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Reese JB, Bober SL, Sorice KA, Handorf E, Chu CS, Middleton D, McIlhenny S, El-Jawahri A. Starting the Conversation: randomized pilot trial of an intervention to promote effective clinical communication about sexual health for gynecologic cancer survivors. J Cancer Surviv 2024; 18:800-809. [PMID: 36604391 PMCID: PMC10323044 DOI: 10.1007/s11764-022-01327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Gynecologic cancer survivors often hesitate to raise sexual health concerns with their clinicians. We pilot tested Starting the Conversation (STC), a theory-guided intervention aimed at facilitating survivors' clinical communication about sexual health. METHODS Survivors (N = 32) were randomized 2:1 to STC (23-min video and accompanying workbook grounded in social cognitive theory that provides information and skills training for communicating with providers about sexual concerns, and resource guide) or control (resource guide only). Feasibility was assessed through enrollment, retention, and intervention completion rates (benchmarks: 60%, 80%, 70%); acceptability was assessed through post-intervention program evaluations (benchmark: 75%). Preliminary effects were assessed for sexual health communication (self-reported after next clinic encounter), self-efficacy for clinical communication about sexual health (post-intervention and 2-month follow-up), and sexual activity and anxiety/depressive symptoms (2-month follow-up). RESULTS All feasibility/acceptability benchmarks were surpassed; 76% enrolled, 97% retained, ≥ 95% used intervention materials, and 100% endorsed STC as acceptable. Positive STC effects were seen for increases in self-efficacy (Cohen's d's = 0.45 at post-intervention; 0.55 at follow-up). In STC, 35% and 45% of women raised or asked about sexual health concerns during the post-intervention clinic visit, respectively, versus 0 and 27% in the control arm. Other measures showed little change. CONCLUSIONS Data support the STC intervention as feasible and acceptable, with promising effects for gynecologic cancer survivors' communication about sexual health concerns. Because sexual health communication is relevant across the treatment trajectory, we included both on-treatment and post-treatment survivors. While this may be a limitation, it could also enhance sample generalizability. A larger trial is needed to determine efficacy. IMPLICATIONS FOR CANCER SURVIVORS Communication about sexual health is important yet lacking for cancer survivors. Patient-focused interventions may help address concerns and improve survivors' health outcomes.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Christina S Chu
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Danny Middleton
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Sarah McIlhenny
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Areej El-Jawahri
- Department of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Boding S, Russell H, Knoetze R, Wilson V, Stafford L. 'Sometimes I can't look in the mirror': Recognising the importance of the sociocultural context in patient experiences of sexuality, relationships and body image after ovarian cancer. Eur J Cancer Care (Engl) 2022; 31:e13645. [PMID: 35790894 PMCID: PMC9787468 DOI: 10.1111/ecc.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ovarian cancer (OC) can significantly change the way women feel about their body. However, personal accounts regarding these changes are lacking in the literature. Therefore, the aim of this study was to gain an understanding of the ways in which OC can affect relationships, sexuality, womanhood and body image. METHODS Ninety-eight Australian women aged 18 and over diagnosed with OC completed an online survey that invited narrative responses to open-ended questions about relationships, sexuality, body image and womanhood following OC treatment. Responses were analysed thematically while applying a sociocultural lens. RESULTS Three themes and two subthemes were identified: Failure and Loss of Femininity and Womanhood, Internalising Public Perception of Body and Illness and Altered Relationships which comprised two subthemes, Loss of the Sexual Self and Relationship Burden. These themes suggest women view themselves and their relationships in comparison with sociocultural understandings of body normalcy. Women often questioned their self-worth, their relationships and place within society due to changes in fertility, sexuality and bodily functioning. CONCLUSION These results highlight a need for health care professionals to open dialogue with women about sexuality and ensure information and support is given to reduce stigma and positively influence self-perception and increase body acceptance.
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Affiliation(s)
- Sally‐Anne Boding
- University of South Australia, Justice and SocietyAdelaideSAAustralia
| | | | - Ricki Knoetze
- University of South Australia, Justice and SocietyAdelaideSAAustralia
| | - Victoria Wilson
- University of South Australia, Justice and SocietyAdelaideSAAustralia
| | - Lesley Stafford
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVICAustralia
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Benedict C, Shaffer KM, Wirtz MR, Ford JS, Reese JB. Current Considerations in Interventions to Address Sexual Function and Improve Care for Women with Cancer. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00343-w] [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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Understanding the Experience of Canadian Women Living with Ovarian Cancer through the Every Woman Study TM. Curr Oncol 2022; 29:3318-3340. [PMID: 35621661 PMCID: PMC9139742 DOI: 10.3390/curroncol29050271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
The Every Woman StudyTM: Canadian Edition is the most comprehensive study to date exploring patient-reported experiences of ovarian cancer (OC) on a national scale. An online survey conducted in Fall 2020 included individuals diagnosed with OC in Canada, reporting responses from 557 women from 11 Canadian provinces/territories. Median age at diagnosis was 54 (11−80), 61% were diagnosed between 2016−2020, 59% were stage III/IV and all subtypes of OC were represented. Overall, 23% had a family history of OC, 75% had genetic testing and 19% reported having a BRCA1/2 mutation. Most (87%) had symptoms prior to diagnosis. A timely diagnosis of OC (≤3 months from first presentation with symptoms) was predicted by age (>50) or abdominal pain/persistent bloating as the primary symptom. Predictors of an acute diagnosis (<1 month) included region, ER/urgent care doctor as first healthcare provider or stage III/IV disease. Regional differences in genetic testing, treatments and clinical trial participation were also noted. Respondents cited substantial physical, emotional, practical and financial impacts of an OC diagnosis. Our national survey has revealed differences in the pathway to diagnosis and post-diagnostic care among Canadian women with OC, with region, initial healthcare provider, specific symptoms and age playing key roles. We have identified many opportunities to improve both clinical and supportive care of OC patients across the country.
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Opławski M, Grabarek BO, Średnicka A, Czarniecka J, Panfil A, Kojs Z, Boroń D. The Impact of Surgical Treatment with Adjuvant Chemotherapy for Ovarian Cancer on Disorders in the Urinary System and Quality of Life in Women. J Clin Med 2022; 11:jcm11051300. [PMID: 35268391 PMCID: PMC8911254 DOI: 10.3390/jcm11051300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
Ovarian cancer is the fourth-most-common cause of death among all malignant cancers in women in Poland. This study aimed to compare the functioning of the urinary system and quality of life in women in the 12-month period following the completion of surgery or adjuvant treatment for ovarian cancer, with patients who underwent a hysterectomy for non-oncological reasons (control group). The study group consisted of 50 patients diagnosed with stage I−III ovarian cancer. Among 38 patients with type II ovarian cancer (group A), surgery followed by first-line chemotherapy was performed. Within this group of patients, 20 had stage I ovarian cancer, while 18 had stage II ovarian cancer. The study was performed at least 6 months after the final chemotherapy cycle, with no clinical, marker or radiological recurrence determined. On the other hand, in 12 patients with stage I type I ovarian cancer, oncological treatment consisted of only surgery, without the need for adjuvant chemotherapy, due to the low stage of the lesions (group B). In turn, the control group consisted of 50 women who underwent uterine removal for non-oncological reasons (group C). The assessment of quality of life was conducted using the questionnaires: Satisfaction with Life Scale (SWLS); Incontinence Impact Questionnaire, short form (IIQ-7); Urogenital Distress Inventory (UDI-6); and the Sexual Satisfaction Scale for 3, 6, 9, and 12 months after the conclusion of oncological treatment. During the follow-up, a significant reduction in the quality of everyday life and sexual life was noted among patients with ovarian cancer, more pronounced in group B, compared to the control group (p < 0.05). The risk of urinary incontinence is independent of the treatment regimen chosen for ovarian cancer. It is necessary to consider comprehensive psychological care and sexual therapy in patients with ovarian cancer and their families.
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Affiliation(s)
- Marcin Opławski
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (A.Ś.); (Z.K.); (D.B.)
- Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University in Cracow, 30-705 Cracow, Poland
- Correspondence:
| | - Beniamin Oskar Grabarek
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (A.Ś.); (Z.K.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland; (J.C.); (A.P.)
- Department of Gynecology and Obstetrics in Zabrze, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Agata Średnicka
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (A.Ś.); (Z.K.); (D.B.)
- Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University in Cracow, 30-705 Cracow, Poland
| | - Justyna Czarniecka
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland; (J.C.); (A.P.)
| | - Agata Panfil
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland; (J.C.); (A.P.)
| | - Zbigniew Kojs
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (A.Ś.); (Z.K.); (D.B.)
| | - Dariusz Boroń
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (A.Ś.); (Z.K.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland; (J.C.); (A.P.)
- Department of Gynecology and Obstetrics in Zabrze, Faculty of Medicine in Zabrze, University of Technology, Academy of Silesia in Katowice, 41-800 Zabrze, Poland
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