Assessment of the Quality of Life Among Post Radiotherapy Cervical Cancer Survivors Compared to Healthy Women at the Kenyatta National Hospital: a Comparative Cross Sectional Study

Abstract

Background: Cervical cancer is the fourth commonest malignancy of women globally. Most patients present with advanced disease whose mainstay of management is chemo-radiotherapy. Chemo-radiotherapy has both short and long-term effects that affect the quality of life (QOL) of survivors. No local studies have evaluated QOL of CCSs given these complications. Objective: To compare the QOL of post-radiotherapy cervical cancer survivors and healthy women attending the reproductive health services clinic at the Kenyatta National Hospital. Methodology: A comparative prospective cross-sectional study of 103 post-radiotherapy cervical cancer patients and 107 cancer-free women attending the reproductive health services clinic at KNH was done between May and July 2019. Systematic sampling was used to recruit study participants and data collected using the EORTC QLQC30 questionnaire. The demographic characteristics of patients were captured, and five functional scales of QOL (physical, role, cognitive, emotional, and social), three symptom scales (nausea, pain, and fatigue), and five single items (dyspnea, insomnia, appetite loss, diarrhea constipation) were evaluated. Data analysis was done using v21 of the statistical package for social scientists (SPSS). Summary statistics for demographic data were computed. The Mann-Whitney U test and Kruskal Wallis test were used to calculate within and between-group comparative analyses of QOL scores and the Analysis of Covariance (ANCOVA) use to control confounding. Analyses were at 95%CI. A P<0.05 was significant. Results: Two hundred and ten patients aged 22-80 years [range 22-80 among cancer survivors and 22-59 among healthy women] were recruited. A majority of cervical cancer survivors were aged 51-60 (36.3%), married (68.0%), unemployed 80.3%), and had a primary level of education (62.1%). A majority had stage 2B of cancer (35.9%), were treated with chemo-radiotherapy (75.4%), and had a post treatment duration of <2 years after (72.0%). Fewer cervical cancer survivors than healthy women had a tertiary level of education [OR (95%CI) = 0.0(0.0-0.02), p=0.01] or were married [OR (95%CI)

=0.7(0.4-1.6), p=0.48]. The odds of unemployment and grand multiparity were 8.6 times and 51 times higher among cervical cancer survivors (p<0.05). The QOL scores for cervical cancer survivors for GHS (64.7 and 78.3), Physical (87.6 and 92.2), Role (85.6 and 95.6), Emotional (82.0 and 88.6), Cognitive (81.1 and 90.5), and social functioning (65.1 and 93.2) were significantly lower among cervical cancer survivors compared to healthy women (p<0.05). The scores for symptoms such as fatigue (20.5 and 11.1), pain (25.2 and 11.8), and appetite loss (14.5and 6.5) were significantly higher among cancer survivors than healthy women (p<0.05). Conclusion: The QOL of cervical cancer survivors is significantly lower than healthy women.