nach oben

Supportive Care in Cancer

Erschienen in:

01.07.2013 | Original Article

Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer

verfasst von: Kimberley Cullen, Karen Fergus, Tracey DasGupta, Iwa Kong, Marg Fitch, Catherine Doyle, Lauran Adams

Erschienen in: Supportive Care in Cancer | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Building upon the findings of a recent qualitative investigation of women’s experiences with rehabilitative vaginal dilator use, the primary goal of this article is to outline a set of preliminary clinical care recommendations that health care professionals may draw upon in addressing women’s unique experiences with vaginal dilator use including their multifaceted struggles with the procedure, possibly enhancing adherence to this practice.

Methods

Ten women participated in in-depth interviews regarding their experiences with using the dilator as prescribed by their health care providers. Following the analysis of these interviews, members of the interdisciplinary research team met to review and discuss the development of clinical care recommendations stemming from these findings.

Results

Eight care recommendations aimed at addressing the concerns expressed by the women interviewed and at improving women’s overall experiences with rehabilitative dilator use emerged: (1) introduce the dilator in a light and straightforward manner; (2) enhance dilator accessibility; (3) introduce the vaginal dilator early on in treatment; (4) emphasize health maintenance over intercourse as a benefit of dilator use; (5) explore and acknowledge women’s values and views of sexuality; (6) increase awareness and sensitivity to emotional reactions; (7) enhance psychoeducational resources for supporting vaginal dilator use; and (8) ensure consistent institutional practice when introducing the dilator.

Conclusion

The clinical care recommendations proposed here reflect the various challenges women may encounter when using the vaginal dilator—which vary from practical to, for some, profoundly emotional—and are designed to better position health care providers to help women navigate these challenges.

American Cancer Society (2012) Cervical Cancer. From http://www.cancer.org/acs/groups/cid/documents/webcontent/003094-pdf.pdf. Accessed 27 Apr 2012

Canadian Cancer Society, Statistics Canada (2011). Canadian Cancer Statistics. From http://www.cancer.ca/∼/media/CCS/Canada%20wide/Files%20List/English%20files%20heading/PDF%20-%20Policy%20-%20Canadian%20Cancer%20Statistics%20-%20English/Canadian%20Cancer%25%2020Statistics%202011%C2%A0%20-%20English.ashx. Accessed 23 Mar 2011

Faithfull S, White I (2008) Delivering sensitive health care information: challenging the taboo of women’s sexual health after pelvic radiotherapy. Patient Educ Couns 71:228–233PubMedCrossRef

Jeffries SA, Robinson JW, Craighead PS, Keats MR (2006) An effective group psychoeducational intervention for improving compliance with vaginal dilation: a randomized controlled trial. Int J Radiat Oncol 65:404–411CrossRef

Brand AH, Bull CA, Cakir B (2006) Vaginal stenosis in patients treated with radiotherapy for carcinoma of the cervix. Int J Gynecol Cancer 16:288–293PubMedCrossRef

Decruze SB, Guthrie D, Magnani R (1999) Prevention of vaginal stenosis in patients following vaginal brachytherapy. Clin Oncol 11:46–48CrossRef

Lancaster L (2004) Preventing vaginal stenosis after brachytherapy for gynaecological cancer: an overview of Australian practices. Eur J Oncol Nurs 8:30–39PubMedCrossRef

Friedman LC, Abdallah R, Schluchter M, Panneerselvam A, Kunos CA (2011) Adherence to vaginal dilation following high dose rate brachytherapy for endometrial cancer. Int J Radiat Oncol 80:751–757CrossRef

Carter J, Sonoda Y, Chi DS, Raviv L, Abu-Rustum NR (2008) Radical trachelectomy for cervical cancer: postoperative physical and emotional adjustment concerns. Gynecol Oncol 111:151–157PubMedCrossRef

10.

Carter J, Goldrank D, Schover LR (2011) Simple strategies for vaginal health promotion in cancer survivors. J Sex Med 8:549–559PubMedCrossRef

11.

Denton AS, Maher J (2003) Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database Syst Rev (1):CD003750

12.

Miles T, Johnson N (2010) Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev (9):CD007291

13.

Johnson N, Miles T, Cornes P (2010) Dilating the vagina to prevent damage from radiotherapy: systematic review of the literature. Bjog-Int J Obstet Gy 117:522–531CrossRef

14.

Velaskar SM, Martha R, Mahantashetty U, Badakare JS, Shrivastava SK (2007) Use of indigenous vaginal dilator in radiation induced vaginal stenosis. Indian J Occup Ther 34:3–6

15.

Jefferies H, Hoy S, McCahill R, Crichton A (2007) Guidelines on vaginal dilator use after pelvic radiotherapy. Nurs Times 103:28–29

16.

American Cancer Society (ACS) Preventing pain during sex 2011. From: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSide Effects/SexualSideEffectsinWomen/SexualityfortheWoman/sexuality-for-women-with-cancer-preventing-pain?docSelected=sexuality-for-women-with-cancer-vaginal-dryness. Accessed 1 Jun 2011

17.

White I, Faithfull S (2006) Vaginal dilation associated with pelvic radiotherapy: a UK survey of current practice. Int J Gynecol Cancer 16:1140–1146PubMedCrossRef

18.

Schover LR, Fife M, David M, Gershenson DM (1989) Sexual dysfunction and treatment for early stage cervical cancer. Cancer 63:204–212PubMedCrossRef

19.

Bruner DW, Lanciano R, Keegan M, Corn B, Martin E, Hanks GE (1993) Vaginal stenosis and sexual function following intracavitary radiation for the treatment of cervical and endometrial cancer. Int J Radiat Oncol 27:825–830CrossRef

20.

Punt L (2011) Patient compliance with the use of vaginal dilators following pelvic radiotherapy for a gynecological cancer. J Radiother Pract 10:13–25

21.

Stilos K, Doyle C, Daines P (2008) Addressing the sexual health needs of patients with gynecologic cancers. Clin J Oncol Nurs 12:457–463PubMedCrossRef

22.

Katz A (2005) The sounds of silence: sexuality information for cancer patients. J Clin Oncol 23:238–241PubMedCrossRef

23.

Cullen K, Fergus K, DasGupta T, Fitch M, Doyle C, Adams L (2012) From “sex toy” to intrusive imposition: a qualitative examination of women’s experiences with vaginal dilator use following treatment for gynecological cancer. J Sex Med 9:1162–1173PubMedCrossRef

24.

Glaser BG, Strauss A (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago

25.

Juraskov I, Butow P, Robertson L, Sharpe L, McLeod C, Hacker N (2003) Post-treatment sexual adjustment following cervical and endometrial cancer: a qualitative insight. Psycho-Oncol 12:267–279CrossRef

26.

Guglietti CL, Rosen B, Murphy KJ, Laframboise S, Dodge J, Ferguson S, Katz J, Ritvo P (2010) Prevalence and predictors of posttraumatic stress in women undergoing an ovarian cancer investigation. Psychol Serv 7(4):266–74.24CrossRef

27.

Urbaniec OA, Collins K, Denson LA, Whitford HS (2011) Gynecological cancer survivors: assessment of psychological distress and unmet supportive care needs. J Psychosoc Oncol 29(5):534–551PubMedCrossRef

Titel: Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer
verfasst von: Kimberley Cullen
Karen Fergus
Tracey DasGupta
Iwa Kong
Marg Fitch
Catherine Doyle
Lauran Adams
Publikationsdatum: 01.07.2013
Verlag: Springer-Verlag
Erschienen in: Supportive Care in Cancer / Ausgabe 7/2013
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1726-6

Springer Medizin

Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer