Cervical Cancer Survivors Research Articles

Mediation Effects of Self-Care Self-Efficacy and Health-Promoting Behaviors on Fear of Cancer Recurrence and Posttraumatic Growth in Postoperative Patients with Cervical Cancer: A Cross-Sectional Study

PurposeThe high recurrence risks significantly contribute to poor health outcomes among postoperative cervical cancer patients. This study aimed to determine the impact of fear of cancer recurrence (FCR) on the posttraumatic growth (PTG) in postoperative cervical cancer patients and to investigate the medicating effects of self-care self-efficacy and health-promoting behaviors within this relationship. MethodsA total of 334 cervical cancer patients who undergone surgery in three tertiary hospitals in Liaoning Province, China, were recruited using a convenience sampling method. Data were collected using the general information questionnaire, the Fear of Progression Questionnaire (fear of cancer recurrence), the Post-traumatic Growth Inventory (PTG), the Strategies Used by People to Promote Health (self-care self-efficacy), and the Health-Promoting Lifestyle Profile (health-promoting behaviors). Data analysis was performed using descriptive analysis, Pearson correlations, and multiple linear regression analysis. A structural equation model was conducted using Amos 24.0 software. ResultsPTG of cervical cancer patients after surgery was significantly and negatively associated with fear of cancer recurrence (r = -.54, P < .001), while positively correlated with self-care self-efficacy (r = .51, P < .001) and health-promoting behaviors (r = .59, P < .001). The mediation model revealed that self-care self-efficacy (Boots 95% CI [-0.39, -0.15]) and health-promoting behaviors (Boots 95% CI: [-0.51, -0.24]) independently served as mediating factors, respectively. Self-care self-efficacy and health-promoting behaviors played a significant chain mediating effect between fear of cancer recurrence and PTG (Boots CI: [-0.19, -0.07]), with an indirect effect of 11.6%. ConclusionsThis study demonstrated that self-care self-efficacy and health-promoting behaviors partially mediated the relationship between fear of cancer recurrence and PTG in cervical cancer survivors after surgery. Implementing tailored interventions focused on enhancing self-care self-efficacy and health-promoting behaviors among cervical cancer survivors may help alleviate concerns about cervical cancer recurrence and enhance PTG following surgery.

Quality of Life Post Cervical Cancer Treatment: A Comparison Between Radical Surgery Approach and Radiotherapy and Chemotherapy.

The assessment of quality of life (QoL) in women with cervical cancer is crucial due to the profound changes they undergo during and after treatment. Often, the significance of sexual factors is underestimated, likely due to societal taboos surrounding such discussions. This study aimed to determine the long-term QoL outcomes, particularly focusing on sexuality, among three therapeutic approaches for cervical cancer: chemotherapy, radiotherapy, and brachytherapy; isolated hysterectomy; and hysterectomy combined with radiotherapy. Conducted from November 2022 to July 2023, this cross-sectional study involved 131 cervical cancer patients. Their QoL was assessed using the MDASI, FACIT-Cx, and risk factor questionnaires. Results were compared across the three treatment groups, revealing notable differences. Patients undergoing chemo/radio/brachytherapy showed significantly lower QoL scores compared to those undergoing isolated hysterectomy. This was evident in reduced scores across FACIT-Cx subscales for physical well-being, specific concerns, and FACIT-total (p < 0.05). The MDASI results similarly indicated greater symptoms and interference in daily activities for the chemo/radio/brachytherapy group. In conclusion, isolated hysterectomy, demonstrated superior QoL outcomes compared to chemo/radio/brachytherapy. Furthermore, the study underscored the importance of addressing sexual concerns in QoL assessments of cervical cancer survivors, emphasizing the need for comprehensive care to enhance overall well-being posttreatment.

Abstract A124: An examination of trust in biomedical research among the Witness Project’s community health workers

Abstract The Witness Project® (NWP) was established in 1991 and has maintained its status as one of NCI’s Evidence Based Cancer Control Program (EBCCP) for decades. NWP is a self-sustaining, culturally competent, grass roots level community-based intervention program that uses breast and cervical cancer survivors known as Witness Role Models and Community Health Workers (CHW). With many locations in unserved communities throughout the United States, NWP provides relevant cancer related education and navigates minority residents through successful completions of cancer related screenings. Health disparities are a longstanding problem due in part to underrepresentations of historically underserved populations in research. Increasing minority and underserved individuals’ participation in research has great disparity mitigating potential. A team of newly trained Black and Hispanic NWP CHW (n=25) will be created as part of a larger multiphase preliminary pilot study designed to increase diverse individuals’ participations in research within Roswell Park’s catchment area. Design, Measures, Setting, and Participants. The primary objective of this cross-sectional study is to assess Black and Hispanic CHW’s trust in biomedical research. Secondary objectives are to explore the feasibility and acceptability of 1) NWP CHW training, and 2) an informal educational intervention about the importance of minority representations in research and it potential to mitigate health disparities. CMWs will complete the Perceptions of Research Trustworthiness (PoRT) scale to evaluate their trust and distrust in biomedical research before and after viewing the informal educational intervention. Preliminary Results and Planned Analyses At the time of abstract submission nineteen CMWs have completed their NWP and CITI training and PoRT assessments. Fifteen CHWs were Black (78.9%) and four Hispanic (21.1%). When all 25 CMWs are trained we will calculate overall and individual item Trust and Distrust subscale scores. Regarding feasibility and acceptability of the CHW training and the informal education intervention, semi structured interviews will provide qualitative feedback and independent samples t-test will be used to compare pre-and post-informal education intervention PoRT scores. Citation Format: Julia Devonish, Martin Mahoney, Elizabeth Bouchard, Cassy Dauphin, Abshiro Ali, Veronica Meadows, Jomary Colon, Dee Johnson. An examination of trust in biomedical research among the Witness Project’s community health workers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A124.

Abstract A120: Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer

Abstract Introduction: Advances in treatment have significantly improved the survival rates of adolescent and young adult (AYA) cancer patients, with a five-year survival rate reaching 86%. However, these survivors remain at increased risk for developing secondary cancers later in life. Racial and ethnic minority groups, such as Hispanics, often experience significant healthcare disparities, including lower cancer screening rates. Cancer survivors, particularly those who are Hispanic and diagnosed as AYAs, may face unique barriers in adhering to recommended cancer screening guidelines. This study examines the uptake rates of colon, breast, and cervical cancer screenings among Hispanic survivors of AYA cancer compared to their age- and sex-matched Hispanic non-cancer controls. Methods: The National Health Interview Survey data (years 2000 - 2021) [R1] were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Data on cancer screening, including whether patients were up- to-date and ever screened for colon, breast, and cervical cancers, were assessed. The US Preventive Services Task Force recommendations were used to determine whether survivors were up-to-date for the cancer screening tests. The sample included 92 colon cancer survivors, 113 breast cancer survivors, and 313 cervical cancer survivors, matched with 920, 1130, and 3130 controls, respectively. Weighted percentages and odds ratios (OR) were calculated, adjusting for age at survey, sex, marital status, education, poverty status, and insurance. Results: Colon cancer screening uptake was significantly higher among survivors, with 26.1% up-to-date versus 11.5% of controls (OR=2.49, 95% CI=1.17-5.30, p=0.019). For breast cancer, 14.6% of survivors were up-to-date compared to 5.1% of controls [R2] (OR=2.51, 95% CI=1.33-4.72, p=0.005), and 82.6% of survivors were ever screened versus 38.7% of controls (OR=7.41, 95% CI=4.43-12.41, p&amp;lt;0.001). Cervical cancer screening showed the most pronounced difference, with 40.6% of survivors up-to-date compared to 19.0% of controls (OR=3.36, 95% CI=2.43- 4.65, p&amp;lt;0.001), and 71.2% of survivors ever screened compared to 28.6% of controls (OR=14.16, 95% CI=8.56-23.40, p&amp;lt;0.001). Conclusion: Hispanic AYA cancer survivors exhibit significantly higher cancer screening rates compared to matched controls. Despite these positive findings, the overall low screening rates highlight the need for targeted interventions to ensure that all survivors adhere to recommended screening guidelines. Enhancing access to healthcare and ensuring continuity of care are critical steps toward reducing disparities and improving health outcomes for this vulnerable population. Citation Format: Eunju Choi, Amy M. Berkman, Clark R Andersen, Michael E. Roth. Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A120.

Impact of Various Treatment Modalities on Long-Term Quality of Life in Cervical Cancer Survivors.

Introduction Given treatment advancements and the long life expectancy of mostly young patients with cervical cancer, their post-treatment quality of life (QoL) is essential to consider. This study aimed to evaluate the long-term QoL in cervical cancer survivors treated with various approaches. Methods We conducted a cross-sectional survey-based study using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module 24 (EORTC-QLQ-CX24) questionnaires and involved members of the online cervical cancer patient support group (01/2024-02/2024). Eligible participants were ≥18 years old, diagnosed with stage IA2-IIB cervical cancer, and had completed their treatment. Respondents were stratified into four management groups: neoadjuvant chemotherapy + surgery +/- radiation therapy (RT), surgery + RT, RT alone, and surgery alone. Results Overall, 173 patients participated: 20 (11.6%) received neoadjuvant chemotherapy + surgery +/- RT, 50 (28.9%) had surgery + RT, 69 (39.9%) had RT alone, and 34 (19.7%) had surgery alone. Patients after surgery alone had significantly better global QoL (p<0.001). Their physical (p<0.001), role (p=0.037), emotional (p=0.024), and social (p=0.006) functioning were also substantially better. This group also reported the lowest severity of fatigue (p=0.001), nausea and vomiting (p<0.001), and diarrhea (p<0.001). Sexual functioning was better in the surgery-alone group in almost all aspects. There were no major differences in QoL among the groups, receiving RT alone or combined with other treatments. Conclusions Cervical cancer survivors who underwent surgery alone reported the highest QoL and lower symptom intensity compared to those treated with RT or treatment combinations. RT combined with other modalities did not appear to substantially decrease QoL compared to RT alone.

Association between the regular use of vaginal dilators and/or sexual activity and vaginal morbidity in locally advanced cervical cancer survivors – An EMBRACE-I study report

PurposeTo provide risk estimations for vaginal morbidity with regard to vaginal dilation (summarizing the use of dilators and/or sexual activity) in locally advanced cervical cancer patients (LACC) treated with definitive radiochemotherapy and image-guided adaptive brachytherapy (IGABT) within the prospective, multi-institutional EMBRACE-I study. Material/MethodsPhysician-assessed vaginal morbidity (CTCAEv3.0), use of vaginal dilators and patient-reported sexual activity (EORTC-CX24) were prospectively assessed at baseline and during regular follow-up.Frequency analysis for vaginal dilation was performed in a sub-cohort of patients with ≥3 follow-ups. Regular dilation was defined if reported in ≥50% of follow-ups, no/infrequent dilation if reported in <50%. Actuarial estimates were calculated with Kaplan-Meier method; comparisons evaluated with the log-rank test. Univariate and multivariable Cox proportional hazard regression were used to evaluate risk factors for vaginal stenosis G≥2. ResultsThe EMBRACE-I study included a total of 1416 patients (2008-2015); 882 were evaluated in the present report with a median follow-up of 60 months. Of those, 565 (64%) reported regular dilation. This was associated with a significantly lower 5-year risk of vaginal stenosis G≥2 compared to no/infrequent dilation (23% vs. 37%, p≤0.001). This univariate finding was confirmed by multivariable analysis, after adjusting for other risk factors (HR=0.630, p=0.001).Regular vaginal dilation was also associated with a significantly higher risk for vaginal dryness G≥1 (72% vs. 67%, p=0.028) and bleeding G≥1 (61% vs. 34%, p≤0.001). ConclusionVaginal stenosis represents irreversible fibrotic changes that can cause pain during gynecological examination and dyspareunia in LACC survivors. Regular vaginal dilation (defined as the use of dilators and/or sexual activity) is associated with a significantly lower risk for G≥2 vaginal stenosis, suggesting a potential improvement of vaginal patency. It is also associated with a significantly higher risk for mild G≥1 dryness and bleeding (no higher risk for G≥2), which both can be clinically managed.

The Effect of Group Counselling based on Constructive Couple Communication on Perceived Spousal Support in Uterine and Cervical Cancer Survivors: A Randomized Control Trial.

Uterine and Cervical cancer survivors face challenges like the disruption of emotional and sexual relationships, struggle to maintain sexual life and intimacy, and the possibility of divorce. The study aimed to determine the effect of group counseling based on couples' constructive communication on perceived spousal support in uterine and cervical cancer survivors. A randomized controlled trial on 40 women who survived uterine and cervical cancer were recruited using convenience sampling and then randomly allocated to a couple-based constructive communication intervention group and a routine cancer center care control group from June 2019 to March 2020 in Motahhari and Imam Khomeini hospitals in Urmia. The intervention group was involved in a group counseling session weekly for 5 weeks, regarding constructive couple communication skills. Perceived spouse support was assessed using the sources of social support scale which has 4 subscales informational, instrumental, emotional, and negative support before and one week after the end of the intervention in both groups. Data analysis was performed using SPSS version 24 through Independent and paired t-tests, Mann-Whitney U test, Wilcoxon, chi-square, and ANCOVA. P value<0.05 was considered statistically significant. The effect of the intervention was statistically significant in reducing negative support in the intervention group (2.70±0.80) in comparison with the control group (3.40±1.04) (P=0.03). It was also statistically significant in increasing informational support (3.45±0.71 vs. 2.15±0.80, P<0.001), instrumental support (3.15±0.58 vs. 2.85±0.74, P<0.001), and emotional support (19.40±1.60 vs. 16.10±2.10, P<0.001). Group counseling based on couple constructive communication increased perceived spousal support in uterine and cervical cancer survivors. Trial Registration Number: IRCT20150125020778N22.

Risks of adverse obstetric outcomes among female survivors of adolescent and young adult cancer in England (TYACSS): a population-based, retrospective cohort study

There are limited data on the risks of obstetric complications among survivors of adolescent and young adult cancer with most previous studies only reporting risks for all types of cancers combined. The aim of this study was to quantify deficits in birth rates and risks of obstetric complications for female survivors of 17 specific types of adolescent and young adult cancer. The Teenage and Young Adult Cancer Survivor Study (TYACSS)-a retrospective, population-based cohort of 200 945 5-year survivors of cancer diagnosed at age 15-39 years from England and Wales-was linked to the English Hospital Episode Statistics (HES) database from April 1, 1997, to March 31, 2022. The cohort included 17 different types of adolescent and young adult cancers. We ascertained 27 specific obstetric complications through HES among 96 947 women in the TYACSS cohort. Observed and expected numbers for births and obstetric complications were compared between the study cohort and the general population of England to identify survivors of adolescent and young adult cancer at a heighted risk of birth deficits and obstetric complications relative to the general population. Between April 1, 1997, and March 31, 2022, 21 437 births were observed among 13 886 female survivors of adolescent and young adult cancer from England, which was lower than expected (observed-to-expected ratio: 0·68, 95% CI 0·67-0·69). Other survivors of genitourinary, cervical, and breast cancer had under 50% of expected births. Focusing on more common (observed ≥100) obstetric complications that were at least moderately in excess (observed-to-expected ratio ≥1·25), survivors of cervical cancer were at risk of malpresentation of fetus, obstructed labour, amniotic fluid and membranes disorders, premature rupture of membranes, preterm birth, placental disorders including placenta praevia, and antepartum haemorrhage. Survivors of leukaemia were at risk of preterm delivery, obstructed labour, postpartum haemorrhage, and retained placenta. Survivors of all other specific cancers had no more than two obstetric complications that exceeded an observed-to-expected ratio of 1·25 or greater. Survivors of cervical cancer and leukaemia are at risk of several serious obstetric complications; therefore, any pregnancy should be considered high-risk and would benefit from obstetrician-led antenatal care. Despite observing deficits in birth rates across all 17 different types of adolescent and young adult cancer, we provide reassurance for almost all survivors of adolescent and young adult cancer concerning their risk of almost all obstetric complications. Our results provide evidence for the development of clinical guidelines relating to counselling and surveillance of obstetrical risk for female survivors of adolescent and young adult cancer. Children with Cancer UK, The Brain Tumour Charity, and Academy of Medical Sciences.

Female sexual function in long-term cervical cancer survivors compared with healthy women and women affected by benign gynecological disorders

ObjectiveTo compare the female sexual function between cervical cancer survivors and healthy women or with benign gynecological diseases. Study designFrom January 1, 2010 to January 31, 2019, a case-control study was conducted to compare the female sexual function of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a routine gynecological examination (n=46) or for a benign gynecological disorder (symptomatic, n=113; asymptomatic, n=26).We prospectively assessed the female sexual function using the Female Sexual Function Index (FSFI). For the contrastive analysis hypothesis, we employed R statistical software. ResultsCervical cancer survivors reported lower sexual activity rates than controls, in general, did (47.12% vs. 88.65%, p=0.0001), and, particularly, compared with healthy and symptomatic controls (47.12% vs. 82.61%, p=0.003; 47.12% vs. 87.61%, p=0.0001, respectively).Sixty and fifty-eight hundredths percent of the cervical cancer survivors experienced female sexual dysfunction, mainly due to hypoactive sexual desire (93.27%). Female sexual dysfunction was diagnosed in 64.32% of the controls, with sexual arousal disorders being the most common diagnosis (44.86%).Compared with controls, cervical cancer survivors exhibited considerably lower FSFI total scores and in sexual desire and lubrication domains (p <0.000; p <0.0001; p=0.023). ConclusionsCervical cancer survivors had worse female sexual function and less sexual activity than controls did, although scores in both groups were in range of FSD. Rates of female sexual dysfunction were similar across cervical cancer survivors and controls, with hypoactive sexual desire and sexual arousal disorders as the most common diagnoses, respectively.

Uterus Transplantation as Infertility Treatment in Gynecological Cancer Survivors: A Systematic Review.

Background: The aim of this systematic review is to summarize the evidence regarding the acceptance of uterine transplantation as infertility treatment among gynecological cancer survivors, surgical and pregnancy outcomes post-transplantation for gynecological cancer survivors, as well as relevant adverse events. Methods: PubMed and Embase were searched for records published since 2000, and extensive reference screening was performed. Results: Out of 1901 unique records identified, 7 are included in this review; 4 examined the proportion of gynecological cancer survivors among applicants for uterine transplantation, 2 examined rejection rates, pregnancy rates, and outcomes after uterine transplantation among gynecological cancer survivors, and 2 reported the frequency of relevant adverse events. Among the applicants, 60/701 (8.6%) were gynecological cancer survivors, only 1 transplanted patient was a cervical cancer survivor and achieved two live births after eight embryo transfers, and 2/27 (7.4%) of uterus transplantation recipients were diagnosed with CIN post-transplantation. Conclusions: Uterus transplantation can be regarded as an infertility treatment for absolute uterine factor infertility (AUFI), although only one gynecological cancer survivor has received a uterus transplantation. The efficacy, safety, and ethical considerations for gynecological cancer survivors need to be addressed for uterine transplantation to become an infertility treatment option for AUFI among gynecological cancer survivors.

Quality of life in long-term cervical cancer survivors compared with healthy women and women with benign gynecological disorders

ObjectiveThe impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls. Study DesignA case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26).To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0–6, 7–12, 13–24, 25–60, and more than 60 months.For the contrastive analysis hypothesis, we employed R statistical software. ResultsExcept for the environment domain at 0–6, 7–12, and 13–24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0–6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13–24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls. ConclusionExcept for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorśquality of life did not vary from that of controls.

Reducing radicality in fertility-sparing surgery is associated with improved in vitro fertilization outcome in early-stage cervical cancer: A national retrospective study

ObjectiveFertility-sparing surgery (FSS) aims to achieve oncological outcomes that are non-inferior to radical treatment while preserving fertility and optimizing reproductive results. This study assesses in vitro fertilization (IVF) outcomes in early-stage cervical cancer survivors following FSS, comparing radical and non-radical approaches. MethodsThis retrospective analysis used data from Hungary's National Health Insurance Fund (2004–2022) on patients who underwent IVF treatment following FSS for early-stage cervical cancer at ten Hungarian fertility clinics. Patients were classified into radical and non-radical surgical groups, with the uterine arteries being spared in the non-radical procedures. RStudio (R software version: 4.2.2) was used for statistical analysis. Student's t-test was used to compare group means, and Fisher's exact test was applied to assess independence and distributions between categorical variables, and to estimate odds. ResultsThe study analyzed data from 122 IVF treatment cycles involving 36 patients. The non-radical group had a significantly higher live birth rate (83%, 5/6 compared to the radical group (17%, 5/30). Additionally, the non-radical group had a significantly higher implantation rate and cumulative live birth rate per oocyte retrieval (37%, 7/19 and 55%, 6/11 respectively) compared to the radical group (8%, 12/148 and 6%, 5/80 respectively). ConclusionThis is the largest study to evaluate IVF outcomes in young cervical cancer survivors who have undergone FSS. The findings suggest that less radical procedures are associated with significantly better IVF outcomes. These results emphasize the importance of considering oncological safety and reproductive outcomes together when choosing FSS for early-stage cervical cancer patients. It also highlights the reproductive benefits of performing less radical surgery.

Pre- and Post-Treatment Quality of Life Among Patients with Advanced Stage Cervical Cancer at Tikur Anbessa Specialized Hospital, Ethiopia.

The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia. This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer. A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values <0.05 and a 95% confidence interval. Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92-75] to 83.33 [66.67-83.33]) and the functional domain QoL (66.67 [40-80] to 70 [46.67-86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021). Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.

Making Sense of Gynecologic Cancer: A Relational Dialectics Approach

ABSTRACT This study used the relational dialectics theory (RDT) as a theoretical lens to examine how the interplay of competing discourses shaped meaning making about gynecologic cancer. A reflexive thematic analysis of the narratives of 12 survivors of cervical cancer, ovarian cancer, and uterine cancer in Arkansas showed two discursive struggles at play, including continuity of care versus change, and voicing versus repressing of feelings. The findings showed that long history of care with physicians contributed to how participants privileged the discourse of continuity of care when faced with a decision to travel for care or receive care locally. We also found that cultural discourses about concealing women’s cancer-afflicted bodies, lack of supportive spaces for women to discuss side effects of cancer treatments, and appropriate communication behavior between patients and physicians shaped the interplay of the discursive struggle of voicing versus repressing. The findings extend the RDT by showing that geographic location, disease characteristics, history of care between patients and physicians, and prevailing cultural discourses can contribute to the interplay of discursive struggles in the gynecologic cancer context. Further, the findings suggest to healthcare professionals to address harmful discourses about gynecologic cancer to help create support avenues for survivors.

A Prospective Study Assessing Sexual Function and Body Image Among Cervical Cancer Survivors: Exploring Treatment Modality Differences

A Prospective Study Assessing Sexual Function and Body Image Among Cervical Cancer Survivors: Exploring Treatment Modality Differences

Development and Internal Validation of a Multivariable Prediction Model for the Sexual Function of Cervical Cancer Survivors

Development and Internal Validation of a Multivariable Prediction Model for the Sexual Function of Cervical Cancer Survivors

Effects of vaginal dilation therapy on vaginal length, vaginal stenosis, vaginal elasticity and sexual function of cervical cancer survivors

Background Cervical cancer survivors can experience vaginal length shortening, vaginal stenosis, vaginal elasticity deterioration, sexual frequency reduction and sexual dysfunction. This prospective, uncontrolled, monocentric clinical interventional study aimed to evaluate the effect of vaginal dilation therapy on vaginal condition and sexual function of cervical cancer survivors who had not received timely vaginal dilation. Methods A total of 139 patients completed the study. They received 6 months of vaginal dilation therapy. We evaluated their vaginal elasticity, vaginal diameter, vaginal length and sexual function before and after vaginal dilation therapy. Their vaginal conditions were evaluated by customised vaginal moulds, and the sexual function was assessed by female sexual function index. The SPSS 25 software was used to analyse all the data. Results Age, vaginal diameter and sexual intercourse frequency before diagnosis were significantly associated with female sexual dysfunction of the patients after cancer treatment. Vaginal dilation therapy improved vaginal stenosis, vaginal length and sexual function in all the patients; however, the vaginal elasticity and incidence of sexual dysfunction did not improve significantly. Sexual intercourse frequency before diagnosis, vaginal elasticity, time interval from last treatment and treatment modalities were significantly associated with the change in female sexual function index score before and after vaginal dilation therapy. Patients with a time interval from the last treatment less than 24 months or those who had moderate or good vaginal elasticity, benefitted more from vaginal dilatation therapy. Conclusions Cervical cancer survivors who had not received timely vaginal dilation still benefitted from vaginal dilation therapy, irrespective of the treatment methods they received. Moreover, vaginal dilation therapy should be performed as early as possible after cervical cancer treatment.

(263) Sexuality and Fertility among Young Women Treated for Cervical Cancer

Abstract Introduction Cervical cancer is the fourth cancer in women. Its incidence is particularly high in developing countries. The increase in cases among young women in low- and middle-income countries may be due to changes in sexual behaviors and an increased risk of HPV infection and the absence of vaccination programs. The mortality and morbidity rates of cervical cancer are very high if diagnosed at an advanced stage. It is a preventable Human Papilloma Virus (HPV) related cancer. Cervical cancer patients are often stigmatized because of the idea that this cancer is associated with early-onset sexuality. Furthermore, the treatments for such cancer are mutilating for women often causing definitive infertility and sexual and/or couple dysfunctions. Objective This study aims to describe the changes in sexuality and fertility among young women diagnosed and treated for cervical cancer Methods It is a monocentric cross-sectional study based on a phone survey. We included and contacted all young women (under 40) when they were diagnosed with and/or treated for cervical cancer in our institution for 11 years from January 2010 to December 2020. We excluded all patients with a history of chronic disease other than cervical cancer. The study took place from January To May 2022. We developed an 8-item questionnaire in the local dialect and used the validated translation of the Female Sexual Function Index (FSFI) to evaluate the participants' sexual function. Results We included 23 cases of cervical cancer in young women, i.e. a response rate of 4.6%. The average age of our sample was 34.7 years (±4.7). The median age of first sexual intercourse was 21.5 years [20–25.25]. The abortion rate was 2 [0.25–2.75] per participant. The median age of the first pregnancy was 21 years [21–27]. The most common symptom leading to the cancer diagnosis was post-coital metrorrhagia in 12 (52.2%) of cases. The first Pap smear led to a cervical cancer diagnosis in 13 cases (56.5%). Five patients had a tumor size ≤ 40 mm and 4 patients were metastatic at the time of the diagnosis. Eighteen patients underwent surgical treatment of whom 5 had a fertility-sparing technique. All patients got radiation. The average duration of follow-up was 5.72 years ±0.3.247. The average survival is 9.7 years (±0.9 years; 95% CI 7.9 – 11.5 years). The 3-year survival rate is 82.6%, and the 5-year survival rate is 82.6%. Five patients expressed a desire for pregnancy after the treatment, one got pregnant after 5 years. Five patients expressed that there was an impact on their sexuality after the treatment with sexual disorders with pain, in particular dyspareunia and vulvodynia, and a decrease in female desire associated with a guilty feeling. All patients had pathological FSFI scores regarding all the domains of female sexual function Conclusions Sexuality and fertility are taboo among young cervical cancer survivors. The sexual stigma of cervical cancer as a sexually transmitted disease is present in our population. Fertility-sparing surgical techniques and less sexually harmful radiation techniques are still to be perfected. Disclosure No.

Sexual health in Belgian cervical cancer survivors: an exploratory qualitative study.

To assess experiences of sexuality and of receiving sexual healthcare in cervical cancer (CC) survivors. A qualitative phenomenological study using semistructured one-on-one interviews was conducted with 15 Belgian CC survivors recruited in 5 hospitals from August 2021 to February 2022. The interviews were audiotaped and transcribed verbatim. Data were analyzed using inductive thematic analysis. COREQ and SRQR reporting guidelines were applied. Most participants experienced an altered sexuality after CC treatment with often long-term loss/lack of sex drive, little/no spontaneity, limitation of positions to avoid dyspareunia, less intense orgasms, or no sexual activity at all. In some cases, emotional intimacy became more prominent. Physical (vaginal bleeding, vaginal dryness, dyspareunia, menopausal symptoms) and psychological consequences (guilt, changed self-image) were at the root of the altered sexuality. Treatment-induced menopause reduced sex drive. In premenopausal patients, treatment and/or treatment-induced menopause resulted in the sudden elimination of family planning. Most participants highlighted the need to discuss their altered sexual experience with their partner to grow together toward a new interpretation of sexuality. To facilitate this discussion, most of the participants emphasized the need for greater partner involvement by healthcare providers (HPs). The oncology nurse or sexologist was the preferred HP with whom to discuss sexual health. The preferred timing for information about the sexual consequences of treatment was at treatment completion or during early follow-up. Both treatment-induced physical and psychological experiences were prominent and altered sexuality. Overall, there was a need for HPs to adopt proactive patient-tailored approaches to discuss sexual health.

Smoking Cessation by Cancer Treatment Status Among Cervical Cancer Survivors

IntroductionContinued smoking following a cancer diagnosis is associated with poorer cancer treatment outcomes and survival times. Little is known about how cancer treatment status at the time of tobacco treatment enrollment impacts long-term smoking cessation outcomes. Using data from a smoking cessation RCT, this study compared long-term cessation outcomes of women undergoing active treatment for cervical cancer at trial enrollment (n=40) to outcomes of women with a history of cervical cancer or cervical intraepithelial neoplasia (CIN) who were not undergoing active cancer treatment at enrollment (n=154). MethodsParticipants (n=194) were randomized to Standard Treatment (ST) or ST plus a 6-session Motivation And Problem Solving (MAPS) telephone counseling protocol (data collected: 2017-2021; analyzed: 2023). Sociodemographic differences between participants undergoing (vs. not undergoing) active cancer treatment at enrollment were examined. Significant covariates were included in a logistic regression analysis comparing the two groups’ smoking cessation outcomes at 12 months, the end of the tobacco treatment period. ResultsParticipants in active cancer treatment at enrollment were significantly younger and less educated than those not in active cancer treatment. Race/ethnicity, relationship status, household income, nicotine dependence, and tobacco treatment condition did not vary by cancer treatment status. After adjusting for tobacco treatment condition, age, and education, being in active cancer treatment at the time of enrollment was associated with lower odds of abstinence at 12-months (5% vs. 20%, aOR=.22, 95% CI [.05-.998]). ConclusionsFurther research is necessary to identify and overcome barriers to abstinence among cancer survivors undergoing active treatment.