Cervical cancer survivor narratives: Lessons for clinical practice and research

Hunter, Jennifer Lynn

Monday, 18 November 2013

Jennifer Lynn Hunter, PhD, RN
School of Nursing, University of Missouri-Kansas City, Kansas City, MO

Learning Objective 1: The learner will be able to list concerns described by gynecologic cancer survivors regarding the impact of cancer treatment on sexual function and intimate relationships.

Learning Objective 2: The learner will be able to apply assessment skills and evidence-based interventions and to identify needed areas of research and improvements in clinical practice.

Background: Cervical cancer is primarily a cancer of economically disenfranchised women. Diagnosis occurring in later stages of disease requires toxic multimodal treatment. Potential complications impact quality of life, social functioning, and intimacy. Gynecological cancer survivors who have been treated with radiation therapy (RT) develop late complications from treatment, including damage to uterus, urinary tract, bowel, nerve, and vagina, all which can significantly impact their quality of life and that of their partners. RT impairs sexual function by causing vaginal epithelial and vascular destruction, atrophy and fibrosis leading to stenosis. Although treatment-related vaginal and sexual sequelae have been well documented, little more is known now than in the 1950s about interventions to prevent or treat these complications. There seems to be an unchallenged acceptance among many healthcare providers that nothing can be done, although small intervention studies have shown promise.

Methods: In-depth semi-structured interviews were used to elicit survivorship narratives of physical complications, the expectedness or surprise of the complications, behavioral and emotional responses, and what information, skills, and support were needed to promote satisfaction in, survival of, and new engagement in intimate relationships.

Findings: Identified themes included: (1) significant unexpected physical changes, (2) experiences of isolation, physical and emotional pain, shame, and fear of intimacy related to complications, (3) poor communication, anticipatory guidance, and intervention from health care providers related to sexual and intimacy issues.

Implications for Clinical Practice and Research: Improvements in health provider education related to sexual aspects of gynecologic cancer survivorship and development of interventions aimed at anticipatory guidance and sexual rehabilitation can reduce the severity of problems experienced by patients and partners. There is great need for further research in this area.

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