Health-Related Quality Of Life After Risk-Reducing Hysterectomy: A Cross-Sectional Study Of Women With Lynch Syndrome

Abstract

Introduction/Background Risk-reducing hysterectomy (RRH) is the most effective strategy for preventing endometrial cancer (EC). An understanding of health-related quality-of-life after surgery is essential to inform counselling and economic evaluations, which are highly dependent on these values. No studies have previously reported this. This study aimed to develop health-related utility-scores (HRUS) following RRH: overall and separately for pre/postmenopausal patients. Methodology Preventing Endometrial Cancers: Comparing Risk-Reducing Strategies (PRESCORES)(ISRCTN17432105) is a cross-sectional study of UK women with Lynch Syndrome. Patients were invited via genetics/gynaecological/colorectal services and patient-groups to complete a questionnaire including EQ-5D. Those who had undergone RRH were compared against controls. Multiple linear regression with non-parametric bootstrapping was used to determine mean differences in EQ-5D HRUS between RRH and controls, overall and for pre/postmenopausal subgroups. Participants were compared against UK general population reference values. Results 2535 potentially eligible women with Lynch Syndrome were invited, with 733 patients included in this interim analysis: 373 following RRH, 360 controls. Mean ages were 56.6 (RRH) and 42.6 years (controls). The RRH group was older (p=51 years following RRH vs postmenopausal controls (p=.18), nor in overall RRH vs control groups (p=0.67). Women with Lynch Syndrome did not have different HRUS to the UK general population (p=0.72). Conclusion RRH is associated with reduced health-related quality-of-life in premenopausal women of -0.04, but not in postmenopausal women or when considering all ages. These findings are critically important for counselling patients considering RRH and health-economic evaluations of EC prevention.