Contemporary Quality of Life Issues Affecting Gynecologic Cancer Survivors

Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Hematology/oncology clinics of North America (Impact Factor: 2.3). 02/2012; 26(1):169-94. DOI: 10.1016/j.hoc.2011.11.001
Source: PubMed


Regardless of cancer origin or age of onset, the disease and its treatment can produce short- and long-term sequelae (ie, sexual dysfunction, infertility, or lymphedema) that adversely affect quality of life (QOL). This article outlines the primary contemporary issues or concerns that may affect QOL and offers strategies to offset or mitigate QOL disruption. These contemporary issues are identified within the domains of sexual functioning, reproductive issues, lymphedema, and the contribution of health-related QOL in influential gynecologic cancer clinical trials.

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    • "This can include uterine complications (perforation, necrosis, infection , abdominal fistulae); bowel (obstruction, rectitis, bloody diarrhea, stricture, recto-vaginal fistulae, perforation ); urinary system (cystitis, hematuria, ureteral strictures or stenosis, hydronephrosis, vesicovaginal or bowel fistulas, renal failure); and neuropathic and pelvic pain that are often severe [2] [5] [7] [19] [20]. All of these potential complications can significantly add to the long-term negative impact on psycho-social-sexual functioning and intimate relations, evidenced by significantly lower scores on measures of general health, vitality, mental health, social and emotional well-being, sexual discomfort and gynecologic symptoms than women without cancer or with other cancers [9] [21]-[23]. Although cervical cancer treatment-related vaginal and sexual complications have been described in the literature for over half a century and have been noted in up to 88% of patients, little has changed in incidence or approach to vaginal toxicity and sexual morbidity during that time [8] [10] [24] [25]. "
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    ABSTRACT: The purpose of this research was to describe women’s narrative accounts of the impact of cervical cancer treatment on their sexual function and intimate relationships, and to evaluate what changes in care and education are needed to enhance quality of life and intimacy after treatment. The research approach was a narrative design, using semi-structured, in-depth interviews. Narratives were examined within and across interviews, and thematic content analysis completed. The study was done in a gynecologic oncology clinic at a public hospital in the Midwest United States. The sample consisted of twelve women, ranging in age from 27 to 59, who had completed the cervical cancer treatment with chemo-radiation or radiation and surgery, and were now followed by their gynecologic oncologists. Across narratives, five major themes were identified, including unexpected physical complications, not “getting back to normal,” emotional pain and isolation, lack of available information, and inadequate health care provider response to treatment complications and sexual relationship problems. Women’s stories reveal that sex and intimacy issues for cervical cancer survivors remain within a culture of silence. In many situations, health professionals did not provide information that realistically prepared women and partners for probable consequences of treatment, did not assess sexual issues before or after treatment, did not recognize various symptoms as being complications of cancer treatment, did not make referrals, and/or recognized complications, but accepted them as “normal” and without solution. Ethical implications for health professionals and the need for education, communication, and the development of new lines of research are discussed.
    Full-text · Article · Jun 2014 · Open Journal of Obstetrics and Gynecology
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    • "e l s e v i e r . c o m / l o c a t e / y g y n o treatments on body image, sexual function and hormone function for premenopausal women have not to be underestimated in gynecologic cancer survivors [7] [8] [9] [10]. "
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    ABSTRACT: Objectives The aim of the study was to prospectively, and longitudinally assess Quality of Life (QoL) and emotional distress in a large series of endometrial cancer (EC patients. Methods Global Health Status of the EORTC QLQ-C30 (GHS), the EORTC QLQ-CX24 (CX24), and the Hospital Anxiety and Depression Scale (HADS) questionnaires were administered at diagnosis, and after 3, 6, 12, and 24 months since surgery. The Generalized Linear Model and the Between Subject test were used to analyze QoL changes over time, and the association between factors and patient QoL. Results GHS scores improved over time, although the statistical significance was not reached. Worse lymphedema scores were documented worsened over time with a trend to recover at the 12- and 24 month evaluation (p-value = 0.028). Scores for Menopausal Symptoms (MS) dramatically worsened over time reaching a 38.5 difference of mean ± SE compared to baseline (p-value = 0.011). Sexual Activity (SxA) scores improved until the 12-month evaluation (p-value = 0.048), and showed a return to baseline levels at the last assessment (p-value = 0.025). A significant improvement of anxiety scores was documented at the 3-month evaluation, and persisted over time. In multivariate analysis, unmarried status was associated with poor scores for sexual activity, while living with someone was associated with worse MS scores. Conclusions Menopausal and lymphedema symptoms heavily affect QoL in EC patients. Since socio-demographic features play a major role in deteriorating SxA and MS, psycho-social intervention, and patient education should be considered as an integral part of EC patient treatment.
    Full-text · Article · Jun 2014 · Gynecologic Oncology
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    ABSTRACT: The study reported here assesses sexuality and sexual functioning among women treated for invasive cervical cancer over broad portions of the life cycle. Hysterectomy and oophorectomy, two widespread interventions in invasive cervical cancer, have potentially important effects on a woman's self-image and sexuality. The investigation focused on women aged 29-69 with histories of invasive cervical cancer (n = 179) from the Connecticut Tumor Registry, 6-29 years postdiagnosis. Logistic regression analysis was used to assess the relative impact of time since cervical cancer diagnosis and treatment received, adjusting for age and social and economic background. Sexuality, sexual function, and potential correlates were assessed using the Sexual Adjustment Scale, the MOS-36, and the Center for Epidemiological Studies-Depression Scale (CES-D). Strong majorities of women in the study indicated that they were sexually active (81.1%) and both desired (81.4%) and enjoyed (90.9%) sexual activity. Neither time since cervical cancer diagnosis nor age significantly affected sexuality or sexual function. Women with hysterectomies (with or without oophorectomy) less often reported lack of interest in (odds ratio [OR] 0.36, p < 0.05) and lack of desire for (OR 0.26, p < 0.05) sexual activity than women who had not had hysterectomies. Among women with hysterectomies, those with oophorectomies had a greater risk (OR 21.1, p < 0.05) of not enjoying sex but did not differ otherwise from those without oophorectomies. These findings suggest that cervical cancer survivors generally have a positive attitude toward sexuality and engage in satisfying sexual activity.
    Preview · Article · Jul 2008 · Journal of Women's Health
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