Psychological Impact On Long-Term Gynaecological Cancer Survivors due to Radiation-indured Survivorship Syndromes

Abstract

Background: We know from previous studies that faecal incontinence (leakage syndrome) has a negative effect on self-assessed quality of life (QOL) and social functioning among gynaecological cancer survivors treated with external pelvic radiotherapy. There is, however, a lack of knowledge regarding how other radiation-induced bowel syndromes affect QOL in these survivors. Aim: To investigate the association between the adverse effects of radiation therapy experienced by gynaecological cancer survivors and their QOL. Methods: In previous studies identified 28 gastrointestinal symptoms that reflect decreasing health among gynaecological cancer survivors after external pelvic radiotherapy measured two to 15 years after treatment. The 28 symptoms were grouped by the original researchers into five radiation-induced survivorship syndromes (urgency syndrome, leakage syndrome, excessive gas discharge, excessive mucus discharge and blood discharge) by using factor analysis. A patient-reported outcome measures (PROMs) questionnaire was sent to 623 survivors and 344 matched population-based controls. Based on six questions chosen from the questionnaire, different QOL outcomes were measured: Self-assessed QOL, feeling sad or depressed, worry or anxiety, psychological well-being, self-assessed physical health and self-esteem. Results: The participation rate for cancer survivors was 76% and for the control group 72%. Data show that all five radiation-induced survivorship syndromes contribute to lower selfassessed QOL, lower psychological well-being, and have negative effects on physical health and self-esteem compared to the control group. No significant elevated risk for depression or anxiety was seen. Conclusion: Gynaecological cancer survivors with radiation-induced survivorship syndrome have a lower self-assessed QOL. Living with urgency, leakage, excessive gas, excessive mucus or blood in faeces is associated with greater occurrence of adverse psychological consequences in survivors than women in the control group.