PSYCHOLOGICAL DISTRESS

Psychological Distress Caused By Physical Changes In Cervical Cancer

Psychological Distress Caused By Physical Changes In Cervical Cancer

Introduction

In the last years, the relevance of psychosocial aspects in gynecologic oncology has become of great interest due to the improvement of screening programs and treatment efficacy, and a consequent increase in the number of long-term survivors and . Much attention has been also focused on the treatment-related acute and late complications of treatment options, given their impact on patients' quality of life (QoL), especially when multimodal treatment strategies are employed. (Basedovski and Rey 2007)

The relevance of QoL assessment has been so widely acknowledged that the NCI has recommended the inclusion of this end point as an outcome of clinical trials, besides the traditional ones such as the response rate, the progression free- and the overall survival . Moreover, also the FDA currently recognizes the assessment of QoL as a parameter through which new cytotoxic agents can be approved and .

Among gynecological malignancies, cervical cancer ranks 3rd world wide, with an age-standardized incidence of 8.9/100,000 women/year, and a number of 9710 estimated new cases in US . Early stage cervical cancer (ECC) patients are triaged to exclusive radiotherapy or radical surgery with equivalent results in terms of clinical outcome, but different rate and types of side effects and . In this context, worse QoL scores have been demonstrated in ECC patients administered exclusive radiotherapy compared to surgery, in terms of physical and mental health, psychosocial distress and sexual functioning . Moreover, cervical cancer survivors receiving both surgery and radiotherapy reported significantly worse sexual or vaginal problems than those treated with surgery alone. (Badger and Sieger 2005)

As far as locally advanced cervical cancer (LACC) patients are concerned, results of recent clinical trials indicated that the addition of cisplatin-based chemotherapy to radiation (CT/RT) is associated with an advantage in terms of disease-free (DFS) and overall survival (OS) compared to exclusive radiotherapy : therefore, since 1999 CT/RT is considered as the gold standard in the treatment of these patients . Nonetheless, the 5-yr survival rate of LACC patients remains around 70% , and alternative therapeutic strategies are worth investigation. In this context, the use of chemotherapy or chemoradiotherapy followed by radical surgery has been also investigated and . Indeed, high rates of pathologic complete response to treatment, and a favorable clinical outcome, associated with acceptable rates of toxicity and complications has been reported and .

While some observations are available on the vaginal changes and sexual dysfunction induced by exclusive radiotherapy in LACC patients , there is no data about the issue of QoL in the same subset of patients administered neo-adjuvant chemotherapy (NACT) plus surgery, or exclusive CT/RT, or neo-adjuvant CT/RT followed by surgery . (Wenzel and Krebs 2005)

The aim of the study was to register and analyze the QoL scores in a single institution series of LACC patients administered preoperative CT/RT, compared to ECC patients undergoing radical surgery. The SF-36 questionnaire on general health, and the HADS questionnaire on mental distress were utilized as QoL ...