Abstract
Introduction
Older women are increasingly undergoing surgery for gynaecological malignancies. Although survival data is available other outcomes such as functional recovery are less well described. However older people are both more vulnerable to changes in function and often prioritise function over survival. There is limited published research examining function outside of context of sexual or urodynamic function following gynaeoncology surgery but a large body or research exists examining health-related quality of life (HrQOL) both as a pre-operative risk factor for survival and as a post-treatment outcome measure in its own right. HRQOL tools may report on physical function as a subcomponent within composite tools.
This systematic review and narrative synthesis describes functional recovery after gynae-oncology surgery with respect to baseline characteristics which - if identified – could enable pre- or post-operative risk reduction.
Methods
Systematic search of MEDLINE and EMBASE databases and Cochrane Library between 1974-2018. Two reviewers independently reviewed abstracts/papers for inclusion against the following criteria:Mean/median age >60Gynaeoncological treatment includes surgery (RCTs, observational or mixed methods studies).Any measure of functional ability as defined by WHO ICF classification section D1–D7 inclusive, D855, D860-79 and D9 using validated tool.Minimum pre-operative and one post-operative measure.
Results analysed and presented using narrative synthesis.
Results
Sixteen studies identified (7 Endometrial, 2 Ovarian, 2 Vulval, 6 mixed cancer types).
1/16 used a standalone functional assessment tool, 15/16 used Health-Related Quality of Life tools (EORTC QLQ C30 (10), FACT-G (3), SF-36 (3)) comprising items describing function.
More studies showed full recovery to baseline (n=11) than incomplete recovery (n=5 including 2 reporting age as a negative association). Recovery was more likely and occurred faster in minimally-invasive surgery. 1 study demonstrated failure to recover baseline functional independence by 12 months.
Frailty associations with socioeconomic status, healthcare utilisation and quality of life among older women residing in regional Australia