Quality of life after treatment for cervical cancer

Correia, Rafaella Araújo; Bonfim, Cristine Vieira do; Ferreira, Daniela Karina da Silva; Furtado, Betise Mery Alencar Sousa Macau; Costa, Heitor Victor Veiga da; Feitosa, Kéllida Moreira Alves; Santos, Solange Laurentino dos

doi:10.1590/2177-9465-EAN-2018-0130

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RESEARCH • Esc. Anna Nery 22 (4) • 2018 • https://doi.org/10.1590/2177-9465-EAN-2018-0130 copy

Quality of life after treatment for cervical cancer

Calidad de vida después del tratamiento del cáncer cervical

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Identify the quality of life of women treated for cervical cancer according to their clinical and socioeconomic characteristics.

Methods:

This was a analytical study on women who were treated for cervical cancer by means of surgery, radiotherapy and chemotherapy. To evaluate their quality of life, the WHOQOL-bref questionnaire was applied. The Mann-Whitney test was used to investigate associations between domains and variables.

Results:

There were associations (p < 0.05) between the WHOQOL-bref domains and the variables of income, conjugal situation, leisure activities and treatment undergone. The physical and psychological domains were associated with overall quality of life (R = 0.54 and R = 0.63, respectively).

Conclusions:

Socioeconomic conditions and the type of treatment undergone influenced the quality of life of these women after their treatment. There is a need to increase the reach of cervical cancer screening among women who are less economically favored; and, after treatment, to offer alternative measures that soften the secondary effects.

Keywords:
Uterine cervical neoplasms; Quality of life; Oncologic Nursing; Women's health

Sociodemographic variables	n (46)	%
Years of schooling
Less than 8 years of schooling	19	41.30
8 years of schooling or more	27	58.70
Race/color
Mixed	30	65.22
White	11	23.91
Black	4	8.70
Yellow	1	2.17
Marital status
with partner	27	58.70
without partner	19	41.30
Work situation
Unemployed	20	43.48
Working in the home	11	23.91
Employed	7	15.22
On medical leave	5	10.87
Other	3	6.52
Location of the home
Recife and its metropolitan region	21	45.65
Interior of the state of Pernambuco	25	54.35
Monthly family income
Up to 1 minimum wage	37	80.43
Over 1 minimum wage	9	19.57
Clinical variables	n (46)	%
Histological type of tumor
Squamous cell carcinoma	42	91.30
Adenocarcinoma	3	6.53
Other	1	2.17
Stage
Advanced disease	29	63.0
Early disease	17	37.0
Treatment performed
Non-surgical (CT/RT)	28	60.88
Surgical + Adjuvant (CT/RT)	9	19.56
Surgical	9	19.56

Domains	Mean (95% CI)	SD	Median	Minimum	Maximum
Physical	56.75 (50.34-63.15)	21.32	60.71	14.29	100.00
Psychological	61.48 (57.01-65.95)	14.87	62.50	20.83	83.33
Social	63.52 (58.50-68.53)	16.69	58.33	8.33	91.67
Environmental	53.06 (49.22-56.89)	12.75	56.25	25.00	81.25
Overall quality of life	59.72 (54.48-64.97)	17.45	62.50	25.00	100.00

Domains and overall quality of life	Domains
Domains and overall quality of life	Physical	Psychological	Social	Environmental
Physical	-	-	-	-
Psychological	0.57^* * p < 0.01;	-	-	-
Social	0.30^† † p < 0.05.	0.52^* * p < 0.01;	-	-
Environmental	0.25	0.34^† † p < 0.05.	0.04	-
Overall quality of life	0.54^* * p < 0.01;	0.63^* * p < 0.01;	0.32^† † p < 0.05.	0.47^* * p < 0.01;

Quality of life (mean ± standard deviation)
Sociodemographic variables	Physical domain	p*	Psychological domain	p*	Social domain	p*	Environmental domain	p*	Overall quality of life	p*
Age group
≤ 50 years (n = 31)	57.62 ± 18.33	0.63	62.23 ± 13.84	0.73	64.17 ± 19.1	0.48	52.19 ± 10.26	0.39	57.92 ± 14.86	0.31
> 50 years (n = 15)	55 ± 27	0.63	60 ± 17.17	0.73	62.23 ± 10.86	0.48	54.8 ± 16.99	0.39	63.34 ± 21.89	0.31
Schooling level
< 8 years of schooling (n = 19)	56.21 ± 20.82	0.82	62.94 ± 10.48	0.96	65.36 ± 10.86	0.77	53.46 ± 13.94	0.68	59.22 ± 19.48	0.94
≥ 8 years of schooling (n = 27)	57.15 ± 22.09	0.82	60.42 ± 17.53	0.96	62.18 ± 20.04	0.77	52.77 ± 12.1	0.68	60.1 ± 16.21	0.94
Race/color
White (n = 11)	67.21 ± 19.16	0.09	62.13 ± 13.37	0.94	63.64 ± 20.51	0.94	55.12 ± 13.79	0.68	63.64 ± 19.73	0.59
Nonwhite (n = 35)	53.37 ± 21.14	0.09	61.28 ± 15.51	0.94	63.49 ± 15.63	0.94	52.39 ± 12.55	0.68	58.46 ± 16.78	0.59
Marital status after treatment
with partner (n = 27)	61.41 ± 21.51	0.08	64.91 ± 14.3	0.07	64.43 ± 17.25	0.45	53.25 ± 11.03	0.63	64.43 ± 16.85	0.05
without partner (n=19)	50.38 ± 19.89	0.08	56.8 ± 14.72	0.07	62.29 ± 16.29	0.45	52.8 ± 15.13	0.63	53.29 ± 16.59	0.05
Work situation after treatment
Working (n = 7)	63.27 ± 21.6	0.30	67.86 ± 9.84	0.30	70.24 ± 14.32	0.26	58.04 ± 5.37	0.14	66.08 ± 6.1	0.33
Not working (n = 39)	55.55 ± 21.35	0.30	60.31 ± 15.44	0.30	62.29 ± 16.98	0.26	52.14 ± 13.54	0.14	58.56 ± 18.64	0.33
Location of home
Recife and its metropolitan region (n = 21)	59.36 ± 22.89	0.37	61.91 ± 17.65	0.56	63.5 ± 17.18	0.82	55.81 ± 12.24	0.21	63.7 ± 17.64	0.22
Interior of the state (n=25)	54.47 ± 20.08	0.37	61.12 ± 12.33	0.56	63.55 ± 16.64	0.82	50.66 ± 12.97	0.21	56.25 ± 16.9	0.22
Monthly family income
Up to 1 minimum wage (n = 37)	53.28 ± 20.32	0.04	59.96 ± 15.6	0.28	62.5 ± 17.54	0.47	51.13 ± 12.73	0.06	57.64 ± 17.24	0.15
Over 1 minimum wage (n = 9)	70.64 ± 20.58	0.04	67.6 ± 9.95	0.28	67.6 ± 12.81	0.47	60.77 ± 10.14	0.06	68.06 ± 16.67	0.15
Quality of life (mean ± standard deviation)
Lifestyle habits	Physical domain	p*	Psychological domain	p*	Social domain	p*	Environmental domain	p*	Overall quality of life	p*
Consumption of alcoholic beverages
Yes (n = 10)	66.08 ± 19.44	0.08	64.17 ± 13.36	0.65	70 ± 13.15	0.20	52.5 ± 13.16	1	61.25 ± 10.95	0.89
No (n = 36)	54.09 ± 21.35	0.08	60.72 ± 15.37	0.65	61.67 ± 17.3	0.20	53.22 ± 12.83	1	59.29 ± 19.02	0.89
Smoking
Smoker (n = 1)	82.15 ± 0	0.24	75 ± 0	0.29	83.34 ± 0	0.16	31.25 ± 0	0.17	50 ± 0	0.54
Former smoker (n = 16)	62.5 ± 14.53		63.81 ± 13.24		66.67 ± 20.42		52.74 ± 10.46		65.63 ± 15.48
Never smoked (n = 29)	52.56 ± 23.71		59.68 ± 15.8		61.02 ± 14		54.02 ± 13.64		56.7 ± 18.16
Recreational leisure activity
Yes (n = 17)	60.3 ± 18.73	0.46	61.52 ± 12.11	0.73	72.06 ± 12.48	0.01	49.45 ± 13.5	0.21	59.56 ± 16.85	0.8
No (n = 29)	54.6 ± 22.82	0.46	61.46 ± 16.54	0.73	58.34 ± 16.98	0.01	55.25 ± 12	0.21	59.83 ± 18.12	0.8
Social leisure activity
Yes (n = 32)	57.26 ± 21.76	0.77	62.77 ± 15.1	0.35	63.45 ± 14.23	0.73	53.63 ± 11.92	0.79	60.49 ± 17.71	0.86
No (n = 14)	55.62 ± 21.1	0.77	58.64 ± 14.48	0.35	63.7 ± 21.84	0.73	51.79 ± 14.85	0.79	58.04 ± 17.41	0.86
Cultural leisure activity
Yes (n = 5)	52.86 ± 25.93	0.74	55 ± 18.5	0.42	61.67 ±3 2.06	0.62	48.13 ± 15.72	0.34	57.5 ± 14.26	0.69
No (n = 41)	57.24 ± 21.03	0.74	62.3 ± 14.44	0.42	63.75 ± 14.44	0.62	53.68 ± 12.44	0.34	60 ± 17.95	0.69
Artisanal leisure activity
Yes (n = 7)	51.54 ± 26.32	0.52	58.34 ± 18.33	0.66	53.58 ± 24.47	0.21	52.68 ± 12.43	0.81	57.15 ± 15.91	0.63
No (n = 39)	57.71 ± 20.56	0.52	62.07 ± 14.37		65.36 ± 14.57	0.21	53.13 ± 12.98	0.81	60.2 ± 17.89	0.63
Physical leisure activity
Yes (n = 1)	50 ± 0	0.65	37.5 ± 0	0.15	33.34 ± 0	0.11	53.13 ± 0	0.76	37.5 ± 0	0.21
No (n = 45)	56.9 ± 21.55	0.65	62.03 ± 14.58		64.21 ± 16.24	0.11	53.06 ± 12.91	0.76	60.23 ± 17.32	0.21

Quality of life (mean ± standard deviation)
Clinical Variables	Physical domain	p*	Psychological domain	p*	Social domain	p*	Environmental domain	p*	Overall quality of life	p*
Staging
Advanced disease (n = 29)	57.91 ± 23.78	0.70	61.02 ± 14.8	0.73	64.59 ± 17.66	0.33	52.8 ± 14.77	0.92	62.5 ± 18.01	0.18
Early disease (n = 17)	54.84 ± 17.04	0.70	62.26 ± 15.42	0.73	61.77 ± 15.33	0.33	53.5 ± 8.9	0.92	55.15 ± 15.98	0.18
Treatment performed
Surgical (n = 9)	56.75 ± 15.82	0.90	65.75 ± 10.99	0.45	65.75 ± 11.37	0.66	56.6 ± 9.04	0.01	56.95 ± 14.13	0.82
Non-surgical (CT/RT) (n = 28)	56.35 ± 24.93		60.96 ± 15.26		63.28 ±18.09		55.44 ± 12.97		61.12 ± 19.72
Surgical + Adjuvant (CT/RT) (n = 9)	57.94 ± 15.13		58.8 ± 17.61		62.04 ± 18.22		42.37 ± 10.26		58.34 ± 13.98
Time elapsed between the end of treatment and the interview
≤ 9 months (n = 36)	55.52 ± 22.99	0.54	60 ± 16.12	0.33	61.67 ± 17.65	0.16	52.5 ± 13	0.65	58.58 ± 18.64	0.37
> 9 months (n = 10)	61.08 ± 14.14	0.54	66.67 ± 7.86	0.33	70 ± 11.25	0.16	55 ± 12.35	0.65	63.75 ± 12.44	0.37
Comorbidities
Some comorbidities (n = 22)	56.11 ± 22.68	0.98	60.42 ± 15.84	0.56	62.85 ± 19.35	0.98	58.08 ± 8.94	0.02	61.46 ± 18.03	0.5
No comorbidity (n = 24)	57.49 ± 20.21	0.98	62.7 ± 13.98	0.56	64.29 ± 13.48	0.98	47.33 ± 14.2	0.02	57.74 ± 17	0.5

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[1] Corresponding author: Cristine Vieira do Bonfim. E-mail: cristine.bonfim@uol.com.br