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Survivors of gynecologic malignancies: impact of treatment on health and well-being

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Abstract

Purpose

While overall survival from gynecologic malignancies has greatly improved over the last three decades, required treatments can lead to multiple health issues for survivors. Our objective was to identify health concerns that gynecologic cancer survivors face.

Methods

A systematic, stratified sample of women with gynecologic malignancies was surveyed for 18 health issues occurring before, during, or after treatment. The impact of clinical features and treatment modality on health issues was assessed through multivariate logistic regression models.

Results

Of 2,546 surveys mailed, 622 were not received by eligible subjects secondary to invalid address, incorrect diagnosis, or death. Thus, 1924 survivors potentially received surveys. Of the 1,029 surveys (53.5 %) completed, median age was 59 years; diagnoses included 29 % cervical, 26 % endometrial, 26 % ovarian/primary peritoneal/fallopian tube, 12.1 % vulvar, and 5.4 % vaginal cancers. The most frequently reported health issues included fatigue (60.6 %), sleep disturbance (54.9 %), urinary difficulties (50.9 %), sexual dysfunction (48.4 %), neurologic issues (45.4 %), bowel complaints (42.0 %), depression (41.3 %), and memory problems (41.2 %). These rankings were consistent with patients’ self-reported rankings of “highest impact” personal issues. After controlling for demographic and clinical variables, multivariate analyses revealed that treatment modality impacted the odds of experiencing a given health issue.

Conclusions

Our study demonstrates that gynecologic cancer survivors experience a high frequency of health conditions and highlights the association between treatment modality and specific health concerns.

Implications for Cancer Survivors

The study findings highlight the multiple health concerns experienced by gynecologic cancer survivors and suggest the potential for developing interventions to mitigate these concerns in survivorship.

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References

  1. Altekruse S, Kosary C, Krapcho M, Neyman N, Aminou R, Waldron W et al. SEER Cancer Statistics Review, 1975–2007. National Cancer Institute, Bethesda, MD. 2010. http://seer.cancer.gov/csr/1975_2007. Accessed February 18 2011.

  2. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. doi:10.3322/caac.21208.

    Article  PubMed  Google Scholar 

  3. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82. doi:10.1056/NEJMsa060185.

    Article  CAS  PubMed  Google Scholar 

  4. Stull VB, Snyder DC, Demark-Wahnefried W. Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population. J Nutr. 2007;137(1 Suppl):243S–8.

    CAS  PubMed  Google Scholar 

  5. Anderson B, Lutgendorf S. Quality of life in gynecologic cancer survivors. CA Cancer J Clin. 1997;47(4):218–25.

    Article  CAS  PubMed  Google Scholar 

  6. Ferrell B, Smith SL, Cullinane CA, Melancon C. Psychological well being and quality of life in ovarian cancer survivors. Cancer. 2003;98(5):1061–71.

    Article  PubMed  Google Scholar 

  7. Hodgkinson K, Butow P, Fuchs A, Hunt GE, Stenlake A, Hobbs KM, et al. Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes. Gynecol Oncol. 2007;104(2):381–9.

    Article  PubMed  Google Scholar 

  8. Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer. 2007;109(12):2607–14.

  9. Lockwood-Rayermann S. Survivorship issues in ovarian cancer: a review. Oncol Nurs Forum. 2006;33(3):553–62.

    Article  PubMed  Google Scholar 

  10. Schultz PN, Beck ML, Stava C, Vassilopoulou-Sellin R. Health profiles in 5836 long-term cancer survivors. Int J Cancer. 2003;104(4):488–95.

    Article  CAS  PubMed  Google Scholar 

  11. Schultz PN, Stava C, Beck ML, Vassilopoulou-Sellin R. Ethnic/racial influences on the physiologic health of cancer survivors. Cancer. 2004;100(1):156–64.

    Article  PubMed  Google Scholar 

  12. Salani R. Survivorship planning in gynecologic cancer patients. Gynecol Oncol. 2013;130(2):389–97. doi:10.1016/j.ygyno.2013.05.022.

    Article  PubMed  Google Scholar 

  13. Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, et al. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005;23(30):7428–36. doi:10.1200/JCO.2004.00.3996.

    Article  PubMed  Google Scholar 

  14. NCI Dictionary of Cancer Terms. National Cancer Institute at the National Institutes of Health. 2012. http://www.cancer.gov/dictionary?cdrid=445089. Accessed November 28 2012.

  15. Ashing-Giwa KT, Tejero JS, Kim J, Padilla GV, Kagawa-Singer M, Tucker MB, et al. Cervical cancer survivorship in a population based sample. Gynecol Oncol. 2009;112(2):358–64. doi:10.1016/j.ygyno.2008.11.002.

    Article  PubMed  Google Scholar 

  16. A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies. CDC Lance Armstrong Foundation. 2004. http://www.cdc.gov/cancer/survivorship/pdf/plan.pdf.

  17. Earle CC. Failing to plan is planning to fail: improving the quality of care with survivorship care plans. J Clin Oncol. 2006;24(32):5112–6.

    Article  PubMed  Google Scholar 

  18. Papadakos J, Bussiere-Cote S, Abdelmutti N, Catton P, Friedman AJ, Massey C, et al. Informational needs of gynecologic cancer survivors. Gynecol Oncol. 2012;124(3):452–7. doi:10.1016/j.ygyno.2011.10.030.

    Article  PubMed  Google Scholar 

  19. Prue G, Rankin J, Allen J, Gracey J, Cramp F. Cancer-related fatigue: a critical appraisal. Eur J Cancer. 2006;42(7):846–63. doi:10.1016/j.ejca.2005.11.026.

    Article  CAS  PubMed  Google Scholar 

  20. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895–908.

    CAS  PubMed  Google Scholar 

  21. Donnelly CM, Blaney JM, Lowe-Strong A, Rankin JP, Campbell A, McCrum-Gardner E, et al. A randomised controlled trial testing the feasibility and efficacy of a physical activity behavioural change intervention in managing fatigue with gynaecological cancer survivors. Gynecol Oncol. 2011;122(3):618–24. doi:10.1016/j.ygyno.2011.05.029.

    Article  CAS  PubMed  Google Scholar 

  22. Phillips NA. Female sexual dysfunction: evaluation and treatment. Am Fam Physician. 2000;62(1):127–36. 41-2.

    CAS  PubMed  Google Scholar 

  23. Derogatis L, Clayton A, Lewis-D'Agostino D, Wunderlich G, Fu Y. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5(2):357–64. doi:10.1111/j.1743-6109.2007.00672.x.

    Article  PubMed  Google Scholar 

  24. Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA, Machin D. Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2003;56(4):937–49.

    Article  PubMed  Google Scholar 

  25. Hill EK, Sandbo S, Abramsohn E, Makelarski J, Wroblewski K, Wenrich ER, et al. Assessing gynecologic and breast cancer survivors' sexual health care needs. Cancer. 2010. doi:10.1002/cncr.25832.

    Google Scholar 

  26. Skjeldestad FE, Rannestad T. Urinary incontinence and quality of life in long-term gynecological cancer survivors: a population-based cross-sectional study. Acta Obstet Gynecol Scand. 2009;88(2):192–9. doi:10.1080/00016340802582041.

    Article  PubMed  Google Scholar 

  27. Skjeldestad FE, Hagen B. Long-term consequences of gynecological cancer treatment on urinary incontinence: a population-based cross-sectional study. Acta Obstet Gynecol Scand. 2008;87(4):469–75. doi:10.1080/00016340801948326.

    Article  PubMed  Google Scholar 

  28. Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Skalla K, et al. Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol. 2002;20(2):485–93.

    Article  CAS  PubMed  Google Scholar 

  29. Tuxen MK, Hansen SW. Neurotoxicity secondary to antineoplastic drugs. Cancer Treat Rev. 1994;20(2):191–214.

    Article  CAS  PubMed  Google Scholar 

  30. Deprez S, Amant F, Smeets A, Peeters R, Leemans A, Van Hecke W, et al. Longitudinal assessment of chemotherapy-induced structural changes in cerebral white matter and its correlation with impaired cognitive functioning. J Clin Oncol. 2012;30(3):274–81. doi:10.1200/JCO.2011.36.8571.

    Article  PubMed  Google Scholar 

  31. Hensley ML, Correa DD, Thaler H, Wilton A, Venkatraman E, Sabbatini P, et al. Phase I/II study of weekly paclitaxel plus carboplatin and gemcitabine as first-line treatment of advanced-stage ovarian cancer: pathologic complete response and longitudinal assessment of impact on cognitive functioning. Gynecol Oncol. 2006;102(2):270–7. doi:10.1016/j.ygyno.2005.12.042.

    Article  CAS  PubMed  Google Scholar 

  32. Correa DD, Zhou Q, Thaler HT, Maziarz M, Hurley K, Hensley ML. Cognitive functions in long-term survivors of ovarian cancer. Gynecol Oncol. 2010;119(2):366–9. doi:10.1016/j.ygyno.2010.06.023.

    Article  PubMed  Google Scholar 

  33. Correa DD, Hess LM. Cognitive function and quality of life in ovarian cancer. Gynecol Oncol. 2012;124(3):404–9. doi:10.1016/j.ygyno.2011.11.005.

    Article  PubMed  Google Scholar 

  34. Verstappen CC, Heimans JJ, Hoekman K, Postma TJ. Neurotoxic complications of chemotherapy in patients with cancer: clinical signs and optimal management. Drugs. 2003;63(15):1549–63.

    Article  CAS  PubMed  Google Scholar 

  35. Huang HQ, Brady MF, Cella D, Fleming G. Validation and reduction of FACT/GOG-Ntx subscale for platinum/paclitaxel-induced neurologic symptoms: a gynecologic oncology group study. Int J Gynecol Cancer. 2007;17(2):387–93. doi:10.1111/j.1525-1438.2007.00794.x.

    Article  CAS  PubMed  Google Scholar 

  36. Cella D, Huang H, Homesley HD, Montag A, Salani R, De Geest K, et al. Patient-reported peripheral neuropathy of doxorubicin and cisplatin with and without paclitaxel in the treatment of advanced endometrial cancer: results from GOG 184. Gynecol Oncol. 2010;119(3):538–42. doi:10.1016/j.ygyno.2010.08.022.

    Article  CAS  PubMed  Google Scholar 

  37. Pignata S, De Placido S, Biamonte R, Scambia G, Di Vagno G, Colucci G, et al. Residual neurotoxicity in ovarian cancer patients in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: the Multicenter Italian Trial in Ovarian cancer (MITO-4) retrospective study. BMC Cancer. 2006;6:5. doi:10.1186/1471-2407-6-5.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wenzel LB, Donnelly JP, Fowler JM, Habbal R, Taylor TH, Aziz N, et al. Resilience, reflection, and residual stress in ovarian cancer survivorship: a gynecologic oncology group study. Psychooncology. 2002;11(2):142–53.

    Article  PubMed  Google Scholar 

  39. Pace A, Giannarelli D, Galie E, Savarese A, Carpano S, Della Giulia M, et al. Vitamin E neuroprotection for cisplatin neuropathy: a randomized, placebo-controlled trial. Neurology. 2010;74(9):762–6. doi:10.1212/WNL.0b013e3181d5279e.

    Article  CAS  PubMed  Google Scholar 

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Funding

This study and/or study investigators were funded by the following grants:

National Institutes of Health 5T32 CA10164202T32 Training Grant

National Institutes of Health K12CA088084 K12 Calabresi Scholar Award

National Institutes of Health 2P50CA098258-06 SPORE in Uterine Cancer

National Institutes of Health 2P50CA083639 SPORE in Ovarian Cancer

National Institutes of Health P30CA016672 MD Anderson Cancer Center Support Grant

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, 1155 Herman Pressler Boulevard, Unit 1362, CPB6.3279, Houston, TX, 77030, USA

    Shannon N. Westin, Charlotte C. Sun, Larissa A. Meyer, Michael M. Frumovitz, Karen H. Lu & Diane C. Bodurka

  2. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    Celestine S. Tung

  3. Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA

    Robin A. Lacour

  4. Division of Quantitative Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Diana L. Urbauer

Authors
  1. Shannon N. Westin
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  2. Charlotte C. Sun
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  3. Celestine S. Tung
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  4. Robin A. Lacour
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  5. Larissa A. Meyer
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  6. Diana L. Urbauer
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  7. Michael M. Frumovitz
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  8. Karen H. Lu
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  9. Diane C. Bodurka
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Corresponding author

Correspondence to Shannon N. Westin.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplemental Table 1

Top 8 health issues affecting ovarian cancer survivors (DOC 30 kb)

Supplemental Table 2

Multivariate logistic regression for the top 8 health issues affecting ovarian cancer survivors (DOC 49 kb)

Supplemental Table 3

Top 8 health issues affecting cervical cancer survivors (DOC 30 kb)

11764_2015_472_MOESM4_ESM.doc

Supplemental Table 4. Multivariate logistic regression for the top 8 health issues affecting cervical cancer survivors (DOC 53 kb)

Supplemental Table 5

Top 8 health issues affecting endometrial cancer survivors (DOC 30 kb)

Supplemental Table 6

Multivariate logistic regression for the top 8 health issues affecting endometrial cancer survivors (DOC 51 kb)

Supplemental Table 7

Top 8 health issues affecting vulvar cancer survivors (DOC 30 kb)

Supplemental Table 8

Multivariate logistic regression for the top 8 health issues affecting vulvar cancer survivors (DOC 46 kb)

Supplemental Table 9

Top 8 health issues affecting vaginal cancer survivors* (DOC 31 kb)

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Westin, S.N., Sun, C.C., Tung, C.S. et al. Survivors of gynecologic malignancies: impact of treatment on health and well-being. J Cancer Surviv 10, 261–270 (2016). https://doi.org/10.1007/s11764-015-0472-9

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  • DOI: https://doi.org/10.1007/s11764-015-0472-9

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