Quality of life and mental health in cervical and endometrial cancer survivors
Introduction
Gynecologic malignancies account for one-third of all cancers in women [1]. Because endometrial and cervical cancers have relatively good 5-year survival rates, quality of life (QOL) outcomes for survivors have become increasingly important. Following initial treatment, gynecologic cancer survivors must frequently adjust to physical limitations, concerns about possibility of recurrence, changes in sexual function, and resumption of roles in family, workplace, and society [1]. While QOL of women with gynecologic malignancies up to 2 years post-treatment has been characterized in prospective studies, little is known about the QOL and mental health of long-term (≥5 years post-treatment) gynecologic cancer survivors.
Several studies have reported that QOL of gynecologic cancer patients does improve following initial decrements around the time of diagnosis and treatment [2], [3], [4]; however, the length of time before complete recovery is unclear. In the longest prospective study comparing QOL in gynecologic cancer survivors and healthy controls, QOL of cervical cancer survivors improved over time but did not reach that of the healthy controls by 18 months post-diagnosis [4]. In contrast, cross-sectional studies of gynecologic cancer survivors 5–7 years post-diagnosis have indicated that QOL in cervical cancer survivors is no different than that of healthy controls, whereas QOL in endometrial cancer survivors is worse [5], [6]. These studies have primarily included women with localized disease, and have not investigated how stage, age, or treatment modality affect QOL.
Investigations of mental health and mood state in gynecologic cancer patients and survivors have detected a wide range in prevalence of mental health difficulties [7], [8], [10], [11]. Most of these studies have included both cancer patients currently undergoing treatment and long-term cancer survivors, and have not examined whether mental health status differs between current patients and survivors. Mental health and mood have not been examined specifically in gynecologic cancer survivors more than 5 years post-diagnosis, or compared between gynecologic cancer survivors and healthy controls.
Although the most important outcome measure in cancer research is survival, QOL and mental health issues are relevant for the 650,000 women in the US who have survived gynecologic cancer [12]. Determining whether these women experience QOL decrements and mental health difficulties is necessary before appropriate interventions can be developed. Such intervention would be especially important given that better QOL has been associated with increased survival [13].
The objective of this study was to examine QOL and mental health in long-term survivors of endometrial and cervical cancer and in healthy comparison participants. Additionally, we investigated how cancer site, state, treatment modality, and demographic variables are related to these outcomes. Survivors of endometrial and cervical cancer were chosen for study as these are two of the most common gynecologic malignancies and have good 5-year survival rates, in contrast to ovarian cancer. It was hypothesized that by 5 years post-diagnosis, QOL and mental health of the gynecologic cancer survivors will have returned to levels of healthy individuals who have not experienced cancer. It was also hypothesized that QOL and mood would not differ between cervical and endometrial cancer survivors.
Section snippets
Participants
Approval was obtained from the Hospital Human Investigation Review Board for performance of the study (IRB # 200205096).
Eligible patients were identified from the UIHC Oncology Registry and from patients taking part in a longitudinal study of endometrial cancer patients in the University of Iowa Division of Gynecologic Oncology. The UIHC Oncology Registry catalogues information about cancer patients undergoing treatment at the University of Iowa Hospitals and Clinics. The registry also follows
Demographics
The self-reported demographic data are shown in Table 1. Participants were predominantly white. There were no significant differences between groups with respect to ethnicity, religion or income (all P values > 0.20). The mean age of participants was 59.6 years (range = 23–90, SD = 11.8). Mean age of endometrial cancer survivors was significantly higher than both healthy controls (P < 0.001) and cervical cancer survivors (P < 0.001). The age difference between cervical cancer survivors and
Quality of life
Overall QOL in cervical and endometrial cancer survivors more than 5 years post-diagnosis was not significantly different from that of healthy women who have not experienced cancer. This result is consistent with longitudinal studies observing that QOL improves over time in gynecologic cancer survivors [3], [6]. This result is also consistent with a cross-sectional study indicating that QOL is not significantly different between cervical cancer survivors 5–7 years post-diagnosis and healthy
Conclusions
These findings pose important implications for health care professionals. The long-term effects of disease factors on QOL and mood have not previously been studied in survivors of gynecologic cancers past 5 years post-diagnosis. The present results suggest that treatment modality, stage of disease, and continuation of side effects have little bearing on the QOL or mood of long-term survivors. Cervical cancer survivors appear to be especially vulnerable to negative mood. Cervical cancer
Acknowledgments
Supported in part by grants R21 CA88293 and R01CA1045-25 to Susan Lutgendorf and by the University of Iowa Honors Program, and the University of Iowa Student Government.
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