The Overall Quality of Life and Oncological Outcomes Following Radical Hysterectomy in Cervical Cancer Survivors Results from a Large Long-Term Single-Institution Study

Abstract

(1) Background: Cervical cancer patients have been found to have worse quality of life (QoL) scores due to cancer treatment, not only when compared to the general population, but also when compared to other gynecological cancer survivors. In Eastern European developing countries, the health care system often cannot afford the uppermost standardized treatment for these patients. In the absence of a comparable study in our country, the authors’ aim for this retrospective cross-sectional observational study was to evaluate the overall survival (OS) and the QoL o cervical cancer survivors; (2) Methods: 430 patients were analyzed. The first objective is to evaluate the OS rates of patients with cervical cancer stages IA2 to IIB undergoing radical hysterectomy (RH) +/− neoadjuvant or adjuvant radiotherapy +/− chemoradiotherapy treatment combinations. The second objective is to assess their QoL, using two standardized questionnaires issued by the European Organisation for Research and Treatment of Cancer (EORTC), namely QLQ-C30 and QLQ-CX24. (3) Results: The mean age of the participants was 51 years (22–76) and the average follow-up time was 65 months (2–128). At the time of the analysis, 308 out of 430 patients were alive, with a mean five-year OS of 72.4%. The multivariate Cox regression analysis identified stage IIB, parametrial invasion, and the lymph node metastases as independent prognostic risk factors negatively impacting the OS. Of the 308 patients still alive at the time of the analysis, 208 (68%) answered the QoL questionnaires. The QLQ-C30 shows a good long-term Global QoL of 64.6 (median), good functioning scores, and a decent symptom scale value. However, the EORTC QLQ-CX24 showed high values of cervical cancer-specific symptoms, namely: lymphedema, peripheral neuropathy, severe menopausal symptoms, and distorted body-image perception. The results also indicate a significant decline in the quality of sexual life with a low sexual enjoyment and decreased level of sexual activities. (4) Conclusion: Despite a good OS, in this setting of patients, cervical cancer survivors have a modest QoL and sexual function. Our study may provide a comparison for future randomized, controlled trials in Eastern European countries needing to confirm these results.

Quality of Life in Cervical Cancer Survivors Treated with Concurrent Chemoradiotherapy

“…In a similar study, Stanca et al evaluated QoL 48 weeks after oncological treatment and obtained quite similar results related to symptom experience and functioning, except for lymphedema and peripheral neuropathy experiencing, which were found to be extremely high. However, it is necessary to mention that these results were calculated for patients treated with various methods and not exclusively with CCRT [33]. Another study of 90 participants demonstrated significantly worse functioning scores but significantly better symptom experience scores after chemoradiation compared with our study [26].…”

“…It was found that not a single participant reported good (sexual/vaginal functioning score ≥ 66.67) sexual/vaginal functioning, 57.1% (n = 4) indicated moderate (33.34-66.66), and 42.9% (n = 3) reported poor functioning (≤33. 33). An equally relevant question for assessing sexual function is the question about the experience of sexual enjoyment.…”

Beyond bladder dysfunction: assessing the full impact of radical hysterectomy on cervical cancer patients

“…Lower-extremity lymphedema is the most common longterm effect following radical hysterectomy and has been associated with increased anxiety, depression and decreased selfconfidence, all contributing to a diminished quality of life [7,23]. The reported incidence of lymphedema secondary to cervical cancer surgeries varies widely, ranging from 7% to 55% [23,24].…”

“…Querleu-Morrow's classification categorizes radical hysterectomy into four types based on the extent of parametrial resection [6]. In addition, the degree of potential denervation following radical hysterectomy is directly linked to the extent of the surgery and its radicality [7].…”

Global Research Trends on Surgery in Uterine Cervical Neoplasms: A Bibliometric Analysis via CiteSpace

“…Cervical cancer with a ve-year survival rate of 60% 18 , many cervical cancer patients are young, socially and sexually active women whose QoL is at risk of being endangered by surgery treatment. A Romania research took translated standardized questionnaires, namely QLQ-C30 and QLQ-CX24 to assess their QoL after radical hysterectomy 19 . The questionnaires include functional scales, symptom scales, global health QoL scale and single items assessing symptoms 20 .…”