Top

Archives of Gynecology and Obstetrics

Published in:

Open Access 01-04-2021 | Gynecologic Cancer | Gynecologic Oncology

Preoperative quality of life as prediction for severe postoperative complications in gynecological cancer surgery: results of a prospective study

Authors: Jalid Sehouli, Kathrin Heise, Rolf Richter, Hannah Woopen, Louise Anders, Melisa Guelhan Inci

Published in: Archives of Gynecology and Obstetrics | Issue 4/2021

Abstract

Purpose

The aim of this study was to investigate preoperative quality of life (QoL) as a predictive tool for severe postoperative complications (POC) in gynecological cancer surgery.

Methods

This is a prospective study of patients undergoing gynecologic cancer surgery at an academic center in Germany. QoL was assessed by the EORTC Quality of Life Questionnaire (QLQ-C30) and the NCCN Distress Thermometer (DT). Several geriatric assessment tools have been applied. POC were graded using Clavien–Dindo criteria. Using multivariable logistic regression models, we identified predictive clinical characteristics for postoperative complications.

Results

Within 30 days of surgery, 40 patients (18%) experienced grade ≥ 3b complications including 9 patients (4%) who died. The dominant complication was anastomosis insufficiency with 13 patients (5.8%). In the multivariable stepwise logistic regression through all univariate significant variables, we found that impaired physical functioning was predictive of POC, defined by an EORTC score < 70 (OR 5.08, 95% CI 2.23–11.59, p < 0.001). Regarding symptoms nausea/vomiting assessed as an EORTC score > 20 (OR 3.08, 95% CI 1.15–8.26, p = 0.025) indicated a significant predictive value. Being overweight or obese (BMI > 25) were also identified as predictive factors (OR 5.44, 95% CI 2.04–14.49, p = 0.001) as were reduced Mini Mental State Examination (MMSE) results < 27 (OR 7.94, 95% CI 1.36–45.46, p = 0.02).

Conclusion

Preoperative QoL measurements could help to predict postoperative complications in patients with gynecological cancer. Patients with limitations of mobility, debilitating symptoms and cognitive impairment have an increased risk for developing severe POC.

Pijpers E, Ferreira I, Stehouwer CDA, Nieuwenhuijzen Kruseman AC (2012) The frailty dilemma Review of the predictive accuracy of major frailty scores. Eur J Intern Med 23:118–123CrossRefPubMed

Repetto L, Fratino L, Audisio RA et al (2002) Comprehensive geriatric assessment adds information to eastern cooperative oncology group performance status in elderly cancer patients: an italian group for geriatric oncology study. J Clin Oncol 20:494–502CrossRefPubMed

Kelly CM, Shahrokni A (2016) Moving beyond Karnofsky and ECOG performance status assessments with new technologies. J Oncol. https://doi.org/10.1155/2016/6186543CrossRefPubMedPubMedCentral

Quinten C, Coens C, Mauer M et al (2009) Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol 10:865–871CrossRefPubMed

Montazeri A (2009) Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes 7:102CrossRefPubMedPubMedCentral

Grande GE, Farquhar MC, Barclay SIG, Todd CJ (2009) Quality of life measures (EORTC QLQ-C30 and SF-36) as predictors of survival in palliative colorectal and lung cancer patients. Palliat Support Care 7:289CrossRefPubMed

Schmidt M, Neuner B, Kindler A et al (2014) Prediction of long-term mortality by preoperative health-related quality-of-life in elderly onco-surgical patients. PLoS ONE 9:e85456CrossRefPubMedPubMedCentral

Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI J Natl Cancer Inst 85:365–376CrossRefPubMed

Webber K, Carolus E, Mileshkin L et al (2019) OVQUEST—life after the diagnosis and treatment of ovarian cancer—an international survey of symptoms and concerns in ovarian cancer survivors. Gynecol Oncol. https://doi.org/10.1016/j.ygyno.2019.08.009CrossRefPubMed

10.

Quinten C, Maringwa J, Gotay CC et al (2011) Patient self-reports of symptoms and clinician ratings as predictors of overall cancer survival. JNCI J Natl Cancer Inst 103:1851–1858CrossRefPubMed

11.

Groenvold M, Klee MC, Sprangers MAG, Aaronson NK (1997) Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 50:441–450CrossRefPubMed

12.

McLachlan S-A, Devins G, Goodwin P (1998) Validation of the european organization for research and treatment of cancer quality of life questionnaire (QLQ-C30) as a measure of psychosocial function in breast cancer patients. Eur J Cancer 34:510–517CrossRefPubMed

13.

Kaasa S, Bjordal K, Aaronson N et al (1995) The EORTC Core Quality of Life questionnaire (QLQ-C30): validity and reliability when analysed with patients treated with palliative radiotherapy. Eur J Cancer 31:2260–2263CrossRef

14.

National Comprehensive Cancer Network (2007b) NCCN practiceguidelines in oncologyTM: distress management. v.1.2007. From, https://nccn.org/professionals/physician_gls/PDF/distress.pdf - Google-Suche. [https://www.google.de/search?q=National+Comprehensive+Cancer+Network.+%282007b%29.+NCCN+practiceguidelines+in+oncologyTM%3A+Distress+management.+v.1.2007Retrieved+May+3%2C+2007%2C+from%2C+http%3A%2F%2Fnccn.org%2Fprofessionals%2Fphysician_gls%2FPDF%2Fdistress.pdf&ie=utf-8&oe=utf-8&client=firefox-b-ab&gfe_rd=cr&ei=b8pbWf_VCZTVXum6tIAK]. Accessed on Retrieved 3 May 2007

15.

Donovan KA, Grassi L, McGinty HL, Jacobsen PB (2014) Validation of the distress thermometer worldwide: state of the science: validation of distress thermometer. Psychooncology 23:241–250CrossRefPubMed

16.

Tang L, Zhang Y, Pang Y et al (2011) Validation and reliability of distress thermometer in Chinese cancer patients. Chin J Cancer Res 23:54–58CrossRefPubMedPubMedCentral

17.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

18.

Bilotta C, Bowling A, Casè A et al (2010) Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy. Health Qual Life Outcomes 8(1):56CrossRefPubMedPubMedCentral

19.

Maisey N, Norman A, Watson M et al (2002) Baseline quality of life predicts survival in patients with advanced colorectal cancer. Eur J Cancer 38:1351–1357CrossRefPubMed

20.

Qi Y, Schild SE, Mandrekar SJ et al (2009) Pretreatment quality of life is an independent prognostic factor for overall survival in patients with advanced stage non-small cell lung cancer. J Thorac Oncol 4:1075–1082CrossRefPubMedPubMedCentral

21.

Von Gruenigen VE, Huang HQ, Gil KM et al (2012) The association between quality of life domains and overall survival in ovarian cancer patients during adjuvant chemotherapy: a Gynecologic Oncology Group Study. Gynecol Oncol 124:379–382CrossRef

22.

Wenzel L, Huang HQ, Monk BJ et al (2005) Quality-of-life comparisons in a randomized trial of interval secondary cytoreduction in advanced ovarian carcinoma: a gynecologic oncology group study. J Clin Oncol 23:5605–5612CrossRefPubMed

23.

Wenzel LB, Huang HQ, Armstrong DK et al (2007) Health-related quality of life during and after intraperitoneal versus intravenous chemotherapy for optimally debulked ovarian cancer: a gynecologic oncology group study. J Clin Oncol 25:437–443CrossRefPubMed

24.

Carey MS, Bacon M, Tu D et al (2008) The prognostic effects of performance status and quality of life scores on progression-free survival and overall survival in advanced ovarian cancer. Gynecol Oncol 108:100–105CrossRefPubMed

25.

Roncolato FT, Joly F, O’Connell R et al (2017) Reducing uncertainty: predictors of stopping chemotherapy early and shortened survival time in platinum resistant/refractory ovarian cancer-The GCIG Symptom Benefit Study. Oncologist 22:1117–1124CrossRefPubMedPubMedCentral

26.

Doll KM, Snavely AC, Kalinowski A et al (2014) Preoperative quality of life and surgical outcomes in gynecologic oncology patients: a new predictor of operative risk? Gynecol Oncol 133:546–551CrossRefPubMedPubMedCentral

27.

Baker J, Janda M, Gebski V et al (2015) Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: Results from the LACE trial. Gynecol Oncol 137:102–105CrossRefPubMed

28.

Quinten C, Martinelli F, Coens C et al (2014) A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites: quality of life prognostic for survival. Cancer 120:302–311CrossRefPubMed

29.

Gil KM, Gibbons HE, Jenison EL et al (2007) Baseline characteristics influencing quality of life in women undergoing gynecologic oncology surgery. Health Qual Life Outcomes 5:25CrossRefPubMedPubMedCentral

30.

Doll KM, Kalinowski AK, Snavely AC et al (2015) Obesity is associated with worse quality of life in women with gynecologic malignancies: an opportunity to improve patient-centered outcomes: obesity and quality of life in gyn cancers. Cancer 121:395–402CrossRefPubMed

31.

Xue D-D, Cheng Y, Wu M, Zhang Y (2018) Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis. Clin Interv Aging 13:723–736CrossRefPubMedPubMedCentral

32.

Mokutani Y, Mizushima T, Yamasaki M et al (2016) Prediction of postoperative complications following elective surgery in elderly patients with colorectal cancer using the comprehensive geriatric assessment. Dig Surg 33:470–477CrossRefPubMed

Title: Preoperative quality of life as prediction for severe postoperative complications in gynecological cancer surgery: results of a prospective study
Authors: Jalid Sehouli
Kathrin Heise
Rolf Richter
Hannah Woopen
Louise Anders
Melisa Guelhan Inci
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keyword: Gynecologic Cancer
Published in: Archives of Gynecology and Obstetrics / Issue 4/2021
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-020-05847-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative quality of life as prediction for severe postoperative complications in gynecological cancer surgery: results of a prospective study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Autoimmunological serum parameters and bone mass density in premature ovarian insufficiency: a retrospective cohort study

Correction to: Evaluation of the efficacy of fractional CO2 laser in the treatment of vulvar and vaginal menopausal symptoms

Laparoscopic nerve-sparing radical hysterectomy without uterine manipulator for cervical cancer stage IB: description of the technique, our experience and results after the era of LACC trial

Gynecologists’ attitudes toward and use of complementary and integrative medicine approaches: results of a national survey in Germany

Evaluation of the efficacy of fractional CO2 laser in the treatment of vulvar and vaginal menopausal symptoms

Fishing for (in)continence: long-term follow-up of women with OASIS–still a taboo