Roxanne Nelson, BSN, RN

May 04, 2017

Fatigue, insomnia, and hot flashes are common in women following treatment for locally advanced cervical cancer and can have an adverse effect on quality of life.

New research presented at the 36th annual congress of the European Society for Radiotherapy and Oncology (ESTRO 36), which begins in Vienna, Austria, on Friday, shows that more than half of all women experienced long-term side effects. Although most symptoms were mild to moderate, up to 4% reported symptoms that were severe or disabling.

These symptoms may have a substantial impact on the daily lives of patients, and they need to be better recognized and treated when necessary, explained lead author Stéphanie Smet, MD, a resident in radiation oncology at the Medical University of Vienna, who presented the research at the meeting.

"Our study shows that around half of women with locally advanced cervical cancer are, at some point, suffering from mild to moderate fatigue, insomnia, and hot flushes," said Dr Smet. "These symptoms could have a serious impact on patients' daily life, possibly influencing how they feel in their professional, social, and family life."

The authors note that advances in definitive treatment of locally advanced cervical cancer have not only increased the number of longtime survivors but have also raised the likelihood of late and persisting treatment-related adverse events.

Although research on associated morbidity has primarily focused on symptoms related to organs at risk, such as bladder, bowel, rectum, or vagina, many patients report that their quality of life is substantially affected by symptoms such as fatigue, insomnia, and hot flashes.

"Thanks to advances in treatment, cancer survival is improving, which makes us aware of the fact that besides the locoregional side effects we are typically focusing on, we should also be vigilant for more general side effects," commented ESTRO president Yolande Lievens, MD, who is also head of the Department of Radiation Oncology at Ghent University Hospital, Belgium.

"These results highlight how important it is to follow cancer survivors in the long term," explained Dr Lievens in a statement. "Medical teams who look after patients treated for cancer of the cervix, and, by extension, other gynecologic and pelvic cancers, need to be aware of symptoms such as fatigue, insomnia, and hot flushes and be able to advise on management and treatment options."

Details of Study Findings

Dr Smet and her colleagues evaluated symptoms among participants of the prospective, observational, multicenter EMBRACE study, which evaluated MRI-guided brachytherapy in locally advanced cervical cancer.

The cohort included 1176 patients with locally advanced cervical cancer who were treated at 22 centers worldwide between 2008 and 2015. Patients received treatment with external-beam readiation therapy, with or without chemotherapy, and MRI-guided brachytherapy in accordance with the GEC-ESTRO guidelines.

Fatigue, insomnia, and hot flashes were prospectively assessed at baseline and then every 3 months for the first year, every 6 months for the second and third year, and then annually.

The average follow-up time for the cohort was 27 months.

The results showed that 64% of patients reported that they were experiencing fatigue to some degree at least once during their regular follow-up examinations. About half of the patients (50%) reported they were experiencing hot flashes, and 43% reported they had insomnia.

Most of the reported symptoms were mild to moderate; symptoms that were severe or disabling were more uncommon, ranging from 2% to 4%.

The authors point out that the prevalence rates showed that both fatigue and insomnia were present at baseline and that both symptoms neither resolved nor worsened over time. In addition, the proportion of patients experiencing hot flashes increased considerably at the first follow-up visit following treatment, but then remained stable for the most part.

Although the patients ranged in age from 22 to 91 years (average age, 49 years), the results showed that these symptoms were more likely to manifest in younger women.

Dr Smet said that more work is needed to differentiate the subgroup of patients who face the highest risk of developing these symptoms; treatment can then be tailored accordingly.

She added that these findings can help clinicians better understand the symptoms experienced by other cancer patients who are also treated with pelvic radiotherapy, including those with other types of gynecologic cancers, as well as rectal and prostate cancer patients.

This study was sponsored by the Medical University of Vienna. Uncommitted research funding was provided by Elekta and Varian Medical Systems for the EMBRACE study. Financial support was provided by the Austrian Federal Ministry of Economy, Family, and Youth and the Austrian Foundation for Research, Technology, and Development through the Christian Doppler Lab for Research in Radiation Oncology.

ESTRO 36. Abstract OC-0051, to be presented May 6, 2017.

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