ABSTRACT
PURPOSE: Pelvic health issues after treatment for gynecological cancer are common. Due to challenges in accessing physiotherapy services, exploring virtual pelvic healthcare is essential. This study aims to understand needs, preferences, barriers, and facilitators for a virtual pelvic healthcare program for gynecological cancer survivors. METHODS: A multi-center, sequential mixed-methods study was conducted. An anonymous online survey (N=50) gathered quantitative data on pelvic health knowledge, opportunities, and motivation. Focus groups (N=14) explored patient experiences and consensus on pelvic health interventions and virtual delivery. Quantitative data used descriptive statistics, and focus group analyses employed inductive thematic analysis. Findings were mapped to the capability, opportunity, and motivation (COM-B) behavior change model. RESULTS: Participants reported lacking knowledge about pelvic health interventions and capability related to the use of vaginal dilators and continence care. Barriers to opportunity included lack of healthcare provider-initiated pelvic health discussions, limited time in clinic with healthcare providers, finding reliable information, and cost of physical therapy pelvic health services. Virtual delivery was seen favorably and may help to address motivational barriers related to embarrassment and frustration with care. CONCLUSION: Awareness of pelvic healthcare is lacking among people treated for gynecological cancer. Virtual delivery of pelvic health interventions is perceived as a solution to enhance access while minimizing travel, cost, embarrassment, and exposure risks. IMPLICATIONS FOR CANCER SURVIVORS: A better understanding of the pelvic health needs of individuals following gynecological cancer treatments enables the development of tailored virtual pelvic health rehabilitation interventions which may improve access to pelvic health survivorship care.
ABSTRACT
INTRODUCTION: Vaginal pain during intercourse and urinary incontinence are common complaints after gynaecological cancer treatments. Pelvic health physiotherapy treatments aim at optimising function through education on the use of vaginal moisturisers, dilation therapy programme and pelvic floor muscle training. Given that barriers such as time, travel, and costs are known to limit access to physiotherapy services, a virtual pelvic health physiotherapy programme may help to facilitate access. The primary objective of this study is to identify preferences, barriers and facilitators from individuals with gynaecological cancer regarding virtual pelvic healthcare survivorship care. METHODS AND ANALYSIS: This patient-oriented, mixed-methods study will involve an online cross-sectional survey data (phase I) and qualitative data from a series of virtual focus groups (phase II). PHASE I: an anonymous survey will be used to assess the demographics, health status, prevalence of urogenital symptoms, as well as knowledge, barriers and facilitators to pelvic health services of people with gynaecological cancer. A total of N=50 participants from Canada will be recruited through convenience and self-selection sampling. PHASE II: a series of virtual semi-structured focus groups will be conducted with 10-15 participants on key topics related to virtual pelvic healthcare. Interviews will be audio-recorded and transcribed, from which key themes and quotes will be identified. An interpretive description qualitative method will guide analysis and implementation of results. ETHICS AND DISSEMINATION: Approval from the Health Research Ethics Board of Alberta-Cancer Committee (HREBA.CC-21-0498) and of the CISSS Bas-Saint-Laurent (CISSSBSL-2021-10) have been obtained. Informed, electronically signed consent will be required from all participants. Results from this work will be published in a peer-reviewed journal and will be used to inform the development and implementation of a new Pelvic eHealth Module for individuals treated for gynaecological cancers. This module will be incorporated into a comprehensive educational and exercise programme offered by a web-based application.
Subject(s)
Delivery of Health Care , Neoplasms , Female , Humans , Qualitative Research , Cross-Sectional Studies , Pelvic Floor , AlbertaABSTRACT
INTRODUCTION: To identify risk factors for PSA bounce (PSAb) and compare characteristics of prostate cancer patients treated with brachytherapy and external beam radiotherapy (EBRT). MATERIALS AND METHODS: We identified 362 patients treated for low risk prostate adenocarcinoma (D'Amico criteria) with a follow up time of at least 36 months. Patients received either: 1) EBRT 76 Gy in 38 fractions (n = 58); 2) hypofractionated EBRT, 45 Gy in 9 once-weekly fractions (n = 74); 3) seed brachytherapy (n = 230). PSAb was defined as a rise >= 0.2 ng/mL with subsequent return to baseline within the first 3 years after treatment. Univariate and multivariate logistic regression models were estimated to assess the association between clinical factors and occurrence of PSAb. RESULTS: There was no significant difference between treatment groups (p = 0.349), with an overall PSAb rate of 28.5%. Upon univariate analysis, the following were predictive of a lower PSAb rate: older age (OR = 0.96), higher PSA at diagnosis (OR = 0.87), more positive biopsy cores (OR = 0.98), and a higher Cancer of the Prostate Risk Assessment (CAPRA) score (CAPRA of 3 versus 1: OR = 0.33). Multivariate analysis confirmed the significance of fewer positive biopsy cores (OR = 0.99) and a lower CAPRA score (CAPRA 3 versus 1: OR = 0.34). These factors also predicted a shorter time to first PSAb. CONCLUSIONS: We found comparable rates of PSAb after different regimens of radiotherapy. We hypothesize that it results from late damage to healthy prostatic tissue. This idea is supported by the fact that we found that clinical factors indicative of a lower tumor burden were predictive of a PSAb.
