Development Of An Integrated Psychosexual Clinical Assessment Strategy For Women Receiving Pelvic Radiotherapy

Introduction & Objectives Pelvic radiotherapy creates a number of physical effects and psychological responses that impact negatively on the sexual health of women and their partners. The aim of this study was to develop an assessment methodology to improve the clinical evaluation of sexual morbidity following pelvic radiotherapy in women. Methods This focused ethnography used participant observation of gynaecological and colorectal oncology follow-up clinics (50 gynaecological, 24 colorectal consultations) plus in-depth interviews with women (n=24), partners (n=5) and health professionals (n=20) to explore the content and context of sexual morbidity assessment after treatment completion. Women with gynaecological (cervical, endometrial) and non-gynaecological (rectal, anal, bladder) cancer who had completed pelvic radiotherapy 3, 6, 12 and 24 months previously were included. Doctors, nurses and therapy radiographers were interviewed for professional perspectives on assessment. This paper presents an analysis (using NVivo v.2) of data from participant observation and interviews. Results Consultations focused on disease surveillance, specific aspects of toxicity monitoring and managing active symptoms. Psychosocial issues were rarely raised by doctors, nurses or patients. Sexual concerns were not routinely assessed in gynaecological clinics unless raised by women. In colorectal clinics sexual morbidity was predominantly assessed via standardised clinical trial toxicity monitoring. Interview data revealed unmet need related to women and couple’s sexual recovery e.g. failure to manage radiotherapy induced menopause, lack of knowledge about sources of advice regarding sexual difficulties, distress caused by unresolved difficulties including loss of sexual desire, dyspareunia and reduced sexual satisfaction. Conclusions The current approach to medical follow-up may not be an appropriate clinical context for the optimal assessment and management of sexual concerns associated with pelvic radiotherapy. These findings are important for the training of health professionals engaged in post-treatment toxicity assessment, provision of information and support and the development of referral pathways.