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Robison K, Kulkarni A, Dizon DS. Sexual Health in Women Affected by Gynecologic or Breast Cancer. Obstet Gynecol 2024; 143:499-514. [PMID: 38207333 DOI: 10.1097/aog.0000000000005506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/29/2023] [Indexed: 01/13/2024]
Abstract
Sexual health problems are prevalent among women affected by gynecologic or breast cancer. It is important to understand the effects cancer treatment can have on sexual health and to have the tools necessary to identify and treat sexual health problems. This Clinical Expert Series discusses practical methods for routinely screening for sexual dysfunction and reviews sexual health treatment options for women affected by cancer. We review the limitations of the current literature in addressing sexual health problems among sexually and gender minoritized communities. Finally, we discuss appropriate timing of referrals to sexual health experts, physical therapists, and sex therapists. Multiple resources available for both patients and clinicians are included.
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Affiliation(s)
- Katina Robison
- Tufts Medical Center, Boston, Massachusetts; Columbia University, New York, New York; and the Lifespan Cancer Institute and Legorreta Cancer Center, Brown University, Providence, Rhode Island
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Olesen ML, Seibaek L, Sekse RJT. Impaired sexual health among women treated for vulvar cancer: An integrated review. J Clin Nurs 2023; 32:6212-6228. [PMID: 37221928 DOI: 10.1111/jocn.16753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Although gynaecological cancer's negative effects on sexual function are well known, most studies on the subject have not included vulvar cancer patients or a multidimensional perspective on sexual health. Therefore, this review aimed to address this research gap and explored the impact of vulvar cancer on women's sexual health from a multidimensional perspective. METHODOLOGY An integrated review was conducted, as described by Whittemore and Knafl. The PubMed, CINAHL, PsycINFO and Embase databases were searched in March 2021 and updated in August 2022 and March 2023. The data were thematically analysed using NVivo, and the PRISMA-ScR and ENTREQ guidelines were followed. FINDINGS The following themes were identified in the 28 reviewed articles: impact of a changed female body, impact on women's sexual identity, consequences for women's sexual relationships and unmet needs and loneliness caused by taboos about sexual health. DISCUSSION Women's impaired sexual health after vulvar cancer points to a great need to understand and holistically investigate sexual health. In addition, healthcare professionals have an obligation to care for the sexual health issues of patients with vulvar cancer. However, most questionnaires used in the selected studies revealed a narrow understanding of sexual health and focused on sexuality as a genital activity. CONCLUSION The sexual health of women with vulvar cancer was tabooed and stigmatised for patients and healthcare professionals. Consequently, women received sparse sexual guidance, felt isolated and had unmet needs. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals need knowledge and training on how to break taboos and address the sexual needs of vulvar cancer patients. Systematic screenings for sexual health needs should be conducted using a multidimensional perspective. TRIAL AND PROTOCOL REGISTRATION The protocol was preregistered at the Open Science Framework (www.osf.io), registration DOI: https://doi.org/10.17605/OSF.IO/YDA2Q PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Affiliation(s)
- Mette Linnet Olesen
- Department of Gynecology, The Interdisciplinary Research Unit of Women's Children's and Families´ Health, Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lene Seibaek
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Institute of Health and Nature, Ilisimatusarfik, University of Greenland, Nuuk, Greenland
- Affiliated to Greenland Centre for Health Research, University of Greenland, Nuuk, Greenland
- Research Centre for Patient Involvement (ResCenPi), Aarhus University, Aarhus, Denmark
| | - Ragnhild Johanne Tveit Sekse
- VID Specialized University, Faculty of Health Sciences, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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3
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van der Linden M, van Hees CL, van Beurden M, Bulten J, van Dorst EB, Esajas MD, Meeuwis KA, Boll D, van Poelgeest MI, de Hullu JA. The Paget Trial: topical 5% imiquimod cream for noninvasive vulvar Paget disease. Am J Obstet Gynecol 2022; 227:250.e1-250.e8. [PMID: 35447145 DOI: 10.1016/j.ajog.2022.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vulvar Paget disease is an extremely rare skin disorder, which is most common in postmenopausal women. Most vulvar Paget disease cases are noninvasive; however, it may be invasive or associated with an underlying vulvar or distant adenocarcinoma. The current treatment of choice for noninvasive vulvar Paget disease is wide local excision, which is challenging because of extensive intraepithelial spread and may cause severe morbidity. Recurrence rates are high, ranging from 15% to 70%, which emphasizes the need for new treatment options. Imiquimod, a topical immune response modifier, has been shown to be effective in a few studies and case reports, and is a promising new treatment modality. OBJECTIVE To prospectively investigate the efficacy, safety, and effect on quality of life of a standardized treatment schedule with 5% imiquimod cream in patients with noninvasive vulvar Paget disease. STUDY DESIGN The Paget Trial is a multicenter prospective observational clinical study including 7 tertiary referral hospitals in the Netherlands. A total of 24 patients with noninvasive vulvar Paget disease were treated with topical 5% imiquimod cream 3 times a week for 16 weeks. The primary efficacy outcome was the reduction in lesion size at 12 weeks after the end of treatment. Secondary outcomes were safety, clinical response after 1 year, and quality of life. Safety was assessed by evaluation of adverse events and tolerability of treatment. Quality of life was investigated with 3 questionnaires taken before, during, and after treatment. RESULTS Data were available for 23 patients, 82.6% of whom responded to therapy. A complete response was reported in 12 patients (52.2%), and 7 patients (30.4%) had a partial response. A histologic complete response was observed in 10 of the 12 patients with a complete response. Patients experienced side effects such as fatigue (66.7%-70.9%) and headaches (16.7%-45.8%), and almost 80% needed painkillers during treatment. Eight patients (34.8%) adjusted the treatment protocol to 2 applications a week, and 3 patients (13.0%) stopped treatment because of side effects after 4 to 11 weeks. Treatment improved quality of life, whereas a slight, temporary negative impact was observed during treatment. Two patients with a complete response developed a recurrence within 1 year after treatment. Follow-up showed 6 patients with a noninvasive recurrence after a median of 31 months (14-46 months) after the end of treatment. CONCLUSION Topical 5% imiquimod cream can be an effective and safe treatment alternative for noninvasive vulvar Paget disease, particularly when compared with treatment with surgical excision.
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Affiliation(s)
- Michelle van der Linden
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Colette L van Hees
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Marc van Beurden
- Department of Gynaecology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eleonora B van Dorst
- Department of Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martha D Esajas
- Department of Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kim A Meeuwis
- Department of Dermatology, Slingeland Hospital Doetinchem, Nijmegen, The Netherlands
| | - Dorry Boll
- Department of Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Zeitoun J, Calvary M, Bonneau C, Rouzier R. Impact of Vulvar Cancer Surgery on Quality of Sex Life: A Review of Literature. J Low Genit Tract Dis 2022; 26:38-42. [PMID: 34798652 DOI: 10.1097/lgt.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Vulvar cancer is a gynecological cancer for which posttreatment morbidity must be known to propose the appropriate medical strategy. The objectives of this article were to review and to summarize the available studies evaluating the impact of vulvar surgery on the quality of sex life. MATERIALS AND METHODS We searched MEDLINE abstracts (source PubMed) and included all studies published between 1990 and 2020 that evaluated the impact of vulvar surgery on the patients' sex life. Articles were selected in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. We evaluated the quality of the studies using the "study quality assessment tools" established by the National Heart Lung and Blood Institute and the health-related quality-of-life score. Summary statistics were used to report the results of the studies selected. RESULTS A total of 41 articles were screened, and 15 studies were included in this review. Two questionnaires, that is, European Organization for Research and Treatment of Cancer QLC C30 and Female Sexual Function Index, were used in 60% of the studies. The quality of the studies was heterogeneous. None of them had a high level of evidence. Eleven of the 16 studies reported an impairment of quality of sex life, mainly related to the size of the initial lesion and the type of surgery performed. Preoperative sexual status, that is, active sex life, age, and morbidity seemed to be important factors. CONCLUSIONS None of the studies had a high level of evidence, and their methodological quality was heterogeneous. More powerful studies using validated questionnaires are necessary. Because this is essential surgery, patients should be informed that if it impacts their sexual life, management strategies will be part of their postoperative care.
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Affiliation(s)
- Jeremie Zeitoun
- département d'oncologie chirurgicale, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Marjolaine Calvary
- département d'oncologie chirurgicale, Institut Curie, PSL Research University, Saint-Cloud, France
| | - Claire Bonneau
- département d'oncologie chirurgicale, Institut Curie, PSL Research University, Saint-Cloud, France
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Messelt A, Thomaier L, Jewett PI, Lee H, Teoh D, Everson-Rose SA, Blaes AH, Vogel RI. Comparisons of emotional health by diagnosis among women with early stage gynecological cancers. Gynecol Oncol 2020; 160:805-810. [PMID: 33384163 DOI: 10.1016/j.ygyno.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess self-reported emotional health in a cohort of women with early stage gynecologic cancers and to explore differences based on primary cancer type. METHODS We analyzed survey data from a cohort study of gynecological cancer patients treated at an academic cancer center. Measures of emotional health included cancer-related quality of life, distress, depression, anxiety, posttraumatic stress disorder (PTSD), and posttraumatic growth. Univariate and multivariate linear regression models examined differences in emotional health measures by primary cancer site. Potential confounders considered for inclusion in the final models were age, stage, education, income, partner status, treatment status, and race. RESULTS 242 patients with early stage disease completed the survey. Patients with cervical and vaginal/vulvar cancers reported greater cancer-related distress, anxiety and PTSD symptoms. Patients with endometrial cancer reported the lowest posttraumatic growth scores, which remained statistically significant after adjustment for demographic and clinical differences. No significant differences in cancer-related quality of life were observed among individuals with different primary cancer sites CONCLUSIONS: These data suggest patients with early-stage gynecologic cancer face different psychosocial sequelae based on primary cancer site, though underlying clinical and sociodemographic factors may play a significant role in this observed relationship. Further research is needed to assess poorer emotional health among individuals with vaginal/vulvar cancers and the lower posttraumatic growth among patients with endometrial cancer as posttraumatic growth is considered a potentially beneficial psychosocial outcome of cancer.
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Affiliation(s)
- Audrey Messelt
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Lauren Thomaier
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Patricia I Jewett
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Heewon Lee
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Deanna Teoh
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Susan A Everson-Rose
- Department of Medicine, Division of General Internal Medicine, and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN, United States of America
| | - Anne H Blaes
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America.
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Chan AK, Bisson EF, Fu KM, Park P, Robinson LC, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Wang MY, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Mummaneni PV. Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis. Neurosurgery 2020; 87:200-210. [PMID: 31625568 DOI: 10.1093/neuros/nyz406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/26/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a paucity of investigation on the impact of spondylolisthesis surgery on back pain-related sexual inactivity. OBJECTIVE To investigate predictors of improved sex life postoperatively by utilizing the prospective Quality Outcomes Database (QOD) registry. METHODS A total of 218 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis were included who were sexually active. Sex life was assessed by Oswestry Disability Index item 8 at baseline and 24-mo follow-up. RESULTS Mean age was 58.0 ± 11.0 yr, and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had sex life impairment. At 24 mo, 130 patients (73.0% of the 178 impaired) had an improved sex life. Those with improved sex lives noted higher satisfaction with surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In multivariate analyses, lower body mass index (BMI) was associated with improved sex life (OR = 1.14; 95% CI [1.05-1.20]; P < .001). In the younger patients (age < 57 yr), lower BMI remained the sole significant predictor of improvement (OR = 1.12; 95% CI [1.03-1.23]; P = .01). In the older patients (age ≥ 57 yr)-in addition to lower BMI (OR = 1.12; 95% CI [1.02-1.27]; P = .02)-lower American Society of Anesthesiologists (ASA) grades (1 or 2) (OR = 3.7; 95% CI [1.2-12.0]; P = .02) and ≥4 yr of college education (OR = 3.9; 95% CI [1.2-15.1]; P = .03) were predictive of improvement. CONCLUSION Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report improvement postoperatively. Sex life improvement was associated with greater satisfaction with surgery. Lower BMI was predictive of improved sex life. In older patients-in addition to lower BMI-lower ASA grade and higher education were predictive of improvement.
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Affiliation(s)
- Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Paul Park
- Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan
| | - Leslie C Robinson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Mohamad Bydon
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- Department of Neurological Surgery, University of Tennessee, Knoxville, Tennessee.,Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Christopher I Shaffrey
- Departments of Neurological Surgery and Orthopedic Surgery, Duke University; Durham, North Carolina
| | - Eric A Potts
- Department of Neurological Surgery, Indiana University, Bloomington, Indiana.,Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Domagoj Coric
- Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | | | - Anthony L Asher
- Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mohammed A Alvi
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jian Guan
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | | | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Preti M, Rotondo JC, Holzinger D, Micheletti L, Gallio N, McKay-Chopin S, Carreira C, Privitera SS, Watanabe R, Ridder R, Pawlita M, Benedetto C, Tommasino M, Gheit T. Role of human papillomavirus infection in the etiology of vulvar cancer in Italian women. Infect Agent Cancer 2020; 15:20. [PMID: 32266002 PMCID: PMC7110671 DOI: 10.1186/s13027-020-00286-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 12/31/2022] Open
Abstract
Background Vulvar squamous cell carcinoma (VSCC) is a rare malignancy of the female genital tract. We aimed to determine the mucosal high-risk human papillomavirus (HPV)-attributable fraction of VSCCs from Italian women using multiple markers of viral infections. Methods VSCCs and 8 metastatic lymph node samples from 107 Italian women were analyzed by a highly type-specific multiplex genotyping assay for the presence of DNA from 119 different HPVs. Tissues were further analyzed for HPV RNA and for upregulation of the cellular protein p16INK4a. Results The rate of mucosal HPV-related tumors defined by viral DNA and RNA positivity was low (7.8%). HPV16 was the most prevalent, followed by 53, 56, and 58. Only five (4.9%) p16INK4a-positive tumors were also positive for both viral DNA and RNA. One (14.3%) metastatic lymph node sample was positive for all three markers. DNA of cutaneous HPVs was detected in only two VSCCs, i.e. genus beta types 5 and 110. Conclusion A small proportion of Italian VSCCs is putatively HPV-related, i.e. positive for both viral DNA and RNA of the same type, thus reinforcing the importance of HPV vaccination. Moreover, this study suggests that a direct role of HPV from genus beta and gamma in vulvar carcinogenesis is unlikely.
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Affiliation(s)
- Mario Preti
- 1Department of Surgical Sciences, University of Turin, Turin, Italy
| | - John Charles Rotondo
- 2International Agency for Research on Cancer, Lyon, France.,3Department of Morphology, Surgery and Experimental Medicine; Section of Pathology, Oncology and Experimental Biology; Laboratories of Cell Biology and Molecular Genetics, University of Ferrara, Ferrara, Italy
| | - Dana Holzinger
- 4Infections and Cancer Epidemiology, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Niccolò Gallio
- 1Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | | | | | - Reiko Watanabe
- 2International Agency for Research on Cancer, Lyon, France
| | - Ruediger Ridder
- Roche mtm laboratories, Mannheim, Germany.,7Ventana Medical Systems Inc., Tucson, AZ USA
| | - Michael Pawlita
- 4Infections and Cancer Epidemiology, Infections and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Chiara Benedetto
- 1Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Tarik Gheit
- 2International Agency for Research on Cancer, Lyon, France
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Skanjeti A, Dhomps A, Paschetta C, Tordo J, Giammarile F. Sentinel Node Mapping in Gynecologic Cancers: A Comprehensive Review. Semin Nucl Med 2019; 49:521-533. [DOI: 10.1053/j.semnuclmed.2019.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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9
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Roberts K, Chong T, Hollands E, Tan J, Mohan GRKA, Cohen PA. Screening for sexual health concerns in survivors of gynecological cancer. Support Care Cancer 2019; 28:599-605. [PMID: 31104133 DOI: 10.1007/s00520-019-04872-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/19/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the impact of a screening tool, the Brief Sexual Symptom Checklist for Women, on referral rates to physiotherapists, sexual counselors, and psychologists for sexual issues among patients attending the practices of two gynecological oncologists. METHODS A prospective observational cohort study. A retrospective cohort of consecutive patients matched for age, diagnosis, and stage was used as a control group. RESULTS Seventy-eight women were recruited to the intervention group. Diagnoses were endometrial carcinoma (38%), ovarian carcinoma (33%), and cervical carcinoma (24%). Sixty percent had completed adjuvant treatment, and 89% were married or in a de facto relationship. More than half of participants reported at least one sexual difficulty and were not satisfied with their sexual function. The most commonly reported sexual issue was decreased sexual desire. Twelve of 77 (15%) women screened in the intervention group were referred to a sexual counselor and/or a physiotherapist for a sexual issue. Twelve percent of women in the intervention group were referred to a sexual counselor, compared with 5% in the control group (p = 0.072). There was no difference in the proportion of women referred to a pelvic floor physiotherapist between the two groups (8% of women in the intervention group vs. 8% in the control group; p = 1.000). CONCLUSIONS In the current study, the Brief Sexual Symptom Checklist for Women identified sexual health concerns in over half of gynecological cancer survivors and resulted in a non-significant trend to more referrals for sexual counseling.
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Affiliation(s)
- Karen Roberts
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Travis Chong
- School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Emma Hollands
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia.,School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jason Tan
- WOMEN Centre, West Leederville, Western Australia, Australia
| | | | - Paul A Cohen
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia. .,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
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10
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Assessing Patient-reported Quality of Life Outcomes in Vulva Cancer Patients: A Systematic Literature Review. Int J Gynecol Cancer 2018; 28:808-817. [DOI: 10.1097/igc.0000000000001211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
ObjectivesVulva cancer (VC) treatment carries a high risk of severe late effects that may have a negative impact on quality of life (QoL). Patient-reported outcome measures (PROMs) are increasingly used when evaluating disease- and treatment-specific effects. However, the adequacy of measures used to assess sequelae and QoL in VC remains unclear. The aims of the present study were to evaluate disease- and treatment-related effects as measured by PROMs in VC patients and to identify available VC-specific PROMs.Methods/MaterialsA systematic literature search from 1990 to 2016 was performed. The inclusion criterion was report of disease- and treatment-related effects in VC patients using PROMs in the assessment. Methodological and reporting quality was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. This systematic review was performed as part of phase 1 of the development of a European Organisation for Research and Treatment of Cancer QoL questionnaire for VC patients.ResultsThe search revealed 2299 relevant hits, with 11 articles extracted including a total of 535 women with VC; no randomized controlled trials were identified. The selected studies exhibited great heterogeneity in terms of PROMs use. Twenty-one different instruments assessed QoL. Most of the questionnaires were generic. Different issues (sexuality, lymphedema, body image, urinary and bowel function, vulva-specific symptoms) were reported as potentially important, but the results were not systematically collected. Only one VC-specific questionnaire was identified but did not allow for assessment and reporting on a scale level.ConclusionsVulva cancer treatment is associated with considerable morbidity deteriorating QoL. To date, there is no validated PROM available that provides adequate coverage of VC-related issues. The study confirms the need for a VC-specific QoL instrument with sensitive scales that allows for broad cross-cultural application for use in clinical trials.
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11
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Forner DM, Mallmann P. Neoadjuvant and definitive chemotherapy or chemoradiation for stage III and IV vulvar cancer: A pooled Reanalysis. Eur J Obstet Gynecol Reprod Biol 2017; 212:115-118. [DOI: 10.1016/j.ejogrb.2017.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 11/16/2022]
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12
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Keefe MK, Zygourakis CC, Theologis AA, Canepa E, Shaw JD, Goldman LH, Burch S, Berven S, Chou D, Tay B, Mummaneni P, Deviren V, Ames CP. Sexual function after cervical spine surgery: Independent predictors of functional impairment. J Clin Neurosci 2016; 36:94-101. [PMID: 27825608 DOI: 10.1016/j.jocn.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/15/2016] [Indexed: 11/17/2022]
Abstract
Sexual function (SF) is an important component of patient-focused health related quality of life (HRQoL), but it has not been well studied in spine surgery. This study aims to assess SF after cervical spine surgery and identify predictors of SF. This single-center retrospective study evaluates SF of adults who underwent cervical spine surgery 2007-2012. Predictor variables included demographics, medical/surgical history, operative information, HRQoL measures (Neck Disability Index, SF-12), validated SF surveys [Female Sexual Function Index (FSFI) and Brief Sexual Function Inventory (BSFI) for males], and a study-specific SF questionnaire. 59 patients (31M, 28F; mean age=56±8.4) had significantly lower SF scores compared to age-matched peers: average BSFI = 2.26±1.22 (vs. 06±0.74), average FSFI=13.05±11.42 (<26.55 indicating sexual dysfunction). In men, lower mental SF-12 and higher NDI, back pain, and number of operated levels were associated with lower BSFI scores (all p<0.05). In women, higher total number of medications and pain medications were associated with lower FSFI scores (both p<0.05). 46% of patients reported difficulty performing a sexual position after surgery that they had previously enjoyed. 39% of men had difficulty on top during intercourse, and 32% of participants reported difficulty performing oral sex. 39% of patients reported worse SF, while only 5% reported an improvement in postoperative SF. Men and women who underwent cervical spine surgery had lower SF scores than age-matched peers, likely attributable to general mental health, regional neck disability, back pain, and medications. A large portion of patients reported subjectively worsened SF after surgery.
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Affiliation(s)
- Malla K Keefe
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA; Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Corinna C Zygourakis
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Alexander A Theologis
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Emma Canepa
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Jeremy D Shaw
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Lauren H Goldman
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA; Department of Radiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Shane Burch
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Sigurd Berven
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Bobby Tay
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Praveen Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, 500 Parnassus Avenue, MU-320W, San Francisco, CA 94143, USA.
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Rm 779M, CA 94143, USA.
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Kobleder A, Mayer H, Senn B. ‘Feeling someone is there for you’ - experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. J Clin Nurs 2016; 26:456-465. [DOI: 10.1111/jocn.13434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Andrea Kobleder
- Institute for Applied Nursing Sciences IPW-FHS; University of Applied Sciences FHS St. Gallen; St. Gallen Switzerland
| | - Hanna Mayer
- Department of Nursing Science; University of Vienna; Vienna Austria
| | - Beate Senn
- Institute for Applied Nursing Sciences IPW-FHS; University of Applied Sciences FHS St. Gallen; St. Gallen Switzerland
- Research Affiliate Sydney Nursing School; University of Sydney; Sydney NSW Australia
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Perceived Health-Related Quality of Life in Women With Vulvar Neoplasia: A Cross Sectional Study. Int J Gynecol Cancer 2016; 26:1313-9. [DOI: 10.1097/igc.0000000000000770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThe aim of the study was to determine health-related quality of life (HRQoL) of women with surgically treated vulvar intraepithelial neoplasia (VIN) and vulvar cancer (VC) during the first week after hospital discharge. Further objectives were to investigate differences between women with VIN and VC as well as to examine whether correlations exist between women’s symptom experience and HRQoL.MethodsThis cross-sectional study was conducted in 8 hospitals in Germany and Switzerland. Women with VIN and VC rated HRQoL with the validated German Short-Form 36. Differences between HRQoL in women with VIN and VC were tested with Wilcoxon rank-sum score. The WOMen with vulvAr Neoplasia (WOMAN) - Patient reported Outcome (PRO) self-report instrument was used to measure women’s symptom experience. Correlations between symptoms and HRQoL were calculated using Spearman correlation coefficient.ResultsWomen with VIN and VC (n = 65) reported lower HRQoL in physical aspects (Physical Component Summary [PCS], 34.9) than that in mental aspects (Mental Component Summary, 40.5). Women with VC had lower HRQoL than women with VIN, as manifested by significant differences concerning the dimensions of “physical functioning” and “role-physical.” “Difficulties in daily life” as a distressing symptom correlated with MCS and PCS. Wound-related symptoms correlated with PCS and psychosocial symptoms/issues with MCS.ConclusionsAnalysis showed that women with vulvar neoplasia reported lower HRQoL in the physical and mental dimensions 1 week after discharge than comparable studies referring to months or years after surgery. Health-related quality of life is influenced by physical impairment because physical symptoms are prevalent 1 week after discharge. Patient education should focus on symptom management in an early postsurgical phase to enhance women’s HRQoL.
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Cowan RA, Black DR, Hoang LN, Park KJ, Soslow RA, Backes FJ, Gardner GJ, Abu-Rustum NR, Leitao MM, Eisenhauer EL, Chi DS. A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease. Gynecol Oncol 2016; 142:139-143. [PMID: 27112632 DOI: 10.1016/j.ygyno.2016.04.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this prospective pilot study was to assess the clinical and histologic effects of topical imiquimod therapy on recurrent extramammary Paget's disease of the vulva. METHODS Patients with biopsy-proven recurrent extramammary Paget's disease presenting to the gynecology outpatient services at two participating institutions were recruited for conservative treatment with 5% imiquimod cream from 2007 to 2011. The topical cream was to be applied 3 times per week for 12weeks. Punch biopsy and photography were performed at baseline and at the 12-week time point. RESULTS Eight patients from two institutions were enrolled. Complete clinical and histologic response was achieved in 6 (75%) patients by the 12-week follow-up appointment. Of the two remaining patients, one had a complete clinical response but no significant histologic response; the other patient was removed from the study protocol secondary to intolerable local irritation. Two patients continue to have no evidence of disease after a median follow-up of 35months. Five are alive with disease. No patients progressed to invasive cancer while receiving therapy. CONCLUSION Topical 5% imiquimod cream is a safe and feasible option for women suffering from recurrent extramammary Paget's disease of the vulva, and should be considered as a viable alternative to surgical management. Given the rare nature of this disease, additional multi-institutional prospective studies should be conducted to explore the efficacy of this treatment regime.
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Affiliation(s)
- Renee A Cowan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Destin R Black
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Lien N Hoang
- Gynecology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Kay J Park
- Gynecology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Robert A Soslow
- Gynecology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Floor J Backes
- Department of Gynecologic Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Medical Center, 460 West 10(th) Avenue, Columbus, OH 43210, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Eric L Eisenhauer
- Department of Gynecologic Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Medical Center, 460 West 10(th) Avenue, Columbus, OH 43210, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
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16
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Emerson J, Robison K. Evaluation of sentinel lymph nodes in vulvar, endometrial and cervical cancers. World J Obstet Gynecol 2016; 5:78-86. [DOI: 10.5317/wjog.v5.i1.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/15/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
Sentinel lymph node (SLN) biopsies are a sensitive tool in evaluating lymph nodes for multiple cancers, and in some diseases they decrease morbidity in both the short- and long-term. SLN detection in gynecologic malignancies has been studied extensively over the past decade. We review the current literature on SLN dissection in vulvar, endometrial and cervical cancers. Large, well-designed trials in each of the three types of cancer have demonstrated high sensitivity and low false-negative rates when SLN biopsy is performed in the correct patients and with an appropriate technical approach. In all of these cases the addition of ultra-staging to conventional pathology yields increased detection of micrometastatic disease. Biopsy of the sentinel nodes is feasible and safe in early vulvar malignancies, with multiple studies describing low recurrence rates in those women who have with negative SLNs. There does not appear to be a survival benefit to lymphadenectomy over SLN biopsy and quality of life is improved in women undergoing SLN biopsy. Optimal treatment strategies for women with positive nodal biopsies, particularly in cases with micrometastatic disease, remain unclear. Multiple large studies investigating the utility of SLN biopsy in endometrial malignancy have found that sentinel nodal status is a reliable predictor of metastases in women with low-risk disease. Prospective studies are ongoing and suggest sentinel nodal detection may soon become widely accepted as an alternative standard of care for select cases of endometrial cancer. In cervical cancer, SLN biopsy is accurate for diagnosing metastatic disease in early stage tumors (≤ 2 cm diameter or stage ≤ IB2) where the risk of metastasis is low. It is unknown if women who undergo SLN biopsy alone will have different survival outcomes than women who undergo complete lymphadenectomy in these cases. In a specific population of women with vulvar cancer, SLN dissection is an effective and safe alternative to complete dissection. It can be offered as an alternative management strategy in these women. In women who do undergo SLN biopsy, it is associated with improved quality of life. Promising evidence supporting the utility of SLN dissection in endometrial and cervical cancer continues to emerge, and it may soon become a reasonable option for select patients. However, continued research and refinement of appropriate patient selection and long-term follow-up are necessary.
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Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol 2016; 140:359-68. [PMID: 26556768 PMCID: PMC4835814 DOI: 10.1016/j.ygyno.2015.11.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. METHODS A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. RESULTS Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy-negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. CONCLUSION Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems.
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Affiliation(s)
- Laura B Huffman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ellen M Hartenbach
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Joanne K Rash
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - David M Kushner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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Jones GL, Jacques RM, Thompson J, Wood HJ, Hughes J, Ledger W, Alazzam M, Radley SC, Tidy JA. The impact of surgery for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of treatment: a longitudinal, mixed methods study. Psychooncology 2015; 25:656-62. [PMID: 26403828 PMCID: PMC5054883 DOI: 10.1002/pon.3992] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To measure the long-term impact of surgical treatment for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of therapy. METHODS Prospective, longitudinal, mixed-methods study. Twenty-three women aged >18 years with a new diagnosis of vulval cancer were recruited. The EORTC QLQ C30, SF-36 and an electronic pelvic floor assessment questionnaire (ePAQ-PF) were administered at baseline (pre-treatment) and 3, 6, 9 and 12 months post-treatment. Mixed effects repeated measures models (all adjusted for age and BMI) were used to investigate changes over time and differences between cancer stage. Qualitative interviews were carried out with 11 of the women and analysed using a thematic approach. RESULTS Mean age was 59.9 years (SD = 15.3; range = 23.8-86.6 yrs). Mean BMI was 30.0 (SD = 4.5; range = 24.4-38.2). Sixteen women had early (Stage 1 to 2B), and seven women had advanced stage disease (Stage 3 to 4B). Questionnaire scores revealed that physical and social functioning, fatigue, pain and general sex life were significantly worse at 12 months than pre-treatment (p = < 0.05). Qualitative analysis revealed multiple treatment side effects which were perceived as severe and enduring. Women with advanced vulval cancer had significantly worse SF-36 mental health scores at 12 months compared to women with early stage disease (p = 0.037). CONCLUSIONS Surgery for vulval cancer has long-term implications which can be persistent 12 months post-treatment. High rates of morbidity relating to lymphoedema and sexual function re-enforce the need for specialist clinics to support women who suffer these complications. © 2015 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.
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Affiliation(s)
- Georgina L Jones
- University of Sheffield, Section of Health Economics and Decision Science, ScHARR, Sheffield, UK
| | - Richard M Jacques
- Design, Trials and Statistics, University of Sheffield, ScHARR, Sheffield, UK
| | - Joanne Thompson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Hilary J Wood
- University of Sheffield, Section of Health Economics and Decision Science, ScHARR, Sheffield, UK
| | - Jane Hughes
- University of Sheffield, Section of Health Economics and Decision Science, ScHARR, Sheffield, UK
| | | | | | - Stephen C Radley
- Sheffield Teaching Hospital NHS Foundation Trust, Royal Hallamshire Hospital, Department of Obstetrics and Gynaecology, Sheffield, UK
| | - John A Tidy
- Sheffield Teaching Hospital NHS Foundation Trust, Royal Hallamshire Hospital, Department of Gynaecological Oncology, Sheffield, UK
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Slomovitz BM, Coleman RL, Oonk MH, van der Zee A, Levenback C. Update on sentinel lymph node biopsy for early-stage vulvar cancer. Gynecol Oncol 2015; 138:472-7. [DOI: 10.1016/j.ygyno.2015.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
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Stabile C, Gunn A, Sonoda Y, Carter J. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer. Transl Androl Urol 2015; 4:169-85. [PMID: 26816823 PMCID: PMC4708131 DOI: 10.3978/j.issn.2223-4683.2015.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention.
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