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Review
. 2022 Nov 26;14(23):5832.
doi: 10.3390/cancers14235832.

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

Samuel Oxley  1   2 , Ran Xiong  3 , Xia Wei  1   4 , Ashwin Kalra  1   2 , Michail Sideris  1   2 , Rosa Legood  4 , Ranjit Manchanda  1   2   4   5   6
Affiliations
Review

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

Samuel Oxley et al. Cancers (Basel). .

Abstract

Background: Risk-reducing hysterectomy (RRH) is the gold-standard prevention for endometrial cancer (EC). Knowledge of the impact on quality-of-life (QoL) is crucial for decision-making. This systematic review aims to summarise the evidence.

Methods: We searched major databases until July 2022 (CRD42022347631). Given the paucity of data on RRH, we also included hysterectomy as treatment for benign disease. We used validated quality-assessment tools, and performed qualitative synthesis of QoL outcomes.

Results: Four studies (64 patients) reported on RRH, 25 studies (1268 patients) on hysterectomy as treatment for uterine bleeding. There was moderate risk-of-bias in many studies. Following RRH, three qualitative studies found substantially lowered cancer-worry, with no decision-regret. Oophorectomy (for ovarian cancer prevention) severely impaired menopause-specific QoL and sexual-function, particularly without hormone-replacement. Quantitative studies supported these results, finding low distress and generally high satisfaction. Hysterectomy as treatment of bleeding improved QoL, resulted in high satisfaction, and no change or improvements in sexual and urinary function, although small numbers reported worsening.

Conclusions: There is very limited evidence on QoL after RRH. Whilst there are benefits, most adverse consequences arise from oophorectomy. Benign hysterectomy allows for some limited comparison; however, more research is needed for outcomes in the population of women at increased EC-risk.

Keywords: Lynch syndrome; decision regret; endometrial cancer prevention; hysterectomy; menopause; quality of life; risk reducing hysterectomy; satisfaction.

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Conflict of interest statement

R.M. declares research funding from Barts & the London Charity, Rosetrees Trust, Eve Appeal, GSK, BGCS, outside this work, an honorarium for grant review from Israel National Institute for Health Policy Research and honorarium for advisory board membership from Astrazeneca/Merck Sharp & Dohme/Everything Genetics limited. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PICO framework of the systematic review. EC, Endometrial cancer; HMB, Heavy menstrual bleeding; DUB, Dysfunctional uterine bleeding; BSO, Bilateral salpingo-oophorectomy; QoL, Quality of Life.
Figure 2
Figure 2
PRISMA flow diagram of study selection [30].
See this image and copyright information in PMC

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