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1.
Acta Oncol ; 63: 230-239, 2024 Apr 29.
Article in English | MEDLINE | ID: mdl-38682457

ABSTRACT

AIM: The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer. METHODS: Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers. RESULTS: Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01). DISCUSSION: There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.


Subject(s)
Pelvic Neoplasms , Psychosocial Intervention , Sexual Health , Humans , Pelvic Neoplasms/psychology , Pelvic Neoplasms/complications , Psychosocial Intervention/methods , Cancer Survivors/psychology , Female , Quality of Life
2.
Health Qual Life Outcomes ; 19(1): 20, 2021 Jan 15.
Article in English | MEDLINE | ID: mdl-33451330

ABSTRACT

BACKGROUND: Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients' quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically. METHODS: A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion. RESULTS: A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting. CONCLUSIONS: This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.


Subject(s)
Abdominal Neoplasms/psychology , Abdominal Neoplasms/therapy , Patient Reported Outcome Measures , Patient Satisfaction/statistics & numerical data , Pelvic Neoplasms/psychology , Pelvic Neoplasms/therapy , Quality of Life/psychology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Professional Practice Gaps
3.
J Med Radiat Sci ; 67(2): 100-101, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32452091

ABSTRACT

How can we better understand and improve our practice around the physical and psychological well-being of women treated with radiation therapy for pelvic malignancy? In this issue, Summerfield et al report the results of a nationwide survey capturing practices around the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS) across New Zealand. This study highlights the need for oncologists to improve care around a challenging but critically important aspect of women's health beyond a cancer diagnosis.


Subject(s)
Pelvic Neoplasms/physiopathology , Pelvic Neoplasms/psychology , Quality of Health Care , Sexual Health , Adult , Female , Humans , Pelvic Neoplasms/therapy , Quality of Life , Surveys and Questionnaires
4.
Support Care Cancer ; 28(6): 2669-2681, 2020 Jun.
Article in English | MEDLINE | ID: mdl-31641868

ABSTRACT

OBJECTIVE: To investigate the frequency of physical activity among female pelvic cancer survivors (i.e., gynecological, rectal, and anal cancer survivors) and to investigate if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and fecal leakage, clinical and sociodemographic characteristics, quality of life (QoL), and depressed and anxious mood. METHODS: Female pelvic cancer survivors (n = 578, mean age 64 years) answered a questionnaire 6-48 months after radiotherapy. A multivariable regression model analyzed factors covarying with frequency of physical activity. We compared QoL and depressed and anxious mood between women practicing physical activity at least or less than once a week. RESULTS: Of 568 women delivering data, 186 (33%) practiced physical activity less than once a week while 382 (67%) practiced physical activity at least weekly. Women who leaked a large or all volume of stools (p = 0.01), had just elementary school level of education (p < 0.001), smokers (p = 0.049), or had lymphedema without receiving lymphedema treatment (p = 0.030) were more likely to practice physical activity less than weekly (50%, 45%, 45%, and 37%, respectively) compared with other women. Women practicing physical activity at least weekly reported better QoL (p < 0.001) and lower frequency of depressed mood (p = 0.044) compared with the others. CONCLUSIONS: Female cancer survivors experiencing fecal leakage were less likely to practice weekly physical activity than survivors without leakage. The survivors practicing weekly physical activity experienced better QoL and experienced depressed mood less frequently than the others.


Subject(s)
Cancer Survivors/psychology , Exercise/physiology , Pelvic Neoplasms/psychology , Quality of Life/psychology , Adult , Aged , Anxiety/psychology , Depression/psychology , Female , Humans , Lymphedema , Middle Aged , Pelvic Neoplasms/radiotherapy , Surveys and Questionnaires , Survivors
5.
Sex Med Rev ; 7(4): 614-626, 2019 10.
Article in English | MEDLINE | ID: mdl-30926459

ABSTRACT

INTRODUCTION: A common negative sequela of cancer treatment in men is sexual dysfunction, which can have a significant psychological impact and can contribute to feelings of depression, anxiety, and other mental health issues. Management of cancer survivors' psychological and mental well-being plays an important role in the treatment and recovery process. AIM: To identify how sexual dysfunction impacts the lives of male cancer survivors and to provide clinicians with treatment recommendations specific to this patient population. METHODS: A total of 51 peer-reviewed publications related to sexual dysfunction in male cancer survivors were selected for analysis. Sources were chosen based on relevance to current cancer therapies, causes and psychological impacts of sexual dysfunction, and treatment recommendations for clinicians caring for cancer survivors. PubMed search terms included "sexual dysfunction," "cancer survivorship," and "male cancer survivors." MAIN OUTCOME MEASURES: Measures of sexual dysfunction were based on cancer survivors reporting inadequate erectile capacity for penetrative sexual intercourse, decreased sensitivity of the genitalia, or inability to enjoy sex. RESULTS AND CONCLUSIONS: Sexual dysfunction was present in male cancer survivors from diverse ages, cancer diagnoses, and treatments of cancer. Many of the men surveyed presented with psychological distress resulting from their posttreatment sexual dysfunction. This had a significant negative impact on their sexual self-esteem, body image, and mental health. Sexual and social development was delayed in survivors of childhood cancer. Healthcare practitioners should initiate conversations with patients regarding the potential for sexual dysfunction at the time of cancer diagnosis and throughout treatment and follow-up. Physical symptoms of sexual dysfunction should be treated, whenever possible, using phosphodiesterase 5 inhibitors or other interventions, and all cancer survivors presenting with psychological distress related to sexual dysfunction should be offered professional counseling. Twitchell DK, Wittmann DA, Hotaling JM, et al. Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship. Sex Med Rev 2019;7:614-626.


Subject(s)
Cancer Survivors/psychology , Pelvic Neoplasms/psychology , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunctions, Psychological/etiology , Adult Survivors of Child Adverse Events/psychology , Depressive Disorder/psychology , Erectile Dysfunction/psychology , Humans , Infertility, Male/psychology , Male , Mental Health , Motivation , Pelvic Neoplasms/therapy , Personal Satisfaction , Self Concept , Sexual Behavior
6.
Psicooncología (Pozuelo de Alarcón) ; 14(2/3): 279-294, jul.-dic. 2017. tab
Article in Spanish | IBECS | ID: ibc-167683

ABSTRACT

Objetivo: el presente estudio evalúa señales de depresión y ansiedad en mujeres con cáncer indicadas para cirugía de exenteración pélvica (EP), e identifica sus percepciones y sentimientos ante la EP. Método: Participaron en el estudio seis mujeres (37 a 64 años) que recibían tratamiento oncológico en un hospital del sur de Brasil. Las pacientes rellenaron una ficha de datos sociodemográficos y respondieron a la Escala Hospitalaria de Ansiedad y Depresión (HADS). También fueron realizadas entrevistas semiestructuradas. Resultados: En general, los resultados revelan reacciones emocionales a la indicación de EP para las participantes. Se verificó la presencia de ansiedad y depresión (50% y 66,7%, respectivamente) en el periodo preoperatorio. A partir del análisis de las entrevistas fue posible identificar dudas y temores sobre el resultado de la cirugía, así como sobre las expectativas de cura del cáncer. También aparecieron sentimientos de miedo, preocupación y ansiedad ante las ostomías. Conclusión: Estudios longitudinales pueden ampliar la comprensión del impacto de la EP, considerando también el periodo postoperatorio. Se subraya la necesidad de un seguimiento psicológico preoperatorio para mujeres indicadas para este procedimiento altamente especializado e invasivo (AU)


Objective: This study aimed to evaluate depression and anxiety in women with cancer who were referred for pelvic exenteration (PE), and to identify their perceptions and feelings regarding PE. Methods: Six women (aged between 37 and 64 years,) undergoing cancer treatment at a hospital in the city of Porto Alegre, Brazil, took part in the study. Sociodemographic data were collected and a semi-structured interview and the Hospital Anxiety and Depression Scale (HADS) were employed. Results: The overall findings revealed emotional implications related to PE. Anxiety and depression were experienced by the participants (50% and 66.7%, respectively) before the surgery. The interviews showed doubts and fears regarding the surgical outcomes as well as expectations for cancer cure. Anxiety, fear and worries associated with ostomies also emerged. Conclusion: Longitudinal studies may contribute to a broader understanding of the impact of this surgery, including the postoperative period. It is possible to highlight the need to psychological assistance before the surgery to women referred to this highly specialized and invasive medical procedure (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Pelvic Exenteration/psychology , Pelvic Neoplasms/psychology , Anxiety , Depression/psychology , Rectal Neoplasms/psychology , Urinary Bladder Neoplasms/psychology , Uterine Cervical Neoplasms/psychology
7.
Oncology (Williston Park) ; 31(4): 286-94, 2017 04 15.
Article in English | MEDLINE | ID: mdl-28412780

ABSTRACT

Sexual and urinary morbidities resulting from treatment of pelvic malignancies are common. These treatment sequelae are significantly bothersome to patients and challenging to address. Awareness of these complications is critical in order to properly counsel patients regarding potential side effects and to facilitate prompt diagnosis and management. Addressing these issues often necessitates a coordinated multidisciplinary approach; however, the effort required often translates into improvement in patient quality of life. Herein we review the sexual and urinary side effects that may arise during or after treatment of pelvic malignancies.


Subject(s)
Cancer Survivors/psychology , Pelvic Neoplasms/therapy , Humans , Pelvic Neoplasms/mortality , Pelvic Neoplasms/psychology , Quality of Life , Sexual Dysfunctions, Psychological/therapy , Urinary Incontinence, Stress/therapy
8.
Am J Hosp Palliat Care ; 34(6): 524-531, 2017 Jul.
Article in English | MEDLINE | ID: mdl-26936922

ABSTRACT

Pain is a common and debilitating symptom in pelvic cancer diseases. Failure in controlling this pain through pharmacological approaches calls for employing multimodal management and invasive techniques. Various strategies are commonly used for this purpose, including palliative radiotherapy, epidural medications and intrathecal administration of analgesic and local anesthetic drugs with pumps, and neural or plexus blockade. This review focuses on the features of minimally invasive palliative procedures (MIPPs), such as radiofrequency ablation, laser-induced thermotherapy, cryoablation, irreversible electroporation, electrochemotherapy, microwave ablation, and cementoplasty as well as their role in palliation of cancer pelvic pain. Despite the evidence of effectiveness and safety of these interventions, there are still many barriers to accessing MIPPs, including the availability of trained staff, the lack of precise criteria of indication, and the high costs.


Subject(s)
Cancer Pain/psychology , Cancer Pain/therapy , Minimally Invasive Surgical Procedures/psychology , Pain Management/psychology , Palliative Care/psychology , Pelvic Neoplasms/psychology , Pelvic Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Withholding Treatment
9.
Rozhl Chir ; 95(9): 358-462, 2016.
Article in Czech | MEDLINE | ID: mdl-27653304

ABSTRACT

INTRODUCTION: Multiorgan resections in the small pelvis are standard procedures in oncosurgery and some indications have no alternative. In advanced pelvic cancer, pelvic exenteration with en bloc resection of the involved organs and structures, including portions of the bony pelvis, is indicated. The 5-year survival rate is fairly good, around 50%, but little is known about the long-term quality of life. The aim was to describe the quality of life of long-term total pelvic exenteration survivors. METHOD: In total, 63 pelvic exenterations were performed between 2000 to 2015 at the Department of Surgery, Thomayer Hospital, First Faculty of Medicine, Charles University in Prague, mostly for primary or relapsed rectal cancer. In this retrospective cohort study, the quality of life was assessed using the EORTC QLQ-C30 (version 3.0) and the EORTC QLQ-CR29 questionnaires. The completed questionnaires were scored according to EORTC instructions. RESULTS: At the time of this survey, 24 patients after TPE were surviving longer than one year after the surgery. The five-year survival of all patients was 49%, median survival 4.6 years, and median follow-up 15 months. Most of our patients reported a good level of their physical, emotional, cognitive and social functions. Some patients reported a worse body image, and of course a worsening in their sexual life. Regarding symptom-oriented questions, some patients evaluated the necessity of more frequent care of the stomia as slightly problematic; most patients reported impotence (men) or painful sexual intercourse (women). CONCLUSION: Long-term quality of life in survivors of pelvic exenteration for rectal cancer is comparable with reported results following primary rectal cancer resection with the exception of the sexual function. The quality of life gradually improves in the course of weeks to months from the surgery. KEY WORDS: pelvic exenteration quality of life.


Subject(s)
Neoplasm Recurrence, Local/psychology , Neoplasm Recurrence, Local/surgery , Pelvic Exenteration/adverse effects , Pelvic Exenteration/psychology , Pelvic Neoplasms/psychology , Pelvic Neoplasms/surgery , Postoperative Complications/etiology , Postoperative Complications/psychology , Quality of Life/psychology , Rectal Neoplasms/psychology , Rectal Neoplasms/surgery , Adult , Aged , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/mortality , Pelvic Neoplasms/mortality , Postoperative Complications/mortality , Rectal Neoplasms/mortality , Retrospective Studies , Surveys and Questionnaires , Survival Analysis
10.
Int J Gynecol Cancer ; 25(8): 1526-33, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26207785

ABSTRACT

OBJECTIVE: The current study evaluates long-term quality of life (QOL) and sexual function of patients with endometrial cancer who received adjuvant pelvic external beam radiotherapy (EBRT) and/or vaginal brachytherapy (BRT). MATERIALS AND METHODS: One hundred forty-four endometrial cancer survivors who were treated between January 2000 and December 2009 in our department were included in this study. Median follow-up was 79 months (range, 31-138 months). Fifty-two patients were treated with 45 to 50.4 Gy EBRT, 76 were with BRT, and 16 were with both EBRT and BRT. Brachytherapy was in the form of vaginal cuff BRT with 5 × 550 cGy high dose rate BRT, prescribed to the first 4 cm and whole wall thickness of vagina. Quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and subscales from the supplemental 24-item Cervical Cancer Module. RESULTS: Vaginal BRT patients reported better physical functioning (P = 0.01), role functioning (P = 0.03), and sexual enjoyment (P = 0.01) compared to EBRT group. Symptom score (P = 0.01), lymphedema (P = 0.03), pain (P = 0.02), and diarrhea (P = 0.009) scores were also higher with EBRT. Vaginal BRT did not worsen symptom scores or sexual functions when added to EBRT. Obese patients experienced higher rates of lymphedema (P = 0.008). Cognitive and role functioning scores were significantly higher in patients with normal body mass index. CONCLUSIONS: External beam radiotherapy negatively affects long-term QOL and sexual functions in endometrial cancer survivors. Vaginal BRT provides higher QOL. Patients with body mass index within normal limits have improved QOL.


Subject(s)
Brachytherapy , Endometrial Neoplasms/psychology , Endometrial Neoplasms/radiotherapy , Quality of Life/psychology , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Staging , Pelvic Neoplasms/psychology , Pelvic Neoplasms/radiotherapy , Prognosis , Radiotherapy Dosage , Radiotherapy, Adjuvant , Survivors , Vaginal Neoplasms/psychology , Vaginal Neoplasms/radiotherapy
11.
Eur J Oncol Nurs ; 19(3): 301-9, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25533805

ABSTRACT

PURPOSE: To explore patients' experience of their illness when undergoing pelvic radiotherapy by describing the presence and severity of distressful symptoms and to explore initiated self-care activities in response to illness and symptoms. METHODS: A mixed-method study was performed which included a core qualitative dataset and a supplementary quantitative dataset. Twenty-nine women undergoing five weeks of radiotherapy were prospectively interviewed during five weeks of treatment in order to capture experiences, distressful symptoms and quality of life during treatment. Grounded theory formed collection and analysis of the qualitative dataset and statistics were used to analyze the quantitative dataset. RESULTS: A maintained self-identity was concluded as being central during the trajectory of treatment. Initiated self-care activities served to alleviate physical, emotional, and social suffering; helping the respondents keep their integrity and sense of self. Previous life experiences influenced the process of being able to maintain self-identity. The gastrointestinal symptoms and pain caused most distress. CONCLUSIONS: In order to be able to maintain self-identity patients endure treatment by focusing on symptoms, on getting cured and on their self-image. Several distressful symptoms implied social limitations and a sense that the body would not take the strain. The result of this study can help health care professionals to gain a better understanding of the struggle to endure pelvic radiotherapy. Further, health care professionals should be more proactive in alleviating their patients' distressful symptoms. The results imply that previous life experiences should precede initiated interventions because these life experiences affect the patients' self-care activities.


Subject(s)
Adaptation, Psychological , Pelvic Neoplasms/psychology , Pelvic Neoplasms/radiotherapy , Quality of Life/psychology , Self Care/methods , Self Concept , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Stress, Psychological , Sweden
12.
J Clin Oncol ; 32(23): 2503-4, 2014 Aug 10.
Article in English | MEDLINE | ID: mdl-25002712
13.
Support Care Cancer ; 21(11): 3063-70, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23812496

ABSTRACT

PURPOSE: Lower limb lymphedema (LLL) is a common condition after pelvic cancer treatment but few studies have evaluated its effect on the quality of life and its consequences on daily life activities among gynecological cancer survivors. METHODS: We identified a cohort of 789 eligible women, treated with pelvic radiotherapy alone or as part of combined treatment of gynecological cancer, from 1991 to 2003 at two departments of gynecological oncology in Sweden. As a preparatory study, we conducted in-depth interviews with gynecological cancer survivors and constructed a study-specific questionnaire which we validated face-to-face. The questionnaire covered physical symptoms originating in the pelvis, demographic, psychological, and quality of life factors. In relation to the lymph system, 19 questions were asked. RESULTS: Six hundred sixteen (78 %) gynecological cancer survivors answered the questionnaire and participated in the study. Thirty-six percent (218/606) of the cancer survivors reported LLL. Overall quality of life was significantly lower among cancer survivors with LLL. They were also less satisfied with their sleep, more worried about recurrence of cancer, and more likely to interpret symptoms from the body as recurrence. Cancer survivors reported that LLL kept them from physical activity (45 %) and house work (29 %) and affected their ability to partake in social activities (27 %) or to meet friends (20 %). CONCLUSION: Lower limb lymphedema has a negative impact on quality of life among gynecological cancer survivors, affecting sleep and daily life activities, yet only a few seek professional help.


Subject(s)
Genital Neoplasms, Female/psychology , Genital Neoplasms, Female/radiotherapy , Lymphedema/etiology , Lymphedema/psychology , Radiotherapy/adverse effects , Survivors/psychology , Activities of Daily Living/psychology , Aged , Anxiety/psychology , Female , Genital Neoplasms, Female/complications , Humans , Lower Extremity , Middle Aged , Pelvic Neoplasms/complications , Pelvic Neoplasms/psychology , Pelvic Neoplasms/radiotherapy , Quality of Life , Radiotherapy/psychology , Sleep Wake Disorders/etiology , Sleep Wake Disorders/psychology , Surveys and Questionnaires/standards , Sweden
14.
Support Care Cancer ; 21(4): 1193-9, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23151649

ABSTRACT

PURPOSE: The Bowel Function Questionnaire (BFQ) has been used in clinical trials to assess symptoms during and after pelvic radiotherapy (RT). This study evaluated the importance of symptoms in the BFQ from a patient perspective. METHODS: Patients reported presence or absence of symptoms and rated importance of symptoms at baseline, 4 weeks after completion of pelvic RT, and 12 and 24 months after RT. The BFQ measured overall quality of life (QOL) and symptoms of nocturnal bowel movements, incontinence, clustering, need for protective clothing, inability to differentiate stool from gas, liquid bowel movements, urgency, cramping, and bleeding. Bowel movement frequency also was recorded. A content validity questionnaire (CVQ) was used to rate symptoms as "not very important," "moderately unimportant," "neutral," "moderately important," or "very important." RESULTS: Most of the 125 participating patients rated all symptoms as moderately or very important. Generally, patients gave similar ratings for symptom importance at all study points, and ratings were independent of whether the patient experienced the symptom. Measures of greatest importance (moderately or very important) at baseline were ability to control bowel movements (94 %), not having to wear protective clothing (90 %), and not having rectal bleeding (94 %). With the exception of need for protective clothing, the presence of a symptom at 4 weeks was associated with significantly worse QOL (P < .01 for all). CONCLUSIONS: The BFQ has excellent content validity. Patients rated most symptoms as moderately or very important, indicating the BFQ is an appropriate tool for symptom assessment during and after pelvic RT.


Subject(s)
Diarrhea/prevention & control , Gastrointestinal Agents/therapeutic use , Intestines/radiation effects , Octreotide/therapeutic use , Pelvic Neoplasms/radiotherapy , Diagnostic Self Evaluation , Diarrhea/psychology , Female , Humans , Intestines/physiopathology , Male , Middle Aged , Pelvic Neoplasms/psychology , Pelvis , Quality of Life , Surveys and Questionnaires , United States
15.
Soc Sci Med ; 76(1): 188-96, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23153544

ABSTRACT

Pelvic radiotherapy creates physical effects and psychological responses that negatively affect the sexual health of women and couples, yet these sexual consequences are not frequently researched or clinically assessed. This focused ethnographic study explored factors that influence the clinical assessment of treatment-induced female sexual difficulties after pelvic radiotherapy within routine medical follow-up. Participant observation of follow-up clinics (n = 69) and in-depth interviews with 24 women, 5 partners and 20 health professionals were undertaken at two cancer centres in the South East of England from 2005 to 2006. Thematic analysis of interview transcripts resulted in five emergent themes, two of which are explored in detail within this paper. A social constructionist approach to human sexuality was used to explore representations of female sexuality in oncology follow-up constructed by clinicians, women and their partners. Yet neither social constructionist nor biomedical (the predominant model in medical follow-up) perspectives on human sexuality provided an adequate interpretation of these study findings. This paper argues that the comprehensive study and practice of sexual rehabilitation in oncology requires a synthesis of both biomedical and social constructionist perspectives in order to capture the complex, subjective and embodied nature of the female sexual response in both health and illness.


Subject(s)
Pelvic Neoplasms/radiotherapy , Sexual Dysfunction, Physiological/rehabilitation , Sexual Dysfunctions, Psychological/rehabilitation , Sexuality/radiation effects , Adult , Aged , England , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pelvic Neoplasms/psychology , Qualitative Research , Radiotherapy/adverse effects , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunctions, Psychological/etiology , Treatment Outcome
17.
Anticancer Res ; 32(2): 657-64, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22287759

ABSTRACT

AIM: The main objective was to delineate the rates and clinical course of sexual function and depression in cancer patients undergoing radiotherapy. PATIENTS AND METHODS: Forty-eight male and 90 female radiotherapy-naive outpatients with breast or pelvic cancer completed the International Index of Erectile Function (IIEF) or the Female Sexual Function Index (FSFI), and the Hamilton Depression Scale (HDS) prior to (phase 1), at the end of (phase 2) and 12 months after radiotherapy (phase 3). RESULTS: Overall, the majority of patients (93.8% of males and 80% of females) experienced intense sexual dysfunction. At presentation, males reported severe erectile dysfunction that was significantly associated with age. However, only in sexual desire was the difference between baseline and phase 3 significant. In females, an improvement was observed in all parameters of FSFI between phase 1 and 3. Females with stage III disease achieved lower scores in almost all parameters of FSFI than those with stage II. Finally, although a quarter of patients reported elevated depression scores, depression was not related to sexual function. CONCLUSION: A significant proportion of cancer patients experience intense levels of sexual dysfunction and depression throughout radiotherapy and the subsequent year. Pelvic radiotherapy affected sexual function to a higher degree than did breast radiotherapy.


Subject(s)
Breast Neoplasms/radiotherapy , Pelvic Neoplasms/radiotherapy , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunctions, Psychological/etiology , Adult , Aged , Aged, 80 and over , Breast Neoplasms/physiopathology , Breast Neoplasms/psychology , Depression/etiology , Depression/psychology , Erectile Dysfunction/etiology , Erectile Dysfunction/psychology , Female , Humans , Male , Middle Aged , Pelvic Neoplasms/physiopathology , Pelvic Neoplasms/psychology , Radiation Injuries/etiology , Radiation Injuries/psychology , Radiotherapy/adverse effects , Sexual Dysfunction, Physiological/psychology , Sexual Dysfunctions, Psychological/psychology
18.
Int J Gynecol Cancer ; 20(3): 449-60, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20375813

ABSTRACT

INTRODUCTION: Fecal incontinence is a symptom reported by cancer survivors after pelvic radiotherapy and is recognized to be one of the most troubling symptom-induced sources of distress to patients. OBJECTIVE: To investigate how fecal incontinence, patient-reported as emptying of all stools into clothing without forewarning, impact self-assessed quality of life from a social, psychological, sexual, and functional aspect among gynecological cancer survivors treated with pelvic radiotherapy. METHODS: We identified a cohort of 789 eligible women in the Stockholm and Gothenburg areas treated with pelvic radiotherapy alone or as combined treatment of gynecological cancer. From the Swedish Population Registry, we identified 478 control women. Data were collected using a study-specific, validated, postal questionnaire including questions covering symptoms from the pelvic region, demographics, social functioning, psychological, and quality-of-life issues. RESULTS: Participation was 78% for cancer survivors and 72% for control women. The fecal incontinence symptom emptying of all stools into clothing without forewarning was reported by 70 cancer survivors (12%), with lowered quality of life in 74% of the 70 cancer survivors. This symptom kept the survivors from going to parties (relative risk [RR], 11.8; 95% confidence interval [CI], 6.6-21.1), kept the survivors from traveling (RR, 9.3; 95% CI, 5.3-16.5), affected their work ability (RR, 7.9; 95% CI, 3.8-16.4), hindered their sexual life (RR, 9.2; 95% CI, 4.8-17.6), and changed them as persons (RR, 4.9; 95% CI, 2.9-8.1). The prevalence of the symptom emptying of all stools into clothing without forewarning among control women was 3 (1%) of 344. CONCLUSIONS: Among gynecological cancer survivors having undergone pelvic radiotherapy alone or as part of a combined treatment, fecal incontinence is associated with social, psychological, sexual, and functional consequences.


Subject(s)
Fecal Incontinence/psychology , Genital Neoplasms, Female/psychology , Pelvic Neoplasms/psychology , Quality of Life , Social Adjustment , Aged , Case-Control Studies , Fecal Incontinence/therapy , Female , Genital Neoplasms, Female/radiotherapy , Genital Neoplasms, Female/surgery , Humans , Middle Aged , Neoplasm Staging , Pelvic Neoplasms/radiotherapy , Pelvic Neoplasms/surgery , Prognosis , Surveys and Questionnaires , Survival Rate , Survivors
19.
Arch Phys Med Rehabil ; 87(12): 1611-7, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17141641

ABSTRACT

OBJECTIVES: To describe the inter-relationships among impairments, performance, and disabilities in survivors of pediatric sarcoma and to identify measurements that profile survivors at risk for functional loss. DESIGN: Prospective, cross-sectional. SETTING: Research facility. PARTICIPANTS: Thirty-two participants in National Cancer Institute clinical trials. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Range of motion (ROM), strength, limb volume, grip strength, walk velocity, Assessment of Motor and Process Skills (AMPS); Human Activity Profile (HAP), Sickness Impact Profile (SIP), standard form of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36); and vocational attitudes and leisure satisfaction. RESULTS: Twenty of 30 survivors tested had moderate or severe loss of ROM; 13 of 31 tested had 90% or less of predicted walk velocity; all of whom had trunk or lower-extremity lesions. Women with decreased ROM (r=.50, P=.06) or strength (r=.74, P=.002) had slow gait velocity. Sixteen of 31 tested were more than 1 standard deviation below normal grip strength. Eighteen had increased limb volume. These 18 had low physical competence (SF-36) (r=-.70, P=.001) and high SIP scores (r=.73, P=.005). AMPS scores were lower than those of the matched normed sample (P<.001). HAP identified 15 of 30 who had moderately or severely reduced activity. Leisure satisfaction was higher in the subjects (P<.001). Eight reported cancer had negatively impacted work and 17 reported that it negatively impacted vocational plans. CONCLUSIONS: Survivors with lower-extremity or truncal lesions and women with decreased ROM and strength likely have slow walk velocity, low exercise tolerance, and high risk for functional loss. They should be identified using ROM, strength, limb volume, and walk time measures.


Subject(s)
Disability Evaluation , Quality of Life , Sarcoma/physiopathology , Sarcoma/psychology , Survivors/psychology , Adolescent , Adult , Bone Neoplasms/physiopathology , Bone Neoplasms/psychology , Child , Cross-Sectional Studies , Employment , Exercise Tolerance/physiology , Extremities/pathology , Extremities/physiopathology , Female , Follow-Up Studies , Gait/physiology , Head and Neck Neoplasms/physiopathology , Head and Neck Neoplasms/psychology , Humans , Male , Muscle Strength/physiology , Pelvic Neoplasms/physiopathology , Pelvic Neoplasms/psychology , Prospective Studies , Range of Motion, Articular/physiology , Sex Factors , Sickness Impact Profile , Walking/physiology
20.
Wien Med Wochenschr ; 156(9-10): 283-7, 2006 May.
Article in German | MEDLINE | ID: mdl-16830247

ABSTRACT

The following case report is about a 55 year old male patient with CUP-syndrome. After developing a malignant bowel obstruction he received five cycles of a palliative chemotherapy with oxaliplatin and irinotecan. The focus is on medical intentions and goals concerning palliative chemotherapy and on discussing patients' attitudes towards chemotherapy. Communication is identified as fundamental skill in shared decision making. On the one hand it improves Patients' satisfaction and palliative care and on the other hand it reduces psychological and existential suffering. In tumors of unknown primary site regimens with different combinations of Platin, Taxol, Etoposide, Irinotecan and Gemcitabine showed responses up to 46% and a survival benefit with an overall median survival up to 12 months and even long term survival.


Subject(s)
Adenocarcinoma, Scirrhous/drug therapy , Adenocarcinoma, Scirrhous/secondary , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Decision Making , Intention , Neoplasms, Unknown Primary/drug therapy , Palliative Care/psychology , Patient Participation , Pelvic Neoplasms/drug therapy , Pelvic Neoplasms/secondary , Physician-Patient Relations , Adenocarcinoma, Scirrhous/psychology , Analgesics, Opioid/therapeutic use , Humans , Male , Middle Aged , Neoplasms, Unknown Primary/psychology , Pain/drug therapy , Pain/psychology , Pelvic Neoplasms/psychology , Terminal Care/psychology
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