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Chen PH, Li YM, Morris K, Makale MT, Mayadev J, Talke FE. Design and Material Characterization of an Inflatable Vaginal Dilator. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1050. [PMID: 38473522 DOI: 10.3390/ma17051050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
There are more than 13,000 new cases of cervical cancer each year in the United States and approximately 245,000 survivors. External beam radiation and brachytherapy are the front-line treatment modalities, and 60% of patients develop vaginal damage and constriction, i.e., stenosis of the vaginal vault, greatly impeding sexual function. The incidence of vaginal stenosis (VS) following radiotherapy (RT) for anorectal cancer is 80%. VS causes serious quality of life (QoL) and psychological issues, and while standard treatment using self-administered plastic dilators is effective, acceptance and compliance are often insufficient. Based on published patient preferences, we have pursued the design of a soft inflatable dilator for treating radiotherapy-induced vaginal stenosis (VS). The critical component of the novel device is the dilator balloon wall material, which must be compliant yet able to exert therapeutic lateral force levels. We selected a commercially available silicone elastomer and characterized its stress-strain characteristics and hyperelastic properties. These parameters were quantified using uniaxial tensile testing and digital image correlation (DIC). Dilator inflation versus internal pressure was modeled and experimentally validated in order to characterize design parameters, particularly the dilator wall thickness. Our data suggest that an inflatable silicone elastomer-based vaginal dilator warrants further development in the context of a commercially available, well-tolerated, and effective device for the graded, controlled clinical management of radiotherapy-induced VS.
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Affiliation(s)
- Po-Han Chen
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
| | - Yu Ming Li
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
| | - Karcher Morris
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
| | - Milan T Makale
- Moores Cancer Center, UC San Diego, 3855 Health Sciences Dr, San Diego, CA 92037, USA
| | - Jyoti Mayadev
- Moores Cancer Center, UC San Diego, 3855 Health Sciences Dr, San Diego, CA 92037, USA
| | - Frank E Talke
- Center for Memory and Recording Research, UC San Diego, 9500 Gilman Dr. MC 0401, La Jolla, CA 92093, USA
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Stewart H, Ashmore L, Kragh-Furbo M, Singleton V, Hutton D. Ghosts in the machinery: Living with and beyond radiotherapy treatment for gynaecological cancer. Health (London) 2024; 28:90-107. [PMID: 35900050 PMCID: PMC10714697 DOI: 10.1177/13634593221114749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper explores post-treatment experiences of women who have had radiotherapy for gynaecological cancer. Drawing on data from a project which explored post-treatment wellbeing, conceptual metaphors of ghosts/haunting are used to engage with enduring legacies of cancer and 'neglected matters' in post-treatment trajectories. Current arrangements of care contribute to the idea that participants are 'out of the other side of cancer' once active treatment completes. Despite broader ambitions for holistic cancer rehabilitation, fragilities of body and mind persist, even when the outward representation is one of health, of looking well, of moving on. We show how neglected matters of cancer (visceral late effects, psychological suffering and lives not lived) are part of living with and beyond cancer. These 'ghosts' manifest in chronic states of unsettledness that are temporarily relieved by individualised 'fixes', such as mobilisation of 'mind over matter' discourse and mindfulness. This discourse and its associated tools are a powerful yet impoverished framing of approaches to living with and beyond cancer. We argue for the need to attend to 'neglected matters' of post-treatment trajectories differently.
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Affiliation(s)
| | - Lisa Ashmore
- Lisa Ashmore, Lancaster Medical School, Lancaster University, Sir John Fisher Drive, Bailrigg, Lancaster LA1 4YW, UK.
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Roussin M, Lowe J, Hamilton A, Martin L. Sexual quality of life in young gynaecological cancer survivors: a qualitative study. Qual Life Res 2023:10.1007/s11136-023-03386-1. [PMID: 36947327 DOI: 10.1007/s11136-023-03386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE The impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a significant and often neglected issue in the treatment and survivorship period of young gynaecological cancer survivors (YGCS). This study sought to explore women's lived experiences to understand how to protect and improve SQoL. METHODS A qualitative study with women aged 18-45 and pre- or perimenopausal at diagnosis (n = 15). A thematic analysis was performed in NVivo. Participants also completed a pre-interview questionnaire and The Female Sexual Distress Scale-Revised (FSDS-R). RESULTS YGCS experienced high psychosexual distress. Notably, seven themes were identified: adjustment, confidence, fear, loss, shame, trauma, and communication. Gynaecological cancer (GC) treatment interfered with everyday life and had a long-term impact on mental, physical, and emotional health, with many reporting an altered sense of self, body image and sexual identity. Single women felt vulnerable in new relationships, while partnered women reported low sexual desire and guilt about sexual difficulties. Open communication, emotional intimacy, and an acceptance of the 'new normal' buffered the trauma of cancer and were vital to relationship satisfaction. Lastly, absent, or blunt patient-clinician communication contributed to psychosexual distress. CONCLUSION GC interferes with sexual function, partner relationships, psychosexual wellbeing, and quality of life. A better understanding of the lived experiences of YGCS can help healthcare providers to adopt a holistic, patient-centric, and multidisciplinary approach to SQoL. YGCS want psychosexual communication and support, across all stages of treatment and care. Healthcare providers should initiate and normalise conversations on the impact of treatment on SQoL.
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Affiliation(s)
- Melanie Roussin
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia.
| | - John Lowe
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia
| | - Anita Hamilton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia
| | - Lisa Martin
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia
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Åkeflo L, Elmerstig E, Bergmark K, Dunberger G. Barriers to and strategies for dealing with vaginal dilator therapy - Female pelvic cancer survivors' experiences: A qualitative study. Eur J Oncol Nurs 2023; 62:102252. [PMID: 36603495 DOI: 10.1016/j.ejon.2022.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/11/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Vaginal changes, a frequently reported late effect among women treated with pelvic radiotherapy, can result in sexual dysfunction and distress. Women are recommended vaginal dilator therapy after completed radiotherapy; however, low adoption has been recognized. This study aims to provide insight into women's difficulties with carrying out vaginal dilator therapy and their experiences of information. METHODS Face-to-face, semi-structured interviews were undertaken with 12 pelvic cancer survivors in a selected sample of women with difficulties adopting the therapy. Interviews were audio-recorded, transcribed and analyzed using qualitative content analysis. RESULTS One overarching theme, Being unprepared, emerged from three identified categories relating to Experience of received information, Experience of performing the therapy, and Motivation to perform the therapy. The women experienced the information as unrealistic and insufficient, and requested clearer and earlier information. Bleeding, pain, fear of cancer recurrence, and recalling memories from treatments were experienced. Women described intestinal symptoms, fatigue, and feeling that the therapy was self-harm as barriers to performing the therapy. They described creating routines, breathing exercises, relaxation, pre-warming the dilator and performing therapy together with their partner as helpful strategies. CONCLUSIONS Careful discussion, early and clear communication, psychoeducation and supportive follow-up of vaginal changes should be integrated into cancer treatment and follow up. Healthcare professionals should be aware of potential difficulties with vaginal dilator therapy and identify women in need of extended support. Research is required to investigate interventions that suit the needs of female pelvic cancer survivors.
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Affiliation(s)
- Linda Åkeflo
- Department of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Department of Social Work, Malmö University, Malmö, Sweden
| | - Karin Bergmark
- Department of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dubinskaya A, Horwitz R, Scott V, Anger J, Eilber K. Is it time for doctors to Rx vibrators? A systematic review of pelvic floor outcomes. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Introduction
Vibrators and similar devices are an underutilized treatment modality in pelvic and sexual medicine, likely because of the limited knowledge on the health benefits of their use.
Objectives
The aim of this study was to review available data regarding the effect of vibrator use on sexual function, pelvic floor function, and chronic unexplained vulvar pain.
Methods
We performed a systematic literature review of PubMed, Embase, and MEDLINE from inception to March 2021 per the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). The search was based on the following keywords: sex toy woman, pelvic vibrator, sexual stimulation vibrator, vaginal vibrator, vibrator pelvic floor, vibrator incontinence, and vulvar pain vibrator. An overall 586 articles were identified. Studies that met inclusion criteria were reviewed: original research, sample of women, vibrator use, and application to the pelvic/genital area. Exclusion criteria included case reports, unrelated content, vibrator not applied to the pelvic/genital area, male participants, or conditions of interest not addressed. A total of 17 original studies met the criteria and were reviewed in depth.
Results
After review of the literature and identification of articles appropriate for the study, there were 8 studies surrounding sexual function, 8 on pelvic floor function (muscle strength/urinary incontinence), and 1 on vulvar pain. Among the identified studies, vibrators were considered an accepted modality to enhance a woman’s sexual experience, improve pelvic floor muscle function, and facilitate treatment of vulvar pain.
Conclusions
Vibrators are not well studied, and given the promising benefits demonstrated in the articles identified, future research efforts should be directed toward investigating their utility. Considering the potential pelvic health benefits of vibrators, their recommendation to women could be included in our pelvic floor disorder treatment armamentarium.
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Affiliation(s)
| | - Rainey Horwitz
- Saint Louis University School of Medicine , Saint Louis, MO 63110
| | - Victoria Scott
- Department of Urology, Cedars Sinai Medical Center , Los Angeles, CA 90048
| | - Jennifer Anger
- Department of Urology, University of San Diego , La Jolla, CA 92121
| | - Karyn Eilber
- Department of Urology, Cedars Sinai Medical Center , Los Angeles, CA 90048
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Fernandes ACNL, Palacios-Ceña D, Pena CC, Duarte TB, de la Ossa AMP, Jorge CH. Conservative non-pharmacological interventions in women with pelvic floor dysfunction: a systematic review of qualitative studies. BMC Womens Health 2022; 22:515. [PMID: 36503437 PMCID: PMC9743653 DOI: 10.1186/s12905-022-02097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Women's adherence is essential to physiotherapeutic treatment of pelvic floor dysfunction, but its related factors are not usually considered in the development of treatment approaches. This study aims to understand how women with pelvic floor dysfunction experience pelvic floor conservative non-pharmacological treatment options. METHODS A systematic review of qualitative studies. The electronic search was performed in MEDLINE/PubMed, CINAHL, Lilacs, SCOPUS, and Web of Science databases. Primary articles on qualitative methods focused on the experience of women regarding pelvic floor conservative non-pharmacological interventions, i.e., pelvic floor muscle training (PFMT), either associated or not with biofeedback, perineal massage, vaginal dilators, and others. A meta-aggregation was performed. RESULTS It was included 22 manuscripts in this review. It was found seven studies about the use of vaginal devices, two about manual intervention and 14 studies on women's experience with PFMT. The findings were synthesized as follows: I) women's experience of manual interventions; II) women's experience using vaginal devices changes according to health professional attitudes; III) women's experiences using vaginal devices varied depending on their pelvic floor dysfunction; IV) reported side effects due to the use of vaginal devices; V) external factors influencing PFMT performance; VI) women's perception of their own personal factors influencing PFMT performance; VII) PFMT characteristics influencing women's adherence; VIII) strategies used by women to include PFMT in their routine. CONCLUSION Women's experience with pelvic floor conservative non-pharmacological treatment options is a complex phenomenon that involves many more variables than simply personal aspects. This is a systematic review of qualitative studies registered in the PROSPERO (CRD42018080244).
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Affiliation(s)
- Ana Carolina Nociti Lopes Fernandes
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
| | - Domingo Palacios-Ceña
- grid.28479.300000 0001 2206 5938University Rey Juan Carlos, Av. Atenas s/n, CP: 28922 Alcorcón, Madrid, Spain
| | - Caroline Caetano Pena
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
| | - Thaiana Bezerra Duarte
- University Center of Northern, Av. Joaquim Nabuco, 1232, Centro, Manaus, AM CEP: 69020-031 Brazil
| | - Aura Maria Paternina de la Ossa
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
| | - Cristine Homsi Jorge
- grid.11899.380000 0004 1937 0722Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP: 14049-900 Brazil
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Morgan O, Lopez MD, Martinez AJC, Marshall DC, Schnur JB. Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap. Sex Med Rev 2022; 10:513-519. [PMID: 36030181 PMCID: PMC9561033 DOI: 10.1016/j.sxmr.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Vaginal stenosis is a distressing side effect of radiation therapy that can impair quality of life. Dilator therapy is an option for patients undergoing pelvic radiotherapy to mitigate vaginal stenosis. Currently, the dilators given to patients by most hospitals are made of plastic, compared to silicone dilators which are available on the market for purchase. OBJECTIVES We conducted a systematic literature review to find information to guide clinical recommendations to pelvic radiotherapy patients on potential differences regarding the use of plastic vs silicone dilators with regard to efficacy, cost, and patient preferences. METHODS A systematic literature review was conducted in Embase, MEDLINE, and PubMed using Emtree terms. To be included in the review, papers needed to: focus on female patients undergoing radiation therapy, assess a vaginal dilator, measure any dilator intervention outcome, and specifically compare plastic vs silicone dilators for any measured outcome (either qualitative or quantitative). RESULTS The initial search yielded 195 articles. Two area experts, with a third expert for arbitration, read each article and found that none met all review inclusion criteria. No studies were found that compared silicone to plastic dilators with regard to efficacy in treating vaginal stenosis due to radiation therapy, no studies were found that compared cost or cost-effectiveness of the 2 dilator types, and no studies were found comparing patient preferences or experiences (eg, comfort, adherence, ease of use) between the 2 dilator types. CONCLUSION The materials used to create dilators have never been rigorously compared in the context of radiotherapy-related vaginal stenosis. Institutions and patients have no data to guide their choice. Significantly more research at the patient and institutional level is needed to explore the potential long-term quality of life and cost benefits of improved adherence with silicone dilator use, and to guide shared decision-making regarding dilator choice. Morgan O, Lopez MD, Martinez AJC, et al. Systematic Review of Comparisons Between Plastic and Silicone Dilators: Revealing a Knowledge Gap. Sex Med Rev 2022;10:513-519.
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Affiliation(s)
- Orly Morgan
- University of Miami, Miller School of Medicine, Miami, FL, USA; University of Miami, Department of Public Health Sciences, Miami, FL, USA.
| | | | - Alberto J Caban Martinez
- University of Miami, Miller School of Medicine, Miami, FL, USA; University of Miami, Department of Public Health Sciences, Miami, FL, USA
| | - Deborah C Marshall
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, New York City, NY, USA; Icahn School of Medicine at Mount Sinai, Department of Radiation Oncology, New York City, NY, USA
| | - Julie B Schnur
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Araya-Castro P, Roa-Alcaino S, Celedón C, Cuevas-Said M, de Sousa Dantas D, Sacomori C. Barriers to and facilitators of adherence to pelvic floor muscle exercises and vaginal dilator use among gynecologic cancer patients: a qualitative study. Support Care Cancer 2022; 30:9289-9298. [PMID: 36065026 PMCID: PMC9444700 DOI: 10.1007/s00520-022-07344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022]
Abstract
Objective Women with gynecologic cancer may suffer from pelvic floor dysfunction (PFD). Before radiotherapy, prehabilitation with pelvic floor muscle exercises (PFME) and vaginal dilator (VD) might prevent it and foster sexual life. This study aims to explore the experience of gynecologic cancer patients getting external beam radiation treatments regarding barriers to and facilitators of adherence to a prehabilitation program to prevent PFD. Methods This qualitative research with thematic content analysis included 11 women with gynecologic cancer and different levels of adherence to PFME and VD. Participants were interviewed based on a semi-structured script. The information was analyzed manually, assisted with Nvivo12® software, and triangulated with open coding. Results High self-motivation, desire to improve their health, symptoms of improvement, availability of time, the desire to resume sexual life, and the support of the partner were facilitators of adherence. The instructional exercise audio, clarity of the information, and closer communication with the physical therapist were also valued. The main barriers were general malaise secondary to oncological treatments, forgetfulness, lack of time, misinformation, lack of coordination with the treatment team, discomfort with the VD, and a feeling of shame. Feedback from the attending physician was a facilitator when present or a barrier when absent. Conclusion These barriers and facilitators should be considered when designing and implementing preventive programs with PFME and VD. Behavioral counselling should consider the desire to remain sexually active; in such cases, including the partner in the therapeutic process is appraised. Otherwise, the focus should be on benefits for maintenance of pelvic floor function.
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Affiliation(s)
- Paulina Araya-Castro
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.,Programa de Doctorado en Educación, Universidad Internacional Iberoamericana, Campeche, México
| | - Sonia Roa-Alcaino
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | | | | | - Cinara Sacomori
- Programa de Doctorado en Educación, Universidad Internacional Iberoamericana, Campeche, México. .,Universidad Bernardo O´Higgins, Santiago, Chile.
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Suvaal I, Hummel SB, Mens JWM, van Doorn HC, van den Hout WB, Creutzberg CL, Ter Kuile MM. A sexual rehabilitation intervention for women with gynaecological cancer receiving radiotherapy (SPARC study): design of a multicentre randomized controlled trial. BMC Cancer 2021; 21:1295. [PMID: 34863145 PMCID: PMC8642903 DOI: 10.1186/s12885-021-08991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual problems are frequently reported after treatment with radiotherapy (RT) for gynaecological cancer (GC), in particular after combined external beam radiotherapy and brachytherapy (EBRT+BT). Studies demonstrate that psychosexual support should include cognitive behavioural interventions and involvement of the patient's partner, if available. Therefore, we developed a nurse-led sexual rehabilitation intervention, including these key components. The intervention was previously pilot-tested and results demonstrated that this intervention improves women's sexual functioning and increases dilator compliance. The objective of the current study is to investigate the (cost-)effectiveness of the intervention compared to optimal care as usual (CAU). We expect that women who receive the intervention will report a statistically significant greater improvement in sexual functioning and - for women who receive EBRT+BT - higher compliance with dilator use, from baseline to 12 months post-RT than women who receive optimal care as usual (CAU). METHODS/DESIGN The intervention is evaluated in the SPARC (Sexual rehabilitation Programme After Radiotherapy for gynaecological Cancer) study, a multicentre, randomized controlled trial (RCT). The primary endpoint is sexual functioning. Secondary outcomes include body image, fear of sexual activity, sexual-, treatment-related- and psychological distress, health-related quality of life and relationship satisfaction. A cost-effectiveness analysis (CEA) will be conducted in which the costs of the intervention will be related to shifts in other health care costs and the impact on patient outcome. The study sample will consist of 220 women with GC treated with RT in specialized GC treatment centres (N = 10). Participants are randomized to either the intervention- or CAU control group (1:1), and within each centre stratified by type of radiotherapy (EBRT+BT vs. EBRT only) and having a partner (yes/no). All women complete questionnaires at baseline (T1) and at 1, 3, 6, and 12 months post-RT (T2, T3, T4 and T5, respectively). DISCUSSION There is a need to improve sexual functioning after RT for GC. This RCT will provide evidence about the (cost-)effectiveness of a nurse-led sexual rehabilitation intervention. If proven effective, the intervention will be a much needed addition to care offered to GC survivors and will result in improved quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT03611517 . Registered 2 August 2018.
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Affiliation(s)
- Isabelle Suvaal
- Department of Gynaecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC, Leiden, the Netherlands.
| | - Susanna B Hummel
- Department of Gynaecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Jan-Willem M Mens
- Department of Radiotherapy, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Moniek M Ter Kuile
- Department of Gynaecology, Leiden University Medical Center, Zone K6-T, PO Box 9600, 2300 RC, Leiden, the Netherlands
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Roussin M, Lowe J, Hamilton A, Martin L. Factors of sexual quality of life in gynaecological cancers: a systematic literature review. Arch Gynecol Obstet 2021; 304:791-805. [PMID: 33847794 PMCID: PMC8325662 DOI: 10.1007/s00404-021-06056-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/27/2021] [Indexed: 12/17/2022]
Abstract
Background The impact of cancer diagnosis and treatment on sexual quality of life (SQoL) is a well-established survivorship issue for gynaecological cancer survivors (GCS), yet little is known on how to intervene. Purpose The aim of this systematic review was to identify the factors explaining the variability in SQoL for GCS. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and the software Covidence. Electronic databases Scopus, Web of Science, PUBMED and CINAHL were searched for original research on GCS published between 2002 and 2018. We performed a two-stage screening process against selection criteria and quality assessment of individual studies. The Salutogenic Theory and the PRECEDE–PROCEED model were used as theoretical frameworks to identify and categorise factors. Results The initial search yielded 3,505 articles resulting in a total of 46 studies used to examine the association between factors of SQoL and gynaecological cancers. Our findings suggested that SQoL varies across subgroups based on age, menopausal status, relationship status, and treatment modality. Protective factors included clinicians’ knowledge and confidence, preventive medical approach, risk and needs assessment, patient–clinician communication, relationship quality, psychosocial support, symptom management, accessibility of psychosexual care, and self-efficacy in the rediscovery of sexuality. Conclusion Despite the high incidence and long-term impact of sexual health issues on quality of life, supportive care needs are not being met. A better understanding of the evidence base around the factors of SQoL can help health professionals take steps to protect and improve SQoL in GCS.
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Affiliation(s)
- Melanie Roussin
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia.
| | - John Lowe
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia
| | - Anita Hamilton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia
| | - Lisa Martin
- School of Health and Behavioural Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sunshine Coast, QLD, 4556, Australia
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Silva TGD, Oliveira KMLD, Morais SCRV, Perreli JGA, Sousa SDMAD, Linhares FMP. Disfunção sexual em mulheres com câncer do colo do útero submetidas à radioterapia: análise de conceito. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Resumo Objetivo analisar o conceito de disfunção sexual em mulheres com câncer do colo do útero submetidas a tratamento radioterápico. Método estudo de análise de conceito fundamentado no referencial metodológico proposto por Walker e Avant, o qual é composto por oito etapas: seleção do conceito; determinação dos objetivos da análise conceitual; identificação dos possíveis usos do conceito; determinação dos atributos críticos ou essenciais; construção de um caso modelo; construção de casos adicionais; identificação dos antecedentes e consequentes do conceito; e definição das referências empíricas. Resultados a amostra final resultou em 11 artigos, que identificaram 4 atributos críticos, 18 antecedentes e 07 consequentes do conceito, os quais permitiram a construção de uma definição conceitual e elaboração de um caso-modelo, com a finalidade de exemplificar o contexto social no qual o conceito encontra-se inserido. Conclusão e implicações para prática alterações na estrutura corporal, déficit de conhecimento, diminuição da frequência das relações sexuais, dispareunia e indiferença do parceiro são alguns dos principais antecedentes e consequentes da disfunção sexual na população estudada. Entretanto, esses fatores ainda são pouco conhecidos, o que limita a realização de ações de promoção, prevenção e reabilitação sexual, sobretudo no campo da enfermagem.
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Araya-Castro P, Sacomori C, Diaz-Guerrero P, Gayán P, Román D, Sperandio FF. Vaginal Dilator and Pelvic Floor Exercises for Vaginal Stenosis, Sexual Health and Quality of Life among Cervical Cancer Patients Treated with Radiation: Clinical Report. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:513-527. [PMID: 32364016 DOI: 10.1080/0092623x.2020.1760981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This clinical report aimed to evaluate the effectiveness of the combination of vaginal dilator (VD) and pelvic floor muscle exercises (PFME) on vaginal stenosis, sexual health and quality of life among women undergoing radiotherapy treatment for cervical cancer; PFME were instructed prior to radiotherapy with six-month follow-up. An intention-to-treat analysis was performed for the 28 women. At four-months after radiotherapy, most of the women (90.9%) maintained/increased one size of the VD and were sexually active (81.8%). Adherence to VD was high. Regarding quality of life, there was more limitation in emotional functioning. VD and PFME were effective at preventing stenosis.
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Affiliation(s)
- Paulina Araya-Castro
- Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
- Health Sciences Faculty, Universidad San Sebastián, Santiago, Chile
| | - Cinara Sacomori
- Escuela de Kinesiología, Universidad Bernardo O'Higgins, Santiago, Chile
| | | | - Patricio Gayán
- Gynecology Unit, Instituto Nacional del Cáncer, Santiago, Chile
| | - Devora Román
- Escuela de Kinesiología, Universidad Bernardo O'Higgins, Santiago, Chile
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13
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Cerentini TM, Schlöttgen J, Viana da Rosa P, La Rosa VL, Vitale SG, Giampaolino P, Valenti G, Cianci S, Macagnan FE. Clinical and Psychological Outcomes of the Use of Vaginal Dilators After Gynaecological Brachytherapy: a Randomized Clinical Trial. Adv Ther 2019; 36:1936-1949. [PMID: 31209699 PMCID: PMC6822871 DOI: 10.1007/s12325-019-01006-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the dimensions of the vaginal canal in patients undergoing gynaecological brachytherapy and the effect of the use of vaginal dilators (VD) used in the follow-up of pelvic physiotherapy. METHODS A total of 88 patients were randomly allocated to the control group (CG) and intervention group (IG). Three evaluations were performed: pre-brachytherapy, post-brachytherapy and follow-up of 3 months. The CG received standard guidance from the health team while the IG was instructed to use VD for 3 months. The dimensions of the vaginal canal (main outcome) were defined by the length of the vagina (centimetres), width (number of full clockwise turns of the opening thread of a gynaecological speculum) and area (defined by the size of the VD). Quality of life and pelvic floor (PF) functionality were also evaluated. RESULTS There was no effect of the VD on vaginal length, width and area among the intention-to-treat (ITT) population. However, in the analysis stratified by adhesion, the CG had a significant decrease in the vaginal area. PF was predominantly hypoactive throughout the follow-up. Quality of life improved in both groups, but the reduction of constipation, vaginal dryness and stress urinary incontinence manifested only in the IG. CONCLUSION The use of VD did not alter the dimensions of the vaginal canal within the first 3 months after the end of radiotherapy treatment. However, there was a large sample loss during follow-up so studies with a larger sample number and longer follow-up time need to be conducted. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03090217.
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Affiliation(s)
| | - Júlia Schlöttgen
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | | | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Stefano Cianci
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Schnürch HG, Ackermann S, Alt-Radtke CD, Angleitner L, Barinoff J, Beckmann MW, Böing C, Dannecker C, Fehm T, Gaase R, Gass P, Gebhardt M, Gieseking F, Günthert A, Hack CC, Hantschmann P, Horn LC, Koch MC, Letsch A, Mallmann P, Mangold B, Marnitz S, Mehlhorn G, Paradies K, Reinhardt MJ, Tholen R, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up of Vaginal Cancer and Its Precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe Frauenheilkd 2019; 79:1060-1078. [PMID: 31680701 DOI: 10.1055/a-0919-4959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose This is an official guideline, published and coordinated by the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Society for Gynecology and Obstetrics (DGGG). Vaginal cancers are rare tumors, which is why there is very little evidence on these tumors. Knowledge about the optimal clinical management is limited. This first German S2k guideline on vaginal cancer has aimed to compile the most current expert knowledge and offer new recommendations on the appropriate treatment as well as providing pointers about individually adapted therapies with lower morbidity rates than were previously generally available. The purpose of this guideline is also to set up a register to record data on treatment data and the course of disease as a means of obtaining evidence in future. Methods The present S2k guideline was developed by members of the Vulvar und Vaginal Tumors Commission of the AGO in an independently moderated, structured, formal consensus process and the contents were agreed with the mandate holders of the participating scientific societies and organizations. Recommendations To optimize the daily care of patients with vaginal cancer: 1. Monitor the spread pattern; 2. Follow the step-by-step diagnostic workup based on initial stage at detection; 3. As part of individualized clinical therapeutic management of vaginal cancer, follow the sentinel lymph node protocol described here, where possible; 4. Participate in the register study on vaginal cancer.
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Affiliation(s)
| | | | - Celine D Alt-Radtke
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf, Germany
| | | | - Jana Barinoff
- St.-Gertrauden-Krankenhaus GmbH Berlin, Berlin, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Carsten Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen, Germany
| | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München, Campus Großhadern, München, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde Gaase+Hugger, Worms, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | | | - Friederike Gieseking
- Dysplasiesprechstunde/Gynäkologisches Laserzentrum in der Frauenarztpraxis Heussweg, Hamburg, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Peer Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting, Germany
| | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Berlin, Berlin, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität Köln, Köln, Germany
| | | | - Simone Marnitz
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Berlin, Germany
| | | | - Reina Tholen
- Deutscher Verband für Physiotherapie, Köln, Germany
| | - Uwe Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Hampl
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
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Damast S, Jeffery DD, Son CH, Hasan Y, Carter J, Lindau ST, Jhingran A. Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology. Pract Radiat Oncol 2019. [PMID: 31302301 DOI: 10.1016/j.prro.2019.07.001.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
PURPOSE Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS); however, no standard protocol exists. This review seeks to update our current state of knowledge concerning VS and VDT in radiation oncology. METHODS AND MATERIALS A comprehensive literature review (1972-2017) was conducted using search terms "vaginal stenosis," "radiation," and "vaginal dilator." Information was organized by key concepts including VS definition, time course, pathophysiology, risk factors, and interventions. RESULTS VS is a well-described consequence of pelvic RT, with early manifestations and late changes evolving over several years. Strong risk factors for VS include RT dose and volume of vagina irradiated. Resultant vaginal changes can interfere with sexual function and correlational studies support the use of preventive VDT. The complexity of factors that drive noncompliance with VDT is well recognized. There are no prospective data to guide optimal duration of VDT, and the consistency with which radiation oncologists monitor VS and manage its consequences is unknown. CONCLUSIONS This review provides information concerning VS definition, pathophysiology, and risk factors and identifies domains of VDT practice that are understudied. Prospective efforts to monitor and measure outcomes of patients who are prescribed VDT are needed to guide practice.
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Affiliation(s)
- Shari Damast
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
| | - Diana D Jeffery
- Department of Defense, Defense Health Agency, Falls Church, Virginia
| | - Christina H Son
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois; Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Damast S, Jeffery DD, Son CH, Hasan Y, Carter J, Lindau ST, Jhingran A. Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology. Pract Radiat Oncol 2019; 9:479-491. [PMID: 31302301 DOI: 10.1016/j.prro.2019.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/03/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS); however, no standard protocol exists. This review seeks to update our current state of knowledge concerning VS and VDT in radiation oncology. METHODS AND MATERIALS A comprehensive literature review (1972-2017) was conducted using search terms "vaginal stenosis," "radiation," and "vaginal dilator." Information was organized by key concepts including VS definition, time course, pathophysiology, risk factors, and interventions. RESULTS VS is a well-described consequence of pelvic RT, with early manifestations and late changes evolving over several years. Strong risk factors for VS include RT dose and volume of vagina irradiated. Resultant vaginal changes can interfere with sexual function and correlational studies support the use of preventive VDT. The complexity of factors that drive noncompliance with VDT is well recognized. There are no prospective data to guide optimal duration of VDT, and the consistency with which radiation oncologists monitor VS and manage its consequences is unknown. CONCLUSIONS This review provides information concerning VS definition, pathophysiology, and risk factors and identifies domains of VDT practice that are understudied. Prospective efforts to monitor and measure outcomes of patients who are prescribed VDT are needed to guide practice.
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Affiliation(s)
- Shari Damast
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut.
| | - Diana D Jeffery
- Department of Defense, Defense Health Agency, Falls Church, Virginia
| | - Christina H Son
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois; Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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17
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Dilator Use After Vaginal Brachytherapy for Endometrial Cancer: A Randomized Feasibility and Adherence Study. Cancer Nurs 2019; 41:200-209. [PMID: 28437283 DOI: 10.1097/ncc.0000000000000500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vaginal brachytherapy, a common treatment of endometrial cancer, is associated with high rates of vaginal stenosis. Recommendations for vaginal dilator use to minimize stenosis generally include 3 times per week for approximately 10 minutes per use. However, adherence rates range widely and are generally well less than 50%. OBJECTIVES The aims of this study were to assess feasibility of recruitment to a study of dilator use and test a theoretically driven enhanced educational program (EEP) to increase adherence. METHODS Eligibility included women treated with postoperative vaginal brachytherapy for stage I to IIIc endometrial cancer. Patients were randomized to either nurse-delivered standard institutional instruction or EEP. RESULTS Of eligible patients, 76% consented, 42 were randomized, and 69% completed the 6-month assessment. Mean age was 58.2 years; 48% were sexually active. There was no difference in adherence between arms. Overall, 20% and 8.3% were adherent to the prescribed use of 3 times per week, and 64% and 16% were adherent to use at least once per week at 6 weeks and 6 months, respectively. Adherence was greater among those motivated by vaginal health and having lower body mass index. Nonadherence was significantly higher among those who are college educated, in the EEP group, and with higher weight. CONCLUSIONS Feasibility of recruitment into a study of vaginal dilator use was high. Adherence was low, and there was no difference between groups. Adherence to vaginal dilator use requires novel interventions to test. IMPLICATIONS FOR PRACTICE Nursing education that includes how dilators may maintain vaginal health may improve use because it was a motivator for adherence in this study.
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18
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Stahl JM, Qian JM, Tien CJ, Carlson DJ, Chen Z, Ratner ES, Park HS, Damast S. Extended duration of dilator use beyond 1 year may reduce vaginal stenosis after intravaginal high-dose-rate brachytherapy. Support Care Cancer 2018; 27:1425-1433. [PMID: 30187220 DOI: 10.1007/s00520-018-4441-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vaginal dilators (VD) are recommended following vaginal or pelvic radiotherapy for patients with endometrial carcinoma (EC) to prevent vaginal stenosis (VS). The time course of VS is not fully understood and the optimal duration of VD use is unknown. METHODS We reviewed 243 stage IA-II EC patients who received adjuvant brachytherapy (BT) at an academic tertiary referral center. Patients were instructed to use their VD three times per week for at least 1-year duration. The primary outcome was development of grade ≥ 1 VS using CTCAEv4 criteria during the follow-up period. The log-rank test and multivariable Cox proportional hazards modeling were used to evaluate the effect of VD use (noncompliance vs. standard compliance [up to 1 year] vs. extended compliance [over 1 year]) on VS. RESULTS The median follow-up was 15.2 months over the 5-year study period. At 15 months, the incidence of VS was 38.8% for noncompliant patients, 33.5% for those with standard compliance, and 21.4% for those with extended compliance (median time to grade ≥ 1 VS was 17.5 months, 26.7 months, and not yet reached for these groups, respectively). On multivariable Cox regression analysis, extended compliance remained a significant predictor of reduced VS risk when compared to both noncompliance (HR 0.38, 95% CI 0.18-0.80, p = 0.012) and standard compliance (HR 0.43, 95% CI 0.20-0.89, p = 0.023). CONCLUSIONS The risk of VS persists beyond 1 year after BT. Extended VD compliance beyond 1 year may mitigate this risk.
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Affiliation(s)
- John M Stahl
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
| | - Jack M Qian
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher J Tien
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Zhe Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Elena S Ratner
- Department of Gynecology and Reproductive Sciences, Section of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Shari Damast
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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Rullo J, Faubion SS, Hartzell R, Goldstein S, Cohen D, Frohmader K, Winter AG, Mara K, Schroeder D, Goldstein I. Biopsychosocial Management of Female Sexual Dysfunction: A Pilot Study of Patient Perceptions From 2 Multi-Disciplinary Clinics. Sex Med 2018; 6:217-223. [PMID: 29789244 PMCID: PMC6085226 DOI: 10.1016/j.esxm.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 03/24/2018] [Accepted: 04/08/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sexual dysfunction is often complex and biopsychosocial. Traditional sexual health care management involves individual providers not in a multi-disciplinary setting. A multi-disciplinary team may consist of a medical provider, pelvic floor physical therapist, and sex therapist. AIM The aim was to explore the patient perceptions of benefit from management of their sexual dysfunction by a biopsychosocial multi-disciplinary team. METHODS A survey was e-mailed to women patients seen by multi-disciplinary teams at 2 different settings: San Diego Sexual Medicine or Mayo Clinic Women's Health Clinic during a 27-month period. Data are reported using summary statistics for age and count for remaining survey responses. Cochran-Armitage tests for trend were used to compare pre- and post-comfort levels. OUTCOMES Main outcome measures included perceived benefit of being managed in a team-based model of care, level of benefit and satisfaction from each provider, and difference from pre-conceived level of comfort to actual comfort after each provider visit. RESULTS 89 of 270 e-mailed surveys were analyzed. Patient populations (mean age 47.6, range 23-77 years) were similar between sites. Overall, 82% of respondents reported moderate/great benefit from the team-based model; 72.1% reported management by all 3 providers valuable/extremely valuable; and 84.3% were somewhat/very satisfied with the model. Women endorsed specific ways in which they benefitted from the team-based model including: improved sexual function (58.1%), feeling validated (72.1%) and listened to (62.8%), that they better understood their health concerns (65.1%), that their partner better understood their health concerns (46.5%), and feeling normal (46.5%). There were no significant differences between the 2 clinics in terms of patient-perceived benefit, value, or satisfaction. CONCLUSIONS The team-based model of care for management of sexual dysfunction in women including a medical provider, physical therapist, and sex therapist is associated with patient-perceived benefit, satisfaction, and value. Rullo J, Faubion S, Hartzell R, et al. Biopsychosocial Management of Female Sexual Dysfunction: A Pilot Study of Patient Perceptions From 2 Multi-Disciplinary Clinics. Sex Med 2018;6:217-223.
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Affiliation(s)
- Jordan Rullo
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA; Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Deborah Cohen
- Fundamental Physical Therapy and Pelvic Wellness, San Diego, CA, USA
| | - Karla Frohmader
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Darrell Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Irwin Goldstein
- San Diego Sexual Medicine, San Diego, CA, USA; Sexual Medicine, Alvarado Hospital, San Diego, CA, USA
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Rullo JE, Lorenz T, Ziegelmann MJ, Meihofer L, Herbenick D, Faubion SS. Genital vibration for sexual function and enhancement: best practice recommendations for choosing and safely using a vibrator. SEXUAL AND RELATIONSHIP THERAPY 2018; 33:275-285. [PMID: 33223961 DOI: 10.1080/14681994.2017.1419558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vibrators are an evidence-based treatment for a variety of sexual dysfunctions and sexual enhancement; however, the use of a genital vibrator lacks best practice recommendations. This aim of this article is to provide current, best practice recommendations regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual or relationship enhancement. A multidisciplinary team of sexual health specialists collaborated to develop best practice recommendations based on a narrative literature review. Recommendations for the use of vibratory stimulation for the treatment of sexual dysfunction are provided, with special attention to counseling patients on choosing and safely using a vibrator. Further study is needed to determine the most effective methods to counsel patients on vibrator use and to provide evidence-based cleaning recommendations.
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Affiliation(s)
- Jordan E Rullo
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tierney Lorenz
- Department of Psychological Science, University of North Carolina At Charlotte, Charlotte, NC, USA
| | | | - Laura Meihofer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Debra Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Rullo JE, Lorenz T, Ziegelmann MJ, Meihofer L, Herbenick D, Faubion SS. Genital vibration for sexual function and enhancement: a review of evidence. SEXUAL AND RELATIONSHIP THERAPY 2018; 33:263-274. [PMID: 33223960 DOI: 10.1080/14681994.2017.1419557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Vibration, as provided by a genital vibrator, is commonly regarded as a tool to enhance sexual pleasure and in modern day society falls under the category of a sex toy. However, the vibrator was not originally intended to be a toy, and its benefits reach far beyond that of a plaything. This article is a narrative review of the current evidence regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual and relationship enhancement. The literature indicates that vibratory stimulation has evidence-based support for the treatment of erectile dysfunction, ejaculatory dysfunction and anorgasmia. Vibratory stimulation is positively correlated with increased sexual desire and overall sexual function. It has also shown benefit for sexual arousal difficulties and pelvic floor dysfunction. Though definitive evidence is lacking, genital vibration is a potential treatment for sexual dysfunction related to a wide variety of sexual health concerns in men and women.
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Affiliation(s)
- Jordan E Rullo
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tierney Lorenz
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Laura Meihofer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Debra Herbenick
- Center for Sexual Health Promotion, Indiana University, Bloomington, IN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Lee Y. Patients' perception and adherence to vaginal dilator therapy: a systematic review and synthesis employing symbolic interactionism. Patient Prefer Adherence 2018; 12:551-560. [PMID: 29695897 PMCID: PMC5905492 DOI: 10.2147/ppa.s163273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vaginal dilator (VD) therapy is often recommended for women receiving pelvic radiation therapy or experiencing pain and discomfort during intercourse, as well as for women with a congenital malformation of the vagina. VD use has both physical and psychological benefits; however, it often causes pain, discomfort, and adverse emotions, including embarrassment and loss of modesty, which often result in low adherence to therapy. OBJECTIVES The aims of this study were to explore the use and adherence of VD therapy in women, identify barriers and facilitators of therapy adherence, and suggest improvement strategies from the theoretical perspective of symbolic interactionism. METHODS A systematic review of the literature was conducted using PubMed, CINAHL, and Scopus databases, with no year restrictions. Articles addressing the experience of women using VD therapy, as well as barriers and facilitators of therapy adherence were selected and analyzed. Then, the theoretical perspective of symbolic interactionism was introduced and applied to synthesize the results. RESULTS A total of 21 articles were selected for the review. Most of the reviewed studies explored VD therapy in women who had undergone pelvic radiation therapy for gynecological cancer. Women's adherence to the therapy ranged between 25% and 89.2%, with great variance in definitions and methods for assessing therapy adherence. Among the five categories of identified barriers to therapy adherence, "unhelpful circumstances" and "negative perceptions toward the VD" were the two most frequently mentioned. The two most frequently reported facilitators of adherence among the six identified categories were "supportive interactions with health care providers" and "risk perception and positive outcome expectancies". On the basis of the perspective of symbolic interactionism, strategies for strengthening interactions with others (eg, health care providers, significant others, and support groups) are discussed in detail. CONCLUSION Strategic intervention regarding the decisive factors identified in the review can benefit women by enhancing their experience and adherence to VD therapy.
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Affiliation(s)
- Yaelim Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
- Correspondence: Yaelim Lee, Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Republic of Korea, Tel +82 10 9950 2731, Email
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Ricketts E, Ridgway E. Sexual healing-still taboo? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S11. [PMID: 28230431 DOI: 10.12968/bjon.2017.26.4.s11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ellie Ricketts
- Project Manager, Living With & Beyond Cancer Team, Mustard Tree Cancer Support Centre, Derriford Hospital, Plymouth
| | - Elizabeth Ridgway
- Oncology Nurse Specialist (Gynae & Sarcoma), Derriford Hospital, Plymouth
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Bakker R, Kenter G, Creutzberg C, Stiggelbout A, Derks M, Mingelen W, Kroon C, Vermeer W, ter Kuile M. Sexual distress and associated factors among cervical cancer survivors: A cross-sectional multicenter observational study. Psychooncology 2016; 26:1470-1477. [DOI: 10.1002/pon.4317] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 10/17/2016] [Accepted: 11/11/2016] [Indexed: 11/07/2022]
Affiliation(s)
- R.M. Bakker
- Department of Gynecology; Leiden University Medical Center; Leiden The Netherlands
| | - G.G. Kenter
- Center of Gynecological Oncology Amsterdam; Amsterdam The Netherlands
| | - C.L. Creutzberg
- Department of Clinical Oncology; Leiden University Medical Center; Leiden The Netherlands
| | - A.M. Stiggelbout
- Department of Medical Decision Making; Leiden University Medical Center; Leiden The Netherlands
| | - M. Derks
- Center of Gynecological Oncology Amsterdam; Amsterdam The Netherlands
| | - W. Mingelen
- Department of Gynecology; Leiden University Medical Center; Leiden The Netherlands
| | - C.D. Kroon
- Department of Gynecology; Leiden University Medical Center; Leiden The Netherlands
| | - W.M. Vermeer
- Department of Gynecology; Leiden University Medical Center; Leiden The Netherlands
| | - M.M. ter Kuile
- Department of Gynecology; Leiden University Medical Center; Leiden The Netherlands
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A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer. Support Care Cancer 2016; 25:729-737. [PMID: 27787681 PMCID: PMC5266770 DOI: 10.1007/s00520-016-3453-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022]
Abstract
Purpose Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. Methods Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). Results Twenty participants were 26–71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. Conclusions According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3453-2) contains supplementary material, which is available to authorized users.
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Yoshida K, Yamazaki H, Nakamura S, Masui K, Kotsuma T, Akiyama H, Tanaka E, Yoshikawa N, Uesugi Y, Shimbo T, Narumi Y, Yoshioka Y. Role of vaginal pallor reaction in predicting late vaginal stenosis after high-dose-rate brachytherapy in treatment-naive patients with cervical cancer. J Gynecol Oncol 2015; 26:179-84. [PMID: 25925294 PMCID: PMC4510333 DOI: 10.3802/jgo.2015.26.3.179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/09/2015] [Accepted: 04/26/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess actual rates of late vaginal stenosis and identify predisposing factors for complications among patients with previously untreated cervical cancer following high-dose-rate brachytherapy. METHODS We performed longitudinal analyses of 57 patients using the modified Dische score at 6, 12, 18, 24, 36, and 60 months after treatment, which consisted of 15 interstitial brachytherapys and 42 conventional intracavitary brachytherapys, with a median follow-up time of 36 months (range, 6 to 144 months). RESULTS More than half of the patients developed grade 1 (mild) vaginal stenosis within the first year of follow-up, and grade 2 (97.5%, moderate) to grade 3 (severe) stenosis gradually increased with time. Actual stenosis rates for grade 1, 2, and 3 were 97.5% (95% confidence interval [CI], 92.7 to 97.5), 60.7% (95% CI, 42.2 to 79.3), and 7.4% (95% CI, 0 to 18.4) at 3 years after treatment. Pallor reaction grade 2-3 at 6 months was only a statistically significant predisposing factor for grade 2-3 late vaginal stenosis 3 years or later with a hazard ratio of 3.48 (95% CI, 1.32 to 9.19; p=0.018) by a multivariate Cox proportional hazard model. Patients with grade 0-1 pallor reaction at 6 months showed a grade ≥2 vaginal stenosis rate of 53%, whereas the grade 2-3 pallor reaction group achieved a grade ≥2 vaginal stenosis rate at 3 years at 100% (p=0.001). CONCLUSION High-dose-rate brachytherapy was associated with high incidence of late vaginal stenosis. Pallor reaction grade 2-3 at 6 months was predictive of late grade 2-3 vaginal stenosis at 3 years after treatment. These findings should prove helpful for patient counseling and preventive intervention.
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Affiliation(s)
- Ken Yoshida
- Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Satoaki Nakamura
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tadayuki Kotsuma
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Hironori Akiyama
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Eiichi Tanaka
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Yasuo Uesugi
- Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Taiju Shimbo
- Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
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