Clinical Investigation
Health-Related Quality of Life in Cervical Cancer Survivors: A Population-Based Survey

https://doi.org/10.1016/j.ijrobp.2008.06.1905Get rights and content

Purpose

In a population-based sample of cervical cancer survivors, health-related quality of life (HRQoL) was assessed 2–10 years postdiagnosis.

Methods and Materials

All patients given a diagnosis of cervical cancer in 1995–2003 in the Eindhoven region, The Netherlands, and alive after Jan 2006 were identified through the cancer registry. Generic HRQoL (36-Item Short-Form Health Survey, EQ-5D), cervical cancer–specific HRQoL (European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module), and anxiety (6-item State Trait Anxiety Inventory) were assessed and compared with a reference population (n = 349). Data for tumor characteristics at diagnosis and disease progression were available.

Results

A total of 291 women responded (69%), with a mean age of 53 ± 13 (SD) years (range, 31–88 years). Treatment had consisted of surgery (n = 195) or a combination of therapies (n = 75); one woman had not been treated. Of all women, 85% were clinically disease free, 2% had a recurrence/metastasis, and in 13%, this was unknown. After controlling for background characteristics (age, education, job and marital status, having children, and country of birth), generic HRQoL scale scores were similar to the reference population, except for worse mental health in survivors. The most frequent symptoms were crampy pain in the abdomen or belly (17%), urinary leakage (15%), menopausal symptoms (18%), and problems with sexual activity. Compared with the 6–10-year survivors, more sexual worry and worse body image were reported by the 2–5-year survivors. Compared with surgery only, especially primary radiotherapy was associated with an increased frequency of treatment-related side effects, also after controlling for age and disease stage at diagnosis and follow-up.

Conclusions

Most cervical cancer survivors were coping well, although their mental health was worse than in the reference population. Even after 2–10 years, radiotherapy was associated with an increased frequency of treatment-related side effects.

Introduction

Cervical cancer is an important cause of death in women, especially in developing countries. In Europe, cervical cancer is diagnosed in 60,000 women annually (1). Because of improved therapies and early detection, the number of women who survive cervical cancer has increased (2). These survivors have been given a diagnosis of a life-threatening disease and were confronted with their own mortality. They may still experience the physical side effects of cervical cancer therapy, such as permanent consequences for sexual function and childbearing, as well as menopausal, urologic, and gastrointestinal symptoms (3). Survivors may also experience anxiety for recurrence of cervical cancer.

Health-related quality of life (HRQoL), defined in this study as the quality of life relating to disease and/or treatment, has been described for the 1 to 5–6 years after treatment of cervical cancer 4, 5, 6, 7, 8. In, e.g., the case of prostate cancer (9) and adult-onset cancers in general (10), long-term cancer survivors showed a comparatively favorable HRQoL, whereas HRQoL was less favorable in survivors of non-Hodgkin disease (11). However, with the exception of a recent Korean study (12), long-term HRQoL after diagnosis of cervical cancer has been described for only small numbers of patients 13, 14, 15.

The present study aims to assess the generic and treatment-specific HRQoL of women who survived cervical cancer. For this, a population-based study was conducted of all women given a diagnosis of cervical cancer in the region of the Eindhoven Cancer Registry (ECR), The Netherlands, in 1995–2003. We hypothesized that HRQoL of survivors would be similar to the general population, HRQoL would be better in long-term than short-term survivors, and adjuvant radiotherapy after surgery would be associated with worse HRQoL than primary radiotherapy.

Section snippets

Setting and respondents

The ECR records data for all patients with newly diagnosed cancer in the south of The Netherlands, an area with 2.3 million inhabitants, 17 hospital locations, and two large radiotherapy institutes (16). In cooperation with the ECR and all gynecologic oncology departments in the region, we conducted a population-based cross-sectional survey. All women could be identified who had cervical cancer diagnosed between Jan 1, 1995, and Dec 31, 2003 (n = 691). Women who had died could be excluded

Respondents' characteristics

Of the 421 cervical cancer survivors (response rate, 69%), 291 completed the questionnaire. The remaining 130 questionnaires were not completed because of wrong address (n = 11), patients' bad health (n = 2), lack of motivation (n = 2), death (n = 1), or unknown reasons (n = 114) (Fig. 1). Compared with the reference group, survivors were older, had a lower education level, and had lower rates of having paid jobs, partners, and children (Table 1).

Clinical data

Average age at diagnosis was 47 years (range,

Discussion

We assessed HRQoL in 291 cervical cancer survivors 2–10 years after diagnosis and treatment and found that the majority was doing well. However, cervical cancer–specific symptoms, such as pain in the abdomen, urinary leakage, and menopausal symptoms, were reported by several women and mental health was significantly worse than in the reference group. The HRQoL scores of 2–5-year survivors were similar to those of 6–10-year survivors, except for more anxiety, worse body image, and more sexual

Acknowledgments

The authors thank the survivors and the women from the reference group for participating in the study and the gynecologists in the region of the Eindhoven Cancer Registry for their friendly cooperation.

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    The study for this report was funded by the Dutch Cancer Society (EMCR 2003-2775). The authors were completely independent from funders in conducting and writing this study.

    Presented as “top ranked abstract” in the plenary session of the Society for Medical Decision Making Europe conference, Engelberg, Switzerland, June 2008; and at the International Society for Quality of Life Research conference on Quality of Life, Toronto, Canada; October 2007. Abstract received the International Society for Quality of Life Research New Investigator Award.

    Conflict of interest: Dr. van Ballegooijen is principal investigator in a project on cost-effectiveness of human papillomavirus vaccination, financed by GSK (a pharmaceutical company that produces human papillomavirus vaccines).

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