Efficacy of a nurse-led sexual rehabilitation intervention for women with gynaecological cancers receiving radiotherapy: results of a randomised trial

• Published in: British journal of cancer Vol. 131; no. 5; pp. 808 - 819
• Main Authors: Suvaal, Isabelle, Hummel, Susanna B., Mens, Jan-Willem M., Tuijnman-Raasveld, Charlotte C., Tsonaka, Roula, Velema, Laura A., Westerveld, Henrike, Cnossen, Jeltsje S., Snyers, An, Jürgenliemk-Schulz, Ina M., Lutgens, Ludy C. H. W., Beukema, Jannet C., Haverkort, Marie A. D., Nowee, Marlies E., Nout, Remi A., de Kroon, Cor D., van den Hout, Wilbert B., Creutzberg, Carien L., van Doorn, Helena C., ter Kuile, Moniek M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2024; Nature Publishing Group
• Subjects: 692/4028/67/1517; 706/689/477/2811; Adult; Aged; Biomedical and Life Sciences; Biomedicine; Brachytherapy; Brachytherapy - adverse effects; Brachytherapy - methods; Cancer Research; Drug Resistance; Epidemiology; Female; Genital Neoplasms, Female - radiotherapy; Genital Neoplasms, Female - rehabilitation; Gynecology; Humans; Middle Aged; Molecular Medicine; Oncology; Osteonectin; Quality of Life; Radiation therapy; Rehabilitation; Sexual Dysfunction, Physiological - rehabilitation; Stenosis; Surveys and Questionnaires; Vagina
• ISSN: 0007-0920; 1532-1827; 1532-1827
• DOI: 10.1038/s41416-024-02775-8

Background The multicentre randomised SPARC trial evaluated the efficacy of a nurse-led sexual rehabilitation intervention on sexual functioning, distress, dilator use, and vaginal symptoms after radiotherapy for gynaecological cancers. Methods Eligible women were randomised to the rehabilitation intervention or care-as-usual. Four intervention sessions were scheduled over 12 months, with concurrent validated questionnaires and clinical assessments. Primary outcome was the Female Sexual Function Index (FSFI). A generalised-mixed-effects model compared groups over time. Results In total, 229 women were included ( n  = 112 intervention; n  = 117 care-as-usual). No differences in FSFI total scores were found between groups at any timepoint ( P  = 0.37), with 12-month scores of 22.57 (intervention) versus 21.76 (care-as-usual). The intervention did not significantly improve dilator use, reduce sexual distress or vaginal symptoms compared to care-as-usual. At 12 months, both groups had minimal physician-reported vaginal stenosis; 70% of women were sexually active and reported no or mild vaginal symptoms. After radiotherapy and brachytherapy, 85% (intervention) versus 75% (care-as-usual) of participants reported dilation twice weekly. Discussion Sexual rehabilitation for women treated with combined (chemo)radiotherapy and brachytherapy improved before and during the SPARC trial, which likely contributed to comparable study groups. Best practice involves a sexual rehabilitation appointment 1 month post-radiotherapy, including patient information, with dilator guidance, preferably by a trained nurse, and follow-up during the first year after treatment. Clinical trial registration NCT03611517.