Gynecologic Cancer

White, Faithfull, and Allan (2013) conducted a focused ethnographic study from the United Kingdom (U.K.) discussing factors influencing the clinical assessment and interventions of longterm sequela of radiotherapy (RT) for women with pelvic malignancies. Pelvic RT causes physical side effects as well as psychosocial responses that negatively impact the sexual health of women and their partners. The authors illustrated the lack of research and thorough clinical assessment available to manage patients long term. The rationale for the study was the existence of a significant population of two million cancer survivors in the U.K. (MacMillan Cancer Support, 2008). Epidemiologic data suggest that few clinical supports are in place for cancer survivors and, therefore, post-treatment quality-of-life (QOL) alterations are not addressed. Clinicians are known to focus on assessment and management of acute treatment-related side effects and are unaware of and reluctant to manage chronic, late, or long-term side effects. QOL and RT studies indicate that women receiving pelvic RT experience significant disruption to sexual well-being. Accurate data in this population do not exist because of minimal prevalence data about the sexual function of the general U.K. adult population. White et al. (2013) contended that research has adopted an essentialist perspective in the study of sexual dysfunction, which has resulted in a neglect of psychological, relational, and social components of male and female longterm, treatment-related sexual side effects. Biologic determinism is identified as the first perspective to emerge in defining sexuality; however, the need to include Foucault’s (1990a, 1990b) theory of social construction, which accounts for the psychosocial effect of the anatomic and physiologic changes, is considered essential and is used as part of the framework of White et al.’s (2013) study. The purpose of the study was to explore factors that influence clinical assessment and management of RT-induced sexual dysfunction and to illustrate the deficiencies of the multiprofessional team (e.g., physicians, nurses, radiotherapists, social workers) in providing quality time for discussion and to craft appropriate interventions during routine oncology follow-up. In addition, the article provided findings of biomedical (i.e., functional), socially constructed, and subjective elements of women’s altered sexual lives following cancer treatment. The study was conducted during a five-month period of participant observation of RT follow-up consultations (N = 69) from two National Health Service cancer centers and 49 in-depth participant interviews (24 women, 5 partners, 20 health professionals). The first theme that emerged was the culture of the clinic shaped by the biomedical model. Two subthemes evolved within that theme: fear of recurrence and limits of the biomedical gaze (only the physical examination, not any leading psychosocial questions posed by the team to assess sexual health). The second theme focused on the construction of female sexuality post-treatment, in which female sexuality was understood by clinicians and women through biologic and anatomic realities created by pelvic RT and sexual impact. The study’s findings explored factors that adversely affect delivery of sexual rehabilitation from a social, organizational, and patient and partner perspective following cancer. Clinicians practicing in inflexible, resource-limited systems with significant time constraints are challenged to go beyond the pure physical assessment and needs of cancer survivors. The knowledge provided in the study is pivotal and extends beyond the clinical diagnosis of women with pelvic cancer. Sexual rehabilitation must be at the forefront of professional oncology nursing practice for all patient populations affected by acute and chronic sexual compromise related to cancer diagnosis and treatment. In addition, issues related to gender equity in this domain must be prioritized and pursued.