Elsevier

Gynecologic Oncology

Volume 119, Issue 2, November 2010, Pages 358-365
Gynecologic Oncology

A 2-year prospective study assessing the emotional, sexual, and quality of life concerns of women undergoing radical trachelectomy versus radical hysterectomy for treatment of early-stage cervical cancer

https://doi.org/10.1016/j.ygyno.2010.07.016Get rights and content

Abstract

Objective

To prospectively assess and describe the emotional, sexual, and QOL concerns of women with early-stage cervical cancer undergoing radical surgery.

Methods

Seventy-one women who were consented for radical trachelectomy (RT) or radical hysterectomy (RH) were enrolled preoperatively in this 2-year study; 52 women (33 RT; 19 RH) were actively followed. Patients completed self-report surveys composed of 4 empirical measures in addition to exploratory items. Data analyses for the 2 years of prospective data are presented.

Results

At preoperative assessment, women choosing RH reported greater concern about cancer recurrence (x = 7.27 [scale from 0 to 10]) than women choosing RT (x = 5.66) (P = 0.008). Forty-eight percent undergoing RH compared to 8.6% undergoing RT reported having adequate “time to complete childbearing” (P < 0.001). Both groups demonstrated scores suggestive of depression (based on the CES-D scale) and distress (based on the IES scale) preoperatively; over time, however, CES-D and IES scores generally improved. Scores on the Female Sexual Functioning Inventory (FSFI) for the total sample were below the mean cut-off (26.55), suggestive of sexual dysfunction; however, the means increased from 16.79 preoperatively to 23.78 by 12 months and 22.20 at 24 months.

Conclusion

Measurements of mood, distress, sexual function, and QOL did not differ significantly by surgical type, and instead reflect the challenges faced by young cervical cancer patients treated by RT or RH without adjuvant treatment. Points of vulnerability were identified in which patients may benefit from preoperative consultation or immediate postoperative support. Overall, patients improved during the first year, reaching a plateau between Year-1 and Year-2, which may reflect a new level of functioning in survivorship.

Introduction

The radical trachelectomy (RT), a fertility-preserving surgery, has gained ever-increasing recognition as a safe oncologic alternative to radical hysterectomy (RH), with similar recurrence rates for early-stage cervical cancer patients of childbearing age [1], [2], [3], [4], [5], [6]. Approximately 40% of women diagnosed with early-stage cervical cancer who have undergone RH could have been acceptable candidates for this procedure [7]. With promising obstetrical outcomes, RT offers these women hope of future childbearing [1], [3], [8], [9]. Reproductive concerns have been shown to be associated with quality of life (QOL) [10]; and with advancing technology, future reproductive options have become a paramount concern for many women.

The long-term psychological and QOL impacts of RT are still not fully understood [11], [12]. No study has assessed and measured the responses of women undergoing RT in these domains. We have conducted a prospective study designed to examine the emotional, sexual, and QOL concerns of women undergoing RT or RH. This study utilized empirical measures and exploratory items to investigate potential group differences prospectively over 2 years.

Section snippets

Methods

This study is an Institutional Review Board (IRB)-approved prospective study at the Memorial Sloan-Kettering Cancer Center (MSKCC). Study informed consent was obtained from participants preoperatively following surgical consent.

Demographic characteristics

Participants' ages ranged from 20 to 45 years (mean = 34.5). RT patients (mean = 32.6) were younger than RH patients (mean = 37.6). Over half of the patients were married/or living with someone (58%, n = 41); approximately one-third were single (35%, n = 25); and 68% (n = 48) had no children at enrollment. Table 1 presents further demographic information.

Medical characteristics and treatment choice

Preoperatively, 43 women (61%) consented for RT and 28 (39%) for RH. Of the women consented for RT, the majority indicated fertility and not having enough

Discussion

During the conceptualization of this study, we hypothesized that women undergoing fertility-preserving treatment would demonstrate more adaptive or favorable responses than those undergoing RH. The scores on measurements of mood, distress, sexual function, and QOL did not differ significantly between groups. However, both groups demonstrated emotional and physical ramifications to their cancer diagnosis, treatment, and immediate postoperative recovery. Much of the existing literature has

Conflicts of interest statement

Jeanne Carter, PhD: none; Yukio Sonoda, MD: Speaker for Genzyme; Dennis S. Chi, MD: Speaker for Genzyme; Richard R. Barakat, MD: none; Raymond E. Baser, MS: none; Leigh Raviv, BA: none; Alexia Iasonos, PhD: none; Carol L. Brown, MD: none; and Nadeem R. Abu-Rustum, MD: none.

Acknowledgments

Financial support: T.J. Martell Foundation and MSKCC Gynecology Philanthropic Funds.

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