Prospective evaluation of quality of life and sexual functioning after radical trachelectomy for early-stage cervical cancer

Objectives: To longitudinally assess quality of life (QOL), sexual functioning, and satisfaction with healthcare decisions in women who have undergone radical trachelectomy for early-stage cervical cancer.Methods: After institutional review board approval, we prospectively enrolled patients with stage IA1-IB1 cervical cancer before undergoing radical trachelectomy to complete validated instruments to assess QOL. These instruments included the General Health-Related QOL (SF-12), the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx), the MD Anderson Symptom Inventory (MDASI), Female Sexual Functioning Index (FSFI), and Satisfaction with Decision (SWD) scale. Instruments were filled out preoperatively (baseline), 4 to 6 weeks postoperatively, at 6 months, at 1 year, and annually thereafter for 4 years. Mixed modeling was used to test for changes from baseline for the survey instruments. A subanalysis was performed comparing QOL scores based on surgical approach.xResults: Thirty-nine patients enrolled in the study, and 35 patients were evaluable. Four patients were excluded because of conversion to radical hysterectomy or limited study participation time. Median age was 30.8 years (range, 21.4–38.7). Median body mass index was 25 kg/m2 (range, 16.1–44.4). Most patients had stage IB1 disease (51%) and underwent robotic radical trachelectomy (69%). The FSFI-arousal (P = .0001), FSFI-lubrication (P < .0001), FSFI-orgasm (P = .0012), FSFI-satisfaction (P = .02), and FSFI-total (P = .002) showed a significant decline at the 4- to 6-week postoperative visit then returned to baseline levels by 6 months. Similarly, the FACT-Cx physical well-being (P < .0001), FACT-Cx social well-being (P < .0001), SF-12 bodily pain (P < .0001), SF-12 physical functioning (P < .0001), SF-12 physical role (P < 0.0001), and SF-12 social functioning (P = .0002) showed a significant decline at the 4-to 6-week postoperative visit then returned to baseline by 6 months. There were no differences in the MDASI or SWD over the follow-up period. There were no differences in QOL scores based on an open versus minimally invasive surgical approach.Conclusions: Several QOL, sexual, and functional assessments decline immediately postoperatively after radical trachelectomy. However, they return to baseline measures by 6 months postoperatively, affording these patients long-term satisfaction with their procedural outcomes regardless of surgical approach. Objectives: To longitudinally assess quality of life (QOL), sexual functioning, and satisfaction with healthcare decisions in women who have undergone radical trachelectomy for early-stage cervical cancer. Methods: After institutional review board approval, we prospectively enrolled patients with stage IA1-IB1 cervical cancer before undergoing radical trachelectomy to complete validated instruments to assess QOL. These instruments included the General Health-Related QOL (SF-12), the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx), the MD Anderson Symptom Inventory (MDASI), Female Sexual Functioning Index (FSFI), and Satisfaction with Decision (SWD) scale. Instruments were filled out preoperatively (baseline), 4 to 6 weeks postoperatively, at 6 months, at 1 year, and annually thereafter for 4 years. Mixed modeling was used to test for changes from baseline for the survey instruments. A subanalysis was performed comparing QOL scores based on surgical approach. xResults: Thirty-nine patients enrolled in the study, and 35 patients were evaluable. Four patients were excluded because of conversion to radical hysterectomy or limited study participation time. Median age was 30.8 years (range, 21.4–38.7). Median body mass index was 25 kg/m2 (range, 16.1–44.4). Most patients had stage IB1 disease (51%) and underwent robotic radical trachelectomy (69%). The FSFI-arousal (P = .0001), FSFI-lubrication (P < .0001), FSFI-orgasm (P = .0012), FSFI-satisfaction (P = .02), and FSFI-total (P = .002) showed a significant decline at the 4- to 6-week postoperative visit then returned to baseline levels by 6 months. Similarly, the FACT-Cx physical well-being (P < .0001), FACT-Cx social well-being (P < .0001), SF-12 bodily pain (P < .0001), SF-12 physical functioning (P < .0001), SF-12 physical role (P < 0.0001), and SF-12 social functioning (P = .0002) showed a significant decline at the 4-to 6-week postoperative visit then returned to baseline by 6 months. There were no differences in the MDASI or SWD over the follow-up period. There were no differences in QOL scores based on an open versus minimally invasive surgical approach. Conclusions: Several QOL, sexual, and functional assessments decline immediately postoperatively after radical trachelectomy. However, they return to baseline measures by 6 months postoperatively, affording these patients long-term satisfaction with their procedural outcomes regardless of surgical approach.