Long-term patient-reported distress in locally advanced cervical cancer patients treated with definitive chemoradiation

Abstract

Background and purpose: To evaluate longitudinal patient-reported distress in cervical cancer patients treated with definitive chemoradiation (CRT). Materials and methods: Between 2011 and 2016, consenting cervical cancer patients treated with definitive CRT who completed 2 revised Edmonton Symptom Assessment System (ESAS-r) questionnaires at clinical visits, including baseline, were included. A linear mixed model was used to assess the longitudinal trend in ESAS-r. A minimal clinically important difference (MCID) for total ESAS-r score was defined as a change of 3-points for improvement and 4-points for deterioration. The proportion of patients with an MCID over time was described using moving averages. To test for changes, mixed effects logistic models were fitted, each of which included patient-specific random intercepts and random slopes. Results: 67 patients were eligible for analysis (736 ESAS-r assessments). Median (range) follow-up was 24 months (range: 15-45) and compliance at 12 months was 60% (40/67). There was a significant decrease in ESAS-r scores over time. Baseline ESAS-r was strongly predictive of ESAS-r at follow-up (p < 0.001). The proportion of patients with an MCID for improvement from baseline significantly increased over time (p < 0.001) and the proportion with an MCID for deterioration significantly decreased over time (p < 0.001). No predictors for distress were found. Conclusions: Long-term cervical cancer survivors experience distress that significantly improves over time to an extent expected to be clinically meaningful for patients. Implementing cervical cancer specific patient-reported outcome tools into practice could better inform patient needs.

Quality of Life among Survivors of Locally Advanced Cervical Cancer Treated with Definitive Chemoradiotherapy in a Decade of Transition

“…19,22,23,[25][26][27] Two papers characterized the temporal evolution of health-related QoL among LACC survivors. 19,21 One reported improvement at 12, 24, and 36 months. 19 In this cohort, 3DCRT or IMRT, and IGBT were used entirely, and hybrid ICISBT was an available modality.…”

“…A Thai study 20 reported using tri-weekly cisplatin, or weekly or tri-weekly carboplatin, as alternative regimens. The EBRT technique was not specified in the studies, except for two, 19,21 both of which used advanced, conformal EBRT techniques (3D CRT, IMRT). One study 22 used standard 2D BRT, while three 19,21,23 used IGBT.…”

“…The EBRT technique was not specified in the studies, except for two, 19,21 both of which used advanced, conformal EBRT techniques (3D CRT, IMRT). One study 22 used standard 2D BRT, while three 19,21,23 used IGBT. Furthermore, two reported using advanced hybrid ICISBT implants.…”

“…The number and quality of studies included in our review reflect the relative paucity of high-quality literature on longterm QoL among LACC survivors. Of the nine papers included in this review, one 19 is a multinational study; six [20][21][22][25][26][27] come from upper-middle or high income countries, namely, Brazil, Canada, Italy, Bosnia and Herzegovina, and Thailand; and two 23,31 come from a lower-middle income country, India. 56 The studies include three small (<50) cross-sectional studies, 20,27,31 one (n ¼ 67) retrospective study, 21 and three small (<60) prospective studies.…”

Snapshot of symptoms of advanced cervical cancer patients referred to the palliative care service in a cancer center in Mexico

“…Patients with CC in public hospitals seek medical care with advanced disease. In addition to the poor prognosis, 6,10 these women experience multiple distressing symptoms associated with the anatomical location of the tumor and/or its treatments 11‐13 …”