Cervical Cancer: Methods for Assessing the Quality of Life

Abstract

The treatment of patients with cervical cancer has changed significantly in recent years. Pelvic surgery, radiotherapy, chemotherapy or combined regimens are successful treatment options in terms of survival (Photopulos 1990; Burke 1994; Landoni et al. 1997; Morris et al. 1999; Rose et al. 1999). For patients with disease of limited volume, radical abdominal hysterectomy is usually performed, which may cause quality of life (QoL) impairments due to physiological and psychological effects. Approximately, 25% of women with early stage cervical cancer reported vaginal changes that persisted 5 years after radical surgery (Bergmark et al. 1999). For locally advanced disease extensive radiotherapy including external pelvic irradiation and brachytherapy has been the standard treatment for several years (Keys and Gibbons 1996). More recently concurrent chemoradiotherapy has become the treatment of choice for locally advanced cervical cancer with promising results in terms of survival (Green et al. 2001). Neoadjuvant chemotherapy followed by radical surgery has been suggested as an alternative to irradiation (Buda et al. 2005). Intensive multimodal therapies are potentially curative treatments, but may produce adverse effects surfacing months or years later. Concomitant chemoradation may double acute and late toxicity and cause severe or potentially life-threatening complications (Kirwan et al. 2003). Vaginal stenosis, atrophy, or loss of elasticity of vaginal tissues after radiotherapy are well-documented. Many women fear that intercourse may be painful or will cause damage. Sexual dysfunctions experienced by women after cervical cancer treatment have been reported (Jensen et al. 2003; Frumovitz et al. 2005; Vistad et al. 2006).