7.2.2 Development of an integrated psychosexual clinical assessment strategy for women receiving pelvic radiotherapy (374)

Isabel White, Clinical Research Training Fellow, Faculty of Health & Medical Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom i.white@surrey.ac.uk

Abstract:

Background:

Pelvic radiotherapy creates a number of physical effects and psychological responses that impact negatively on the sexual well-being of women and their partners (Juraskova et al 2003, Davidson et al 2003 ; Jensen et al 2003).

Aims:

The aim of this study was to develop an assessment methodology to improve the clinical evaluation of sexual morbidity following radiotherapy in women with pelvic malignancy.

Methods:

This focused ethnography used participant observation of gynaecological and colorectal oncology follow-up clinics (50 gynaecological, 19 colorectal consultations) plus in-depth interviews with women (n=24), partners (n=5) and health professionals (n=20) to explore the context and content of sexual morbidity assessment after treatment completion. Women with gynaecological (cervical, endometrial) and non-gynaecological (rectal, anal, bladder) cancer who had completed radical pelvic radiotherapy 3, 6, 12 and 24 months previously were included. Doctors, nurses and therapy radiographers were interviewed to establish professional perspectives on assessment. Participant observation and interview data were analysed using both SPSS v.14 and NVivo v.2 software.

Results:

Consultations focused on disease surveillance, specific aspects of toxicity monitoring and managing active symptoms. Psychosocial issues were raised in only 42% (n=29) of consultations. Sexual concerns were not routinely assessed in gynaecological clinics (11/50) while in colorectal clinics they were predominantly explored via standardised clinical trial toxicity monitoring (6/19). Health professionals felt inhibited discussing sexual concerns with older women and when partners were present. Patient and partner interviews revealed inconsistency in the management of treatment induced menopause, inadequate knowledge of sexual health resources and unidentified difficulties including loss of desire, dyspareunia and reduced sexual satisfaction.

Discussion & conclusions:

The current model of medical follow-up may not be an appropriate clinical context for the optimal assessment and management of sexual concerns associated with pelvic radiotherapy. These findings are important for the development of supportive care services and training of health professionals engaged in post-treatment toxicity assessment, patient information and support.

Biography:

Isabel’s clinical and research interests contribute to the development of psychosexual practice in oncology. She is a board member of the International Society for Sexuality and Cancer (ISSC) and provides psychosexual therapy to clients experiencing a range of sexual difficulties, including those associated with cancer and other chronic illnesses. While at City University (London) she was principle investigator for two studies related to psychosexual practice: an exploration of the sexual support needs of couples affected by prostate cancer and a survey of current UK practice related to the use of vaginal dilators after pelvic radiotherapy. Her current research at the University of Surrey aims to develop an integrated psychosexual assessment strategy for use in clinical oncology practice with women receiving pelvic radiotherapy.