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Kaufman R, Agrawal L, Teplinsky E, Kiel L, Abioye O, Florez N. From diagnosis to survivorship addressing the sexuality of women during cancer. Oncologist 2024:oyae242. [PMID: 39269314 DOI: 10.1093/oncolo/oyae242] [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: 03/29/2024] [Accepted: 08/09/2024] [Indexed: 09/15/2024] Open
Abstract
For women diagnosed with cancer, side effects affecting their sexuality are extremely common and can be distressing and life-changing; however, most women are left in the dark without any guidance from their oncology teams regarding possible side effects and treatment options. American Society of Clinical Oncology clinical guidelines provide guidance on the recommended assessments related to the domains of sexual function and their respective interventions. Despite the existence of these guidelines, the reality is that only a few women with cancer are asked about sexual concerns that result from cancer treatments. Common barriers to sexuality discussion reported by oncology providers include a lack of qualification and knowledge, not having a place to refer patients, and not knowing how to start the conversation. Social media remains a widely untapped resource regarding sexuality and cancer interventions, as people are increasingly turning to social media for health information and advice. This may be especially relevant for sexuality, as oncologists may not feel comfortable or well-trained to discuss the topic, and patients may be reluctant to bring up sexual concerns during their visits. Social media can play a critical role in studying sexual health and in sexuality interventions, particularly in adolescent and young adult patients with cancer. Here, we discuss the lack of inclusion regarding sexuality in oncology, the rates of sexual dysfunction in patients with cancer, treatment options for common sexual concerns, how to utilize the reach of various social media channels, and provide patient and provider resources.
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Affiliation(s)
- Rebekah Kaufman
- Department of Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Laila Agrawal
- Medical Oncology, Norton Cancer Institute, Louisville, KY 40241, United States
| | - Eleonora Teplinsky
- Medical Oncology, Valley Mount Sinai Comprehensive Cancer Center, Paramus, NJ 07652, United States
| | - Lauren Kiel
- Department of Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Oyepeju Abioye
- Department of Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Narjust Florez
- Department of Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
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Perrucci E, Macchia G, Cerrotta A, Andrulli AD, Autorino R, Barcellini A, Campitelli M, Corrao G, Costantini S, De Sanctis V, Di Muzio J, Epifani V, Ferrazza P, Fodor A, Garibaldi E, Laliscia C, Lazzari R, Magri E, Mariucci C, Pace MP, Pappalardi B, Pastorino A, Piccolo F, Scoglio C, Surgo A, Titone F, Tortoreto F, De Felice F, Aristei C. Prevention and management of radiotherapy-related toxicities in gynecological malignancies. Position paper on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology). LA RADIOLOGIA MEDICA 2024; 129:1329-1351. [PMID: 39198369 PMCID: PMC11379782 DOI: 10.1007/s11547-024-01844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/01/2024] [Indexed: 09/01/2024]
Abstract
Multi-modal therapies for gynecological cancers management may determine a wide range of side effects which depend on therapy-related factors and patient characteristics and comorbidities. Curative or adjuvant pelvic radiotherapy is linked with acute and late toxicity due to irradiation of organs at risk, as small and large bowel, rectum, bladder, pelvic bone, vagina and bone marrow. Successful toxicity management varies with its severity, Radiation Centre practice and experience and skills of radiation oncologists. This position paper was designed by the Italian Association of Radiation and Clinical Oncology Gynecology Study Group to provide radiation oncologists with evidence-based strategies to prevent and manage acute and late toxicities and follow-up recommendations for gynecological cancer patients submitted radiotherapy. Six workgroups of radiation oncologists with over 5 years of experience in gynecologic cancers were setup to investigate radiotherapy-related toxicities. For each topic, PubMed database was searched for relevant English language papers from January 2005 to December 2022. Titles and abstracts of results were checked to verify suitability for the document. Reference lists of selected studies and review papers were added if pertinent. Data on incidence, etiopathogenesis, prevention, treatment and follow-up of acute and late side effects for each organ at risk are presented and discussed.
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Affiliation(s)
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - Annamaria Cerrotta
- Radiotherapy Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Rosa Autorino
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Maura Campitelli
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Corrao
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Costantini
- Radiation Oncology Centre, Santa Maria Hospital, Terni, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, Department of Medicine, Surgery and Translational Medicine, St. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Jacopo Di Muzio
- Dipartimento Di Oncologia P.O. S. Anna - SS Radioterapia, A.O.U "Città Della Salute E Della Scienza", Turin, Italy
| | - Valeria Epifani
- Radiation Oncology Section, University of Perugia, Perugia, Italy.
| | | | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Garibaldi
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Concetta Laliscia
- Department of Translational Medicine, Radiation Oncology Division, University of Pisa, Pisa, Italy
| | - Roberta Lazzari
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Magri
- Department of Radiotherapy, Santa Chiara Hospital, Trento, Italy
| | - Cristina Mariucci
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Maria Paola Pace
- UOC Radioterapia Oncologica, Ospedale Generale Provinciale di Macerata, AST Macerata, Italy
| | - Brigida Pappalardi
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Federica Piccolo
- Radiotherapy Unit, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Claudio Scoglio
- Radiotherapy Unit, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Francesca Titone
- Radiation Oncology Unit, Department of Oncology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
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Friedman JC, Hutchens K, Hampanda K, Scott S, Huguelet P, Appiah L, Alaniz VI. Understanding Physician Practices and Preferences Using Vaginal Stents to Prevent Postoperative Vaginal Stenosis in Pediatric and Adolescent Patients. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00260-2. [PMID: 39098549 DOI: 10.1016/j.jpag.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/04/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
STUDY OBJECTIVE The purpose of this study is to describe practices to prevent vaginal stenosis in pediatric and adolescent patients and to evaluate the strengths and weaknesses of available vaginal stents. METHODS An online survey was distributed to North American Society for Pediatric and Adolescent Gynecology (NASPAG) members with an optional follow-up focus group. Quantitative and qualitative data were synthesized to highlight physician practices and preferences using vaginal stents, strengths and weakness of stents, and ideal stent properties. RESULTS Twenty physicians completed at least 50% of the survey, and 4 participated in the focus group. Most were pediatric and adolescent gynecology specialists (95%) with fellowship training (60%) and experience in managing Müllerian anomalies (80%). Physicians reported they "always" used a vaginal stent when performing vaginoplasty for distal vaginal agenesis with a graft (62.5%) or without a graft (37.5%) and for transverse vaginal septa (57.1%). The most common type of stents used were packed condoms (60%), tracheobronchial stents (40%), Foley catheters (35%), and custom stents (35%). Participants described an ideal vaginal stent as something that would stay in place, cause little discomfort, expand, and come in a variety of lengths. CONCLUSION There are limited vaginal stent options for the pediatric and adolescent gynecology population. Participants reported variability in stents used to prevent vaginal stenosis, with commonly used vaginal stents having significant weaknesses. Future efforts are needed to identify and develop postoperative clinical guidelines to prevent vaginal stenosis.
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Affiliation(s)
- Julie C Friedman
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado.
| | - Kendra Hutchens
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Karen Hampanda
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Stephen Scott
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Patricia Huguelet
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Leslie Appiah
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Veronica I Alaniz
- University of Colorado Department of OBGYN, Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
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Di Stanislao M, Coada CA, De Terlizzi F, Di Costanzo S, Fiuzzi E, Mezzapesa F, Dondi G, Paoli D, Damiani GR, Raspagliesi F, Bogani G, Ditto A, Morganti AG, De Iaco P, Perrone AM. Laser Therapy in Heavily Treated Oncological Patients Improves Vaginal Health Parameters. Cancers (Basel) 2024; 16:2722. [PMID: 39123449 PMCID: PMC11311561 DOI: 10.3390/cancers16152722] [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: 06/22/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
This study aimed to investigate the efficacy and duration of multiple non-ablative intravaginal CO2 laser (V-lase®) cycles in breast cancer patients, gynecological and other pelvic cancers previously subjected to multiple oncological treatments. This prospective study enrolled women under the age of 65 years who reported vaginal symptoms. Data on the Vaginal Health Index (VHI), vaginal length (VL), vaginal pain measured using a Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI) were collected at baseline and before each laser application, and at subsequent follow-up visits. A total of 170 laser applications were performed on 113 women with various types of cancer. Most patients (57.5%) had received radiotherapy-based treatments before receiving laser treatment. Vaginal health parameters and sexual function improved significantly with each laser application. However, a temporary decline in these improvements occurred during the intervals between cycles. Such worsening was reversed with the subsequent cycle in all groups of patients, irrespective of the type of oncological treatments they had undergone. Multiple course vaginal laser therapy showed promising results as a potential treatment for vaginal atrophy in heavily treated gynecological and breast cancer patients, necessitating further research to determine the optimal time interval between cycles to ensure sustained positive effects.
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Affiliation(s)
- Marco Di Stanislao
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Camelia Alexandra Coada
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | | | - Stella Di Costanzo
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Enrico Fiuzzi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Francesco Mezzapesa
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Giulia Dondi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
| | - Damiano Paoli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | | | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.R.); (G.B.); (A.D.)
| | - Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.R.); (G.B.); (A.D.)
| | - Antonino Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (F.R.); (G.B.); (A.D.)
| | | | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (M.D.S.); (E.F.); (F.M.); (G.D.); (P.D.I.); (A.M.P.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (C.A.C.); (D.P.)
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Manea E, Chitoran E, Rotaru V, Ionescu S, Luca D, Cirimbei C, Alecu M, Capsa C, Gafton B, Prutianu I, Serban D, Simion L. Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix. Bioengineering (Basel) 2024; 11:506. [PMID: 38790373 PMCID: PMC11117609 DOI: 10.3390/bioengineering11050506] [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: 04/16/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024] Open
Abstract
Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.
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Affiliation(s)
- Elena Manea
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Chitoran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Sinziana Ionescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Dan Luca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihnea Alecu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Cristina Capsa
- Radiology and Medical Imaging Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Bogdan Gafton
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iulian Prutianu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Morpho-Functional Sciences I—Histology, University of Medicine and Pharmacy “Gr. T. Popa”, 700483 Iasi, Romania
| | - Dragos Serban
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- Surgery Department IV, Bucharest Clinical Emergency Hospital, 050098 Bucharest, Romania
| | - Laurentiu Simion
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
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Dugan CL, Othieno AA, Goldman ME. Genitourinary Syndrome of Menopause in Cancer Survivors. Clin Obstet Gynecol 2024; 67:89-100. [PMID: 38108399 DOI: 10.1097/grf.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Genitourinary syndrome of menopause (GSM) encompasses the symptoms of estrogen deprivation in the vaginal, vulva, and bladder areas. Because many cancer treatments induce a hypoestrogenic state, GSM is common in cancer survivors. The number of cancer survivors is increasing, and the unique aspects of GSM management for cancer survivors, such as the safety of hormonal therapies, is important to understand. In this review, we cover important considerations in the assessment of GSM; nonpharmacologic, behavioral, integrative, pharmacologic, and medical device treatments for GSM: the unique considerations in GSM by cancer treatment modality; bladder manifestations of GSM; and GSM in specific populations.
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Affiliation(s)
- Catherine L Dugan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Alisha A Othieno
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
| | - Mindy E Goldman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
- Midi Health, Menlo Park, California
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Hu H, Wang Z, Xue L, Zhang T, Jing Y, Li Y. Effects of neoadjuvant chemotherapy combined with radical laparoscopic surgery with quality nursing care on clinical efficacy and sex hormones in patients with cervical cancer. Am J Transl Res 2024; 16:477-486. [PMID: 38463583 PMCID: PMC10918130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/23/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To observe the effects of neoadjuvant chemotherapy combined with radical laparoscopic surgery with quality nursing care on the clinical efficacy and sex hormones of cervical cancer patients. METHODS The clinical data of 107 patients with cervical cancer admitted to Yanan University Affiliated Hospital between January 2017 and January 2020 were retrospectively analyzed in this study. Among them, 50 patients received only laparoscopic radical surgery (surgical group), and the other 57 received neoadjuvant chemotherapy combined with laparoscopic radical surgery (Joint group); patients in both groups received quality nursing care. The baseline and surgical data of the two groups were compared, and the changes in tumor markers and sex hormones before and after treatment were analyzed. Cox regression was used to analyze the independent prognostic factors affecting patients' 2-year survival. RESULTS The patients in the two groups did not show statistical differences in baseline and surgical data (all P > 0.05). After treatment, the levels of squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), and serum glycan antigen 125 (CA125) were significantly reduced in both groups. However, the reduction was more pronounced in the joint group than that in the surgical group (P < 0.0001). Meanwhile, estrogen (E2) levels decreased more significantly in the Joint group, while follicle-stimulating hormone (FSH) and luteinizing hormone (LH) increased more significantly (all P < 0.0001). Multifactorial Cox regression analysis revealed that E2, LH and SCC-Ag were independent prognostic factors affecting 2-year survival (all P < 0.05). CONCLUSION Neoadjuvant chemotherapy combined with laparoscopic radical surgery is more effective in reducing the levels of tumor markers and significantly affects the levels of sex hormones. E2, LH, and SCC-Ag are the independent prognostic factors for 2-year survival in patients with cervical cancer. This study provides evidence to support the comprehensive treatment of cervical cancer.
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Affiliation(s)
- Haifeng Hu
- Department of Oncology, Yanan University Affiliated Hospital Yan'an 716000, Shaanxi, China
- Department of Oncology, Yanan City Hospital of TCM Yan'an 716000, Shaanxi, China
| | - Zhishang Wang
- Department of Oncology, Yanan University Affiliated Hospital Yan'an 716000, Shaanxi, China
| | - Lanhui Xue
- Department of Oncology, Yanan University Affiliated Hospital Yan'an 716000, Shaanxi, China
| | - Tongmei Zhang
- Perinatal Health Clinic, Baoji Maternal and Child Health Hospital Baoji 721000, Shaanxi, China
| | - Yanru Jing
- Department of Obstetrical, Baoji Maternal and Child Health Hospital Baoji 721000, Shaanxi, China
| | - Yawen Li
- Department of Operating Room, Baoji Maternal and Child Health Hospital Baoji 721000, Shaanxi, China
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8
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Kovacevic N, Cilensek I, Merlo S, Segedin B. Modern approach to the management of genitourinary syndrome in women with gynecological malignancies. Radiol Oncol 2023; 57:292-298. [PMID: 37494601 PMCID: PMC10476906 DOI: 10.2478/raon-2023-0038] [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] [Received: 05/15/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND The term genitourinary syndrome of menopause was first used in 2014 by the North American Menopause Society and the International Society for the Study of Women's Sexual Health to describe conditions previously known as atrophic vaginitis, urogenital atrophy, or vulvovaginal atrophy. It is a complex, chronic, progressive condition characterized by a wide range of signs and symptoms affecting sexual function and the tissues of the urinary and genital tracts. The main cause of genitourinary syndrome of menopause is estrogen deficiency caused by ovarian removal or dysfunction. The most bothersome symptoms are vaginal dryness, decreased vaginal lubrication, and pain during penetration and intercourse. They all have a negative impact on the quality of life. CONCLUSIONS The main goal of treatment is to relieve the symptoms. Treatment modalities are pharmacological or non-pharmacological. The first-line treatment for mild to moderate symptoms is the use of personal lubricants and moisturizers, but the gold standard is estrogen replacement therapy. Hormone therapy may not be an option for women with hormone-dependent cancer.
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Affiliation(s)
- Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Health Care Angela Boškin, Jesenice, Slovenia
| | - Ines Cilensek
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Segedin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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9
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Cianci S, Tarascio M, Arcieri M, La Verde M, Martinelli C, Capozzi VA, Palmara V, Gulino F, Gueli Alletti S, Caruso G, Restaino S, Vizzielli G, Conte C, Palumbo M, Ercoli A. Post Treatment Sexual Function and Quality of Life of Patients Affected by Cervical Cancer: A Systematic Review. Medicina (B Aires) 2023; 59:medicina59040704. [PMID: 37109662 PMCID: PMC10144819 DOI: 10.3390/medicina59040704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction: The aim of this study is to analyze the available scientific evidence regarding the quality of life (QoL) and sexual function (SF) in patients affected by cervical cancer (CC) after surgical and adjuvant treatments. Materials and Methods: Preliminary research was conducted via electronic database (MEDLINE, PubMed and Cochrane Library) with the use of a combination of the following keywords: SF, QoL, and CC. The principal findings considered in the present review were the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered, and the principal findings concerning SF and QoL. Results: All studies were published between 2003–2022. The studies selected consisted of one randomized control study, seven observational studies (three prospective series), and nine case control studies. The scores used were focused on SF, QOL, fatigue, and psychological aspects. All studies reported a decreased SF and QOL. The most developed questionnaires were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Female Sexual Function Index (FSFI), the Hospital Anxiety and Depression scale (HADS), and the Female Sexual Distress Scale (FSDS). Discussion: All studies reported a decreased SF and QOL. In addition to the perception of body image, several factors coexist in influencing the outcomes such as the physical, hormonal, psychological. Conclusions: Sexual dysfunction after CC treatment has a multifactorial aetiology which negatively affects the quality of life. For these reasons, it is important to follow and support patients with a multidisciplinary team (doctors, nurses, psychologists, dieticians) before and after therapy. This type of tailored therapeutic approach should become a standard. Women should be informed about possible vaginal changes and menopausal symptoms after surgery and on the positive effects of psychological therapy.
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Affiliation(s)
- Stefano Cianci
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98124 Messina, Italy
| | - Mattia Tarascio
- Obstetrics and Gynecology Unit, Department of Woman and Child, Azienda Sanitaria Provinciale di Catania, 95124 Catania, Italy
| | - Martina Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122 Messina, Italy
- Department of Medical Area (DAME), Clinic of Obstretics and Gynecology “Santa Maria della Misericordia”, University Hospital Azienda Sanitaria Universitaria Friuli Centrale, University of Udine, 33100 Udine, Italy
| | - Marco La Verde
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138 Napoli, Italy
| | - Canio Martinelli
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98124 Messina, Italy
| | - Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Vittorio Palmara
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98124 Messina, Italy
| | - Ferdinando Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Salvatore Gueli Alletti
- Obstetrics and Gynecology Unit, Department of Woman and Child, Ospedale Buccheri La Ferla Fatebenefratelli, 90123 Palermo, Italy
| | - Giuseppe Caruso
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy
| | - Stefano Restaino
- Department of Medical Area (DAME), Clinic of Obstretics and Gynecology “Santa Maria della Misericordia”, University Hospital Azienda Sanitaria Universitaria Friuli Centrale, University of Udine, 33100 Udine, Italy
| | - Giuseppe Vizzielli
- Department of Medical Area (DAME), Clinic of Obstretics and Gynecology “Santa Maria della Misericordia”, University Hospital Azienda Sanitaria Universitaria Friuli Centrale, University of Udine, 33100 Udine, Italy
| | - Carmine Conte
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy
| | - Alfredo Ercoli
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98124 Messina, Italy
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10
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Suvaal I, Kirchheiner K, Nout RA, Sturdza AE, Van Limbergen E, Lindegaard JC, Putter H, Jürgenliemk-Schulz IM, Chargari C, Tanderup K, Pötter R, Creutzberg CL, Ter Kuile MM. Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy. Gynecol Oncol 2023; 170:123-132. [PMID: 36682090 DOI: 10.1016/j.ygyno.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The EMBRACE-vaginal morbidity substudy prospectively evaluated physician-assessed vaginal changes and patient-reported-outcomes (PRO) on vaginal and sexual functioning problems and distress in the first 2-years after image-guided radio(chemo)therapy and brachytherapy for locally advanced cervical cancer. METHODS Eligible patients had stage IB1-IIIB cervical cancer with ≤5 mm vaginal involvement. Assessment of vaginal changes was graded using CTCAE. PRO were assessed using validated Quality-of-Life and sexual questionnaires. Statistical analysis included Generalized-Linear-Mixed-Models and Spearman's rho-correlation coefficients. RESULTS 113 eligible patients were included. Mostly mild (grade 1) vaginal changes were reported over time in about 20% (range 11-37%). At 2-years, 47% was not sexually active. Approximately 50% of the sexually active women reported any vaginal and sexual functioning problems and distress over time; more substantial vaginal and sexual problems and distress were reported by up to 14%, 20% and 8%, respectively. Physician-assessed vaginal changes and PRO sexual satisfaction differed significantly (p ≤ .05) between baseline and first follow-up, without further significant changes over time. No or only small associations between physician-assessed vaginal changes and PRO vaginal functioning problems and sexual distress were found. CONCLUSIONS Mild vaginal changes were reported after image-guided radio(chemo)therapy and brachytherapy, potentially due to the combination of tumors with limited vaginal involvement, EMBRACE-specific treatment optimization and rehabilitation recommendations. Although vaginal and sexual functioning problems and sexual distress were frequently reported, the rate of substantial problems and distress was low. The lack of association between vaginal changes, vaginal functioning problems and sexual distress shows that sexual functioning is more complex than vaginal morbidity alone.
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Affiliation(s)
- I Suvaal
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - K Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - R A Nout
- Department of Radiotherapy, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - A E Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - E Van Limbergen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - J C Lindegaard
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - H Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - I M Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Chargari
- Department of Radiation Oncology, Institute Gustave-Roussy, Paris, France
| | - K Tanderup
- Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - M M Ter Kuile
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC Leiden, the Netherlands.
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11
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Change in vaginal length and sexual function in women who undergo surgery ± radiation therapy for endometrial cancer. Brachytherapy 2023; 22:334-342. [PMID: 36849277 DOI: 10.1016/j.brachy.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE Endometrial Cancer (EC) is the most common gynecologic malignancy in the United States. Standard treatment is TAH/BSO with radiation therapy (RT) and chemotherapy given based on risk. Treatment can cause significant vaginal changes, including shortening, narrowing, loss of elasticity, atrophy, and dryness. These are not life threatening, but affect a woman's physical, psychological, and social functioning. Adjuvant vaginal dilator use is often advised, but there are inconsistent recommendations on use. This prospective study compared vaginal length changes and sexual function in women compliant with dilation versus not after surgery and RT. METHODS AND MATERIALS Enrolled patients underwent surgery for Stage I-IIIC EC ±RT. Vaginal dilator use was recommended for women receiving RT (external beam or brachytherapy). Vaginal length was measured with a vaginal sound and the Female Sexual Function Index (FSFI) was used to assess sexual function. RESULTS Forty-one enrolled patients had sufficient data for analysis. Dilation significantly increased FSFI scores (p = 0.02) while RT without dilation showed a significant decrease (p = 0.04). Dilation helped maintain vaginal length for all patients (0 cm vs. 1.8 cm loss (p = 0.03)). Individual arms did not show statistically significant changes in length with dilation, though the trend showed RT without dilation had an average loss of 2.3 cm as compared to only 0.2 cm for regular dilation. Notably, there was no difference in length change with dilation for surgery alone versus surgery and RT (p = 0.14). CONCLUSION This data provides novel, prospective evidence of the benefit of vaginal dilation for maintaining vaginal length and improving sexual health after any pelvic treatment for EC. This evidence also supports that the addition of RT after surgery does not appear to significantly worsen vaginal shortening. This study has important implications for providing a strong foundation for future studies and helping to establish solid clinical management criteria for the prevention of vaginal stenosis and promotion of female sexual health.
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12
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Chin C, Damast S. Brachytherapy impacts on sexual function: An integrative review of the literature focusing on cervical cancer. Brachytherapy 2023; 22:30-46. [PMID: 36567175 DOI: 10.1016/j.brachy.2022.10.012] [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: 08/02/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
There is growing awareness of the importance of sexual health in the quality of life of cancer patients and survivors. Brachytherapy, a vital component for the curative treatment of cervical cancer, leads to both direct and indirect sequelae that result in vaginal and sexual morbidity. The emergence of 3D image-guided adaptive brachytherapy has led to a better understanding of dose-and-effect relationships for critical organs-at-risk and there are new recommendations for vaginal dose reporting in the ongoing EMBRACE II study. An understanding of the vagina as an organ-at-risk and its dose-and-effect relationships can help brachytherapists limit dose to the vagina and improve sexual morbidity. Brachytherapists play a critical role in the primary and secondary prevention of vaginal and sexual sequelae resulting from treatment. Through close surveillance and recognition of common symptoms, brachytherapists can intervene with effective strategies to prevent and treat vaginal and sexual symptoms. This review summarizes the current literature on dosimetric factors that may predict for vaginal morbidity. It will focus on quantitative and qualitative reports of brachytherapy-related vaginal toxicity and sexual dysfunction. Lastly, it will review the available evidence supporting clinical interventions to mitigate the development and progression of vaginal and sexual sequelae to improve functional quality post-treatment.
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Affiliation(s)
- Christine Chin
- Radiation Oncology, Columbia University Irving Medical Center New York, New York, NY.
| | - Shari Damast
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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13
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Identification of Risk Factors for Sexual Dysfunction after Multimodal Therapy of Locally Advanced Rectal Cancer and Their Impact on Quality of Life: A Single-Center Trial. Cancers (Basel) 2022; 14:cancers14235796. [PMID: 36497279 PMCID: PMC9736520 DOI: 10.3390/cancers14235796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/13/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Sexual function is crucial for the quality of life and can be highly affected by preoperative therapy and surgery. The aim of this study was to identify potential risk factors for poor sexual function and quality of life. METHODS Female patients were asked to complete the Female Sexual Function Index (FSFI-6). Male patients were demanded to answer the International Index of Erectile Function (IIEF-5). RESULTS In total, 79 patients filled in the questionary, yielding a response rate of 41.57%. The proportion of women was represented by 32.91%, and the median age was 76.0 years (66.0-81.0). Sexual dysfunction appeared in 88.46% of female patients. Severe erectile dysfunction occurred in 52.83% of male patients. Univariate analysis showed female patients (OR: 0.17, 95%CI: 0.05-0.64, p = 0.01), older age (OR: 0.34, 95%CI 0.11-1.01, p = 0.05), tumor localization under 6cm from the anal verge (OR: 4.43, 95%CI: 1.44-13.67, p = 0.01) and extension of operation (APR and ISR) (OR: 0.13, 95%CI: 0.03-0.59, p = 0.01) as significant risk factors for poor outcome. Female patients (OR: 0.12, 95%CI: 0.03-0.62, p = 0.01) and tumors below 6 cm from the anal verge (OR: 4.64, 95%CI: 1.18-18.29, p = 0.03) were shown to be independent risk factors for sexual dysfunction after multimodal therapy in the multivariate analysis. Quality of life was only affected in the case of extensive surgery (p = 0.02). CONCLUSION Higher Age, female sex, distal tumors and extensive surgery (APR, ISR) are revealed risk factors for SD in this study. Quality of life was only affected in the case of APR or ISR.
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14
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Gough K, Bergin RJ, Drosdowsky A, Aranda S, Mileshkin L, Jackson M, Kinnane N, Bernshaw D, Juraskova I, White K, Mohamed M, Schofield P. Women with gynaecological cancer awaiting radiotherapy: Self-reported wellbeing, general psychological distress, symptom distress, sexual function, and supportive care needs. Gynecol Oncol 2022; 167:42-50. [PMID: 36064679 DOI: 10.1016/j.ygyno.2022.08.008] [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: 05/25/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better serve women with gynaecological cancers, we need a sound understanding of their health, wellbeing and needs. This study sought to explore these issues in a sample of Australian women before commencing curative radiotherapy. METHODS We undertook a secondary analysis of baseline data from a supportive care trial (n = 311). Descriptive statistics were used to summarise responses to measures of wellbeing, general psychological distress, symptom distress, sexual function and vaginal changes, and supportive care needs. Pre-specified regression models were used to examine sources of variation in wellbeing and sexual function. RESULTS Women reported lower emotional, functional and physical wellbeing than population norms (all p < 0.001). The prevalence of general psychological distress was 31% (95% CI 26-36%). Distress caused by physical symptoms was typically low. Health system and information needs comprised eight of the top ten moderate-to-high supportive care needs. Most women reported no change in interest for physical contact or sex compared to pre-diagnosis, but some sexually active women (16-24%) reported smaller vaginal size, increased dryness, and more pain on intercourse. General psychological distress was a robust marker of poorer wellbeing and sexual function. CONCLUSIONS Before radiotherapy, a substantial minority of women with gynaecological cancers experience general psychological distress, reduced wellbeing and moderate-to-high health system and information needs. A model of comprehensive care incorporating assessment of unmet needs, general psychological distress, and sexual issues is recommended. Healthcare providers may require training to elicit and respond to a constellation of interrelated issues and access relevant services for women requiring additional support.
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Affiliation(s)
- Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC 3052, Australia.
| | - Rebecca Jane Bergin
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria, Australia; Department of General Practice and Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Drosdowsky
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sanchia Aranda
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC 3052, Australia
| | - Linda Mileshkin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Jackson
- School of Clinical Medicine, Randwick Campus, UNSW Sydney, New South Wales, Australia
| | - Nicole Kinnane
- Gynaecology Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Bernshaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ilona Juraskova
- Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kate White
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Cancer Care Research Unit, Sydney Local Health District, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, New South Wales, Australia
| | - Mustafa Mohamed
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Department of Psychological Sciences, Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
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15
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Martins J, Vaz AF, Grion RC, Costa-Paiva L, Baccaro LF. Correction to: Topical estrogen, testosterone, and vaginal dilator in the prevention of vaginal stenosis after radiotherapy in women with cervical cancer: a randomized clinical trial. BMC Cancer 2021; 21:811. [PMID: 34266416 PMCID: PMC8281714 DOI: 10.1186/s12885-021-08543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jumara Martins
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Ana Francisca Vaz
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Regina Celia Grion
- Radiotherapy Section, Woman's Hospital - Caism/Unicamp, Campinas, SP, Brazil
| | - Lúcia Costa-Paiva
- Department of Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Luiz Francisco Baccaro
- Department of Gynecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
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