Quality of life in gynecologic oncology: Two key topics.

摘要

INTRODUCTION: Gynecologic oncology patients experience a multitude of symptoms that may negatively impact quality of life (QOL). These may result from radical surgical interventions or may be due to the natural progression of their disease. These patients have extensive needs, needs which are ill defined and understudied by investigators. Two key areas for research include the better understanding of the QOL changes that patients undergo in response to radical pelvic surgery and optimizing symptom management and overall care at the end of life.;MANUSCRIPT I - A Prospective Study of Quality of Life in Patients Undergoing Pelvic Exenteration: Interim Results.;BACKGROUND: Pelvic exenteration (PE) is a radical procedure that affects many domains of QOL. Little prospective data exist on QOL after pelvic exenteration.;OBJECTIVES: To prospectively examine the QOL-changes following PE using a comprehensive battery of psychological instruments.;METHODS: Patients undergoing PE were interviewed preoperatively and at 3, 6, and 12 month after PE for physical/psychological symptoms and overall QOL using standardized instruments (EORTC-QLQ-C30, EORTC-CR38, EORTC QLQ-BLM-30, BFI, BPI-SF, IADL, CES-D, IES-R). Clinic interviews were supplemented with telephone ones whenever the former wasn't feasible. Data were examined using repeated measure ANOVAs.;RESULTS: Since 2005, 27 female patients were enrolled and underwent PE. Three patients died of disease within one year of surgery and four completed <1 year of follow up. Of the remaining 20 patients, 16 (80%) were available for interview at the four time points and form the study cohort (3 anterior, 1 posterior, and 12 total PE). Median age was 58 years (range 28-76). Overall QOL (F=6.3, p<0.02), ability to perform instrumental daily activities (F=6.8, p<0.02), body image (F=11.9, p<0.00) and sexual function (F=8.0, p<0.01) all declined at 3 month but were near baseline by 12 month after PE. Although, overall, physical function followed a similar trend (F=14.8, p<0.00), it did not return to baseline. At the 12 month interview, patients reported increased gastrointestinal symptoms (F=8.9, p<0.01) but significantly less stress-related ideation (F=6.1, p<0.03) compared to baseline. Pain levels did not change significantly during the study period (F=0.4, p<0.74).;DISCUSSION: Although patients report lingering gastrointestinal symptoms and some persistent decline in physical function after PE, most adjust well returning to almost baseline functioning within a year. Providers can counsel patients that many, though not all, symptoms in the first 3 months following exenteration are likely to improve as they adapt to their changed health status. These preliminary results await confirmation of a larger analysis.;MANUSCRIPT II - Palliative Care in Gynecologic Oncology.;BACKGROUND: Patients with advanced gynecologic malignancies suffer from a multitude of symptoms; pain, nausea and vomiting, constipation, anorexia, diarrhea, dyspnea, as well as symptoms resulting from intestinal obstruction, hypercalcemia, ascites and/or ureteral obstruction.;METHODS: Prior literature regarding the optimal management of the main symptoms affecting terminal patients with advanced gynecologic malignancies was compiled and summarized.;RESULTS: Pain is best addressed through a multimodal approach. The optimum palliative management of end-stage malignant intestinal obstruction remains controversial with no clear guidelines governing the choice of surgical versus medical management.;DISCUSSION: Patient selection for palliative surgery for the relief of end-stage malignant intestinal obstruction should be highly individualized, because only carefully selected candidates may derive real benefit from such surgeries. More emphasis on palliative care education in training programs is needed.;OVERALL CONCLUSIONS: Understanding the diverse challenges encountered by patients with advanced gynecologic malignancies and incorporating information obtained through QOL research into identifying rehabilitation needs, designing effective interventions and characterizing those patients that are most suitable for these interventions may help providers to better tailor supportive services.