Patient Reported Outcomes/QoL/Survivorship

PV 03 - Poster Viewing Q&A - Session 3

TU_19_3370 - A Pilot Study to Identify Adherence Rates and Barriers to Vaginal Dilator Use after Pelvic Radiotherapy

Tuesday, September 17
1:00 PM - 2:15 PM
Location: ASTRO Innovation Hub

A Pilot Study to Identify Adherence Rates and Barriers to Vaginal Dilator Use after Pelvic Radiotherapy
G. Alban1, D. L. Buscariollo2, T. Cheng3, M. King3, H. J. Mamon3, S. Bober4, and L. J. Lee1; 1Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 2Department of Radiation Oncology, Swedish Cancer Institute, Seattle, WA, 3Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, 4Dana-Farber Cancer Institute, Boston, MA

Purpose/Objective(s): Vaginal stenosis (VS) is a well-known late effect of pelvic radiation therapy (RT), which may impact a patient’s sexual health as well as interfere with surveillance pelvic exams. Although vaginal dilator (VD) therapy is routinely recommended for patients who receive pelvic RT, the barriers to VD use and adherence rates have not been well studied. We designed a pilot study to understand the barriers to VD therapy by developing longitudinal patient-reported support program for women who received pelvic RT.

Materials/Methods: From 02/18 to 10/18, all women who completed pelvic RT for gynecological or gastrointestinal malignances received a set of VDs of various sizes with standardized teaching by radiation oncology nurses. After all questions were addressed, patients were invited to participate in an e-mail based longitudinal support program. The educational materials and survey instrument were developed by multidisciplinary consensus between radiation oncology physicians, nurses and a sexual health expert. Enrolled patients were sent an email with a link to a RedCap survey 1, 3 and 6 mo after RT to access patient confidence and frequency of VD use, the barriers to use, and an inquiry whether they would like a call from their providers or to stop participating in the program.

Results: With a median follow-up (FU) of 8.8 mo (r: 2.7 – 10.7), a total of 56 women were enrolled. Primary disease sites were: 54% endometrial, 13% cervical, 11% colorectal, 7% vaginal, 7% ovarian, 4% vulvar, 4% anal and 2% pelvic sarcoma. Median age was 64.6 years (r: 17 – 82). RT modalities were: 37% vaginal brachytherapy alone, 27% external beam RT and 36% both. The response rate to the email questionnaire at 1, 3 and 6 months was 36%, 33% and 15%, respectively. Of the 56 enrolled patients, 28 (50%) responded at least in 1 time-point. Patient-reported frequency of VD use in the last 30 days was: 4 times or more in 43%, 1-3 times in 48% and no use in 9%. The self-reported barriers to VD use are summarized in Table 1. Common barriers for VD use reported were trouble remembering (69%), uncertainly if the VD helps (50%) and vaginal tightness (50%).

Conclusion: Our VD pilot support program identified common barriers for VD use after pelvic RT. Based on these findings, we will integrate additional educational tools and resources during routine FU visits as well as a survivorship clinic. Table 1. Patients Self-Rated Barriers to Using VD (total = 44)
NOT AT ALL A BARRIER SOMEWHAT OF A BARRIER VERY MUCH OF A BARRIER TOTAL
Discomfort when using VD 24 (63%) 12 (32%) 2 (5%) 38
Vaginal tightness 21 (55%) 15 (45%) 2 (5%) 38
Vaginal dryness 27 (73%) 9 (24%) 1 (3%) 37
Bleeding when using VD 34 (92%) 2 (5%) 1 (3%) 37
Lack of privacy 28 (78%) 8 (22%) 0 36
Lack of time 23 (59%) 11 (28%) 5 (13%) 39
Remembering to use VD 12 (31%) 23 (59%) 4 (10%) 39
Unsure if the VD is helping 18 (50%) 15 (42%) 3 (8%) 36
Unsure on how to use the VD 30 (73%) 6 (15%) 3 (7%) 41
Anxiety about using the VD 23 (60%) 12 (32%) 3 (8%) 38
Lack of support from my partner 36 (100%) 0 0 36
Uncomfortable using a VD 21 (55%) 14 (37%) 3 (8%) 38

Author Disclosure: G. Alban: None. D.L. Buscariollo: None. M. King: None. H.J. Mamon: Honoraria; Up to Date. L.J. Lee: Research Grant; Bridge Expansion Grant, Astra Zeneca, Joint Center of Radiation Therapy, Dana-Farber Cancer Institute. Employee; Brigham and Women's Physician Organization.

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