Objective. To evaluate the impact of treatment for genital cancer on quality o f life and body image to determine patientstherapyrelated needs for quality im provement of medical care before and after surgery. Methods. We started to evalu ate women with cervical cancer planned for pelvic exenteration in 1993 and integ rated women planned for a Wertheim-Meigs surgery in 1995 before surgery, 4 and 12 months after surgery. Thanks to funding since 1999, more than 400 patients wi th a diagnosis of genital (n = 185) or breast (n = 217) cancer participated in t his prospective study until July 2003. In this paper, we will focus on n = 129 w omen with cervical cancer. The assessment protocol included objective questionna ires for quality of life and body image (CARES; EORTC; Body image by Strauss and Appelt). The evaluation of quality of life incorporated five dimensions: physic al and psychosocial health, marital and sexual status, and medical interaction. Results. Before surgery, women with a Wertheims procedure indicated significantly less problems concerning the quali ty of life global score (P = 0.002) and several subscales compared to women with a pelvic exenteration. After surgery, both groups indicated their sexual proble ms to be the greatest restriction in terms of quality of life, especially in wom en with non-reconstructive surgery as well as in women with adjuvant radio and/ or chemotherapy. Concerning body image, attractiveness or self-confidence was s ignificantly reduced postoperatively compared to the preoperative status for bot h groups (P = 0.000), and also worsened with the extent of treatment. Worries ab out the patients family persisted over time and represented the most important item about all questions concerning quality of life as well as the fear of recu rrence. Conclusion. This on-going study demonstrates the interferences between the treatment modality and the patients quality of life, especially about sexu ality and body image. Our results suggest not only to provide reconstructive sur gery if possible, but also to integrate psychosocial information aspects on futu re quality of life outcome before surgery as well as to offer psychosocial suppo rt related to the extent of treatment modality after surgery.
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