Scandinavian Journal of Caring Sciences

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

Symptom Experience After Surgical Treatment for Vulvar Cancer—A Scoping Review

ABSTRACTBackgroundPrevious reviews have indicated a high burden of physical, emotional and sexual symptoms in women who have undergone surgery for vulvar cancer. Numerous surgical modifications have been made over the past few decades to limit post‐operative symptoms. However, few reviews have investigated a wide range of symptoms in women with vulvar cancer. A comprehensive review of the literature examining these symptoms following advanced surgical treatment for vulvar cancer could contribute to an updated understanding of symptom experiences in these women.AimTo map the literature on women's symptom experiences after surgical treatment for vulvar cancer.MethodsA scoping review was conducted, following the Preferred Reporting Items for Systematic reviews and Meta‐Analysis extension for Scoping Reviews (PRISMA‐ScR). The included studies provided independent analyses of women with vulvar cancer, utilised patient‐reported outcome measures or qualitative data, were published between 2008 and 2024 and were in English, Danish, Norwegian or Swedish. Searches were conducted on February 20, 2024, in Embase, MEDLINE, CINAHL and PsycINFO. Data were thematically analysed as described by Braun and Clarke.ResultsThe following themes were identified in the 20 studies: lymphedema, sexuality and body image, pain, physical functioning, fatigue, urinary symptoms, emotional symptoms and support from relatives and healthcare professionals.ConclusionWomen who have undergone surgery for vulvar cancer experience several physical and emotional symptoms. However, there is a shortage of qualitative studies that thoroughly explore the concept of symptom experience and quantitative studies that include vulvar‐specific patient‐reported outcome measures.Trial and Protocol RegistrationThe protocol was preregistered on Open Science Framework on April 9, 2024, registration https://doi.org/10.17605/OSF.IO/429JW.

Unmet Palliative Care Needs of Patients Newly Diagnosed With Advanced Gynaecological Cancer in Korea: A Mixed‐Method Study

ABSTRACT Background Newly diagnosed advanced gynaecological cancer patients may have different palliative care needs than those diagnosed earlier. Identifying unmet palliative care needs and the kind of support they want should be prioritised to provide appropriate support for them. Aim The aim of this study was to determine the unmet palliative care needs of Korean patients with newly diagnosed advanced gynaecological cancer and to explore the support they desire from family, medical staff, hospitals and government. Methods A mixed‐method study included quantitative approaches with a cross‐sectional design and inductive qualitative approaches with individual written narratives. Among the original data obtained from 115 patients with advanced gynaecological cancer through an online survey, this study included only quantitative and qualitative data from 75 patients diagnosed with gynaecological cancer within the past year. Regarding quantitative data, the Problems and Needs in Palliative Care Questionnaire was used, and palliative care needs were analysed using the range in percentages of subscales. Through qualitative content analysis, qualitative data were newly analysed regarding the palliative care participants wanted from various support providers. Results The palliative care needs were divided into two aspects: ‘problem’ and ‘need for care’. For both aspects, psychological issues, physical symptoms and financial problems were the three most prevalent domains. Participants wanted their families to provide physical and emotional support. They desired information, emotional support, trustworthy partnerships and professionalism from medical staff; healthcare‐related and emotional palliative care programs from hospitals; and policies for financial and service‐related assistance from the government. Conclusions As newly diagnosed advanced gynaecological cancer patients have various palliative care needs, they need to form a multidisciplinary team of experts to provide complicated and integrated support. We recommended that an early palliative care program be created to meet the patients' palliative care needs shown in our findings in future studies.