title: Long-Term Impact of Endometrial Cancer Diagnosis and Treatment on Health-Related Quality of Life and Cancer Survivorship: Results From the Randomized PORTEC-2 Trial.
abstract: OBJECTIVE
  To evaluate the long-term health-related quality of life (HRQL) after external beam radiation therapy (EBRT) or vaginal brachytherapy (VBT) among PORTEC-2 trial patients, evaluate long-term bowel and bladder symptoms, and assess the impact of cancer on these endometrial cancer (EC) survivors.
  
  
  METHODS
  In the PORTEC-2 trial, 427 patients with stage I high-intermediate-risk EC were randomly allocated to EBRT or VBT. The 7- and 10-year HRQL questionnaires consisted of EORTC QLQ-C30; subscales for bowel and bladder symptoms; the Impact of Cancer Questionnaire; and 14 questions on comorbidities, walking aids, and incontinence pads. Analysis was done using linear mixed models for subscales and (ordinal) logistic regression with random effects for single items. A two-sided P value <.01 was considered statistically significant.
  
  
  RESULTS
  Longitudinal HRQL analysis showed persisting higher rates of bowel symptoms with EBRT, without significant differences in global health or any of the functioning scales. At 7 years, clinically relevant fecal leakage was reported by 10.6% in the EBRT group, versus 1.8% for VBT (P=.03), diarrhea by 8.4% versus 0.9% (P=.04), limitations due to bowel symptoms by 10.5% versus 1.8% (P=.001), and bowel urgency by 23.3% versus 6.6% (P<.001). Urinary urgency was reported by 39.3% of EBRT patients, 25.5% for VBT, P=.05. No difference in sexual activity was seen between treatment arms. Long-term impact of cancer scores was higher among the patients who had an EC recurrence or second cancer.
  
  
  CONCLUSIONS
  More than 7 years after treatment, EBRT patients reported more bowel symptoms with impact on daily activities, and a trend for more urinary symptoms, without impact on overall quality of life or difference in cancer survivorship issues.
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.m.de_boer.ONCO@lumc.nl.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: de Boer
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Remi A
authors.initials: RA
authors.lastname: Nout
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ina M
authors.initials: IM
authors.lastname: Jürgenliemk-Schulz
authors.affiliation: Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Jobsen
authors.affiliation: Department of Radiation Oncology (MAASTRO), University Medical Centre Maastricht, The Netherlands.
authors.forename: Ludy C H W
authors.initials: LC
authors.lastname: Lutgens
authors.affiliation: Arnhem Radiotherapy Institute (ARTI), Arnhem, The Netherlands.
authors.forename: Elzbieta M
authors.initials: EM
authors.lastname: van der Steen-Banasik
authors.affiliation: Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: Jan Willem M
authors.initials: JW
authors.lastname: Mens
authors.affiliation: Radiotherapy Institute Friesland, Leeuwarden, The Netherlands.
authors.forename: Annerie
authors.initials: A
authors.lastname: Slot
authors.affiliation: Department of Radiation Oncology, Radiotherapy Group Deventer, Deventer, The Netherlands.
authors.forename: Marika C
authors.initials: MC
authors.lastname: Stenfert Kroese
authors.affiliation: Research Department, Netherlands Comprehensive Cancer Organization, Eindhoven, The Netherlands; Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Oerlemans
authors.affiliation: Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: Comprehensive Cancer Center The Netherlands-West, Leiden, The Netherlands.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Verhoeven-Adema
authors.affiliation: Department of Gynecologic Oncology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hans W
authors.initials: HW
authors.lastname: Nijman
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D003967:Diarrhea / Q000453:epidemiology; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy*; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D016496:Incontinence Pads; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012044:Regression Analysis; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D053202:Urinary Incontinence, Urge / Q000453:epidemiology