Health and Quality of Life Outcomes

Gynecologic malignancies occur in approximately 1 in 20 women in the United States. Until recently, clinical management of these cancers has focused almost exclusively on prolonging the survival of patients. A recent literature search using MEDLINE revealed relatively few research studies that reported data on quality of life (QOL) in a gynecologic cancer population. Reports in the literature have been conflicting, with some studies finding deterioration in QOL and some finding stability or improvement in QOL over time. Until recently, the impact of various treatments (surgery, radiation, chemotherapy) on QOL in this population was unknown. Recently, the QOL of women with gynecologic cancer has been compared to that of women with other types of cancer. Also, risk factors for poor adjustment in gynecologic cancer are beginning to be investigated. This presentation will attempt to 1) summarize the relevant literature on QOL in a gynecologic cancer population, 2) compare QOL in this population to other types of cancer, 3) examine risk factors for poor adjustment and 4) describe the limitations of the literature and future research directions. Overall, it appears that QOL is most negatively affected from time of diagnosis through completion of treatment. Following treatment, QOL appears to improve over the course of 6–12 months, but then appears to remain stable from that time through two years post-treatment. Compared to breast cancer patients, it appears that gynecologic cancer patients experience poorer QOL on several domains during active treatment, but that after completion of treatment, overall QOL is similar between groups. Risk factors for maladjustment include treatment with radiotherapy or multi-modality treatment, increased length of treatment, younger age, and coping using a disengaged style. Other risk factors include lower education, poor social support and lower levels of religious belief. The significance of these findings and future research directions will be discussed. Review of Literature Until recently, treatment for gynecologic malignancies has focused almost exclusively on prolongation of life, and few research studies have adequately addressed issues related to quality of life [1]. Quality of life (QOL) typically involves the assessment of several dimensions: physical well-being, emotional well-being, social well-being, and functional well-being. As recently as 1993, Andersen published an article acknowledging a grave lack of research on quality of life and challenging "institutions and study groups to support quality of life research for women with gynecologic cancer" [2]. To date, few studies have utilized QOL as a primary endpoint. Published: 20 August 2003 Health and Quality of Life Outcomes 2003, 1:33 Received: 16 July 2003 Accepted: 20 August 2003 This article is available from: http://www.hqlo.com/content/1/1/33 © 2003 Pearman; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.