Needs and priorities of women with endometrial and cervical cancer

Abstract

Introduction: Rehabilitation after cancer is important, and efficient rehabilitation requires knowledge of patient’s needs. This study aimed to identify short-term rehabilitation needs of women with endometrial and cervical cancer.

Methods: Ninety-six women (82.6%) were included in an exploratory questionnaire study from Odense University Hospital from September 2011 to March 2012. Needs were assessed pre-treatment and 3 months later using the three-levels-of-needs questionnaire. Furthermore, 16 women participated in focus group interviews following the treatment. The interviews were audio-recorded, transcribed verbatim and analyzed thematically.

Results: Forty-four of the included women were diagnosed with cervical cancer (median age 45 years). Of these, 22 had FIGO-stage 1 disease (50%) and 23 received radiation therapy (52.3%). The remaining 52 women (median age 66.5 years) were diagnosed with endometrial cancer. Of these, 38 had FIGO-stage 1 disease (73.1%) and 25 were treated with laparoscopic surgery (48.1%). Emotional functioning was significantly worse prior to treatment in both the cancers (p < 0.001 cervical and p = 0.002 endometrial) and worry constituted an unmet need in 70.7% of cervical and 34.7% of endometrial cancer patients. Both the patient groups experienced significant lymphedema post-treatment [endometrial cancer (p = 0.006) and cervical cancer (p = 0.002)]. Further, urological problems were more prevalent post-treatment in endometrial cancer patients (p = 0.018), while sexual problems were of specific concern for cervical cancer patients (p = 0.029). However, in both cancer groups, the mean problem intensity scores were comparable to normative data, suggesting that the majority of patients will not require extensive rehabilitation. Qualitative analysis indicated that treatment modality and marital status severely impacted on coping, suggesting that irradiated and single women are at higher risk of developing rehabilitation needs. Additionally, women younger than 55 years more often requested help dealing with sexual and psychological complications.

Discussion: Women with endometrial and cervical cancer experience emotional problems prior to therapy and lymphedema, and urological and sexual problems following treatment. An awareness of these problems may facilitate early identification of women with unmet needs and enable individualized follow-up adjusted for such patient’s needs. Interventions aimed at improving sexual and psychological functioning should be available.

• Depression and anxiety in oncology patients
• psycho-oncology
• psychosomatic gynecology
• quality of life
• sexual health

Current knowledge on this subject

• The treatment of gynecologic cancer is associated with a variety of physical and emotional complications.

• Current knowledge is primarily based on cross-sectional studies and describes the long-term prevalence of complications.

• The process of rehabilitation is highly individual and relies on an accurate assessment of patient’s needs.

What this study adds

• Unmet needs and priorities of women with endometrial and cervical cancer were assessed longitudinally using the three-levels-of-needs questionnaire as well as two focus group interviews.

• The women reported few needs of rehabilitation.

• Specific needs regarding emotional, sexual and urogenital functioning were identified.

Acknowledgements

We acknowledge the Danish Gynecological Cancer Group for providing us with clinical data from their database.

Declaration of interest

The authors report no conflicts of interest.