A qualitative exploration of physical and psychosocial well-being in the short and long term after treatments for cervical cancer

The feasibility and acceptability of delivering and evaluating a physical activity intervention (ACCEPTANCE) for cervical cancer survivors

BACKGROUND

Cervical cancer treatment can be associated with long-term physical, psychological and emotional issues leading to compromised quality of life (QOL). Physical activity (PA) may improve QOL in cervical cancer survivors.

METHODS

A one-arm pre/post-feasibility study with parallel process evaluation was conducted to test the feasibility and acceptability of a 12-week PA intervention (ACCEPTANCE). Feasibility was determined by using pre-established criteria relating to inclusion criteria, recruitment and retention, compliance with intervention components and compliance with evaluation measures. The 12-week intervention consisted of (1) an online education session on the benefits of PA and a barrier identification and problem-solving session; (2) a Fitbit monitor; (3) daily and weekly diary entries; (4) brief fortnightly online health coaching sessions; and (5) organising and participating in group walks; (6) online social interaction via a messaging group. Measures included accelerometer assessed PA and sleep, quality-of-life and PA behaviour change questionnaires distributed at 4-time points (baseline, week 6, week 12, and week 24). Process evaluation measures were questionnaires on the acceptance of intervention components and semi-structured interviews with participants after completion.

RESULTS

Thirty participants were recruited with a retention rate of 77% at week 24. The education session, health coaching and Fitbit PA monitor were deemed to be feasible based on compliance rates whilst the online messaging group, diary and group walking compliance suggested that modifications would be needed for these components. Accelerometer and questionnaires were deemed to be feasible evaluation measures based on compliance rates. Process evaluation results suggest that the Fitbit and health coaching sessions were perceived to be the most beneficial aspects of the programme as they enabled self-monitoring of behaviour and goal setting. Unexpected mechanisms of behaviour change were the integration of a small change approach and formation of habits to facilitate PA, whilst barriers to behaviour change included the online, virtual nature of the programme, poor mental health, and environmental challenges. PA levels were higher after the intervention, whilst global QOL was seen to worsen throughout the study, and depression and anxiety symptoms improved.

CONCLUSIONS

The ACCEPTANCE study is deemed to be feasible based on criteria established a priori, and only minor modifications would needed to implement in a definitive randomised control trial. The intervention showed potential to increase PA, through hypothesised mechanisms of self-monitoring behaviour and problem solving and unexpected mechanisms such as habit formation.

TRIAL REGISTRATION

ISRCTN16349793, Registered 30 September 2020.

Systematic review of the needs and health-related quality of life domains relevant to people surviving cancer in Europe

PURPOSE

To systematically review qualitative studies on outcomes, needs, experiences, preferences, concerns and health-related quality of life (HRQoL) of people surviving cancer in Europe in the last decade.

METHODS

Protocol registered ( https://www.crd.york.ac.uk/PROSPERO , ID575065).

INCLUSION CRITERIA

studies with qualitative methods, constructs related to HRQoL, and adults surviving cancer in Europe. The search was conducted in PubMed and Scopus since 2013. Abstracts and full text were revised, data extracted and study risk of bias assessed independently by two researchers. The primary outcomes were the themes arising from each study. A thematic analysis stratified according to the study objective was undertaken by grouping themes into categories.

RESULTS

Of 18,256 articles identified, 43 fulfilled the inclusion criteria: 16 studies with a generic objective and 27 with specific objectives. Seven categories (57 themes) emerged from the studies with a generic focus: Clinical Management (n = 16), Symptoms and Physical Function (n = 5), Psychological Function (n = 21), Social Function (n = 18), HRQoL (n = 3), Life Disruption (n = 6), and Individual Factors (n = 1). The 12 studies focused on treatment and care experiences stand out among those with specific objectives, with most themes fitting into the same seven categories.

CONCLUSIONS

Results clearly showed the predominance of the social and psychological function domains over physical domains among people surviving cancer, additionally identifying specific needs in clinical management, such as information and communication, and relationship with and support from professionals. Therefore, these aspects should be incorporated into the evaluation of patient-centred initiatives for people surviving cancer.

LIMITATIONS

only two databases were searched, and most European countries were not represented.

Qualitative exploration of uterine cancer care for lesbian, gay, bisexual, trans and queer (LGBTQ+) patients in the UK: shifting from equality to equity

OBJECTIVE

Patients identifying as lesbian, gay, bisexual, transgender and/or queer/questioning (LGBTQ+) report significant disparities in cancer care and are disproportionally affected by a cancer diagnosis on a number of health-related indicators. This study aimed to explore uterine cancer (UC) care from the perspectives of LGBTQ+ patients and stakeholders, to identify this population's care needs, which have been underprioritised thus far.

METHODS AND ANALYSIS

Qualitative interview data were collected from three cohorts of participants: LGBTQ+ UC patients, partners of UC patients and stakeholders who provide advocacy and/or support within the UC care pathway, including healthcare professionals (HCPs). Semi-structured qualitative interviews were conducted and data were analysed using inductive reflexive thematic analysis.

RESULTS

Fifteen participants (three patients, one partner, eight HCPs and three cancer support charity representatives) were recruited. Data analysis identified themes which represented participants' reflections on the relevance and opportunities for identity disclosure during the diagnostic pathway; feelings and implications of not fitting into the gynaecological cancer environment and, opportunities and challenges surrounding HCP education, and protocolled sexual and gender identity data collection.

CONCLUSION

UC patients who identify as LGBTQ+ have specific care needs and considerations, particularly related to transvaginal procedures and survivorship. Opportunities for disclosure of patients' LGBTQ+ identity during the UC care pathway are essential for these needs to be recognised. Despite this, there are conflicting agendas between HCPs and stakeholders on the best approach to integrate disclosure processes. The current findings highlight the need for public health agendas and clinical services to address the needs of LGBTQ+ UC patients.

The Experience of Cervical Cancer Patients Undergoing Hysterectomy: A Qualitative Study

INTRODUCTION

Due to different social and cultural backgrounds, cervical cancer patients' experience of the treatment process and quality of life after treatment will be different. This study sought to gain in-depth understanding of the experiences of Chinese cervical cancer patients as regards their quality of life and physical symptoms.

METHODOLOGY

Semi-structured interviews were used to collect data. We recruited 15 women with cervical cancer in eastern China for in-depth interviews. All data were entered into the NVivo 12 software program for analysis.

RESULTS

Four themes emerged from the data: (a) uncertainty; (b) physical suffering; (c) psychological pressure; and (d) challenges of marriage and family.

DISCUSSION

Cervical cancer patients showed concerns about the disease itself and the physical discomfort it causes, as well as changes in social relations. Health professionals need to talk about these issues and develop strategies to address them accordingly.

Hormone replacement therapy in women with iatrogenic premature ovarian insufficiency after radiotherapy for cervical cancer: A retrospective cohort and survey study

OBJECTIVES

This study assessed the uptake of hormone replacement therapy (HRT) in cervical cancer patients with iatrogenic menopause. Survival in relation to HRT use was assessed via a retrospective chart study, and the severity of menopausal symptoms, motivations and barriers to starting HRT were examined via questionnaires.

STUDY DESIGN

In total, 293 women under the age of 51 and treated with radiotherapy for cervical cancer between 2010 and 2020 were identified. Medical records were searched for information on HRT use. If still living, women were sent digital questionnaires addressing menopausal symptoms, quality of life (QoL) and potential barriers and motivations concerning HRT use. Univariable data were analysed using Mann-Whitney U, chi-square, and Fisher's exact test, while logistical regression was used to analyse relationships between certain variables and use of HRT and survival.

RESULTS

Overall HRT uptake was 78.1 %, which was related to age and Charlson Comorbidity Index, but independent of the duration of radiotherapy or FIGO stage. Overall survival was higher for HRT users (χ2(1) = 4.3, p = 0.038). Questionnaires were sent to 193 patients and 100 completed it (response rate 51.8 %). Main reasons for HRT use were relief of hot flushes and improvement in QoL. For women below age 51, QoL was indeed higher for current HRT users than for non-HRT users (EQ-index 0.8 vs. 0.7, p = 0.008).

CONCLUSIONS

HRT prescription rate was inversely correlated with age. Survival was not negatively affected by HRT use. It is important to stress the benefits of HRT and address women's fears regarding its use.

Symptom clusters and characteristics of cervical cancer patients receiving concurrent chemoradiotherapy: A cross-sectional study

Background

Cervical cancer patients have a high symptom burden during concurrent chemoradiotherapy (CCRT) and urgently need precise symptom management strategies. Nonetheless, the symptom profile and influencing factors are unclear.

Methods

A total of 234 patients with cervical cancer who underwent CCRT in a tertiary care hospital clinical oncology center in Guangxi Zhuang Autonomous Region from March 2022 to March 2023 were included in the study. The general information questionnaire, M.D. Anderson symptom inventory, Fatigue Scale-14, Pittsburgh Sleep Quality Index, and grip strength test were used for the investigation. Symptom clusters were extracted by exploratory factor analysis, and latent profile analysis was performed using Mplus 8.0 software. Multinomial logistic regression was used to explore the factors influencing the potential categories of symptom clusters.

Results

Exploratory factor analysis extracted four symptom clusters: a fatigue-related symptom cluster, a gastrointestinal-related symptom cluster, a mood-related symptom cluster, and a physical-related symptom cluster, of which the fatigue-related symptom cluster was more severe and was divided into three potential categories: low fatigue-good muscle fitness type (25.63%), general fatigue-moderate muscle fitness type (68.37%) and high fatigue-low muscle fitness type (6%). Multinomial logistic regression analysis showed that hemoglobin levels, tumor stage, absence of complications, and unemployment were factors influencing the fatigue-related symptom cluster in patients undergoing CCRT for cervical cancer.

Conclusions

Cervical cancer patients experience multiple symptom clusters during CCRT. Different characteristics appeared in different clusters. Among them, fatigue-related symptom clusters were more severe and heterogeneous. In clinical practice, we should pay attention to and use high symptom feature predictors, focusing on the core symptoms that play a dominant role, achieving early identification and management, and reducing patients' symptom burden.

Quality of Life in Cervical Cancer Survivors Treated with Concurrent Chemoradiotherapy

Background and Objectives: Cervical cancer is the fourth most common cancer in women globally. As survival rates gradually increase, it becomes necessary to assess the quality of life (QoL) after treatment. It is known that different treatment modalities have different effects on QoL. Therefore, we aimed to evaluate the QoL of cervical cancer survivors (CCSs) treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: A cross-sectional monocentric study, conducted in Vilnius university hospital Santaros klinikos between November 2018 and November 2022, included 20 women, who were interviewed once using the European Organization for Research and Treatment of Cancer (EORTC)-designed Quality-of-Life questionnaire cervical cancer module (QLQ-CX24). The sociodemographic and clinical data as well as the results of the questionnaire are presented in mean, standard deviation and percentages. The QoL scores were compared between different age and stage groups using the Mann-Whitney U test. Results: Twenty participants, aged from 27 to 55 years, with a mean age of 44 years (SD = 7.6) participated in the study. All the participants were CCSs with an International Federation of Gynecology and Obstetrics (FIGO) stage from IB to IIIB and all of them were treated with CCRT. The symptom experience was relatively low and revealed a good result (21.8, SD = 10.2). Mean scores on body image, sexual/vaginal functioning, menopausal symptoms and sexual worry scales indicated moderate functioning and a moderate level of some of the cervical cancer specific symptoms after CCRT. Sexual activity and sexual enjoyment of the CCSs were low (11.7 (SD = 16.3), 14.3 (SD = 17.8), respectively). Conclusions: Cervical cancer survivors report a relatively good quality of life regarding symptom experience; however, women following concurrent chemoradiotherapy tend not to be sexually active and rarely feel sexual enjoyment. In addition, this treatment modality negatively affects a woman's body image and self-perception as a woman.

Prescription of hormone replacement therapy among cervical cancer patients with treatment-induced premature menopause

OBJECTIVE

To examine the utilization of hormone replacement therapy (HRT) among newly diagnosed cervical cancer patients who experienced premature menopause due to primary treatment.

METHODS

The MarketScan Databases were used to identify newly diagnosed cervical cancer patients <50 years of age with premature menopause after hysterectomy with bilateral salpingo-oophorectomy (primary surgery) or primary external beam pelvic radiation (primary radiotherapy). We examined the cumulative utilization of HRT until 24 months after the loss of ovarian function. Fine-Gray subdistribution hazard models were developed to examine the factors associated with cumulative HRT use. The duration of HRT use was analyzed by Kaplan-Meier curves.

RESULTS

A total of 1826 patients, including 352 (19.3%) who underwent primary surgery and 1474 (80.7%) who received primary radiotherapy, were identified. Overall, 39.0% of patients received HRT within 24 months of primary treatment. HRT was used in 49.4% of those who underwent primary surgery and in 36.6% of those who received primary radiotherapy (p<0.0001). The median duration of HRT use was 60 days among the entire cohort and was significantly shorter for the primary radiotherapy group than the primary surgery group (35 vs 90 days, p<0.0001). Primary radiotherapy, older age, residency in the Northeastern USA, and Black race were associated with a lower likelihood of HRT use.

CONCLUSIONS

HRT was prescribed to less than half of patients with newly diagnosed cervical cancer under the age of 50 who experienced premature menopause due to primary treatment. Among those who used HRT the duration of use was short.