Identification of Predictive Factors in Endometriosis for Improvement in Patient Quality of Life

Abstract

Study Objective: To investigate predictive factors for change in quality of life (QOL) between pre-and postoperative periods in patients with endometriosis. Design: A prospective and multicenter cohort study. Setting: Five districts including a tertiary referral center and private and general public hospitals. Patients: Nine hundred eighty-one patients aged 15 to 50 years underwent laparoscopic treatment (preferred approach) for endometriosis between January 2004 and December 2012. Interventions: Laparoscopic treatment for endometriosis. All revised American Fertility Society stages were included. Measurements and Main Results: QOL was evaluated using the 36-Item Short Form Survey questionnaire. Factors influencing changes for each 36-Item Shorty Form Survey domain score between t0 (before surgery) and 1 year after surgery were predicted on the basis of univariate and multivariable analyses. The effect size (ES) method was used to measure changes in QOL. Univariate analysis revealed that 47% of stage IV endometriosis patients presented an improvement in the postoperative Physical Component Summary (PCS) score (ES ≥ 0.8) versus 26%, 31.3%, and 27.5% of patients with stage I, II, and III, respectively (p <.001). Forty-four percent and 38% of patients with chronic pelvic pain (CPP) presented an improvement in postoperative PCS and Mental Component Summary scores (ES>0.8) versus 23% and 24% of patients without CPP, respectively (p <.001). Multivariable analysis (ES > 0.8 vs ES < 0) revealed that women with CPP were more likely to experience greater improvement in postoperative PCS and Mental Component Summary scores than women without CPP (relative risk [RR] = 2.7; 95% confidence interval [CI], 1.7−4.4; p <.001 and RR = 1.8; 95% CI, 1.2−2.8; p <.01, respectively). Accordingly, fertile patients were more likely to show higher rates of improvement in the postoperative PCS score than infertile patients (RR = 1.8; 95% CI, 1.1−3.1; p <.05). Conclusion: Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in QOL after surgery. CPP is the most significant independent predictive factor for changes in QOL scores.

Long-Term Evolution of Quality of Life and Symptoms Following Surgical Treatment for Endometriosis: Different Trajectories for Which Patients?

“…This prospective multicenter study was previously presented [ 8 , 18 ] and concerned a cohort of 962 consecutive patients aged 15–50 years treated by laparoscopy between January 2004 and December 2012.…”

“…Patients lost to follow-up included those who declined further participation in the study and those who could not be contacted due to a change in address or telephone number. Intensity of pain was reported using a visual analog scale (VAS) (0 represents no pain and 10 the worst imaginable pain), and quality of life was evaluated using the French version of the Medical Outcome Study Short Form 36 Item Health Survey (MOS SF-36) [ 8 , 18 , 19 , 20 ]. Pelvic pain symptoms (dysmenorrhea, chronic pelvic pain (Cpp) and dyspareunia) have been previously described [ 18 , 21 ].…”

“…Intensity of pain was reported using a visual analog scale (VAS) (0 represents no pain and 10 the worst imaginable pain), and quality of life was evaluated using the French version of the Medical Outcome Study Short Form 36 Item Health Survey (MOS SF-36) [ 8 , 18 , 19 , 20 ]. Pelvic pain symptoms (dysmenorrhea, chronic pelvic pain (Cpp) and dyspareunia) have been previously described [ 18 , 21 ]. Medical treatment prescribed after surgery included contraception (oral progestins, the Mirena intrauterine device, implant, continuous pills), Luteinizing Hormone Releasing Hormone (LHRH) analogues or antigonadotropic agents.…”

“…Our surgical technique has been previously described [ 18 ]. Laparoscopy being the preferred approach, surgical treatment of endometriosis was performed as follows: superficial peritoneal lesions were treated by bipolar coagulation or peritoneal resection; endometriomas were treated by cystectomy as described previously [ 22 ]; recto-vaginal nodules were treated by shaving or by colorectal resection where a satisfactory shaving procedure was deemed impossible (our surgical technique has been previously reported [ 11 , 23 ]).…”

Quality of Life in Women with Deep Endometriosis: A Cross-Sectional Study

“…[10][11][12][13][14] The majority of studies in the literature did not evaluate women according to the disease stage, although few studies show a poorer QOL in later stages. 15 In addition, women with chronic pain have a lower QOL due to both physical and psychological factors. 16,17 The literature also shows that pain reduction is generally not related to the improvement of psychological disturbances.…”