Editorial

Late Radiotherapy Effects: Is Bowel Morbidity Adequately Documented or Patients' Needs Managed Appropriately?

Practitioners and researchers require an outcome measure that accurately identifies the range of common treatment-induced changes in sexual function and well-being experienced by women after cervical or endometrial cancer. This systematic review critically appraised the measurement properties and clinical utility of instruments validated for the measurement of female sexual dysfunction (FSD) in this clinical population.

A bibliographic database search for questionnaire development or validation papers was completed and methodological quality and measurement properties of selected studies rated using the Consensus-based Standards for the selection of health Measurement Instrument (COSMIN) checklist.

738 articles were screened, 13 articles retrieved for full text assessment and 7 studies excluded, resulting in evaluation of 6 papers; 2 QoL and 4 female sexual morbidity measures. Five of the six instruments omitted one or more dimension of female sexual function and only one instrument explicitly measured distress associated with sexual changes as per DSM V (APA 2013) diagnostic criteria.

None of the papers reported measurement error, responsiveness data was available for only two instruments, three papers failed to report on criterion validity, and test-retest reliability reporting was inconsistent. Heterosexual penile-vaginal intercourse remains the dominant sexual activity focus for sexual morbidity PROMS terminology and instruments lack explicit reference to solo or non-coital sexual expression or validation in a non-heterosexual sample. Four out of six instruments included mediating treatment or illness items such as vaginal changes, menopause or altered body image.

Findings suggest that the Female Sexual Function Index (FSFI) remains the most robust sexual morbidity outcome measure, for research or clinical use, in sexually active women treated for cervical or endometrial cancer.

Development of an instrument that measures sexual dysfunction in women who are infrequently/not sexually active due to treatment consequences is still required to identify women in need of sexual rehabilitation.

Patient-reported outcome measures (PROMs) are a useful way of recording patient perceptions of the impact of their cancer and the consequences of treatment. Understanding the impact of radiotherapy longer term requires tools that are sensitive to change but also meaningful for patients. PROMs are useful in defining symptom severity but also the burden of illness for cancer patients. Patient-reported outcomes are increasingly being seen as a way to improve practice by enhancing communication, improving symptom management as well as identifying patient care needs. This paper provides an overview of the use of PROMs in radiotherapy and considerations for tool choice, analysis and the logistics of routine data collection. Consistent assessment is essential to detect patient problems as a result of radiotherapy, but also to address emerging symptoms promptly.