Evaluation of physical function and quality of life before and after nonradical surgical therapy for stage IA1 and IA2-IB1 cervical cancer (GOG-0278)

Objective

To examine patient outcomes before and after cone biopsy (CB) or simple hysterectomy (SH) and pelvic lymph node dissection (PLND) for bladder, bowel, and sexual function, quality of life (QOL), cancer worry, reproductive concerns, and lymphedema.

Methods

We stratified women with stage IA1 (lymphovascular space invasion–positive) and IA2-IB1 (≤2 cm) cervical carcinoma by fertility preservation (CB) or none (SH) with PLND. All patients completed study questionnaires at baseline (preoperatively) and postoperatively at 4–6 weeks and 6-, 12-, 18-, and 24-months, consisting of: Functional Assessment Cancer Therapy - Cervical Cancer (FACT-Cx); Female Sexual Functioning Index (FSFI), and 2 Patient-Reported Outcomes Measurement Information System (PROMIS) items; Gynecologic Cancer Lymphedema Questionnaire (GCLQ); Impact of Events Scale (IES); and Reproductive Concerns Scale (RCS).

Results

We enrolled 224 patients from 10/12 to 10/21, with 72 choosing CB and 152 SH. A total of 169 patients (54 CB; 115 SH) were eligible for QOL analysis and completed baseline assessment with at least one follow-up assessment. Postoperatively in both groups, bladder and bowel function slightly decreased but recovered over time, sexual function declined at 6 weeks but improved over time, QOL increased, and cancer worry decreased. As per the GCLQ, 12 patients reported a diagnosis of lymphedema with a GCLQ score change ≥4 (6 CB; 6 SH).

Conclusions

Nonradical surgery for early-stage cervical cancer is associated with excellent QOL and small decreases in physical function (bladder, bowel, sexual) that quickly improve postoperatively to baseline or above. Lymphedema rates were low but present in both groups.