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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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Comparing the effects of self-selected MUsic versus predetermined music on patient ANXiety prior to gynaecological surgery: the MUANX randomized controlled trial. Trials 2021; 22:535. [PMID: 34389022 PMCID: PMC8362289 DOI: 10.1186/s13063-021-05511-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety is frequently observed in the preoperative setting. The negative impact of preoperative anxiety is well known. In the context of gynaecological surgery, anxiety is exacerbated by the fact that the intervention can have catastrophic repercussions on a woman's body image, sexuality, and psycho-affective well-being. Music listening is increasingly used as an alternative therapy for minimizing preoperative anxiety. Personal preferences, familiarity, and popularity may be key elements for an optimal relaxation response to music. This study aimed to determine whether listening to self-selected music decreases preoperative anxiety in women scheduled to undergo gynaecologic surgery compared with predetermined music from an application (MUSIC CARE®). METHODS The MUANX study was a single-blind, monocentric, parallel, superiority, randomized controlled trial. A total of 174 women were included and randomized in two groups between August 2017 and September 2018. Patients in the intervention group listened to the personal music playlist that they had created before being hospitalized. Patients in the control group listened to the predetermined playlist on the MUSIC CARE® application. All patients received standard nursing care and listened to 20 min of music 1 h before surgery. Anxiety scores were assessed before and after the music session using Spielberger's State-Trait Anxiety Inventory (STAI). RESULTS The mean age of the 171 evaluated patients was 41.5 years (SD = 10.0 years). Before the music session, the STAI state anxiety score was similar in the control group (M = 38.8, SD = 11.9) and the intervention group (M = 39.0, SD = 13.1). After the music session, this score had significantly decreased in both the control group (M = -7.2, SD = 9.0) and the intervention group (M = -5.5, SD = 6.6), with no significant difference in score reduction between groups. Physiological parameters were unchanged after the music session. No significant differences in postoperative measurements (pain intensity, hospitalization duration) were observed between the two groups. CONCLUSION Self-selected music is as effective as predetermined music for reducing patient anxiety before gynaecological surgery. As it has no side effects and is easily applicable in gynaecological surgical services, this non-drug intervention may be proposed by healthcare professionals in the management of preoperative anxiety. TRIAL REGISTRATION The MUANX trial (MUsic therapy on ANXiety) is registered at the US National Institutes of Health ( ClinicalTrials.gov ) #NCT03226834. Registered on 24 July 2017. https://clinicaltrials.gov/ct2/show/NCT03226834?term=muanx&draw=2&rank=1.
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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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Taylor AH, Tortolani D, Ayakannu T, Konje JC, Maccarrone M. (Endo)Cannabinoids and Gynaecological Cancers. Cancers (Basel) 2020; 13:E37. [PMID: 33375539 PMCID: PMC7795647 DOI: 10.3390/cancers13010037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
Gynaecological cancers can be primary neoplasms, originating either from the reproductive tract or the products of conception, or secondary neoplasms, representative of metastatic disease. For some of these cancers, the exact causes are unknown; however, it is recognised that the precise aetiopathogeneses for most are multifactorial and include exogenous (such as diet) and endogenous factors (such as genetic predisposition), which mutually interact in a complex manner. One factor that has been recognised to be involved in the pathogenesis and progression of gynaecological cancers is the endocannabinoid system (ECS). The ECS consists of endocannabinoids (bioactive lipids), their receptors, and metabolic enzymes responsible for their synthesis and degradation. In this review, the impact of plant-derived (Cannabis species) cannabinoids and endocannabinoids on gynaecological cancers will be discussed within the context of the complexity of the proteins that bind, transport, and metabolise these compounds in reproductive and other tissues. In particular, the potential of endocannabinoids, their receptors, and metabolic enzymes as biomarkers of specific cancers, such as those of the endometrium, will be addressed. Additionally, the therapeutic potential of targeting selected elements of the ECS as new action points for the development of innovative drugs will be presented.
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Affiliation(s)
- Anthony H. Taylor
- Endocannabinoid Research Group, Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester LE1 7RH, UK; (A.H.T.); (T.A.)
- Department of Molecular and Cell Biology, University of Leicester, Leicester LE1 7RH, UK
| | - Daniel Tortolani
- European Centre for Brain Research, IRCCS Santa Lucia Foundation, 00164 Rome, Italy;
| | - Thangesweran Ayakannu
- Endocannabinoid Research Group, Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester LE1 7RH, UK; (A.H.T.); (T.A.)
- Gynaecology Oncology Cancer Centre, Liverpool Women’s NHS Foundation Trust, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3GB, UK
| | - Justin C. Konje
- Endocannabinoid Research Group, Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester LE1 7RH, UK; (A.H.T.); (T.A.)
| | - Mauro Maccarrone
- European Centre for Brain Research, IRCCS Santa Lucia Foundation, 00164 Rome, Italy;
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Heo J, Chun M, Oh YT, Noh OK. Psychiatric comorbidities among endometrial cancer survivors in South Korea: a nationwide population-based, longitudinal study. J Gynecol Oncol 2018; 30:e15. [PMID: 30740948 PMCID: PMC6393629 DOI: 10.3802/jgo.2019.30.e15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 10/17/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This longitudinal study aimed to analyze the prevalence of mental disorders in endometrial cancer survivors in South Korea. METHODS We assessed mental disorders in a nationwide cohort of 8,155 patients who were diagnosed with endometrial cancer between January 1, 2010, and December 31, 2014. We categorized the prevalence of mental disorders based on age and time of diagnosis. RESULTS Based on the first diagnosis, mental disorders were identified in 567 (7.0%) among patients with endometrial cancer. Of those patients, 249 (43.9%) were diagnosed with depression and 248 (43.7%) with anxiety. The overall incidence of mental disorders peaked within 2 months after hysterectomy. The rate of stress reaction/adjustment disorder increased most rapidly among the mental disorders after hysterectomy. While depression rates were relatively high among younger individuals (under 50 years), anxiety was more frequent in older people (over 50 years old). In the entire prescription (n=6,034), depression had the highest incidence (n=3,801), followed by anxiety (n=1,774). Over 89% (n=5,362) of the mental disorder treatment claims were from psychiatric medical departments. CONCLUSION Mental disorders showed different prevalence patterns among endometrial cancer survivors depending on patient age and the nature of the disease. Intensive and personalized management of distress is necessary for endometrial cancer survivors.
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Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Young Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.,Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea.
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Contributions of the Japanese Gynecologic Oncology Group (JGOG) in Improving the Quality of Life in Women With Gynecological Malignancies. Curr Oncol Rep 2017; 19:25. [PMID: 28303492 DOI: 10.1007/s11912-017-0580-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Japanese Gynecologic Oncology Group (JGOG) is leading Japan in the treatment of gynecological malignancies. The JGOG consists of three treatment committees focusing on uterine cervical cancer, endometrial cancer, and ovarian cancer. Each committee makes efforts to improve treatment and diagnosis. In addition, the Supportive and Palliative Care Committee was established in 2015. Novel studies of supportive care and palliative care have been initiated by this committee. Furthermore, surveys about not only treatment results such as overall survival rates but also quality of life (QOL) and cost-effectiveness assessments are performed by the ovarian cancer committee. Improvements of patients' QOL in the treatment of gynecological malignancies were divided into three concepts as follows: QOL associated with cancer treatment, health care after cancer therapy, and progression of cancer. In this review, we report the contributions and future plans for the improvement of QOL in patients with gynecological malignancies.
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