title: Prospective quality of life study of South African women undergoing treatment for advanced-stage cervical cancer.
abstract: OBJECTIVE
  The majority of South African cervical cancer patients present with advanced-stage disease. Chemoradiation therapy, in comparison with radiation therapy, results in marginally improved survival in women with advanced cervical cancer. The impact on the quality of life due to the addition of a chemosensitizer in a situation of limited survival benefits warrants objective assessment. This prospective study compares the quality of life for women with cervical cancer and treated with radiation or chemoradiation therapy at Tygerberg Hospital, South Africa.
  
  
  METHODS
  A prospective study was done in a population with a high incidence of advanced cervical cancer. Quality of life measurements were done at pretreatment, post treatment, and follow-up. The European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire and the Cervix Cancer Module were used.
  
  
  RESULTS
  The study included 219 women. Forty-four women were treated with primary surgery. A total of 102 women completed primary radiation therapy and 73 women completed primary chemoradiation therapy. The demographic characteristics of the last 2 treatment groups were different. Women receiving chemoradiation therapy had a higher educational level (P < 0.01) and had less advanced stage (III or IV) cervical cancer (P < 0.01). Radiation therapy was used significantly more in HIV-positive women. The presiding clinicians chose treatment options based on clinical factors unrelated to quality of life. Chemoradiation therapy resulted in statistically more improvement in the pain (P < 0.05), fatigue (P < 0.05), appetite loss (P < 0.01), and nausea and vomiting (P < 0.05) quality of life domains. In these domains, pretreatment quality of life scores were significantly higher in the radiation therapy group, implying a poorer quality of life status at the initiation of treatment. In post hoc analysis, the global health domain was significantly more improved (P = 0.03) by chemoradiation. Peripheral neuropathy was not increased by chemoradiation.
  
  
  CONCLUSIONS
  Chemoradiation therapy improved quality of life more than radiation therapy in certain domains. This allows for selection of chemoradiation as a treatment option in situations where quality of life is the end point of treatment.
authors.affiliation: Unit of Gynaecological Oncology, Tygerberg Hospital, University of Stellenbosch, Stellenbosch, South Africa. Electronic address: dutoitg@worldonline.co.za.
authors.forename: George Campbell
authors.initials: GC
authors.lastname: du Toit
authors.affiliation: Centre for Statistical Consultation, University of Stellenbosch, Stellenbosch, South Africa.
authors.forename: Martin
authors.initials: M
authors.lastname: Kidd
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D005069:Evaluation Studies as Topic; D005221:Fatigue; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
keywords: Cervical cancer; Chemoradiation; Quality of life