Goal setting in cancer rehabilitation and relation to quality of life among women with gynaecological cancer

Figures & data

Table I. Socio-demographic baseline data for women enrolled in the rehabilitation programme.

	Endometrial N = 50	Ovarian N = 65	Cervical N = 36	p-value
Age, mean (CI), years	62.5 (60.4–64.5)	60.2 (57.9–62.6)	45.3 (41.9–48.8)
Age, median	63	62	45
	N (%)	N (%)	N (%)
Age groups				< 0.001
20–40	1 (2)	2 (3)	15 (42)
41–60	16 (32)	27 (42)	18 (50)
61–75	33 (66)	36 (55)	3 (8)
Education				0.693
Basic	13 (26)	10 (15)	7 (19)
High school	21 (42)	31 (48)	18 (50)
Higher education	16 (32)	24 (37)	11 (31)
Employment status				< 0.001
In employment	17 (34)	22 (34)	20 (56)
Unemployed	4 (8)	5 (8)	12 (33)
Retired	29 (58)	37 (57)	4 (11)
Missing		1 (1)
Marital status				0.571
Single^a	9 (18)	17 (26)	7 (19)
Married or cohabitant	41 (82)	48 (74)	29 (81)

^a(widowed, divorced or never married). p-values in bold indicate a significant difference between the groups. CI, 95% confidence interval.

Table II. Health-related quality of life at 1^st and 2^nd rehabilitation session according to EORTC QLQ-C30 and the disease-specific questionnaires for endometrial, ovarian and cervical cancer.

Measure	1^st session		2^nd session		Wilcoxon signed-rank test
	N	Mean (CI)	N	Mean (CI)	p-value	(n pair)
C30: all patients
Global health score	123	63.0 (59.2–66.8)	112	71.9 (67.7–76.0)	< 0.001	(112)
Physical functioning	123	76.2 (72.9–79.5)	112	86.4 (83.1–89.7)	< 0.001	(112)
Emotional functioning	123	78.2 (74.5–81.8)	112	83.8 (80.0–87.6)	= 0.005	(112)
Cognitive functioning	123	83.1 (79.4–86.7)	112	86.9 (83.1–90.8)	= 0.116	(112)
Social functioning	122	82.4 (78.0–86.7)	112	87.2 (83.1–91.3)	= 0.028	(111)
EN24: endometrial cancer
Sexual interest (F)	39	12.8 (6.0–19.7)	39	34.2 (25.4–42.9)	< 0.001	(37)
Sexual activity (F)	37	6.3 (1.9–10.7)	38	31.6 (23.5–39.6)	< 0.001	(35)
Sexual enjoyment (F)	5	46.7 (−0.5–93.9)	22	63.6 (52.5–74.7)	= 0.157	(5)
Poor body image (S)	42	8.7 (3.6–13.9)	42	5.6 (1.2–9.9)	= 0.516	(41)
Sexual/vaginal (S)	4	15.3 (−6.8–37.4)	22	18.7 (9.5–27.9)	= 0.577	(4)
Physical functioning	43	82.7 (77.2–88.2)	42	91.9 (87.4–96.4)	< 0.001	(42)
Emotional functioning	43	83.9 (79.3–88.6)	42	89.5 (85.1–93.9)	= 0.059	(42)
Cognitive functioning	43	87.6 (82.8–92.4)	42	90.9 (86.5–95.3)	= 0.183	(42)
Social functioning	43	92.6 (86.8–98.5)	42	96.8 (93.4–100.2)	= 0.14 2	(42)
OV28: ovarian cancer
Body image (S)	47	67.4 (58.1–76.6)	42	75.8 (67.6–84.0)	= 0.500	(41)
Sexuality (F)	47	91.1 (85.4–96.8)	42	79.8 (71.9–87.7)	< 0.001	(42)
Physical functioning	48	72.0 (66.8–77.1)	43	81.2 (75.8–86.7)	< 0.001	(43)
Emotional functioning	48	74.8 (68.4–81.2)	43	81.5 (74.9–88.1)	= 0.062	(43)
Cognitive functioning	48	81.3 (75.6–86.9)	43	83.7 (76.6–90.9)	= 0.449	(43)
Social functioning	47	73.4 (65.7–81.2)	43	80.2 (73.3–87.1)	= 0.148	(42)
CX24: cervical cancer
Body image (S)	32	76.0 (68.5–83.6)	27	80.2 (72.0–88.5)	= 0.082	(27)
Sexual activity (F)	32	8.3 (2.2–14.4)	27	27.2 (16.2–38.2)	= 0.002	(27)
Sexual enjoyment (F)	7	71.4 (50.2–92.7)	17	76.5 (60.7–92.2)	= 0.048	(7)
Sexual/vaginal (S)	6	84.7 (67.7–101.7)	17	81.9 (73.0–90.7)	= 0.340	(6)
Sexual worry (S)	31	39.8 (25.2–54.4)	26	38.5 (26.0–50.9)	= 0.481	(26)
Physical functioning	32	73.9 (67.6–80.1)	27	86.2 (78.9–93.5)	< 0.001	(27)
Emotional functioning	32	75.5 (67.9–83.2)	27	78.7 (69.9–87.5)	= 0.244	(27)
Cognitive functioning	32	79.7 (70.6–88.8)	27	85.8 (77.0–94.6)	= 0.506	(27)
Social functioning	32	81.8 (74.3–89.2)	27	83.3 (73.1–93.6)	= 0.360	(27)

p-value < 0.05 is highlighted in bold. F, function scale. A high score represents a high level of functioning; S, symptom scale. A high score represents a high level of problems; EORTC QLQ-EN24, disease-specific module for endometrial cancer; EORTC QLQ-OV28, disease-specific module for ovarian cancer; EORTC QLQ-CX24, disease-specific module for cervical cancer.

Figure 1. Flowchart for the study.

Table III. Number and proportions of patients who formulated at least one goal within the categories of goals at session 1 and 2.

Session 1	Total n = 123	Endometrial cancer n = 43	Ovarian cancer n = 48	Cervical cancer n = 32	Fisher`s exact test
Category of goal	n (%)	n (%)	n (%)	n (%)	p-value
Physical	120 (98)	42 (98)	47 (98)	31 (97)	1.000
Social	57 (46)	19 (44)	27 (56)	11 (34)	0.156
Emotional	51 (41)	14 (33)	22 (46)	15 (47)	0.356
Existential	9 (7)	2 (5)	3 (6)	4 (13)	0.462
Cognitive	7 (6)	2 (5)	1 (2)	4 (13)	0.170
Sexuality	34 (28)	9 (21)	10 (21)	15 (47)	0.025

Session 2	Total n = 112	Endometrial cancer n = 41	Ovarian cancer n = 44	Cervical cancer n = 27
Category of goal	n (%)	n (%)	n (%)	n (%)
Physical	100 (89)	33 (80)	41 (93)	26 (96)	0.112
Social	41 (37)	14 (34)	22 (50)	5 (19)	0.028
Emotional	43 (38)	16 (39)	14 (32)	13 (48)	0.385
Existential	9 (8)	2 (5)	7 (16)	0 (0)	0.043
Cognitive	5 (4)	3 (7)	2 (5)	0 (0)	0.363
Sexuality	16 (14)	5 (12)	6 (14)	5 (19)	0.742

p-value < 0.05 is highlighted in bold.

Table IV. Health-related quality of life (HRQOL) scores and association with goal setting in rehabilitation programme with two sessions. Mean scores and mean differences of EORTC quality of life scores, between women with and without goals are shown together with the crude and adjusted OR's for goal formulation when the EORTC scores increase by 10 points.

Quality of life score Type of goal	N	All Mean (CI)	Goals		1^st session			N	Goals		2^nd session
			No mean	Yes mean	Mean diff. (CI)	OR	OR adj. ^(a) (CI)		No mean	Yes mean	Mean diff. (CI)	OR	OR adj. ^(a) (CI)
C30: all cancers
Physical functioning (F) Physical goals	123	75.0 (70.6; 79.3)	91.1	75.8	15.3 (−6.1; 36.6)	0 .43	0.38 (0.10; 1.43)	111	94.5	85.5	9.0 (−2.0; 20.1)	0.60	0.69 (0.37; 1.31)
Social functioning (F) Social goals	122	77.0 (72.0; 81.6)	81.3	83.6	−2.3 (−11.1; 6.4)	1.04	1.08 (0.91; 1.27)	111	90.4	81.3	9.1 (0.7; 17.5)	0.82	0.81 (0.66; 0.99)
Emotional functioning (F) Emotional goals	123	65.5 (61.4; 69.7)	82.8	71.7	11.1 (3.9; 18.2)	0.75	0.76 (0.63; 0.93)	111	87.7	77.2	10.5 (3.0; 18.1)	0.76	0.75 (0.61; 0.93)
Global health status (F) Existential goals	123	57.7 (53.5; 62.0)	62.7	66.7	−4.0 (−18.5; 10.7)	1.09	1.13 (0.80; 1.61)	84	72.6	62.0	10.6 (−4.7; 25.8)	0.81	0.86 (0.62; 1.19)
Cognitive functioning (F) Cognitive goals	123	74.7 (70.4; 79.1)	83.8	71.4	12.4 (−3.4; 28.1)	0.78	0.81 (0.59; 1.11)	84	87.3	80.0	7.3 (−11.5; 26.0)	0.87	0.83 (0.57; 1.20)
EN24: Endometrial cancer							OR adj.^(b)						OR adj.^(b)
Sexual interest (F) Sexual goals	39	17.4 (10.3; 24.5)	12.2	14.8	−2.6 (−19.0; 13.9)	1.05	1.05 (0.74; 1.49)	39	34.3	33.3	1.0 (−25.6; 27.6)	0.98	0.86 (0.56; 1.32)
Sexual activity (F) Sexual goals	37	15.5 (8.3; 22.7)	5.6	9.5	−3.9 (−15.3; 7.4)	1.23	1.22 (0.69; 2.17)	38	31.3	33.3	−2.0 (−26.1; 22.1)	1.03	0.88 (0.54; 1.41)
Sexual enjoyment (F) Sexual goals	5	71.8 (53.7; 89.9)	33.3	55.5	−22.2 (−143.0; 98.6)	1.23	1.34 (0.68; 2.63)	22	66.7	50.0	16.7 (−11.8; 45.2)	0.72	0.62 (0.32; 1.19)
Body image (S) Sexual goals	42	11.7 (5.3; 18,0)	6.6	16.7	−10.1 (−22.4; 2.2)	1.37	1.36 (0.89; 2.05)	41	6.0	3.3	2.7 (−11.2; 16.6)	0.83	0.94 (0.38; 2.32)
Vaginal problems (S) Sexual goals	3	13.7 (0.8; 26.6)	16.7	11.1	5.6 (−)	0.73	(−)	22	16.7	27.8	−11.1 (−35.0; 12.8)	1.28	1.48 (0.80; 2.75)
OV28: Ovarian cancer							OR adj. ^(b)						OR adj.^(b)
Body image (S) Sexual goals	47	67.2 (58.9; 75.5)	70.7	55.0	15.7 (−6.6; 38.1)	0.85	0.83 (0.66; 1.05)	42	74.1	86.1	−12.0 (−35.5; 11.4)	1.27	1.25 (0.79; 1.98)
Sexuality functioning (F) Sexual goals	47	84.9 (78.0; 91.7)	90.1	95.0	−4.9 (−19.0; 9.1)	1.17	1.10 (0.67; 1.81)	42	81.9	66.7	15.27 (−7.1; 37.7)	0.79	0.81 (0.58; 1.13)
CX24: Cervical cancer							OR adj.^(b)						OR adj.^(b)
Body image (S) Sexual goals	32	71.0 (61.4; 80.6)	79.7	71.9	7.8 (−7.23; 23.01)	0.82	0.87 (0.58; 1.32)	27	80.8	77.8	3.0 (−18.5; 24.6)	0.93	0.92 (0.57; 1.47)
Sexual activity (F) Sexual goals	32	16.7 (8.0; 25.4)	9.8	6.7	3.13 (−9.3; 15.5)	0.89	0.73 (0.46; 1.18)	27	30.3	13.3	17.0 (−11.1; 45.0)	0.74	0.73 (0.43; 1.23)
Sexual enjoyment (F) Sexual goals	7	64.1 (46.7; 81.5)	66.7	83.3	−16.6 (−67.4; 34.0)	1.52	1.45 (0.53; 3.95)	17	80.0	50.0	30.0 (−18.0; 78.03)	0.75	0.75 (0.46; 1.22)
Vaginal problem (S) Sexual goals	6	82.7 (68.5; 96.9)	81.3	91.7	−10.4 (−51.4; 30.6)	1.78	3.47 (0.09; 129.72)	17	81.7	83.3	−1.6 (−30.2; 26.9)	1.06	1.06 (0.35; 3.16)
Sexual worry (S) Sexual goals	31	38.2 (25.1; 51.4)	27.1	53.3	−26.3 (−54.3; 1.8)	1.19	1.07 (0.85; 1.35)	26	34.9	53.3	−18.4 (−49.8; 13.0)	1.22	1.29 (0.89; 1.87)

Negative mean differences shoved that women with goals had a greater mean than women without goals. P-value < 0.05 is highlighted in bold. OR ^(a) were adjusted for cancer type; OR ^(b) adjusted for age. CI, 95% confidence interval; F, functional scale; S, symptom scale.