L M Wiltink1, M King2, F Müller2,3, M S Sousa4, M Tang5, A Pendlebury6, J Pittman7,8, N Roberts9,10, L Mileshkin11,12, R Mercieca-Bebber13, M-A Tait2, R Campbell2, C Rutherford2,14. 1. The University of Sydney, Faculty of Science, School of Psychology, Quality of Life Office, Sydney, Australia. l.m.wiltink@lumc.nl. 2. The University of Sydney, Faculty of Science, School of Psychology, Quality of Life Office, Sydney, Australia. 3. Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 4. Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia. 5. Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. 6. Department of Oncology, Mercy Hospital for Women, Heidelberg, Australia. 7. Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia. 8. Western Sydney University, Campbelltown, Australia. 9. Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia. 10. School of Social Work and Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. 11. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. 12. The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Australia. 13. University of Sydney, NHMRC Clinical Trials Centre, Sydney, Australia. 14. The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia.
Abstract
PURPOSE: Given the high survival rate of cervical cancer patients, understanding women's health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women's HRQL, including symptoms, functioning, and global HRQL. METHODS: We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized. RESULTS: We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter vagina, pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3-6 months after treatment. In patients with metastatic or recurrent disease, pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time. CONCLUSION: Whereas most symptoms worsen during treatment and improve in the first 3 months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs.
PURPOSE: Given the high survival rate of cervical cancerpatients, understanding women's health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women's HRQL, including symptoms, functioning, and global HRQL. METHODS: We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized. RESULTS: We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter vagina, pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3-6 months after treatment. In patients with metastatic or recurrent disease, pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time. CONCLUSION: Whereas most symptoms worsen during treatment and improve in the first 3 months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs.
Entities:
Keywords:
Cervical cancer; Chemotherapy; Patient-reported outcomes; Quality of life; Radiotherapy; Surgery
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