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Patients More Satisfied With Less Invasive Fibroid Treatment Options

Regardless of which of three treatment methods were used, women who had their symptomatic uterine fibroids addressed reported that their symptoms diminished and their quality of life significantly increased, according to a new study to be published in the May issue of Radiology. The treatments examined in the study were hysterectomy, uterine artery embolization (UAE), and a noninvasive MR-guided focused ultrasound (MRgFUS) procedure.

“When discussing treatment options for women with uterine fibroids, the pros and cons of each treatment option need to be outlined,” says Fiona M. Fennessy, MD, PhD, an assistant professor of radiology at Harvard Medical School and lead author of the study. “But until now, we haven't been able to evaluate all of the options with health-related quality-of-life measures, assessing symptom relief as well as the pain, anxiety, or recovery time associated with the treatment itself.”

The researchers surveyed a total of 197 women who underwent hysterectomy (62), UAE (74), or MRgFUS (61) for symptomatic uterine fibroids between 2004 and 2006. The mean ages of the women in the three groups were 47, 44, and 47, respectively. Using a single measure that encompasses all the different quality-of-life benefits from a healthcare intervention (called a utility weight), researchers were able to compare quality of life before and after treatment.

In addition, short-term utility weights for the actual treatments the women underwent were scrutinized, allowing for the comparison of the actual treatment experiences among the options. To assess quality of life in the short term, the researchers used the waiting trade-off method, which is based on the fact that people tend to wait longer to avoid unpleasant tests or procedures. Patients who underwent a hysterectomy reported that they would wait 21 weeks to avoid the procedure, while patients in the other two groups said they would put off their procedures by only 14 weeks.

“Quality of life significantly increased following each of the fibroid treatment options,” Fennessy says. “But patients rated the non- or minimally invasive treatments—UAE and MRgFUS—more favorably.”

The minimally invasive UAE procedure is increasingly used as an alternative to hysterectomy and requires only a small nick in the skin through which a catheter is inserted to deliver embolic particles that block blood flow to the fibroids. UAE may be associated with a number of days of pain and cramping.

The MRgFUS procedure is noninvasive and uses ultrasound energy to ablate the fibroids. MRgFUS is quick and painless for many, and symptom relief has been shown to occur by 12 weeks.

“In order to be widely adopted, MRgFUS must be deemed as beneficial as the established alternatives,” Fennessy says. “Our study not only provides measures to aid in future cost-utility analysis of uterine fibroid treatments, but it may be helpful to patient and physician decision making with regard to treatment options.”

Such a study seems like a step in the right direction. More scientific knowledge about treatment options and their clinical outcomes as well as patient satisfaction and cost of each option could steer patients toward cost-effective treatments with good outcomes in a way that the current healthcare system doesn’t.

— Source: RSNA