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
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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