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Comptour A, Figuier C, Pereira B, Chauvet P, Bourdel N, Canis M. Endometriosis: Age at diagnosis and the severity of the disease. J Gynecol Obstet Hum Reprod 2024; 53:102759. [PMID: 38467186 DOI: 10.1016/j.jogoh.2024.102759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Endometriosis is often described as a progressive disease beginning with menarche and menstrual bleeding. However, this is controversial, as the origin of the disease remains unknown. The objective of this study was to investigate the association between the severity of endometriosis and age at initial diagnosis. MATERIAL AND METHODS This prospective multicenter cohort study included 964 patients, newly and histologically diagnosed with endometriosis during laparoscopic treatment. The main outcome measures were diagnostic lesions with staging according to rAFS (revised American Fertility Society) scores, intensity of pain based on VAS (Visual Analog Scale) scores and quality of life from SF-36 questionnaire results. Age was treated as a categorical variable. Univariate and multivariable analyses (linear and multinomial ordinal) were conducted taking into account two by two multiple comparisons. The results were expressed with effect sizes and 95 % confidence intervals. MAIN FINDINGS No significant association between age and rAFS stage was found (p = 0.053). The percentage of patients with a deep nodule ≥ 2 cm was respectively 20 %, 25 %, 21 %, 18 % and 9 % for patients aged ≤ 25, 26-30, 31-35, 36-40 and >40 years respectively (p = 0.005). For dysmenorrhea, 64 %, 61 %, 54 %, 51 % and 32 % of patients aged ≤25, 26-30, 31-35, 36-40 and >40 years respectively reported a VAS score of ≥7 (p ≤ 0.001). CONCLUSION Prospective data obtained in patients newly diagnosed with endometriosis, revealed that the rAFS score is not related to patient age, and that the percentage of patients with a nodule ≥ 2 cm and severe dysmenorrhea did not increase with age. These percentages were significantly lower in patients aged > 40.
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Affiliation(s)
- Aurélie Comptour
- INSERM, CIC 1405 CRECHE Unit, CHU Clermont-Ferrand, Department of Gynecological Surgery, Clermont-Ferrand, France
| | - Claire Figuier
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics, Clermont-Ferrand, France
| | - Pauline Chauvet
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Nicolas Bourdel
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France.
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Andres MP, Riccio LGC, Abrao HM, Manzini MS, Braga L, Abrao MS. Visual Analogue Scale Cut-off Point of Seven Represents Poor Quality of Life in Patients with Endometriosis. Reprod Sci 2024; 31:1146-1150. [PMID: 38057531 DOI: 10.1007/s43032-023-01406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
Establishing objective criteria to assess endometriosis symptoms is crucial in defining therapeutic strategies. The visual analogue scale (VAS) is the most used system to enhance the accuracy and reduce the subjectivity of pain assessment, and symptoms of endometriosis are considered severe when the VAS score is ≥ 7 cm. Pain symptoms can significantly impact patients' quality of life, resulting in psychological and social distress. The aim of this study is to evaluate whether a VAS cut-off point of 7 cm for each pain symptom correlates with a diminished quality of life in women with endometriosis. This retrospective study included 1129 patients who underwent surgical treatment for endometriosis. Dysmenorrhea, acyclic pelvic pain, deep dyspareunia, dyschezia, and dysuria were assessed using a 0-10 cm VAS. The Short Form-36 (SF-36) questionnaire was employed to evaluate the quality of life 6 months prior to surgery. Dysmenorrhea was the most prevalent symptom reported in 93.6% of cases, with a mean VAS of 7.6 cm. The quality of life reported was reduced in most patients, with domain scores ranging from 49.4 to 80.1. The mean SF-36 scores in all domains were significantly lower in patients with severe pain (VAS score ≥ 7 cm) compared to those with mild to moderate pain (VAS < 7 cm). This trend was observed across all evaluated pain symptoms. Our research demonstrates that the prevalent VAS cut-off point for establishing severe pain symptoms in endometriosis (VAS ≥ 7 cm) accurately represents the negative impact of the disease on women's quality of life, as assessed via the SF-36 questionnaire.
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Affiliation(s)
- Marina Paula Andres
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Gynecologic Division, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Luiza Gama Coelho Riccio
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Faculdade de Medicina da Universidade Santo Amaro, São Paulo, SP, Brazil
| | - Henrique Mendonca Abrao
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Gynecologic Division, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | | | - Lais Braga
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Mauricio Simoes Abrao
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil.
- Gynecologic Division, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
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Tiringer D, Pedrini AS, Gstoettner M, Husslein H, Kuessel L, Perricos A, Wenzl R. Evaluation of quality of life in endometriosis patients before and after surgical treatment using the EHP30 questionnaire. BMC Womens Health 2022; 22:538. [PMID: 36550530 PMCID: PMC9773436 DOI: 10.1186/s12905-022-02111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKROUND Endometriosis is one of the most common gynecological illnesses causing extensive psychological, physical and social impact on patient's life and exerts negative effects on health-related quality of Life (HRQoL). However, the effects of surgery on the postoperative HRQoL in the different endometriosis subgroups have not been fully evaluated. METHODS We performed a comparative retrospective study between 2014 and 2018 at the Medical University of Vienna, including all patients with surgically confirmed endometriosis who had completed the standardized Endometriosis Health Profile-30 (EHP-30) questionnaire 1 day after surgery (the questions refer to the 4 weeks preoperatively) and 6-10 weeks postoperatively. RESULTS Compared to preoperative values, we found significant benefits, regarding postoperative conditions, in our study group (n = 115) in all five categories, "pain" (HR 0.78, p < 0.001); "self-determination" (HR 0.92, p < 0.001); "emotional health" (HR 0.83, p < 0.001);" social environment" (HR 0.67, p < 0.001); and "self-image" (HR 0.47, p < 0.001). Patients with only peritoneal endometriosis had the lowest preoperative clinical symptoms and there were no significant changes in any of the categories. In the subgroups deep infiltrating endometriosis (DIE) and DIE + ovarian endometrioma, surgical intervention results in a significantly greater improvement in all categories of EHP 30 compared to ovarian endometrioma without DIE or peritoneal endometriosis. CONCLUSION Our study shows, that especially women with DIE-with or without ovarian endometrioma-demonstrate a more pronounced benefit from surgical therapy compared to patients with peritoneal endometriosis or endometrioma without DIE.
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Affiliation(s)
- D. Tiringer
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A. S. Pedrini
- grid.5361.10000 0000 8853 2677Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - M. Gstoettner
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - H. Husslein
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - L. Kuessel
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A. Perricos
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - R. Wenzl
- grid.22937.3d0000 0000 9259 8492Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Sima RM, Pleş L, Socea B, Sklavounos P, Negoi I, Stănescu AD, Iordache II, Hamoud BH, Radosa MP, Juhasz-Boess I, Solomayer EF, Dimitriu MCT, Cîrstoveanu C, Şerban D, Radosa JC. Evaluation of the SF-36 questionnaire for assessment of the quality of life of endometriosis patients undergoing treatment: A systematic review and meta-analysis. Exp Ther Med 2021; 22:1283. [PMID: 34630638 PMCID: PMC8461506 DOI: 10.3892/etm.2021.10718] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022] Open
Abstract
Endometriosis has a negative influence on the physical, psychological, and social aspects of a patient's life; therefore, it affects the health-related quality of life (HRQoL). The current review aimed to investigate the efficiency of a 36-item generic questionnaire survey (SF-36) for patients with endometriosis who were undergoing medical or surgical treatment. A search strategy including the key words ‘endometriosis’, ‘quality of life’ (QOL), and ‘questionnaire SF-36’ was applied using the PubMed/MEDLINE, EMBASE, and Cochrane databases in order to include articles that evaluated the QOL among women with endometriosis using the SF-36. Only articles that included interviews of patients both before and after surgical or medical endometriosis treatment or those articles that compared study groups were considered. The qualitative analysis was based on 37 articles, whereas the quantitative analysis utilized 14 articles. The research participants included 11,101 women, among whom 6,888 patients were diagnosed with endometriosis. The analysis recorded 17 studies dealing with all types of endometriosis, 9 studies dealing with deep infiltrative endometriosis (DIE), and 9 studies dealing with bowel endometriosis or DIE with bowel involvement. QOL was evaluated using only SF-36 in 12 studies that collectively included 1,912 women and using SF-36 in association with other questionnaires in 25 studies that collectively included 8,022 women. For patients with endometriosis, physical functioning [odds ratio (OR), 78.87; 95% confidence interval (CI), 68.97-88.77; I2=98.77%; P≤0.001] was the most affected life parameter. This parameter showed the highest improvement after surgical intervention (OR, 63.39; 95% CI, 48.71-78.07; I2=97.65%; P≤0.001) or hormonal treatment (OR, 38.65; 95% CI, 14.39-62.91; I2=38.65%; P≤0.001). The 36-item survey generic questionnaire seems to be an efficient tool for assessment of the QOL of life of women with endometriosis who are undergoing surgical or medical treatment. It can be applied before and after the procedure, and it can also be used for comparing study groups.
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Affiliation(s)
- Romina-Marina Sima
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Liana Pleş
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Panagiotis Sklavounos
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Ionuţ Negoi
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Anca-Daniela Stănescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Ioan-Iulian Iordache
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Marc Phillip Radosa
- Department of Gynecology, University Hospital Leipzig, D-04103 Leipzig, Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Erich Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Mihai C T Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Cătălin Cîrstoveanu
- Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Pediatrics Department, 'Maria Sklodowska Curie' Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Dragoş Şerban
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Julia Caroline Radosa
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
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Long-Term Evolution of Quality of Life and Symptoms Following Surgical Treatment for Endometriosis: Different Trajectories for Which Patients? J Clin Med 2020; 9:jcm9082461. [PMID: 32752110 PMCID: PMC7463511 DOI: 10.3390/jcm9082461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
Many studies have shown a global efficacy of laparoscopic surgery for patients with endometriosis in reducing painful symptoms and improving quality of life (QoL) in the short and long-term. The aim of this study was to analyze the different trajectories of long-term evolution in QoL and symptoms following surgical treatment for endometriosis, and to identify corresponding patient profiles. This prospective and multicenter cohort study concerned 962 patients who underwent laparoscopic treatment for endometriosis. QoL was evaluated using the Short Form (SF)-36 questionnaire and intensity of pain was reported using a visual analog scale prior to surgery and at 6, 12, 18, 24 and 36 months after surgery. Distinctive trajectories of pain and QoL evolution were identified using group-based trajectory modeling, an approach which gathers individuals into meaningful subgroups with statistically similar trajectories. Pelvic symptom trajectories (models of the evolution of dysmenorrhea, dyspareunia and chronic pelvic pain intensity over years) correspond to (1) patients with no pain or pain no longer after surgery, (2) patients with the biggest improvement in pain and (3) patients with continued severe pain after surgery. Our study reveals clear trajectories for the progression of symptoms and QoL after surgery that correspond to clusters of patients. This information may serve to complete information obtained from epidemiological methods currently used in selecting patients eligible for surgery.
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Sun KP, Chen Q, Hong ZN, Huang JS, Cao H. Health-related quality of life in adults undergoing transthoracic device closure of ventricular septal defect. J Cardiothorac Surg 2019; 14:176. [PMID: 31639022 PMCID: PMC6805436 DOI: 10.1186/s13019-019-1004-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the health-related quality of life (HRQoL) of adult patients who underwent transthoracic device closure of ventricular septal defect (VSD). Methods During the perioperative and postoperative period, a standard scale involving eight dimensions was used to analyze the HRQoL of 85 adult patients who underwent thoracic device closure of VSD and 80 healthy adults located locally were randomly selected as the control group in our center. Results A total of 80 patients’ and 80 healthy adults’ questionnaires were received with complete feedback. Out of all of the items that were investigated, postoperative patients experienced better feelings in some dimensions than the control group. Postoperative feedback was also better than preoperative feedback in some dimensions. In the comparison of the subgroups of these patients, the scores of the elderly were lower than those of the young in most dimensions. Males had more positive feedback in two aspects (“role-physical” (p = 0.01) and “vitality” (p = 0.003)), whereas unmarried people seemed to have poor emotional responses (“role-emotional” (p < 0.01) and “vitality” (p = 0.023)). There was no significant difference in any dimensions except “social functioning” (p < 0.01) between people with different levels of education. Conclusions Most of the adult patients who underwent thoracic closure of VSD felt that they could lead a normal life. They seemed to have reasonably normal psychosocial responses compared to healthy controls. Many patients even though their HRQoL was better than healthy individuals.
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Affiliation(s)
- Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zhi-Nuan Hong
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Jiang-Shan Huang
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated Hospital of Fujian Medical University, the Daoshan Road 18, Gulou District, Fuzhou, 350001, People's Republic of China.
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Identification of Predictive Factors in Endometriosis for Improvement in Patient Quality of Life. J Minim Invasive Gynecol 2019; 27:712-720. [PMID: 31146030 DOI: 10.1016/j.jmig.2019.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To investigate predictive factors for change in quality of life (QOL) between pre- and postoperative periods in patients with endometriosis. DESIGN A prospective and multicenter cohort study. SETTING Five districts including a tertiary referral center and private and general public hospitals. PATIENTS Nine hundred eighty-one patients aged 15 to 50 years underwent laparoscopic treatment (preferred approach) for endometriosis between January 2004 and December 2012. INTERVENTIONS Laparoscopic treatment for endometriosis. All revised American Fertility Society stages were included. MEASUREMENTS AND MAIN RESULTS QOL was evaluated using the 36-Item Short Form Survey questionnaire. Factors influencing changes for each 36-Item Shorty Form Survey domain score between t0 (before surgery) and 1 year after surgery were predicted on the basis of univariate and multivariable analyses. The effect size (ES) method was used to measure changes in QOL. Univariate analysis revealed that 47% of stage IV endometriosis patients presented an improvement in the postoperative Physical Component Summary (PCS) score (ES ≥ 0.8) versus 26%, 31.3%, and 27.5% of patients with stage I, II, and III, respectively (p <.001). Forty-four percent and 38% of patients with chronic pelvic pain (CPP) presented an improvement in postoperative PCS and Mental Component Summary scores (ES>0.8) versus 23% and 24% of patients without CPP, respectively (p <.001). Multivariable analysis (ES > 0.8 vs ES < 0) revealed that women with CPP were more likely to experience greater improvement in postoperative PCS and Mental Component Summary scores than women without CPP (relative risk [RR] = 2.7; 95% confidence interval [CI], 1.7-4.4; p <.001 and RR = 1.8; 95% CI, 1.2-2.8; p <.01, respectively). Accordingly, fertile patients were more likely to show higher rates of improvement in the postoperative PCS score than infertile patients (RR = 1.8; 95% CI, 1.1-3.1; p <.05). CONCLUSION Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in QOL after surgery. CPP is the most significant independent predictive factor for changes in QOL scores.
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Comptour A, Chauvet P, Canis M, Grémeau AS, Pouly JL, Rabischong B, Pereira B, Bourdel N. Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2019; 26:717-726. [DOI: 10.1016/j.jmig.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022]
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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Arcoverde FVL, Andres MDP, Borrelli GM, Barbosa PDA, Abrão MS, Kho RM. Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2018; 26:266-278. [PMID: 30244153 DOI: 10.1016/j.jmig.2018.09.774] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 11/27/2022]
Abstract
Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, was conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: all types endometriosis, deep infiltrative endometriosis (DIE), and bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean differences between the 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (.21; 95% confidence interval [CI], .04-.38); significant improvement after surgical treatment for DIE in Vitality (.67; 95% CI, .41-.94), Social Functioning (.59; 95% CI, .18-.99), Role Emotional .49; 95% CI, .02-.97), Mental Health (.39; 95% CI, .03-.74), Physical Functioning (.93; 95% CI, .49-1.38), Bodily Pain (1.23; 95% CI, .47-1.99), General Health (.57; 95% CI, .02-1.12), MCS (.55; 95% CI, .10-1.00), and Physical Component Score (PCS; .73; 95% CI, .27-1.18); and significant improvement after surgery for bowel endometriosis for all 8 domains (Vitality [1.00; 95% CI, .56-1.43], Social Functioning [.97; 95% CI, .57-1.37], Role Emotional [1.17; 95% CI, .7-1.63], Mental Health [.94; 95% CI, .5-1.38], Physical Functioning [.74; 95% CI, .3-1.18], Role Physical [1.25; 95% CI, .75-1.76], Bodily Pain [1.39; 95% CI, .79-1.98], General Health [.84; 95% CI, 1.46-1.22]), MCS (.93; 95% CI, .47-1.40), PCS (.82; 95% CI, .40-1.23), and total score (1.15; 95% CI, .48-1.83). Only 1 study assessed patients with minimal disease and showed significant improvement in PCS (p = .002) and MCS (p <.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in most health domains of health-related QOL, with the greatest improvement found in the Bodily Pain domain.
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Affiliation(s)
- Fernanda Vieira Lins Arcoverde
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina de Paula Andres
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Giuliano Moysés Borrelli
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila de Almeida Barbosa
- Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Mauricio Simões Abrão
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and.
| | - Rosanne Marie Kho
- Benign Gynecology Surgery Section (Dr. Kho), Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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Chauvet P, Guiguet-Auclair C, Comptour A, Denouël A, Gerbaud L, Canis M, Bourdel N. Feelings and expectations in endometriosis: Analysis of open comments from a cohort of endometriosis patients. J Gynecol Obstet Hum Reprod 2018; 47:281-287. [PMID: 29807206 DOI: 10.1016/j.jogoh.2018.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Endometriosis symptoms may have a negative effect on health-related quality of life (HRQoL). Analyses of open comments are known to be a key source of information and support. The authors aimed to analyse open comments associated with a validation scale study, in order to ascertain whether the questionnaires allowed an adequate exploration of patient preoccupations and in so doing define important quality of life themes not assessed in HRQoL scales. MATERIAL AND METHODS Analysis of open comments, following two questionnaires (SF-36 and EHP-30) as part of a national study evaluating the EHP-30, was performed. Questionnaires were distributed online, via a link to the RedCap Internet platform. The association EndoFrance, a support group for endometriosis patients, notified women of the launching of the study. Women were asked to complete the questionnaire and had the opportunity to comment. Comments were gathered, coded systematically, and categorised by theme. RESULTS Of the 1156 women who responded to the questionnaire, 913 (79.0%) declared having a confirmed surgical diagnosis of endometriosis, and 265 comments were analysed. Comments were classified in 20 themes. Correspondence between the themes and items for both questionnaires and the open comments was investigated for all topics, including those non-addressed by the questionnaires. 8 themes are not mentioned in both questionnaires, 9 themes are covered by EHP-30, two by SF-36 and only one by both. CONCLUSION Anonymous data collection and subsequent analysis proves to be an effective and practical way of obtaining patient opinion on their pathology. Analysis of comments may provide additional and useful information to the classical HRQoL Scale.
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Affiliation(s)
- Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- Department of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Aurélie Comptour
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France
| | - Amélie Denouël
- EndoFrance, 01120 Montluel, France; Research and Innovation Department, Montpellier University Hospital, 34090 Montpellier, France
| | - Laurent Gerbaud
- Department of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, place Henri Dunant, 63000 Clermont-Ferrand, France
| | - Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, place Lucie Aubrac, 63100 Clermont-Ferrand, France; Faculty of Medicine, ISIT-University of Auvergne, place Henri Dunant, 63000 Clermont-Ferrand, France.
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