Quality of Life in Women After Pelvic Exenteration for Gynecological Malignancies

open access
 Quality of Life in Women After Pelvic Exenteration for Gynecological Malignancies: A Multicentric Study.

 Women receiving PE for advanced epithelial ovarian cancer were not included in the study.....Patients affected by ovarian cancer have been excluded from the study because of the frequent upper abdominal involvement, which requires an extensive supramesocolic cytoreductive surgery concomitant with PE.

Objectives: This retrospective, multicentric study investigates quality-of-life issues and emotional distress in gynecological cancer survivors submitted to pelvic exenteration (PE).

Methods: The Global Health Status scale of European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30; the EORTC QLQ-CX24 (CX24), and EORTC QLQ-OV28 questionnaires were administered at least 12 months from surgery only in women with no evidence of further recurrence after PE. Statistical analysis was performed by the analysis of variance (for repeated measures.

Results: Ninety-six subjects affected by gynecological malignancies receiving PE were enrolled in the study. Anterior PE was performed in 47 patients (49%), posterior PE was performed in 29 cases (30.2%), and total PE performed in 20 women (20.8%). In 38 cases (39.6%), a definitive colostomy was performed. Urinary diversion with continent pouch was created in 11 patients. (11.5%), whereas in the remaining cases, a noncontinent pouch was reconstructed. Patients showed a significant discomfort in attitude to disease (71.5 +/- 4.7), body image (48.9 +/- 6.4), financial difficulties (56.2 +/- 5.8), gastrointestinal symptoms (constipation, 47.8 +/- 5.1; diarrhea, 62.4 +/- 6.6; appetite loss, 43.6 +/- 6.7), insomnia (64.5 +/- 6.6), Global Health Status (64.6 +/- 3.8), physical functioning (65.8 +/- 4.6), role functioning (58.8 +/- 5.8), and emotional functioning (67.4 +/- 4.2). A higher number of ostomies (hazard rate [HR], 7.613; P = 0.012), the creation of a noncontinent bladder (HR, 8.230; P = 0.009), and of definitive colostomy (HR, 8.516; P = 0.008) emerged as independent predictors of poorer Global Health Status scores. Older age (HR, 11.235; P = 0.003), vaginal/vulvar cancer (HR, 7.369; P = 0.013), total/posterior PE (HR, 7.393; P = 0.013), higher number of ostomies (HR, 7.613; P = 0.012), the creation of a noncontinent bladder (HR, 8.230; P = 0.009), and of definitive colostomy (HR, 8.516; P = 0.008) emerged as independent predictors of lower body image levels.

Conclusions: Long-term psycho-oncological support is strongly recommended. The reduction of ostomies seems the most effective way to improve patients' quality of life.

 .....In this context, it is well known that besides the impact
of cancer diagnosis by itself, the surgical removal of organs
accomplishing reproductive functions significantly affects QoL
in women with gynecological cancer.5 Therefore, it is conceivable
to hypothesize that the impairment of bowel, urinary, and
sexual functions related to mutilating surgical approach, such as
PE, may have profound psychological implications onwomen’s
self-identity and QoL.14,15 However, despite these considerations,
only few experiences have evaluated the QoL of gynecological
cancer patients submitted to PE.16,17.....