Lene Seibæk

Impaired sexual health among women treated for vulvar cancer: An integrated review

AbstractBackgroundAlthough gynaecological cancer's negative effects on sexual function are well known, most studies on the subject have not included vulvar cancer patients or a multidimensional perspective on sexual health. Therefore, this review aimed to address this research gap and explored the impact of vulvar cancer on women's sexual health from a multidimensional perspective.MethodologyAn integrated review was conducted, as described by Whittemore and Knafl. The PubMed, CINAHL, PsycINFO and Embase databases were searched in March 2021 and updated in August 2022 and March 2023. The data were thematically analysed using NVivo, and the PRISMA‐ScR and ENTREQ guidelines were followed.FindingsThe following themes were identified in the 28 reviewed articles: impact of a changed female body, impact on women's sexual identity, consequences for women's sexual relationships and unmet needs and loneliness caused by taboos about sexual health.DiscussionWomen's impaired sexual health after vulvar cancer points to a great need to understand and holistically investigate sexual health. In addition, healthcare professionals have an obligation to care for the sexual health issues of patients with vulvar cancer. However, most questionnaires used in the selected studies revealed a narrow understanding of sexual health and focused on sexuality as a genital activity.ConclusionThe sexual health of women with vulvar cancer was tabooed and stigmatised for patients and healthcare professionals. Consequently, women received sparse sexual guidance, felt isolated and had unmet needs.Implications for clinical practiceHealthcare professionals need knowledge and training on how to break taboos and address the sexual needs of vulvar cancer patients. Systematic screenings for sexual health needs should be conducted using a multidimensional perspective.Trial and protocol registrationThe protocol was preregistered at the Open Science Framework (www.osf.io), registration DOI: https://doi.org/10.17605/OSF.IO/YDA2QPatient or public contributionNo patient or public contribution.

Impact of Lymphedema on Women's Lives After Gynaecological Cancer: An Integrative Review

ABSTRACT Background Secondary Lower‐Limb Lymphedema (LLL) is a frequent, progressive late effect affecting women after gynaecological cancer treatment, causing swelling due to fluid accumulation in the interstitial spaces in the lower extremities, the lower abdomen, hips and genitals. There is no consensus on how to define and quantify LLL, which makes research on treatment effect difficult. A negative relation between LLL and quality of life has been reported. Aim To review the literature concerning the identification and impact of LLL on women's lives after gynaecological cancer, including physical, psycho‐social and existential aspects. Methods In an integrative review, as described by Whittemore & Knafl, data were thematically analysed. Results Forty‐one papers published between 2003 and 2024, encompassing a total of 11,488 participants, were included. The overarching theme was limited knowledge of LLL among healthcare professionals and patients and identification discrepancies. It highlighted a widespread lack of awareness among healthcare professionals and the absence of a standardised approach to LLL assessment. This was further substantiated by the considerable heterogeneity in both diagnostic and measurement methods. Consequently, women received minimal information, experienced delayed diagnoses and had restricted access to treatment. These shortcomings had a negative impact on daily life, affecting physical and psychosocial wellbeing, as well as sexual health. The women reported unmet needs, which led them to adopt proactive approaches and various coping strategies. Conclusion LLL profoundly affects women's quality of life, physical and psychosocial health and existential well‐being. Lack of standardised assessment and diagnostic criteria and clear care pathways creates knowledge gaps, delays diagnosis and fragments care, while its ‘homeless’ status leaves responsibility unclear. Urgent systemic change is needed: research must define evidence‐based strategies and policy makers should prioritise multidisciplinary centres and education, with healthcare adopting patient‐centred, multidisciplinary practices to ensure timely diagnosis, referral and self‐management support. Trial Registration https://osf.io/jrh6c

Days alive and out of hospital after surgical treatment of epithelial ovarian cancer: A Danish nationwide cohort study

Days alive and out of hospital (DAOH) is a validated outcome measure in perioperative trials integrating information on primary hospitalization, readmissions, and mortality. It is negatively associated with advanced age. However, DAOH has not been described for surgical treatment of epithelial ovarian cancer (EOC), primarily diagnosed in older patients. We conducted a Danish nationwide cohort study including patients undergoing debulking surgery for EOC from 2013 to 2018. DAOH was explored for 30 (DAOH30), 90 (DAOH90), and 180 (DAOH180) postoperative days in younger (<70 years) and older (≥70 years) patients with advanced-stage disease stratified by surgical modality (primary (PDS) or interval debulking surgery (IDS)). We examined the associations between patient- and surgical outcomes and low or high DAOH30. Overall, 1168 patients had stage IIIC-IV disease and underwent debulking surgery. DAOH30 was 22 days [interquartile range (IQR): 18, 25] and 23 days [IQR: 18, 25] for younger and older patients treated with PDS, respectively. For IDS, DAOH30 was 25 days [IQR: 22, 26] for younger and 25 days[IQR: 21, 26] for older patients. We found no significant differences between age cohorts regarding DAOH30, DAOH90, and DAOH180. Low DAOH30 was associated with poor performance status, PDS, extensive surgery, and long duration of surgery in adjusted analysis. DAOH did not differ significantly between age cohorts. Surgical rather than patient-related factors were associated with low DAOH30. Our results likely reflect a high selection of fit older patients for surgery, reducing the patient-related differences between younger and older patients receiving surgical treatment.