Impact of Chemoradiotherapy on Quality of Life in Cervical Cancer Patients: A Prospective Cohort Study

Abstract

Background: Cervical cancer is considered to be a global health challenge, particularly in low- and middle-income countries. Romania reports one of the highest burdens in Europe due to limited access to screening and HPV vaccination. Chemoradiotherapy is standard for locally advanced disease, but the impact on quality of life (QoL) for a low- and middle-income population has not yet been explored. This study aims to evaluate the effect of chemoradiotherapy on the QoL of cervical cancer survivors in the Romanian population. Methods: This prospective observational study included 111 patients with stage I-IV cervical cancer undergoing chemoradiotherapy. QoL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire before, during, and after treatment. Demographic and clinical data were collected. The statistical analyses included t-tests, ANOVA, and linear mixed-effects models to evaluate changes over time and the influence of sociodemographic and treatment-related factors. Results: FACT-G scores significantly increased after treatment, with improvements in physical and functional well-being. Better before-treatment QoL was associated with urban residence, early-stage disease, marital status, and higher education. Among treatment toxicities, only nausea had a statistically significant negative effect on QoL during treatment, while other toxicities showed no significant impact. Conclusions: Chemoradiotherapy in cervical cancer patients was not associated with a substantial deterioration in quality of life during treatment and was followed by significant improvement after therapy completion. These findings highlight a favorable short-term QoL trajectory and emphasize the need for longitudinal studies to assess whether such benefits are maintained over the long term.

Keywords: Functional Assessment of Cancer Therapy-General (FACT-G); adverse events; cervical cancer; chemoradiotherapy; quality of life (QoL).

Figure 1

Study flowchart.

Figure 2

FACT-G subdomain scores before, during, and after treatment.

Figure 3

Quality of life for each subdomain. Overall, the score increases for each subdomain after treatment, with slightly worse scores during treatment.

Figure 4

Mixed effects for FACT-G score at baseline (T1) to after treatment (T2) for main toxicities (binary). Bars not crossing 0 are statistically significant.

Figure 5

Mixed effects for PWB scores at baseline (T1) to after treatment (T2). Bars not crossing 0 are statistically significant.