ESTRO 2022

Session Item

Sunday

May 08

16:55 - 17:55

Room D4

Patient-reported outcomes

Co-Chair: David Dearnaley, United Kingdom;

Chair: Jo Haviland, United Kingdom

Session Code: 2490

Session Type: Proffered Papers

Track: Interdisciplinary

17:05 - 17:15

Impact of persistent symptoms on long-term quality of life of cervical cancer survivors in EMBRACE I

Sofia Spampinato, The Netherlands

Presentation Number: OC-0588

Abstract

Abstract Title:

Impact of persistent symptoms on long-term quality of life of cervical cancer survivors in EMBRACE I

Authors:

Sofia Spampinato¹, Kari Tanderup¹, Remi Nout², Stéphanie Smet³, Jacob C. Lindegaard¹, Lars U. Fokdal¹, Richard Pötter⁴, Alina Sturdza⁴, Barbara Segedin⁵, Ina Jürgenliemk-Schulz⁶, Kjersti Bruheim⁷, Umesh Mahantshetty⁸, Cyrus Chargari⁹, Bhavana Rai¹⁰, Rachel Cooper¹¹, Elzbieta van der Steen-Banasik¹², Marit Sundset¹³, Ericka Wiebe¹⁴, Elena Villafranca¹⁵, Erik Van Limbergen¹⁶, Supriya Chopra¹⁷, Kathrin Kirchheiner⁴

¹Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; ²Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands; ³Algemeen Ziekenhuis Turnhout, Department of Radiation Oncology, Turnhout, Belgium; ⁴Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria; ⁵Institute of Oncology Ljubljana, Department of Radiotherapy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; ⁶University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands; ⁷The Radium Hospital, Oslo University Hospital, Department of Oncology, Oslo, Norway; ⁸Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India; ⁹Gustave-Roussy, Department of Radiotherapy, Villejuif, France; ¹⁰Postgraduate Institute of Medical Education and Research, Department of Radiotherapy and Oncology, Chandigarh, India; ¹¹St James's University Hospital, Leeds Cancer Centre, Leeds, United Kingdom; ¹²Radiotherapiegroep Arnhem, Department of Radiotherapy, Arnhem, The Netherlands; ¹³St. Olavs Hospital, Clinic of Oncology and Women's Clinic, Trondheim, Norway; ¹⁴Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada; ¹⁵Hospital of Navarra, Department of Radiation Oncology, Pamplona, Spain; ¹⁶University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium; ¹⁷Tata Memorial Centre, Homi Bhabha National Institute, Advanced Centre for Treatment Research and Education in Cancer, Mumbai, India

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Purpose or Objective

To evaluate the impact of persistent patient-reported symptoms on different aspects of quality of life (QoL) in locally advanced cervical cancer (LACC) survivors.

Material and Methods

Longitudinal patient-reported outcome from the prospective, multi-institutional, observational EMBRACE I study (an international study on MRI-guided brachytherapy in LACC) was evaluated. Symptoms and QoL were prospectively scored with the EORTC questionnaires C30 and CX24 at baseline and regular follow-ups. Out of 1416 patients enrolled, 740 patients with baseline and ≥3 late follow-ups were analysed. Late, persistent, treatment-related symptoms (LAPERS) were defined if reported by patients (≥”a little”) for at least half of the assessments and with progression beyond baseline condition. For this analysis, gastrointestinal (GI), urinary and general/unspecific symptoms were selected (Table1). QoL aspects were linearly transformed into a continuous scale (0-100 score). Linear mixed-effects models (LMM) were applied to evaluate the long-term impact of LAPERS on QoL aspects. The percentage of reduction in QoL for patients with persistent symptoms compared to patients without persistent symptoms was evaluated by calculating the difference between the areas under the curves obtained with LMM (Figure1).

Results

Median follow-up was 59 months. Incidences of persistent symptoms ranged from 16% (n=118) to 37% (n=269) for abdominal cramps and hot flashes, respectively (Table1). Overall, presence of any persistent symptom impacted QoL, although with varying magnitude (Table1). The percentage of reduction in QoL aspects ranged between 1% (hot flashes and physical functioning) and 25% (need to rest/weakness and role functioning). Fatigue-related symptoms and pain showed the highest impact on all QoL aspects. Role functioning and Global health/QoL were the most impaired aspects, with reductions of ≥15% for the majority of individual symptoms. The reduction in role functioning in 5 years was 25% and 14% for patient with persistent need to rest and diarrhea, respectively (Figure1). Among GI symptoms, persistent abdominal cramps were the most detrimental, with reductions ranging from 14% to 20% for physical and role functioning, respectively. Among all the symptoms, persistent hot flashes resulted in the least impairment for all QoL aspects.

Conclusion

Persistent treatment-related symptoms scored subjectively by LACC survivors as ≥”a little” considerable affect QoL. Based on this analysis, all persistent symptoms were reflected in QoL impairments, but with different impact. Organ-related symptoms often induced by treatment (i.e. diarrhea, urinary incontinence, etc.) showed less impact on QoL aspects (typical reductions of 10-15%) than general symptoms such as fatigue and pain (typical reductions of 15-25%). In addition to optimize treatment to reduce organ-related morbidity, these findings also highlight the need for a comprehensive morbidity management strategy that targets these complex and multi-faceted symptoms.