Resilience, pain, and health-related quality of life in gynecological patients undergoing surgery for benign and malignant conditions: a 12-month follow-up study

Abstract

Background Gynecological surgery has many impacts on women’s physical and mental health, and efforts to improve recovery from surgery are constantly under evaluation. Resilience is an ability to overcome stressors and adversities, such as traumas and surgeries. This study aimed to explore patients’ resilience and psychological symptoms in relation to recovery, health-related quality of life (HRQoL), and pain one year after gynecological surgery. Methods In a prospective cohort study, we enrolled consecutive elective gynecologic surgery patients who completed questionnaires before and at one year after surgery: the Resilience Scale-25, the 15D instrument of HRQoL (15D), the Life Satisfaction Scale-4, and the Hospital Anxiety and Depression Scale. Their mean 15D scores were compared to those of an age-matched sample of women from the general Finnish population (n = 2743). Results We enrolled 271 women who underwent gynecological surgery due to benign (n = 190) and malignant (n = 81) diagnoses. Resilience was equally high in women with benign and malignant diagnoses at both time points. Higher resilience associated with less pain, analgesic use, and better pain relief from the use of pain medication at 12 months after surgery. Pain intensity was similar in the two groups, but patients with benign diseases had less pain at 12 months than before surgery. Before surgery, patients’ HRQoL was worse than that of the general population, but at 12 months the mean HRQoL of patients with benign diseases had improved to the same level as that in the general population but had decreased further in patients with malignant diseases. Anxiety was higher and life satisfaction was lower in patients with malignant diseases before surgery. At 12 months, anxiety had decreased in both groups, and life satisfaction had increased in patients with malignant diseases. Depression was similarly low in both groups and time points. Conclusions Resilience correlated with less pain one year after surgery. After surgery, HRQoL improved in patients with benign diseases but deteriorated in patients with malignant diseases. Patients with low resilience should be identified during preoperative evaluation, and health care professionals should give these patients psychological support to enhance their resilience. Trial Registration ClinicalTrials.gov; registered October 29, 2019; identifier: NCT04142203; retrospectively registered.

Family‐oriented care and health‐related quality of life for women with gynaecological cancer: A cross‐sectional mixed‐method study

“…Furthermore, the experience of distress was statistically significant in the first phase of treatment. The qualitative description of insufficient emotional support confirms the quantitative findings of distress, and this result is in line with a Finnish study by Isokääntä et al (2022), who followed patients with gynaecological cancer for 12 months and examined the results of the HRQoL questionnaire. Distress worsened in the malignant cancer group during the follow-up period.…”

“…The respondent chooses the level that best describes her/his present health status from each dimension (15D©). This instrument can be used to assess the quality-of-life experience of a specific patient group and has been widely used in studies of cancer patients (Flyum et al, 2021;Isokääntä et al, 2022).…”

“…The qualitative descriptions of intimate life issues and the need for guidance and support converge with the quantitative response rate regarding sexual activity, which was worse when looking at mean variables. In the study by Isokääntä et al (2022), during the follow-up period, sexual activity worsened when women rated it using the same HRQoL measure (15D©). It is important to note that in the HRQoL measure, sexual activity is measured as an experience of sexual life, while in the qualitative descriptions, the emphasis is more generally on issues related to sexual health and woman-centredness.…”

Association Between Preoperative Patient Resilience and Patient-Reported Outcomes After Rotator Cuff Repair

“…Resilience has been specifically chosen over other tools for evaluating the psychological impact on outcomes as the ability to cope with stress is useful in the recovery and rehabilitation after surgery across many fields of medicine. 3 , 10 , 16 A recent study evaluating total knee arthroplasty (TKA) patients showed that preoperative resilience is an important predictor of physical and mental health of patients at 3 months and 12 months postsurgery. 16 Further, greater concurrent resilience was associated with better scores across all measured outcomes, which is in contrast to a recent study of TKA patients by Haffar et al 8 which found no significant correlation between resilience and patient-reported outcome scores, both measured 1 year postoperatively.…”