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Studying the Physical Function and Quality of Life Before and After Surgery in Patients With Stage I Cervical Cancer

Not Applicable
Active, not recruiting
Conditions
Cervical Squamous Cell Carcinoma
Lymphedema
Stage IA1 Cervical Cancer AJCC v6 and v7
Cervical Adenosquamous Carcinoma
Stage IB1 Cervical Cancer AJCC v6 and v7
Cervical Adenocarcinoma
Stage IA2 Cervical Cancer AJCC v6 and v7
Interventions
Procedure: Conization
Other: Quality-of-Life Assessment
Other: Questionnaire Administration
Procedure: Therapeutic Conventional Surgery
Procedure: Therapeutic Lymphadenectomy
Registration Number
NCT01649089
Lead Sponsor
GOG Foundation
Brief Summary

This clinical trial studies the physical function and quality-of-life before and after surgery in patients with stage I cervical cancer. Studying quality-of-life in patients undergoing surgery for cervical cancer may help determine the intermediate-term and long-term effects of surgery.

Detailed Description

PRIMARY OBJECTIVES:

I. To examine the changes before and after non-radical surgical treatment (simple hysterectomy or cone biopsy \[fertility preservation\] and pelvic lymphadenectomy) on functional outcomes of bladder, bowel, and sexual function for stage IA1 (lymphatic vessel invasion positive \[LVSI+\]) and IA2-IB1 (=\< 2 cm) carcinoma of the cervix.

II. To evaluate incidence and severity of lymphedema after non-radical surgery (simple hysterectomy or cone biopsy \[fertility preservation\] and pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2-IB1 (=\< 2 cm) carcinoma of the cervix.

SECONDARY OBJECTIVES:

I. To investigate if non-radical surgery (simple hysterectomy or cone biopsy \[fertility preservation\] with pelvic lymphadenectomy) demonstrates greater physical function and less toxicity in comparison to historical data on radical surgery (radical hysterectomy or radical trachelectomy).

II. To evaluate incidence and severity of treatment-related adverse events, including surgical complications, among the entire cohort and by treatment type.

III. To evaluate changes in quality of life (QOL) (Functional Assessment of Cancer Therapy-Cervix \[FACT-Cx\]), cancer worries (Impact of Events Scale \[IES\]) and sexual (Female Sexual Function Index \[FSFI\])/reproductive concerns (RCS) among the entire cohort and by treatment type.

IV. To explore relationships (correlation, interaction, independence) between functional outcomes (i.e., bladder function, bowel function, sexual function), adverse events (including and surgical complication lymphedema \[Gynecologic Cancer Lymphedema Questionnaire (GCLQ)\]), cancer worry (IES), surgical complications, and overall quality of life (FACT-Cx).

V. To determine participants' intention for conception \& fertility rates (Integrative Care for Fertility \[ICF\]) and assess the reproductive concerns (RCS) of women following cone biopsy and pelvic lymphadenectomy for stage IA1 (LVSI+) and IA2-IB1 (=\< 2 cm) carcinoma of the cervix.

VI. To estimate the efficacy of non-radical surgery (simple hysterectomy or cone biopsy \[fertility preservation\] and pelvic lymphadenectomy) for stage IA1 (LVSI+) and IA2-IB1 (=\< 2 cm) carcinoma of the cervix.

OUTLINE:

Patients undergo cone biopsy and pelvic lymphadenectomy or simple hysterectomy and pelvic lymphadenectomy.

Patients complete the FACT-Cx, the IES, the FSFI, the GCLQ, and the Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires at baseline, 4-6 weeks after surgery, and then every 6 months for 3 years. Patients undergoing cone biopsy and pelvic lymphadenectomy also complete the ICF and RCS questionnaires.

After completion of study treatment, patients are followed up at 4-6 weeks, every 3 months for 1 year, and then every 6 months for 2 years.

Recruitment & Eligibility

Status
ACTIVE_NOT_RECRUITING
Sex
Female
Target Recruitment
224
Inclusion Criteria
  • Patient must consent for the appropriate surgery
  • Patients with a histologic diagnosis of squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma of the cervix, stage IA1 (lymph-vascular space invasion [LVSI]+), IA2, and IB1 (tumor size [maximum visible or palpable]) =< 2 cm), any grade
  • All patients must have undergone a cone biopsy or loop electrosurgical excision procedure (LEEP); depth of invasion must be =< 10 mm
  • Patients must have no evidence of metastasis on positron emission tomography (PET) scan or magnetic resonance imaging (MRI) or computed tomography (CT) scan of the pelvis and chest imaging
  • Patients who have met the pre-entry requirements
  • Patients must have signed an approved informed consent and authorization permitting release of personal health information
  • Patient must have Gynecologic Oncology Group (GOG) performance status of 0, 1, or 2
Exclusion Criteria
  • Patients with stage IA1 disease who are LVSI negative
  • Patients with stage IB1 with tumor size (maximum visible or palpable) > 2 cm
  • Patients with >= stage IB2 disease
  • Patients with clear cell or neuroendocrine cell types
  • Patients with depth of invasion > 10 mm on first cone biopsy (or LEEP)
  • Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer, are excluded if there is any evidence of other malignancy being present within the last five years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy

Study & Design

Study Type
INTERVENTIONAL
Study Design
SINGLE_GROUP
Arm && Interventions
GroupInterventionDescription
Treatment (cone biopsy/lymphadenectomy or hysterectomy)Quality-of-Life AssessmentPatients undergo cone biopsy and pelvic lymphadenectomy or simple hysterectomy and pelvic lymphadenectomy.
Treatment (cone biopsy/lymphadenectomy or hysterectomy)ConizationPatients undergo cone biopsy and pelvic lymphadenectomy or simple hysterectomy and pelvic lymphadenectomy.
Treatment (cone biopsy/lymphadenectomy or hysterectomy)Questionnaire AdministrationPatients undergo cone biopsy and pelvic lymphadenectomy or simple hysterectomy and pelvic lymphadenectomy.
Treatment (cone biopsy/lymphadenectomy or hysterectomy)Therapeutic LymphadenectomyPatients undergo cone biopsy and pelvic lymphadenectomy or simple hysterectomy and pelvic lymphadenectomy.
Treatment (cone biopsy/lymphadenectomy or hysterectomy)Therapeutic Conventional SurgeryPatients undergo cone biopsy and pelvic lymphadenectomy or simple hysterectomy and pelvic lymphadenectomy.
Primary Outcome Measures
NameTimeMethod
Change in bladder and bowel function score based on supplemental bladder and bowel questions plus 4 items from the Functional Assessment of Cancer Therapy-Cervix (3 bladder and 1 bowel question)Baseline to 3 years

Analysis of variance methods with repeated measurements and a time component will initially be used to determine whether there are significant changes over time.

Change in sexual function and activity based on Female Sexual Function Index (19 items) score plus 2 Patient Reported Outcomes Measurement Information System screener itemsBaseline to 3 years

Analysis of variance methods with repeated measurements and a time component will initially be used to determine whether there are significant changes over time.

LymphedemaUp to 3 years

Based on Cancer Lymphedema Questionnaire score.

Maximum grade and duration of severe adverse events associated with bladder, bowel, and sexual dysfunction and lymphedemaUp to 3 years after non-radical surgical procedure

Graded according to Common Terminology Criteria for Adverse Events version 4.0 (version 5.0 will be used staring April 1, 2018).

Secondary Outcome Measures
NameTimeMethod
Maximum grade of treatment-related adverse eventsUp to 30 days after surgical procedure

Graded according to Common Terminology Criteria for Adverse Events version 4.0 (version 5.0 will be used staring April 1, 2018).

Change in overall quality of lifeBaseline to 3 years

Will be assessed based on Functional Assessment of Cancer Therapy-Cervix (15 items) score. Analysis of variance methods with repeated measurements and a time component will initially be used to determine whether there are significant changes over time.

Site of first recurrenceUp to 3 years

Classified as either local (pelvis regions, including vaginal) or distant (abdomen, lung, bone, brain, and other).

Change in cancer worries based on Impact of Events scoreBaseline to 3 years

Analysis of variance methods with repeated measurements and a time component will initially be used to determine whether there are significant changes over time.

Change in reproductive concerns based on reproductive concerns (14 items) scoreBaseline to 3 years

Analysis of variance methods with repeated measurements and a time component will initially be used to determine whether there are significant changes over time.

Recurrence-free survivalUp to 3 years

Product-limit estimates according to the method of Kaplan and Meier will be used to estimate recurrence-free survival. In addition, Cox proportional hazard regression will be employed to evaluate relative risk (hazard ratio) adjusting for known prognostic factors. Trellis plots will be used to display point estimates of hazard ratio and respective 95% confidence intervals from subgroup analyses. Local recurrence will be summarized using frequency tables and plot of cumulative incidence of local recurrence over time.

Overall survivalUp to 3 years

Product-limit estimates according to the method of Kaplan and Meier will be used to estimate overall survival. In addition, cox proportional hazard regression will be employed to evaluate relative risk (hazard ratio) adjusting for known prognostic factors. Trellis plots will be used to display point estimates of hazard ratio and respective 95% confidence intervals from subgroup analyses. Gompertz hazard regression will also be employed to evaluate relative risk (hazard ratio) and cure rates, adjusting for known prognostics factors.

Trial Locations

Locations (185)

Cancer Center at Saint Joseph's

🇺🇸

Phoenix, Arizona, United States

Saint Joseph's Hospital and Medical Center

🇺🇸

Phoenix, Arizona, United States

Sutter Auburn Faith Hospital

🇺🇸

Auburn, California, United States

Sutter Cancer Centers Radiation Oncology Services-Auburn

🇺🇸

Auburn, California, United States

Alta Bates Summit Medical Center-Herrick Campus

🇺🇸

Berkeley, California, United States

Mills-Peninsula Medical Center

🇺🇸

Burlingame, California, United States

Sutter Cancer Centers Radiation Oncology Services-Cameron Park

🇺🇸

Cameron Park, California, United States

Eden Hospital Medical Center

🇺🇸

Castro Valley, California, United States

Sutter Davis Hospital

🇺🇸

Davis, California, United States

Palo Alto Medical Foundation-Fremont

🇺🇸

Fremont, California, United States

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Cancer Center at Saint Joseph's
🇺🇸Phoenix, Arizona, United States
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