Lost workdays in uterine cervical cancer survivors compared to the general population: impact of treatment and relapse

The socioeconomic burden of cervical cancer and its implications for strategies required to achieve the WHO elimination targets

INTRODUCTION

Cervical cancer is almost entirely preventable by vaccination and screening. Population-based vaccination and screening programs are effective and cost effective, but millions of people do not have access to these programs, causing immense suffering. The WHO Global Strategy for the elimination of cervical cancer as a public health problem calls for countries to meet ambitious vaccination, screening, and treatment targets.

AREAS COVERED

Epidemiological evidence indicates marked socioeconomic gradients in the burden of cervical cancer and vaccination, screening, and treatment coverage. The unacceptable socioeconomic burden of cervical cancer is largely a function of inequitable access to these programs. We discuss these inequities, and highlight strategies enabled by new evidence and technology. Single dose HPV vaccination, HPV-based screening, and the rapidly moving technology landscape have enabled task-shifting, innovation in service delivery and the possibility of scale. Equitable access to optimal care for the treatment of invasive cancers remains a challenge.

EXPERT OPINION

Cervical cancer can be eliminated equitably. It will require global political will, sustained public and private investment, and community leadership to safely and sustainably embed proven tools, technology and infrastructure in local health and knowledge systems.

The Impact of Chronic Pelvic Pain and Bowel Morbidity on Quality of Life in Cervical Cancer Patients Treated With Radio (Chemo) Therapy. A Systematic Literature Review

Abstract

Introduction

Radiotherapy, administered with or without chemotherapy is the gold standard treatment for cervical cancer with both curative and palliative intent. However, the treatments often result in adverse events, mainly chronic pelvic pain and bowel morbidity, which can negatively impact quality of life.

Aim

To systematically appraise peer reviewed evidence regarding chronic pelvic pain and bowel morbidity and their impact on quality-of-life of cervical cancer patients treated with radiotherapy with or without chemoradiation therapy.

Design

A systematic review of original peer-reviewed research evidence.

Data Collection Methods and Tools

A systematic search conducted between April and May 2021, and updated in September 2024, using PubMed, Hinari, CINAHL and Google Scholar, for peer reviewed papers published between 2008 and 2019. Data were extracted using a structured checklist designed to capture key elements about the methods and findings of the research.

Results

There were 245 articles retrieved with 29 meeting the inclusion criteria. 11 studies were conducted in Europe, eight in Asia, one in North America, three in Africa, while six were multinational/multicontinental. 13 of the papers were longitudinal, 10 cross-sectional, three literature reviews, one open randomised controlled trial, and two retrospective studies of prospectively collected data. Studies reported disruptions in nearly all domains of quality-of-life, including global, physical, emotional/psychological, financial, sexual, social, role functioning as a result of being treated with radiotherapy or radio-chemotherapy.

Conclusion

Chronic pelvic pain and bowel morbidity are common adverse events experienced by cervical cancer patients receiving, or who have received, pelvic radiotherapy or radio-chemotherapy. Symptoms occur to varying degrees and exert a negative toll on the quality-of-life of women. Clinicians should be more aware and prioritise thorough assessment and management of symptoms before, during and after treatment. There is limited population-based and longitudinal research about the topic, and on chronic pelvic pain in general, which limits generalisability. Longitudinal studies with more extended periods of follow-up are needed.

Cancer survivor late-effects, chronic health problems after cancer treatment: what's the evidence from population and registry data and where are the gaps?

PURPOSE OF REVIEW

Improvements in cancer treatment have led to more people living with and beyond a cancer diagnosis but survivors may have increased health problems as they age. The purpose of this review is to critically evaluate population data exploring incidence of late effects for cancer survivors.

RECENT FINDINGS

18 studies were identified between 2013 and 2023 that explored the impact on survivors' physical and emotional health. Patients who had been treated at least 2 years previously for cancer had significant cardiovascular risk factors compared with age-matched controls. Women with breast cancer were more likely to have cardiovascular disease, including hypertension, arrythmias and congestive heart failure. This was associated with anthracyclines and/or trastuzumab as part of systemic anti-cancer therapy. Survivors of colorectal cancer were three times more likely to have acute kidney injury than age-matched controls. Stress and mood disorders were higher in survivors of testicular cancer and prostate cancer.

SUMMARY

Population studies are important to identify the 'real world' consequences of cancer and its treatment beyond clinical trials. Knowledge is critical for managing an ageing cancer population. Data to personalise cancer survivorship care, not only helps determine potential health risks, but can improve secondary prevention, emotional health, recovery, and long-term outcomes.

Disability pension among gynaecological cancer survivors with or without radiation-induced survivorship syndromes

Purpose

Gynaecological cancer patients treated with external radiation therapy to the pelvis may face long-lasting and long-term gastrointestinal syndromes. The aim of this study was to assess the association between such radiation-induced survivorship syndromes and disability pension among gynaecological cancer survivors treated with pelvic radiation therapy.

Methods

This prospective register study included gynaecological cancer survivors (n=247) treated during 1991–2003, alive at the time of the study, and <65 years of age. In 2006, they completed a postal questionnaire measuring patient-reported outcomes. The self-reported data were linked to the national register on disability pensions. Relative risks and risk differences with 95% confidence intervals (CIs) of being granted a disability pension were estimated using log-binomial regression.

Results

Gynaecological cancer survivors with gastrointestinal syndromes had a higher risk of disability pension than survivors without such syndromes. Survivors with blood discharge syndrome had a 2.0 (95% CI 1.3–3.2) times higher risk of disability pension than survivors without blood discharge syndrome. The relative risk among survivors with urgency syndrome was 1.9 (1.3–2.9) and for leakage syndrome, 2.1 (1.4–3.1). Adjusting for age did not affect our interpretation of the results.

Conclusions

Gynaecological cancer survivors with a specific radiation-induced survivorship syndrome have a higher risk of disability pension than survivors without that specific syndrome.

Implications for Cancer Survivors

The findings highlight the need for more awareness and knowledge regarding the potential role of radiation-induced survivorship syndromes for continuing work among gynaecological cancer survivors. Work-life-related parameters should be considered during radiotherapy and rehabilitation after treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11764-021-01077-9.

Gynaecological cancer leads to long-term sick leave and permanently reduced working ability years after diagnosis

PURPOSE

The aim of the study was to investigate overall patterns in labour market affiliation, risk for permanently reduced work ability and prevalence of long-term sickness absence among women diagnosed with gynaecological cancer.

METHODS

We followed 8451 women diagnosed with ovarian, endometrial or cervical cancer, and 72,311 women with no history of cancer in nationwide registers for up to 19 years (mean 7.5 years). We computed hazards ratios for permanently reduced working ability and annual proportions of long-term sick leave.

RESULTS

Patterns of labour market affiliation varied by cancer diagnosis and stage. The hazard of permanently reduced working ability was increased for survivors of all three cancers but most pronounced for women diagnosed with advanced ovarian cancer. The highest hazard ratios were found 2-5 years after diagnosis, and they persisted for years in all groups and throughout the follow-up period of 19 years in women diagnosed with advanced cervical cancer. In the subgroups of women who continued to be potentially active on the labour market, long-term sick leave was more prevalent among cancer survivors than women with no history of cancer up to 10 years after diagnosis.

CONCLUSIONS

Women diagnosed with localised as well as advanced gynaecological cancer are at prolonged risk for permanently reduced working ability and long-term sick leave.

IMPLICATIONS FOR CANCER SURVIVORS

Gynaecological cancer can have long-term as well as permanent consequences for working ability, and survivors who remain active on the labour market might have to take more sick leave even years after cancer diagnosis than other women at their age.

Long-term cervical cancer survivors on disability pension: a subgroup in need of attention from health care providers

PURPOSE

Survivors of cervical cancer have an increased risk for permanently reduced work ability qualifying for disability pension (DP). Few studies describe the social and health situation of long-term survivors of cervical cancer (LSCCs) on DP as a subgroup among LSCCs. The purpose was to investigate the socio-demographic and health status of LSCCs holding DP in a population-based cohort using LSCCs holding paid work as reference.

METHODS

Altogether, 354 LSCCs under 67 years (age of retirement pension in Norway) at survey participated in this study. They responded to a mailed questionnaire containing social, health, and clinical issues.

RESULTS

Among LSCCs 24% held DP at a median of 11 years (range 6-15) after diagnosis versus 12% in the general female population. Compared to LSCCs in paid work, those on DP had significantly higher mean age at survey, short education, more comorbid somatic diseases, poorer self-rated health, higher level of neurotoxic side effects, more chronic fatigue, and higher mean levels of anxiety and depression. Increased age, presence of musculo-skeletal diseases, and increased levels of depression and pain remained significantly associated with DP in multivariate analysis.

CONCLUSIONS

One in four LSCCs held DP which was twice the rate of the general female population. Several somatic and psychological conditions amenable to treatment were significantly associated with holding DP.

IMPLICATIONS FOR CANCER SURVIVORS

LSCCs holding DP should check their health regularly since conditions that can be treated are common, and health care providers should be aware of this opportunity.

Prognosis for different patterns of distant metastases in patients with uterine cervical cancer: a population-based analysis

Background: Uterine cervical cancer (UCC) is a common malignant tumor in women. We conducted this work to provide a though description on the patterns of distant metastases and to investigate the relevant factors for prognosis of UCC patients based on a large population.

Patients and methods: UCC patients with FIGO stage IVB, being the study group, were identified from the Surveillance, Epidemiology, and End Result (SEER) database from 2010 to 2016. UCC patients with same inclusion criteria, being validation group, were identified from Tianjin First Central Hospital from 2004 to 2017. Patterns of distant metastases were described according to the number of metastatic sites. Survival of different patterns were calculated and prognostic factors were investigated by Cox hazard regression analysis.

Results: Distant metastases were recorded in 1448 UCC patients among whom 295 patients (30.8%) developed metastases in two or more organs. Compared with the median OS of 8 (95%CI, 7.07-8.93) months in the patients with the single site, worse survival of 5 (95%CI, 4.29-5.71) months was noticed in the patients with multiple metastases. Age ≥ 65 years, black race, higher grade, higher T stage and more metastatic sites were proved to be the prognostic factors for all the patients in the advanced stage and the results were partly validated in the validation cohort. Moreover, black race and higher T-stage for the patients with the single metastatic sites and age ≥ 65, uninsured status, surgical treatment and metastatic pattern for the patients with two metastatic sites were prognostic factors. No independent factor was found in patients with three or more metastases.

Conclusion: Around 70% of the patients suffered one site distant metastasis in UCC patients with IVB stage while 30% with multiple metastases and a significantly reduced survival. Different survivals and prognostic factors were noticed for different patterns of distant metastases.

Why do we continue to overtreat stage Ia carcinoma of the cervix?

The current recommended treatment for stage Ia2 cervical cancer is a radical or modified radical hysterectomy. Although in the United States the incidence of cervical cancer is low and declining, almost 50% of the >4000 new cases will present in early stages. An estimated 2200 women each year will undergo radical hysterectomy and many will have both early- and late-onset complications. The purpose of this review is to examine if there is still a role for radical hysterectomy in the proper treatment of stage Ia2 cervical cancer given most recent data. Sufficient histological evidence suggests that although parametrial involvement and lymph node metastases can increase the risk for recurrence, they are relatively uncommon at early stages. Worldwide data that challenge radical hysterectomy as standard of care have shown that conservative management of stage Ia2 cervical cancer results in similar survival and recurrence rates. It is the recommendation based on all reviewed data that radical hysterectomy should no longer be considered standard of care in all cases of stage Ia2 cervical cancer.