title: Factors associated with poor quality of life among cervical cancer survivors: implications for clinical care and clinical trials.
abstract: BACKGROUND
  The purpose of this study is to identify factors that are associated with poor quality of life (QOL) among cervical cancer survivors.
  
  
  METHODS
  Patients identified through the California Cancer Registry were recruited to participate in a randomized counseling intervention. Patient-reported outcomes (PROs) were collected at study baseline (9-30 months post-diagnosis) and subsequent to the intervention. Multivariable linear models were used to identify independent factors associated with poor baseline QOL.
  
  
  RESULTS
  Non-Hispanic (N=121) and Hispanic (N=83) women aged 22-73 completed baseline measures. Approximately 50% of participants received radiation therapy with or without chemotherapy. Compared to the US population, cervical cancer patients reported lower QOL and significantly higher levels of depression and anxiety (26% and 28% >1 SD above the general population means, respectively). Among those in the lowest quartile for QOL, 63% had depression levels >1 SD above the mean. In addition, treatment with radiation±chemotherapy (p=0.014), and self-reported comorbidities predating the cancer diagnosis (p<0.001) were associated with lower QOL. Sociodemographic characteristics explained only a small portion of variance in QOL (r(2)=0.23). Persistent gynecologic problems, low social support, depression, somatization, less adaptive coping, comorbidities, sleep problems and low education were all independently associated with low QOL in multivariate analysis (r(2)=0.74).
  
  
  CONCLUSIONS
  We have identified key psychological and physical health factors that contribute significantly to poor quality of life subsequent to definitive cancer treatment. The majority of these factors are amenable to supportive care interventions and should be evaluated at the time of primary treatment.
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.affiliation: Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA.
authors.forename: Susie
authors.initials: S
authors.lastname: Hsieh
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Nelson
authors.affiliation: Creighton University, Phoenix, AZ, USA.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Monk
authors.affiliation: Creighton University, Phoenix, AZ, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Chase
authors.affiliation: Northwestern University, Evanston, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.affiliation: Program in Public Health, University of California, Irvine, Irvine, CA, USA; Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA. Electronic address: lwenzel@uci.edu.
authors.forename: Lari
authors.initials: L
authors.lastname: Wenzel
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology*; D001213:Asian / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D011788:Quality of Life / Q000523:psychology*; D011878:Radiotherapy; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000523:psychology; D012944:Social Support; D017741:Survivors / Q000523:psychology*; D002583:Uterine Cervical Neoplasms / Q000523:psychology* / Q000628:therapy; D044465:White People / Q000523:psychology; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Cervical cancer; Clinical trial; Patient-reported outcomes; Symptoms