In this study, we compared the severity of climacteric symptoms after surgery and adjuvant therapy among different groups of gynecological cancer survivors. Symptom severity decreased with time since surgery in patients with endometrial or ovarian cancer. Patients with cervical cancer showed greater symptom severity compared with those with endometrial or ovarian cancer, and their symptoms’ severity showed no change over time.
In this study, the severity of climacteric symptoms decreased with the time elapsed since surgery in patients with endometrial and ovarian cancer. This is consistent with a previous study that reported improvements in the QOL and mood of patients with gynecological cancer at 1 year after treatment . However, two other studies showed that the treatment method, cancer stage, and time since cancer diagnosis are not correlated with QOL or mood  and that QOL after treatment is not improved at 2 years after surgery when comparing patients with gynecological cancer . In contrast to symptom severity in patients with endometrial and ovarian cancer in our study, that in patients with cervical cancer remained unchanged over time. The severity of mental symptoms, such as depression and loss of volition, was higher in patients with cervical cancer than in those with endometrial and ovarian cancer regardless of the time elapsed since surgery. In agreement, a study showed that, in patients with cervical cancer, the QOL does not reach that of healthy individuals, not even at 2 years after surgery . Therefore, the type of gynecological cancer, rather than the time elapsed since surgery, has a major effect on these differences.
Gynecological cancer survivors who are young and/or have undergone chemotherapy have lower QOL than those treated surgically . Indeed, in this study, patients with cervical cancer were younger at initial consultation than those with ovarian or endometrial cancer, where age at first consultation positively correlated with time since surgery. For example, we compared patients with cervical cancer with those with endometrial cancer using chi-squared test and adjusted the results with age at first consultation categorized in three groups (< 45, 45–55, and > 55 years) using the Cochrane-Mantel-Haenszel test. We found that the severity of several symptoms, such as shoulder stiffness and wakefulness (Supplementary Table 5), was still higher in patients with cervical cancer.
Patients with gynecological cancer and healthy individuals were shown to have similar QOL, health, psychological health, socioeconomic status, and family status . However, particularly those with cervical cancer have lower mental and physical HRQOL than do those with other cancer types . Moreover, these patients have worse anxiety, depression, anger, and confusion levels than do those with endometrial cancer , even though the latter report markedly more negative mood than do healthy individuals . Our results indicated that vasomotor symptoms were more severe in patients with cervical or ovarian cancer than with endometrial cancer, while mental symptoms such as irritability, nervousness, anxiety, depression, loss of volition, and wakefulness were more severe in those with cervical cancer than in those with endometrial cancer. The questionnaire in this study covered both mental and physical parameters of climacteric symptoms, but mental symptoms were not more severe in those with any cancer type when summing up the degree of symptom scores with regard to mental or physical parameters (Supplementary Table 6). The present study results demonstrate the importance of climacteric symptoms in evaluating the QOL and well-being of gynecological cancer survivors, and especially of cervical cancer survivors, although further studies are needed to confirm our findings.
This study had certain limitations. First, the study was performed at a single institution. Second, there was no control group without cancer diagnosis, and we could not compare the symptom severity with those without gynecological cancer. Third, we did not investigate differences in the socioeconomic background of patients. QOL, mood, and mental health are considered to be significantly associated with education, income, presence or absence of a partner, etc. . Numerous studies have compared climacteric symptoms after cancer treatment and adjuvant therapy across different socioeconomic strata , and socioeconomic background can present risks for menopausal symptoms . In Japan, it is often difficult to ask patients about their socioeconomic status. In a previous study, we intended to ask subjects about their socioeconomic status; however, that plan had been rejected by the Ethics Committee. Moreover, there are differences between Japan and other countries with respect to healthcare information and social background. Thus, more studies are required to include these factors. Fourth, we did not classify patients with respect to cancer stage. Although several reports have addressed the relationship between the QOL of patients with gynecological cancer and cancer stage, their results are inconsistent [27–29], and further studies are needed to address this issue. Fifth, some of the patients in this study were enrolled more than 20 years ago, and it is possible that surgical advances in the past two decades have resulted in improvements in postoperative symptoms . Therefore, we also did not classify patients with respect to operational procedure on hysterectomy. There are several procedures that might affect post-surgical QOL, viz., simple (sometimes extended), semi-radical, and radical hysterectomy. Surgical procedures have improved significantly so we decided that it was difficult to use procedures as an independent variable. Finally, this study was cross-sectional; thus, changes in patients’ symptoms during the course of the study are unknown.