Treatment for Gynecologic Cancer: A Review of the Effects on Female Sexuality

Targeted therapy of cancer stem cells: inhibition of mTOR in pre-clinical and clinical research

Cancer stem cells (CSCs) are a type of stem cell that possesses not only the intrinsic abilities of stem cells but also the properties of cancer cells. Therefore, CSCs are known to have self-renewal and outstanding proliferation capacity, along with the potential to differentiate into specific types of tumor cells. Cancers typically originate from CSCs, making them a significant target for tumor treatment. Among the related cascades of the CSCs, mammalian target of rapamycin (mTOR) pathway is regarded as one of the most important signaling pathways because of its association with significant upstream signaling: phosphatidylinositol 3‑kinase/protein kinase B (PI3K/AKT) pathway and mitogen‑activated protein kinase (MAPK) cascade, which influence various activities of stem cells, including CSCs. Recent studies have shown that the mTOR pathway not only affects generation of CSCs but also the maintenance of their pluripotency. Furthermore, the maintenance of pluripotency or differentiation into specific types of cancer cells depends on the regulation of the mTOR signal in CSCs. Consequently, the clinical potential and importance of mTOR in effective cancer therapy are increasing. In this review, we demonstrate the association between the mTOR pathway and cancer, including CSCs. Additionally, we discuss a new concept for anti-cancer drug development aimed at overcoming existing drawbacks, such as drug resistance, by targeting CSCs through mTOR inhibition.

Characteristics of Patients Presenting to a Psycho-Oncology Outpatient Clinic

OBJECTIVE

We aimed to determine the overall profile of patients in a psycho-oncology clinic and the differences in their characteristics according to the cancer site.

METHODS

The charts of 740 patients aged under 81 years were reviewed. The data from 586 completed questionnaires were subjected to multiple comparison analyses using one-way analysis of variance to examine the demographic and clinical differences according to the cancer site.

RESULTS

Most (n=532, 71.9%) patients were referred. Most new patients (n=426, 96.6%) received a psychiatric diagnosis; the most common diagnosis was depressive disorder (n=234, 31.6%). Likewise, depressive disorder accounted for the majority of diagnoses in all groups except for the digestive system cancer group in which sleep-wake disorder was the most prevalent. The female genital cancer group showed a higher level of anxiety symptoms than other groups, except for breast and haematolymphoid cancer groups, and psychological distress than all other groups.

CONCLUSION

There appear to be delays in the referral of cancer patients seeking psychiatric help to a psycho-oncology clinic. Along with tailoring approaches by cancer site, thorough evaluation and appropriate management of sleep-wake and anxiety symptoms are important for digestive system and female genital cancer patients, respectively.

Sexuality post gynaecological cancer treatment: a qualitative study with South African women

OBJECTIVES

This study investigated women's experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment.

DESIGN

The study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis.

SETTING

Data collection took place at a follow-up clinic within the gynaeoncology unit at a public-sector tertiary hospital in Cape Town, South Africa.

PARTICIPANTS

Purposive sampling was used to recruit participants, and the final sample consisted of 34 women aged 29-70 ([Formula: see text]=52). All women had received a gynaecological cancer diagnosis and had been treated with either surgery, chemotherapy, radiation or a combination of these. On average, the participants were between 12 and 30 months post treatment.

RESULTS

Women expressed how their sexual functioning post treatment was both nuanced and complex, how heteronormative gender expectations influenced their intimate relationships, and how they experienced a re-embodiment of their sexual subjectivity post treatment. Participants felt that more sexual functioning information from healthcare providers, as well as peer support groups, would assist them in navigating the sexuality changes they experienced.

CONCLUSIONS

The findings of this study broaden conceptualisations of sexuality post treatment by detailing the ways that it is complex, nuanced, relational and ever shifting. More research is needed about how to incorporate holistic psychosexual support post treatment into the public healthcare system in South Africa.

Anticipatory Nausea and Vomiting Among Ovarian, Lymphoma, and Breast Cancer Patients Receiving Chemotherapy: Implications for Behavioural Treatment

Cancer patients undergoing chemotherapy frequently experience anticipatory distress before treatment sessions. Eighty-six cancer patients (ovarian, lymphoma and breast) were assessed to determine the prevalence of anticipatory nausea and vomiting (ANV). Approximately one patient in three reported anticipatory nausea (AN), and of these 6 also experienced anticipatory vomiting (AV). Several patients reported anticipatory anxiety without any sensation of nausea. Clinically the notion of anticipatory distress may be more fruitful so that the problem of pretreatment anxiety is also addressed. Generally, AN was rated as moderate or worse in severity, occurred fairly consistently, and often began well before arrival at hospital on treatment day. It is suggested that future research should endeavour to link more closely the topography of the problem and the intervention techniques employed, as well as evaluating a broader range of possible interventions.

Psychological functioning and quality of life in lung transplant candidates and recipients

OBJECTIVE

The purpose of this study was to examine the psychological functioning and quality of life (QOL) of lung transplant candidates and recipients.

METHODS

The following measures were completed by 36 lung transplant candidates (the pretransplant group [PRE]) and 73 recipients (the posttransplant group [POST]): the Rand-36 Item Health Survey 1.0 (RAND-36), visual analog scale of overall QOL (OQOL), Brief Symptoms Inventory (BSI), Derogatis Sexual Functioning Inventory (DSFI), Hospital Anxiety and Depression Scale (HAD), Rosenberg Self-Esteem Scale (RSES), and Body Cathexis Scale (BC).

RESULTS

Compared to the PRE, POST patients had significantly better scores on the following measures: RAND-36 total, physical health, role limitations due to physical health, general health, vitality, and social functioning subscales (all p < 0.0001); visual analog scale of OQOL (p < 0.0001); BSI (p < 0.05); BC (p < 0.05); HAD anxiety (p < 0.05) and depression (p < 0.0001); and RSES (p < 0.05). Despite better scores, some areas did not differ between the PRE and the POST, and many patients continued to experience impairments in psychological functioning. Specifically, the RAND-36 emotional health and role limitations due to emotional health subscale scores did not differ between the PRE and the POST and they remained lower than published norms. A significant proportion of patients in both groups (44% of PRE patients and 28% of POST patients) had borderline or clinical levels of anxiety (ie, the HAD). Finally, PRE and POST mean scores were significantly lower than published norms on the RSES (p < 0.05) and the body image scale of the DSFI (p < 0.05).

CONCLUSIONS

Although lung transplant recipients have better general, physical, and psychological health than their pretransplant counterparts, the present research suggests that both groups experience impairment in several areas of psychological functioning. Future research into the QOL of the lung transplant population should be aimed at recognizing, intervening, and improving patients' psychological and emotional well-being.

Quality of life in female lung transplant candidates and recipients

OBJECTIVE

Quality of life (QOL) studies of lung transplant recipients indicate that there are improvements following transplantation. More recently, there has been some suggestion that certain QOL issues are different for men and women. The purpose of the present study was to examine changes in QOL, body satisfaction, and sexual functioning in women lung transplant recipients.

STUDY POPULATION

Seven prelung transplant (PRE) and 34 postlung transplant (POST) women.

MAIN OUTCOME MEASURES

The RAND-36 Health Survey, Body Cathexis Scale, Derogatis Sexual Functioning Inventory, Hospital Depression and Anxiety Scale, Rosenberg Self-Esteem Scale, and an open-ended questionnaire.

RESULTS

Higher scores were found in the POST group with respect to general health and role limitations due to physical health. We were unable to detect significant differences between the groups with respect to emotional well-being, role limitations due to emotional health, and social functioning. There were significant differences between the PRE and the POST body satisfaction scores. Although there was no significant difference in overall sexual functioning, recipients in the PRE group reported higher sex drive. Eleven of the POST recipients (52%) scored below the 10th percentile in overall sexual functioning.

CONCLUSIONS

Overall QOL improves following lung transplantation; however, the lack of differences in many domains of QOL raises the concern that women lung transplant recipients may continue to have significant impairments, including those regarding sexuality and body satisfaction.

Psychological aspects of genital human papillomavirus infection: a preliminary report

Genital human papillomavirus (HPV) infection can lead to self-inflicted blame and hypochondriac fears as well as to problems with sexuality. The aim of this study was to assess the psychological and psychodynamic aspects of patients with widespread genital HPV infection entering into a clinical trial in which they were randomly assigned to three treatment groups: CO2 laser ablation, intramuscular interferon-alpha, CO2 laser ablation plus intramuscular interferon-alpha. Fifty-one patients were studied. Patients were asked to take a series of questionnaires which included a self-rating questionnaire for gathering information on sexuality, emotional relationship with the partner and social life. A visual analog scale was used to rate intensity of pain during sexual intercourse. Each patient went also through an in-depth interview with a clinical psychologist and filled out two personality tests to measure depression (CDQ = IPAT depression test) and anxiety (ASQ = IPAT anxiety test). Results indicated a high percentage of sexual impairments after therapy (28 cases), presence of fear of cancer (14 cases) and worsenings in the emotional relationship with the partner. No difference was found among groups of treatment.

Medical and psychosocial predictors of sexual outcome among women with systemic lupus erythematosus

The influence of medical and psychosocial variables on sexual outcome in 100 women with systemic lupus erythematosus was examined. Subjects were administered a sexual adjustment interview and scales assessing depression, body image, and relationship quality. Medical data were obtained from patients and physicians. Key predictors of sexual outcome were disease severity (P < 0.001), premorbid sexual adjustment (P < 0.05), and relationship quality (P < 0.05). Results suggest that the impact of systemic lupus erythematosus on sexual response may best be understood by considering a combination of interpersonal, psychological, and medical conditions in a patient's life.

Psychosocial adjustment following major gynaecological surgery for carcinoma of the cervix and vulva

One-hundred and five women had undergone major gynaecological surgery for carcinoma of the cervix and vulva were interviewed retrospectively to elicit post-operative psychosocial and psychosexual problems. This interview took place between 6 months and 5 yr after surgery. Responses to the Hospital Anxiety and Depression Scale indicated that 20% of the women were 'probable' cases of anxiety and 21% were 'definite' cases. On the depression scale, 18% were 'doubtful' cases and 14% were 'definite' cases. Scores on the scales were not associated with age of the woman, the type of operation or the time period between being interviewed and the operation. Two-thirds of the women who were sexually active prior to the operation indicated ongoing sexual problems when interviewed and the presence of these problems was found to be significantly associated with the woman's level of anxiety.

The care of patients undergoing surgery for gynaecological cancer: the need for information, emotional support and counselling

This study was undertaken by interviewing 105 patients who had undergone major gynaecological surgery for carcinoma of the cervix or vulva in the previous 5 years. A high proportion of the women was still found to be depressed and anxious when interviewed and the majority reported chronic sexual problems. The women were asked if they had received enough information regarding their illness and its treatment, and a high proportion would have liked to have had more information on the after-effects of the operation, including physical, sexual and emotional aspects. Many of the younger women would have liked their partner to have been included in the discussions and 25% of the 40 partners who responded to the questionnaire would have liked more information on the illness and its treatment. The women also indicated their needs for emotional support, discussion and counselling.

Coping with palliative chemotherapy

Comparatively little is known about how patients with advanced cancer cope with palliative chemotherapy. This study uses grounded theory to analyse the coping responses of 24 women with advanced breast or ovarian cancer. Half the sample received chemotherapy at home, and the remainder were treated in hospital. The results suggest that four predominant coping styles are used; think positive/fighter (n = 8), acceptance (n = 8), fearfulness (n = 5) and hopelessness (n = 3). In addition, a range of coping strategies that reduced the threat of chemotherapy are identified. The findings have implications for the provision of quality patient care in palliative therapy, especially in relation to individualizing patient education.

Rehabilitation of the cancer patient

Cancer patients often require extensive rehabilitation after treatment. Organization of a rehabilitation team and determination of its goals are a primary aim of such programs. Studies of job security and insurability demonstrate significant problems and biases toward the cancer patient. Discussion has been made of specific male and female sexual rehabilitation programs as well as programs directed at other physical disabilities secondary to head and neck or amputation surgery. Attention is drawn toward familiarizing the surgeon with these problems in order to enhance his treatment of the cancer patient.

Psychosomatic Aspects of Gynecologic Oncology: Present Status and Future Directions

Among women genital malignancies are second in frequency only to breast cancer. Primary disease sites include the endometrium, cervix, ovary, and vulva. With early diagnosis and aggressive therapy, two-thirds of these women will survive for at least 5 years. This encouraging prognosis is in contrast to the distress that may be experienced by women during diagnosis, treatment, and recovery periods. A brief review of major avenues of current research and clinical work is provided, including; psychological responses to gynecologic cancer symptomatology; affective distress; sexual problems; and treatment-related distress. Areas for future investigation are highlighted, including difficulties occurring with disease recurrence; disruption of close relationships; and problems of the elderly woman with cancer.

Sexual dysfunction and signs of gynecologic cancer

Forty-one women recently diagnosed with early-stage cervical or endometrial cancer and a matched group of healthy women in no gynecologic distress, participated in a detailed assessment of their sexual functioning. Data included the range and frequency of sexual behavior, level of sexual responsiveness, and the presence of sexual dysfunction. Multivariate analyses of variance indicated that prior to the onset of cancer signs/symptoms the gynecologic cancer patients reported similar patterns of sexual activity and responsiveness as the healthy sample. With the appearance of disease signs, however, the gynecologic cancer patients reported experiencing significant sexual dysfunction symptoms. While sexual morbidity is typically conceptualized as occurring after the diagnosis and treatment of cancer, these data indicate that such changes are a major source of variation in describing the prediagnosis sexual status of the gynecologic cancer patient.

Anxiety and cancer treatment: response to stressful radiotherapy

Previous research with individuals undergoing surgery or diagnostic procedures provided a conceptual framework for analysis of radiation therapy, a common form of cancer treatment. The present investigation was designed to document the magnitude of anxiety patients experience in response to one particularly stressful form of radiation treatment. In addition, the change in anxiety responses with repeated exposures and individual differences among patients that may affect their adjustment were explored. In Part 1, gynecologic cancer patients receiving their first internal radiotherapy application were studied. As the time for treatment neared, subjective and physiologic indicants of anxiety and distress among the patients significantly increased. By 24 hours post-treatment, anxiety for all patients remained elevated. These post-treatment data are convergent with other investigations of post-treatment distress among cancer patients, but contrast with data obtained from those receiving treatment for benign conditions. A subset of the women who required two applications of radiotherapy participated in Part 2. These patients continued to respond negatively during the second treatment. Data on individual differences in anxiety responses (i.e., low vs. high anxiety) were obtained in both investigations and suggest that those with low levels of pre-treatment anxiety experience considerable disruption post-treatment.

Sexual functioning among breast cancer, gynecologic cancer, and healthy women

An investigation was conducted to determine the specific type of sexual functioning deficits and the relationship between global sexual satisfaction and adjustment in two related life areas, the marital relationship and a woman’s body image, for two groups of cancer patients at high risk for sexual difficulties. Analyses revealed that the aspects of sexual functioning for matched samples of breast cancer patients and gynecologic cancer patients that differed from those of healthy women were the frequency of sexual behaviors and the level of sexual arousal. Whereas women’s evaluations of their current sexual life had no relationship to their marital adjustment ratings, analyses suggested that body image disruption may be a prevalent problem for gynecologic cancer patients.

The role of sexual rehabilitation in the treatment of patients with cancer

The goal of sexual rehabilitation is to restore the patient's ability to engage in intimate interpersonal relationships. It incorporates the restoration of both self-esteem and bodily function. When appropriate and desired, sexual rehabilitation includes restoring the physical ability to engage in sexual activity. Rehabilitation begins at diagnosis and continues throughout therapy. It addresses the specific desires of each patient and incorporates the contributions of every member of a health care team. An adaptation of Annon's PLISSIT model is appropriate to this multidisciplinary, holistic approach. All patients need permission (P) and limited information (LI); frequently, dispelling myths and eliminating ignorance about therapy are enough to enable patients to resume sexual intimacy. Specific suggestions (SS) help patients whose irradiation, hormone therapy, or radical surgery have resulted in physiologic or anatomic alteration to the genitals or the mechanisms of sexual response. Highly skilled professionals provide intensive therapy (IT), which may include surgical reconstruction, implantation of prosthetic devices, or intensive marital and sexual counseling.

Anxiety and cancer treatment: response to stressful radiotherapy

Previous research with individuals undergoing surgery or diagnostic procedures provided a conceptual framework for analysis of radiation therapy, a common form of cancer treatment. The present investigation was designed to document the magnitude of anxiety patients experience in response to one particularly stressful form of radiation treatment. In addition, the change in anxiety responses with repeated exposures and individual differences among patients that may affect their adjustment were explored. In Part 1, gynecologic cancer patients receiving their first internal radiotherapy application were studied. As the time for treatment neared, subjective and physiologic indicants of anxiety and distress among the patients significantly increased. By 24 hours post-treatment, anxiety for all patients remained elevated. These post-treatment data are convergent with other investigations of post-treatment distress among cancer patients, but contrast with data obtained from those receiving treatment for benign conditions. A subset of the women who required two applications of radiotherapy participated in Part 2. These patients continued to respond negatively during the second treatment. Data on individual differences in anxiety responses (i.e., low vs. high anxiety) were obtained in both investigations and suggest that those with low levels of pre-treatment anxiety experience considerable disruption post-treatment.

Primary orgasmic dysfunction: diagnostic considerations and review of treatment

As a diagnostic category, primary orgasmic dysfunction includes all women who have never experienced orgasm under any circumstances except sleep or fantasy. However, the research samples of nonorgasmic women in clinical reports and empirical investigations are heterogeneous with regard to disruption of earlier phases of the sexual response cycle and emotional concomitants of the dysfunction. The major treatment models—systematic desensitization, sensate focus, directed masturbation, and hypnosis—are presented, and empirical support is reviewed. Separate discussion is included for investigations comparing treatment modalities. Finally, a strategy for future programmatic sex therapy research is suggested within the broader context of psychotherapy outcome research.

The effect of several intertrial intervals on the 1 Hz interference effect

Gynecologic cancers cause over 600,000 deaths annually in women worldwide. The development of chemoresistance after initial rounds of chemotherapy contributes to tumor relapse and death due to gynecologic malignancies. In this regard, cancer stem cells (CSCs), a subpopulation of stem cells with the ability to undergo self-renewal and clonal evolution, play a key role in tumor progression and drug resistance. Aldehyde dehydrogenases (ALDH) are a group of enzymes shown to be robust CSC markers in gynecologic and other malignancies. These enzymes also play functional roles in CSCs, including detoxification of aldehydes, scavenging of reactive oxygen species (ROS), and retinoic acid (RA) signaling, making ALDH an attractive therapeutic target in various clinical scenarios. In this review, we discuss the critical roles of the ALDH in driving stemness in different gynecologic malignancies. We review inhibitors of ALDH, both general and isoform-specific, which have been used to target CSCs in gynecologic cancers. Many of these inhibitors have been shown to be effective in preclinical models of gynecologic malignancies, supporting further development in the clinic. Furthermore, ALDH inhibitors, including 673A and CM037, synergize with chemotherapy to reduce tumor growth. Thus, ALDH-targeted therapies hold promise for improving patient outcomes in gynecologic malignancies.