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abstract
The health-related quality of life journey of gynecologic oncology surgical patients: Implications for the incorporation of patient-reported outcomes into surgical quality metrics
Highlights
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- Temporary declines in functional QOL are balanced by improvements in emotional QOL and anxiety.
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- Commonly used HRQOL instruments may not best reflect the perioperative surgical experience.
Abstract
Objective
To report the changes in patient-reported quality of life for women undergoing gynecologic oncology surgeries.
Methods
In
a prospective cohort study from 10/2013–10/2014, women were enrolled
pre-operatively and completed comprehensive interviews at baseline, 1,
3, and 6 months post-operatively. Measures included the disease-specific
Functional Assessment of Cancer Therapy-General (FACT-GP), general
Patient Reported Outcome Measure Information System (PROMIS) global
health and validated measures of anxiety and depression. Bivariate
statistics were used to analyze demographic groups and changes in mean
scores over time.
Results
Of 231
patients completing baseline interviews, 185 (80%) completed 1-month,
170 (74%) 3-month, and 174 (75%) 6-month interviews. Minimally invasive (n = 115, 63%) and laparotomy (n = 60, 32%) procedures were performed. Functional wellbeing (20 → 17.6, p < 0.0001) decreased at 1-month, and recovered by 3 and 6 months. Emotional wellbeing increased (16.3 → 20.1, p < 0.0001) and anxiety decreased (54.2 → 49.0, p < 0.0001)
at 1-month, and were stable at 3 and 6 months. Physical wellbeing
scales were not sensitive to surgery. These patterns were consistent
across procedure type, cancer diagnosis, and adjuvant therapy
administration. In an exploratory analysis of the interaction of QOL and
quality, patients with increased postoperative healthcare resource use
were noted to have higher baseline levels of anxiety.
Conclusions
For
women undergoing gynecologic oncology procedures, temporary declines in
functional wellbeing are balanced by improvements in emotional
wellbeing and decreased anxiety symptoms after surgery. Not all commonly
used QOL surveys are sensitive to changes during the perioperative
period and may not be suitable for use in surgical quality metrics.
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