Jeanne Carter1, Helen Q Huang2, Jane Armer3, Jay W Carlson4, Suzy Lockwood5, Susan Nolte6, James Kauderer7, Alan Hutson8, Joan L Walker9, Aimee C Fleury10, Albert Bonebrake11, John T Soper12, Cara Mathews13, Oliver Zivanovic14, William Edward Richards15, Annie Tan16, David S Alberts17, Richard R Barakat18, Lari B Wenzel19. 1. Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, USA. Electronic address: carterj@mskcc.org. 2. NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center; Elm & Carlton Streets., Buffalo, NY 14263, USA. Electronic address: HuangH@NRGOncology.org. 3. Sinclair School of Nursing, DC 116.05, Mizzou North Suite 415, 115 Business Loop 70 West, Columbia, MO 65010, USA. Electronic address: Armer@missouri.edu. 4. Cancer Research for the Ozarks, 1235 E. Cherokee, Springfield, MO 65804, USA. Electronic address: Jay.Carlson@Mercy.Net. 5. Texas Christian University, Harris College of Nursing & Health Sciences, TCU Box 298620, Ft Worth, TX 76129, USA. Electronic address: S.lockwood@tcu.edu. 6. Abington Memorial Hospital, 1200 Old York Road, Abington, PA 19001, USA. Electronic address: susanannnolte@gmail.org. 7. NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center; Elm & Carlton Streets., Buffalo, NY 14263, USA. Electronic address: KaudererJ@NRGOncology.org. 8. NRG Oncology; Clinical Trial Development Division; Biostatistics & Bioinformatics; Roswell Park Comprehensive Cancer Center; Elm & Carlton Streets., Buffalo, NY 14263, USA. Electronic address: Alan.Hutson@Roswellpark.org. 9. Stephenson Cancer Center, OUHSC, Oklahoma City, OK 73104, USA. Electronic address: Joan-walker@ouhsc.edu. 10. Women's Cancer Center of Nevada, 3131 la St. Ste 241, Las Vegas, NV 89169, Canada. Electronic address: afleury@wccenter.com. 11. Cancer Research for the Ozarks-Cox Health, Ferrell Duncan Clinic GYN-ONC, Springfield, MO 65807, USA. Electronic address: Albert.bonebrake@coxhealth.com. 12. Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, 110 Physicians Office BLDG, 170 Manning Drive, Chapel Hill, NC 27599, USA. Electronic address: jsoper@med.unc.edu. 13. Division of Gynecologic Oncology, Women & Infants Hospital of Rhode Island, Alpert School of Medicine at Brown University, 101 Dudley St., Providence, RI 02905, USA. Electronic address: CMathews@wihri.org. 14. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address: Zivanovo@mskcc.org. 15. Director of Gynecologic Oncology and Surgical Specialists, St. Joseph's/Candler Health System, 225 Candler Dr., Savannah, GA 31405, USA. Electronic address: drrichards@sjchs.org. 16. Minnesota Oncology, 11850 Blackfoot Street, NW, Suite 100, Coon Rapids, MN 55433, USA. Electronic address: Annie.tan@usoncology.com. 17. Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA. Electronic address: DAlberts@uacc.arizona.edu. 18. Northwell Health Cancer Institute, 1111 Marcus Avenue, New Hyde Park, NY 11042, USA. Electronic address: rbarakat@northwell.edu. 19. Program in Public Health, University of California, Irvine, Irvine, CA, USA; Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA,. Electronic address: lwenzel@uci.edu.
Abstract
OBJECTIVE: To assess quality of life (QOL) in patients who developed lower-extremity lymphedema (LLE) after radical gynecologic cancer surgery on prospective clinical trial GOG 244. METHODS: The prospective, national, cooperative group trial GOG-0244 determined the incidence of LLE and risk factors for LLE development, as well as associated impacts on QOL, in newly diagnosed patients undergoing surgery for endometrial, cervical, or vulvar cancer from 6/4/2012-11/17/2014. Patient-reported outcome (PRO) measures of QOL (by the Functional Assessment of Cancer Therapy [FACT]), body image, sexual and vaginal function, limb function, and cancer distress were recorded at baseline (within 14 days before surgery), and at 6, 12, 18, and 24 months after surgery. Assessments of LLE symptoms and disability were completed at the time of lower limb volume measurement. A linear mixed model was applied to examine the association of PROs/QOL with a Gynecologic Cancer Lymphedema Questionnaire (GCLQ) total score incremental change ≥4 (indicative of increased LLE symptoms) from baseline, a formal diagnosis of LLE (per the GCLQ), and limb volume change (LVC) ≥10%. RESULTS: In 768 evaluable patients, those with a GCLQ score change ≥4 from baseline had significantly worse QOL (p < 0.001), body image (p < 0.001), sexual and vaginal function (p < 0.001), limb function (p < 0.001), and cancer distress (p < 0.001). There were no significant differences in sexual activity rates between those with and without LLE symptoms. CONCLUSIONS: LLE is significantly detrimental to QOL, daily function, and body image. Clinical intervention trials to prevent and manage this chronic condition after gynecologic cancer surgery are needed.
OBJECTIVE: To assess quality of life (QOL) in patients who developed lower-extremity lymphedema (LLE) after radical gynecologic cancer surgery on prospective clinical trial GOG 244. METHODS: The prospective, national, cooperative group trial GOG-0244 determined the incidence of LLE and risk factors for LLE development, as well as associated impacts on QOL, in newly diagnosed patients undergoing surgery for endometrial, cervical, or vulvar cancer from 6/4/2012-11/17/2014. Patient-reported outcome (PRO) measures of QOL (by the Functional Assessment of Cancer Therapy [FACT]), body image, sexual and vaginal function, limb function, and cancer distress were recorded at baseline (within 14 days before surgery), and at 6, 12, 18, and 24 months after surgery. Assessments of LLE symptoms and disability were completed at the time of lower limb volume measurement. A linear mixed model was applied to examine the association of PROs/QOL with a Gynecologic Cancer Lymphedema Questionnaire (GCLQ) total score incremental change ≥4 (indicative of increased LLE symptoms) from baseline, a formal diagnosis of LLE (per the GCLQ), and limb volume change (LVC) ≥10%. RESULTS: In 768 evaluable patients, those with a GCLQ score change ≥4 from baseline had significantly worse QOL (p < 0.001), body image (p < 0.001), sexual and vaginal function (p < 0.001), limb function (p < 0.001), and cancer distress (p < 0.001). There were no significant differences in sexual activity rates between those with and without LLE symptoms. CONCLUSIONS: LLE is significantly detrimental to QOL, daily function, and body image. Clinical intervention trials to prevent and manage this chronic condition after gynecologic cancer surgery are needed.
Authors: Kelley C Wood; Jessica Bertram; Tiffany Kendig; Mary Hidde; Aliza Leiser; Alexandre Buckley de Meritens; Mackenzi Pergolotti Journal: Support Care Cancer Date: 2022-07-01 Impact factor: 3.359