Changes in quality of life among patients with cervical cancer undergoing rehabilitation: a prospective cohort study

Vollständiger Abstract

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Background. Cervical cancer (CC) remains a significant problem in gynecologic oncology, occupying leading positions in the morbidity structure among women. Current treatment methods have a substantial impact on the quality of life (QoL) of patients. However, data on the dynamics of QoL during the rehabilitation process in patients with CC across different stages are insufficient. Objective: To analyze the QoL dynamics during the rehabilitation period in CC patients who received various treatment modalities over a 3-year follow-up period, using the Functional Assessment of Cancer Therapy General (FACT-G) questionnaire with extension for CC. Material and methods. A prospective cohort study was conducted involving 302 patients with verified CC. The participants were divided into four groups in accordance with disease stage and treatment modality, ranging from conization for carcinoma in situ to chemoradiotherapy for stage III, and a control group (n=43). The rehabilitation program integrated prehabilitation and subsequent rehabilitation, combining pharmacological, non-pharmacological, and psychotherapeutic approaches. QoL was assessed before treatment, at 1 week, 1, 3, 6, 12 months, 2 and 3 years. Results. Before treatment, all groups of CC patients had significantly lower QoL scores compared to the control group (total FACT-G score: from 78.3±6.1 in Group 0 to 54.2±7.2 in Group 3 vs. 97.5±5.4 in the control group; p<0.05). The dynamics of QoL were biphasic: an acute decline in the early period (1 week 1 month) followed by gradual recovery. Patients with early-stage disease (Group 0) showed the fastest and most complete recovery to the control group’s level by the 6[th] month. In Group 3 (chemoradiotherapy), recovery was the slowest and most incomplete: at 3 years, the total FACT-G score (82.3±6.3) remained significantly below control values (p<0.05). The greatest impairments were observed in “physical well-being” and “emotional well-being” domains. Conclusion. The QoL during the rehabilitation period fluctuates due to treatment modality and therapy extent. While patients after fertility-sparing surgeries have the most favorable prognosis for recovery, patients after chemoradiotherapy require the most intense and prolonged rehabilitation. The obtained data can be used to develop personalized rehabilitation programs.