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Falk SJ, Bober S. Cancer and Female Sexual Function. Obstet Gynecol Clin North Am 2024; 51:365-380. [PMID: 38777489 DOI: 10.1016/j.ogc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Sexual health is a concern that often goes unaddressed among female cancer survivors. Management of these issues depends upon the type of malignancy, stage and other tumor characteristics, treatment, and the history, concerns, and goals of the individual patient.
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Affiliation(s)
- Sandy J Falk
- Sexual Health Program, Adult Survivorship Program, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - Sharon Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, SW320, Boston, MA 02215, USA
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Cyr MP, Camden C, Dumoulin C, Dostie R, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. Gynecological Cancer Survivors' Experiences of Dyspareunia and Factors Influencing Care-Seeking Behavior: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2669-2681. [PMID: 37058221 DOI: 10.1007/s10508-023-02589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Pain during sexual intercourse, also called dyspareunia, affects most women after treatment for gynecological cancer. Previous work adopted a biomedical approach to depict dyspareunia in this population, which provided a narrow perspective of this condition. Taking into account women's experiences of dyspareunia and the factors influencing their care-seeking behaviors would provide insight to improve care in the context of gynecological cancer. The aim of this study was to describe gynecological cancer survivors' experiences of dyspareunia and factors influencing care-seeking behavior. A qualitative study was performed with 28 gynecological cancer survivors with dyspareunia. Individual telephone interviews were conducted based on the Common-Sense Model of Self-Regulation. Interviews were recorded and transcribed for analysis using the interpretative description framework. Concerning their experience, participants reported the oncological treatments as the primary cause of dyspareunia. Loss of libido, lower vaginal lubrication, and smaller vaginal cavity were described as being linked with dyspareunia. Women explained how dyspareunia and these changes had led them to engage less in, and even interrupt, sexual activity. They expressed that they were distressed, felt less of a woman, and experienced low control and/or self-efficacy. Regarding the factors influencing women's care-seeking behaviors, participants emphasized that they were provided with insufficient information and support. Balancing priorities, denial or reluctance, misbeliefs, resignation and acceptance, and negative emotions were reported as barriers, whereas acknowledgement of sexual dysfunction, desire for improvement, awareness of treatment possibilities, willingness to undertake treatment and treatment acceptability were reported as facilitators to seeking care. Findings suggest that dyspareunia is a complex and impactful condition after gynecological cancer. While this study highlights the importance of alleviating the burden of sexual dysfunction in cancer survivors, it identified factors that should be considered in the provision of services to improve care.
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Affiliation(s)
- Marie-Pierre Cyr
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12E Avenue N, Sherbrooke, QC, J1H 5N4, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Chantal Camden
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12E Avenue N, Sherbrooke, QC, J1H 5N4, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
| | - Rosalie Dostie
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12E Avenue N, Sherbrooke, QC, J1H 5N4, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Paul Bessette
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Annick Pina
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Walter Henry Gotlieb
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Korine Lapointe-Milot
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Hélène Mayrand
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001, 12E Avenue N, Sherbrooke, QC, J1H 5N4, Canada.
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
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Turhal E, Koç Z. Sexual Function and Quality of Life Among Turkish Oncology Patients Receiving Chemotherapy. Semin Oncol Nurs 2023; 39:151401. [PMID: 36898936 DOI: 10.1016/j.soncn.2023.151401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/12/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Sexual health and sexual function in oncology patients are inseparable elements of general quality of life and important indicators of emotional well-being. The aim of this study was to determine the relationship between the quality of life and sexual function of oncology patients receiving chemotherapy. DATA SOURCES This cross-sectional and correlational study was conducted within the chemotherapy unit of a university hospital between June 25, 2017, and June 21, 2018. A total of 410 oncology outpatients participated in this study. Data were collected using the FACT-G Quality of Life Evaluation Scale, the Arizona Sexual Experiences Scale, and the Edmonton Symptom Assessment Scale. CONCLUSION A negative and weak statistically significant relationship between the Arizona Sexual Experiences Scale total score and the FACT-G Quality of Life Evaluation Scale total score was found (r = -0.224, P < .01). The regression model where the FACT-G Quality of Life Evaluation Scale total scores (F = 3.263; P < .001) and Arizona Sexual Experiences Scale total scores (F = 8.937; P < .001) of the patients were taken as dependent variables and their sociodemographic and clinical characteristics were taken as independent variables was found to be statistically significant. IMPLICATION FOR NURSING PRACTICE Psychosocial and medical evaluation should be performed when a concern or problem regarding the sexual life of an oncology patient is detected. The sexual quality of life of oncology patients should be improved through sexual counseling and education. Patients and their families should be encouraged to participate in family support programs.
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Affiliation(s)
- Ebru Turhal
- Lecturer, Medical Simulation Center, Karadeniz Teknik University, Trabzon, Turkey
| | - Zeliha Koç
- Professor, Health Science Faculty, Ondokuz Mayıs University, Samsun, Turkey.
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Sears C, Santos-Iglesias P, Millman R, Jacox N, Wiebe E, Walker LM. Implementation of individually tailored treatment plans in a group-based intervention for women with mixed vulvo-vaginal and sexual health concerns following cancer treatment: A feasibility study. Eur J Oncol Nurs 2022; 63:102236. [PMID: 36827834 DOI: 10.1016/j.ejon.2022.102236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE This study evaluated a professionally-led, group-based vulvo-vaginal and sexual health (VSH) workshop for women diagnosed with cancer. The study goals were to: (1) implement and assess a novel group intervention for diverse VSH concerns; (2) explore post-workshop changes in symptom bother, motivation to use VSH treatments, and frequency of VSH treatment use; (3) examine post-workshop changes in sexual well-being. METHODS A group-based educational workshop to address a variety of VSH concerns was developed and implemented. During the workshop, participants created an individualized treatment plan by selecting from various VSH treatment options presented. Treatment plan follow-ups were administered online at one-, two-, and three-months post-workshop. At baseline and three-month follow-up, participants completed online questionnaires to assess self-reported vulvo-vaginal symptoms, sexual function, sexual distress, and use of VSH strategies. RESULTS 195 participants (age 20-81) attended workshops over a 2.5-year period. Individualized treatment plans were effectively completed by most participants (92%). Preliminary results show decreases in bother severity associated with VSH concerns post-workshop, stabilizing after 2 months. At three-month follow-up, participants reported increased use of VSH treatment strategies. Sexual satisfaction, sexual distress, and emotional impact of vulvovaginal symptoms also improved. CONCLUSIONS Workshop attendance was associated with increased uptake of VSH treatment strategies and improvements in several parameters of sexual well-being. Findings indicate that individualized treatment plans can be implemented effectively in a group setting and that a one-time, group-based educational workshop can meaningfully impact VSH-related behavior change, reduce vulvo-vaginal symptom bother and promote sexual well-being in patients with diverse VSH concerns.
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Affiliation(s)
- Carly Sears
- Department of Oncology, University of Calgary, 1331 - 29th St., NW, Calgary, AB, Canada
| | - Pablo Santos-Iglesias
- Department of Psychology, Cape Breton University, 1250 Grand Lake Rd, Sydney, NS, Canada
| | - Roanne Millman
- Department of Oncology, University of Calgary, 1331 - 29th St., NW, Calgary, AB, Canada; West Coast Centre for Sex Therapy, 2695 Granville St., # 302, Vancouver, BC, Canada
| | - Natalie Jacox
- Department of Oncology, University of Calgary, 1331 - 29th St., NW, Calgary, AB, Canada
| | - Ericka Wiebe
- Department of Oncology, University of Alberta, 11560 University Ave., Edmonton, AB, Canada
| | - Lauren M Walker
- Department of Oncology, University of Calgary, 1331 - 29th St., NW, Calgary, AB, Canada; Arnie Charbonneau Cancer Research Institute, University of Calgary, 3280 Hospital Dr., NW., Calgary, AB, Canada.
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Changes in pelvic floor morphometry and muscle function after multimodal physiotherapy for gynaecological cancer survivors suffering from dyspareunia: a prospective interventional study. Physiotherapy 2022; 114:54-62. [DOI: 10.1016/j.physio.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 08/19/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022]
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Cyr MP, Dostie R, Camden C, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors suffering from pain during sexual intercourse: Results from a one-year follow-up mixed-method study. PLoS One 2022; 17:e0262844. [PMID: 35077479 PMCID: PMC8789131 DOI: 10.1371/journal.pone.0262844] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A large proportion of gynecological cancer survivors suffer from pain during sexual intercourse, also known as dyspareunia. Following a multimodal pelvic floor physical therapy (PFPT) treatment, a reduction in pain and improvement in psychosexual outcomes were found in the short term, but no study thus far has examined whether these changes are sustained over time. PURPOSE To examine the improvements in pain, sexual functioning, sexual distress, body image concerns, pain anxiety, pain catastrophizing, painful intercourse self-efficacy, depressive symptoms and pelvic floor disorder symptoms in gynecological cancer survivors with dyspareunia after PFPT, and to explore women's perceptions of treatment effects at one-year follow-up. METHODS This mixed-method study included 31 gynecological cancer survivors affected by dyspareunia. The women completed a 12-week PFPT treatment comprising education, manual therapy and pelvic floor muscle exercises. Quantitative data were collected using validated questionnaires at baseline, post-treatment and one-year follow-up. As for qualitative data, semi-structured interviews were conducted at one-year follow-up to better understand women's perception and experience of treatment effects. RESULTS Significant improvements were found from baseline to one-year follow-up on all quantitative outcomes (P ≤ 0.028). Moreover, no changes were found from post-treatment to one-year follow-up, supporting that the improvements were sustained at follow-up. Qualitative data highlighted that reduction in pain, improvement in sexual functioning and reduction in urinary symptoms were the most meaningful effects perceived by participants. Women expressed that these effects resulted from positive biological, psychological and social changes attributable to multimodal PFPT. Adherence was also perceived to influence treatment outcomes. CONCLUSIONS Findings suggest that the short-term improvements following multimodal PFPT are sustained and meaningful for gynecological cancer survivors with dyspareunia one year after treatment.
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Affiliation(s)
- Marie-Pierre Cyr
- Faculty of Medicine and Health Sciences, School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Rosalie Dostie
- Faculty of Medicine and Health Sciences, School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Chantal Camden
- Faculty of Medicine and Health Sciences, School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Chantale Dumoulin
- Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Paul Bessette
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Medicine and Health Sciences, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annick Pina
- Faculty of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Walter Henry Gotlieb
- Faculty of Medicine, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Korine Lapointe-Milot
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Faculty of Medicine and Health Sciences, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Hélène Mayrand
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Departments of Obstetrics and Gynecology and Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mélanie Morin
- Faculty of Medicine and Health Sciences, School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Vargas Maldonado D, Madsen AM. Vaginal symptoms in women who are affected by gynecologic cancer. Curr Opin Obstet Gynecol 2021; 33:474-482. [PMID: 34494971 DOI: 10.1097/gco.0000000000000743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Pelvic floor disorders are common among gynecologic cancer survivors. With improvements in survivorship, quality of life conditions in these women need greater attention and care. This review focuses specifically on vulvovaginal symptoms, which are common and have a negative impact on sexual health and quality of life in women affected by gynecologic cancer. RECENT FINDINGS We review publications on treatment-specific sexual health outcomes, screening and treatment of vulvovaginal symptoms and sexual pain, and surgical management options. Recent evidence regarding the safety of concomitant prolapse repair at the time of surgery for gynecologic malignancies and CO2 laser therapy is discussed and areas needing further research and innovation are highlighted. SUMMARY Pelvic floor disorders, including vaginal and sexual health concerns, are common in women affected by gynecologic cancer due to both common risk factors and as a side effects of cancer treatment. Gynecologists play a critical role in screening, treatment, and collaboration with other specialists to provide comprehensive care for these women throughout their lifetime.
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Affiliation(s)
- Darlene Vargas Maldonado
- Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Sexual dysfunction is extremely common in cancer survivors. Cancer survivors are living longer, and survivorship issues like sexual functioning are now a part of routine cancer care. Oncology providers need to be as comfortable assessing and addressing these issues as they would any other aspect relating to cancer care. Providers should know how to perform an evaluation for sexual dysfunction, understand basic treatment options, and have appropriate referrals available to ensure that the patient's needs are met. This review provides an overview of sexual dysfunction pertaining to women who are survivors of cancer and articulates areas needing further research.
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Affiliation(s)
- Mindy Goldman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 2356 Sutter Street, San Francisco, CA 94143, USA.
| | - Mary Kathryn Abel
- University of California, San Francisco School of Medicine, 2356 Sutter Street, San Francisco, CA 94143, USA
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Dandamrongrak P, Chaiwong S, Ekalaktam P, Achariyapota V. Sexual dysfunction in Thai gynecologic malignancies survivors: A single-institutional cross-sectional observational survey. J Obstet Gynaecol Res 2021; 47:4005-4013. [PMID: 34376017 DOI: 10.1111/jog.14980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the prevalence of female sexual dysfunction (FSD) in gynecologic cancer survivors. METHODS A cross-sectional observation survey recruited women aged 18-65 years old who were diagnosed with gynecologic cancers and underwent surgery, radiation, chemotherapy, or combined modalities. Data were collected from September 2019 to March 2020 by the Thai version of the female sexual function index questionnaire to define FSD. The survey contained six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. RESULTS Of the 98 women included in the study, the mean age was 48.7 ± 10.6 years old. Two-third (67.3%) of the participants was premenopausal, had been diagnosed with ovarian cancer, and had early-stage gynecologic cancers. Fifty-eight of 98 (59.2%) participants were sexually active in the past 4 weeks before the survey. Among those, 89.6% had FSD. The median scores in the FSD group were significantly lower than those in the non-FSD group in all six domains, namely, desire, arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05). There was no statistically significant difference observed between participants with and without FSD in terms of age group, cancer-related data, or sexual behavior data, except participants who had good/excellent relationships with their partners, which impacted FSD (p = 0.01). CONCLUSIONS This study discovered the high prevalence (89.6%) of hidden issue of "female sexual dysfunction" in Thai gynecologic cancer survivors. The good/excellent relationships with their partners affected the FSD who were sexually active in the past 4 weeks before the survey.
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Affiliation(s)
- Poonsuk Dandamrongrak
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirintip Chaiwong
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakwaran Ekalaktam
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vuthinun Achariyapota
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Michael S, Skaczkowski G, Wilson C. Sexual satisfaction and sexual distress after cancer: The role of body image disruption, self-compassion, sexual pain and relationship satisfaction. Psychooncology 2021; 30:1902-1909. [PMID: 34157169 DOI: 10.1002/pon.5755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/23/2021] [Accepted: 06/17/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify variables that correlate with sexual satisfaction and sexual distress among adult cancer survivors, and how these differ, providing a basis from which approaches to intervention may be identified. This study examined four key variables: body image disruption, self-compassion, relationship satisfaction and sexual pain, previously all linked to sexual quality of life. METHODS A cross-sectional survey was conducted online, with participants (n = 113) recruited via cancer charities, support groups and sexual counsellors' networks. A multivariate multiple regression analysis was conducted to analyse relationships among variables. RESULTS In a regression adjusted for age, sex and time since diagnosis, higher sexual distress was significantly associated with higher body image disruption (β = 0.23; p = 0.024), lower self-compassion (β = -0.29; p = 0.009) and higher sexual pain (β = 0.39; p < 0.001); but not relationship satisfaction (β = -0.08; p = 0.434). Higher sexual satisfaction was significantly associated with higher relationship satisfaction (β = 0.35; p = 0.002) and lower sexual pain (β = -0.29; p = 0.005), but not body image disruption (β = -0.19; p = 0.089), or self-compassion (β = 0.06; p = 0.614). Sexual pain had a significantly stronger association with sexual distress than sexual satisfaction; F (1, 84) = 18.29, p < 0.001. CONCLUSIONS Sexual distress and sexual satisfaction are associated with different psycho-social correlates even though both are used as indicators of sexual health. Research should seek to further understand the differences in these two critical markers of sexual health, with these differences likely to highlight the need to match interventions to the nature of the sexual difficulties experienced following cancer treatment.
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Affiliation(s)
- Sarah Michael
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gemma Skaczkowski
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Australia.,Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Carlene Wilson
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Austin Hospital, Melbourne, Australia
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Åkeflo L, Elmerstig E, Dunberger G, Skokic V, Arnell A, Bergmark K. Sexual health and wellbeing after pelvic radiotherapy among women with and without a reported history of sexual abuse: important issues in cancer survivorship care. Support Care Cancer 2021; 29:6851-6861. [PMID: 34003379 PMCID: PMC8464554 DOI: 10.1007/s00520-021-06263-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
Aims Sexual abuse is a women’s health concern globally. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. This study aims to explore sexual health and wellbeing in women after pelvic radiotherapy and to determine the relationship between sexual abuse and sexual dysfunction, and decreased wellbeing. Methods Using a study-specific questionnaire, data were collected during 2011–2017 from women with gynaecological, anal, or rectal cancer treated with curative pelvic radiotherapy in a population-based cohort and a referred patient group. Subgroup analyses of data from women with a reported history of sexual abuse were conducted, comparing socio-demographics, diagnosis, aspects of sexual health and wellbeing. Results In the total sample of 570 women, 11% reported a history of sexual abuse and among these women the most common diagnosis was cervical cancer. More women with than without a history of sexual abuse reported feeling depressed (19.4% vs. 9%, p = 0.007) or anxious (22.6% vs. 11.8%, p = 0.007) and suffering genital pain during sexual activity (52% vs. 25.1%, p = 0.011, RR 2.07, CI 1.24–3.16). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (68.5% vs. 31.4% p ≤ 0.001) and inelasticity (66.6% vs. 33.3%, p ≤ 0.001). Conclusions Our findings suggest that a history of both sexual abuse and pelvic radiotherapy in women are associated with increased psychological distress and sexual impairment, challenging healthcare professionals to take action to prevent retraumatisation and provide appropriate interventions and support.
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Affiliation(s)
- Linda Åkeflo
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden
| | - Gail Dunberger
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Viktor Skokic
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Amanda Arnell
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Karin Bergmark
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. A Prospective Single-Arm Study Evaluating the Effects of a Multimodal Physical Therapy Intervention on Psychosexual Outcomes in Women With Dyspareunia After Gynecologic Cancer. J Sex Med 2021; 18:946-954. [PMID: 33931347 DOI: 10.1016/j.jsxm.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dyspareunia affects most women after treatment for gynecologic malignancies. However, to date, evidence-based interventions remain limited and no study has examined the effects of multimodal physical therapy on psychosexual outcomes in these patients. AIM To assess the effects of multimodal physical therapy on psychosexual outcomes including sexual distress, body image concerns, pain anxiety, pain catastrophizing, pain self-efficacy and depressive symptoms in women with dyspareunia after treatment for gynecologic malignancies. METHODS Thirty-one gynecologic cancer survivors with dyspareunia enrolled in this prospective single-arm interventional study. The participants undertook 12 weekly sessions of physical therapy incorporating education, pelvic floor muscle exercises with biofeedback, manual therapy and home exercises. Outcome measures were evaluated pre- and post-treatment. Paired t-tests were conducted to investigate the changes from pre-treatment (P-value ˂ 0.05) while effect sizes (Cohen's d) were calculated to measure the magnitude of the change. MAIN OUTCOME MEASURES Sexual distress (Female Sexual Distress Scale-Revised), body image concerns (Body Image Scale), pain anxiety (Pain Anxiety Symptoms Scale), pain catastrophizing (Pain Catastrophizing Scale), pain self-efficacy (Painful Intercourse Self-Efficacy Scale) and depressive symptoms (Beck Depression Inventory-II). RESULTS Significant changes were found from pre- to post-treatment for all psychosexual outcomes. Women reported reductions in sexual distress (P ˂ 0.001, d = 1.108), body image concerns (P ˂ 0.001, d = 0.829), pain anxiety (P ˂ 0.001, d = 0.980), pain catastrophizing (P ˂ 0.001, d = 0.968) and depression symptoms (P = 0.002, d = 0.636) with an increase in pain self-efficacy (P ˂ 0.001, d ≥ 0.938) following the intervention. CLINICAL IMPLICATIONS The results suggest that multimodal physical therapy significantly improves sexual distress, body image concerns, pain anxiety, pain catastrophizing, pain self-efficacy and depressive symptoms in our sample of women with dyspareunia after treatment for gynecologic malignancies. The medium to large effect sizes obtained with the high proportion of women presenting meaningful changes according to the known minimal clinically important difference or clinical cut-off underlines the significance of these effects. STRENGTHS & LIMITATIONS The current study used validated questionnaires to assess the psychosexual outcomes of a well-designed physical therapy intervention using multiple modalities to address the multifaceted aspect of dyspareunia in cancer survivors. This study did not include a control group, which may limit drawing definitive conclusions. CONCLUSION Findings showed that multimodal physical therapy yielded significant improvements in psychosexual outcomes in gynecologic cancer survivors with dyspareunia. A randomized controlled trial is indicated to confirm these results. Cyr M-P, Dumoulin C, Bessette P, et al. A Prospective Single-Arm Study Evaluating the Effects of a Multimodal Physical Therapy Intervention on Psychosexual Outcomes in Women With Dyspareunia After Gynecologic Cancer. J Sex Med 2021;18:946-954.
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Affiliation(s)
- Marie-Pierre Cyr
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Paul Bessette
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annick Pina
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Walter Henry Gotlieb
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Korine Lapointe-Milot
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Hélène Mayrand
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
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Cyr MP, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercourse: A multicenter prospective interventional study. Gynecol Oncol 2020; 159:778-784. [PMID: 33010968 DOI: 10.1016/j.ygyno.2020.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Painful sexual intercourse (dyspareunia) is a distressing condition affecting a large proportion of gynecological cancer survivors, yet treatments remain limited and poorly studied. This multicenter prospective interventional study examined the feasibility, acceptability and effects of multimodal pelvic floor physical therapy in gynecological cancer survivors with dyspareunia. METHODS Thirty-one endometrial and cervical cancer survivors with dyspareunia participated in 12 weekly 60-min physical therapy sessions combining education, manual therapy, pelvic floor muscle exercises using biofeedback and home exercises, which included the use of a dilator. The adherence rate to home exercises (≥80%), the attendance rate at physical therapy sessions (≥80% of participants attending ≥10 sessions) and the dropout rate (˂15%) served as feasibility and acceptability outcomes and benchmarks. Pain intensity, pain quality, sexual function, pelvic floor dysfunction symptoms and quality of life were measured at baseline and post-treatment. Treatment satisfaction and participants' perceived improvement were also assessed. RESULTS The adherence rate was 88% (SD 10), 29/31 (94%) women attended ≥10 treatment sessions, and the dropout rate was 3%. Moreover, women experienced significant improvements in all outcomes after the intervention (p ≤ 0.044). They also reported being highly satisfied with the treatment (9.3/10 (SD 1.2)), and 90% of them were very much or much improved. CONCLUSIONS Our findings support the feasibility and acceptability of multimodal pelvic floor physical therapy for gynecological cancer survivors with dyspareunia. The intervention also led to significant improvements in pain, sexual function, pelvic floor dysfunction symptoms and quality of life. A randomized controlled trial is needed to confirm these results.
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Affiliation(s)
- Marie-Pierre Cyr
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, 7077 Park Avenue, Montreal, Quebec H3N 1X7, Canada; Research Center of the Institut Universitaire de Gériatrie de Montréal, 4545 Queen Mary, Montreal, Quebec H3W 1W6, Canada
| | - Paul Bessette
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annick Pina
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, University of Montreal, PO Box 6128 Centre-ville Station, Montreal, Quebec H3C 3J7, Canada; Research Center of the Centre Hospitalier de l'Université de Montréal, 900 Saint-Denis, Montreal, Quebec H2X 0A9, Canada
| | - Walter Henry Gotlieb
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, McGill University, 1001 Decarie Blvd, Montreal, Quebec H4A 3J1, Canada; Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1E2, Canada
| | - Korine Lapointe-Milot
- Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada; Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada
| | - Marie-Hélène Mayrand
- Research Center of the Centre Hospitalier de l'Université de Montréal, 900 Saint-Denis, Montreal, Quebec H2X 0A9, Canada; Departments of Obstetrics and Gynecology and Social and Preventive Medicine, Faculty of Medicine, University of Montreal, PO Box 6128 Centre-ville Station, Montreal, Quebec H3C 3J7, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada.
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Sexual Function, Quality of Life, and Mood After Radiation Therapy in Patients with Anal Cancer. J Gastrointest Cancer 2020; 51:204-210. [PMID: 30980294 DOI: 10.1007/s12029-019-00233-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE/OBJECTIVE(S) Definitive chemoradiation (CRT) results in high cure rates of anal cancer, with advanced radiation (RT) techniques improving toxicity. However, there is limited data regarding these patients' sexual function (SF), quality of life (QOL), and mood. We hypothesized that anal cancer treatment would result in detrimental effects on SF, QOL, and mood. MATERIALS/METHODS We prospectively surveyed patients with anal cancer treated with definitive CRT. We assessed SF for women with the Female Sexual Function Index (FSFI) and for men with the International Index of Erectile Function (IIEF). For all patients, we assessed QOL using EORTC QLQ-C30 and CR29 and mood using the Hospital Anxiety and Depression Scale (HADS). We reported descriptive statistics for SF, QOL, and mood and used univariate analysis to evaluate predictors of SF for women. RESULTS Of 50 eligible patients, 84% completed the surveys. Median time from RT until survey was 36 months (1-97 months). Women (n = 34) reported poor SF overall (mean FSFI score = 15, scale 2-36, standard deviation (SD) 10.4). Most women reported poor SF related to satisfaction, desire, orgasm, arousal, pain, and lubrication. Men (n = 8) also had poor overall satisfaction (mean IIEF score = 6.1, scale 2-10, SD 3.6). Men reported poor erectile function and lower satisfaction with intercourse. Mean QLQ-C30 QOL score was 86.5 (SD 16.3). Results from EORTC QLQ-CR-20 demonstrated patients experienced poor sexual interest. Per HADS, 2.5% reported depression and 18% anxiety. CONCLUSION Patients with anal cancer experience sexual dysfunction after RT, with QOL and mood symptoms similar to patients with other cancers. Our data support the need for ongoing efforts to understand and address issues with SF, QOL, and mood following RT for these patients.
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Quality of life in women treated with chemotherapy for breast cancer in Cali, Colombia. ACTA ACUST UNITED AC 2020; 40:349-361. [PMID: 32673462 PMCID: PMC7505510 DOI: 10.7705/biomedica.4971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Breast cancer is a serious neoplasm that originates in mammary tissues whose treatment with chemotherapy seems to generate significant changes in the quality of life.
Objective: To determine the risk factors associated with health-related quality of life in women with breast cancer under chemotherapy in Cali, Colombia.
Materials and methods: We conducted an observational, cross-sectional study with analytical components in a sample of 80 female patients using the QLQ-C30 questionnaire for cancer, and the QLQ-BR23 for breast cancer, as well as sociodemographic and clinical information. We performed a logistic regression analysis to determine associated risk factors through adjusted OR and 95% CI; the quality of life was classified using the QLQ-BR23.
Results: The most relevant symptoms were fatigue, insomnia, and hair loss. Physical functionality, feelings of pleasure, and sexual activity were reduced. The factors associated with low quality of life were mammary symptoms (adjusted OR= 5.5; 95% CI: 1.2-24.8; p = 0.038), systemic therapy side effects (adjusted OR = 7.3; IC95%: 2.6-22.1; p = 0.012), lower sexual pleasure (adjusted OR = 1.8; IC95%: 1.2-11.8; p = 0.027) and reduction of expectations about the future (adjusted OR = 4.2; IC95%: 1.1-17.8; p = 0.045).
Conclusions: The quality of life in women with breast cancer and under chemotherapy was mainly affected by the side effects of the therapy; the most relevant signs and symptoms identified were hair loss, insomnia, and fatigue besides breast symptoms, lower physical functionality, and decreased sensation of sexual pleasure. We recommend intervention strategies aimed at improving the quality of life and the physical and emotional care of these patients.
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Liu M, Juravic M, Mazza G, Krychman ML. Vaginal Dilators: Issues and Answers. Sex Med Rev 2020; 9:212-220. [PMID: 32014450 DOI: 10.1016/j.sxmr.2019.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Vaginal dilators are often prescribed to facilitate an adaptive brain-body connection to decrease anxiety and pain that can be experienced in anticipation of sexual intercourse among populations of women with sexual pain syndromes. Postmenopausal women, cancer survivors, and women with a wide variety of pelvic floor disorders who experience genito-pelvic pain/penetration disorder (GPPPD) are often advised to incorporate vaginal dilators into their pelvic floor rehabilitation program and treatment regimens to enable penetrative intercourse with less pain. However, little is known about the behaviors of dilator users, what treatment protocols are most effective, how patients are currently using their dilators, and how effective are clinicians in helping their patients achieve success with their dilation therapy. METHODS A recent PubMed literature search was performed using the key words vaginal dilator, vaginal dilator therapy, sexual quality of life, vaginal stenosis, vaginal dilation, vaginismus. A total of 29 English articles were reviewed and summarized. Articles were excluded for the following reasons: not in English and unrelated to dilator therapy. MAIN OUTCOME MEASURE This article will summarize the current research on vaginal dilators and discuss needs for future research to maximize patients' compliance and success with this treatment. Much of the summary data regarding user behavior will come from the early survey data with Milli, a novel, patient-controlled electronic dilator that slowly expands 1 mm at a time from its smallest diameter, 15 mm to a maximum diameter of 40 mm. Milli is currently being used by more than 1,000 women, and 3-month follow-up data were recorded on 335 of those patients. RESULTS Dilators exist in multiple forms (plastic, latex, and medical grade material), may come individually or in sets, and many have special features such as vibration or the ability to be heated or cooled before use. Little is known about patients' use of dilators and the Milli's 3-month survey serves as an insight to patient dilator behavior. The most common medical goals for patients undergoing dilation treatment were return to penetrative intercourse and pain reduction during coitus. Patients were dilated on average 2.72 days/week; 56.8% of patients had suffered from sexual pain for 2 or more years and 36.3% had previously used static dilators. More than 70% of Milli users purchased Milli and are using Milli without the direct guidance of a clinician. The most common emotions patients used to describe their treatment were not only "anxious," "frustrated," but also "empowered" and "optimistic." The most common dilatory session duration was 6-10 minutes, mostly in the evening/bedtime (68.3%), located in the bedroom (96.8%). Adjunctive treatment included the following: vaginal moisturizers, local estrogen products, coital lubricants, and genital pelvic floor physical therapy. During the dilation sessions, women most often watched TV/videos, practiced mindfulness, or listened to soothing music. Factors that showed trends toward improved patient outcomes were length of dilation treatment (greater than 3 months) and use of meditation and soothing music. Factors not associated with improvement trends were as follows: when/where patients dilated and patient demographics including age, race, or religious preferences. CONCLUSION Patients who purchase dilators have often suffered with their condition for a long time and had difficulty finding a competent health-care clinician well versed in sexual pain syndromes that can help them. When patients did find a clinician, there were no clinically proven standardized protocols or formalized guidelines to give to patients about how to best use their dilators. Larger long-term interventions investigating a standardized dilation protocol are planned in future studies to better elucidate the effective and optimal dilation treatment plans. Liu M, Juravic M, Mazza G, et al. Vaginal Dilators: Issues and Answers. Sex Med Rev 2021;9:212-220.
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Affiliation(s)
- Marisa Liu
- University of California Irvine, Department of OBGYN, Irvine, CA, USA
| | | | - Genevieve Mazza
- University of California Irvine, Department of OBGYN, Irvine, CA, USA
| | - Michael L Krychman
- University of California Irvine, Department of OBGYN, Irvine, CA, USA; Southern California Center for Sexual Health and Survivorship Medicine Inc, Newport Beach, CA, USA.
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Foley Catheter as a Vaginal Stent in a Toddler with Vaginal Rhabdomyosarcoma. J Pediatr Adolesc Gynecol 2018; 31:315-317. [PMID: 29233732 DOI: 10.1016/j.jpag.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/27/2017] [Accepted: 12/03/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sarcoma botryoides is a variant of embryonal rhabdomyosarcoma with cure rates exceeding 90%. Vaginal presentation is rare and treatment includes chemotherapy and local radiation. Sequelae of vaginal radiation in this age group have not been well defined. However, vaginal stenosis is a known result of pelvic radiation in adult women with vaginal dilation as the primary method of prevention and treatment. CASE An 18-month-old child was diagnosed with vaginal rhabdomyosarcoma and underwent chemotherapy and vaginal brachytherapy radiation treatment. Six weeks after completion of radiation, vaginoscopy was performed with placement of a nonlatex Foley catheter to prevent vaginal stricture. When removed, vaginal patency was normal with no vaginal erosion. SUMMARY AND CONCLUSION Use of a soft, flexible, nonlatex catheter might prevent vaginal stricture in a young child.
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Grande E, Glen H, Aller J, Argenziano G, Lamas MJ, Ruszniewski P, Zamorano JL, Edmonds K, Sarker S, Staehler M, Larkin J. Recommendations on managing lenvatinib and everolimus in patients with advanced or metastatic renal cell carcinoma. Expert Opin Drug Saf 2017; 16:1413-1426. [PMID: 28920492 DOI: 10.1080/14740338.2017.1380624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There are several second-line treatment options for patients with renal cell carcinoma after first-line failure of a tyrosine kinase inhibitor, especially with the recent approvals of cabozantinib, nivolumab, and the lenvatinib plus everolimus combination. A lack of reliable biomarkers and an overall lack of prospective head-to-head comparisons make it a challenge to choose a second-line treatment in the clinic. Areas covered: In this review/meta-opinion, we describe the safety profile of the lenvatinib plus everolimus combination in renal cell carcinoma. The combination of lenvatinib plus everolimus has achieved the highest rates of objective responses and the longest progression free and overall survival in cross-comparison trials. At the same time, the safety profile of this combination, including the rate of total and severe adverse events, the percentage of dose reductions required, and the rate of treatment discontinuation, was less favorable compared with available monotherapy options, suggesting that better management could help to maximize the activity of this combination while protecting patients from undue harm. Expert opinion: Herein, we aim to postulate multidisciplinary recommendations on the advice to offer to patients and caregivers before starting treatment and how to manage the combination from the perspective of daily clinical practice.
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Affiliation(s)
- E Grande
- a Medical Oncology Department , Ramón y Cajal University Hospital , Madrid , Spain
| | - H Glen
- b Consultant in Medical Oncology, Honorary Clinical Senior Lecturer, NRS Research Fellow , Beatson West of Scotland Cancer Centre , Glasgow , UK
| | - J Aller
- c Endocrinology Department , Puerta de Hierro University Hospital , Madrid , Spain
| | - G Argenziano
- d Dermatology Unit , University of Campania , Naples , Italy
| | - M J Lamas
- e Pharmacy Department , Complexo Hospitalario de Santiago de Compostela , Santiago de Compostela , Spain
| | - P Ruszniewski
- f Paris Diderot University. Gastroenterology Department , Beaujon Hospital, Assistance Publique-Hôpitaux de Paris , Clichy , France
| | - J L Zamorano
- g Head of Cardiology, CIBERCV , University Hospital Ramon y Cajal , Madrid , Spain
| | - K Edmonds
- h Oncology Nurse , Royal Marsden Hospital , London , UK
| | - S Sarker
- h Oncology Nurse , Royal Marsden Hospital , London , UK
| | - M Staehler
- i Urology Department , Klinikum der Ludwig-Maximilians Universität , Munich , Germany
| | - J Larkin
- j Medical Oncology Department , Royal Marsden Hospital , London , UK
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