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Suvaal I, Kirchheiner K, Nout RA, Sturdza AE, Van Limbergen E, Lindegaard JC, Putter H, Jürgenliemk-Schulz IM, Chargari C, Tanderup K, Pötter R, Creutzberg CL, Ter Kuile MM. Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy. Gynecol Oncol 2023; 170:123-132. [PMID: 36682090 DOI: 10.1016/j.ygyno.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The EMBRACE-vaginal morbidity substudy prospectively evaluated physician-assessed vaginal changes and patient-reported-outcomes (PRO) on vaginal and sexual functioning problems and distress in the first 2-years after image-guided radio(chemo)therapy and brachytherapy for locally advanced cervical cancer. METHODS Eligible patients had stage IB1-IIIB cervical cancer with ≤5 mm vaginal involvement. Assessment of vaginal changes was graded using CTCAE. PRO were assessed using validated Quality-of-Life and sexual questionnaires. Statistical analysis included Generalized-Linear-Mixed-Models and Spearman's rho-correlation coefficients. RESULTS 113 eligible patients were included. Mostly mild (grade 1) vaginal changes were reported over time in about 20% (range 11-37%). At 2-years, 47% was not sexually active. Approximately 50% of the sexually active women reported any vaginal and sexual functioning problems and distress over time; more substantial vaginal and sexual problems and distress were reported by up to 14%, 20% and 8%, respectively. Physician-assessed vaginal changes and PRO sexual satisfaction differed significantly (p ≤ .05) between baseline and first follow-up, without further significant changes over time. No or only small associations between physician-assessed vaginal changes and PRO vaginal functioning problems and sexual distress were found. CONCLUSIONS Mild vaginal changes were reported after image-guided radio(chemo)therapy and brachytherapy, potentially due to the combination of tumors with limited vaginal involvement, EMBRACE-specific treatment optimization and rehabilitation recommendations. Although vaginal and sexual functioning problems and sexual distress were frequently reported, the rate of substantial problems and distress was low. The lack of association between vaginal changes, vaginal functioning problems and sexual distress shows that sexual functioning is more complex than vaginal morbidity alone.
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Affiliation(s)
- I Suvaal
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - K Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - R A Nout
- Department of Radiotherapy, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - A E Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - E Van Limbergen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - J C Lindegaard
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Chargari
- Department of Radiation Oncology, Institute Gustave-Roussy, Paris, France
| | - K Tanderup
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M M Ter Kuile
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC Leiden, the Netherlands.
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Tounkel I, Nalubola S, Schulz A, Lakhi N. Sexual Health Screening for Gynecologic and Breast Cancer Survivors: A Review and Critical Analysis of Validated Screening Tools. Sex Med 2022; 10:100498. [PMID: 35287046 PMCID: PMC9023241 DOI: 10.1016/j.esxm.2022.100498] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/04/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Innes Tounkel
- New York Medical College School of Medicine, Department of Obstetrics and Gynecology, Valhalla, NY, USA.
| | - Shreya Nalubola
- New York Medical College School of Medicine, Department of Obstetrics and Gynecology, Valhalla, NY, USA
| | - Alexandra Schulz
- New York Medical College School of Medicine, Department of Obstetrics and Gynecology, Valhalla, NY, USA
| | - Nisha Lakhi
- New York Medical College School of Medicine, Department of Obstetrics and Gynecology, Valhalla, NY, USA; Richmond University Medical Center, Deptartment of Obstetrics and Gynecology, Staten Island, NY, USA
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Mishra N, Singh N, Sachdeva M, Ghatage P. Sexual Dysfunction in Cervical Cancer Survivors: A Scoping Review. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:594-607. [PMID: 35141708 PMCID: PMC8820405 DOI: 10.1089/whr.2021.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Sexual function in cervical cancer survivors declines significantly after treatments irrespective of the modality used. Only a few studies have looked at their psychosexual needs, perception, and acceptance of psychosexual support. This review summarizes findings of current qualitative as well as quantitative studies to understand the plight of cervical cancer survivors regarding sexual dysfunction and the management issues. The effect of gynecologic cancers on sexuality depends on multiple factors such as psychosexual factors, biologic factors, and age. Younger patients have poorer outcomes with a more pronounced impact on sexual well-being. Radicality of surgery has direct correlation with sexual dysfunction. Low or no sexual interest, lack of lubrication, dyspareunia, and reduced vaginal caliber are frequently found. For too long, researchers have focused on defining the prevalence and types of sexual problems after various cancer treatments. The area that continues to be neglected is the evaluation of effective interventions to prevent or treat cancer-related sexual dysfunction. In particular, mental health and medical specialists need to collaborate to create cost-effective treatment programs. Collaborative intervention with gynecologists, sexologists, radiotherapists, and nursing staff would be beneficial to optimize the sexual wellness of cancer survivors and their spouses.
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Affiliation(s)
- Neha Mishra
- Department of Obstetrics and Gynaecology, GIMS, Greater Noida, India
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nilanchali Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
- Department of Gynaecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Mohini Sachdeva
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prafull Ghatage
- Department of Gynaecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Long-term Pelvic Floor Function and Quality of Life After Radical Surgery for Cervical Cancer: A Multicenter Comparison Between Different Techniques for Radical Hysterectomy With Pelvic Lymphadenectomy. Int J Gynecol Cancer 2018; 26:1538-43. [PMID: 27465892 DOI: 10.1097/igc.0000000000000776] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This study aimed to compare urinary and bowel symptoms and quality of life (QoL) among women treated with a Wertheim-Meigs (WM, type III) or Wertheim-Okabayashi (WO, type IV) radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. METHODS In this cross-sectional observational study, patients treated with a WO or a (nerve sparing) WM radical hysterectomy (with or without adjuvant radiotherapy) between January 2000 and December 2010 in the Center for Gynaecological Oncology Amsterdam or Leiden University Medical Center were included. To assess QoL, urinary and bowel symptoms we used the EORTC QLQ-C30, EORTC QLQ-CX24, and Leiden Questionnaire. We performed a multivariate analysis to identify factors associated with urinary symptoms. RESULTS Two hundred sixty-eight women were included (152 WO and 116 WM). Quality of life was not significantly different in patients treated by WO or WM. Urinary symptoms were more often reported by patients in the WO group compared to the WM group: "feeling of urine retention" (53% vs 32%), "feeling less/no urge to void" (59% vs 14%), and "timed voiding" (49% vs 10%). With regard to bowel symptoms, there was no difference between both. Multivariate analysis showed that surgical technique was an independent factor for differences in urinary symptoms. CONCLUSIONS Patients undergoing more radical surgery for early-stage cervical cancer report significantly more urinary dysfunction, whereas bowel function and health-related QoL are not decreased.
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Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer. Int J Gynecol Cancer 2017; 27:1729-1736. [PMID: 28704329 DOI: 10.1097/igc.0000000000001067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Nerve-sparing radical hysterectomy for early stage cervical cancer was introduced to improve quality of life after treatment. Sparing the pelvic autonomic nerves reduces bladder, bowel, and sexual dysfunction. The Leiden nerve-sparing radical hysterectomy (LNSRH) was modified to the Swift procedure, the latter being more radical regarding the sacrouterine and parametrial resection. We investigate whether nerve-sparing surgery has comparable oncological outcomes as the conventional radical hysterectomy (CRH). Concurrently, we investigate whether there is a difference regarding the oncological outcomes of the 2 nerve-sparing techniques. METHODS This is a single-center, observational prospective cohort study analyzing oncological outcomes in women undergoing CRH (1994-1999), LNSRH (2001-2005), or Swift procedure (2006-2010) for early stage cervical cancer (International Federation of Gynecology and Obstetrics IA2-IIA). RESULTS Three hundred sixty-three patients (124 CRH, 122 LNSRH, and 117 Swift) were included. International Federation of Gynecology and Obstetrics stage IB2 or higher (P = 0.005) was significantly more prevalent in the CRH cohort. The 5-year pelvic relapse-free survival and overall survival were not significantly different between the 3 cohorts (P = 0.116). Regarding the nerve-sparing cohorts, the Swift cohort showed a significant better 5-year overall survival (87.2%) compared with the LNSRH cohort (78.8%) (P = 0.04). In the LNSRH cohort, resection planes less than 5 mm free and need for adjuvant therapy were significantly higher than in the Swift cohort (P = 0.026 and 0.046, respectively). CONCLUSIONS The nerve-sparing radical hysterectomy shows a similar oncological outcome compared with the CRH. The more radical Swift version of nerve-sparing techniques is preferable to the former LNSRH procedure.
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White ID, Sangha A, Lucas G, Wiseman T. Assessment of sexual difficulties associated with multi-modal treatment for cervical or endometrial cancer: A systematic review of measurement instruments. Gynecol Oncol 2016; 143:664-673. [DOI: 10.1016/j.ygyno.2016.08.332] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 10/21/2022]
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A systematic review of quality of life and sexual function of patients with cervical cancer after treatment. Int J Gynecol Cancer 2015; 24:1146-57. [PMID: 25033255 DOI: 10.1097/igc.0000000000000207] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research findings of QoL and sexual function in CCSs after treatment on the basis of self-reported questionnaires and to update the current knowledge of overall QoL and sexual function in CCSs. METHODS Studies from electronic database between May 1966 and May 2013 were rated on their internal validity as methodological assessment. Thirty-two studies were included, wherein 15 studies had a relatively good methodology. RESULTS Anorectal function, urinary symptoms, and lymphedema were commonly reported as physical symptoms. As to psychosocial domains, the studies illustrated that anxiety decreased with age, whereas depression generally increased with age. Sexual function was involved in most of the studies. Vaginal dryness, dyspareunia, short vagina, and sexual dissatisfaction were prominent issues of sexual dysfunction and vaginal changes in CCSs. In terms of treatment modality, radiotherapy was thought to be associated with worse QoL and sexual function in CCSs. CONCLUSIONS The studies showed that QoL and sexual function in CCSs were compromised compared with the general population to different extents. Quality of life and sexual function should be paid with more attention in patients with cervical cancer after treatment.
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Hoole J, Kanatas A, Calvert A, Rogers SN, Smith AB, Mitchell DA. Validated questionnaires on intimacy in patients who have had cancer. Br J Oral Maxillofac Surg 2015; 53:584-93. [PMID: 26037739 DOI: 10.1016/j.bjoms.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
Problems with intimacy in patients with cancer of the head and neck may not be recognised. Our aim was to review published papers on patient-reported outcomes that record concerns about intimacy, sex, and function, to help develop a tool for use in head and neck cancer. We specifically looked for instruments with evidence of validation in patients with cancer, which could be used to identify problems with intimacy and sexuality. After evaluating 2563 papers, we identified 20 that satisfied our inclusion criteria, and these have been presented in a tabulated form. This review has shown the need to develop a questionnaire on intimacy that is specific to patients with cancer of the head and neck. It is an important issue that must be addressed by clinical and research teams, and will be done most effectively if it is linked to specific interventions.
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Affiliation(s)
- J Hoole
- Lead Cancer Nurse and Psychosexual Therapist, Calderdale and Huddersfield NHS Foundation Trust.
| | - A Kanatas
- Consultant Head and Neck Surgeon / Senior Lecturer, Leeds Teaching Hospitals and St James Institute of Oncology.
| | - A Calvert
- DFY2 in oral and maxillofacial surgery, Leeds Teaching Hospitals, Leeds General Infirmary, LS1 3EX.
| | - S N Rogers
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK.
| | - A B Smith
- York Health Economics Consortium Ltd, Level 2 Market Square, University of York, York, YO10 5NH, United Kingdom.
| | - D A Mitchell
- Consultant Oral/Maxillofacial & Head & Neck Surgeon, Bradford Teaching Hospitals NHS Foundation Trust.
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Sobral Portela E, Soto González M. Problemas sexuales derivados de la histerectomía. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Quality of life (QOL) in women treated for gynecologic malignancies with radiation therapy: A literature review of patient - reported outcomes. Gynecol Oncol 2014; 134:403-9. [DOI: 10.1016/j.ygyno.2014.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/21/2022]
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Self-Reported Sexual, Bowel and Bladder Function in Cervical Cancer Patients Following Different Treatment Modalities: Longitudinal Prospective Cohort Study. Int J Gynecol Cancer 2013; 23:1717-25. [DOI: 10.1097/igc.0b013e3182a80a65] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveConventional radical hysterectomy with pelvic lymphadenectomy (RHL) for early-stage cervical cancer is associated with significant bladder, anorectal, and sexual dysfunction. Nerve-sparing modification of RHL (NS-RHL) has been developed with the aim to reduce surgical treatment-related morbidity. Postoperative radiation therapy (RT) is offered to patients with unfavorable prognostic features to improve local control. The aim of the study was to assess self-reported morbidity of various types of treatment in cervical cancer patients.MethodsSelf-reported symptoms were prospectively assessed before and 1 and 2 years after treatment by the Dutch Gynaecologic Leiden Questionnaire.ResultsIncluded were 229 women (123 NS-RHL and 106 conventional RHL). Ninety-four (41%) received RT. Up to 2 years (response rate, 81%), women reported significantly more bowel, bladder, and sexual symptoms compared with the pretreatment situation. No significant difference was found between the conventional RHL and NS-RHL with the exception of the unexpected finding that a smaller percentage in the NS-RHL group (34% vs 68%) complained about numbness of the labia and/ or thigh. Radiation therapy had a negative impact on diarrhea, urine incontinence, lymphedema, and sexual symptoms (especially a narrow/short vagina).ConclusionsIn the current longitudinal cohort study, treatment for early-stage cervical cancer was associated with worse subjective bladder, anorectal, and sexual functioning, irrespective of the surgical procedure used. Postoperative RT resulted in a significant deterioration of these functions. The results have to be interpreted with caution in view of the study design and method used.
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