Health-related Quality of Life Among Cervical Cancer Survivors at a Tertiary Hospital in Kumasi, Ghana

Abstract

BackgroundCervical cancer survivors often experience significant diminution in health-related quality of life (HRQoL). We aimed to investigate the overall HRQoL, determine the role of the stage of disease and type of treatment received on HRQoL, and evaluate predictors of HROoL among cervical cancer survivors in Ghana.MethodsA hospital-based cross-sectional study was conducted in 153 cervical cancer patients who completed curative treatment between January 2004 and December 2018 at Komfo Anokye Teaching Hospital. The European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ C-30) supplemented with the cervical cancer-specific (EORTC QLQ-CX24) module was used. The Kruskal-Wallis test was used to determine the effect of the stage of cervical cancer and the type of treatment received on mean scores of the different domains of HRQoL. Multivariate logistic regression was performed to identify predictors of HRQoL.ResultsThe mean global health status (GHS) was 79.7 (+/-16.2), and it differed significantly with FIGO stage, with 84.1 76.2, and 79.9, for stages I, II and III respectively (p=0.012). Financial burden was higher in participants with FIGO stage II compared to stage I disease (45.4 vs 20.8, p=0.012.). The mean GHS scores for surgery, chemoradiation and radiation only were 85.2, 75.9, and 82.1 respectively (p=0.027). Compared to participants who were treated with Chemoradiation, those treated with surgery had lower financial difficulties (12.1 vs 41.6 , p=0.019), better body image (95.7vs 79.5, p =0.039) and better symptom experience (5.9 vs 12.0, p =0.043).The likelihood that survivors’ HQROL is affected is decreased with illiteracy (AOR = 0.30, 95% CI=0.09–1.00), and increased with complaints of pain (AOR=5.50, 95%CI=1.68-18.29), loss of appetite (AOR=13.24, 95% CI=2.71– 64.67) and diminution in body image perception (AOR = 6.04, 95% CI=1.67–21.83). ConclusionCervical cancer survivors in Ghana have overall satisfactory HRQoL. Surgical treatment is associated with improved HRQoL and less financial burden. Efforts to enhance HRQoL should also be focused on maximizing survivors’ body image and managing pain and loss of appetite. Educating women about expected impacts on their quality of life, and strategies to manage and mitigate these impacts, is essential.