Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy.

Autor: Suvaal I; Department of Obstetrics and Gynecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC Leiden, the Netherlands., Kirchheiner K; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Nout RA; Department of Radiotherapy, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands., Sturdza AE; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Van Limbergen E; Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium., Lindegaard JC; Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark., Putter H; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands., Jürgenliemk-Schulz IM; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., Chargari C; Department of Radiation Oncology, Institute Gustave-Roussy, Paris, France., Tanderup K; Department of Radiation Oncology, Aarhus University Hospital, Aarhus, Denmark., Pötter R; Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Creutzberg CL; Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands., Ter Kuile MM; Department of Obstetrics and Gynecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC Leiden, the Netherlands. Electronic address: M.M.ter_Kuile@lumc.nl.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2023 Mar; Vol. 170, pp. 123-132. Date of Electronic Publication: 2023 Jan 20.
DOI: 10.1016/j.ygyno.2023.01.005
Abstrakt: 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.
Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: