Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy?
Identifieur interne : 004650 ( Ncbi/Merge ); précédent : 004649; suivant : 004651Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy?
Auteurs : I D White [Royaume-Uni] ; H. Allan [Royaume-Uni] ; S. Faithfull [Royaume-Uni]Source :
- British Journal of Cancer [ 0007-0920 ] ; 2011.
Abstract
Oncology follow-up has traditionally prioritised disease surveillance and the assessment and management of symptoms associated with cancer and its treatment. Over the past decade, the focus on late effects of treatment has increased, particularly those that have an adverse effect on long-term function and quality of life. The aim of this research was to explore factors that influence the identification of treatment-induced female sexual difficulties in routine oncology follow-up after radical pelvic radiotherapy.
A structured observation schedule was used to systematically record topics discussed in 69 radiotherapy follow-up consultations observed over a 5-month period.
Analysis suggests that physical toxicity assessment focused on bowel (81%) and bladder (70%) symptoms. Vaginal toxicity was discussed less frequently (42%) and sexual issues were explored in only 25% of consultations. Formal recording of radiation toxicity through assessment questionnaires was limited to patients participating in clinical trials. Surveillance activity and the management of active physical symptoms predominated and psychosocial issues were addressed in only 42% of consultations.
Female sexual morbidity after pelvic radiotherapy remains a neglected aspect of routine follow-up and cancer survivorship. Developments in both individual practice and service provision are necessary if the identification and management of treatment-induced female sexual difficulties is to be improved.
Url:
DOI: 10.1038/bjc.2011.339
PubMed: 21897386
PubMed Central: 3185952
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy?</title>
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, 57 Waterloo Road, London SE1 8WA,<country>UK</country>
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, Guildford GU2 7TE,<country>UK</country>
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<author><name sortKey="Faithfull, S" sort="Faithfull, S" uniqKey="Faithfull S" first="S" last="Faithfull">S. Faithfull</name>
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<series><title level="j">British Journal of Cancer</title>
<idno type="ISSN">0007-0920</idno>
<idno type="eISSN">1532-1827</idno>
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<front><div type="abstract" xml:lang="en"><sec><title>Background:</title>
<p>Oncology follow-up has traditionally prioritised disease surveillance and the assessment and management of symptoms associated with cancer and its treatment. Over the past decade, the focus on late effects of treatment has increased, particularly those that have an adverse effect on long-term function and quality of life. The aim of this research was to explore factors that influence the identification of treatment-induced female sexual difficulties in routine oncology follow-up after radical pelvic radiotherapy.</p>
</sec>
<sec><title>Methods:</title>
<p>A structured observation schedule was used to systematically record topics discussed in 69 radiotherapy follow-up consultations observed over a 5-month period.</p>
</sec>
<sec><title>Results:</title>
<p>Analysis suggests that physical toxicity assessment focused on bowel (81%) and bladder (70%) symptoms. Vaginal toxicity was discussed less frequently (42%) and sexual issues were explored in only 25% of consultations. Formal recording of radiation toxicity through assessment questionnaires was limited to patients participating in clinical trials. Surveillance activity and the management of active physical symptoms predominated and psychosocial issues were addressed in only 42% of consultations.</p>
</sec>
<sec><title>Interpretation:</title>
<p>Female sexual morbidity after pelvic radiotherapy remains a neglected aspect of routine follow-up and cancer survivorship. Developments in both individual practice and service provision are necessary if the identification and management of treatment-induced female sexual difficulties is to be improved.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Br J Cancer</journal-id>
<journal-title-group><journal-title>British Journal of Cancer</journal-title>
</journal-title-group>
<issn pub-type="ppub">0007-0920</issn>
<issn pub-type="epub">1532-1827</issn>
<publisher><publisher-name>Nature Publishing Group</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21897386</article-id>
<article-id pub-id-type="pmc">3185952</article-id>
<article-id pub-id-type="pii">bjc2011339</article-id>
<article-id pub-id-type="doi">10.1038/bjc.2011.339</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Clinical Study</subject>
</subj-group>
</article-categories>
<title-group><article-title>Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy?</article-title>
<alt-title alt-title-type="running">Assessment of female sexual morbidity after pelvic radiotherapy</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>White</surname>
<given-names>I D</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="caf1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Allan</surname>
<given-names>H</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Faithfull</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<aff id="aff1"><label>1</label>
<institution>Supportive Cancer Care Research Group, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, King's College</institution>
, 57 Waterloo Road, London SE1 8WA,<country>UK</country>
</aff>
<aff id="aff2"><label>2</label>
<institution>Division of Health and Social Care, Faculty of Health and Medical Sciences, University of Surrey, Stag Hill</institution>
, Guildford GU2 7TE,<country>UK</country>
</aff>
</contrib-group>
<author-notes><corresp id="caf1"><label>*</label>
E-mail: <email>isabella.white@kcl.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>27</day>
<month>09</month>
<year>2011</year>
</pub-date>
<pub-date pub-type="epub"><day>06</day>
<month>09</month>
<year>2011</year>
</pub-date>
<volume>105</volume>
<issue>7</issue>
<fpage>903</fpage>
<lpage>910</lpage>
<history><date date-type="received"><day>20</day>
<month>05</month>
<year>2011</year>
</date>
<date date-type="rev-recd"><day>28</day>
<month>07</month>
<year>2011</year>
</date>
<date date-type="accepted"><day>02</day>
<month>08</month>
<year>2011</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2011 Cancer Research UK</copyright-statement>
<copyright-year>2011</copyright-year>
<copyright-holder>Cancer Research UK</copyright-holder>
</permissions>
<abstract><sec><title>Background:</title>
<p>Oncology follow-up has traditionally prioritised disease surveillance and the assessment and management of symptoms associated with cancer and its treatment. Over the past decade, the focus on late effects of treatment has increased, particularly those that have an adverse effect on long-term function and quality of life. The aim of this research was to explore factors that influence the identification of treatment-induced female sexual difficulties in routine oncology follow-up after radical pelvic radiotherapy.</p>
</sec>
<sec><title>Methods:</title>
<p>A structured observation schedule was used to systematically record topics discussed in 69 radiotherapy follow-up consultations observed over a 5-month period.</p>
</sec>
<sec><title>Results:</title>
<p>Analysis suggests that physical toxicity assessment focused on bowel (81%) and bladder (70%) symptoms. Vaginal toxicity was discussed less frequently (42%) and sexual issues were explored in only 25% of consultations. Formal recording of radiation toxicity through assessment questionnaires was limited to patients participating in clinical trials. Surveillance activity and the management of active physical symptoms predominated and psychosocial issues were addressed in only 42% of consultations.</p>
</sec>
<sec><title>Interpretation:</title>
<p>Female sexual morbidity after pelvic radiotherapy remains a neglected aspect of routine follow-up and cancer survivorship. Developments in both individual practice and service provision are necessary if the identification and management of treatment-induced female sexual difficulties is to be improved.</p>
</sec>
</abstract>
<kwd-group><kwd>pelvic radiotherapy toxicity</kwd>
<kwd>sexual morbidity</kwd>
<kwd>assessment</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="fig1"><label>Figure 1</label>
<caption><p>Range of topics discussed during women's consultations with medical staff.</p>
</caption>
<graphic xlink:href="bjc2011339f1"></graphic>
</fig>
<fig id="fig2"><label>Figure 2</label>
<caption><p>Sexual issues discussed in follow-up consultations with medical staff.</p>
</caption>
<graphic xlink:href="bjc2011339f2"></graphic>
</fig>
<table-wrap id="tbl1"><label>Table 1</label>
<caption><title>Patient demographics in observed consultations</title>
</caption>
<table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col>
<col align="char" char="("></col>
</colgroup>
<thead valign="bottom"><tr><th align="left" valign="top" charoff="50"><bold>Patient demographics</bold>
</th>
<th align="char" valign="top" char="(" charoff="50"><bold>No. (%) (<italic>n</italic>
=69)</bold>
</th>
</tr>
</thead>
<tbody valign="top"><tr><td align="left" valign="top" charoff="50">Cervical cancer</td>
<td align="char" valign="top" char="(" charoff="50">20 (29%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50">Endometrial cancer</td>
<td align="char" valign="top" char="(" charoff="50">30 (43.5%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50">Anal cancer</td>
<td align="char" valign="top" char="(" charoff="50">5 (7.2%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50">Rectal cancer</td>
<td align="char" valign="top" char="(" charoff="50">14 (20.3%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"><italic>Clinical stage</italic>
</td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"> I/II</td>
<td align="char" valign="top" char="(" charoff="50">29 (43.3%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"><italic>Clinical stage</italic>
</td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"> III/IV</td>
<td align="char" valign="top" char="(" charoff="50">38 (56.7%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"><italic>Treatment type</italic>
</td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"> CTRT</td>
<td align="char" valign="top" char="(" charoff="50">31 (44.9%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> EBBRA</td>
<td align="char" valign="top" char="(" charoff="50">32 (46.4%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> EBRT</td>
<td align="char" valign="top" char="(" charoff="50">6 (8.7%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50">Time post-RT <6 months</td>
<td align="char" valign="top" char="(" charoff="50">31 (44.9%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50">Time post-RT 6–11 months</td>
<td align="char" valign="top" char="(" charoff="50">9 (13%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50">Time post-RT ⩾12 months</td>
<td align="char" valign="top" char="(" charoff="50">29 (42%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50">Age of woman ⩽60 years</td>
<td align="char" valign="top" char="(" charoff="50">32 (46.4%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50">Age of woman >60 years</td>
<td align="char" valign="top" char="(" charoff="50">37 (53.6%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"><italic>Relationship status</italic>
</td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"> Partner</td>
<td align="char" valign="top" char="(" charoff="50">48 (69.6%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> No partner</td>
<td align="char" valign="top" char="(" charoff="50">14 (20.3%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> Status not known</td>
<td align="char" valign="top" char="(" charoff="50">7 (10.1%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"><italic>Woman accompanied at consultation</italic>
</td>
<td align="char" valign="top" char="(" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50"> Yes</td>
<td align="char" valign="top" char="(" charoff="50">30 (43.5%)</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> No</td>
<td align="char" valign="top" char="(" charoff="50">39 (56.5%)</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="t1-fn1"><p>Abbreviations: CTRT, chemoradiotherapy; EBRT, external beam pelvic radiotherapy; EBBRA, external beam radiotherapy and vaginal brachytherapy.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tbl2"><label>Table 2</label>
<caption><title>Strategies to enhance discussion of treatment-induced female sexual morbidity in oncology practice</title>
</caption>
<table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col>
<col align="left"></col>
</colgroup>
<thead valign="bottom"><tr><th align="left" valign="top" charoff="50"><bold>Perceived barrier</bold>
</th>
<th align="left" valign="top" charoff="50"><bold>Practice recommendation</bold>
</th>
</tr>
</thead>
<tbody valign="top"><tr><td align="left" valign="top" charoff="50">Clinician embarrassment</td>
<td align="left" valign="top" charoff="50">Advanced communication skills training
Clinical supervision (group) and case discussions
Training in psychosexual medicine</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50">Lack of knowledge/skills in the assessment of female sexual dysfunction</td>
<td align="left" valign="top" charoff="50">Development of PROM for treatment-related female sexual morbidity
Use of structured patient self-report questionnaires in oncology follow-up to guide consultation agenda
Staff training on sexual history taking</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50">Lack of knowledge in management of treatment-induced sexual difficulties</td>
<td align="left" valign="top" charoff="50">Development of clinical guidelines for commonly encountered female sexual difficulties, including sexual aversion/fear, reduced/absent desire, sexual pain, arousal and orgasmic disorders and reduced sexual satisfaction
Training in psychosexual medicine</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50">Lack of knowledge of specialist services for sexual dysfunction</td>
<td align="left" valign="top" charoff="50">Development of information resource for patients and clinicians regarding websites, patient information resources and local sexual counselling services
Development of agreed clinical management pathways and referral routes within/beyond the cancer centre</td>
</tr>
<tr><td align="left" valign="top" charoff="50"> </td>
<td align="left" valign="top" charoff="50"> </td>
</tr>
<tr><td align="left" valign="top" charoff="50">Inadequate resources/time to address sexual concerns in routine medical follow-up</td>
<td align="left" valign="top" charoff="50">Development of advanced practice nursing roles for high-risk patient groups (breast, colorectal, gynae-oncology, urology services)
Establish nurse-led survivorship programmes/services for range of treatment consequences, including sexual dysfunction
Development of psychosexual practice within psycho-oncology services
Development of cancer survivorship expertise in primary care roles/services</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="t2-fn1"><p>Abbreviations: PROM, patient reported outcome measures.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Royaume-Uni</li>
</country>
</list>
<tree><country name="Royaume-Uni"><noRegion><name sortKey="White, I D" sort="White, I D" uniqKey="White I" first="I D" last="White">I D White</name>
</noRegion>
<name sortKey="Allan, H" sort="Allan, H" uniqKey="Allan H" first="H" last="Allan">H. Allan</name>
<name sortKey="Faithfull, S" sort="Faithfull, S" uniqKey="Faithfull S" first="S" last="Faithfull">S. Faithfull</name>
</country>
</tree>
</affiliations>
</record>
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