Christin Julia Meltzer‐Gunnes

Long‐term quality of life, vulvar symptoms, and sexual functioning: A cross‐sectional study of Norwegian vulvar cancer survivors

AbstractIntroductionVulvar cancer survivors are at risk of experiencing impaired health‐related quality of life and sexual functioning after treatment. However, studies on survivorship challenges, particularly several years after treatment, are scarce. Our aim was to assess health‐related quality of life in Norwegian vulvar cancer survivors more than 5 years after treatment and to compare reported vulvar symptoms and sexual functioning with women from a normative sample of the general Norwegian female population.Material and MethodsPatients treated primarily for early‐stage vulvar squamous cell carcinoma at the Norwegian Radium Hospital between 2006 and 2016 were invited to participate. Health‐related quality of life, vulvar symptoms, and sexual functioning were assessed using the EORTC QLQ‐C30 and EORTC QLQ‐VU34. To recruit a normative sample, the EORTC QLQ‐VU34 was also distributed to a sample of Norwegian women with no prior history of cancer. EORTC QLQ‐C30 scores among vulvar cancer survivors were compared to “thresholds for clinical importance.” EORTC QLQ‐VU34 scores among cancer survivors were compared to those of the normative sample.ResultsA total of 44 (57%) of 77 vulvar cancer survivors completed the questionnaires, and 334 women from the general population were included for the normative sample. A considerable proportion of cancer survivors reported clinically relevant problems: 43% reported impaired physical functioning, while 30% experienced impaired emotional, cognitive, and social functioning. Genital and groin symptoms were significantly more common among cancer survivors than among women in the normative sample. Fewer vulvar cancer survivors were sexually active (9/44 (20%) versus 232/334 (69%)) and they reported a higher degree of sexual dysfunction compared to the normative sample.ConclusionsVulvar cancer survivors reported impaired health‐related quality of life even several years after treatment. Vulvar complaints and impaired sexual functioning were more common among vulvar cancer survivors than among women from the normative sample.

Time trends in human papillomavirus prevalence and genotype distribution in vulvar carcinoma in Norway

AbstractIntroductionApproximately 25%–43% of all vulvar carcinomas are associated with human papillomavirus (HPV). In many countries, vulvar carcinoma incidence rates are increasing, possibly due to greater HPV exposure. However, studies exploring changes in HPV prevalence and genotype distribution in vulvar carcinoma over time are scarce. Our aim was to evaluate time trends in HPV prevalence and genotype distribution in vulvar squamous cell carcinoma in an unselected, nationwide sample of Norwegian women. Further, we explored clinical and histopathological aspects in relation to HPV status and investigated whether HPV status was associated with survival.Material and methodsAll vulvar squamous cell carcinoma cases from 1970–1975 and 2000–2005 were extracted from the Cancer Registry of Norway and corresponding tissue blocks were retrieved. After detailed histology review, HPV testing was conducted using real‐time TaqMan PCR. Overall survival rates were calculated using the Kaplan–Meier method. Multivariable Cox regression analysis was performed to estimate hazard ratios adjusted for age at diagnosis, stage and diagnostic period.ResultsHistological review was performed on 352 vulvar squamous cell carcinoma cases. We were able to obtain valid HPV analysis results for 282 cases, Overall, 29.8% (95% CI 24.5%–35.5%) of cases were high‐risk HPV (hrHPV)‐positive. When comparing the two periods, we found that the percentage of hrHPV‐positive tumors increased significantly from 23% (95% CI 16.0%–31.4%) in 1970–1975 to 35.3% (95% CI 27.8%–43.3%) in 2000–2005 (P = 0.025). The predominant genotypes were HPV 16 (73%), HPV 33 (21%), and HPV 18 (6%), with similar distributions in both periods. In the more recent cohort, several additional genotypes were detected: HPV 6, 11, 39, 45, 52, 58 and 66 were found in smaller percentages, ranging from 1.8% to 3.6%. In univariate analysis, patients with HPV‐positive tumors showed improved overall survival compared with patients with HPV‐negative tumors (hazard ratio [HR] 0.65, 95% CI 0.48–0.86).ConclusionsThe prevalence of HPV in vulvar squamous cell carcinomas in Norway was significantly higher in 2000–2005 than in 1970–1975. The three predominant genotypes were HPV 16, 33 and 18 in both time periods. However, several other HPV genotypes have emerged over the last decades. HPV‐positivity was associated with better overall survival.