Abstract
This study evaluates the contribution of sociodemographic, clinical, and psychological variables to quality of life (QoL) of women with cervical cancer in the follow-up phase. This cross-sectional study, conducted at the Portuguese Oncology Institute of Lisbon, included 200 women with cervical cancer during follow-up. Patients were assessed on QoL (EORTC QLQ-C30), body image and specific symptoms (EORTC QLQ-CX24), psychological morbidity (HADS), social support (SSSS), emotional expression (CECS), and spirituality (SpREUK). Education and social support contributed positively to QoL, whereas body image and symptoms contributed negatively. Body image played a moderating role in the relationship between depression and QoL, but not between anxiety and QoL. Spirituality and emotional expression did not moderate the relationship between anxiety/depression and QoL. Health professionals should reference and monitor women with cervical cancer, providing support at the diagnosis and follow-up phase since physical and psychological symptoms, resulting from the disease, remain after the end of treatment and contribute negatively to their QoL. Interventions should focus on these particular outcomes to promote patients’ QoL.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., … Takeda, F. (1993). The european organization for research and treatment for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365–376. https://doi.org/10.1093/jnci/85.5.365.
Abbott-Anderson, K., & Kwekkeboom, K. L. (2012). A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecologic Oncology, 124, 477–489. https://doi.org/10.1016/j.ygyno.2011.11.030.
Azmawati, M. N., Najibah, E., Hatta, M. D. A. Z., & Norfazilah, A. (2014). Quality of life by stage of cervical cancer among Malaysian patients. Asian Pacific Journal of Cancer Prevention, 15, 5283–5286. https://doi.org/10.7314/APJCP.2014.15.13.5283.
Bacalhau, R. (2017). Indicadores Psicossociais da Qualidade de Vida no Cancro do Colo do Útero [Psychosocial Indicators of Quality of Life in Cervix Cancer]. Doctoral thesis not published, University of Minho, School of Psychology.Braga, Portugal.
Bae, H., & Park, H. (2016). Sexual function, depression, and quality of life in patients with cervical cancer. Supportive Care in Cancer, 24, 1277–1283. https://doi.org/10.1007/s00520-015-2918-z.
Basu, P., Mittal, S., Vale, D. B., & Kharaji, Y. C. (2018). Secondary prevention of cervical cancer. Best Practice & Research Clinical Obstetrics & Gynaecology, 47, 73–85. https://doi.org/10.1016/j.bpobgyn.2017.08.012.
Büssing, A. (2010). Spirituality as a resource to rely on in chronic illness: The spREUK questionnaire. Religions, 1, 9–17. https://doi.org/10.3390/rel1010009.
Carpenter, K. M., Fowler, J. M., Maxwell, G. L., & Andersen, B. L. (2010). Direct and buffering effects of social support among gynecologic cancer survivors. Annals of Behavioral Medicine, 39, 79–90. https://doi.org/10.1007/s12160-010-9160-1.
Castro, B., Ribeiro, D. P., Oliveira, J., Pereira, M. B., Sousa, J. C., & Yaphe, J. (2014). Rastreio do câncer do colo do útero: Limites etários, periodicidade e exame ideal: Revisão da evidência recente e comparação com o indicador de desempenho avaliado em Portugal. Ciência & Saúde Coletiva, 19, 1113–1122. https://doi.org/10.1590/1413-81232014194.18002012.
Conley, C., Bishop, B., & Andersen, B. (2016). Emotions and emotion regulation in breast cancer survivorship. Healthcare, 4, 56–78. https://doi.org/10.3390/healthcare4030056.
Dallabrida, F. A., Loro, M. M., Rosanelli, C. L. S. P., Souza, M. M., Gomes, J. S., & Kolankiewicz, A. C. B. (2014). Qualidade de vida de mulheres tratadas por câncer do colo de útero. Revista Da Rede de Enfermagem Do Nordeste, 15, 116–122. https://doi.org/10.15253/2175-6783.2014000100015.
Deshields, T. L., Potter, P., Olsen, S., & Liu, J. (2014). The persistence of symptom burden: Symptom experience and quality of life of cancer patients across one year. Supportive Care in Cancer, 22, 1089–1096. https://doi.org/10.1007/s00520-013-2049-3.
Fernandes, W. C., & Kimura, M. (2010). Qualidade de vida relacionada à saúde de mulheres com câncer de colo uterino. Revista Latino-Americana de Enfermagem, 18, 01–08. https://doi.org/10.1590/S0104-11692010000300010.
Fornazari, S. A., & Ferreira, R. E. R. (2010). Religiosidade/espiritualidade em pacientes oncológicos: Qualidade de vida e saúde. Psicologia: Teoria E Pesquisa, 26, 265–272. https://doi.org/10.1590/s0102-37722010000200008.
Garssen, B., Uwland-Sikkema, N. F., & Visser, A. (2015). How spirituality helps cancer patients with the adjustment to their disease. Journal of Religion and Health, 54, 1249–1265. https://doi.org/10.1007/s10943-014-9864-9.
Greenwald, H. P., McCorkle, R., Baumgartner, K., Gotay, C., & Neale, A. V. (2014). Quality of life and disparities among long-term cervical cancer survivors. Journal of Cancer Survivorship, 8, 419–426. https://doi.org/10.1007/s11764-014-0352-8.
Greimel, E. R., Vlasic, K. K., Waldenstrom, A.C., Duric, V. M., Jensen, P. T., Singer, S., … Wydra, D. (2006). The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaire cervical cancer module: EORTC QLQ-CX24. Cancer, 107, 1812–1822. https://doi.org/10.1002/cncr.22217.
Guerrero, G. P., Zago, M. M. F., Sawada, N. O., & Pinto, M. H. (2011). Relação entre espiritualidade e câncer: Perspectiva do paciente. Revista Brasileira de Enfermagem, 64, 53–59. https://doi.org/10.1590/S0034-71672011000100008.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. New York: Guilford Press.
Hayes, A. F., & Matthes, J. (2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41, 924–936. https://doi.org/10.3758/brm.41.3.924.
Hayes, A. F., & Montoya, A. K. (2017). A tutorial on testing, visualizing, and probing an interaction involving a multicategorical variable in linear regression analysis. Communication Methods and Measures, 11, 1–30. https://doi.org/10.1080/19312458.2016.1271116.
Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour Research and Therapy, 98, 39–57. https://doi.org/10.1016/j.brat.2016.11.001.
Hossain, N., Akter, Q. M., Banu, F., & Mahmud, S. (2015). Quality of life of cervical cancer patients after completion of treatment—A study among Bangladeshi women. Bangladesh Medical Research Council Bulletin, 41, 131–137. https://doi.org/10.3329/bmrcb.v41i3.29970.
Johnson, P. O., & Neyman, J. (1936). Tests of certain linear hypotheses and their application to some educational problems. Statistical Research Memoirs, 1, 57–93.
Khalil, J., Bellefqih, S., Sahli, N., Afif, M., Elkacemi, H., Elmajjaoui, S., … Benjaafar, N. (2015). Impact of cervical cancer on quality of life: Beyond the short term (Results from a single institution). Gynecologic Oncology Research and Practice, 2, 7–13. https://doi.org/10.1186/s40661-015-0011-4.
Kimmel, M., Fairbairn, M., Giuntoli, R., Jernigan, A., Belozer, A., Payne, J., … Díaz-Montes, T. P. (2014). The importance of social support for women with elevated anxiety undergoing care for gynecologic malignancies. International Journal of Gynecological Cancer, 24, 1700–1708. https://doi.org/10.1097/igc.0000000000000285.
Kluegel, S., Luecke, C., Meta, A., Schild-Suhren, M., Malik, E., Philipsen, A., & Mueller, H. H. (2017). Concomitant psychiatric symptoms and impaired quality of life in women with cervical cancer: A critical review. International Journal of Women’s Health, 9, 795–804. https://doi.org/10.2147/IJWH.S143368.
Kobayashi, M., Ohno, T., Noguchi, W., Matsuda, A., Matsushima, E., Kato, S., & Tsujii, H. (2009). Psychological distress and quality of life in cervical cancer survivors after radiotherapy. International Journal of Gynecological Cancer, 19, 1264–1268. https://doi.org/10.1111/IGC.0b013e3181a3e124.
Korfage, I. J., Essink-Bot, M. L., Mols, F., Poll-Franse, L., Kruitwagen, R., & Ballegooijen, M. (2009). Health-related quality of life in cervical cancer survivors: A population-based survey. International Journal of Radiation: Oncology–Biology–Physics, 73, 1501–1509. https://doi.org/10.1016/j.ijrobp.2008.06.1905.
Kumar, R., Singh, K. K., Rae, A. A., Singh, R. K., & Singh, G. R. (2016). Prevalence of anxiety and depression among cancer patients. Journal of Medical Science and Clinical Research, 4, 13696–13699. https://doi.org/10.18535/jmscr/v4i11.30.
Lau, K., Yim, P., & Cheung, E. (2013). Psychiatric morbidity in chinese women after cervical cancer treatment in a regional gynaecology clinic. East Asian Arch Psychiatry, 23, 144–153. Retrieved from http://easap.asia/index.php/find-issues/past-issue/item/204-v23n4-p144-153.
Lee, Y., Lim, M. C., Kim, S. I., Joo, J., Lee, D. O., & Park, S. (2016). Comparison of quality of life and sexuality between cervical cancer survivors and healthy women. Cancer Research and Treatment, 48, 1321–1329. https://doi.org/10.4143/crt.2015.425.
Li, C., Chen, M., Chang, T., Chou, H., & Chen, M. (2015). Social support buffers the effect of self-esteem on quality of life of early-stage cervical cancer survivors in Taiwan. European Journal of Oncology Nursing, 19, 486–494. https://doi.org/10.1016/j.ejon.2015.02.008.
Lim, A. W., Ramirez, A. J., Hamilton, W., Sasieni, P., Patnick, J., & Forbes, L. J. L. (2014). Delays in diagnosis of young females with symptomatic cervical cancer in England: An interview-based study. British Journal of General Practice, 64, 602–610. https://doi.org/10.3399/bjgp14X681757.
Livneh, H. (2001). Psychosocial adaptation to chronic illness and disability: A conceptual framework. Rehabilitation Counseling Bulletin, 44, 151–160. https://doi.org/10.1177/003435520104400305.
Mantegna, G., Petrillo, M., Fuoco, G., Venditti, L., Terzano, S., Anchora, L. P., … Ferrandina, G. (2013). Long-term prospective longitudinal evaluation of emotional distress and quality of life in cervical cancer patients who remained disease-free 2-years from diagnosis. BMC Cancer, 13, 127–135. https://doi.org/10.1186/1471-2407-13-127.
Marlow, L. A., McGregor, L. M., Nazroo, J. Y., & Wardle, J. (2014). Facilitators and barriers to help-seeking for breast and cervical cancer symptoms: A qualitative study with an ethnically diverse sample in London. Psycho-Oncology, 23, 749–757. https://doi.org/10.1002/pon.3464.
Marroquín, B., Czamanski-Cohen, J., Weihs, K. L., & Stanton, A. L. (2016). Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors. Journal of Behavioral Medicine, 39, 832–844. https://doi.org/10.1007/s10865-016-9751-9.
Osann, K., Hsieh, S., Nelson, E. L., Monk, B. J., Chase, D., Cella, D., & Wenzel, L. (2014). Factors associated with poor quality of life among cervical cancer survivors: Implications for clinical care and clinical trials. Gynecologic Oncology, 135, 266–272. https://doi.org/10.1016/j.ygyno.2014.08.036.
Pais-Ribeiro, J., Pinto, C., & Santos, C. (2008). Validation Study of the Portuguese Version of the Qlc-C30-V.3. Psicologia, Saúde & Doenças, 9, 89–102. https://doi.org/10.5707/cjbiolsci.2015.8.1.24.33.
Pais-Ribeiro, J., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225–237. https://doi.org/10.1080/13548500500524088.
Patrão, I. (2007). O ciclo psico-oncológico no cancro da mama: Estudo do impacto psicossocial do diagnóstico e dos tratamentos. [The psycho-oncological cycle in breast cancer: The Study of the social impact of diagnosis and treatment]. Retrieved from http://repositorio.ispa.pt/handle/10400.12/208.
Peh, C. X., Liu, J., Bishop, G. D., Chan, H. Y., Chua, S. M., Kua, E. H., & Mahendran, R. (2017). Emotion regulation and emotional distress: The mediating role of hope on reappraisal and anxiety/depression in newly diagnosed cancer patients. Psycho-Oncology, 26, 1191–1197. https://doi.org/10.1002/pon.4297.
Pereira, M. G., Vilaça, M., Pedras, S., Vieira, S., & Lima, S. (2019). Validation of the spiritual and religious attitudes in dealing with illness (SpREUK) in Portuguese Alzheimer‘s patients. Journal of Religion, Spirituality, & Aging. https://doi.org/10.1080/15528030.2019.1610989.
Pinto, C., & Ribeiro, J. L. P. (2010). Avaliação da espiritualidade dos sobreviventes de cancro: Implicações na qualidade de vida. Revista Portuguesa de Saúde Pública, 28, 49–56. Retrieved from http://www.scielo.mec.pt/scielo.php?script=sci_abstract&pid=S0870-90252010000100006&lng=pt&nrm=i.
Prasongvej, P., Nanthakomon, T., Jaisin, K., Chanthasenanont, A., Lertvutivivat, S., Tanprasertkul, C., … Suwannarurk, K. (2017). Quality of life in cervical cancer survivors and healthy women: Thai urban population study. Asian Pacific Journal of Cancer Prevention, 18, 385–389. https://doi.org/10.22034/apjcp.2017.18.2.385.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891. https://doi.org/10.3758/brm.40.3.879.
Przezdziecki, A., Sherman, K. A., Baillie, A., Taylor, A., Foley, E., & Stalgis-Bilinski, K. (2013). My changed body: Breast cancer, body image, distress and self-compassion. Psycho-oncology, 22, 1872–1879. https://doi.org/10.1002/pon.3230.
Quartana, P. J., Laubmeier, K. K., & Zakowski, S. G. (2006). Psychological adjustment following diagnosis and treatment of cancer: An examination of the moderating role of positive and negative emotional expressivity. Journal of Behavioral Medicine, 29, 487–498. https://doi.org/10.1007/s10865-006-9069-0.
Reese, J. B., Lepore, S. J., Handorf, E. A., & Haythornthwaite, J. A. (2017). Emotional approach coping and depressive symptoms in colorectal cancer patients: The role of the intimate relationship. Journal of Psychosocial Oncology, 35, 578–596. https://doi.org/10.1080/07347332.2017.1331492.
Reutter, K. K., & Bigatti, S. M. (2014). Religiosity and spirituality as resiliency resources: Moderation, mediation, or moderated mediation? Journal for the Scientific Study of Religion, 53, 56–72. https://doi.org/10.1111/jssr.12081.
Ribeiro, J. L. P. (2011). Escala de satisfação com o suporte social (1st ed.). Lisboa: Placebo.
Rubinsak, L. A., Terplan, M., Martin, C. E., Fields, E. C., McGuire, W. P., & Temkin, S. M. (2019). Co-occurring substance use disorder: The impact on treatment adherence in women with locally advanced cervical cancer. Gynecologic Oncology Reports. https://doi.org/10.1016/j.gore.2019.03.016.
Sarwer, D. B., & Cash, T. F. (2008). Body image: interfacing behavioral and medical sciences. 10.1016/j. asj.2008.03.007
Sasaki, Y., Iwanari, O., Arakawa, I., Moriya, T., Mikami, Y., Iihara, K., & Konno, R. (2017). Cervical cancer screening with human papillomavirus DNA and cytology in Japan. International Journal of Gynecological Cancer, 27, 523–529. https://doi.org/10.1097/IGC.0000000000000898.
Sekse, R. J. T., Gjengedal, E., & Råheim, M. (2013). Living in a changed female body after gynecological cancer. Health Care for Women International, 34, 14–33. https://doi.org/10.1080/07399332.2011.645965.
Sekse, R. J. T., Hufthammer, K. O., & Vika, M. E. (2014). Fatigue and quality of life in women treated for various types of gynaecological cancers: A cross-sectional study. Journal of Clinical Nursing, 24, 546–555. https://doi.org/10.1111/jocn.12647.
Sociedade Portuguesa de Ginecologia. (2016). Cancro Ginecológico. Consensos Nacionais 2016. Retrieved from http://www.spginecologia.pt/uploads/cancro_ginecologico_9JAN2017.pdf.
Stokes, R., & Frederick-Recascino, C. (2003). Women’s perceived body image: Relations with personal happiness. Journal of Women & Aging, 15, 17–29. https://doi.org/10.1300/J074v15n01_3.
Tejada, M. G., Bilbao, A., Baré, M., Briones, E., Sarasqueta, C., Quintana, J. M., & Escobar, A. (2015). Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer. Psycho-Oncology, 25, 891–897. https://doi.org/10.1002/pon.4022.
Teo, I., Cheung, Y. B., Lim, T. Y. K., Namuduri, R. P., Long, V., & Tewani, K. (2017). The relationship between symptom prevalence, body image, and quality of life in Asian gynecologic cancer patients. Psycho-Oncology, 27, 69–74. https://doi.org/10.1002/pon.4457.
Watson, M., & Greer, S. (1983). Development of a questionnaire measure of emotional control. Journal of Psychosomatic Research, 27, 299–305. https://doi.org/10.1016/0022-3999(83)90052-1.
World Health Organisation. (2014). Comprehensive cervical cancer control: A guide to essential practice (2nd ed.). Geneva: World Health Organization. Retrieved from http://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-guide/en/.
Xie, Y., Zhao, F., Lu, S., Huang, H., Pan, X., Yang, C., & Qiao, Y. (2013). Assessment of quality of life for the patients with cervical cancer at different clinical stages. Chinese Journal of Cancer, 32, 275–282. https://doi.org/10.5732/cjc.012.10047.
Yagmur, Y., & Duman, M. (2016). The relationship between the social support level perceived by patients with gynecologic cancer and mental adjustment to cancer. International Journal of Gynecology and Obstetrics, 134, 208–211. https://doi.org/10.1016/j.ijgo.2015.12.010.
Yang, Y., Liu, L., Wang, Y., Wu, H., Yang, X., Wang, J., & Wang, L. (2013). The prevalence of depression and anxiety among Chinese adults with cancer: A systematic review and meta-analysis. BMC Cancer, 13, 393–408. https://doi.org/10.1186/1471-2407-13-393.
Zhao, Z., Pan, X., Lv, S., Xie, Y., Zhang, S., Qiao, Y., … Zhao, F. (2014). Quality of life in women with cervical precursor lesions and cancer: A prospective, 6-month, hospital-based study in China. Chinese Journal of Cancer, 33, 339–345. https://doi.org/10.5732/cjc.013.10139.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression scale. Acta Psychiatry Scandinavia, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Acknowledgements
The authors want to thank the Portuguese Oncology Institute of Lisbon, Francisco Gentil.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors Ana Clara Lopes, Rosário Bacalhau, Martim Santos, Marta Pereira, and M. Graça Pereira declare they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
All participants signed an informed consent form, participated voluntarily, and were assured anonymity along with the possibility of withdrawing at any time.
Research Involving Human Participants
All procedures followed the ethical principles outlined in the Declaration of Helsinki, and the Ethics Committee of the institution where data collection took place approved this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lopes, A.C., Bacalhau, R., Santos, M. et al. Contribution of Sociodemographic, Clinical, and Psychological Variables to Quality of Life in Women with Cervical Cancer in the Follow-Up Phase. J Clin Psychol Med Settings 27, 603–614 (2020). https://doi.org/10.1007/s10880-019-09644-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-019-09644-0