Li Jessie Y, D'Addario Johanna, Tymon-Rosario Joan, Menderes Gulden, Young Melissa R, Johung Kimberly, Ratner Elena, Minkin Mary Jane, Damast Shari
Departments of Therapeutic Radiology.
Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
Am J Clin Oncol. 2021 Apr 1;44(4):143-149. doi: 10.1097/COC.0000000000000800.
The objective of this study was to examine patterns of care and outcomes of female cancer patients treated for sexual and menopausal symptoms following pelvic radiotherapy (PRT) at our institution's multidisciplinary Sexuality, Intimacy, and Menopause (SIMS) Program.
We performed a retrospective review of 69 female patients who received PRT for gynecologic or gastrointestinal malignancies and were referred for SIMS Program intervention. Indications for referral and treatment patterns were summarized. Preintervention and postintervention, patients were screened at follow-up visits, and symptoms were recorded. Statistics were performed using Stata 13.1.
Cancer types included cervical (53.6%), endometrial (31.9%), anorectal (5.8%), and vulvar/vaginal (8.7%). The median age was 48 years (interquartile range: 38 to 58 y). Patients were educated on vaginal lubricants, moisturizers, and dilator therapy both before and after PRT. Reasons for SIMS referral included persistent menopausal symptoms (50.7%), dyspareunia (40.6%), vaginal dryness (37.7%), decreased libido (17.4%), intimacy concerns (17.4%), and/or physical examination alterations (27.5%). SIMS interventions included vaginal estrogen (77.3%), nonhormonal climacteric interventions (53%), systemic hormone therapy (31.8%), dehydroepiandrosterone (4.6%), testosterone cream (4.6%), and/or psychological pharmacotherapy or counseling (13.6%). With a median follow-up of 36 months (interquartile range: 18 to 58 mo), sexual symptoms improved or were stable in 83.6%, while menopausal symptoms improved or were stable in 80.5%.
This study highlights the importance of multidisciplinary care in improving the sexual and menopausal symptoms of women after PRT. Future work examining the impact of intervention timing with respect to PRT and measures of patient satisfaction is warranted.
本研究的目的是在我们机构的多学科性、亲密关系和更年期（SIMS）项目中，研究盆腔放疗（PRT）后接受性和更年期症状治疗的女性癌症患者的护理模式和结局。
我们对69例因妇科或胃肠道恶性肿瘤接受PRT并被转诊至SIMS项目进行干预的女性患者进行了回顾性研究。总结了转诊指征和治疗模式。在干预前和干预后，对患者进行随访筛查并记录症状。使用Stata 13.1进行统计分析。
癌症类型包括宫颈癌（53.6%）、子宫内膜癌（31.9%）、肛管直肠癌（5.8%）和外阴/阴道癌（8.7%）。中位年龄为48岁（四分位间距：38至58岁）。患者在PRT前后均接受了阴道润滑剂、保湿剂和扩张器治疗的教育。转诊至SIMS的原因包括持续性更年期症状（50.7%）、性交困难（40.6%）、阴道干燥（37.7%）、性欲减退（17.4%）、亲密关系问题（17.4%）和/或体格检查改变（27.5%）。SIMS干预措施包括阴道雌激素（77.3%）、非激素更年期干预（53%）、全身激素治疗（31.8%）、脱氢表雄酮（4.6%）、睾酮乳膏（4.6%）和/或心理药物治疗或咨询（13.6%）。中位随访时间为36个月（四分位间距：18至58个月），83.6%的患者性症状改善或稳定，80.5%的患者更年期症状改善或稳定。
本研究强调了多学科护理在改善PRT后女性性和更年期症状方面的重要性。未来有必要开展工作，研究干预时机对PRT的影响以及患者满意度的衡量指标。
