Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

SIMPLE SUMMARY: This study aimed to review the research on the quality of life after hysterectomy (surgical removal of the womb) to prevent endometrial (womb) cancer. We conducted a systematic review on this topic, and found only four papers. After this operation, women had reduced worry about cancer, and were generally satisfied. There was a severe impact from the removal of both ovaries, which resulted in menopause-symptoms, particularly for women not taking hormone-replacement. We also looked at papers reporting quality of life after hysterectomy to treat heavy or abnormal periods. We found 25 papers, and generally these reported that women were satisfied after this operation, with improved quality of life, and were very unlikely to have worse sexual function or urinary problems. This review demonstrates that there is very little evidence on quality of life after this surgery to prevent endometrial cancer, and highlights how more research is needed. ABSTRACT: Background: Risk-reducing hysterectomy (RRH) is the gold-standard prevention for endometrial cancer (EC). Knowledge of the impact on quality-of-life (QoL) is crucial for decision-making. This systematic review aims to summarise the evidence. Methods: We searched major databases until July 2022 (CRD42022347631). Given the paucity of data on RRH, we also included hysterectomy as treatment for benign disease. We used validated quality-assessment tools, and performed qualitative synthesis of QoL outcomes. Results: Four studies (64 patients) reported on RRH, 25 studies (1268 patients) on hysterectomy as treatment for uterine bleeding. There was moderate risk-of-bias in many studies. Following RRH, three qualitative studies found substantially lowered cancer-worry, with no decision-regret. Oophorectomy (for ovarian cancer prevention) severely impaired menopause-specific QoL and sexual-function, particularly without hormone-replacement. Quantitative studies supported these results, finding low distress and generally high satisfaction. Hysterectomy as treatment of bleeding improved QoL, resulted in high satisfaction, and no change or improvements in sexual and urinary function, although small numbers reported worsening. Conclusions: There is very limited evidence on QoL after RRH. Whilst there are benefits, most adverse consequences arise from oophorectomy. Benign hysterectomy allows for some limited comparison; however, more research is needed for outcomes in the population of women at increased EC-risk.