A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer

• Published in: Supportive care in cancer 2017-03, Vol.25 (3), p.729-737
• Main Authors: Bakker, R. M., Mens, J. W. M., de Groot, H. E., Tuijnman-Raasveld, C. C., Braat, C., Hompus, W. C. P., Poelman, J. G. M., Laman, M. S., Velema, L. A., de Kroon, C. D., van Doorn, H. C., Creutzberg, C. L., ter Kuile, M. M.
• Format: Article
• Language: English
• Subjects: Aged; Brachytherapy; Brachytherapy - adverse effects; Cancer; Care and treatment; Constriction, Pathologic - etiology; Constriction, Pathologic - nursing; Constriction, Pathologic - rehabilitation; Female; Genital Neoplasms, Female - nursing; Genital Neoplasms, Female - physiopathology; Genital Neoplasms, Female - radiotherapy; Genital Neoplasms, Female - rehabilitation; Gynecology; Humans; Intervention; Medical research; Medicine; Medicine & Public Health; Middle Aged; Nurse's Role; Nurses; Nursing; Nursing Research; Oncology; Original; Original Article; Pain Medicine; Pilot Projects; Prospective Studies; Radiation Injuries - etiology; Radiation Injuries - nursing; Radiation Injuries - physiopathology; Radiation Injuries - rehabilitation; Radiation therapy; Rehabilitation; Rehabilitation Medicine; Sexual behavior; Sexual Behavior - physiology; Sexual disorders; Surveys and Questionnaires; Vagina - pathology; Vagina - physiopathology; Vagina - radiation effects
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-016-3453-2

Purpose Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. Methods Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). Results Twenty participants were 26–71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. Conclusions According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.