The quality of life among women with cervical cancer treated with chemo-radiation at Mulago radiotherapy unit

Abstract

Introduction: Chemo-radiation therapy still remains the most applicable method in the management of patients with advanced cancer of the cervix in Mulago hospital. However, the side effects associated with the treatment have a major impact on the quality of life (QOL) of these women. The QOL in Ugandan women treated for cervical cancer with chemo- radiotherapy has not been assessed thus creating a gap in the literature and hampering an attempt to improve QOL in this group of patients. Objective: The aim of this study was therefore to evaluate the impact of chemo- radiotherapy treatment on QOL and to determine what socioeconomic and demographic factors are closely related to QOL decrements in Ugandan women treated for cervical cancer at Mulago national referral hospital. Methods: This was a prospective cohort study conducted at the radiotherapy department of Mulago national referral hospital, (Uganda) from December/ 2013 to June / 2014). QOL was measured using the Functional Assessment of Cancer Treatment questionnaire (FACT-Cx) and a demographics questionnaire answered by 61 patients treated for cancer of the cervix. The data was analyzed using STATA version 13. Data Analysis: Demographics and clinical characteristics were summarized using medians and interquartile range for continuous variables, and percentages for categorical variables. In addition descriptive analysis was done using tables; the difference in the distribution of clinical characteristics before and after chemo-radiation was compared using Spearman’s correlation. To answer objective One, the QOL scores were summarized using means and standard deviations, and compared using the paired Student’s T- test. To answer objective Two, the association of demographic characteristics (age, education, marital status and occupational status) with change in QOL was assessed using generalized estimating equations because the data was correlated (that is before and after, assessed on same individual). Study Results: Among the 61 participants, the mean age at diagnosis was at 45 (SD=8.6) years. The majority of the study participants, 59% (35/61) were married. 78% (47/61) of the participants were unemployed and 62% (37/61) had below primary education. It was also noted that the majority of our participants presented with advanced disease; 60.7 %. All these factors could have affected their quality of life. At the end of the study, respondents had expressed considerable positive changes with improvements in several domains of QOL especially the physical well being (p<0.001), emotional well being (p=0.01) and overall scores (p<0.001). Participants reported no improvement in the sexual symptoms with poor scores in the sexual domain. However quality of life changes were seen to be grossly independent of the social demographic factors. Patients with greater than stage 2B disease and those with older age were found to have poor quality of life scores compared to their younger counterparts. Conclusion: The QOL of cervical cancer patients in Mulago Hospital had improved at 6 weeks post treatment with chemo-radiation and there was no influence of the social demographic factors on QOL.The long term effects of the treatment were not studied. To improve QOL in cancer survivors, interventions focusing on early diagnosis and treatment are recommended. . Study Utility: Knowing the impact of chemo-radiation on the QOL may improve the outcome of patients treated with chemo-radiation at Mulago hospital.