Gynecologic Cancer Survivors Research Articles

Utilization of support services by gynecologic cancer survivors (1143)

Utilization of support services by gynecologic cancer survivors (1143)

Financial toxicity and time costs in gynecologic and breast cancer survivors (1113)

Financial toxicity and time costs in gynecologic and breast cancer survivors (1113)

Correction to Maheu et al. (2023).

Most fear of cancer recurrence (FCR) interventions have small effects, and few target FCR. This randomized controlled trial (RCT) with breast and gynecological cancer survivors evaluated the efficacy of a cognitive-existential fear of recurrence therapy (FORT) compared to an attention placebo control group (living well with cancer [LWWC]) on FCR. One hundred and sixty-four women with clinical levels of FCR and cancer distress were randomly assigned to 6-weekly, 120 min FORT (n = 80) or LWWC (n = 84) group sessions. They completed questionnaires at baseline (T1), posttreatment (T2; primary endpoint), 3 (T3), and 6 months (T4) posttreatment. Generalized linear models were used to compare group differences in the fear of cancer recurrence inventory (FCRI) total score and secondary outcomes. FORT participants experienced greater reductions from T1 to T2 on FCRI total with a between-group difference of -9.48 points (p = .0393), resulting in a medium effect of -0.530, with a maintained effect at T3 (p = .0330) but not at T4. For the secondary outcomes, improvements were in favor of FORT, including FCRI triggers (p = .0208), FCRI coping (p = .0351), cognitive avoidance (p = .0155), need for reassurance from physicians (p = .0117), and quality of life (mental health; p = .0147). This RCT demonstrated that FORT, compared to an attention placebo control group, resulted in a greater reduction in FCR posttreatment and at 3 months posttreatment in women with breast and gynecological cancer, indicating its potential as a new treatment strategy. We recommend a booster session to sustain gains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Review of Commonly used Health-Related Quality of Life instruments in Gynecological Cancer Survivors.

The number of cancer survivors is increasing steadily due to an aging population, continuing improvement in early detection, and treatment. Comparative effectiveness studies and clinical trials are being done to assess late effects of treatment and health-related quality of life. This is in addition to long-term follow-up to assess survival. The aim of the review was to summarize the literature on commonly used quality of life instruments for patients with gynecological cancers with special focus on patient reported outcomes. A literature review was done to summarize the commonly used health-related quality of life instruments in gynecological cancer survivors. Most items assess general quality of life, sexual function, and/or treatment-related toxicity. The commonly reported instruments are the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) with disease specific modules for cervix, ovary, and endometrium. Another tool is the Functional Assessment of Cancer Therapy (FACT) questionnaire with similar disease specific modules. The questionnaires were accessed with permission from these organizations. These instruments typically have about 10-30 questions that assess treatment related bowel and bladder toxicity. This is connected to the patients' self-reported quality of life, generally ranked using a 5-point scale. Length and emphasis vary in different questionnaires. The validated tools in cancer populations allow better quantification and assessment of quality of life. However, there may be limitations. Some of the general instruments may be too broad to assess treatment-related long-term side effects. Others may be too narrow to generalize closely related patient groups. Also, some questions may not be culturally appropriate in certain situations.

The association between cardiovascular disease and breast and gynecologic cancers among black female patients

IntroductionLittle is known about whether a breast or gynecologic cancer diagnosis increases long-term cardiovascular disease (CVD) risk among Black females. The purpose of this study was to determine whether a breast or gynecologic cancer diagnosis is associated with CVD risk and identify determinants of subsequent CVD risk among Black females with an incident breast or gynecologic cancer diagnosis. MethodsUsing the Southern Community Cohort Study data from 2002–2016, this study was designed to analyze CVD incidence among Black females without cancer or CVD at enrollment. Cox proportional hazards regression models with or without covariates were used to explore the relationship between a breast or gynecologic cancer diagnosis and CVD risk among women without cancer as well as without CVD at enrollment (N=11,486). In addition, Cox proportional hazards regression models, excluding those who developed CVD before breast and gynecologic cancer diagnosis and those with other types of cancers, were used to assess determinants of CVD risk among breast and gynecologic cancer survivors. ResultsOf 11,486 Black females, 531 developed a breast or gynecological cancer (4.6%) over a median follow-up of 140 months (interquartile range: 123-159 months). Compared to women without cancer, women with a breast or gynecological cancers had greater than 20% higher risk of incident CVD during the follow-up period. Without adjusting for covariates, positive association between CVD risk and breast cancer was observed (hazard ratio (HR) = 1.24; 95% confidence interval (CI) = 1.11 - 1.39; p < 0.001); as well as between CVD risk and a gynecological cancer (HR = 1.23; 95% CI = 1.03 - 1.46; p = 0.021). Yet, after adjusting for covariates, CVD risk was only significantly associated with breast cancer (p = 0.001) but not gynecologic cancer. In cancer case-only analyses, CVD risk was significantly increasing with age (p < 0.05). ConclusionsLike study populations of predominantly White females, our results suggest that, adjusting for covariates, Black females possess a higher risk of CVD following a breast cancer diagnosis compared to women who did not develop breast cancer. Our results suggest a need for active CVD surveillance in the cancer survivorship phase.

The physical and psychological aspects of quality of life mediates the effect of radiation-induced urgency syndrome on disability pension in gynecological cancer survivors.

Radiation-induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors. We used patient-reported outcome measures from working-age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure-mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two-sided. Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1-4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2-3.9)). The proportions mediated were higher for physical aspects of QoL (35%-71%) than for psychological aspects (2%-47%). The investigated aspects of the self-assessed QoL of gynecological cancer survivors may play a role in these women's continuing work-life. It appears that physical health, satisfaction with sleep, psychological well-being, and other investigated aspects of QoL mediate the urgency syndrome-disability pension association.

Sexual Health and Quality of Life in Cancer Survivors With Pelvic Radiation Injuries.

Little knowledge exists on how late radiation tissue injuries (LRTIs) affect sexual health and health-related quality of life (HRQOL) in pelvic cancer survivors. To explore sexual health and HRQOL in cancer survivors with pelvic LRTI. A descriptive cross-sectional study was conducted, including 83 pelvic cancer survivors with LRTI. Data on sexual health, LTRIs, and HRQOL were collected by validated questionnaires, whereas medical variables were collected from medical records. Participants' sexual health was severely impaired. Bowel and urinary LRTIs correlated with most of the symptoms of impaired sexual health (Pearson r = -0.241 to -0.376, P < .05-.01). Men and women reported different sexual challenges related to functional and symptomatic variables but not on the gender-neutral aspects of sexual health. Younger survivors, gynecological cancer survivors, or those who received external and internal radiation or additional chemotherapy reported significantly ( P < .05-.001) higher levels of sexual impairment. Participants' HRQOL was impaired. Several dimensions of sexual health correlated significantly ( P < .05-.001) with the functional dimensions of reduced HRQOL. Cancer survivors with pelvic LRTIs experience severely impaired sexual health across genders, with negative consequences for their HRQOL. Healthcare professionals should include sexual health as an important part of individual patients' health and HRQOL throughout their treatment trajectory and follow-up, by screening sexual health, implementing measures and interventions to promote sexual health, and supporting survivors' coping and health-promoting strategies.

Evaluation of incontinence and lymphedema in gynecological cancer patients along with their impact on the quality of life.

The aim of this study is to evaluate the patients who developed both urinary incontinence and lymphedema in gynecological cancer survivors and to investigate the impact of these conditions on the quality of life among these patients. Our study included 56 patients who have lymphedema and urinary incontinence which started within first 2years after surgery for gynecological cancer. We evaluated the presence of urinary incontinence by Overactive Bladder Assessment Tool (OABT) and Urogenital Distress Inventory (UDI). Incontinence Impact Questionnaire (IIQ-7) was used to assess the quality of life. OABT and UDI scores were found to be statistically significantly increased in patients with grade 3 lymphedema (respectively p: 0.006, p: 0.008). A statistically significant difference was found between lymphedema grade 1-2-3 patients in terms of IIQ-7 (p:0.002). The difference was statistically significant between the grade 1-3 (p:0.001) and grade 2-3 (p:0.013) groups. We did not find any correlation between age, type of cancer, radiotherapy, and urinary incontinence. There was a statistically significant positive correlation between BMI and OABT, UDI scores (respectively, r = 0.43, p = 0.001; r = 0.38, p = 0.003). It was concluded that there was a relationship between urinary incontinence and grade 3 lymphedema in gynecological cancer survivors. Grade 3 lymphedema increases urinary incontinence and worsens daily living functions in these patients.

Preventive behaviors and behavioral risk factors among gynecologic cancer survivors: Results from the 2020 Behavioral Risk Factor Surveillance System Survey.

Maintaining a healthy lifestyle is an important factor in promoting positive outcomes for gynecologic cancer survivors. We examined preventive behaviors among gynecologic cancer survivors (n = 1824) and persons without a history of cancer in a cross-sectional analysis, using data from the 2020 Behavioral Risk Factor Surveillance System survey (BRFSS). BRFSS is a cross-sectional telephone-based survey of U.S. residents 18 years of age and older, which collects information about health-related factors and use of preventive services. The prevalence rates of colorectal cancer screening were respectively 7.9 (95% CI: 4.0-11.9) and 15.0 (95% CI: 4.0-11.9) %-points higher among gynecologic and other cancer survivors compared to that of 65.2% among those without any history of cancer. However, no differences were observed in breast cancer screening between gynecologic cancer survivors (78.5%) and respondents without any history of cancer (78.7%). Coverage of influenza vaccination among gynecologic cancer survivors were 4.0 (95% CI: 0.3-7.6) %-points higher than that of the no cancer group, but 11.6 (95% CI: 7.6-15.6) %-points lower than that of the other cancer group. Pneumonia vaccination rate among gynecologic cancer survivors, however, was not statistically different than that of other cancer survivors and respondents with no history of cancer. When examining modifiable risk behaviors, the prevalence of smoking among gynecologic cancer survivors was 12.8 (95% CI: 9.5-16.0) and 14.2 (95% CI: 10.8-17.7) %-points higher than smoking prevalence among other cancer survivors and respondents without any history of cancer. The rate differentials were even higher in rural areas, 17.4 (95% CI: 7.2-27.6) and 18.4 (95% CI: 7.4-29.4) %-points respectively. There were no differences in the prevalence of heavy drinking across the groups. Lastly, gynecologic and other cancer survivors were less likely to be physically active (Δ = -12.3, 95% CI: -15.8 to -8.8 and Δ = -6.9, 95% CI: -8.5 to -5.3, respectively) than those without any history of cancer. Smoking prevalence among gynecologic cancer survivors is alarmingly high. Intervention studies are needed to identify effective ways to assist gynecologic cancer survivors to quit smoking and refrain from hazardous alcohol consumption. In addition, women with gynecologic malignancies should made aware of the importance of physical activity.

Effects of phytoncide on immune cells and psychological stress of gynecological cancer survivors: randomized controlled trials.

This study aimed to identify neuroendocrine substances and natural killer (NK) cells, including their subsets and receptors, to determine whether phytoncides scented in an urban hospital could help improve stress in cancer survivors. Fifty-five gynecological cancer survivors were assigned to either the control group (CG, n=28) or phytoncide group (PTG, n=27). The PTG meditated by lying down in a space scented with phytoncide for 1 hr a day, 5 days a week for 8 weeks. Stress levels in both groups were high prior to the experiment and decreased by 9.31%±45.98% (P=0.003) only in the PTG after the experiment. Although the parasympathetic nerve activity of the PTG increased, the epinephrine and cortisol levels were significantly (P<0.001) decreased by 5.29%±25.5% and by 24.94%±11.62%. Moreover, the PTG showed a significant increase in the levels of NK cell subsets after 8 weeks, whereas there was no improvement in the CG. In conclusion, phytoncide fragrance reduces stress, increases the number of NK cells and their family even in a nonforest environment, and improves innate immunocytes in gynecological cancer survivors; parasympathetic nerve activity and cortisol hormones play critical roles in this process. That is, a phytoncide essential oil helps to stimulate changes in immunocytes' mobility by affecting the human nervous and endocrine systems, thereby providing relief for psychological stress among cancer survivors who previously had cancer cells.

Intra-abdominal Surgery and Intestinal Syndromes After Pelvic Radiation Therapy

To determine the effects of intra-abdominal surgery on the intensities of 5 radiation-induced intestinal syndromes in survivors of pelvic cancer. The analysis included 623 women born in 1927 or later who had survived cancer. They all had received external radiation therapy toward the pelvic area to treat gynecologic cancers. Information from 344 women who did not undergo irradiation, matched for age and residency, was also included. Main outcome measures after the surgical procedures were the intensity scores for 5 radiation-induced intestinal syndromes: urgency-tenesmus syndrome, fecal-leakage syndrome, excessive mucus discharge, excessive gas discharge, and blood discharge. The scores were based on symptom frequencies obtained from patient-reported outcomes and on factor loadings obtained from a previously reported factor analysis. Follow-up was 2 to 15 years after radiation therapy. Among survivors of cancer, intra-abdominal surgery increased the intensity of the urgency-tenesmus syndrome, the fecal-leakage syndrome, excessive gas discharge, and blood discharge but had a negligible effect on mucus discharge. Intra-abdominal surgery had an especially negative effect on the urgency-tenesmus syndrome. Although the combination of appendectomy with 1 or more other intra-abdominal surgeries resulted in the highest score for all syndromes, appendectomy alone had weak to no effect. In women who did not undergo irradiation, a similar pattern was seen, albeit with much lower scores. We found intra-abdominal surgery to be a risk factor among survivors of gynecologic cancer, increasing the intensity score of 4 out of 5 radiation-induced intestinal syndromes. During radiation therapy, it may be worthwhile to pay extra attention to the dose of unwanted ionizing radiation to the intestines if the patient previously has undergone intra-abdominal surgery.

Vaginal Erbium Laser as a non-hormonal therapeutical procedure for managing urinary symptoms in breast and gynecological cancer survivors

Vaginal Erbium Laser as a non-hormonal therapeutical procedure for managing urinary symptoms in breast and gynecological cancer survivors

Gynecological Cancer Survivors' Experiences and Desire for Follow-up After Recent Treatment: A Phenomenological Hermeneutic Study.

Gynecological cancer survivors experience a variety of challenges after discharge from hospital treatment. Cancer support and rehabilitation are recognized as significant facilitators for quality of life in survivorship but are reported to be insufficient by gynecological cancer survivors. To describe the lived experiences of gynecological cancer survivors and how their needs for follow-up should be met following recently completed treatment. This study used a phenomenological hermeneutic design with individual in-depth interviews with 20 women after recently completed cancer treatment. Transcribed interviews were analyzed with the Lindseth and Norberg phenomenological hermeneutic method. Four themes were identified: "a brutal transition to life after cancer," "fear of recurrence overshadowing the existence," "a need for professional support," and "information is not given unless asked for." After completing gynecological cancer treatment, the fear of cancer recurrence is dominating, regardless of prognosis and diagnosis. At the same time, information and support from healthcare professionals are described as lacking. Participants expressed a need to be contacted directly as a formal routine by healthcare professionals after cancer treatment with cancer-specific information as this may alleviate the existential suffering that the cancer experience brings. A person-centered, systematic follow-up rehabilitation is needed as a continuation of the care provided during cancer treatment. Future research is needed to explore the impact on women's quality of life when gynecologic-specific information is given in advance of hospital discharge after completing treatment.

Symptom burdens in long-term survivors of gynecologic cancer receiving acupuncture care.

e24152 Background: Gynecologic cancer survivors (GCS) experience physical and emotional symptom burdens (SB) due to advanced, recurrent disease and intensive treatment often requiring supportive, complementary/integrative therapies. Yet, limited evidence exists on which specific SB require attention and intervention. This study aimed to identify demographics and SB of GCS referred for outpatient acupuncture services at a U.S. cancer center. Methods: A retrospective analysis was conducted of GCS actively receiving outpatient acupuncture services at the University of Chicago Supportive Oncology Program between March 2021 and June 2022. A brief self-reported SB assessment using a 0-10 Likert rating scale was completed at each acupuncture treatment. Socio-demographic (age, religion), disease information (stage) and SB (pain, insomnia) information was obtained from the medical record. Descriptive statistics were analyzed and paired sample t-tests evaluated SB differences prior to first and final treatment. Results: Eighty-three percent (54 of 65 referred) GCS received outpatient acupuncture care. Seventeen percent (11 of 65 referred) were unable to seek acupuncture due to disease progression leading to referral for end-of-life care (e.g. hospice, home palliative care). The mean age of GCS receiving acupuncture was 60y (range 30-81); 97% Non Hispanic, 65% White; 32% African American; 58% married; 53% with children; 65% Christian; 59% retired/on disability. Fifty percent of GCS had endometrial dx, 47% ovarian; 95% Stage IV; mean 7y since dx (range = .6-20y); 88% lacked advanced directives (e.g. DNR). Seventy percent completed at least four weekly acupuncture treatments. Prevalent SB were fatigue (94.1%), sleep disturbance (88.3%), pain (88.2%), anxiety (82.6%); and neuropathy (52.9%). On average, elevated SB mean scores were fatigue, numbness, anxiety, and hot flashes. Neuropathy was scored as the most severe (≥8 of 10). No significant improvement in SB was identified at the third treatment (p = 0.10). At the sixth session, GCS reported significantly less pain (p = 0.02). SB change was both statistically and clinically significant in 61-73% GCS at last session, except nausea. Only 0-5% of GCS reported worsening SB after acupuncture. Conclusions: Our results suggest acupuncture may aid in GCS SB control serving as a useful adjunct during cancer treatment and beyond. Early acupuncture referral may benefit GCS coping with SB during the cancer trajectory and is warranted. Future research should use a longitudinal prospective cohort design with validated SB measures.

Black voices on gynecologic cancer: Understanding experiences.

e18680 Background: Structural racism and bias affects care of Black gynecologic cancer patients. Factors associated with disparities in Black cancer death rates have been associated with structural racism which has systematically limited the standard of living (wealth, housing, education, healthy food and healthcare) for Black people. Recent studies point to implicit bias, and lack of cultural sensitivity playing a significant role in the health outcomes of Black cancer patients. For instance, despite NCCN guidelines, oncologists underprescribe chemotherapy for older Black women with ovarian cancer and underdose chemotherapy for Black women with cervical cancer. Moreover, Black women dying from advanced uterine cancer are given pain medication at lower rates &amp; there are disparities in palliative care utilization amongst Black patients with metastatic gynecologic cancer. The voices of Black patient advocates are frequently missing from research studies. By centering the voices of Black patient advocates, we can identify new means of addressing &amp; positively impacting disparities within the clinical care spectrum (from diagnosis to survivorship). Our study group, Black Voices on Gynecologic Cancer: Understanding Experiences, aimed to identify common and unique scenarios of racism and bias in the experiences of Black patients with gynecologic cancer seeking medical attention. Methods: Focus groups were advertised using social media and partner patient advocacy organizations. We conducted five focus groups of 24 Black gynecologic cancer survivors using a Zoom platform. Key themes were identified through individual and group review of transcripts. Results: The themes that emerged from the focus groups included: (1) lack of communication and/or clarity in patient/provider communication - “… my first appointment with my gyn I did…share that…I'm having these hot flashes, night sweats…so he gave me some medicine, but… they´d never really addressed and had a conversation about like this is what your body will be experiencing…So, I really have been dependent on other women that have gone through this.”, (2) insufficient mental health support throughout and after treatment, (3) experiences with misdiagnosis (4) provider’s inadequate management of patient pain, (5) failure to mention clinical trials and (6) difficulty navigating insurance. Conclusions: Our study identified gaps in the care of Black gynecologic cancer patients. The second phase of BVOGUE will reduce structural barriers that prohibit authentic patient and community engagement around gynecologic cancer care and participation in academic research for Black cancer patients. We will pilot modules for both cancer education and research advocacy. This model will serve as a roadmap for all cancer centers creating action plans for engagement, inclusion, and participation.

(015) Sexual Health and Relationship Enhancement (SHARE) for Women with Breast Cancer: Results from a Clinical Trial

Abstract Introduction Sexual difficulties in the context of cancer survivorship remains an important, unsolved problem. Interventions must be efficacious and disseminable. Interventions that can be delivered to heterogeneous survivor groups can maximize impact on patients' quality of life. Objective Test a group psychosexual intervention -- Sexual Health and Relationship Enhancement (SHARE) -- designed for gynecologic cancer survivors in a sample of breast cancer survivors to determine feasibility and efficacy. Methods Participants were breast cancer survivors (N = 28). The majority (53.6%) was diagnosed at stage I (stage II: 35.7%, stage III: 10.7%). The participants were primarily Caucasian (75%) with an average age of 50.6 years (SD = 11.7, range = 29-79) and the majority were partnered (75%). Intent-to-treat (IIT) analyses were conducted for treatment outcomes. Using all available data, mixed effects modeling tested for change in treatment outcomes from the initial assessment to 3-, 6-, and 9-month assessments. Cohen’s d effect sizes were reported at post-treatment (6 months) and follow-up (9 months). The reliable change index was used to determine whether reliable clinical change had been achieved for each patient. Results The 12-session attendance rate was 23%. The mean number of SHARE sessions attended was 9 (SD=3.2). The rate therapy dropout was 10% (n=3). The patients viewed the treatment as helpful; average helpfulness ratings were 2.5 out of 3.0 (SD=0.4) and 84% of ratings fell in the moderately to very helpful range. Using a 0 to 10 point scale for cohesion, the means were 8.0 (SD=1.1) for involvement in the therapy experience and 9.2 (SD=1.1) for felt support. Significant linear effects of time (improvements) were seen for sexual function, satisfaction, and distress (p&amp;lt;.001); sexual behavior did not change. Effect sizes of change from baseline to post-treatment and follow-up on significant outcome measures were large (d=0.75-1.06). Most participants’ improvement in sexual function (65.2%) and sexual distress (66.7%) was reliable. Almost half of participants reported clinical levels of sexual distress at baseline that decreased to sub-clinical levels at follow-up, and 16.7% of participants had baseline clinical sexual dysfunction that was sub-clinical at follow-up. Conclusions SHARE-B is feasible and efficacious for addressing sexual morbidity following breast cancer, indicating it is likely possible to deliver to women with a variety of disease sites improving scalability of the intervention. Disclosure No

65 - Vaginal Erbium Laser as a non-hormonal therapeutical procedure for managing urinary symptoms in breast and gynecological cancer survivors

65 - Vaginal Erbium Laser as a non-hormonal therapeutical procedure for managing urinary symptoms in breast and gynecological cancer survivors

Gynecological Cancer Survivors' Experiences of Dyspareunia and Factors Influencing Care-Seeking Behavior: A Qualitative Study.

Pain during sexual intercourse, also called dyspareunia, affects most women after treatment for gynecological cancer. Previous work adopted a biomedical approach to depict dyspareunia in this population, which provided a narrow perspective of this condition. Taking into account women's experiences of dyspareunia and the factors influencing their care-seeking behaviors would provide insight to improve care in the context of gynecological cancer. The aim of this study was to describe gynecological cancer survivors' experiences of dyspareunia and factors influencing care-seeking behavior. A qualitative study was performed with 28 gynecological cancer survivors with dyspareunia. Individual telephone interviews were conducted based on the Common-Sense Model of Self-Regulation. Interviews were recorded and transcribed for analysis using the interpretative description framework. Concerning their experience, participants reported the oncological treatments as the primary cause of dyspareunia. Loss of libido, lower vaginal lubrication, and smaller vaginal cavity were described as being linked with dyspareunia. Women explained how dyspareunia and these changes had led them to engage less in, and even interrupt, sexual activity. They expressed that they were distressed, felt less of a woman, and experienced low control and/or self-efficacy. Regarding the factors influencing women's care-seeking behaviors, participants emphasized that they were provided with insufficient information and support. Balancing priorities, denial or reluctance, misbeliefs, resignation and acceptance, and negative emotions were reported as barriers, whereas acknowledgement of sexual dysfunction, desire for improvement, awareness of treatment possibilities, willingness to undertake treatment and treatment acceptability were reported as facilitators to seeking care. Findings suggest that dyspareunia is a complex and impactful condition after gynecological cancer. While this study highlights the importance of alleviating the burden of sexual dysfunction in cancer survivors, it identified factors that should be considered in the provision of services to improve care.

The most unmet needs on Gynecological and Breast Cancer Survivors, A Systematic Review

Introduction: The complexity of treating gynecological and breast cancer causes unmet needs for survivors. This systematic review aimed to identify the most unmet needs of gynecological and breast cancer survivors from the available evidence. Method: Researchers searched the electronic databases PubMed, Cochrane, CINAHL, Ebsco Host, and Science Direct with predetermined criteria. The keywords used were combinations of "gynaecologic* cancer" OR "gynaecologic* cancer survivors" OR "breast cancer" OR "breast cancer survivors" AND "unmet needs." A systematic review was made using PRISMA, the critical appraisal was carried out with the JBI instrument, and bias analysis was carried out using the Robvis Tool. Results: There are 12 selected articles. The two highest unmet needs domains for gynecological and breast cancer survivors are the health system information and psychological domains. Conclusions: Nurses and other health workers must pay attention to implementing holistic care to meet the various needs of gynecological cancer survivors, including health system information and psychological domains. Introduccion: La complejidad del tratamiento del cancer ginecológico y de mama genera necesidades insatisfechas para los sobrevivientes. Esta revisión sistemática tuvo como objetivo identificar las necesidades más insatisfechas de las sobrevivientes de cancer ginecológico y de mama a partir de la evidencia disponible.Método: Los investigadores realizaron búsquedas en las bases de datos PubMed, Cochrane, CINAHL, Ebsco Host, Science Direct con criterios electrónicos predeterminados. Las palabras claves usadas fueron combinacion de " cáncer " ginecológico *"O" sobrevivientes de cáncer ginecológico *" O " cáncer de mama" O " sobrevivientes de cáncer de mama" Y " necesidades insatisfechas ". Se realizó una revisión sistemática mediante PRISMA, la evaluación crítica se realizó con el instrumento JBI y el análisis de sesiones mediante la herramienta Robvis.Resultados: Hay 12 artículos seleccionados. Los dos dominios de necesidades insatisfechas más importantes para los sobrevivientes de cáncer ginecológico y cáncer de mama son el dominio de informacion del sistema de salud y el dominio psicológico.Conclusión: Las enfermeras y otros trabajadores de la salud deben prestar atencion a la implementacion de una atención holística para satisfacer las diversas necesidades de los sobrevivientes de cancer ginecológico, incluidas las necesidades de información del sistema de salud y los dominios psicológicos.

A survey of female sexual dysfunction in gynaecological cancer survivors: A case–control study

BackgroundWith diagnostic and treatment advancements in cancer management, the need for improvement of survivors’ quality of life has been increasing. One of the issues affecting the quality of life in gynecologic cancer survivors is a decline in their sexual function, which is affected in many ways. In order to assess sexual dysfunction in gynecologic cancer survivors. ObjectiveThis study is designed to assess different areas of sexual function including desire, arousal, vaginal lubrication, orgasm, satisfaction, and pain. Materials and methodsPatients who had completed treatment since 6 months to 6 years ago included in the case–control study starting from January 2019 to January 2020. Twenty-nine sexually active gynecologic cancer survivors with sexual dysfunction were enrolled as cases and 91 sexually active ones without sexual problems were assigned to the control group. The Female Sexual Function Index (FSFI) questionnaire consisting of 19-items and six areas was completed for each participant. ResultsAverage sexual dysfunction score of the case group was 16.78 with cut-off point of 28 for dysfunction. The most common domain of sexual dysfunction was pain (96.55%), followed by sexual arousal (86.21%), vaginal lubrication (72.41%), orgasm (72.41%), satisfaction (65.52%) and sexual desire (55.17%). ConclusionIn gynecologic cancer survivors, sexual dysfunction was directly related to employment, brachytherapy and co-existing DM and inversely related to the time elapsed since cancer diagnosis and menopause. Asking about sexual problems and referral to a specialist should be included in the patient treatment process.