Combined chemotherapy and radiotherapy can now prolong the lives of women with locally advanced cervical cancer (LACC), yet it leaves more than half of them with long-term side effects including insomnia, fatigue and hot flashes.
Researchers presented findings from their study, “Fatigue, insomnia, hot flashes (CTCAE) after definitive RCHT+IGABT for cervical cancer (EMBRACE),” at the recent European Society for Radiotherapy & Oncology (ESTRO) 36 meeting in Vienna.
For some time, doctors have focused on how major organs such as the bladder, bowel, rectum and vagina are affected by chemo and radiotherapy. However, in clinical practice, women often complained of unspecific symptoms had significantly affect their overall quality of life — leading a team of Austrian, British, Danish, Dutch, French, Indian and Slovenian researchers to address the incidence and clinical relevance of these symptoms.
The study — lasting from 2008 to 2015 — enrolled 1,176 LACC patients from 22 centers. Doctors followed them for an average 27 months. All women received the gold-standard treatment of combined external beam radiation therapy (EBRT) with chemotherapy, followed by internal radiation therapy (brachytherapy), according to the guidelines.
The researchers found that 64 percent of women experienced fatigue at least once during their regular post-treatment follow-up exams. In addition, 43 percent complained of insomnia, and 50 percent reported hot flushes. All these symptoms were mild to moderate, yet they were severe or disabling when it came to fatigue (4 percent of the total), insomnia (3 percent) and hot flushes (2 percent).
“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. These symptoms could have a serious impact on patients’ daily life, possibly influencing how they feel in their professional, social and family life,” Dr. Stéphanie Smet, lead author of the study, said in a press release. “This is a relatively young group of patients, so many will possibly face decades of coping with their symptoms.”
Over time, the incidence of these symptoms tends to increase, with 61.3 percent of survivors likely to suffer hot flushes, 54 percent insomnia and 72.8 percent fatigue within five years of treatment, according to the study.
“It is important to realize that these symptoms can already exist before patients start the treatment, sometimes even before they are diagnosed with cancer,” said Smet, a resident in radiation oncology at Austria’s Medical University of Vienna. “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.”
Drugs, physical exercise and psychological counselling have been used in cancer-related fatigue and insomnia, and hormone replacement therapy may be a therapeutic possibility to manage hot flushes, said Smet. Still, more studies are needed to understand the risk of developing these symptoms, and to help women make decisions concerning possible treatments.
“These results highlight how important it is to follow cancer survivors in the long term,” said ESTRO President Yolande Lievens, head of the radiation oncology department at Belgium’s Ghent University Hospital. “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.”