Linda Åkeflo - Radiotherapy-induced late effects among female pelvic cancer survivors - sexual health, wellbeing and impact of nurse-led interventions

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Abstract
This thesis addresses unmet needs concerning sexual health issues and low wellbeing in female cancer survivors treated with pelvic radiotherapy. The aim was to improve knowledge about sexual health, wellbeing and vaginal changes in female cancer survivors treated with pelvic radiotherapy, and study the impact of nurse-led interventions.

Methods/Results: Quantitative and qualitative methods were used. Studies I-III (n=605, n=260, n=570) are prospective, population-based cohort studies using study-specific questionnaires. Self-reported data concerning physical symptoms and psycho-social health were collected in a cohort of women treated with pelvic radiotherapy for gynecological, anal, or rectal cancer. Statistically significant improvements were shown in satisfaction with overall sexual health and quality of life, and reduced genital pain, depression, and anxiety following individualized nurse-led interventions. No improvements were shown in sexual function. Reduced urgency to defecate was associated with improved satisfaction with overall sexual health. Reduced fecal leakage was associated with lower anxiety. Depression, anxiety, and genital pain were statistically
significantly more common among women with than without a history of sexual abuse. In study IV, qualitative content analysis of interviews with women (n=12) revealed one overarching theme, being unprepared, for receiving information about and performing vaginal dilator therapy. Physical and emotional reactions arose, and complex psychological and practical barriers to motivating the therapy emerged. Some strategies were developed to enhance motivation.

Conclusions: The results indicate that individualized interventions using a biopsychosocial approach in a nurse-led clinic focusing on radiotherapy-induced physical late effects can improve sexual health and wellbeing. The high impact of sexual abuse on sexual health and wellbeing needs to be taken into account in supportive care. Improved follow-up concerning vaginal dilator therapy, information routines, and psychoeducation integrated in the cancer treatment, are needed.

More women with a previous history of sexual abuse reported vaginal pain