Skip to main content

Advertisement

SpringerLink
Log in

Patient-reported outcomes of non-pharmacological interventions for endometrial cancer survivors: a systematic review

  • Review
  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

The objective of this review was to assess the efficacy of non-pharmacological interventions on endometrial cancer (EC) survivors’ QOL, and their use of patient-reported outcome measures (PROMs).

Methods

We conducted a systematic review of randomized controlled trials (RCTs) of non-pharmacological interventions that assessed the impact of intervention on EC survivors’ general and domain-specific QOL (i.e., physical, psychological, and social well-being) using PROMs.

Results

Of the 3178 studies identified, 28 full-text articles were reviewed, and 10 were included in the review. Nine RCTs assessed at least one PROM as a primary outcome and six assessed a PROM as a secondary outcome, but few studies used validated PROMs. Significant improvements in general QOL were found in two studies, domain-specific QOL in three studies, and both general and domain-specific QOL in three studies; however, effect sizes ranged from small to large and no significant effects were found for social well-being and few were found for psychological well-being.

Conclusions

Few non-pharmacological interventions for EC survivors targeted QOL, even though QOL was assessed as either a primary or secondary outcome of the RCT. Despite this, findings suggest that non-pharmacological interventions for EC survivors hold promise for improving general and domain-specific QOL. Use of validated PROMs would greatly enhance outcome reporting and facilitate comparisons across studies. More interventions are also needed that address social and psychological functioning in this population.

Implications for Cancer Survivors

Our review highlights a need to (1) expand non-pharmacological RCTs for EC survivors, (2) increase the use of validated PROMs measuring QOL, and (3) address psychosocial domains of QOL when developing interventions for this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66:271–89.

    PubMed  Google Scholar 

  2. Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69:363–85.

    Google Scholar 

  3. SEER. SEER Cancer Stat Facts: Endometrial Cancer. Bethesda, MD 2017.

  4. Rowlands IJ, Lee C, Beesley VL, Janda M, Nagle CM, Webb PM. Women’s perceptions of their lifestyle and quality of life several years after a diagnosis of endometrial cancer. Cancer Nurs. 2015;38:E21–E8.

    PubMed  Google Scholar 

  5. Smits A, Lopes A, Das N, Bekkers R, Galaal K. The impact of BMI on quality of life in obese endometrial cancer survivors: does size matter? Gynecol Oncol. 2014;132:137–41.

    PubMed  Google Scholar 

  6. Basen-Engquist K, Scruggs S, Jhingran A, Bodurka DC, Lu K, Ramondetta L, et al. Physical activity and obesity in endometrial cancer survivors: associations with pain, fatigue, and physical functioning. Am J Obstet Gynecol. 2009;200:288. e1–8.

    Google Scholar 

  7. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med. 2003;348:1625–38.

    PubMed  Google Scholar 

  8. von Gruenigen VE, Gibbons HE, Kavanagh MB, Janata JW, Lerner E, Courneya KS. A randomized trial of a lifestyle intervention in obese endometrial cancer survivors: quality of life outcomes and mediators of behavior change. Health Qual Life Outcomes. 2009;7:17.

    Google Scholar 

  9. Wild S, Bryden J, Lee R, Bishop J, Finlayson A, Byrne C, et al. Cancer, cardiovascular disease and diabetes mortality among women with a history of endometrial cancer. Br J Cancer. 2007;96:1747–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC. Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol. 2012;126:176–9.

    PubMed  Google Scholar 

  11. von Gruenigen V, Frasure H, Kavanagh MB, Janata J, Waggoner S, Rose P, et al. Survivors of uterine cancer empowered by exercise and healthy diet (SUCCEED): a randomized controlled trial. Gynecol Oncol. 2012;125:699–704.

    Google Scholar 

  12. Kitson S, Ryan N, MacKintosh ML, Edmondson R, Duffy JM, Crosbie EJ. Interventions for weight reduction in obesity to improve survival in women with endometrial cancer. Cochrane Database Syst Rev. 2018.

  13. Joly F, McAlpine J, Nout R, Avall-Lundqvist E, Shash E, Friedlander M, et al. Quality of life and patient-reported outcomes in endometrial cancer clinical trials: a call for action! Int J Gynecol Cancer. 2014;24:1693–9.

    PubMed  Google Scholar 

  14. Bradley S, Rose S, Lutgendorf S, Costanzo E, Anderson B. Quality of life and mental health in cervical and endometrial cancer survivors. Gynecol Oncol. 2006;100:479–86.

    PubMed  Google Scholar 

  15. Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncol. 2007;46:417–32.

    Google Scholar 

  16. Zandbergen N, de Rooij BH, Vos MC, Pijnenborg JM, Boll D, Kruitwagen RF, et al. Changes in health-related quality of life among gynecologic cancer survivors during the two years after initial treatment: a longitudinal analysis. Acta Oncol. 2019;58:790–800.

    PubMed  Google Scholar 

  17. Shisler R, Sinnott JA, Wang V, Hebert C, Salani R, Felix AS. Life after endometrial cancer: a systematic review of patient-reported outcomes. Gynecol Oncol. 2018;148:403–13.

    PubMed  Google Scholar 

  18. Ferrell B, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res. 1995;4:523–31.

    CAS  PubMed  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.

    Google Scholar 

  20. Brotto LA, Erskine Y, Carey M, Ehlen T, Finlayson S, Heywood M, et al. A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol. 2012;125:320–5.

    PubMed  PubMed Central  Google Scholar 

  21. Donnelly CM, Blaney JM, Lowe-Strong A, Rankin JP, Campbell A, McCrum-Gardner E, et al. A randomised controlled trial testing the feasibility and efficacy of a physical activity behavioural change intervention in managing fatigue with gynaecological cancer survivors. Gynecol Oncol. 2011;122:618–24.

    CAS  PubMed  Google Scholar 

  22. Donoyama N, Satoh T, Hamano T, Ohkoshi N, Onuki M. Effects of Anma therapy (Japanese massage) on health-related quality of life in gynecologic cancer survivors: a randomized controlled trial. PLoS One. 2018;13:e0196638.

    PubMed  PubMed Central  Google Scholar 

  23. Haggerty AF, Hagemann A, Barnett M, Thornquist M, Neuhouser ML, Horowitz N, et al. A randomized, controlled, multicenter study of technology-based weight loss interventions among endometrial cancer survivors. Obesity (Silver Spring). 2017;25(Suppl 2):S102–S8.

    CAS  Google Scholar 

  24. Koutoukidis DA, Beeken RJ, Manchanda R, Burnell M, Ziauddeen N, Michalopoulou M, et al. Diet, physical activity, and health-related outcomes of endometrial cancer survivors in a behavioral lifestyle program: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomized controlled pilot trial. Int J Gynecol Cancer : official journal of the International Gynecological Cancer Society. 2019;29:531–40.

    Google Scholar 

  25. McCarroll ML, Armbruster S, Frasure HE, Gothard MD, Gil KM, Kavanagh MB, et al. Self-efficacy, quality of life, and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): a randomized controlled trial. Gynecol Oncol. 2014;132:397–402.

    CAS  PubMed  Google Scholar 

  26. Olesen ML, Duun-Henriksen AK, Hansson H, Ottesen B, Andersen KK, Zoffmann V. A person-centered intervention targeting the psychosocial needs of gynecological cancer survivors: a randomized clinical trial. J. 2016;10:832–41.

    Google Scholar 

  27. Rossi A, Garber CE, Ortiz M, Shankar V, Goldberg GL, Nevadunsky NS. Feasibility of a physical activity intervention for obese, socioculturally diverse endometrial cancer survivors. Gynecol Oncol. 2016;142:304–10.

    PubMed  Google Scholar 

  28. Rutledge TL, Rogers R, Lee SJ, Muller CY. A pilot randomized control trial to evaluate pelvic floor muscle training for urinary incontinence among gynecologic cancer survivors. Gynecol Oncol. 2014;132:154–8.

    PubMed  Google Scholar 

  29. von Gruenigen VE, Courneya KS, Gibbons HE, Kavanagh MB, Waggoner SE, Lerner E. Feasibility and effectiveness of a lifestyle intervention program in obese endometrial cancer patients: a randomized trial. Gynecol Oncol. 2008;109:19–26.

    Google Scholar 

  30. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.

    PubMed  Google Scholar 

  31. Patrick H, Williams GC. Self-determination theory: its application to health behavior and complementarity with motivational interviewing. Int J Behav Nutr Phys Act. 2012;9:18.

    PubMed  PubMed Central  Google Scholar 

  32. Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998;13:623–49.

    Google Scholar 

  33. Marshall SJ, Biddle SJ. The transtheoretical model of behavior change: a meta-analysis of applications to physical activity and exercise. Ann Behav Med. 2001;23:229–46.

    CAS  PubMed  Google Scholar 

  34. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.

    CAS  PubMed  Google Scholar 

  35. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. 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: Journal of the National Cancer Institute. 1993;85:365–76.

    CAS  PubMed  Google Scholar 

  36. Beck AT, Beamesderfer A. Assessment of depression: the depression inventory. Psychol Meas Psychopharmacol: Karger Publishers; 1974. p. 151–69.

  37. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    CAS  Google Scholar 

  38. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.

    CAS  PubMed  Google Scholar 

  39. Smits A, Lopes A, Das N, Bekkers R, Massuger L, Galaal K. The effect of lifestyle interventions on the quality of life of gynaecological cancer survivors: a systematic review and meta-analysis. Gynecol Oncol. 2015;139:546–52.

    PubMed  Google Scholar 

  40. De Boer SM, Nout RA, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, et al. Long-term impact of endometrial cancer diagnosis and treatment on health-related quality of life and cancer survivorship: results from the randomized PORTEC-2 trial. Int J Radiat Oncol Biol Phys. 2015;93:797–809.

    PubMed  Google Scholar 

  41. Robertson MC, Lyons EJ, Song J, Cox-Martin M, Li Y, Green CE, et al. Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention. Health Qual Life Outcomes. 2019;17:1–9.

    Google Scholar 

  42. Basen-Engquist K, Carmack C, Brown J, Jhingran A, Baum G, Song J, et al. Response to an exercise intervention after endometrial cancer: differences between obese and non-obese survivors. Gynecol Oncol. 2014;133:48–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Lucas AR, Focht BC, Cohn DE, Buckworth J, Klatt MD. A mindfulness-based lifestyle intervention for obese, inactive endometrial cancer survivors: a feasibility study. Integrative Cancer Ther. 2017;16:263–75.

    Google Scholar 

  44. McCarroll ML, Armbruster S, Pohle-Krauza RJ, Lyzen AM, Min S, Nash DW, et al. Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. Gynecol Oncol. 2015;137:508–15.

    PubMed  Google Scholar 

  45. Maxwell-Smith C, Hince D, Cohen PA, Bulsara MK, Boyle T, Platell C, et al. A randomized controlled trial of WATAAP to promote physical activity in colorectal and endometrial cancer survivors. Psycho-Oncol. 2019.

  46. Comis RL, Miller JD, Aldigé CR, Krebs L, Stoval E. Public attitudes toward participation in cancer clinical trials. J Clin Oncol. 2003;21:830–5.

    PubMed  Google Scholar 

  47. Lara PN Jr, Higdon R, Lim N, Kwan K, Tanaka M, Lau DHM, et al. Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. J Clin Oncol. 2001;19:1728–33.

    PubMed  Google Scholar 

  48. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncol: Journal of the Psychological, Social and Behavioral Dimensions of Cancer. 2006;15:306–20.

    Google Scholar 

  49. Towsley GL, Beck SL, Watkins JF. “Learning to live with it”: coping with the transition to cancer survivorship in older adults. J Aging Stud. 2007;21:93–106.

    Google Scholar 

  50. Zebrack BJ. Cancer survivor identity and quality of life. Cancer Pract. 2000;8:238–42.

    CAS  PubMed  Google Scholar 

  51. Koutoukidis D, Beeken R, Lopes S, Knobf M, Lanceley A. Attitudes, challenges and needs about diet and physical activity in endometrial cancer survivors: a qualitative study. European journal of cancer care. 2017;26:e12531.

    Google Scholar 

  52. Donnelly C, Lowe-Strong A, Rankin J, Campbell A, Blaney J, Gracey J. A focus group study exploring gynecological cancer survivors’ experiences and perceptions of participating in a RCT testing the efficacy of a home-based physical activity intervention. Support Care Cancer. 2013;21:1697–708.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Ashley Buchanan & Hoda Badr

  2. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    McKenzie Roddy

Authors
  1. Ashley Buchanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. McKenzie Roddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hoda Badr
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ashley Buchanan: formal analysis, investigation, data curation, writing–original draft, writing–review and editing, visualization; McKenzie Roddy: investigation, writing–review and editing; Hoda Badr: conceptualization, methodology, validation, writing–review and editing, visualization, project administration, supervision

Corresponding author

Correspondence to Hoda Badr.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buchanan, A., Roddy, M. & Badr, H. Patient-reported outcomes of non-pharmacological interventions for endometrial cancer survivors: a systematic review. J Cancer Surviv 15, 526–535 (2021). https://doi.org/10.1007/s11764-020-00946-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-020-00946-z

Keywords

Search

Navigation