Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T12:38:53.918Z Has data issue: false hasContentIssue false

Patient compliance with the use of vaginal dilators following pelvic radiotherapy for a gynaecological cancer

Published online by Cambridge University Press:  15 March 2011

Lisa Punt*
Affiliation:
Cambridge University Hospitals NHS foundation Trust, Cambridge, UK Sheffield Hallam University, Sheffield, UK
*
Correspondence to: Mrs Lisa Punt, Oncology Centre, Box 193, Addenbrooke’s Hospital, Cambridge CB20QQ, UK. E-mail: [email protected]

Abstract

Background: In July 2005 the national forum of gynaecological oncology nurses published the first UK best practice guidelines for the use of vaginal dilators after pelvic radiotherapy. It was written following a Cochrane review by Denton and Maher suggesting that vaginal dilators minimised vaginal stenosis and improved sexual function. Women within the author’s large cancer centre are advised to use vaginal dilators in accordance with the national recommendations.

Primary outcome measure: To evaluate compliance with the use of vaginal dilators in women who have received radiotherapy for either cervix or endometrial cancer. Compliance was defined as the use of vaginal dilators two or more times a week, at 6 months.

Design: One hundred and sixty-four women were posted questionnaires. Potential participants had received pelvic radiotherapy for cancer of the cervix or endometrium, were 6 months to 5 years post-treatment and disease free. The 18-point questionnaire consisted of 11 points assessing demographics and dilator use, while points 12–18 related to vaginal symptoms. Simple descriptive statistics were used to describe demographics. Mann–Whitney U and Fisher’s exact tests were used for one-at-a-time analysis of compliance against age, vaginal symptoms, treatment modality and cancer type.

Results: Seventy-five completed questionnaires were returned (response rate 45.7%). Seventy-four out of the 75 respondents had been offered vaginal dilators during treatment. 89.2% (66/74) were compliant with vaginal dilation (95% confidence interval 80.1% to 94.4%).

Conclusion: The compliance rate in this study was greater than seen in previously published studies. This could be due to the intervention by practitioners within the author’s cancer centre. Further prospective evaluation studies are required to explore the potential benefits of intervention at 6 months post-treatment to improve long-term compliance.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Greimel, E, Winter, R, Kapp, K, Haas, J. Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psych-Oncology 2008; 18:476482.CrossRefGoogle Scholar
Stead, ML, Fallowfield, L, Selby, P, Brown, JM. Psychosexual function and impact of gynaecological cancer. Best Pract Res Clin Obstet Gynaecol 2007; 21:309320.CrossRefGoogle ScholarPubMed
Jenson, P. Gynaecological cancer and sexual functioning: does treatment modality have an impact? Sexologies 2007; 16:279285.CrossRefGoogle Scholar
Graziottin, A, Serafini, A, Palacios, S. Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction. Maturitas 2009; 63:128134.CrossRefGoogle ScholarPubMed
Cartwright-Alcarese, F. Addressing sexual dysfunction following radiation therapy for a gynaecological malignancy. Oncology Nurse Forum 1995; 22:12271232.Google Scholar
Bertelsen, K. Sexual dysfunction after treatment of cervical cancer. Dan Med Bull 1983; 30(Suppl 2):3134.Google ScholarPubMed
Abitbol, MM, Davenport, JH. Sexual dysfunction after therapy for cervical carcinoma. Am J Obstet Gynecol 1974; 119:181189.CrossRefGoogle ScholarPubMed
Bruner, DW, Lanciano, R, Keegan, M, Corn, B, Martin, E, Hanks, GE. Vaginal stenosis and sexual function following intracavity radiation for the treatment of cervical and endometrial carcinoma. Int J Radiat Oncolo Biol Phys 1993; 27:825830.CrossRefGoogle Scholar
Flay, L, Matthews, J. The effects of radiotherapy on the sexual function of women treated for cervical cancer. Int J Radiat Oncolo Biol Phys 1995; 31:399404.CrossRefGoogle ScholarPubMed
Bergmark, K, Avall-Lundqvist, E, Dickman, PW, Henningsohn, L, Steineck, G. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 1999; 340:13831389.CrossRefGoogle ScholarPubMed
Punt, L. Psychosexual problems in gynaecological malignancy. In: Booth, S, Bruera, E. Oxford Palliative Care Consultations. First edition. Oxford: Oxford University Press 2004.Google Scholar
Nunns, D, Williamson, K, Swaney, L, Davy, M. The morbidity of surgery and adjuvant radiotherapy in the management of endometrial carcinoma. Int J Gynecol Cancer 2000; 10:233238.CrossRefGoogle ScholarPubMed
Denton, AS, Maher, EJ. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database Syst Rev 2003; 1:CD003750.Google Scholar
Poma, P. Post-irradiation vaginal occlusion: non-operative management. Int J Gynaecol Obstet 1980; 18:9092.CrossRefGoogle Scholar
Hartman, P, Diddle, AW. Vaginal stenosis following irradiation therapy for carcinoma of the cervix uteri. Cancer 1972; 30:426429.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Decruze, S, Guthrie, D, Magnani, R. Prevention of vaginal stenosis in patients following brachytherapy. Clin Oncol 1999; 11:4648.CrossRefGoogle ScholarPubMed
Schover, LR, Fife, M, Gershenson, DM. Sexual dysfunction and treatment for early stage cervical cancer. Cancer 1989; 63:204212.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Robinson, JW, Faris, PD, Scott, CB. Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynaecological carcinoma treated with radiotherapy. Int J Radiat Oncolo Biol Phys 1999; 44:497506.CrossRefGoogle ScholarPubMed
Jeffries, SA, Robinson, JW, Craighead, PS, Keats, MR. An effective group psychoeducational intervention for improving compliance with vaginal dilation: a randomized controlled trial. Int J Radiat Oncol Biol Phys 2006; 65:404411.CrossRefGoogle ScholarPubMed
Tourangeau, R, Yan, T. Sensitive questions in surveys. Psychol Bull 2007; 133:859883.CrossRefGoogle ScholarPubMed
Frykholm, G, Pahlman, L, Glimelius, B. Combined chemo-and radiotherapy vs. radiotherapy alone in the treatment of primary, non-resectable adenocarcinoma of the rectum. Int J Radiat Oncol Biol Phys 2001; 50:427434.CrossRefGoogle Scholar
Tan, LT, Zahra, M. Long-term survival and late toxicity after chemoradiotherapy for cervical cancer–the Addenbrooke’s experience. Clin Oncol (R Coll Radiol) 2008; 20:358364.CrossRefGoogle ScholarPubMed