scholarly journals Changes in the Vaginal Microbiome and Associated Toxicities Following Radiation Therapy for Gynecologic Cancers

2021 ◽  
Vol 11 ◽  
Author(s):  
Despina Tsementzi ◽  
Rebecca Meador ◽  
Tony Eng ◽  
Pretesh Patel ◽  
Joseph Shelton ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cancer Patients ◽  
Gynecologic Cancer ◽  
Cancer Therapies ◽  
Healthy Controls ◽  
Vaginal Microbiome ◽  
Vaginal Symptoms ◽  
Persistent Symptoms ◽  
Healthy Women ◽  
Symptom Persistence

Postmenopausal women often suffer from vaginal symptoms associated with atrophic vaginitis. Additionally, gynecologic cancer survivors may live for decades with additional, clinically significant, persistent vaginal toxicities caused by cancer therapies, including pain, dyspareunia, and sexual dysfunction. The vaginal microbiome (VM) has been previously linked with vaginal symptoms related to menopause (i.e. dryness). Our previous work showed that gynecologic cancer patients exhibit distinct VM profiles from healthy women, with low abundance of lactobacilli and prevalence of multiple opportunistic pathogenic bacteria. Here we explore the association between the dynamics and structure of the vaginal microbiome with the manifestation and persistence of vaginal symptoms, during one year after completion of cancer therapies, while controlling for clinical and sociodemographic factors. We compared cross-sectionally the vaginal microbiome in 134 women, 64 gynecologic patients treated with radiotherapy and 68 healthy controls, and we longitudinally followed a subset of 52 women quarterly (4 times in a year: pre-radiation therapy, 2, 6 and 12 months post-therapy). Differences among the VM profiles of cancer and healthy women were more pronounced with the progression of time. Cancer patients had higher diversity VMs and a variety of vaginal community types (CTs) that are not dominated by Lactobacilli, with extensive VM variation between individuals. Additionally, cancer patients exhibit highly unstable VMs (based on Bray-Curtis distances) compared to healthy controls. Vaginal symptoms prevalent in cancer patients included vaginal pain (40%), hemorrhage (35%), vaginismus (28%) and inflammation (20%), while symptoms such as dryness (45%), lack of lubrication (33%) and dyspareunia (32%) were equally or more prominent in healthy women at baseline. However, 24% of cancer patients experienced persistent symptoms at all time points, as opposed to 12% of healthy women. Symptom persistence was strongly inversely correlated with VM stability; for example, patients with persistent dryness or abnormally high pH have the most unstable microbiomes. Associations were identified between vaginal symptoms and individual bacterial taxa, including: Prevotella with vaginal dryness, Delftia with pain following vaginal intercourse, and Gemillaceaea with low levels of lubrication during intercourse. Taken together our results indicate that gynecologic cancer therapy is associated with reduced vaginal microbiome stability and vaginal symptom persistence.

scholarly journals Comparison of vaginal microbiota in gynecologic cancer patients pre‐ and post‐radiation therapy and healthy women

2020 ◽  
Vol 9 (11) ◽  
pp. 3714-3724
Author(s):  
Despina Tsementzi ◽  
Angela Pena‐Gonzalez ◽  
Jinbing Bai ◽  
Yi‐Juan Hu ◽  
Pretesh Patel ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cancer Patients ◽  
Gynecologic Cancer ◽  
Vaginal Microbiota ◽  
Healthy Women ◽  
Post Radiation

Sexual health inquiry preferences among gynecologic cancer patients after radiation therapy.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 87-87
Author(s):  
Gerard Edward Heath ◽  
Pamela Fairchild ◽  
Mitchell Berger ◽  
Anagha Tolpadi ◽  
Christina Chapman ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Sexual Dysfunction ◽  
Sexual Health ◽  
Sexual Function ◽  
Cancer Patients ◽  
Gynecologic Cancer ◽  
Healthcare Providers ◽  
Sexual History ◽  
Categorical Variables ◽  
Gynecologic Cancers

87 Background: Following radiation therapy (RT), gynecologic oncology patients report high rates of sexual dysfunction. However, little is known regarding communication of sexual health among these patients and their healthcare providers. The aim of this study was to assess the beliefs/attitudes of patients regarding sexual history taking. Methods: Survey results were obtained from 75 women who presented for follow up care for gynecologic cancers in the radiation oncology department. The surveys assessed patient beliefs about sexual health and its impact on overall quality of life, the role practitioners should play in obtaining an accurate sexual history, and preferences and level of embarrassment regarding sexual history collection. Overall level of sexual functioning was assessed using the Female Sexual Function Index (FSFI). Chi-squared tests were used to analyze categorical variables and logistic regression modeling was used to predict agreement with survey statements. Results: Most subjects were white and married with a mean FSFI score of 9.9 [(SD = 10.3) sexual dysfunction is defined as < 26.5]. 78.7% agreed that sexual function is an important component of overall health, and only 12.0% reported embarrassment about discussing their sexual health with healthcare providers. 62.79% agreed that medical providers should take a sexual history on a regular basis. However, 58.7% and 22.7% of women report never or almost never being asked about their sexual health by their primary care physician or Ob/Gyn, respectively. Approximately two-thirds of women expressed a preference to have a female provider obtain their sexual health history. Conclusions: Gynecologic cancer patients s/p RT report low sexual function scores. A majority agree that sexual function is essential to overall health. They report little embarrassment regarding discussions of sexual health, yet, note limited discussion about the topic with their healthcare providers. This work highlights the need for improvements in communication about sexual health. We suggest that healthcare providers caring for women with gynecologic cancers should more regularly inquire about their patients’ sexual health and function.

scholarly journals Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1471 ◽  
Author(s):  
Won Ick Chang ◽  
Hyun-Cheol Kang ◽  
Hong-Gyun Wu ◽  
Hak Jae Kim ◽  
Seung Hyuck Jeon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Laparoscopic Surgery ◽  
Propensity Score ◽  
Lower Extremity ◽  
Cancer Patients ◽  
Gynecologic Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I–III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL.

Pilot Study of Vaginal Microbiome Using QIIME 2™ in Women With Gynecologic Cancer Before and After Radiation Therapy

2019 ◽  
pp. E48-E59 ◽  
Keyword(s):  
Radiation Therapy ◽  
Pilot Study ◽  
Gynecologic Cancer ◽  
Human Microbiome ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Rrna Gene ◽  
Vaginal Microbiome ◽  
Bioinformatics Pipeline ◽  
Before And After

Objectives: To characterize the vaginal microbiome using QIIME 2™ (Quantitative Insights Into Microbial Ecology 2) in women with gynecologic cancer. Sample & Setting: 19 women with gynecologic cancer before and after radiation therapy at a comprehensive cancer center in Atlanta, Georgia. Methods & Variables: This pilot study analyzed vaginal microbiome communities using a microbiome analysis pipeline, beginning with 16S rRNA gene sequencing and processing through use of a bioinformatics pipeline to downstream microbial statistical analysis. Results: The findings showed the methods to be robust, and most women with gynecologic cancer showed depletion of Lactobacillus. Compared to those pre–radiation therapy, women post–radiation therapy showed higher abundances of Mobiluncus, Atopobium, and Prevotella but lower abundances of Lactobacillus, Gardnerella, and Peptostreptococcus, which are associated with bacterial vaginosis. Implications for Nursing: This study presents the fundamentals of human microbiome data collection and analysis methods to inform nursing science. Assessing the vaginal microbiome provides a potential pathway to develop interventions to ameliorate dysbiosis of the vaginal microbiome.

scholarly journals Patterns and Trends of Herbal Medicine Use among Patients with Gynecologic Cancer

2021 ◽  
Vol 81 (06) ◽  
pp. 699-707
Author(s):  
Anna-Katharin Theuser ◽  
Carolin C. Hack ◽  
Peter A. Fasching ◽  
Sophia Antoniadis ◽  
Katharina Grasruck ◽  
...  
Keyword(s):  
Herbal Medicine ◽  
Regression Model ◽  
Cancer Patients ◽  
Medical Information ◽  
Gynecologic Cancer ◽  
University Hospital ◽  
Healthy Controls ◽  
Herbal Products ◽  
Gynecology And Obstetrics ◽  
Healthy Persons

Abstract Background More and more information about complementary and integrative medicine is becoming available, especially among cancer patients. However, little is known about the use of herbal medicine by patients with gynecologic cancers. This study aimed to assess the use of herbal products by gynecologic cancer patients compared with healthy controls. Methods This cross-sectional study was conducted at the Department for Gynecology and Obstetrics of Erlangen University Hospital and included 201 patients with gynecologic cancer and 212 healthy controls. Use of herbal medicines was evaluated using a standardized questionnaire. Medical information on cancer patients was collected from hospital records. Group comparisons were done using a logistic regression model. Risk ratios were assessed using a Poisson regression model. Results Gynecologic cancer patients used herbal medicine significantly less often than healthy persons. 69% of gynecologic cancer patients and 81% of healthy participants reported using herbal products. 40% of cancer patients and 56% of healthy persons reported using plants for medicinal purposes. Motives of cancer patients for using herbal medicine included treatment of cancer-related symptoms. The major source of information for both groups was family and friends. Conclusions Although herbal medicine was used less by patients with gynecologic cancer, herbal products were used by both cancer patients and healthy individuals. To provide cancer patients with optimal therapy, oncologists should be informed about the herbal products used by their patients as this will allow them to take their patientsʼ self-medication with herbal medicine into account. Counseling by oncologists on the use of herbal medicine should be encouraged.

Trajectories of sexual dysfunction and its risk factors in women with gynecologic cancer across radiation therapy and healthy controls.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24097-e24097
Author(s):  
Jinbing Bai ◽  
Despina Tsementzi ◽  
Pretesh R. Patel ◽  
Joseph W Shelton ◽  
Mary Dolan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Sexual Dysfunction ◽  
Gynecologic Cancer ◽  
Study Cohort ◽  
Healthy Controls ◽  
High Arousal ◽  
High Ph ◽  
Increased Risk ◽  
Patient Reported

e24097 Background: Women with gynecological cancer (GynCa) reported an increased risk for acute and long-term sexual dysfunction across cancer treatments, especially radiation therapy (RT). However, limited data exist on the course of sexual dysfunction across RT and its risk factors are unknown. This study sought to characterize women’s sexual dysfunction trajectories and identified risk factors of persistent sexual dysfunction. Methods: Using a longitudinal study design, patient-reported sexual dysfunction, demographic and clinical data were collected. Women receiving RT for GynCa older than 18 years or age, race, and BMI matched healthy controls were enrolled. Female Sexual Function Index (FSFI) was used to assess women’s sexual dysfunction. Patients completed all the questionnaires pre-RT, at the end of RT, 6- and 12-month post-RT. Group-based trajectory modeling was used to identify trajectories of sexual dysfunction and risk factors of persistent sexual dysfunction. Results: Eighty-two patients were analyzed, including 36 GynCa patients receiving RT and 46 healthy post-menopausal women, comprising of 33 Blacks, 44 Whites, and 5 others. Three trajectory groups of sexual dysfunction (total FSFI score) were identified: low risk (17.4%), moderate risk (12.3%), and high risk (70.4%). All three trajectory groups were significantly different from each other (p<0.01). Similarly, three trajectories were identified for each of six FSFI domains: desire (low [6.3%], moderate [62.5%], high [31.2%], p<0.01); arousal (low [38.1%], moderate [46.4%], high [15.4%], p<0.01); lubrication (low [49.7%], moderate [44.6%], high [5.7%], p<0.01); orgasm (low [43.8%], moderate [31.3%], high [24.9%], p<0.01); pain (low [25.5%], moderate [64.2%], high [10.3%], p<0.01); and satisfaction (low [8.3%], moderate [61.4%], high [30.3%], p<0.01). Risk factors of sexual dysfunction were high pH (p=0.007) and without chemotherapy (p=0.019). Young women had more arousal (p=0.011); high education level was associated with high arousal (p=0.039); low pH was associated with high arousal (p=0.018) and orgasm (p=0.036). No risk factors were found for desire and satisfaction domains. BMI, surgery, and study cohort (cancer vs healthy) were not predictors of sexual dysfunction trajectories. Conclusions: This study identified three trajectories of sexual dysfunction. Low education, high pH, no chemotherapy, and elder women were risk factors of severe sexual dysfunction. Sexual dysfunction interventions should address these risk factors.

scholarly journals Faecal Microbiota Composition Varies between Patients with Breast Cancer and Healthy Women: A Comparative Case-Control Study

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2705
Author(s):  
Christine Bobin-Dubigeon ◽  
Huyen Trang Luu ◽  
Sébastien Leuillet ◽  
Sidonie N. Lavergne ◽  
Thomas Carton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Shannon Index ◽  
Healthy Controls ◽  
Breast Cancer Patients ◽  
Faecal Microbiota ◽  
Irritable Bowel Disease ◽  
Healthy Women ◽  
Irritable Bowel

The intestinal microbiota plays an essential role in many diseases, such as obesity, irritable bowel disease (IBD), and cancer. This study aimed to characterize the faecal microbiota from early-stage breast cancer (BC) patients and healthy controls. Faeces from newly diagnosed breast cancer patients, mainly for an invasive carcinoma of no specific type (HR+ and HER2−), before any therapeutic treatment and healthy controls were collected for metabarcoding analyses. We show that the Shannon index, used as an index of diversity, was statistically lower in the BC group compared to that of controls. This work highlights a reduction of microbial diversity, a relative enrichment in Firmicutes, as well as a depletion in Bacteroidetes in patients diagnosed with early BC compared to those of healthy women. A tendency towards a decreased relative abundance of Odoribacter sp., Butyricimonas sp., and Coprococcus sp. was observed. This preliminary study suggests that breast cancer patients may differ from healthy subjects in their intestinal bacterial composition.

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