ReviewThe impact of cervical cancer on quality of life—The components and means for management
Introduction
Cervical cancer is a major health issue worldwide. Each year, approximately 500,000 new cases of cervical cancer are diagnosed, and more than 270,000 deaths result from this disease [1]. In the United States (US), in 2007, an estimated 11,150 cases of cervical cancer are expected to be diagnosed, and every 2 1/2 h a woman will die of cervical cancer in the US [2].
Recent US data estimates that 24.9 million women between the ages of 14 and 59 are currently infected with a human papillomavirus [3] and more than 80% of women will acquire a genital human papillomavirus infection by age 50 [4]. At least 100 human papillomavirus types have been sequenced and identified; of which more than 40 infect the genital mucosa. Approximately 15 of these viruses are known to be oncogenic, or high-risk virus types, with oncogenic human papillomavirus DNA detected in 99.7% of all cervical cancer cases [5], [6], [7]. Of the oncogenic virus types, 16 and 18 account for approximately 77% of all cervical cancer cases in North America [8]. Two other highly prevalent oncogenic virus types, 45 and 31, account for an additional 8% of all cervical cancers [8].
The economic and quality-of-life (QoL) burden of cervical disease is significant and highlights the need for treatment and prevention options for this condition. In 2001, the estimated direct costs associated with cervical precancerous lesions was $3.6 billion [9]. Total annual healthcare costs of human papillomavirus-related conditions in the US range from $2.25 to $4.6 billion. The health-related QoL areas most impacted by human papillomavirus include emotional, social, and sexual functioning [10].
The impact of cervical cancer on a woman's life can also be assessed by the number of years of life lost. On average, every woman who dies of cervical cancer loses about 26 years of life. This is considerably greater than the average years of life lost to breast cancer (19.2 years) and is only lower than testicular cancer in males (35.9 males). Furthermore, among women, acquired immune deficiency syndrome is the only illness that has a greater number of average years of life lost (34.5 years) [11].
In an effort to assist the clinician in understanding and addressing the aforementioned QoL effects of cervical cancer, we review some of the studies on QoL in cervical cancer patients. We expand the review to include the effects on the cervical cancer patient's significant other. Finally, we put forth suggestions on how clinicians can address the QoL impact of cervical cancer and precancerous lesions.
The QoL clinical studies cited in this review were identified through a literature search of PubMed and MD Consult. The criteria considered for inclusion were the number of participants in each study, the validated, objective, clinical tools used to assess QoL in each study, and the outcomes of each study.
Section snippets
Effects of abnormal cervical cytology on quality of life
Since the introduction of the Papanicolaou (Pap) test in the 1950s and its widespread application as a screening tool, the incidence of squamous cell cervical cancer and associated mortality has decreased by up to 70% [12]. However, a general lack of knowledge among women regarding cervical cancer screening still persists. Approximately 40% of women are unaware that a Pap test screens for cervical cancer [13], [15]. Also, many women do not understand the meaning of an abnormal Pap test, do not
Psychological, psychosocial, and mental health issues
Compared with other gynecologic cancers, survivors of cervical cancer have reported more mood disorders. Specifically, cervical cancer patients experience significantly more anxiety, dysphoria, anger, and confusion than endometrial cancer patients or healthy controls. Mean scores for anxiety and depression were also higher in patients with early stage cervical cancer or precancerous lesions than in the general population [28]. Somatization may also aggravate their anxiety, as every symptom
Quality of life issues experienced by women and their partners
An important element to remember in assessing QoL in relation to cervical cancer is partner dysfunction. The few available qualitative studies regarding male partners of women with invasive cervical cancer found that the male partner desired to be more involved at diagnosis, felt guilt that their spouses had contracted the disease, and felt that they had no one to talk to about the effects of the disease [44], [45]. Additionally, 50% of men reported that their partners' diagnosis and treatment
Improving quality of life
The comprehensive care of cervical cancer patients requires not only curative efforts but also attention to the psychological needs of patients and their families. Research into the unmet needs of cervical cancer patients has revealed deficiencies in several areas, including emotional support; information from physicians concerning prognosis, treatment, and side effects; communication with families about death; and discussion about possible sexual side effects [50]. Providing such support can
Conclusions
Cervical cancer impacts many levels—the psychological impact on individual women, the financial burden on their families and society, and the years of life lost due to premature death. Women diagnosed with cervical cancer experience significant emotional distress and anxiety. Post-operatively, treatment for cervical cancer can have long-lasting effects, in terms of reproduction, fertility, physical pain, and intimate relationships.
An abnormal screening result, or the detection of mild
Acknowledgment
Editorial support provided by AlphaBioCom, LLC.
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