminished trait anxiety over time (p&amp;lt;0.001). For depression, women with ≥$60,000 income and college educated had lower BDI-II depression (p&amp;lt;0.000). Yet, women with a cancer history had significantly greater BDH-II depression (p= 0.048). Mental health over time varied by race as non-whites had greater gains in mental health (p=0.001) over time than whites (p=0.03). Conclusion: Semi-annual DCE-MRI did not cause a significantly elevated state anxiety or depression, nor was there a significant decline in mental health over time for groups regardless of cancer history and genetic mutation status. Coping style may have an impact on psychosocial outcomes for those undergoing heightened surveillance over time. Citation Format: Amico AL, Fang R, Raoul A, Wroblewski K, Nielsen S, Weipert C, Abe H, Sheth D, Romero I, Kulkarni K, Schacht D, Patrick-Miller L, Verp M, Bradbury AR, Hlubocky F, Olopade OI. Psychosocial impact of a multi-modality surveillance program for women at high-risk for breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-04.

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study

ObjectiveTo assess the correlation between different pain symptoms and different domains of women's health-related quality of life (HRQoL).MethodsSeventy-seven women with deep infiltrating endometriosis were successively enrolled between June 2011 and August 2013 while being prepared to undergo laparoscopy due to pain and/or infertility. We quantified the intensities of dysmenorrhea, deep dyspareunia, chronic pelvic pain, and dyschezia (menstrual and non-menstrual) using a 11-point visual analog scale (VAS: 0–10) and the validated full versions of the Short Form 36 (SF36) and Endometriosis Health Profile (EHP30) questionnaires to assess HRQoL. The pain symptoms were considered simultaneously in a hierarchical agglomerative clustering method (exploratory multivariate approach) and the associations among scores were tested by bivariate correlation.ResultsDysmenorrhea showed the lowest similarity on to the multivariate cluster analysis and no statistically significant correlation with the other pain symptoms: deep dyspareunia (P=0.244), chronic pelvic pain (P=0.108), menstrual dyschezia (P=0.238), and non-menstrual dyschezia (P=0.380). Dysmenorrhea and chronic pelvic pain were the main symptoms correlated with all domains of the SF36 and the EHP30 (core instrument) questionnaires (P<0.05).ConclusionDysmenorrhea and chronic pelvic pain were independent factors associated with HRQoL.

Menstruation, objectification and health-related quality of life: A questionnaire study.

To explore young women's health-related quality of life (HRQOL) and investigate whether menstrual and menarche experiences and objectification predict mental and physical health components of HRQOL. Menstruation plays a fundamental role in female biology, in women's relationship to their bodies and consequently in women's health and their HRQOL. Cross-sectional explorative survey design. A questionnaire that included the SF-36v2, the Self-objectification Questionnaire (SOQ), the Body Surveillance and Body Shame subscales of the Objectified Body Consciousness Scale, the Belief and Attitudes Towards Menstruation Questionnaire (four subscales), and questions on menarche and menstruation was administered at the end of 2013 to 319 Icelandic women who represented the population by age. The SF-36v2 includes eight dimensions addressing the mental and physical components of HRQOL. Scores are presented as raw data scores and scores based on standardised score of American women and range from 0 to 100 with higher scores indicating better HRQL. A hierarchical multiple linear regression model was employed to calculate significant predictors of mental and physical health components of HRQOL. Mean raw data scores on SF36-v2 dimensions ranged from 54.7 to 91.5. The participants scored below the standardised, mean norm-based score for all dimensions. Secrecy of menstruation, experience of body shame and pain during menstruation predicted worse mental HRQOL. To believe in the proscriptive role and the unpleasantness of menstruation, experience of body shame, medication for menstrual pain and not holding a university education predicted worse physical HRQOL. These two models explained 30% and 22% of the variance of the mental and physical components of SF36-v2, respectively. Young women's mental and physical HRQOL is influenced by the specific context of their lives. Women's health education should take into account the various relationships women may have with their bodies.

Prevalence of urinary incontinence among women and analysis of potential risk factors in Germany and Denmark.

Urinary incontinence (UI) is a prevalent condition that interferes with women's health-related quality of life. Prevalence rates from earlier studies are wide-ranging, due to heterogeneity in methodology, definition of UI and the populations included. We aimed to determine the prevalence of UI and associated risk factors in Germany and Denmark using the same methodology, definition and population. A postal survey was conducted in two regions in Germany and Denmark, including 8000 women aged 18+ years. UI was defined as any complaint of involuntary loss of urine. The questionnaire contained socio-demographic questions and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF). The response rate in Germany and Denmark was 46.2 and 66.6% (p < 0.001) and the prevalence rate of UI was 48.3 and 46.4% (p = 0.188), respectively. Stress urinary incontinence dominated among younger women, and urgency urinary incontinence and mixed urinary incontinence among women 80+ years in Germany and Denmark, respectively. The subgroup of women with body mass index (BMI) ≥35 had the highest prevalence of UI (67.3%). The subgroup of women with BMI <35 were more likely to have stress urinary incontinence, and the subgroup of women with BMI ≥35 were more likely to have mixed urinary incontinence. UI was significantly associated with age as with BMI, vaginal delivery, chronic obstructive pulmonary disease, and having at least one co-morbidity. Prevalence rates in the two regions in Germany and Denmark were similar, despite significantly different response rates. This difference may reflect various attitudes towards answering a questionnaire, but the response rate on questions concerning UI seemed consistent.

Is there an association between women's consultations with a massage therapist and health-related quality of life? Analyses of 1800 women aged 56–61 years

The use of complementary and alternative medicine (CAM) is commonplace in Australia with massage being a popular CAM modality. This is a sub-study from the Australian Longitudinal Study on Women's Health (ALSWH). A total of 2120 mid-age (56-61 year old) women who consulted a CAM practitioner were invited to participate in this study. The Short-Form (SF-36) questionnaire was used to measure women's health-related quality of life. A total of 1800 women returned the questionnaire generating a response rate of 85.0%. Overall, 912 (50.7%) women visited a massage therapist in the previous 12 months. Women with lower quality of life scores in terms of bodily pain (p=0.012) and/or emotional health (p=0.029) were more likely to consult a massage therapist than those with higher scores. The implications of these associations are important for informing healthcare providers in providing effective and coordinated care for patients with pain and mood symptoms.

Health State Utility Impact of Breast Cancer in U.S. Women Aged 18-44 Years.

Breast cancer affects women's health-related quality of life negatively, but little is known about how breast cancer affects this in younger women aged 18-44 years. This study measures preference-based health state utility (HSU) values, a scaled index of health-related quality of life for economic evaluation, for younger women with breast cancer and compares these values with same-age women with other cancers and older women (aged ≥45 years) with breast cancer. Data from the 2009 and 2010 Behavioral Risk Factor Surveillance System were analyzed in 2014. The sample included 218,852 women; 7,433 and 18,577 had histories of breast and other cancers. HSU values were estimated using Healthy Days survey questions and a published mapping algorithm. Linear regression models for HSU were estimated by age group (18-44 and ≥45 years). The adjusted breast cancer HSU impact was four times larger for younger women than for older women (-0.097 vs -0.024, p<0.001). For younger women, the effect of breast cancer on HSU was 70% larger than that of other cancers (-0.097 vs -0.057, p=0.024). Younger breast cancer survivors reported lower HSU values than older survivors, highlighting the impact of breast cancer on the physical and mental health of younger women. The estimates may be used to evaluate quality-adjusted life-years or expectancy for prevention or treatment of breast cancer. This study also indicates that separate quality of life adjustments for women by age group are important for economic analysis of public health breast cancer interventions.