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A systematic review of the impact of contemporary treatment modalities for cervical cancer on women’s self-reported health-related quality of life

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Abstract

Purpose

Given the high survival rate of cervical cancer patients, understanding women’s health-related quality of life (HRQL) during and after treatment is of major clinical importance. We conducted a systematic review to synthesize all available evidence about the effects of each contemporary treatment modality for cervical cancer on all dimensions of women’s HRQL, including symptoms, functioning, and global HRQL.

Methods

We searched four electronic databases from January 2000 to September 2019, cross-referenced and searched by author name for studies of patients treated for cervical cancer that reported patient-reported outcomes (PROs) before treatment and with at least one post-treatment measurement. Two independent reviewers applied inclusion and quality criteria and extracted findings. Studies were categorized by treatment to determine specific treatment effects on PROs. Results were narratively summarized.

Results

We found twenty-nine papers reporting 23 studies. After treatments with curative intent for early or locally advanced disease, lymphedema, diarrhea, menopausal symptoms, tight and shorter vagina, pain during intercourse, and sexual worries remained long-term problems; however, sexual activity improved over time. HRQL and psychological distress were impacted during treatment with also worsening of global HRQL but improved 3–6 months after treatment. In patients with metastatic or recurrent disease, pain improved during palliative treatment or remained stable, with no differences in global HRQL found over time.

Conclusion

Whereas most symptoms worsen during treatment and improve in the first 3 months after completing treatment, symptoms like lymphedema, menopausal symptoms, and sexual worries develop gradually and persist after curative treatment. These findings can be used to inform clinical practice and facilitate communication and shared decision-making. More research is needed in very early cervical cancer and the impact of fertility sparing therapy on PROs.

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Author information

Authors and Affiliations

  1. The University of Sydney, Faculty of Science, School of Psychology, Quality of Life Office, Sydney, Australia

    L. M. Wiltink, M. King, F. Müller, M.-A. Tait, R. Campbell & C. Rutherford

  2. Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    F. Müller

  3. Faculty of Health, IMPACCT, University of Technology Sydney, Sydney, Australia

    M. S. Sousa

  4. Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia

    M. Tang

  5. Department of Oncology, Mercy Hospital for Women, Heidelberg, Australia

    A. Pendlebury

  6. Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia

    J. Pittman

  7. Western Sydney University, Campbelltown, Australia

    J. Pittman

  8. Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia

    N. Roberts

  9. School of Social Work and Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

    N. Roberts

  10. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

    L. Mileshkin

  11. The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Australia

    L. Mileshkin

  12. University of Sydney, NHMRC Clinical Trials Centre, Sydney, Australia

    R. Mercieca-Bebber

  13. The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia

    C. Rutherford

Authors
  1. L. M. Wiltink
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  2. M. King
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  3. F. Müller
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  4. M. S. Sousa
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  8. N. Roberts
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  9. L. Mileshkin
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  12. R. Campbell
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Contributions

Wiltink, L.M: led data extraction, analysis, and manuscript drafting and revision

King, M: conception and design, data interpretation, and manuscript revision and approval

Müller, F: data extraction, analysis, and manuscript revision and approval

Sousa, M.S.: data extraction, analysis, and manuscript revision and approval

Tang, M: data extraction, analysis, and manuscript revision and approval

Pendlebury, A: data extraction, analysis, and manuscript revision and approval

Pittman, J: data extraction, analysis, and manuscript revision and approval

Roberts, N: data extraction, analysis, and manuscript revision and approval

Mileshkin, L: conceptualization, methodology, data interpretation, and manuscript revision and approval

Mercieca-Bebber, R: data extraction, analysis, and manuscript revision and approval

Tait, M.-A: data extraction, analysis, and manuscript revision and approval

Campbell, R: data extraction, analysis, and manuscript revision and approval

Rutherford, C: conceptualization, methodology, data interpretation, writing original draft, writing—review, editing and approval, and supervision

Corresponding author

Correspondence to L. M. Wiltink.

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Conflict of interest

MT reports travel support from Roche, outside the submitted work. RMB reports UCB project funding, outside the submitted work. The other authors have no conflicts of interest to disclose.

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Wiltink, L.M., King, M., Müller, F. et al. A systematic review of the impact of contemporary treatment modalities for cervical cancer on women’s self-reported health-related quality of life. Support Care Cancer 28, 4627–4644 (2020). https://doi.org/10.1007/s00520-020-05554-2

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