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. 2023 Apr:181:109501.
doi: 10.1016/j.radonc.2023.109501. Epub 2023 Jan 30.

Association of persistent morbidity after radiotherapy with quality of life in locally advanced cervical cancer survivors

Sofia Spampinato  1 , Kari Tanderup  2 , Jacob C Lindegaard  3 , Maximilian P Schmid  4 , Alina Sturdza  5 , Barbara Segedin  6 , Ina M Jürgenliemk-Schulz  7 , Astrid De Leeuw  8 , Kjersti Bruheim  9 , Umesh Mahantshetty  10 , Cyrus Chargari  11 , Bhavana Rai  12 , Rachel Cooper  13 , Elzbieta van der Steen-Banasik  14 , Marit Sundset  15 , Ericka Wiebe  16 , Elena Villafranca  17 , Erik Van Limbergen  18 , Bradley R Pieters  19 , Li Tee Tan  20 , Ludy C H W Lutgens  21 , Peter Hoskin  22 , Stéphanie Smet  23 , Richard Pötter  24 , Remi Nout  25 , Supriya Chopra  26 , Kathrin Kirchheiner  27 ; EMBRACE Collaborative Group Appendix
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Free article

Association of persistent morbidity after radiotherapy with quality of life in locally advanced cervical cancer survivors

Sofia Spampinato et al. Radiother Oncol. 2023 Apr.
Free article

Abstract

Purpose: To quantify the association of persistent morbidity with different aspects of quality of life (QOL) in locally advanced cervical cancer (LACC) survivors.

Material and methods: Longitudinal outcome from the EMBRACE-I study was evaluated. Patient-reported symptoms and QOL were prospectively scored (EORTC-C30/CX24) at baseline and regular follow-ups. Physician-assessed symptoms were also reported (CTCAEv.3). Persistent symptoms were defined if present in at least half of the follow-ups. QOL items were linearly transformed into a continuous scale. Linear mixed-effects models (LMM) were applied to evaluate and quantify the association of persistent symptoms with QOL. Overall QOL deterioration was evaluated by calculating the integral difference in QOL over time obtained with LMM for patients without and with persistent symptoms.

Results: Out of 1416 patients enrolled, 741 with baseline and ≥ 3 late follow-ups were analyzed (median 59 months). Proportions of persistent EORTC symptoms ranged from 21.8 % to 64.9 % (bowel control and tiredness). For CTCAE the range was 11.3-28.6 % (limb edema and fatigue). Presence of any persistent symptom was associated with QOL, although with varying magnitude. Role functioning and Global health/QOL were the most impaired aspects. Fatigue and pain showed large differences, with reductions of around 20 % for most of the QOL aspects. Among organ-related symptoms, abdominal cramps showed the largest effect.

Conclusion: Persistent symptoms are associated with QOL reductions in LACC survivors. Organ-related symptoms showed smaller differences than general symptoms such as fatigue and pain. In addition to optimizing treatment to minimize organ-related morbidity, effort should be directed towards a more comprehensive and targeted morbidity management.

Keywords: Clinical trial; Locally advanced cervical cancer; Morbidity; Patient reported outcome; Quality of life.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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