Abstract
Cervical cancer and its treatments can affect quality of life in many ways, both positively and negatively, from diagnosis through to the acute treatment and survivorship phases. In research settings, the collective term used for all these impacts is health-related quality of life (HRQOL). These include psychological distress related to impairment of functioning, body image, sexual function, and fertility. Additional distress often follows surgical, radiotherapy, and chemotherapy treatments as these can cause urinary, gastrointestinal, and neurologic side effects, physical changes, and sexual dysfunction. Some side effects and changes are chronic, such as psychosexual problems after treatment. It is therefore important to assess symptoms, side effects, and various aspects of functioning, all of which impact HRQOL, during and after cervical cancer treatment. HRQOL information collected in clinical trials can complement clinical data to guide improvements in clinical practice and to counsel individual patients about the impact of treatment and assist them to make treatment decisions. Assessment of HRQOL in clinic can facilitate communication about HRQOL-related issues arising from cervical cancer treatment, alerting multidisciplinary health teams to issues requiring management. In this chapter, we introduce terminology and discuss how cervical cancer and its various treatments affect patients’ HRQOL including side effects of treatment, psychosexual problems, and fertility issues. Methods for assessing HRQOL in cervical cancer are discussed, and current ongoing clinical trials are summarised.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Osoba D. Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol. 1994;12(3):608–16.
Revicki DA, Osoba D, Fairclough D, et al. Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Qual Life Res. 2000;9(8):887–900.
Food and Drug Administration. Patient reported outcome measures: use in medical product development to support labelling claims. US Department of Health & Human Support Food & Drug Administration; MD, USA 2009.
Deshields TL, Potter P, Olsen S, et al. The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year. Support Care Cancer. 2014;22(4):1089–96.
Cancer Council Australia. Understanding cervical cancer: Cancer Council NSW; 2015. https://www.cancer.org.au/content/about_cancer/ebooks/Understanding_Cervical_Cancer_booklet_September_2017.pdf
Thomas SG, Sato HR, Glantz JC, et al. Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients. Obstet Gynecol. 2013;122(5):976–80.
Xie Y, Zhao FH, Lu SH, et al. Assessment of quality of life for the patients with cervical cancer at different clinical stages. Chin J Cancer. 2013;32(5):275–82.
Costa D, Mercieca-Bebber R, Rutherford C, et al. The impact of cancer on psychological and social outcomes. Aust Psychol. 2016;51:89–99.
Au H-J, Ringash J, Brundage M, et al. Added value of health-related quality of life measurement in cancer clinical trials: the experience of the NCIC CTG. Expert Rev Pharm Out. 2010;10(2):119–28.
Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: the case of cataract surgery. Med Care. 1995;33(4):As236–44.
Basch E, Jia X, Heller G, et al. Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. J Natl Cancer Inst. 2009;101(23):1624–32.
Agarwal S, Bodurka DC. Symptom research in gynecologic oncology: a review of available measurement tools. Gynecol Oncol. 2010;119(2):384–9.
Sigaard L, Larsen H, Mikkelsen T, et al. Living experiences with late effects after treatment for cervical cancer. Support Care Cancer. 2015;23(1):S311.
Marth C, Landoni F, Mahner S, et al. Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2017;28(4):iv72–83.
Cibula D, Velechovska P, Slama J, et al. Late morbidity following nerve-sparing radical hysterectomy. Gynecol Oncol. 2010;116(3):506–11.
Bogani G, Serati M, Nappi R, et al. Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy. J Sex Med. 2014;11(12):3012–20.
Arimoto T, Kawana K, Adachi K, et al. Minimization of curative surgery for treatment of early cervical cancer: a review. Jpn J Clin Oncol. 2015;45(7):611–6.
Karimi-Zarchi M, Mousavi A, Gilani MM, et al. Conservative treatment in early cervical cancer. Int J Biomed Sci. 2013;9(3):123–8.
Arbyn M, Kyrgiou M, Simoens C, et al. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ. 2008;337:a1284.
Schwarz TM, Kolben T, Gallwas J, et al. Comparison of two surgical methods for the treatment of CIN: classical LLETZ (large-loop excision of the transformation zone) versus isolated resection of the colposcopic apparent lesion – study protocol for a randomized controlled trial. Trials. 2015;16:225.
Kim HS, Kim K, Ryoo SB, et al. Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis. J Gynecol Oncol. 2015;26(2):100–10.
Surgical menopause Victoria, Australia: Australasian Menopause Society Limited; 2013 [cited 2017 August 20]. https://www.menopause.org.au/hp/information-sheets/756-surgical-menopause
UK CR. A trial looking at surgery for cervical cancer (SHAPE). Trial number CRUK/13/015. London: Cancer Research UK; 2017 [cited 2017 August 30]. http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-surgery-for-cervical-cancer-shape
Maas CP, Trimbos JB, DeRuiter MC, et al. Nerve sparing radical hysterectomy: latest developments and historical perspective. Crit Rev Oncol Hematol. 2003;48(3):271–9.
van Gent MD, Romijn LM, van Santen KE, et al. Nerve-sparing radical hysterectomy versus conventional radical hysterectomy in early-stage cervical cancer. A systematic review and meta-analysis of survival and quality of life. Maturitas. 2016;94:30–8.
Xue Z, Zhu X, Teng Y. Comparison of nerve-sparing radical hysterectomy and radical hysterectomy: a systematic review and meta-analysis. Cell Physiol Biochem. 2016;38(5):1841–50.
Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. Obstet Gynaecol. 2011;13(3):143–8.
Hakvoort RA, Thijs SD, Bouwmeester FW, et al. Comparing clean intermittent catheterisation and transurethral indwelling catheterisation for incomplete voiding after vaginal prolapse surgery: a multicentre randomised trial. BJOG. 2011;118(9):1055–60.
Aoun F, van Velthoven R. Lower urinary tract dysfunction after nerve-sparing radical hysterectomy. Int Urogynecol J. 2015;26(7):947–57.
Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogynecol J. 2014;25(1):91–6.
Ferrandina G. Long term evaluation of quality of life and emotional distress in patients with cervical cancer. Int J Gynecol Obstet. 2012;119:S188–S9.
Chan JL, Letourneau J, Salem W, et al. Sexual satisfaction and quality of life in survivors of localized cervical and ovarian cancers following fertility-sparing surgery. Gynecol Oncol. 2015;139(1):141–7.
Korfage IJ, Essink-Bot ML, Mols F, et al. Health-related quality of life in cervical cancer survivors: a population-based survey. Int J Radiat Oncol Biol Phys. 2009;73(5):1501–9.
Klee M, Thranov I, Machin PD. The patients’ perspective on physical symptoms after radiotherapy for cervical cancer. Gynecol Oncol. 2000;76(1):14–23.
Laurentius T, Altendorf-Hofmann A, Camara O, et al. Impact of age on morbidity and outcome of concurrent radiochemotherapy in high-risk FIGO stage I to IVA carcinoma of the uterine cervix following laparoscopic surgery. J Cancer Res Clin Oncol. 2011;137(3):481–8.
Pfaendler KS, Wenzel L, Mechanic MB, et al. Cervical cancer survivorship: long-term quality of life and social support. Clin Ther. 2015;37(1):39–48.
Kim SI, Lim MC, Lee JS, et al. Comparison of lower extremity edema in locally advanced cervical cancer: pretreatment laparoscopic surgical staging with tailored radiotherapy versus primary radiotherapy. Ann Surg Oncol. 2016;23(1):203–10.
Vistad I, Cvancarova M, Kristensen GB, et al. A study of chronic pelvic pain after radiotherapy in survivors of locally advanced cervical cancer. J Cancer Surviv. 2011;5(2):208–16.
Kirchheiner K, Potter R, Tanderup K, et al. Health-related quality of life in locally advanced cervical cancer patients after definitive chemoradiation therapy including image guided adaptive brachytherapy: an analysis from the EMBRACE study. Int J Radiat Oncol Biol Phys. 2016;94(5):1088–98.
Maduro JH, Pras E, Willemse PH, et al. Acute and long-term toxicity following radiotherapy alone or in combination with chemotherapy for locally advanced cervical cancer. Cancer Treat Rev. 2003;29(6):471–88.
Sekse RJ, Hufthammer KO, Vika ME. Fatigue and quality of life in women treated for various types of gynaecological cancers: a cross-sectional study. J Clin Nurs. 2015;24(3–4):546–55.
Wo JY, Viswanathan AN. The impact of radiotherapy on fertility, pregnancy, and neonatal outcomes of female cancer patients. Int J Radiat Oncol Biol Phys. 2009;73(5):1304–12.
Gubbala K, Laios A, Gallos I, et al. Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis. J Ovarian Res. 2014;7(1):69.
Siahpush M, Singh GK. Sociodemographic predictors of pap test receipt, currency and knowledge among Australian women. Prev Med. 2002;35(4):362–8.
Greenwald HP, McCorkle R, Baumgartner K, et al. Quality of life and disparities among long-term cervical cancer survivors. J Cancer Surviv. 2014;8(3):419–26.
McGarvey EL, Baum LD, Pinkerton RC, et al. Psychological sequelae and alopecia among women with cancer. Cancer Pract. 2001;9(6):283–9.
Hesketh PJ, Batchelor D, Golant M, et al. Chemotherapy-induced alopecia: psychosocial impact and therapeutic approaches. Support Care Cancer. 2004;12(8):543–9.
Tageja N, Groninger H. Chemotherapy-induced nausea and vomiting: an overview and comparison of three consensus guidelines. Postgrad Med J. 2016;92(1083):34–40.
Lohr L. Chemotherapy-induced nausea and vomiting. Cancer J. 2008;14(2):85–93.
Jean-Pierre P, McDonald BC. Neuroepidemiology of cancer and treatment-related neurocognitive dysfunction in adult-onset cancer patients and survivors. Handb Clin Neurol. 2016;138:297–309.
Tewari KS, Sill MW, Penson RT, et al. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet. 2017;390(10103):1654–63.
Penson RT, Huang HQ, Wenzel LB, et al. Bevacizumab for advanced cervical cancer: patient-reported outcomes of a randomised, phase 3 trial (NRG Oncology-Gynecologic Oncology Group protocol 240). Lancet Oncol. 2015;16(3):301–11.
Datta NR, Samiei M, Bodis S. Radiation therapy infrastructure and human resources in low- and middle-income countries: present status and projections for 2020. Int J Radiat Oncol Biol Phys. 2014;89(3):448–57.
Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.
De Vuyst H, Alemany L, Lacey C, et al. The burden of human papillomavirus infections and related diseases in sub-Saharan Africa. Vaccine. 2013;31(5):F32–46.
Keller M, Sommerfeldt S, Fischer C, et al. Recognition of distress and psychiatric morbidity in cancer patients: a multi-method approach. Ann Oncol. 2004;15(8):1243–9.
Simard S, Thewes B, Humphris G, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Surviv. 2013;7(3):300–22.
Conic I, Miljkovic S, Tosic-Golubovic S, et al. Anxiety levels related to the type of therapy for cervical cancer. Cent Eur J Med. 2012;7(4):490–6.
Hazewinkel MH, Sprangers MAG, Van Der Velden J, et al. Severe pelvic floor symptoms after cervical cancer treatment are predominantly associated with mental and physical well-being and body image: a cross-sectional study. Int J Gynecol Cancer. 2012;22(1):154–60.
Carter J, Rowland K, Chi D, et al. Gynecologic cancer treatment and the impact of cancer-related infertility. Gynecol Oncol. 2005;97(1):90–5.
Angarita AM, Johnson CA, Fader AN, et al. Fertility preservation: a key survivorship issue for young women with cancer. Front Oncol. 2016;6:102.
Chan JL, Letourneau J, Salem W, et al. Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients. J Cancer Surviv. 2017;11(1):58–63.
Bakker RM, Kenter GG, Creutzberg CL, et al. Sexual distress and associated factors among cervical cancer survivors: a cross-sectional multicenter observational study. Psycho-Oncology. 2016;26(10):1470–7.
Lonnée-Hoffmann R, Pinas I. Effects of hysterectomy on sexual function. Curr Sexual Health Rep. 2014;6(4):244–51.
Vermeer WM, Bakker RM, Kenter GG, et al. Cervical cancer survivors’ and partners’ experiences with sexual dysfunction and psychosexual support. Support Care Cancer. 2016;24:1679–87.
Ghafoori F, Noughabi ZS, Sarafraz N, et al. Sexual outcomes in women with cervical cancer: a review article. Iran J Obstet Gynecol Infert. 2016;19(28):22–7.
Solbrække KN, Bondevik H. Absent organs—present selves: exploring embodiment and gender identity in young Norwegian women’s accounts of hysterectomy. Int J Qual Stud Health, 2015;10. https://doi.org/10.3402/qhw.v10.26720.
Syse A, Kravdal Ø. Does cancer affect the divorce rate? Demogr Res. 2007;16(15):469–92.
De Groot JM, Mah K, Fyles A, et al. The psychosocial impact of cervical cancer among affected women and their partners. Int J Gynecol Cancer. 2005;15(5):918–25.
Maguire R, Kotronoulas G, Simpson M, et al. A systematic review of the supportive care needs of women living with and beyond cervical cancer. Gynecol Oncol. 2015;136(3):478–90.
Ye S, Yang J, Cao D, et al. A systematic review of quality of life and sexual function of patients with cervical cancer after treatment. Int J Gynecol Cancer. 2014;24(7):1146–57.
Alcala HE, Mitchell E, Keim-Malpass J. Adverse childhood experiences and cervical Cancer screening. J Womens Health (Larchmt). 2017;26(1):58–63.
Jayasinghe YL, Sasongko V, Lim RW, et al. The association between unwanted sexual experiences and early-onset cervical cancer and precancer by age 25: a case-control study. J Womens Health (Larchmt), 2016, 17. https://doi.org/10.1089/jwh.2016.5742.
Szender JB, Cannioto R, Gulati NR, et al. Impact of physical inactivity on risk of developing cancer of the uterine cervix: a case-control study. J Low Genit Tract Dis. 2016;20(3):230–3.
Gerritsen JK, Vincent AJ. Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2016;50(13):796–803.
Sawyer A. Complementary exercise and quality of life in patients with breast cancer. Br J Nurs. 2014;23(16):S18–23.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organisation for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.
Flechtner H, Bottomley A. Quality of life assessment and research in the EORTC (European Organisation for Research and Treatment of Cancer). Oncologie. 2006;8(5):443–6.
Cherny NI, Sullivan R, Dafni U, et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Ann Oncol. 2015;26(8):1547–73.
Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015;33(23):2563–77.
Gilbert A, Sebag-Montefiore D, Davidson S, et al. Use of patient-reported outcomes to measure symptoms and health related quality of life in the clinic. Gynecol Oncol. 2015;136(3):429–39.
Snyder CF, Aaronson NK, Choucair AK, et al. Implementing patient-reported outcomes assessment in clinical practice: a review of the options and considerations. Qual Life Res. 2012;21(8):1305–14.
Valderas JM, Kotzeva A, Espallargues M, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17(2):179–93.
PROQOLID Patient-Reported Outcome and Quality of Life Instruments Database [Internet]. Mapi Research Trust. 2016 [cited 2016 November 28]. http://www.proqolid.org/instruments
King MT. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11(2):171–84.
Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford: Oxford University Press; 1996.
Cella D, Tulsky DS, Gray R, et al. The Functional Assessment of Cancer Therapy (FACT) scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.
Greimel ER, Kuljanic Vlasic K, Waldenstrom AC, et al. The European Organization for Research and Treatment of Cancer (EORTC) quality-of-life questionnaire cervical cancer module: EORTC QLQ-CX24. Cancer. 2006;107(8):1812–22.
Ding Y, Hu Y, Hallberg IR. Psychometric properties of the Chinese version of the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx) measuring health-related quality of life. Health Qual Life Outcomes. 2012;10(1):124.
Calhoun EA, Welshman EE, Chang CH, et al. Psychometric evaluation of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (Fact/GOG-Ntx) questionnaire for patients receiving systemic chemotherapy. Int J Gynecol Cancer. 2003;13(6):741–8.
Cella D, Peterman A, Hudgens S, et al. Measuring the side effects of taxane therapy in oncology: the functional assessment of cancer therapy-taxane (FACT-taxane). Cancer. 2003;98(4):822–31.
Levine M, Guyatt G, Gent M, et al. Quality of life in stage II breast cancer: an instrument for clinical trials. J Clin Oncol. 1988;6(12):1798–810.
Coates A, Glasziou P, McNeil D. On the receiving end – III. Measurement of quality of life during cancer chemotherapy. Ann Oncol. 1990;1:213–7.
Luckett T, King MT. Choosing patient-reported outcome measures for cancer clinical research – practical principles and an algorithm to assist non-specialist researchers. Eur J Cancer. 2010;46(18):3149–57.
Snyder CF, Watson ME, Jackson JD, et al. Patient-reported outcome instrument selection: designing a measurement strategy. Value Health. 2007;10:S76–85.
Luckett T, King MT, Butow PN, et al. Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations. Ann Oncol. 2011;22(10):2179–90.
Mercieca-Bebber R, Palmer MJ, Brundage M, et al. Design, implementation and reporting strategies to reduce the instance and impact of missing patient-reported outcome (PRO) data: a systematic review. BMJ Open. 2016;6(6):e010938.
Aaronson NK, Elliott TE, Greenhalgh J, et al. User’s guide to implementing patient-reported outcomes assessment in clinical practice, Version 2: January: International Society for Quality of Life Research; 2015.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Rutherford, C., Mercieca-Bebber, R., Tait, M., Mileshkin, L., King, M.T. (2019). Quality of Life in Women with Cervical Cancer. In: Farghaly, S. (eds) Uterine Cervical Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-02701-8_15
Download citation
DOI: https://doi.org/10.1007/978-3-030-02701-8_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-02700-1
Online ISBN: 978-3-030-02701-8
eBook Packages: MedicineMedicine (R0)