Susan K. Peterson

Comparing long-term sexual dysfunction across different uterine cancer treatment modalities

The objective of this study was to assess differences in long-term sexual and menopausal side effects after uterine cancer treatment among treatment modalities. This is a cross-sectional study that examined women treated for uterine cancer from 2006-2018. Eligible women included those who underwent a hysterectomy/bilateral salpino-oophorectemy alone (HS), with brachytherapy (BT), or with external beam radiation therapy (EBRT). A noncancer cohort of women who underwent a hysterectomy/BSO for benign indications were also identified (non-CA). To compare outcomes, we utilized a shortened form of the female sexual function index (FSFI) and the menopause survey, which consists of 3 subscales: hot flashes, vaginal symptoms, and urinary symptoms. Demographic, comorbidity, and other treatment variables were collected. Survey totals were compared across cohorts using ANOVA tests and logistic regression. A total of 284 women completed the Menopause Survey (Non-CA 64, HS 60, BT 69, EBRT 91); 116 women reported sexual activity in the last 4 weeks and completed the FSFI (NC 32, HS 21, BT 31, EBRT 32). The mean FSFI score for the entire cohort was 11.4 (SD 4.16), which indicates poor sexual function. There was no significant difference between any cohort in the overall FSFI score (p = 0.708) or in any of the FSFI subscales (all p > 0.05). On univariate analysis, BT was associated with fewer menopausal hot flashes and vaginal symptoms compared to the non-CA cohort (p < 0.05), which did not persist on multivariable analysis. There was no significant difference in sexual dysfunction or menopausal symptoms in those treated for uterine cancer with or without adjuvant radiation. Most patients reported poor sexual function.

Demographic and social determinants of human immunodeficiency virus status among women with cervical cancer in a low-resource setting.

Zambia faces one of the world's highest cervical cancer and human immunodeficiency virus (HIV) burdens, yet how demographics and social determinants of health relate to HIV status among women with cervical cancer remains unclear. We conducted a prospective, Institutional Review Board-approved cross-sectional study of women aged ≥18 years with newly diagnosed cervical cancer at the Cancer Diseases Hospital in Lusaka, Zambia, from June 2022 to April 2025. Participants completed a culturally adapted Accountable Health Communities Health-Related Social Needs questionnaire. Demographic and social need variables were compared by HIV status, with associated factors evaluated via univariable and multi-variable logistic regression. Among 290 women, 160 (55.2%) were living with HIV. They were younger (median age 48 vs 53 years, p = .002), more often unmarried (49% vs 31%, p = .002), and more likely to live in urban areas (62% vs 43%, p = .003) than women living without HIV. They reported greater prior cervical cancer screening (48% vs 28%, p < .001) and knowledge (40% vs 25%, p = .008). Social needs were high across both groups: food insecurity (77%), transport barriers (82%), financial hardship (88%), loneliness (65%), and perceived stress (75%), with no HIV-related differences. In multi-variable analysis, younger age (adjusted odds ratio [aOR] 0.76 per 5 years, 95% confidence interval [CI] 0.66 to 0.87), unmarried status (aOR 3.06, 95% CI 1.79 to 5.35), urban residence (aOR 2.00, 95% CI 1.21 to 3.32), and prior knowledge of cervical cancer (aOR 1.86, 95% CI 1.08 to 3.23) were associated with HIV. No social need domain showed an independent association. In Zambian women with cervical cancer, HIV status is linked to demographic factors and cancer awareness, but not social needs, which were uniformly high across patients. This highlights the need to expand education and screening, especially for younger and unmarried women, and integrate socioeconomic support to improve outcomes in Zambia and similar high-burden settings.