Health-related Quality of Life in Women with Cervical Cancer

To analyze the factors associated with health-related quality of life (HRQoL) in women with cervical cancer (CC) in a single center in Rio de Janeiro, state of Rio de Janeiro, Brazil.

Methods

A cross-sectional study in women with a diagnosis of CC followed-up in the gynecology outpatient clinic of the Hospital do Câncer II (HCII, in the Portuguese acronym) of the Instituto Nacional de Câncer (INCA, in the Portuguese acronym). The data were collected from March to August 2015. Women with palliative care, communication/cognition difficulty, undergoing simultaneous treatment for other types of cancer, or undergoing chemotherapy and/or radiation therapy were excluded. For the evaluation of the HRQoL, a specific questionnaire for women with CC was used (Functional Assessment of Cancer Therapy - Cervix Cancer [FACT-Cx]). The total score of the questionnaire ranges from 0 to 168, with higher scores indicating a better HRQoL.

Results

A total of 115 women were included in the present study, with a mean age of 52.64 years old (standard deviation [SD] = 12.13). The domains of emotional (16.61; SD = 4.55) and functional well-being (17.63; SD = 6.15) were those which presented the worst scores. The factors that had an association with better HRQoL in women with CC were having a current occupation, a longer time since the treatment and diagnosis, and women who had undergone hysterectomy.

Conclusion

Considering the domains of HRQoL of the women treated for cervical cancer, a better score was observed in the domains of physical and social/family wellbeing. For most domains, better scores were found between those with a current occupation, with a longer time after the diagnosis and treatment, and among those who had undergone a hysterectomy.

Keywords:
uterine cervical neoplasms; quality of life; cross-sectional studies; data collection

Variables	n	%
Schooling/ educational level
Incomplete elementary school education	72	62.5
Complete elementary school education	43	37.5
Marital status
Married/stable relationship	54	47.0
Divorced	19	16.5
Widowed	21	18.3
Single	21	18.3
Race
White	43	37.4
Other	72	62.6
Occupation
Yes	41	35.7
No	74	64.3
Currently smoking
Yes	11	9.6
No	104	90.4
Alcohol consumption (previous 7 days)
Yes	20	17.4
No	95	82.6
Stage (FIGO)
IA	12	10.4
IB	36	31.3
IIA	17	14.8
IIB	19	16.5
IIIA	13	11.3
IIIB	18	15.7
Treatment
Chemotherapy + radiotherapy	73	63.5
Hysterectomy	42	36.5

FACT-Cx	Mean (SD)	Median	Minimum	Maximum	Score range
Physical well-being (PWB)	19.26 (5.63)	19.0	4.0	28.0	0–28
Social/Family well-being (SWB)	18.20 (5.78)	18.0	2.0	28.0	0–28
Emotional well-being (EWB)	16.61 (4.55)	16.0	6.0	24.0	0–24
Functional well-being (FWB)	17.63 (6.15)	18.0	2.0	28.0	0–28
Additional Concerns	41.69 (8.49)	42.0	20.0	60.0	0–60
Total FACT-Cx	112.15 (22.91)	109.5	61.0	168.0	0–168

Variables	Physical well-being (PWB)		Social well-being (SWB)		Emotional well-being(EWB)		Functional well-being(FWB)		Additional Concerns		Total FACT-Cx
Variables	Mean (SD)	p-value	Mean (SD)	p-value	Mean (SD)	p-value	Mean (SD)	p-value	Mean (SD)	p-value	Mean (SD)	p-value
Age (years old)
< 50	18.96 (5.16)	0.633	16.93 (6.65)	0.500	16.20 (4.40)	0.432	16.34 (5.96)	0.600	40.61 (7.81)	0.600	109.84 (22.78)	0.248
≥50	19.47 (5.97)	0.633	19.13 (4.90)	0.500	16.88 (4.66)	0.432	18.53 (6.17)	0.600	42.55 (8.97)	0.600	113.96 (23.06)	0.248
Stage (FIGO)
< IIB	18.74 (5.39)	0.387	17.60 (5.82)	0.341	15.86 (4.65)	0.123	16.90 (6.43)	0.263	40.67 (7.96)	0.256	109.84 (22.78)	0.133
≥ IIB	19.66 (5.83)	0.387	18.67 (5.75)	0.341	17.19 (4.42)	0.123	18.20 (5.91)	0.263	42.57 (8.90)	0.256	113.96 (23.06)	0.133
Treatment
CT + RT	18.48 (5.35)	0.500	17.21 (6.13)	0.020	16.36 (4.78)	0.456	17.16 (6.49)	0.282	40.52 (8.22)	0.058	108.21 (20.99)	0.024
Hysterectomy	20.62 (5.93)	0.500	19.85 (4.77)	0.020	17.02 (4.16)	0.456	18.45 (5.50)	0.282	43.81 (8.68)	0.058	118.86 (24.73)	0.024
Children
No	21.44 (6.00)	0.228	23.37 (4.41)	0.008	18.22 (4.55)	0.237	21.00 (6.59)	0.880	44.13 (10.41)	0.402	128.43 (23.06)	0.051
Yes	19.08 (5.60)	0.228	17.79 (5.69)	0.008	16.46 (4.54)	0.237	17.35 (6.06)	0.880	41.49 (8.34)	0.402	110.92 (22.55)	0.051
Time since treatment (years)
≤ 2	18.80 (4.89)	0.325	16.97 (5.88)	0.008	16.00 (4.50)	0.115	15.75 (5.66)	<0.001	41.25 (7.61)	0.538	108.51 (20. 81)	0.056
> 2	19.84 (6.54)	0.325	19.89 (5.25)	0.008	17.35 (4.55)	0.115	20.00 (5.97)	<0.001	42.30 (9.62)	0.538	117.39 (24.97)	0.056
Time since diagnosis (years)
≤ 2	18.83 (4.12)	0.451	16.29 (5.88)	0.001	15.54 (4.54)	0.021	15.45 (5.13)	<0.001	41.72 (7.02)	0.975	108.27 (19.91)	0.097
> 2	19.63 (6.68)	0.451	19.88 (5.18)	0.001	17.50 (4.40)	0.021	19.50 (6.38)	<0.001	41.67 (9.72)	0.975	115.88 (25.09)	0.097
Education (elementary school)
Incomplete	19.11 (5.89)	0.814	17.14 (5.80)	0.122	16.20 (4.68)	0.432	17.91 (5.67)	0.694	42.63 (7.99)	0.364	110.38 (22.14)	0.541
Complete	19.36 (5.50)	0.814	18.89 (4.48)	0.122	16.88 (4.48)	0.432	17.45 (6.49)	0.694	41.08 (8.81)	0.364	113.28 (23.50)	0.541
Variables	Physical well-being (PWB)		Social well-being (SWB)		Emotional well-being (EWB)		Functional well-being (FWB)		Additional Concerns		Total FACT-Cx
Variables	Mean (SD)	*p-value*	Mean (SD)	*p-value*	Mean (SD)	*p-value*	Mean (SD)	*p-value*	Mean (SD)	*p-value*	Mean (SD)	*p-value*
With partner
Yes	19.57 (5.88)	0.577	17.24 (5.90)	0.085	16.70 (4.33)	0.840	17.43 (6.13)	0.734	42.55 (6.92)	0.315	112.76 (21.06)	0.792
No	18.98 (5.45)	0.577	19.15 (5.55)	0.085	16.52 (4.78)	0.840	17.82 (6.22)	0.734	40.87 (9.76)	0.315	111.54 (24.82)	0.792
Race
White	18.67 (6.17)	0.391	18.15 (5.53)	0.944	15.79 (4.84)	0.138	17.28 (5.67)	0.634	40.87 (8.78)	0.448	110.03 (24.16)	0.48
Other	19.61 (5.31)	0.391	18.23 (5.96)	0.944	17.10 (4.33)	0.138	17.85 (6.45)	0.634	42.18 (8.34)	0.448	113.40 (22.25)	0.48
Occupation
No	18.41 (5.48)	0.028	17.27 (5.08)	0.024	15.99 (4.12)	0.048	16.70 (5.96)	0.028	40.43 (7.46)	0.041	106.83 (19.49)	0.001
Yes	20.80 (5.66)		19.87 (6.61)		17.75 (5.12)		19.32 (6.22)	0.028	43.97 (9.80)	0.041	122.03 (25.67)	0.001
BMI		0.028		0.024		0.048
Adequate	18.21 (5.04)	0.123	17.08 (5.18)	0.122	16.40 (4.04)	0.721	15.88 (5.39)	0.018	41.16 (8.40)	0.629	107.37 (19.89)	0.127
Overweight and obese	19.89 (5.91)	0.123	18.86 (6.04)	0.122	16.72 (4.85)	0.721	18.68 (6.37)	0.018	42.00 (8.59)	0.629	114.72 (24.14)	0.127

Domains of quality of life	Difference in means(β coefficient)	95% CI	p-value
Physical well-being (PWB)
Occupation (Yes)	2.39	0.26–4.54	0.028
Social well-being (SWB)
Time since diagnosis (> 2 years)	3.53	1.53–5.53	0.001
Having Children (No)	4.88	1.05–8.721	0.013
Treatment (Hysterectomy)	2.57	0.51–4.63	0.015
Emotional well-being (EWB)
Time since diagnosis (> 2 years)	1.96	0.30–3.63	0.021
Functional well-being (FWB)
Time since treatment (> 2 years)	4.25	2.09–6.41	< 0.001
Additional Concerns
Occupation (Yes)	3.54	0.14–6.94	0.041
Total FACT-Cx
Occupation (Yes)	14.01	4.98–23.05	0.003
Treatment (Hysterectomy)	8.82	- 0.10–17.75	0.053

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[1] Address for correspondence
Luciana Castaneda, PhD, Instituto Federal do Rio de Janeiro, Rua Pereira de Almeida, 88, 20260-100, Praça da Bandeira, Rio de Janeiro, RJ, Brazil (e-mail: lucianacastaneda@yahoo.com.br).