Gynäkologische Onkologie: systematische Erfassung der therapieabhängigen Lebensqualität zur Verbesserung der Versorgung - eine prospektive Longitudinalstudie

Objective: To evaluate the impact of treatment for genital cancer on quality of life and body image to determine patients' therapy-related needs with respect to qualitative improvements of medical care before and after surgery. Methods: Between June 1993 and July 2003 129 women with cervical cancer were assessed before and 4 and 12 months after surgery by semistructured interviews and standardised questionnaires. Thanks to funding, since 1999 all patients with a diagnosis of genital or breast cancer can participate in this prospective study. In this paper we will focus on therapy-related changes in quality of life and body image in women with cervical cancer. The evaluation of quality of life (CARES) incorporated five aspects: physical and psychosocial health; marital and sexual status; medical interaction. With respect to body image (Strauss and Appelt) the attractiveness/self-confidence and sexual uncertainty were evaluated. Results: Before surgery, women with a Wertheim's procedure had significantly less problems with regard to the quality of life global score (p = 0.002) and several subscales compared to women with a pelvic exenteration. After surgery, both groups indicated that sexual problems were the greatest limitation in terms of quality of life, especially in women with non-reconstructive surgery as well as in women with adjuvant radio- and/or chemotherapy. With respect to body image, attractiveness/self-confidence was significantly reduced postoperatively compared to the preoperative status in both groups (p = 0.000), and also worsened with the extent of treatment. Conclusion: This on-going study demonstrates the interrelationship between the treatment and the patient's quality of life, especially with regard to sexuality and body image. Our results suggest not only providing reconstructive surgery if possible, but also integrating psychosocial information on future quality of life before surgery as well as offering psychosocial support related to the extent of treatment after surgery.