Elsevier

Clinical Therapeutics

Volume 37, Issue 1, 1 January 2015, Pages 39-48
Clinical Therapeutics

Original Resarch
Cervical Cancer Survivorship: Long-term Quality of Life and Social Support

https://doi.org/10.1016/j.clinthera.2014.11.013Get rights and content

Abstract

Purpose

Surgery, radiotherapy, and chemotherapy are the mainstays of cervical cancer treatment. Many patients receive multiple treatment modalities, each with its own long-term effects. Given the high 5-year survival rate for cervical cancer patients, evaluation and improvement of long-term quality of life are essential.

Methods

Pertinent articles were identified through searches of PubMed for literature published from 1993 to 2014. We summarize quality of life data from long-term follow-up studies of cervical cancer patients. We additionally summarize small group interviews of Hispanic and non-Hispanic cervical cancer survivors regarding social support and coping.

Findings

Data are varied in terms of the long-term impact of treatment on quality of life, but consistent in suggesting that patients who receive radiotherapy as part of their treatment have the highest risk of increased long-term dysfunction of bladder and bowel, as well as sexual dysfunction and psychosocial consequences. Rigorous investigations regarding long-term consequences of treatment modalities are lacking.

Implications

Continued work to improve treatment outcomes and survival should also include a focus on reducing adverse long-term side effects. Providing supportive care during treatment and evaluating the effects of supportive care can reduce the prevalence and magnitude of long-term sequelae of cervical cancer, which will in turn improve quality of life and quality of care.

Introduction

As the fourth most common cancer among women, cervical cancer is diagnosed in 528,000 women annually and results in 266,000 deaths.1 In the United States, 12,360 new diagnoses and 4,020 cervical cancer−related deaths are expected in 2014.2 Thankfully, there continue to be improvements in outcomes from surgery, radiotherapy, and chemotherapy in terms of progression-free and overall survival.3 However, treatment-related effects, including urinary, gastrointestinal, sexual, and neurologic side effects, can disrupt long-term quality of life (QOL). Because treatment is curative for 85% to 90% of patients with stage I cervical cancer, it is important not to lose focus on the impact of long-term QOL and the interventions that can improve QOL. In addition, cervical cancer patients have been found to have worse QOL scores, not only when compared with the general population, but also when compared with other gynecologic cancer survivors.3

Presently, there are 245,022 cervical cancer survivors living in the United States, each with their own set of victories and challenges as they continue their lives without cancer.4 The goal of this article is to review the key literature regarding QOL among long-term cervical cancer survivors (at least 5 years); delineate the most common challenges to QOL; and identify, where available, both primary treatment modifications that improve long-term QOL and forms of treatment for the long-term sequelae that affect QOL.

Section snippets

Methods

Relevant articles and abstracts published between 1993 and 2014 were identified through searches of PubMed using the following search terms: cervical cancer, long-term effects, survivorship, quality of life, radiation proctitis, bladder dysfunction, bowel dysfunction, sexual dysfunction, lymphedema, and psychosocial support. Data regarding QOL, social support, and coping were abstracted from a focus group of cervical cancer survivors. Themes emerging from group interviews were extracted from

Conclusions

Although data are mixed, concerns remain that during the time of re-entry into survivorship, cervical cancer survivors’ QOL is not that of baseline controls.30 For the 245,022 cervical cancer survivors living in the United States, that has significant ramifications not only on QOL but productivity in life.4 In this review, we have identified the most common long-term sequelae of treatments for cervical cancer that affect the QOL of cervical cancer survivors, whether treatment was surgical,

Conflicts of Interest

The authors have indicated that they have no conflicts of interest regarding the content of this article.

Acknowledgments

This study was supported by RO1 CA118136-05 (Lari Wenzel), P30 CA-62203-14 (Lari Wenzel), and P20 CA174292-01 (Lari Wenzel and Mindy Mechanic).

The authors would like to thank the student researchers who participated in data abstraction from the focus group of cervical cancer survivors.

References (52)

  • F. Plotti et al.

    Sexual function after modified radical hysterectomy (Piver II/Type B) vs. classic radical hysterectomy (Piver III/Type C2) for early stage cervical cancer. A prospective study

    J Sex Med

    (2012)
  • I. Vistad et al.

    A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer

    Gynecol Oncol

    (2006)
  • L. Wenzel et al.

    Quality of life in long-term cervical cancer survivors

    Gynecol Oncol

    (2005)
  • A. Achouri et al.

    Complications of lymphadenectomy for gynecologic cancer

    Eur J Surg Oncol

    (2013)
  • K. Kirchheiner et al.

    Posttraumatic stress disorder after high-dose-rate brachytherapy for cervical cancer with 2 fractions in 1 application under spinal/epidural anesthesia: incidence and risk factors

    Int J Radiat Oncol Biol Phys

    (2014)
  • M. Klee et al.

    Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer

    Gynecol Oncol

    (2000)
  • M.C. Hung et al.

    Estimation of potential gain in quality of life from early detection of cervical cancer

    Value Health

    (2014)
  • I.J. Korfage et al.

    Health-related quality of life in cervical cancer survivors: a population-based survey

    Int J Radiat Oncol Biol Phys

    (2009)
  • V. Bjelic-Radisic et al.

    Quality of life characteristics inpatients with cervical cancer

    Eur J Cancer

    (2012)
  • K. Osann et al.

    Factors associated with poor quality of life among cervical cancer survivors: Implications for clinical care and clinical trials

    Gynecol Oncol

    (2014)
  • E. Barnas et al.

    The quality of life of women treated for cervical cancer

    Eur J Oncol Nurs

    (2012)
  • E.S. Ratner et al.

    Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology

    Maturitas

    (2011)
  • S.K. Yip et al.

    Psychological morbidity and female urinary incontinence. Best practice & research

    Clinical obstetrics & gynaecology

    (2007)
  • S. Ye et al.

    Quality of life and sexual function of patients following radical hysterectomy and vaginal extension

    J Sex Med

    (2014)
  • S.C. Muluk et al.

    Pneumatic compression device treatment of lower extremity lymphedema elicits improved limb volume and patient-reported outcomes

    Eur J Vasc Endovasc Surg

    (2013)
  • Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC...
  • Cited by (124)

    View all citing articles on Scopus
    View full text