De Rosa, Nicoletta (2020) Cognitive disorder, quality of life and sexual function in women with gynecological cancer. [Tesi di dottorato]

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Abstract

Introduction: Gynecological cancer patients show a poor quality of life (QoL) since cancer diagnosis and treatment deeply impact on the sexual function (SF), on the family life, on the social activities and, also, on the working activity of the surviving patients. Vulnerability to depression is increased across the menopause transition and is particularly high in gynecological cancer patients. About 20-30% of patients with gynaecological cancer experience psychological distress at some point during their cancer journey. Cognitive functioning was generally considered independent of mood or tiredness. However, cognitive disorders are a common condition in women going through menopause. Cancer-related cognitive impairment (CRCI) has been reported in non-central nervous system neoplasms survivors. The purpose of this study was to evaluate the perception of cognitive decrement in patients undergoing surgical and / or medical therapy for gynecological cancers. Methods: All women diagnosed with primary gynecological cancer and undergoing active medical treatment have been enrolled in a cross-sectional prospective study. Before starting treatment and after 6 months, patients were interviewed to evaluate the effects of cancer treatment on perceived cognitive function (using FACT-Cog -version 3), on depression (using Beck Depression Inventory-II test) and on quality of life (using EORTC-QLQC-30). Age, education level, marital status, lifestyle, menopausal state at diagnosis, cancer type, cancer stage, treatment modality were also recorded. The differences between baseline and post-treatment results have been evaluated with Student's t-test. The results have been stratified by the menopausal state at diagnosis, type of tumor (endometrial, cervical, ovarian, vulvar) disease stage and type of treatment (chemotherapy or radiotherapy). Results: Seventy-three patients were included. A significant reduction in perceived cognitive impairments was demonstrated (CogPCI: 61.35±13.83 vs 55.05±16.56; p <0.05). On the contrary, a significant improvement was shown in depression state (BDII: 21.14±11.23 vs 12.82±12.33, p <0.005). The menopausal state at surgery, tumor site, stage and treatment modality seem to influence the variables analyzed. Conclusion: CRCI is a true risk also in gynecological cancer survivors. The cognitive impairment does not seem to be dependent on depression or to a menopausal condition. Assessing cognitive decline in cancer survivorship is essential for ensuring the optimum quality of life and functioning.

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