Vaginal changes, sexual functioning and distress of women with locally advanced cervical cancer treated in the EMBRACE vaginal morbidity substudy

I. Suvaal, K. Kirchheiner, R. A. Nout, A. E. Sturdza, E. Van Limbergen, J. C. Lindegaard, H. Putter, I. M. Jürgenliemk-Schulz, C. Chargari, K. Tanderup, R. Pötter, C. L. Creutzberg, M. M. ter Kuile*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective: The EMBRACE-vaginal morbidity substudy prospectively evaluated physician-assessed vaginal changes and patient-reported-outcomes (PRO) on vaginal and sexual functioning problems and distress in the first 2-years after image-guided radio(chemo)therapy and brachytherapy for locally advanced cervical cancer. Methods: Eligible patients had stage IB1-IIIB cervical cancer with ≤5 mm vaginal involvement. Assessment of vaginal changes was graded using CTCAE. PRO were assessed using validated Quality-of-Life and sexual questionnaires. Statistical analysis included Generalized-Linear-Mixed-Models and Spearman's rho-correlation coefficients. Results: 113 eligible patients were included. Mostly mild (grade 1) vaginal changes were reported over time in about 20% (range 11–37%). At 2-years, 47% was not sexually active. Approximately 50% of the sexually active women reported any vaginal and sexual functioning problems and distress over time; more substantial vaginal and sexual problems and distress were reported by up to 14%, 20% and 8%, respectively. Physician-assessed vaginal changes and PRO sexual satisfaction differed significantly (p ≤ .05) between baseline and first follow-up, without further significant changes over time. No or only small associations between physician-assessed vaginal changes and PRO vaginal functioning problems and sexual distress were found. Conclusions: Mild vaginal changes were reported after image-guided radio(chemo)therapy and brachytherapy, potentially due to the combination of tumors with limited vaginal involvement, EMBRACE-specific treatment optimization and rehabilitation recommendations. Although vaginal and sexual functioning problems and sexual distress were frequently reported, the rate of substantial problems and distress was low. The lack of association between vaginal changes, vaginal functioning problems and sexual distress shows that sexual functioning is more complex than vaginal morbidity alone.

Original languageEnglish
Pages (from-to)123-132
Number of pages10
JournalGynecologic Oncology
Volume170
DOIs
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
The EMBRACE-vaginal morbidity substudy was supported by Elekta AB and Varian Medical Systems through unrestricted research grants and study sponsoring through the Medical University of Vienna . We acknowledge the principal investigators at the participating centers (Aarhus University Hospital, Institute Gustave-Roussy, Leiden University Medical Center, Medical University of Vienna, University Hospitals Leuven, University Medical Center Utrecht) for all their work and involvement in the EMBRACE-vaginal morbidity substudy. We are greatly indebted to the women who participate in the substudy and complete the questionnaires over the years.

Publisher Copyright:
© 2023 The Authors

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