The impact of radiotherapy late effects on quality of life in gynaecological cancer patients

Abstract

The aims of this study were to assess changes in quality of life (QoL) scores in relation to radical radiotherapy for gynaecological cancer (before and after treatment up to 3 years), and to identify the effect that late treatment effects have on QoL. This was a prospective study involving 225 gynaecological cancer patients. A QoL instrument (European Organisation for the Research and Treatment of Cancer QLQ-C30) and late treatment effect questionnaire (Late Effects Normal Tissues - Subjective Objective Management Analysis) were completed before and after treatment (immediately after radiotherapy, 6 weeks, 12, 24 and 36 months after treatment). Most patients had acute physical symptoms and impaired functioning immediately after treatment. Levels of fatigue and diarrhoea only returned to those at pre-treatment assessment after 6 weeks. Patients with high treatment toxicity scores had lower global QoL scores. In conclusion, treatment with radiotherapy for gynaecological cancer has a negative effect on QoL, most apparent immediately after treatment. Certain late treatment effects have a negative effect on QoL for at least 2 years after radiotherapy. These treatment effects are centred on symptoms relating to the rectum and bowel, for example, diarrhoea, tenesmus and urgency. Future research will identify specific symptoms resulting from late treatment toxicity that have the greatest effect on QoL; therefore allowing effective management plans to be developed to reduce these symptoms and improve QoL in gynaecological cancer patients.

Figure 1

European Organisation for the Research and Treatment of Cancer QLQ-C30 subscales over time (months). Higher scores on the global quality of life (QoL) and functional scales represent better QoL, whereas higher scores on the symptom scales correspond to a higher level of symptom experience, and therefore worse QoL (range 0–100).

Figure 2

Late Effects Normal Tissues (LENT) – Subjective Objective Management Analysis (SOMA) subscales over time (months). Higher scores on the LENT SOMA scales indicate a higher level of symptom experience from treatment-related toxicity (range 0–4).

Figure 3

European Organisation for the Research and Treatment of Cancer QLQ-C30 global quality of life subscale over time for the ‘high’ and ‘low’ Late Effects Normal Tissues – Subjective Objective Management Analysis (LENT SOMA) score groups.