Impact of Vaginal Symptoms and Hormonal Replacement Therapy on Sexual Outcomes After Definitive Chemoradiotherapy in Patients With Locally Advanced Cervical Cancer: Results from the EMBRACE-I Study

EMBRACE Collaborative Group

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2 Citations (Scopus)

Abstract

Purpose: To evaluate patient-reported sexual outcomes after chemoradiation therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer in the observational, prospective, multicenter EMBRACE-I study. Methods and Materials: Sexual outcomes were assessed prospectively with the European Organization for Research and Treatment of Cancer Qualify of Life Questionnaire (EORTC-QLQ-CX24) at baseline and follow-up. Crude incidence and prevalence rates of sexual activity, vaginal functioning problems (dryness, shortening, tightening, pain during intercourse), and sexual enjoyment were evaluated. Associations between pain during intercourse and vaginal functioning problems or sexual enjoyment were calculated, pooling observations over all follow-ups (Spearman correlation coefficient). In patients who were frequently sexually active (≥50% of follow-ups), the effects of regular hormonal replacement therapy (HRT) on vaginal functioning problems were evaluated (Pearson χ2). Results: The analysis involved 1045 patients with a median follow-up of 50 months. Sexual activity was reported by 22% of patients at baseline and by 40% to 47% of patients during follow-up (prevalence rates). Vaginal functioning problems in follow-up were dryness (18%-21%), shortening (15%-22%), tightening (16%-22%), pain during intercourse (9%-21%), and compromised enjoyment (37%-47%). Pain during intercourse was significantly associated with vaginal tightening (r = 0.544), shortening (r = 0.532), and dryness (r = 0.408) and negatively correlated with sexual enjoyment (r = –0.407). Regular HRT was associated with significantly less vaginal dryness (P = .015), shortening (P = .024), pain during intercourse (P = .003), and borderline higher sexual enjoyment (P = .062). Conclusions: Vaginal functioning problems are associated with pain and compromised sexual enjoyment. Further effort is required for the primary prevention of vaginal morbidity with dose optimization and adaptation. Secondary prevention strategies, including HRT for vaginal and sexual health after radiation therapy in locally advanced cervical cancer, should be considered and sexual rehabilitation programs should be developed further.

Original languageEnglish
Pages (from-to)400-413
Number of pages14
JournalInternational Journal of Radiation Oncology Biology Physics
Volume112
Issue number2
DOIs
Publication statusPublished - 1 Feb 2022

Bibliographical note

Funding Information:
The EMBRACE study was supported by Elekta AB and Varian Medical System through unrestricted research grants and study sponsoring through the Medical University of Vienna.

Disclosures: During the conduct of the study, K.K., M.P.S., A.S., R.P., and K.T. report grants from Elekta AB and Varian Medical Systems. K.T. also reports grants from the Danish Cancer Society. K.K., M.P.S., A.S., and R.P. also report study sponsoring from the Medical University of Vienna. Outside the submitted work, J.C.L. reports grants from Varian Medical Systems; K.T. reports grants from Elekta AB; R.N. reports grants from KWF, NWO, Elekta AB, Varian Medical Systems, and Accuray; and S.Sp. reports grants from the Danish Cancer Society. M.S. and A.S. report personal fees from Elekta AB. C.C. reports personal fees from Elekta AB, MSD and GSK, and research support from Roche and TherAguix.

Publisher Copyright:
© 2021 Elsevier Inc.

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