Spampinato Sofia, Tanderup Kari, Lindegaard Jacob C, Schmid Maximilian P, Sturdza Alina, Segedin Barbara, Jürgenliemk-Schulz Ina M, De Leeuw Astrid, Bruheim Kjersti, Mahantshetty Umesh, Chargari Cyrus, Rai Bhavana, Cooper Rachel, van der Steen-Banasik Elzbieta, Sundset Marit, Wiebe Ericka, Villafranca Elena, Van Limbergen Erik, Pieters Bradley R, Tee Tan Li, Lutgens Ludy C H W, Hoskin Peter, Smet Stéphanie, Pötter Richard, Nout Remi, Chopra Supriya, Kirchheiner Kathrin
Danish Center for Particle Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark.
Danish Center for Particle Therapy, Aarhus University Hospital, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark.
Radiother Oncol. 2023 Apr;181:109501. doi: 10.1016/j.radonc.2023.109501. Epub 2023 Jan 30.
To quantify the association of persistent morbidity with different aspects of quality of life (QOL) in locally advanced cervical cancer (LACC) survivors.
Longitudinal outcome from the EMBRACE-I study was evaluated. Patient-reported symptoms and QOL were prospectively scored (EORTC-C30/CX24) at baseline and regular follow-ups. Physician-assessed symptoms were also reported (CTCAEv.3). Persistent symptoms were defined if present in at least half of the follow-ups. QOL items were linearly transformed into a continuous scale. Linear mixed-effects models (LMM) were applied to evaluate and quantify the association of persistent symptoms with QOL. Overall QOL deterioration was evaluated by calculating the integral difference in QOL over time obtained with LMM for patients without and with persistent symptoms.
Out of 1416 patients enrolled, 741 with baseline and ≥ 3 late follow-ups were analyzed (median 59 months). Proportions of persistent EORTC symptoms ranged from 21.8 % to 64.9 % (bowel control and tiredness). For CTCAE the range was 11.3-28.6 % (limb edema and fatigue). Presence of any persistent symptom was associated with QOL, although with varying magnitude. Role functioning and Global health/QOL were the most impaired aspects. Fatigue and pain showed large differences, with reductions of around 20 % for most of the QOL aspects. Among organ-related symptoms, abdominal cramps showed the largest effect.
Persistent symptoms are associated with QOL reductions in LACC survivors. Organ-related symptoms showed smaller differences than general symptoms such as fatigue and pain. In addition to optimizing treatment to minimize organ-related morbidity, effort should be directed towards a more comprehensive and targeted morbidity management.
量化局部晚期宫颈癌（LACC）幸存者持续发病与生活质量（QOL）不同方面之间的关联。
评估了EMBRACE-I研究的纵向结果。在基线和定期随访时对患者报告的症状和生活质量进行前瞻性评分（EORTC-C30/CX24）。还报告了医生评估的症状（CTCAEv.3）。如果在至少一半的随访中出现，则定义为持续症状。将生活质量项目线性转换为连续量表。应用线性混合效应模型（LMM）来评估和量化持续症状与生活质量之间的关联。通过计算LMM得出的无持续症状和有持续症状患者随时间的生活质量积分差异，评估总体生活质量恶化情况。
在纳入的1416例患者中，分析了741例有基线及≥3次晚期随访的患者（中位时间59个月）。持续的EORTC症状比例范围为21.8%至64.9%（肠道控制和疲劳）。对于CTCAE，范围为11.3 - 28.6%（肢体水肿和疲劳）。任何持续症状的存在都与生活质量相关，尽管程度不同。角色功能和总体健康/生活质量是受损最严重的方面。疲劳和疼痛表现出较大差异，大多数生活质量方面降低约20%。在与器官相关的症状中，腹部绞痛的影响最大。
持续症状与LACC幸存者的生活质量降低相关。与器官相关的症状与疲劳和疼痛等一般症状相比，差异较小。除了优化治疗以尽量减少与器官相关的发病外，应努力进行更全面和有针对性的发病管理。
