Forty-seven studies (n=4,924) were included: 5 RCTs (n=1,404), 27 cohort studies (n=1,698), 14 cross-sectional designs (n=1,670) and 1 secondary analysis of an RCT (n=152).
The interpretation of the results was complex given the substantial heterogeneity in sample size; study design; the nature and timing of administered measurement tools; and patient, treatment and comparison characteristics. In addition, a comprehensive summary of the results was not possible because of missing or under-reported data.
Curative chemotherapy (15 studies).
The only included RCT for curative treatment showed no statistical differences in HRQoL in epithelial ovarian cancer patients receiving toptecan or paclitaxel. A number of studies looked at the effect of repeated cycles of treatment, including 2 cohort studies using a different instrument to that used in the RCT. The first of these studies reported positive scores for physical well-being and relationship with doctor within a 6-cycle regimen. The second found no significant differences on any of the scores, but deteriorations were noted in emotional well-being and relationship with doctor after the tenth cycle. The results from another study suggested poorer HRQoL scores in women who had previously experienced treatment side-effects. When chemotherapy was used as an adjuvant treatment (6 studies), improved HRQoL was noted in an RCT when gluthathione was added to a cisplatin-based regimen for women with ovarian cancer. However, a cohort study revealed that newly diagnosed patients were likely to suffer lower HRQoL scores when cisplatin was administered post-surgery. Three studies examining combination adjuvant treatments (platinum and taxel-based chemotherapy after debulking surgery) for advanced ovarian cancer found that HRQoL improved, particularly with paclitaxel and carboplatin therapy. Neoadjuvant therapy (debulking surgery after primary chemotherapy) appeared to improve HRQoL, but this was only investigated in 2 studies, one of which was lacking in data.
Palliative chemotherapy (4 studies).
RCT evidence showed that paclitaxel-treated patients had higher HRQoL scores than those receiving oxaliplatin, but baseline data were not available. The results from 3 cohort studies also suggested an overall improvement in HRQoL scores for those receiving various palliative treatments, and especially over time as the side-effects became better controlled.
Curative radiotherapy (9 studies).
In 4 studies (including 1 RCT), a negative impact on HRQoL scores was noted at the end of treatment, irrespective of cancer type. However, improvements were reported at the 6-month follow-up. This negative trend appeared similarly in another study using a different measurement tool. A cohort study of adjuvant radiotherapy (operative and radiotherapy treatments) reported acceptable HRQoL scores post-treatment in women with different gynaecologic cancers, especially in terms of relationships with doctors and social well-being.
Palliative radiotherapy (1 study).
One cohort study reported higher HRQoL following treatment, but only in those patients who had achieved a high baseline Karnofsky function score.
Surgery (8 studies).
Several studies were unable to facilitate any useful analysis on HRQoL because of variations in objectives and procedures. Two studies used different measurement tools to assess the effects of radical hysterectomy, showing the best HRQoL outcomes in women with their ovaries preserved. One study (in which some patients had received pelvic radiation) reported positive scores for emotional well-being and relationship with doctors. Poorer HRQoL was noted in a study of women treated for genital cancer. Two further studies examining surgery and adjuvant radiation showed improvements on some domains of HRQoL in women with early stage cancer. Comparison of chemotherapy, radiotherapy and surgery (10 studies).
Three studies supplied data on the comparison of these interventions, concluding that HRQoL was lower following chemotherapy than for surgery or radiotherapy. Surgical patients (including those receiving total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadectomy) had the highest QoL scores at follow up. Another study concluded poor outcomes for older patients following radiotherapy. The interpretation of the other studies was hindered by a lack of reporting on HRQoL outcomes.