University of Texas Southwestern Medical Center Dallas, TX
I. Anawate1, C. Lumley1, S. Silverwood2, M. Anchondo1, K. Hughes3, C. Kernell1, R. Bhatia4, and S. Grover5; 1UNIVERSITY OF TEXAS SOUTHWESTERN, Dallas, TX, 2MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE, Grand Rapids, MI, 3WAKE FOREST UNIVERSITY, Winston-Salem, NC, 4JOHNS HOPKINS UNIVERSITY, Baltimore, MD, 5Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Purpose/Objective(s): Cervical cancer is one of the most prevalent cancer types for women globally. The aim of this systematic review is to assess different tools used to evaluate quality of life (QoL) after pelvic radiation for cervical cancer and differences in QoL after pelvic radiation globally. This review hypothesizes regional preferences in the selection of these tools and an absence of uniformity in the application of surveys.Materials/
Methods: A systematic review was carried out using PubMed, Embase, Global Health, Global index medicus, and Scopus on 11/22/2021 and on 6/14/2023 to search publications that evaluated QoL of cervical cancer patients during and after radiation. Excluded from this analysis were studies involving cancers originating outside the cervix, those not exclusively undergoing radiation or chemoradiotherapy, systematic reviews, and non-English studies. Results: This study consisted of 237 studies covering 25,693 patients. 52 countries were represented. Of the 219 studies conducted in one country, most were conducted in Asia (35.6%) followed by Europe (32.9%). The most frequently represented country, however, was the United States (13.9% of studies).One hundred quality of life instruments were identified. EORTC QLQ-C30 (38.0% of studies) and EORTC QLQ-Cx24 (29.5%) were the most common. Study-specific questionnaires, created by the authors for the specific study, were the third most common (13.5%). The FACT-G and FACT-Cx were used in 8.0% and 7.2% of studies, and the SF-36 and SF-12 were used in 4.2% and 3.0% of studies. Due to heterogeneity of the instruments used, there were limited comparisons made between QoL data collected in different regions.Data from the EORTC QLQ-C30 and QLQ-CX24 was extracted from 14 studies. At completion of treatment, EORTC QLQ-C30 data showed average scores assessing global health status ranging from 59.5-82.11, physical functioning from 54.17-89.8, role functioning from 53.92-91.7, emotional functioning from 51.78-71.7, cognitive functioning from 76.2-91.1, fatigue 37.3-45.42, and pain ranging from 18.2-46.28. EORTC QLQ-CX24 data after treatment showed average scores assessing body image ranging from 33.8-59.5, sexual activity from 23.7-83, sexual/vaginal functioning from 25-34.4, symptom experience from 12.6-17, peripheral neuropathy from 7.1-21.9, and menopausal symptoms ranging from 1.2-26.9. Conclusion: The findings from this study reveal a fragmented landscape, marked by significant variability in QoL survey use and distribution during patient treatment. There is a need for a global standardized method to evaluate QoL after treatment of cervical cancer with radiotherapy in order to compare QoL across regions. Despite having a large burden of cervical cancer, QoL data from Africa is limited. Simplified tools to evaluate QoL may assist with broader collection of quality of life data, which may help lead to advancements that can improve QoL of women with cervical cancer after radiation globally.
