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Objective . To evaluate the impact of treatment for genital cancer on quality of life and body image to determine patients' therapy-related needs for quality improvement of medical care before and after surgery. Methods . We started to evaluate women with cervical cancer planned for pelvic exenteration in 1993 and integrated women planned for a Wertheim–Meigs surgery in 1995 before surgery, 4 and 12 months after surgery. Thanks to funding since 1999, more than 400 patients with a diagnosis of genital ( n = 185) or breast ( n = 217) cancer participated in this prospective study until July 2003. In this paper, we will focus on n = 129 women with cervical cancer. The assessment protocol included objective questionnaires for quality of life and body image (CARES; EORTC; Body image by Strauss and Appelt). The evaluation of quality of life incorporated five dimensions: physical and psychosocial health, marital and sexual status, and medical interaction. Results . Before surgery, women with a Wertheim's procedure indicated significantly less problems concerning the quality of life global score ( P = 0.002) and several subscales compared to women with a pelvic exenteration. After surgery, both groups indicated their sexual problems to be the greatest restriction in terms of quality of life, especially in women with non-reconstructive surgery as well as in women with adjuvant radio and/or chemotherapy. Concerning body image, attractiveness or self-confidence was significantly reduced postoperatively compared to the preoperative status for both groups ( P = 0.000), and also worsened with the extent of treatment. Worries about the patient's family persisted over time and represented the most important item about all questions concerning quality of life as well as the fear of recurrence. Conclusion . This on-going study demonstrates the interferences between the treatment modality and the patient's quality of life, especially about sexuality and body image. Our results suggest not only to provide reconstructive surgery if possible, but also to integrate psychosocial information aspects on future quality of life outcome before surgery as well as to offer psychosocial support related to the extent of treatment modality after surgery.

OBJECTIVE Women with gynecologic cancer are confronted with difficult decisions regarding the therapeutic options. The objective of the present paper is to demonstrate the relationship between surgical procedures and the outcome on quality of life and to discuss the implications for patient management. METHODS Gynecologic patients were assessed in a prospective study with preoperative semistructured interviews and objective assessments (T1), interviews were repeated 4 and 12 months postoperatively (T2, T3). RESULTS Women planned for hysterectomy with severe complaints indicate a better postoperative quality of life. Cancer patients, however, tend to feel more distressed about the surgical procedure if they could not be treated organ preserving or by reconstructive techniques. Medical interaction is dependent on the patient's anxiety level and mostly important for their quality of life before and after surgery. CONCLUSION Psychosomatic research is not only necessary to understand the patient's needs before and after surgery but may also serve as an evaluation method of therapeutical options. By this methods we are able to anticipate the medical and psychological consequences of the therapeutic decisions. Future studies will systematically explore the alternating effect of surgical procedures on the patient's well-being.

After radical gynecologic surgery women are faced with therapy-induced changes of their body. Since 1995, the body images of women who undergo pelvic exenteration, Wertheim-Meigs-operation or hysterectomy are assessed preoperatively and four and twelve months postoperatively. The aim of this multidimensional prospective study is to get basic information for effective counselling and support. One year after hysterectomy women state to have a normal body image. Cancer patients feel less attractive, less self-confident and more discontented in sexuality depending on therapy-induced changes of their bodies. These women could profit from problem-related preoperative counselling. Postoperative counselling offers will be helpful to support women in the process of acceptance of bodily changes and in the reorganisation of their sexual life.

Objectives. The goal of this study was to evaluate the impact of reconstructive and nonreconstructive surgical procedures on quality of life and body image for women who undergo pelvic exenteration. Methods. Twenty-eight patients were assessed in a prospective study with a preoperative semistructured interview and an objective assessment (T1). Interviews and questionnaires were repeated 4 (T2) and 12 (T3) months postoperatively. The women were divided into groups with two, one, or no ostomies. A separate comparison was made of women with and without vaginal capacity. Quality of life was defined in terms of five categories according to the definition of health proposed by the World Health Organization: physical and psychosocial health; marital and sexual status; medical interactions. Results. At all points in time, the patients' quality of life was affected most significantly by worries about the progression of the tumor. Twelve months postoperatively, patients with two ostomies reported a significantly lower quality of life ( P = 0.008) and poorer body image ( P = 0.002) than patients with no ostomy. At T3, patients with vaginal capacity reported fewer problems in all categories related to quality of life and significantly ( P = 0.015) fewer sexual problems. Conclusion. An evaluation of quality of life and body image demonstrates the benefits of newer techniques for organ reconstruction. Thus, organ reconstruction should be performed whenever possible in patients with pelvic exenteration.