Life after cancer - as bad as we think?
A new Australian study claims that women who survive gynaecological cancers have a good quality of life - although there were some unanswered questions about the impact of treatment on sexual activity.
The study of 202 women attending a follow-up clinic is reported in this month's issue of the journal Psycho-Oncology.
"Although a few individuals did not feel they had a good quality of life, on average patients rated their quality of life as being good," said lead author Dr Robyn Leake, an expert in obstetrics and gynaecology at King Edward Memorial Hospital in Western Australia.
The women in the study had survived endometrial and cervical cancer, and to a lesser extent ovarian and vulval tumours. They had received radiotherapy and surgery (such as removal of the uterus, ovaries, parts of the vulva, or lymph glands in the inner thigh), and had returned to the clinic each year for internal examinations and other follow-up.
The researchers gave the women a questionnaire called FLIC (Functional Living Index - Cancer) specifically designed for cancer survivors, which asked them to rate how they felt about various aspects of their physical and social function. The questionnaires were filled out in the clinic and handed to the nurse before they visited their doctor.
Dr Leake said the patients scored between 59 and 154 (out of a possible range of 22 to 154) with most scoring around 140, indicating they felt they had a good quality of life.
Questions remain about sex
The researchers also asked other questions not included in the FLIC survey, including those on sexual function and overall quality of life. However the information gathered raised more questions.
"We realised that the question on sex was inadequate," said Dr Leake. "Nearly half the participants did not answer it and we could not tell whether this was because it wasn't relevant to them or because there was a problem."
Of those who did respond, over half reported their sexual function was the same or better than prior to treatment, while around 15 per cent said it had worsened. Patients who lived with a partner were more likely to report a worsening of sexual function than those who did not.
"We needed to get more information and this is part of an ongoing evaluation," she said.
The researchers also asked doctors to rate the patients' quality of life and found that interestingly, that doctors were rather more pessimistic.
"Doctors consistently rated patients as worse off," said Dr Leake, adding that she thought doctors reflected general community perception about such patients.
Patients who had received radiotherapy rated their quality of life as being worse than before treatment. Dr Leake said that the reason for this was not investigated but that radiotherapy could cause problems with bladder functioning and scarring of the genital tract.
The study did not differentiate between patients with different severity of cancer and treatment.
Evaluation of a patient's quality of life following treatments is important in assessing new cancer treatments, especially when several kinds of treatment results offer similar survival rates.