ESTRO 2017: Cervical Cancer Survivors Frequently Suffer From Long-Term Fatigue, Insomnia, and Hot Flashes

Key Points

  • Sixty-four percent of women were experiencing fatigue to some degree at least once during their regular follow-up examinations in the years after treatment.
  • Forty-three percent of women reported experiencing insomnia, and 50% reported experiencing hot flashes.
  • These symptoms were mainly in the mild to moderate range—severe or disabling symptoms were rare, at 4%, 3%, and 2% respectively—and younger women were more likely to experience these symptoms.

Around half of women who have been treated for locally advanced cervical cancer suffer from symptoms of insomnia, fatigue, or hot flashes at some point, according to new research presented at the European Society for Radiotherapy & Oncology (ESTRO) 36 Conference (Abstract OC-0051).

Cervical cancer affects more than 500,000 women around the world each year, with an average age at diagnosis of 50. Survival rates, even in metastatic disease, have increased, meaning women are living with side effects of the cancer and its treatment for longer periods of time.

Stéphanie Smet, MD, a resident in radiation oncology at the Medical University of Vienna, Austria, said that these symptoms may have a substantial impact on patients’ daily lives and they need to be better recognized and treated when necessary.

EMBRACE Study

These findings come from a larger study called EMBRACE, which involved 1,176 patients with locally advanced cervical cancer treated at 22 centers around the world between 2008 and 2015. All received the gold-standard treatment of radiotherapy combined with chemotherapy, followed by brachytherapy, where a magnetic resonance imaging (MRI) scanner is used to guide a radioactive implant to the site of the cancer to deliver a high dose of radiotherapy. Patients were followed up for an average of 27 months. They were assessed for symptoms by their doctors and filled in questionnaires themselves.

Findings

The results show that 64% of women were experiencing fatigue to some degree at least once during their regular follow-up examinations in the years after treatment. Forty-three percent of women reported experiencing insomnia, and 50% reported experiencing hot flashes. These symptoms were mainly in the mild to moderate range. Severe or disabling symptoms were rare, at 4%, 3%, and 2% respectively.

Patients were on average 49 years old (range = 22–91), and the results show that younger women were more likely to experience these symptoms.

Commentary

Dr. Smet commented, “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 [flashes]. These symptoms could have a serious impact on patients’ daily life, possibly influencing how they feel in their professional, social, and family life.”

“More and more women diagnosed with this type of cancer are surviving for longer, thanks to advances in radiotherapy. This is a relatively young group of patients, so many will possibly face decades of coping with their symptoms.”

“It is important to realize that these symptoms can already exist before patients start the treatment—sometimes even before they are diagnosed with cancer. It is difficult to distinguish whether and to what extent these symptoms are caused by the cancer itself, by the treatment, or by other factors. In most cases, it is probably a combination,” she said.

Until now, research in this area of radiotherapy has primarily focused on symptoms related to nearby organs at risk, such as the bladder, bowel, rectum, or vagina.

Dr. Smet continued, “We hope that by presenting our report we will create more awareness for these under-recognized symptoms. There has been a great deal of research on treating cancer-related fatigue and insomnia, and treatment options include drugs, physical exercise, and psychological counselling. Hormone replacement therapy can be a safe and effective treatment for hot [flashes], if it administered as soon as the menopause begins and for a period of 4 to 5 years.”

Dr. Smet told the congress that more work is needed to decipher which patients are most at risk of developing these symptoms and how to tailor support accordingly. She also said that the study could help understand the symptoms experienced by other cancer patients who are treated with pelvic radiotherapy. This includes other gynecologic cancers, as well as rectal and prostate cancer.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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