Survivorship and cervical cancer

In a literature review by Pfaendler et al, long term quality of life for cervical cancer survivors was shown to have a high correlation with the method of treatment(s) used. Treatment-related effects, including urinary, gastrointestinal, sexual, and neurologic side effects were shown to interfere with the quality of life in cervical cancer patients [25]. Patients who have undergone more radical surgery and, in particular, radiotherapy had more persistent bladder, bowel and sexual dysfunction many years after treatment [26]. It is essential that cervical, like many other kinds of cancer, continues to be viewed as a life long journey with emphasis on improving treatments that minimize the impact on quality of life.

Impact of treatment on the bladder and bowel

The stage and grade of the cancer and the method of treatment(s) can have a long-term impact on the urinary system and bowel. Surgical treatment and radiation therapy, particularly when both used, lead to risks of sequelae (an abnormal condition resulting from a previous disease) in the urinary and gastrointestinal systems. It is estimated that approximately twenty per cent of cervical cancer survivors have long-term bladder dysfunction [27]. Furthermore, up to ninety per cent of patients can have permanent changes in their bowel habits after pelvic radiotherapy, and up to fifty per cent state that these symptoms negatively affect their quality of life [28].

Sexual dysfunction

As cervical cancer impacts a relatively young demographic—the average age of diagnosis is 50—sexual dysfunction can significantly affect quality of life [29]. In a case-control study of 254 cervical cancer survivors 4 to 11 years after diagnosis with no subsequent recurrence or second tumour, cervical cancer survivors had significantly worse mean scores for sexual discomfort, as well as hot flashes, vaginal dryness, and vaginal bleeding and reproductive concerns compared to the control group [30]. The common thread that emerging from the literature review by Pfaendler et al suggests that although sexual discomfort remains a concern for many cervical cancer patients (dependent on the radicalness of treatment they receive) overall sexual and vaginal functioning improves over the course of time [31].

Lymphedema

Damage during a pelvic lymph node dissection to lymphatics or alterations in connective tissue caused by radiotherapy that result in obstruction of the lymphatic vessels can cause lower-limb lymphedema. Lymphedema can worsen over time for cervical cancer patients.  The physical effects of lymphedema in the lower limbs can include leg heaviness and discomfort, skin tightness, and sexual dysfunction. Lymphedema can decrease a person’s ability to function to perform activities of daily living. Lower-extremity lymphedema has been associated with increased anxiety and depression, and decreased self-confidence, all leading to a decreased quality of life [32].

Treatments for lymphedema including routine use of an elastic support hose during the first year after treatment can reduce long-term complications. When lymphedema is diagnosed, external compression and physical therapy are the usual course of treatment for lymphedema, as well as behavior modification. Physical therapy includes manual lymphatic drainage as well as skin care, specific exercises, and external compression. Most lymphedema patients can be managed with conservative therapy; for those whose symptoms cannot be controlled with the aforementioned, surgery is an option [33].

Psychosocial problems and social support

Mood and stress disorders, body image and fear of recurrence can affect the quality of life of cervical cancer patients [34]. Wenzel et al found that a ‘persistent cancer-specific distress was significantly higher in patients with younger age, lower spiritual well-being, more reproductive concerns, worse mental state, and poor social support and maladaptive coping’ [35]. Furthermore, Pfaendler et al found that in interviews with cervical cancer survivors that social support was highlighted as being essential to coping with cancer diagnosis, treatment and emotions that followed.  In particular, they emphasized how instrument having emotional support from their partners was, even over assisted or practical support [36].

Reference 

[25] Pfaendler, Krista S., MD, Lari Wenzel, PhD, Mindy B. Mechanic, and Kristine R. Penner, MD. "Cervical Cancer Survivorship: Long-term Quality of Life and Social Support." Clinical Therapeutics 37.1 (2015): 39-48. Clinical Therapeutics. Clinical Therapeutics, 1 Jan. 2015. Web. 20 Aug. 2015.
[26] ibid.
[27] ibid.
[28] ibid.
[29] ibid.
[30] Wenzel, L., DeAlba, I., Habbal, R. et al. Quality of life in long-term cervical cancer survivors. Gynecol Oncol. 2005; 97: 310–317. Web. 20 Aug. 2015.
[31] Pfaendler, Krista S., MD, Lari Wenzel, PhD, Mindy B. Mechanic, and Kristine R. Penner, MD. "Cervical Cancer Survivorship: Long-term Quality of Life and Social Support." Clinical Therapeutics 37.1 (2015): 39-48. Clinical Therapeutics. Clinical Therapeutics, 1 Jan. 2015. Web. 20 Aug. 2015.
[32] Tiwari, P., Coriddi, M., Salani, R., and Povoski, S.P. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol. 2013; 11: 237. Web. 20 Aug. 2015.
[33] Pfaendler, Krista S., MD, Lari Wenzel, PhD, Mindy B. Mechanic, and Kristine R. Penner, MD. "Cervical Cancer Survivorship: Long-term Quality of Life and Social Support." Clinical Therapeutics 37.1 (2015): 39-48. Clinical Therapeutics. Clinical Therapeutics, 1 Jan. 2015. Web. 20 Aug. 2015.
[34] ibid.
[35] Wenzel, L., DeAlba, I., Habbal, R. et al. Quality of life in long-term cervical cancer survivors. Gynecol Oncol. 2005; 97: 310–317. Web. 20 Aug. 2015.
[36] Pfaendler, Krista S., MD, Lari Wenzel, PhD, Mindy B. Mechanic, and Kristine R. Penner, MD. "Cervical Cancer Survivorship: Long-term Quality of Life and Social Support." Clinical Therapeutics 37.1 (2015): 39-48. Clinical Therapeutics. Clinical Therapeutics, 1 Jan. 2015. Web. 20 Aug. 2015.