Effect of postoperative rehabilitation on quality of life in patients with vulvar cancer

Aim: to evaluate the quality of life parameters dynamics in patients with vulvar cancer I and II stages during postoperative rehabilitation.

Materials and Methods. A prospective comparative randomized study included 47 women with vulvar cancer I–II stages, aged 38 to 70 years, with an average age of 56.3 ± 3.9 years. Patients were randomized into 2 groups: 24 of them underwent postoperative rehabilitation and 23 were included in the comparison group. Quality of life and sexual function, as well as psycho-emotional state were assessed using a set of questionnaires: quality of life of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, Functional Assessment of Cancer Therapy-General (FACT-G) with an extension for vulvar cancer, Female Sexuality Index (FSFI) and WAM (well-being, activity, mood).

Results. Patient who receiving postoperative rehabilitation even during the first three months, a reliable positive dynamics of all parameters of FSFI and EORTC, except cognitive function, was noted. At the same time, in the patients not undergoing postoperative rehabilitation program there was no reliable difference in the results of the questionnaires, except for FSFI, but the severity of changes was significantly less than in the patients of the research group. Dynamics in the EORTC parameters in women in postoperative rehabilitation averaged 14.8 points with 7.8 points in the comparison group. In the FACT-G questionnaire, the dynamics were even more pronounced with 19.9 and 6.8 points respectively. There was a reliable positive trend in improving the quality of sexual life and a decrease in the percentage of women suffer from pain and discomfort during sexual intercourse: from 25,0 % (n = 6) to 4,2 % (n = 1) in the study group and from 21,7 % (n = 5) to 13,0 % (n = 3) in the comparison group. Improvement in sexual desire and satisfaction during the year was noted in 5 (20.8 %) women in the study group and only 2 (8.7 %) in the comparison group.

Conclusion. The developed program of postoperative rehabilitation of patients with vulvar cancer, which includes individual and group psychotherapy, "anti-cancer diet therapy", dosed physical activity, dynamic correction of vaginal biocoenosis showed high efficiency already during the first 6 months. All patients with vulvar cancer in the postoperative period should receive active rehabilitation aimed at correction of psycho-emotional state and sexual function, which will improve the quality of life and improve further prognosis.

1. Weinberg D., Gomez-Martinez R.A. Vulvar cancer. Obstet Gynecol Clin North Am. 2019;46(1):125–35. https://doi.org/10.1016/j.ogc.2018.09.008.

2. Solopova A.G., Moskvichyova V.S., Blbulyan T.A. et al. Topical issues of prevention, diagnosis and treatment of vulvar and vaginal cancer. [Aktual'nye voprosy profilaktiki, diagnostiki i lecheniya raka vul'vy i vlagalishcha]. Akusherstvo, Ginekologia i Reprodukcia. 2018;12(4):62–70. (In Russ.). https://doi.org/10.17749/2313-7347.2018.12.4.062-070.

3. Bogani G., Martinelli F., Ditto A. et al. The association of pre-treatment HPV subtypes with recurrence of VIN. Eur J Obstet Gynecol Reprod Biol. 2017;211:37–41. https://doi.org/10.1016/j.ejogrb.2017.01.057.

4. Carrone A., Riganelli L., Savone D. et al. HPV-related vulvar diseases and perspectives of p16INK4a immunochemistry: a review of the literature. Tumori. 2017;103(6):511–5. https://doi.org/10.5301/tj.5000642.

5. Forner D.M., Dakhil R., Lampe B. Quality of life and sexual function after surgery in early stage vulvar cancer. Eur J Surg Oncol. 2015;41(1):40–5. https://doi.org/10.1016/j.ejso.2014.10.050.

6. Carter J., Stabile C., Seidel B. et al. Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors. J Cancer Surviv. 2017;11(2):274–83. https://doi.org/10.1007/s11764-016-0585-9.

7. Major J., Brackenbury F., Gibbon K., Tomson N. The impact of vulval disease on patients’ quality of life. J Comm Nurs. 2016;30(2):40–4.

8. Hazewinkel M.H., Laan E.T., Sprangers M.A. et al. Long-term sexual function in survivors of vulvar cancer: a cross-sectional study. Gynecol Oncol. 2012;126(1):87–92. https://doi.org/10.1016/j.ygyno.2012.04.015.

9. Smits A., Lopes A., Das N. et al. The effect of lifestyle interventions on the quality of life of gynaecological cancer survivors. Gynecol Oncol. 2015;139(3):546–52. https://doi.org/10.1016/j.ygyno.2015.10.002.

10. Holt K.A., Mogensen O., Jensen P.T., Hansen D.G. Goal setting in cancer rehabilitation and relation to quality of life among women with gynaecological cancer. Acta Oncol. 2015;54(10):1814–23. https://doi.org/10.3109/0284186X.2015.103700.

11. Duijts S.F.A., van Egmond M.P., Spelten E. et al. Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review. Psychooncology. 2014;23(5):481–92. https://doi.org/10.1002/pon.3467.

12. McCallum M., Jolicoeur L., Lefebvre M. et al. Supportive care needs after gynecologic cancer: where does sexual health fit in? Oncol Nurs Forum. 2014;41(3):297–306. https://doi.org/10.1188/14.ONF.297-306.

13. Mishra S.I., Scherer R.W., Geigle P.M. et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;(8):CD007566. https://doi.org/10.1002/14651858.CD007566.pub2.

14. Dessole M., Petrillo M., Lucidi A. et al. Quality of life in women after pelvic exenteration for gynecological malignancies: a multicentric study. Int J Gynecol Cancer. 2018;28(2):267–73. https://doi.org/10.1097/IGC.0000000000000612.

15. Forner D.M., Dakhil R., Lampe B. Quality of life and sexual function after surgery in early stage vulvar cancer. Eur J Surg Oncol. 2015;41(1):40–5. https://doi.org/10.1016/j.ejso.2014.10.050.

16. Novackova M., Halaska M.J., Robova H. et al. A prospective study in the evaluation of quality of life after vulvar cancer surgery. Int J Gynecol Cancer. 2015;25(1):166–73. https://doi.org/10.1097/IGC.0000000000000313.

17. Pilger A., Richter R., Fotopoulou C. et al. Quality of life and sexuality of patients after treatment for gynaecological malignancies: results of a prospective study in 55 patients. Anticancer Res. 2012;32(11):5045–9.

18. Frimer M., Turker L.B., Shankar V. et al. The association of sexual dysfunction with race in women with gynecologic malignancies. Gynecol Oncol Rep. 2019;30:100495. https://doi.org/10.1016/j.gore.2019.100495

19. Gehrig L., Kobleder A., Werner B. et al. Are written information or counseling (WOMAN-PRO II program) able to improve patient satisfaction and the delivery of health care of women with vulvar neoplasms? Secondary outcomes of a multicenter randomized controlled trial. Pflege. 2017;30(5):257–69. https://doi.org/10.1024/1012-5302/a000558.

20. Solopova A.G., Moskvichyova V.S., Blbulyan T.A. et al. Rehabilitation of vulvar cancer patients. [Reabilitaciya bol'nyh rakom vul'vy]. Akusherstvo i ginekologiya. 2019;(12):188–92. (In Russ.). https://doi.org/10.18565/aig.2019.12.188-192.

21. Fayers P., Aaronson N., Bjordal K. et al. The EORTC QLQ-C30 scoring manual. 3d ed. Brussels, Belgium: EORTC, 2001. 78 p. Available at: https://www.eortc.org/app/uploads/sites/2/2018/02/SCmanual.pdf. [Accessed: 01.06.2020].

22. Greimel E.R., Kuljanic Vlasic K., Waldenstrom A.C. et al. The European Organization for Research and Treatment of Cancer (EORTC) Qualityof- Life questionnaire cervical cancer module: EORTC QLQ-CX24. Cancer. 2006;107(8):1812–22. https://doi.org/10.1002/cncr.22217.

23. Colombo R., Doherty D.J., Wilson C.M. et al. Implementation and preliminary analysis of FACT-G Quality of Life Questionnaire within an Oncology Survivorship Clinic. Cureus. 2018;10(3):e2272. https://doi.org/10.7759/cureus.2272.

24. Edianto D., Yaznil M.R., Chartyansari A.A., Effendi I.H. Assessment of the quality of life for gynecologic cancer patients using Functional Assessment of Cancer Therapy-General (Fact-G) Questionnaire at Haji Adam Malik Hospital. Open Access Maced J Med Sci. 2019;7(16):2569–73. https://doi.org/10.3889/oamjms.2019.391.

25. Rosen R., Brown C., Heiman J. et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.