Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: results from the LACE trial

Objective: To examine the association between preoperative quality of life (QoL) and postoperative adverse events in women treated for endometrial cancer. Methods: 760 women with apparent Stage I endometrial cancer were randomised into a clinical trial evaluating laparoscopic versus open surgery. This analysis includes women with preoperative QoL measurements, from the Functional Assessment of Cancer Therapy- General (FACT-G) questionnaire, and who were followed up for at least 6 weeks after surgery (n=684). The outcomes for this study were defined as (1) the occurrence of moderate to severe AEs adverse events within 6 months (Common Toxicology Criteria (CTC) grade ≥3); and (2) any Serious Adverse Event (SAE). The association between preoperative QoL and the occurrence of AE was examined, after controlling for baseline comorbidity and other factors. Results: After adjusting for other factors, odds of occurrence of AE of CTC grade ≥3 were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.00-1.03, p=0.030), which was driven by physical well-being (PWB) (OR=1.09, 95% CI 1.04-1.13, p=0.0002) and functional well-being subscales (FWB) (OR=1.04, 95% CI 1.00-1.07, p=0.035). Similarly, odds of SAE occurrence were significantly increased with each unit decrease in baseline FACT-G score (OR=1.02, 95% CI 1.01-1.04, p=0.011), baseline PWB (OR=1.11, 95% CI 1.06-1.16, p<0.0001) or baseline FWB subscales (OR=1.05, 95% CI 1.01-1.10, p=0.0077). Conclusion: Women with early endometrial cancer presenting with lower QoL prior to surgery are at higher risk of developing a serious adverse event following surgery. Funding: Cancer Council Queensland, Cancer Council New South Wales, Cancer Council Victoria, Cancer Council, Western Australia; NHMRC project grant 456110; Cancer Australia project grant 631523; The Women and Infants Research Foundation, Western Australia; Royal Brisbane and Women’s Hospital Foundation; Wesley Research Institute; Gallipoli Research Foundation; Gynetech; TYCO Healthcare, Australia; Johnson and Johnson Medical, Australia; Hunter New England Centre for Gynaecological Cancer; Genesis Oncology Trust; and Smart Health Research Grant QLD Health.

Walter Godshaw (Gottschalk), Louise "Isa" Gottschalk nee Rosenthal and Peter Zander; England.

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Freddy Godshaw (Gottschalk) sailing with his friend Peter Zander at a camp shortly after Freddy left Germany; England.

Left: Freddy Godshaw (Gottschalk); right: Peter Zander

Walter and Freddy Godshaw (Gottschalk) with their uncle Ernst Meyerhof; London, England.

From left to right: Walter Godshaw, Ernst Meyerhof, and Freddy Godshaw

Ernst Gottschalk sitting in a car petting his dog Whip; London, England.

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Portrait of Ralph and Joan Grahme with Ralph's sister Ilse Schuster nee Gottschalk and her husband James at restaurant "Old Vienna"; London, England.

Left to right: Ralph Grahme, Joan Grahme, Ilse Schuster nee Gottschalk, and James Schuster;

Portrait of Ernst Gottschalk with his wife Louise "Isa" nee Rosenthal; Welwyn Garden City, England.

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Ruth Weiss nee Stern with Annette, Meir, and David Weiss at Mortimer Hill Farm; Mortimer, England.

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Alice Burlin nee Molling, Therese Gottschalk nee Molling, and Line Stern nee Wallerstein at Alice Burlins's home; Linton near Cambridge, England.

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Ruth Weiss nee Stern with Annette, Meir, and David Weiss at Mortimer Hill Farm; Mortimer, England..

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Wedding portrait of Freddy Gottschalk and Barbara Joan Doble with guests; Welwyn Garden City, England.

Portrait includes a number of family members who were able to get to England before the war and who chose to remain there.

Desiderius Herlinger, Annie Unger, Fritz Unger and Leopold Giustina (chauffeur) on driving trip to England.

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Herbert Reiss with his wife Trude Loewy on the beach in England Portraits Couples

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Freddy Godshaw (Gottschalk) sailing with his friend Peter Zander at a camp shortly after Freddy left Germany; England.

Left: Freddy Godshaw (Gottschalk); right: Peter Zander

Walter and Freddy Godshaw (Gottschalk) with their uncle Ernst Meyerhof; London, England.

From left to right: Walter Godshaw, Ernst Meyerhof, and Freddy Godshaw