Prospective assessment of patient-reported outcomes in gynecologic cancer patients before and after pelvic exenteration

Objective: Pelvic exenteration (PE) is a surgical procedure associated with significant morbidity offered to select women with locally advanced or recurrent gynecologic cancers. This ongoing study examines an array of patient-reported outcomes and satisfaction with PE. Methods: Since February 2009, prospectively enrolled participants completed questionnaires evaluating body image (BIS), depression (CESD), social support (DUFSS), symptoms (MDASI), sexual function (SAQ), functional status (SF-12), quality of life (The Stoma-QOL), satisfaction with decision (SWD) and an investigator-designed survey at baseline, 6, and 12 months after PE. Mann-Whitney and Wilcoxon signed-rank tests were used to evaluate the data. Results: Fifty-four women enrolled. Median age was 56 years (31, 85). Median BMI was 30.7 kg/m² (16.8, 54.4). The majority of patients (78%) were white. Cancer diagnoses included 41% cervix, 22% uterus, 19% vagina, 17% vulva and 2% ovary. Most surgeries were total PEs (76%). Patients were satisfied with their decision to undergo PE at 6 and 12 months. One year after exenteration, 79% of women stated they would have a PE again. Sexual pleasure decreased from baseline to 12 months after PE (p = 0.02), while sexual discomfort remained unchanged (p = 0.42). Body image worsened over time (p = 0.003). Physical functioning (SF-12) declined (p = 0.001), while mental functioning remained stable (p = 0.46). There were no significant changes in stoma-related QOL, social support, or depression scores. Conclusions: Despite a decrease in physical functioning, persistent low body image and sexual pleasure, most women were satisfied with their decision and would undergo pelvic exenteration again. This study identifies survivorship issues that should be addressed after PE.