Joseph Daniels

Experiences of patients with cervical cancer undergoing concurrent chemoradiation therapy at the Korle-Bu teaching hospital in Ghana: an explorative qualitative study

Cervical cancer is one of the leading causes of morbidity and mortality in women worldwide, especially in limited-resource settings. Concurrent chemoradiation followed by brachytherapy is the standard of care for patients with locally advanced cervical cancer. Concurrent treatment with external beam radiotherapy and chemotherapy is however, associated with a considerable risk of toxicity. Patients who are treated experience emotional, psychological, social, financial and physiological consequences. The aim of the study was to explore the experiences of women with cervical cancer undergoing concurrent chemoradiation therapy at the Korle-Bu Teaching Hospital in Accra, Ghana, and to identify aspects of care that could be improved to enhance their overall treatment experience. The research was an explorative-descriptive qualitative study involving Ghanaian women with a histo-pathologically confirmed diagnosis of cervical cancer undergoing chemoradiation. Qualitative data were collected via semi-structured in-person interviews and thematically analysed. Four main themes were identified, namely: "deciding on the choice of treatment", "cruising through therapy", "losing self-image", and "evolving into a new person: from caterpillar to butterfly". Some of the patients experienced psychological effects such as fear and depression, whereas others encountered financial difficulties as well as disruption of social relations to the point of isolation. Many patients received support from their spouses, family members and/or care givers. The study highlights significant gaps in cervical cancer awareness among patients prior to diagnosis, leading to fear and anxiety during treatment. Most patients deferred treatment decisions to healthcare professionals due to their expertise. Concurrent chemotherapy profoundly affects patients' well-being, causing psychological distress, physical side effects, economic burden, and social isolation. Patients adopt various coping strategies, including inner resolve, faith in God, and social support.

The sexuality of women with cervical cancer undergoing definitive radiotherapy in Ghana

The purpose of this study was to assess the sexuality of cervical cancer patients undergoing radiotherapy at a major cancer treatment center in Ghana. This is an area of interest as globally; cervical cancer kills approximately 342,000 people per annum with an estimated number of 604,000 new cases in 2020. Acknowledging the World Health Organization's definition of sexual health as a state of physical, mental and social well-being in relation to sexuality, this paper sheds light on how these dimensions affect the quality of life of cervical cancer patients. This was a longitudinal study, which assessed the impact of radiotherapy on the sexuality of both premenopausal and postmenopausal cervical cancer patients presenting for primary treatment with chemoradiation from April to July, 2021 at a major cancer treatment centre in Ghana. The Female Sexual Function Index and Body Image Scale questionnaires were respectively used to evaluate the sexual functions scores among the cervical cancer patients, and to assess the impact of the treatment on their body image. MATLAB software was used for data analysis. Most of the cervical cancer patients sampled were postmenopausal (57 %). About 79 % premenopausal and 96 % postmenopausal cervical cancer patients were sexually inactive during radiotherapy (day 15). Also, 48 % premenopausal and 24 % postmenopausal patients were very dissatisfied with their bodies at the onset of treatment. The frequency of orgasm in cervical cancer patients declined after treatment causing a deterioration in their sexual function. The patients' sexuality was influenced by age and menopausal status. The decreased sexual desire of the patients resulted in emotional distancing from their partners, which invariably induced changes in their partners' level of sexual interest. This study established significant differences between premenopausal and postmenopausal cervical cancer patients who were generally very dissatisfied with their sexual relationships with their partners on day 1 (p = 0.02) and on day 15 (p = 0.00) of treatment. The majority of patients who presented for treatment for cervical cancer in this study were postmenopausal. Their interest in sexual activity was more influenced by their menopausal status than their antineoplastic treatment. This study indicates that cervical cancer patients are more likely to develop sexual health problems which could substantially worsen over the course of their treatment and beyond. The study will contribute within the oncology team by assisting personnel in putting in place measures that will guide the treatment of cervical cancer patients and improve quality of care.