A new study co-led by investigators at the UCLA Health Jonsson Comprehensive Cancer Center found that women with early-stage cervical cancer who received radiation plus chemotherapy reported a greater short-term decline in quality of life compared to those who received radiation alone.
Quality of life was measured using the FACT-Cx TOI score, which tracks physical well-being and daily functioning. At three weeks, patients receiving both treatments scored 5.1 points lower than those receiving radiation alone, and by seven weeks the gap widened to 6.3 points. While both groups reported drops in well-being early in treatment, especially between weeks three and seven, by nine months there were no meaningful differences in quality of life, and pain, and gastrointestinal and urinary symptoms had returned to baseline in both groups.
BACKGROUND
In the past, clinical trials for cervical cancer have mainly measured survival outcomes like how long patients lived or how long it took for the cancer to return, but these measures do not fully capture how treatments affect patients' daily lives. Patient-reported outcomes give researchers a direct view of quality of life, side effects, and symptom burden, yet they are often collected less frequently than clinician-reported toxicities. This trial was the first U.S.-based study in early-stage cervical cancer to prospectively collect patient-reported outcomes. It evaluated whether adding chemotherapy to radiation after surgery improved recurrence-free survival, while also tracking how treatment impacted patients' experiences with side effects including gastrointestinal issues, neuropathy and blood-related toxicities.
METHOD
The phase III trial enrolled 316 women with stage I/IIA intermediate-risk cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy. Participants were randomly assigned to receive either radiation alone (152) or radiation plus chemotherapy (147). Patients completed questionnaires on quality of life, symptoms, and side effects before treatment and again at three, seven, and 36 weeks after starting therapy. Survey completion was high, with 90% of participants completing the three-week questionnaire, 88% completing the seven-week questionnaire and 81% completing the 36-week questionnaire.
IMPACT
The findings highlight the importance of providing extra supportive care during the most challenging phase of treatment—weeks three to seven—when declines in quality of life are most pronounced.
"Although adding chemotherapy to radiation did not improve outcomes for women with early-stage, intermediate-risk cervical cancer, this study gave us important insight into patients' experiences," said Dr. Dana Chase , professor of obstetrics and gynecology in the division of gynecologic oncology at the David Geffen School of Medicine at UCLA and first author of the study. "These findings show that physicians should focus on providing extra support both during treatment and throughout the post-treatment recovery period."
Researchers say the next step is to design clinical trials testing interventions to address side effects during radiation with or without chemotherapy, with the goal of improving quality of life for women undergoing treatment.
JOURNAL
The study was published in the journal Gynecologic Oncology.
AUTHORS
Dr. Chase is the study's lead and first author. The senior author is Dr. Sang Young Ryu from the Korea Institute of Radiological and Medical Sciences. Other authors are Helen Q. Huang, Wei Deng, Wui-Jin Koh, William Rodgers, William Small Jr, Kevin Albuquerque, Jyoti Mayadev, Charles A. Leath, Bradley Monk, Beob-Jong Kim, Dae-Yeon Kim, Chi Heum Cho, Jae-Weon Kim, Jae Hong No, Laura Holman, Ashley Stuckey, Denise Fabian, Alexandra H. Smick, Lari Wenzel, and Karen Gil. A list of affiliations can be found here.
FUNDING
The study was supported in part by grants from the National Cancer Institute and NRG Oncology.
