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Tahseen R, Ahmed Y, Tariq M, Abrar S, Ali N. Compliance and clinical efficacy of vaginal dilator after radiotherapy for cervical and endometrial malignancies. Ecancermedicalscience 2023; 17:1545. [PMID: 37377680 PMCID: PMC10292859 DOI: 10.3332/ecancer.2023.1545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Indexed: 06/29/2023] Open
Abstract
Objective To investigate the compliance and clinical efficacy of vaginal dilators (VDs) as an educational intervention in patients receiving pelvic radiation therapy (RT) for endometrial and cervical malignancies. Material and methods This is a single institution, retrospective chart review. Patients undergoing pelvic RT for endometrial or cervical cancer at our center were educated about the use of a VD starting 1 month after completion of RT. The patients were assessed after 3 months of prescribing VD. The demographic details and physical examination findings were extracted from medical records. Results We identified 54 female patients at our institution during the 6-month duration. The median mean age of patients was 54 ± 9.9 years. Twenty-four (44.4%) had endometrial cancers and 30 (55.6%) were diagnosed with cervical cancers. All patients received external beam RT, 38 (70.4%) received a dose of 45 Gy, and 16 (29.6%) patients received 50.4 Gy. Brachytherapy was also received by all patients, 28 (51.9%) received 5 Gy × 2 fractions, 4 (7.4%) received 7 Gy × 3 fractions and 22 (40.7%) received 8 Gy × 3 fractions. The compliance with VD use was 36 (66.6%) patients. Twenty-two (40.7%) used 2-3 times a week, 8 (14.8%) used <2 times per week and 6 (11.9%) used only once a month, and 18 (33.3%) did not use the VD post-treatment. Per vaginal (PV) examination findings of the patient's vagina with normal mucosa were evaluated in 32 (59.3%) and adhesions were found in 20 (37.0%) and 2 (3.7%) were unable to examine due to dense adhesions. During examination 12 (22.2%) had bleeding PV, however, the majority of the patients, 42 (77.8%) experienced no bleeding PV. Out of the 36 patients who used a VD, it was found to be efficacious in 29 (80.6%) of patients. Upon stratification of efficacy with a frequency of VD, 72.4% (n = 21) efficacy was seen in patients using frequent VD as prescribed 2-3 times per week. Conclusion The compliance and efficacy of VD use after radiation to pelvic in cervical and endometrial cancers at 3 months follow-up were found to be 66.6% and 80.6%, respectively. This shows that VD therapy is an effective interventional tool and patients should receive specialist education about vaginal stenosis as toxicity at the outset of treatment.
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Affiliation(s)
- Rabia Tahseen
- Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan
| | - Yumna Ahmed
- Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan
| | - Maria Tariq
- Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan
| | - Sehrish Abrar
- Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan
| | - Nasir Ali
- Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan
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Ali S, Skirton H, Clark MT, Donaldson C. Integrative review of cervical cancer screening in Western Asian and Middle Eastern Arab countries. Nurs Health Sci 2017; 19:414-426. [PMID: 29058371 DOI: 10.1111/nhs.12374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 07/12/2017] [Accepted: 07/20/2017] [Indexed: 01/21/2023]
Abstract
Population-based screening programs have resulted in minimizing mortality and morbidity from cervical cancer. The aim of this integrative review was to explore the factors influencing access of women from Western Asian and Middle Eastern Arab countries to cervical cancer screening. A systematic search for studies conducted in Arab countries in those regions, and published in English between January 2002 and January 2017, was undertaken. Thirteen papers were selected and subjected to quality appraisal. A three step analysis was used, which involved a summary of the evidence, analysis of both quantitative and qualitative data, and integration of the results in narrative form. Few population-based cervical cancer screening programs had been implemented in the relevant countries, with low knowledge of, and perceptions about, cervical screening among Arab women, the majority of whom are Muslim. Factors affecting the uptake of cervical cancer screening practices were the absence of organized, systematic programs, low screening knowledge among women, healthcare professionals' attitudes toward screening, pain and embarrassment, stigma, and sociocultural beliefs. Policy changes are urgently needed to promote population-based screening programs. Future research should address the promotion of culturally-sensitive strategies to enable better access of Arab Muslim women to cervical cancer screening.
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Affiliation(s)
- Suhailah Ali
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,College of Nursing, Kirkuk University, Kirkuk, Iraq
| | - Heather Skirton
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK
| | - Maria T Clark
- School of Nursing, University of Birmingham, Edgbaston, UK
| | - Craig Donaldson
- School of Biomedical and Healthcare Sciences, Plymouth University, Plymouth, UK
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Bai Y, Liu Q, Chen X, Gao Y, Gong H, Tan X, Zhang M, Tuo J, Zhang Y, Xiang Q, Deng F, Liu G. Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women. Psychooncology 2017; 27:442-449. [PMID: 28749603 DOI: 10.1002/pon.4510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/14/2017] [Accepted: 07/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yang Bai
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Qing Liu
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Xinguang Chen
- School of Health Sciences; Wuhan University; Wuhan Hubei China
- Department of Epidemiology; University of Florida; Gainesville FL USA
| | - Yanduo Gao
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Huiyun Gong
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Xiaodong Tan
- School of Health Sciences; Wuhan University; Wuhan Hubei China
| | - Min Zhang
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Jiyu Tuo
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Yuling Zhang
- Institute of Cancer Prevention and Control; Wuhan Hubei China
| | - Qunying Xiang
- Maternal and Child Health Care Hospital; Wufeng Hubei China
| | - Fenghua Deng
- Maternal and Child Health Care Hospital; Wufeng Hubei China
| | - Guiling Liu
- Maternal and Child Health Care Hospital; Wufeng Hubei China
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Muliira RS, Salas AS, O'Brien B. Quality of Life among Female Cancer Survivors in Africa: An Integrative Literature Review. Asia Pac J Oncol Nurs 2017; 4:6-17. [PMID: 28217724 PMCID: PMC5297234 DOI: 10.4103/2347-5625.199078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Quality of life (QOL) has been studied extensively among cancer populations in high income countries where cancer care resources are available to many. Little is known concerning the QOL of cancer groups residing in Africa where resources can be scarce. The integrative review of the literature explored and critically examined studies that had addressed QOL in female cancer survivors in Africa. The extent to which QOL studies incorporated a cultural perspective was also examined. Research studies published between 2005 and 2015 were retrieved from five databases: CINAHL, MEDLINE, SCOPUS, ProQuest dissertations and Theses full text, and GlobalHealth. Primary qualitative or quantitative studies regardless of sample size or setting were included. A total of 300 studies were identified and 28 full text studies were retrieved and assessed for eligibility. Eight studies met inclusion criteria. Factors that affected the QOL were socio-demographic especially age, education, employment, income and residence; illness-related factors such as having advanced cancer and multiple symptoms; treatment-related factors associated with surgery and radiotherapy; psychosocial factors such as support and anxiety; and cultural factors including fatalism and bewitching. Practice implications entail increasing awareness among nurses and allied healthcare providers of the potential effects on QOL of a cancer diagnosis and treatment of female cancers such as pain, fatigue, sexual dysfunction, hormonal and body image changes, anxiety, depression and cultural practices. Failure to identify and deal with these may result in poor treatment adherence, low self-esteem, and ultimately poor QOL.
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Affiliation(s)
| | - Anna Santos Salas
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Beverley O'Brien
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Grover S, Xu MJ, Yeager A, Rosman L, Groen RS, Chackungal S, Rodin D, Mangaali M, Nurkic S, Fernandes A, Lin LL, Thomas G, Tergas AI. A systematic review of radiotherapy capacity in low- and middle-income countries. Front Oncol 2015; 4:380. [PMID: 25657930 PMCID: PMC4302829 DOI: 10.3389/fonc.2014.00380] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/18/2014] [Indexed: 11/13/2022] Open
Abstract
Objectives: The cancer burden in low- and middle-income countries (LMIC) is substantial. The purpose of this study was to identify and describe country and region-specific patterns of radiotherapy (RT) facilities in LMIC. Methods: A systematic review of the literature was undertaken. A search strategy was developed to include articles on radiation capacity in LMIC from the following databases: PubMed, Embase, CINAHL Plus, Global Health, and the Latin American and Caribbean System on Health Sciences Information. Searches included all literature up to April 2013. Results: A total of 49 articles were included in the review. Studies reviewed were divided into one of four regions: Africa, Asia, Eastern Europe, and South America. The African continent has the least amount of resources for RT. Furthermore, a wide disparity exists, as 60% of all machines on the continent are concentrated in Egypt and South Africa while 29 countries in Africa are still lacking any RT resource. A significant heterogeneity also exists across Southeast Asia despite a threefold increase in megavoltage teletherapy machines from 1976 to 1999, which corresponds with a rise in economic status. In LMIC of the Americas, only Uruguay met the International Atomic Energy Agency recommendations of 4 MV/million population, whereas Bolivia and Venezuela had the most radiation oncologists (>1 per 1000 new cancer cases). The main concern with the review of RT resources in Eastern Europe was the lack of data. Conclusion: There is a dearth of publications on RT therapy infrastructure in LMIC. However, based on limited published data, availability of RT resources reflects the countries’ economic status. The challenges to delivering radiation in the discussed regions are multidimensional and include lack of physical resources, lack of human personnel, and lack of data. Furthermore, access to existing RT and affordability of care remains a large problem.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Melody J Xu
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Alyssa Yeager
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lori Rosman
- Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Reinou S Groen
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital , Baltimore, MD , USA
| | - Smita Chackungal
- Department of Surgery, University of Western Ontario , London, ON , Canada
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Margaret Mangaali
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Sommer Nurkic
- Johns Hopkins School of Public Health , Baltimore, MD , USA
| | - Annemarie Fernandes
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lilie L Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Gillian Thomas
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons , New York, NY , USA
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Knowledge, attitudes, practices, and perceived risk of cervical cancer among Kenyan women: brief report. Int J Gynecol Cancer 2014; 23:895-9. [PMID: 23694983 DOI: 10.1097/igc.0b013e31828e425c] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Eastern Africa has the highest incidence and mortality rates from cervical cancer worldwide. It is important to describe the differences among women and their perceived risk of cervical cancer to determine target groups to increase cervical cancer screening. METHODS In this cross-sectional study, we surveyed women seeking reproductive health services in Kisumu, Kenya to assess their perceived risk of cervical cancer and risk factors influencing cervical cancer screening uptake. χ² statistics and t tests were used to determine significant factors, which were incorporated into a logistic model to determine factors independently associated with cervical cancer risk perception. RESULTS Whereas 91% of the surveyed women had heard of cancer, only 29% of the 388 surveyed women had previously heard of cervical cancer. Most had received their information from health care workers. Few women (6%) had ever been screened for cervical cancer and cited barriers such as fear, time, and lack of knowledge about cervical cancer. Nearly all previously screened women (22/24 [92%]) believed that cervical cancer was curable if detected early and that screening should be conducted annually (86%). Most women (254/388 [65%]) felt they were at risk for cervical cancer. Women with perceived risk of cervical cancer were older (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), reported a history of marriage (OR, 2.08; CI, 1.00-4.30), were less likely to feel adequately informed about cervical cancer by health care providers (OR, 0.76; CI, 0.18-0.83), and more likely to intend to have cervical cancer screening in the future (OR, 10.59; CI, 3.96-28.30). Only 5% of the women reported that they would not be willing to undergo screening regardless of cost. CONCLUSIONS Cervical cancer is a major health burden for women in sub-Saharan Africa, yet only one third of the women had ever heard of cervical cancer in Kisumu, Kenya. Understanding factors associated with women's perceived risk of cervical cancer could guide future educational and clinical interventions to increase cervical cancer screening.
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