A Comparative Study of Symptom Distress, Anxiety, Depression, And Quality of Life in Women with Cervical Cancer from the Completion of Radiotherapy Combined with Chemotherapy to over 5 Years of Survivorship

Abstract

Introduction Cervical cancer remains one of the most prevalent malignancies among Thai women. Although treatment has significantly improved survival rates, many patients continue to endure both acute and long-term side effects. These include distressing conditions such as vaginal stenosis and dryness, as well as alterations in urinary and bowel function resulting from radiation-induced tissue damage. Such complications not only compromise physiological functioning but also exert profound psychological consequences, leading to anxiety and depression associated with changes in body image and the loss of sexual function. These sequelae directly impair long-term quality of life. Accordingly, systematic follow-up and investigation of post-treatment effects across different phases of survivorship are essential for holistic rehabilitation. A deeper understanding the trajectory and nature of symptoms at each stage enables nurses to provide patient-centered care strategies that effectively support recovery. Ultimately, such approaches promote well-being and empower cervical cancer survivors to resume their lives with greater happiness and sustained quality of life. 

Objective The objective of this study was to compare symptom distress, anxiety, depression, and quality of life among women with cervical cancer following completion of concurrent chemoradiotherapy, across three distinct post-treatment groups: (1) within 0–1 year post-treatment, (2) more than 1 to 5 years post-treatment, and (3) beyond 5 years post-treatment.

Design This study employed a descriptive comparative design, guided by a quality-of-life framework derived from a review of the literature, integrating with the Functional assessment of cancer therapy–cervix (FACT-Cx). Quality of life is conceptualized as an individual’s perception of well-being despite illness or treatment, including five domains: physical, social/family, emotional, functional, and cervical cancer-specific aspects. Patients undergoing concurrent chemoradiotherapy frequently experience side effects and complications, which tend to intensify with prolonged treatment. Moreover, patients differ in their perceptions and responses to these symptoms. Assessing quality of life across all five domains provides health professionals with essential information for nursing care and symptom management. The impact of disease and treatment extends across physical, social, emotional, and functional dimensions, thereby influencing overall well-being. Systematic monitoring of quality of life offers a critical foundation for holistic rehabilitation, enabling healthcare teams to design patient-centered strategies that promote recovery and support cervical cancer survivors in regaining normalcy and sustaining a good quality of life. 

Methodology The sample comprised 150 women diagnosed with cervical cancer who had completed concurrent chemoradiotherapy according to the prescribed treatment plan and were attending scheduled follow-up visits at the National Cancer Institute. Participants were selected purposively based on inclusion criteria and stratified into three groups of 50 individuals each, according to survivorship duration: Group 1, patients within one year post-treatment; group 2, patients between more than one year and up to five years post-treatment; and Group 3, patients beyond five years post-treatment. Sample size determination was conducted using the G*Power program, with an effect size of 0.19, a significance level (α) of .05, and a desired statistical power of .80. To account for potential dropout, the sample size was increased by 5%, resulting in 50 participants per group, for a total of 150. Data collection instruments included: (1) a personal information questionnaire, (2) a symptom assessment form related to disease and treatment, (3) anxiety and depression questionnaires, and (4) the FACT-Cx quality-of-life instrument. Data were collected between May 2023 and October 2024 in the outpatient clinic following medical examina- tions. Data analysis was performed using descriptive statistics and the Kruskal–Wallis test. 

Results The participants had a mean age of 54.5 years (SD = 10.75). The majority were married (64.7%), utilized the Universal Health Coverage scheme (64.0%), and were diagnosed primarily with stage II and III cervical cancer equally (41.3%). Significant differences were observed across groups in symptom distress, anxiety, depression, and overall quality of life (χ2 = 75.932, p < .001; χ2 = 48.558, p < .001; χ2 = 37.546, p < .001; χ2 = 75.932, p < .001, respectively). Pairwise comparisons revealed statistically significant differences among all groups in symptom distress, anxiety, depression, and overall quality of life, except for depression between group 1 (≤ 1 year post-treatment) and group 3 (> 5 years post-treatment), where no significant difference was found. 

Recommendation The findings of this study can be applied to the development of nursing strategies aimed at managing symptoms, alleviating distress, reducing anxiety and depression, and ultimately enhancing the quality of life of cervical cancer patients following treatment. Nurses should conduct regular assessments of symptom burden, symptom perception, anxiety, and depression across different survivorship phases. Such systematic evaluation enables timely, individualized, and patient-centered interventions that effectively respond to patients’ evolving needs, thereby supporting holistic recovery and promoting sustained well-being.