The impact of treatment for gynecological cancer on health-related quality of life (HRQoL): a systematic review

Steric Hindrance-Engineered Redox-Responsive Disulfide-Bridged Homodimeric Prodrug Nanoassemblies for Spatiotemporally Balanced Cancer Chemotherapy

The rational design of tumor-responsive prodrug nanoassemblies requires precise control over systemic stability and site-specific activation. While α-position disulfide bonds are advantageous for rapid response to redox conditions, they also risk premature drug leakage during circulation. This study introduces a steric hindrance-guided approach to engineer disulfide-bridged podophyllotoxin homodimeric prodrugs for spatiotemporal controlled delivery. By monomethyl or dimethyl substitution of the carbon atoms adjacent to the α-disulfide bond, we can modulate steric hindrance. Excessive hindrance destabilizes the nanoassemblies and slows effective drug release, while moderate hindrance (monomethyl modification) enhances pharmacokinetic properties and promotes selective tumor activation. In vivo studies indicate that monomethyl-modified prodrug nanoassemblies exhibit superior antitumor efficacy and reduced off-target toxicity compared to PPT solution. This work underscores the importance of steric hindrance in optimizing prodrug nanoassembly stability and tumor-specific activation, offering a comprehensive strategy for redox-responsive nanomedicines.

Optimizing Palliative Pelvic Radiotherapy in Gynecological Cancers: A Systematic Review and Analysis

BACKGROUND

Palliative radiotherapy plays a crucial role in managing symptomatic gynecological cancers (GCs). This article aims to systematically review literature studies on palliative pelvic radiotherapy in cervical, endometrial, ovarian, vaginal, and vulvar cancers. The primary focus is centered around evaluating symptom relief, quality of life (QOL), and toxicity in order to ascertain optimal radiotherapy regimens.

METHODOLOGY

For this thorough review, we mainly relied on Medline to gather papers published until November 2023. Selected studies specifically detailed symptomatology and QOL responses in palliative pelvic radiotherapy used for GCs.

RESULTS

Thirty-one studies, mostly retrospective studies and those lacking standardized outcome measures, showed varied responses. Encouraging outcomes were noted in managing hemorrhage (55%) and pain control (70%). However, comprehensively assessing overall symptom response rates and toxicity remained challenging. Investigations into 10 Gy fractionation revealed benefits in addressing tumor-related bleeding and pain in female genital tract cancers.

CONCLUSIONS

Palliative pelvic radiotherapy effectively manages symptomatic GCs. Nonetheless, unresolved dosing and fractionation considerations warrant further investigation. Embracing modern therapies alongside radiotherapy offers improved symptom control, emphasizing the importance of selecting suitable patients for successful GC palliation interventions.

Financial Toxicity Experiences of Patients With Cancer in Indonesia: An Interpretive Phenomenological Analysis

OBJECTIVES

Financial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia.

METHODS

Semistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis.

RESULTS

We identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members.

CONCLUSIONS

This is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.

Quality of life of older gynecologic oncology patients at the initiation of chemotherapy

AIM

To evaluate older gynecologic oncology patients' quality of life (QOL) at the initiation of chemotherapy and compare their QOL scores with a female age-matched general population (GP) sample.

DESIGN

Cross-sectional.

METHODS

Older (n = 122) gynecologic oncology patients completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) that evaluates global health and five functional scales (range from 0 to 100). Differences in QOL scores between our sample and the GP were evaluated using one-sample t-tests and effect sizes were calculated using Cohen's d.

RESULTS

Patients' mean age was 70.7 years (±6.6). Mean scores for the function scales ranged from 58.5 (±31.1) for role function to 86.1 (±17.0) for cognitive function. Compared to the GP, our sample reported significantly lower scores for global health status, social, role and physical functioning, and a significantly higher score for cognitive functioning. No differences were found in emotional functioning scores.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Assessing Patient-reported Quality of Life Outcomes in Vulva Cancer Patients: A Systematic Literature Review

Objectives

Vulva cancer (VC) treatment carries a high risk of severe late effects that may have a negative impact on quality of life (QoL). Patient-reported outcome measures (PROMs) are increasingly used when evaluating disease- and treatment-specific effects. However, the adequacy of measures used to assess sequelae and QoL in VC remains unclear. The aims of the present study were to evaluate disease- and treatment-related effects as measured by PROMs in VC patients and to identify available VC-specific PROMs.

Methods/Materials

A systematic literature search from 1990 to 2016 was performed. The inclusion criterion was report of disease- and treatment-related effects in VC patients using PROMs in the assessment. Methodological and reporting quality was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. This systematic review was performed as part of phase 1 of the development of a European Organisation for Research and Treatment of Cancer QoL questionnaire for VC patients.

Results

The search revealed 2299 relevant hits, with 11 articles extracted including a total of 535 women with VC; no randomized controlled trials were identified. The selected studies exhibited great heterogeneity in terms of PROMs use. Twenty-one different instruments assessed QoL. Most of the questionnaires were generic. Different issues (sexuality, lymphedema, body image, urinary and bowel function, vulva-specific symptoms) were reported as potentially important, but the results were not systematically collected. Only one VC-specific questionnaire was identified but did not allow for assessment and reporting on a scale level.

Conclusions

Vulva cancer treatment is associated with considerable morbidity deteriorating QoL. To date, there is no validated PROM available that provides adequate coverage of VC-related issues. The study confirms the need for a VC-specific QoL instrument with sensitive scales that allows for broad cross-cultural application for use in clinical trials.

The relationship between hypertension and health-related quality of life: adjusted by chronic pain, chronic diseases, and life habits in the general middle-aged population in Japan

OBJECTIVES

The aim of this study was to examine the relationship between hypertension and health-related quality of life (HRQoL) adjusted by chronic pain, other chronic diseases, and life habits in the general middle-aged population in Japan.

METHODS

This study is a population-based cross-sectional study. In this study, 1117 participants aged 40-65 years and living in Shika Town completed a self-administered questionnaire including Short Form-36 (SF-36). The scores of SF-36 among hypertensives were compared with those of normotensives. The independent association of hypertension with each SF-36 subscale was analyzed using a multiple linear regression model adjusted by age, BMI, chronic pain, chronic diseases, sleep, exercise, and occupational status. We analyzed two groups; Group 1 which contained 846 participants completed the questionnaire without coronary heart disease and cerebral vascular disease, Group 2 which contained 686 participants without coronary heart disease, cerebral vascular disease, or diseases accompanied by chronic pain (gastroduodenal ulcer, fracture, osteoarthritis, osteoporosis, rheumatoid arthritis, and disc herniation).

RESULTS

In Group 2, hypertensive women had a lower general health perception than normotensive women [unstandardized coefficients; B = -8.84, 95 % confidence interval (95 % CI) = -13.3 to -4.34, standardized coefficients; β = -0.200, p < 0.001], whereas hypertensive men had higher social functioning than normotensive men (B = 5.66, 95 % CI = 1.30-10.0, β = 0.149, p < 0.05) after adjusting by chronic pain and life habits.

CONCLUSIONS

These results may be due to the sex difference in the light of the perception for health.

The impact of surgery for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of treatment: a longitudinal, mixed methods study

OBJECTIVE

To measure the long-term impact of surgical treatment for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of therapy.

METHODS

Prospective, longitudinal, mixed-methods study. Twenty-three women aged >18 years with a new diagnosis of vulval cancer were recruited. The EORTC QLQ C30, SF-36 and an electronic pelvic floor assessment questionnaire (ePAQ-PF) were administered at baseline (pre-treatment) and 3, 6, 9 and 12 months post-treatment. Mixed effects repeated measures models (all adjusted for age and BMI) were used to investigate changes over time and differences between cancer stage. Qualitative interviews were carried out with 11 of the women and analysed using a thematic approach.

RESULTS

Mean age was 59.9 years (SD = 15.3; range = 23.8-86.6 yrs). Mean BMI was 30.0 (SD = 4.5; range = 24.4-38.2). Sixteen women had early (Stage 1 to 2B), and seven women had advanced stage disease (Stage 3 to 4B). Questionnaire scores revealed that physical and social functioning, fatigue, pain and general sex life were significantly worse at 12 months than pre-treatment (p = < 0.05). Qualitative analysis revealed multiple treatment side effects which were perceived as severe and enduring. Women with advanced vulval cancer had significantly worse SF-36 mental health scores at 12 months compared to women with early stage disease (p = 0.037).

CONCLUSIONS

Surgery for vulval cancer has long-term implications which can be persistent 12 months post-treatment. High rates of morbidity relating to lymphoedema and sexual function re-enforce the need for specialist clinics to support women who suffer these complications. © 2015 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

Developing an Evidence-Based, Nurse-Led Psychoeducational Intervention With Peer Support in Gynecologic Oncology

BACKGROUND

The physical and psychosocial impact of radiotherapy for gynecologic cancer requires complex interventions to address treatment-related, psychosocial, and psychosexual and survivorship needs. A multidisciplinary approach is required to address these needs, but standard practice is varied and lacks a sound evidence base.

OBJECTIVE

The aim of this study was to describe the process of development and pilot testing of a novel evidence-based, complex psychoeducational intervention aiming to improve psychosocial outcomes for gynecologic-oncology patients treated curatively with radiotherapy.

METHODS

The intervention combines tailored nursing consultations with telephone peer support pretreatment, midtreatment, end of treatment, and posttreatment. The UK Medical Research Council framework for developing complex interventions was used to produce an evidence-based, feasible, and acceptable intervention.

RESULTS

Intervention manuals and study materials were informed by literature reviews of best-available evidence, relevant theory, and iterative consumer and expert consultations. The nurse manual specified content for consultations providing self-care information, coaching tailored to individual needs, and multidisciplinary care coordination. The peer manual described phone consultations aimed at providing psychosocial support and encouraging adherence to self-care strategies. Three peers and 1 nurse underwent rigorous skills and knowledge-based intervention delivery training. The intervention was pilot tested with 6 patients. Qualitative feedback led to minor design and content changes.

CONCLUSIONS

The intervention was found to be feasible, relevant, and acceptable to participants and clinicians and is currently being tested in a national randomized controlled trial (PeNTAGOn).

IMPLICATIONS FOR PRACTICE

The Medical Research Council framework is useful in developing nursing interventions. The specific methods and strategies described are useful for designing future complex studies targeting patient supportive care.

Health behaviors and quality of life in Chinese survivors of cervical cancer: a retrospective study

Background

The aim of this study was to evaluate health behaviors and quality of life (QoL) in cervical cancer survivors, and to identify factors that may compromise or enhance their health-related QoL.

Methods

Data were collected retrospectively from the records of 102 consecutive patients with cervical cancer treated from May 2007 to January 2009 at the People’s Hospital of Xintai City in Shandong Province. The study methodology was guided by the contextual model of health-related QoL.

Results

The results showed the significant mediating effects of general health status and psychological well-being between life burden and health-related QoL, between sexual impact of the disease and health-related QoL, and between the patient–doctor relationship and health-related QoL. In addition, there were a significant association between health-related QoL, education level, tumor stage, marital status, and age. Life burden and the patient-doctor relationship was also related to the sexual impact of the disease. However, no significant difference in health-related QoL and sexual impact was observed according to type of treatment received.

Conclusion

These results advance our understanding of the predictors of health-related QoL and the relationship between them. Health-related QoL in cervical cancer survivors may be improved by mediating life burden, sexual functioning, and the patient–doctor relationship.

Effects of music relaxation video on pain and anxiety for women with gynaecological cancer receiving intracavitary brachytherapy: a randomised controlled trial

The purpose of this study was to explore the effects of music relaxation video on pain severity, opioid utilisation, and anxiety experienced by women with gynaecological cancer undergoing intracavitary brachytherapy. A two-group randomised controlled trial was conducted in an academic comprehensive cancer centre. Sixty women were randomly assigned to either an experimental group ( n = 31) that watched a 30-minute music relaxation video four times (total 120 minutes) or a control group ( n = 29) that received standard nursing care during the first 44 hours of the intracavitary brachytherapy. Data were collected to evaluate the effects on pain severity, opioid utilisation and anxiety between groups. Pain scores were measured before and after patients watched the 30-minute music relaxation video and anxiety scores were measured following the video. The amount of opioid consumption was recorded during the 44-hour treatment. Data were tested using ANOVA and t-test. Perceived pain reduction was statistically significant in the experimental group ( p = 0.027), but this did not translate into lower total consumption of opioids between the two study groups. Anxiety level reduction was statistically significant in the experimental group ( p = 0.001). Music relaxation videos hold promise to be used in conjunction with standard pharmacologic therapy to reduce perceived pain and anxiety levels during the treatments.

Baseline Demographic Profile and General Health Influencing the Post-Radiotherapy Health Related Quality-of-Life in Women with Gynaecological Malignancy Treated with Pelvic Irradiation

Background:

Cancer specific survival and quality-of-life (QOL) assessment are important in evaluating cancer treatment outcomes. Baseline demographic profiles have significant effects on follow-up health related QOL (HRQOL) and affect the outcome of treatments.

Materials and Methods:

Post-operative gynaecological cancer patients required adjuvant pelvic radiation enrolled longitudinal assessment study. Patients had completed the short form-36 (SF-36) questionnaire before the adjuvant radiotherapy and functional assessments of cancer therapy-general module at 6^th month's follow-up period to assess the HRQOL. Baseline variables were race, age, body mass index (BMI), education, marital status, type of surgery, physical composite scores (PCS) and mental composite scores (MCS) summary scores of the SF-36. Univariate and multivariate regression analysis used to determine the influence of these variables on post-radiotherapy HRQOL domains.

Results:

Baseline PCS, MCS, age, education and marital status had positively correlation with post-radiotherapy HRQOL while higher BMI had a negative impact in univariate analysis. In multivariate regression analysis, education and MCS had a positive correlation while higher BMI had a negative correlation with HRQOL domains.

Conclusion:

Enhance our ability to detect demographic variables and modify those factors and develops new treatment aimed at improving all aspect of gynaecological cancer including good QOL.

Understanding the impact of the treatment pathway upon the health-related quality of life of women with newly diagnosed endometrial cancer - a qualitative study

PURPOSE

(1) To determine the impact of treatment and recovery on the health-related quality of life (HRQoL) of endometrial cancer (EC) patients. (2) To explore how treatment types and delivery affect HRQoL and invite suggestions for improvement.

METHODS

Qualitative study. In-depth, semi-structured interviews at 3, 6, 9 or 12 months post-treatment were carried out with 22 women with stage IA to IVB EC who had undergone treatment at a tertiary referral centre for gynaecological cancers in Sheffield, UK. 21 were treated surgically and 4 received adjuvant treatment. Data were analysed using an inductive thematic approach.

RESULTS

Four dominant themes emerged regarding the treatment pathway: pre-treatment concerns, experience during treatment, post-treatment and survivorship issues. Expectations and understandings of EC and its treatment were often inaccurate. Proper explanations eased anxiety but were uncommon. Laparoscopic surgery was welcomed where offered but did not necessarily influence coping ability. Instead, women evaluated treatment impacts against their expectations. Treatments affected women's physical abilities, self-perception and relationships resulting in re-evaluation of lifestyle.

CONCLUSIONS

The impact of treatment upon HRQoL for women with EC differs from other gynaecological cancers. Better information provision would enhance coping ability. Coping methods and expectations appear to influence HRQoL more than treatment modality.

Risk-scoring model for prediction of non-home discharge in epithelial ovarian cancer patients

BACKGROUND

Identification of preoperative factors predictive of non-home discharge after surgery for epithelial ovarian cancer (EOC) may aid counseling and optimize discharge planning. We aimed to determine the association between preoperative risk factors and non-home discharge.

STUDY DESIGN

Patients who underwent primary surgery for EOC at Mayo Clinic between January 2, 2003 and December 29, 2008 were included. Demographic, preoperative, and intraoperative factors were retrospectively abstracted. Logistic regression models were fit to identify preoperative factors associated with non-home discharge. Multivariable models were developed using stepwise and backward variable selection. A risk-scoring system was developed for use in preoperative counseling.

RESULTS

Within our cohort of 587 EOC patients, 12.8% were not discharged home (61 went to a skilled nursing facility, 1 to a rehabilitation facility, 1 to hospice, and there were 12 in-hospital deaths). Median length of stay was 7 days (interquartile range [IQR] 5, 10 days) for patients dismissed home compared with 11 days (IQR 7, 17 days) for those with non-home dismissals (p < 0.001). In multivariable analyses, patients with advanced age (odds ratio [OR] 3.75 95% CI [2.57, 5.48], p < 0.001), worse Eastern Cooperative Oncology Group (ECOG) performance status (OR 0.92 [95% CI 0.43, 1.97] for ECOG performance status 1 vs 0 and OR 5.40 (95% CI 2.42, 12.03) for score of 2+ vs 0; p < 0.001), greater American Society of Anesthesiologists (ASA) score (OR 2.03 [95% CI 1.02, 4.04] for score ≥3 vs < 3, p = 0.04), and higher CA-125 (OR 1.28 [95% CI 1.12, 1.46], p < 0.001) were less likely to be discharged home. The unbiased estimate of the c-index was excellent at 0.88, and the model had excellent calibration.

CONCLUSIONS

Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.

Interleukin 17 Induces Up-Regulation of Chemokine and Cytokine Expression Via Activation of the Nuclear Factor κB and Extracellular Signal–Regulated Kinase 1/2 Pathways in Gynecologic Cancer Cell Lines

Objectives

Previous studies have revealed that interleukin 17 (IL-17) contributes to pathological processes in many solid tumors. However, the roles of IL-17 in gynecologic cancer still remain elusive, hindering the deep understanding of gynecologic tumorigenesis.

Methods

In the present study, to delineate the functional roles of IL-17 in gynecologic cancer, IL-17 stimulation was introduced in cell lines of 3 gynecologic cancers, and IL-17–induced expression of chemokines and cytokines and possible signaling pathways were investigated.

Results

Our results showed that in HEC-1-B (human endometrial cancer) cells, IL-17 stimulation induced mRNA level increases of CCL2, CCL5, CCL20, CXCL2, and IL-8. Similar treatment in HeLa cells caused increases in the mRNA levels of CCL2, CXCL2, IL-6, and IL-8, and in SKOV3 cells, mRNA levels of CCL2, CCL20, CXCL1, CXCL2, IL-6, and IL-8 increased. The increases in mRNA levels induced by IL-17 were dose- and time-dependent. Furthermore, with the addition of the NF-κB (nuclear factor κ–light-chain–enhancer of activated B) and extracellular signal–regulated kinase inhibitors pyrrolidine dithiocarbamate and PD98059, the IL-17–induced CCL2 mRNA level was significantly compromised. IL-17 stimulation also activated phosphorylation of IκBα and extracellular signal–regulated kinase 1/2 in a time-dependent manner.

Conclusion

These results demonstrated that IL-17 may regulate chemokines and cytokines in gynecologic cancers.

Hypoactive sexual desire disorder in a population-based study of Brazilian women: associated factors classified according to their importance

OBJECTIVE

The etiology of hypoactive sexual desire disorder (HSDD) is known to be multifactorial, involving biological, psychosexual, and context-related factors. The objective of the present study was to analyze the factors associated with female HSDD and to stratify these factors according to their importance.

METHODS

This was a population-based, hierarchical study conducted in Brazil, based on data from previous research on the Brazilian Sexual Life Study, conducted between November 2002 and February 2003 in various Brazilian cities. The primary study consisted of a self-administered and anonymous questionnaire, addressing sociodemographic parameters, general health, life habits, behavior, and complaints related to sexual function. The association between HSDD and various other factors was assessed. The data were evaluated by hierarchical multiple regression analysis.

RESULTS

The prevalence of HSDD in this sample was 9.5%. Associations were found with cardiovascular disease, breast cancer, posttraumatic stress, poorer education level, being older, being married, a lack of information on sexuality in childhood/adolescence, and a limited sexual repertoire. Women who consumed moderate amounts of alcohol were found to be less likely to have HSDD.

CONCLUSIONS

Analysis of the associated factors classified in order of importance and analysis of the characteristics of the sexual relationships provide additional information to currently available data on the traditional concepts of HSDD.

Assessing health-related quality of life in gynecologic oncology: a systematic review of questionnaires and their ability to detect clinically important differences and change

OBJECTIVES

Researchers wishing to assess the health-related quality of life (HRQoL) of women with gynecologic cancers have a range of questionnaires to choose from. In general, disease-, treatment-, or symptom-specific questionnaires are assumed to be better able to identify between-group differences (sensitivity) and changes over time (responsiveness) than are cancer-specific or generic questionnaires. However, little work has tested this assumption in oncology. We set out to (a) identify all multidimensional HRQoL questionnaires used in studies with women with gynecologic cancer and (b) evaluate their track records in identifying minimal clinically important differences (MCIDs), with a view to making recommendations.

METHODS

We searched MEDLINE using the term quality of life and each gynecologic cancer type, as well as the names of identified questionnaires. We used 10% of the scale range as the threshold for an MCID.

RESULTS

We identified 1 generic (SF-36/SF-12), 3 cancer-specific (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ] C30, Functional Assessment of Cancer Therapy-General [FACT-G], and short-form Cancer Rehabilitation Evaluation System [CARES-SF]), and 1 disease-specific (QOL-Ovarian Cancer Patient Version) HRQoL questionnaires and 5 disease-specific (QLQ-OV28, FACT-O for ovarian, QLQ-CX24, FACT-Cx for cervical and FACT-V for vulvar), 1 treatment-specific (FACT and Gynecologic Oncology Group-Ntx for neurotoxicity), and 2 symptom-specific (FACT-Anemia and Functional Assessment of Chronic Illness and Therapy [FACIT]-Fatigue) modules. Twenty-seven articles reported results from 26 studies in which an MCID had been identified. The FACIT's anemia and fatigue subscales were more sensitive, and the neurotoxicity subscale more sensitive and responsive than the FACT-G on at least 1 comparison. However, we found no evidence for superior performance by the FACT-G compared with the SF-36 or EORTC and FACIT disease-specific modules versus the QLQ-C30 and FACT-G. There was also little evidence to favor EORTC versus FACIT questionnaires or vice versa.

CONCLUSIONS

The evidence we reviewed offered little support for the hypothesis that disease-, symptom-, or treatment-specific instruments are more sensitive and responsive than cancer-specific or generic questionnaires. However, conclusions were limited by the small number of head-to-head comparisons available. We summarize the clinical contexts in which each instrument identified an MCID to inform choice of questionnaire(s), sample size calculations, and interpretation of results in future studies.

Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers

OBJECTIVE

Women with gynecological cancers have reported poor health-related quality of life (QOL), with complex physical and psychological needs post-surgery and during chemotherapy treatment. There are no studies reporting interventions addressing these needs post-hospital discharge in this population.

METHODS

Patients were randomized into two groups. The intervention group received 6 months of specialized care by an Advanced Practice Nurse (APN); in addition, women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse (PCLN). The attention control group was assisted with symptom management by a research assistant. The effects of the 6-month intervention were evaluated using self-report questionnaires at baseline (24-48 h after surgery), 1, 3, and 6 months post- surgery. QOL assessments included the Center for Epidemiological Studies-Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12). The sample for the longitudinal analysis included 123 who completed QOL outcome measures across three occasions post-surgery.

RESULTS

The APN intervention resulted in significantly less uncertainty than the attention control intervention 6 months after surgery. When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group, the sub-group had significantly less uncertainty, less symptom distress, and better SF-12 mental and physical QOL over time.

CONCLUSION

Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect.

Quality of life among long-term gynaecological cancer survivors

BACKGROUND

The population of gynaecological cancer survivors is growing. However, there is little knowledge of the long-term quality of life among these former patients. The aim of this study was to investigate the long-term quality of life in women treated successfully for gynaecological cancer and a control group of representative women selected from the general population.

MATERIAL AND METHODS

The study comprised women aged 30-75 years residing in the central part of Norway. Cases were 319 gynaecological cancer survivors treated at St Olav's Hospital Trondheim, Norway, between 1987 and 1996, whereas 1276 age-matched women selected at random from the general population served as controls. The study population was identified and the respondents were invited to answer a postal questionnaire. After one reminder, the response rate was 55% (176/319) and 41% (521/1276) for cases and controls, respectively. Sixteen cases and 28 controls had incomplete responses to most questions and were excluded from the analyses. Eligible for the final analyses were 160 cases and 493 controls. Ferrans & Powers' Quality of Life Index (QLI) was used. All analyses were performed in SPSS version 13.0 with chi-square (categorical variables) and Mann-Whitney (continuous variables) tests. p <or= 0.05 is the level of statistical significance.

RESULTS

Cases had on an average, a complete recurrence-free period of 12 years (range 7-18). No differences were detected between cases and controls in the global quality of life or in any of the four sub-dimensions of QLI. Furthermore, no difference was found in co-morbidity, but cases consulted more often hospital physicians than controls did.

INTERPRETATION

Long-term gynaecological cancer survivors enjoy the same quality of life as women in the general population.

Cervical cancer survivorship in a population based sample

OBJECTIVE

Though cervical cancer is preventable, this cancer nonetheless poses serious mortality and morbidity threats to American women and women globally. The purpose of this study is to utilize a multidimensional framework to assess Health-related Quality of Life (HRQOL) and its salient predictors among a population based sample of cervical cancer survivors.

METHODS

A cross-sectional design was used with a population-based sample ascertained from the California Cancer Surveillance Program. Descriptive, bivariate and multivariate regression analyses were conducted.

RESULTS

Participants were 560 cervical cancer survivors: English-speaking Latina- (n=88), Spanish-speaking Latina- (n=199) and European- (n=273) Americans. The greatest concerns were documented for family/social and emotional well-being, and body image and sexual health. In general, Latina-Americans reported poorer overall HRQOL, functional, emotional, and social/family wellbeing compared to European-Americans. Differences in HRQOL persisted by ethnic/language group after controlling for covariates. Radiation, comorbidity, role limitations, perceived health status, psychological wellbeing, body image, sexual impact, doctor-patient relationship, and social support were significant predictors of overall HRQOL. The regression model explained 58% of the variance in predicting HRQOL.

CONCLUSION

These cervical cancer survivors reported poor to moderate HRQOL with persistent psychosocial challenges. Our findings indicate that lower SES, monolingual Latinas are at greatest risk for poor HRQOL outcomes. Clinicians should pay attention to their patients' socio-ecological context as a risk factor for poorer outcomes; and provide early referrals to resources that are low cost and culturally and linguistically appropriate.

Quality of life in obese postmenopausal women

The aim of this review was to identify the ways in which obesity affects the health-related quality of life (HRQoL) of postmenopausal women. This was considered important because a growing body of literature has identified obesity as a significant predictor for a poor psychological wellbeing and negative HRQoL, particularly in women, and because during the transition through the menopause women tend to accumulate more body weight. After searching eight electronic databases, only nine papers appeared meaningful. Although a meta-analysis was not possible, we found that a body mass index (BMI) >30 kg/m2 was associated with a poor HRQoL in postmenopausal women; particularly in the areas associated with physical functioning, energy and vitality, and health perceptions. Thus, clinical management of obese postmenopausal women should focus on weight reduction and exercise in an attempt to improve wellbeing in these areas. However, the paucity of research, the different instruments chosen to measure HRQoL and the methodological limitations of the studies identified, prevented firm conclusions being made about whether the relationship between BMI and HRQoL is linear in postmenopausal women. Further research is needed to explore this relationship; particularly in comparison with underweight postmenopausal women and obese premenopausal women, where a few papers have identified these women as having a worse HRQoL than their obese postmenopausal counterparts. Other measures of central adiposity, including waist circumference and waist-hip ratio are recommended as useful supplemental measures to BMI in future studies.

Quality of life of women with gynecologic cancer: associated factors

OBJECTIVE

To evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer.

METHODS

A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL.

RESULTS

The mean age of the participants was 56.8 +/- 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001).

CONCLUSION

Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL.

Baseline characteristics influencing quality of life in women undergoing gynecologic oncology surgery

BACKGROUND

Quality of life (QoL) measurements are important in evaluating cancer treatment outcomes. Factors other than cancer and its treatment may have significant effects on QoL and affect assessment of treatments. Baseline data from longitudinal studies of women with endometrial or ovarian cancer or adnexal mass determined at surgery to be benign were analyzed to determine the degree to which QoL is affected by baseline differences in demographic variables and health.

METHODS

This study examined the effect of independent variables on domains of the Functional Assessment of Cancer Therapy (FACT-G) pre-operatively in gynecologic oncology patients undergoing surgery for pelvic mass suspected to be malignant or endometrial cancer. Patients also completed the Short Form Medical Outcomes Survey (SF-36) questionnaire (a generic health questionnaire that measures physical and mental health). Independent variables were surgical diagnosis (ovarian or endometrial cancer, benign mass), age, body mass index (BMI), educational level, marital status, smoking status, physical (PCS) and mental (MCS) summary scores of the SF-36. Multiple regression analysis was used to determine the influence of these variables on FACT-G domain scores (physical, functional, social and emotional well-being).

RESULTS

Data were collected on 157 women at their pre-operative visit (33 ovarian cancer, 45 endometrial cancer, 79 determined at surgery to be benign). Mean scores on the FACT-G subscales and SF-36 summary scores did not differ as a function of surgical diagnosis. PCS, MCS, age, and educational level were positively correlated with physical well-being, while increasing BMI was negatively correlated. Functional well-being was positively correlated with PCS and MCS and negatively correlated with BMI. Social well-being was positively correlated with MCS and negatively correlated with BMI and educational level. PCS, MCS and age were positively correlated with emotional well-being. Models that included PCS and MCS accounted for 30 to 44% of the variability in baseline physical, emotional, and functional well-being on the FACT-G.

CONCLUSION

At the time of diagnosis and treatment, patients' QoL is affected by inherent characteristics. Assessment of treatment outcome should take into account the effect of these independent variables. As treatment options become more complex, these variables are likely to be of increasing importance in evaluating treatment effects on QoL.