Improving Patient Compliance with Vaginal Dilator Therapy by Implementation of Sexual Health Consult in Gynecologic Malignancies after Radiation Therapy

PURPOSE/OBJECTIVE(S)

Typical vaginal dilator therapy (VDT) compliance falls short at approximately 30% of patients in reported studies, which could lead to vaginal stenosis (VS) in as high as 88% of patients who undergo radiation therapy (RT) for gynecologic malignancies. In an ongoing effort to improve adherence to VDT aimed to prevent vaginal stenosis post pelvic and vaginal RT, a prospective study was implemented to assess the feasibility and the impact on vaginal dilator therapy adherence when implementing a consult with the oncology women's sexual health clinic following the completion of radiation therapy.

MATERIALS/METHODS

This was a single institution, prospective analysis and feasibility study that included patients diagnosed with a gynecologic cancer who were treated with RT to the pelvic and or vaginal tissues. Using purposive sampling, the treating radiation oncologists identified eligible patients and referred them to the oncology women's sexual health clinic for consult four to six weeks status post completion of RT in a six-month period. A post treatment survey was conducted via a telephone interview 12 weeks after the sexual health clinic initial consult to assess vaginal dilator therapy compliance. Descriptive statistics were calculated.

RESULTS

Pre-intervention retrospective data analysis revealed poor compliance to VDT with only 3 of 40 (7.5%) patients judged as compliant. Post-intervention, 30 of 37 (81.1%) patients in the sample were judged compliant. The adherence rate in the post-intervention group was significantly higher (Fisher's Exact Test two-tailed p-value < 0.0001). With confidence of 95%, the proportion of the potential population that would adhere post intervention was between 68.5% and 93.7%. Sociodemographic and clinical characteristics did not have a statistically significant correlation with VDT compliance.

CONCLUSION

Implementing a referral to an oncology women's sexual health clinic at the completion of RT for the sample population is feasible. Our project demonstrates that instituting this new sexual health clinic may have a large, positive impact on patient compliance to vaginal dilator therapy. More importantly, this may lead to decrease incidences of vaginal stenosis and improvement in patient health outcomes and quality of life (QoL).

Implementing an Additional Weekly Treatment Visit with an Advance Practice Provider to Reduce Hospitalizations and Improve Quality of Care in Patients Undergoing Radiation Therapy

PURPOSE/OBJECTIVE(S)

Patients undergoing chemotherapy and radiation therapy (RT) simultaneously are at an increased risk of developing complications and requiring hospitalization. To reduce acute hospital admissions, patients were seen in an additional weekly on treatment visit, named high risk on-treatment visits (HR OTVS) with a radiation oncology advanced practice provider to identify and manage treatment induced symptoms. With early identification and management of these symptoms, our goal was to improve patient's wellbeing and reduce the rate of hospitalizations while undergoing radiation therapy, limiting treatment breaks, and improving patient outcomes.

MATERIALS/METHODS

Oneyear of radiation therapy patients and their hospitalization rate during active radiation treatment was studied 2017. In 2018, the new quality implementation of HR OTVs was added at the end of the week (in addition to on-treatment visit day with the physician) for patients deemed high-risk of complications during radiation therapy. In 2019, one full year after implementation of HR OTVs, hospitalization rates were examined in patients undergoing radiation therapy and directly compared to hospitalization rates of 2017 before the new visit implementation.

RESULTS

In 2017,40 out of 417 patients undergoing RT in our department were admitted to the hospital versus 44 out of 668 patients in 2019. As a result of implementing APP lead HR OTVs, the inpatient hospitalization rate went from 9.6% down to 6.5%. Chi-square test confirmed this to be significant with p value 0.03 (p <0.5). Of the 40 patients hospitalized in 2017, 9 of those 40 were undergoing concurrent chemotherapy and radiation and 0% had additional high-risk visits. In 2019, 12 of the 44 admissions included patients receiving concurrent chemoradiation. Of these specific 12 patients, 4 saw APP weekly and 8 did not. If a patient was undergoing chemotherapy and radiation therapy and they saw the nurse practitioner weekly, they were less likely to be admitted to the hospital (33% versus 67%).

CONCLUSION

Utilizing advanced practice practitioners with weekly high-risk visits in addition to the routine on treatment visit can help identify, monitor, and manage treatment induced side effects, and in turn reduce hospitalization rates of patients undergoing radiation therapy.