title: The impact of surgery for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of treatment: a longitudinal, mixed methods study.
abstract: To measure the long-term impact of surgical treatment for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of therapy.
  
  
  
  Prospective, longitudinal, mixed-methods study. Twenty-three women aged >18 years with a new diagnosis of vulval cancer were recruited. The EORTC QLQ C30, SF-36 and an electronic pelvic floor assessment questionnaire (ePAQ-PF) were administered at baseline (pre-treatment) and 3, 6, 9 and 12 months post-treatment. Mixed effects repeated measures models (all adjusted for age and BMI) were used to investigate changes over time and differences between cancer stage. Qualitative interviews were carried out with 11 of the women and analysed using a thematic approach.
  
  
  
  Mean age was 59.9 years (SD = 15.3; range = 23.8-86.6 yrs). Mean BMI was 30.0 (SD = 4.5; range = 24.4-38.2). Sixteen women had early (Stage 1 to 2B), and seven women had advanced stage disease (Stage 3 to 4B). Questionnaire scores revealed that physical and social functioning, fatigue, pain and general sex life were significantly worse at 12 months than pre-treatment (p = < 0.05). Qualitative analysis revealed multiple treatment side effects which were perceived as severe and enduring. Women with advanced vulval cancer had significantly worse SF-36 mental health scores at 12 months compared to women with early stage disease (p = 0.037).
  
  
  
  Surgery for vulval cancer has long-term implications which can be persistent 12 months post-treatment. High rates of morbidity relating to lymphoedema and sexual function re-enforce the need for specialist clinics to support women who suffer these complications. © 2015 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.
authors.affiliation: University of Sheffield, Section of Health Economics and Decision Science, ScHARR, Sheffield, UK.
authors.forename: Georgina L
authors.initials: GL
authors.lastname: Jones
authors.affiliation: Design, Trials and Statistics, University of Sheffield, ScHARR, Sheffield, UK.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Jacques
authors.affiliation: Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Thompson
authors.affiliation: University of Sheffield, Section of Health Economics and Decision Science, ScHARR, Sheffield, UK.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Wood
authors.affiliation: University of Sheffield, Section of Health Economics and Decision Science, ScHARR, Sheffield, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Hughes
authors.affiliation: University of New South Wales, Sydney, NSW, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Ledger
authors.affiliation: UPMC Beacon Hospital, Dublin, Ireland.
authors.forename: Mo'iad
authors.initials: M
authors.lastname: Alazzam
authors.affiliation: Sheffield Teaching Hospital NHS Foundation Trust, Royal Hallamshire Hospital, Department of Obstetrics and Gynaecology, Sheffield, UK.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Radley
authors.affiliation: Sheffield Teaching Hospital NHS Foundation Trust, Royal Hallamshire Hospital, Department of Gynaecological Oncology, Sheffield, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Tidy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009367:Neoplasm Staging; D017773:Pelvic Floor; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014846:Vulvar Neoplasms / Q000523:psychology* / Q000601:surgery; D055815:Young Adult