Changes in health-related quality of life among gynecologic cancer survivors during the two years after initial treatment: a longitudinal analysis

Abstract

Background: While many cancer survivors experience persistent impairments in health-related quality of life (HRQoL) for extended periods of time, others recover soon after treatment. The aim of this research is to assess changes in health-related quality of life in endometrial and ovarian cancer survivors during two years post initial treatment, and to assess clinical and sociodemographic characteristics associated with those changes. Methods: This prospective population-based cohort study includes longitudinal data of endometrial (N ¼ 221) and ovarian (N ¼ 174) cancer survivors diagnosed between 2011 and 2014. The EORTC QLQ-C30 functioning scales were used to assess HRQoL after initial treatment and after 6, 12 and 24 months. Clinical (stage, treatment and comorbidities) and sociodemographic (age, marital status and socioeconomic status) characteristics were obtained from the Netherlands Cancer Registry and through self-administered questionnaires. Linear mixed models were used to assess changes in HRQoL over time and characteristics associated with these changes. Results: Among both endometrial and ovarian cancer patients, HRQoL improved within the first 6 months after initial treatment. Changes in HRQoL were mainly associated with clinical characteristics including comorbidities, treatment and tumor stage, and to a lesser extent with sociodemographic characteristics such as socioeconomic status. However, these associations varied per tumor type. Endometrial cancer survivors, who received radiotherapy and had no comorbidities, reported greater improvements in some HRQoL scales over time. Ovarian cancer patients who received chemotherapy and with advanced tumor stages reported poorer functioning during treatment. Most functioning domains (global health, physical and role functioning) recovered to levels of patients without chemotherapy or with early-stage disease after 12 months, but cognitive and social functioning remained impaired. Conclusion: Some subgroups of patients, including those with multiple comorbidities, with an advanced tumor stage and who received chemotherapy, may be in need of additional support as they are less likely to show improvements in HRQoL over time.

Do age and comorbidity impair recovery during two years after treatment for endometrial cancer?

“…In line with our findings, various studies have found that, in patients with endometrial cancer or different cancer types, independent of age, comorbidity was associated with poorer HRQoL at baseline or HRQoL deterioration at follow-up [11][12][13]32]. One previous study from our group reported on the association between changes in HRQoL and clinical and sociodemographic characteristics of patients included in the Rogy Care trial and also described the association between cumulative comorbidity burden and poorer HRQoL [12]. What our study adds to the existing knowledge is a detailed comparison of the association of age and comorbidity with changes in HRQoL and the use of longitudinal data from an age-and gender-matched normative control population for comparison of outcomes.…”

“…Only few studies assessed HRQoL longitudinally in patients with endometrial cancer [12,[33][34][35][36][37]. Most had small sample sizes [33,36], either excluded patients with significant comorbidity or did not report on comorbidity [33][34][35][36], or studied the impact of specific treatment modalities on HRQoL rather than the impact of clinical characteristics [33][34][35][36][37].…”

“…Non-respondents were older and had higher disease stages. Details concerning differences between full respondents and respondents lost to follow-up have been described elsewhere [12]. In short, respondents lost to follow-up were older, less often had a partner and had more comorbidities than patients who completed all questionnaires.…”

“…Various prior studies have found that age above 60 and comorbidity were independently associated with treatment-related morbidity and poorer survival [6][7][8][9][10]. Perhaps more importantly, both factors may also impact health-related quality of life (HRQoL) [11][12][13][14][15]. This outcome is of particular interest to patients suffering from cancers with a relatively good prognosis such as endometrial cancer and to older adults with cancer, who often give preference to maintenance or improvement of HRQoL rather than a small increase in survival [6,16].…”

“…Understanding the evolution of HRQoL during and after treatment can be an important factor in decision-making regarding oncologic treatment. In the limited studies available, having multiple comorbid conditions was associated with poorer HRQoL after treatment [12,13]. Age was a factor, but the association varied: one found patients aged ≥65 years to be at higher risk of poorer outcome [15], while others reported poorer results for patients under 60 years of age [14,17].…”