Quality of life in women with cervical precursor lesions and cancer: a prospective, 6-month, hospital-based study in China

Abstract

The overall survival of patients with cervical cancer has improved due to detection at an early stage and availability of comprehensive treatments in China. As patients' lives prolonged, it is important to understand their health-related quality of life (QoL) during and after treatment. We used the EQ-5D questionnaire to assess QoL of 194 patients with cervical lesions at Sichuan University West China Second Hospital between May 2010 and January 2011. Patients were surveyed before primary treatment and at 1, 3, and 6 months after primary treatment. Results showed a consistent decline in EQ-5D scores in the spectrum of cervical lesions at each time point after treatment (all P < 0.05). For patients with precursor lesions, there was an increasing trend along the timeline of treatment (P < 0.01). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month (P = 0.01) and gradually increased to higher levels at 6 months post-treatment than those before treatment (P < 0.01). EQ-5D scores followed a similar trend in patients with advanced cervical cancer (P = 0.04), though they did not statistically rebound after 6 months (0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62). Regarding advanced cervical cancer, EQ-5D scores for women above 40 years of age appeared to recover more rapidly and reached higher levels than those for women below 40 years (P = 0.03). Caution and extra care are recommended in the early period of cervical cancer treatment given the slight deterioration in the QoL, and in particular, for younger cervical cancer patients. Our study implies that health care providers may need to improve the health-related QoL of cervical cancer patients.

Figure 1.. Distribution of EQ-5D scores for each stage of cervical lesion along the timeline of treatment.

For patients with precursor lesions, EQ-5D scores followed an increasing trend along the timeline of treatment (F = 26.65, P < 0.01 after Greenhouse-Geisser correction for overall comparison; P < 0.05 for pairwise comparisons). For patients with early-stage cervical cancer, EQ-5D scores declined in the first month of treatment (P = 0.01) and by 6 months, gradually increased to a higher level than that before primary treatment (P < 0.01). EQ-5D scores showed a similar trend in patients with advanced cervical cancer (F = 5.38, P < 0.01 after Greenhouse-Geisser correction for overall comparison), though scores were not statistically recovered at 6 months after treatment (0.84 ± 0.19 vs. 0.86 ± 0.11, P = 0.62).

Figure 2.. Comparison of EQ-5D scores between younger and older women with cervical lesions along the timeline of treatment.

Among women with advanced cervical cancer, EQ-5D scores for the women equal to or above 40 years appeared to recover more rapidly and reached a higher level of QoL than those for the women below 40 years (P = 0.03). However, there were no other significant differences between the two age groups for any other stage of cervical lesions at different time points.

Figure 3.. Comparison of EQ-5D and VAS scores along the timeline of treatment.

The EQ-5D and VAS scores showed similar changes along the timeline of treatment and correlated with each other at different time points (Pearson coefficients: 0.57 for overall analysis, and 0.38, 0.66, 0.58, and 0.51 for each time point; all P < 0.01).