Gynecological cancer uniquely affects health-related quality of life. A 2023 literature review reports that treatment side effects such as fatigue, pain, and sexual dysfunction impact psychological well-being. Younger patients and those in advanced stages generally experience greater challenges. Tailoring treatment approaches and implementing supportive care can help improve health-related quality of life for survivors.
Gynecological cancers constitute 14.4% of newly diagnosed cancer cases in women globally. Each cancer type imposes a specific burden on patients’ quality of life. A literature review published in the International Journal of Gynecological Cancer reviewed the current knowledge regarding the impact of gynecological cancers on health-related quality of life (HRQoL).
Psychological Distress and Sexual Impairment
Ovarian cancer, often diagnosed late, is the most challenging gynecological cancer, with the worst 5-year survival rate. Survivors demonstrate good long-term HRQoL but often suffer psychological distress and sexual impairment, with no significant differences between early- and late-stage disease. Physical complications and side effects significantly impact psychosocial health, with younger survivors experiencing more HRQoL distress. CA125 testing and fear of recurrence cause increased anxiety. Sexual dysfunction manifests as a lack of sexual desire, vaginal dryness, and dyspareunia, which could lead to relationship tension and further psychological distress.
Impact of Treatment Choices in Endometrial Cancer Patients
Endometrial cancer, often detected early, is primarily treated through surgery; conflicting information exists regarding the impact of open versus laparoscopic approaches on HRQoL. Sentinel lymph node biopsy has been reported to improve HRQoL by reducing the risk of lymphedema. Although external beam radiation therapy is associated with more severe bowel, bladder, and sexual dysfunction than brachytherapy, there has been no significant impact on overall QoL or difference in cancer survivorship issues.
Endometrial cancer patients experience reduced HRQoL with increased stress, anxiety, depression, sexual dysfunction, and sleep deprivation. Sexual function in survivors is influenced by age, time since diagnosis, and physician consultation before starting sexual activity. Moreover, obesity is associated with lower HRQoL and physical functioning.
Radiotherapy and Surgery Impacts in Cervical Cancer Patients
Radiotherapy is associated with decreased HRQoL as compared to surgery or chemotherapy, with side effects persisting up to 10 years post-treatment. Radical hysterectomy, standard for early-stage cases, is associated with reduced lubrication, vaginal shortening, lack of sensation, and dyspareunia. Nerve-sparing approaches can prevent sexual, bladder, and bowel issues.
Recent research has demonstrated no difference in HRQoL between open and minimally invasive radical hysterectomy. Sentinel lymph node biopsy yields better HRQoL outcomes, with less leg heaviness and fatigue than full lymphadenectomy. Despite ovary preservation, sexual function impairment persists across treatment modalities. Depression, fatigue, and pain are linked to lower HRQoL in survivors.
Vulvar Cancer Patients Face Distinct Challenges After Treatment
Vulvar cancer may have the greatest impact on HRQoL due to its external location and disfiguring management. Sexual dysfunction is common and related to the type and extent of surgery, with older age linked to worse sexual dysfunction. A full inguinal lymphadenectomy increases the risk of lower limb lymphedema and lowers HRQoL by affecting appearance, mobility, self-image, and finances. Depression and anxiety are common; shame, insecurity, and difficulty in self-care and daily activities are important factors. There is a need for an integrated care model to address patients’ unmet needs.
Source:
Gil-Ibáñez, B., Davies-Oliveira, J., González, G. L., Díaz-Feijóo, B., Tejerizo-García, A., & Sehouli, J. (2023). Impact of gynecological cancers on health-related quality of life: historical context, measurement instruments, and current knowledge. International Journal of Gynecological Cancer, 33(11), 1800–1806. https://doi.org/10.1136/ijgc-2023-004804
