Quality of Life and Sexual Health in Endometrial Cancer Survivors
Quality of life (QOL) and sexual health are complex phenomena, reflecting an individual’s status at baseline as well as the effects of cancer diagnosis and treatment. Clinicians caring for patients with endometrial cancer aim to maximize survival outcomes without compromising cancer survivorship, health, and well-being.
Amy and Vernon E. Faulconer Distinguished Chair in Medical Science
“The issue of sexual function is more complex. Our goal is really to minimize any decrement caused by our treatment.”
Some important things that we need to consider are how endometrial cancer affects a patient’s life and how a patient copes with treatment. You may be curing their cancer, but you may also be making their life more miserable. There are instruments that are available to measure QOL, usually called patient-reported outcomes, that utilize various surveys. In patients with endometrial cancer, we like to measure QOL by incorporating these patient-reported outcomes into randomized controlled trials to avoid some of the biases that are associated with some of these instruments when used in other settings. It is very important that as many QOL outcomes as possible are standardized so that useful data can be obtained.
Among patients with early endometrial cancer, most short-term QOL outcomes in clinical trials are much better in those who undergo minimally invasive surgery compared with those who undergo open surgery. Eventually, over the course of months, the QOL data for these 2 approaches tend to merge. After treatment, QOL measures may improve over time. For example, in a 2022 study of 1222 women with gynecologic cancer (ie, endometrial, ovarian, cervical, or vulvar), QOL measures declined during the 3 months after diagnosis but showed improvement at 12 months after treatment.
The issue of sexual function is more complex. Our goal is really to minimize any decrement caused by our treatment. One of the best predictors of postoperative or post-therapeutic sexual function is pretherapy sexual function, and interventions generally do not help patients become more sexually active if they were not sexually active prior to undergoing treatment for their endometrial cancer. In early-stage patients, QOL advantages with minimally invasive surgery may not extend to sexual function; however, mean Female Sexual Function Index scores can suggest sexual dysfunction postoperatively regardless of surgical approach. There are other factors that are associated with better postoperative sexual function, including physical exercise, time elapsed since surgery, consultation with a physician, and less anxiety. Further, Facondo et al reported that, in higher-risk patients, adjuvant high-dose brachytherapy does not appear to worsen measures of either QOL or sexual function compared with surgery alone.
The effects of obesity on QOL are also mixed and complex. For some patients, obesity can be a minor inconvenience, but for others, it can significantly impact their health and QOL. It is well established that patients who are obese are likely to experience more surgery-related complications and have a higher risk of other complications related to obesity that are independent of the effects of cancer and its treatments.
Facondo G, Vullo G, De Sanctis V, et al. Quality of life and sexual functioning among endometrial cancer patients treated with one week adjuvant high-dose-rate vaginal brachytherapy schedule. J Contemp Brachytherapy. 2022;14(4):341-346. doi:10.5114/jcb.2022.119198
Ferguson SE, Panzarella T, Lau S, et al. Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer. Gynecol Oncol. 2018;149(3):476-483. doi:10.1016/j.ygyno.2018.04.558
Glasspool R, Wheelwright S, Bolton V, et al. Modifiable pre-treatment factors are associated with quality of life in women with gynaecological cancers at diagnosis and one year later: results from the HORIZONS UK national cohort study. Gynecol Oncol. 2022;165(3):610-618. doi:10.1016/j.ygyno.2022.03.012
Matulonis UA, Huang HQ, Filiaci VL, et al. Patient reported outcomes for cisplatin and radiation followed by carboplatin/paclitaxel versus carboplatin/paclitaxel for locally advanced endometrial carcinoma: an NRG oncology study. Gynecol Oncol. 2022;164(2):428-436. doi:10.1016/j.ygyno.2021.11.021
Shisler R, Sinnott JA, Wang V, Hebert C, Salani R, Felix AS. Life after endometrial cancer: a systematic review of patient-reported outcomes. Gynecol Oncol. 2018;148(2):403-413. doi:10.1016/j.ygyno.2017.11.007