Recovery Issues of Fertility-Preserving Surgery in Patients With Early-Stage Cervical Cancer and a Model for Survivorship: The Physician Checklist

Abstract

Introduction:To present a qualitative data analysis of items exploring the treatment, adjustment, and recovery of 33 patients who underwent radical trachelectomy (RT), and to determine the feasibility of using a physician checklist (PCL) as a model for survivorship assessment.Methods:This prospective study was approved by the Memorial Sloan-Kettering Cancer Center's Institutional Review Board. Participants completed a survey including exploratory items focused on fertility issues and reproductive concerns, treatment, adjustment, and recovery over 2 years. All responses to the exploratory questions were transcribed verbatim; thematic analysis was used to identify, evaluate, and show patterns within the data set; and descriptive statistics were calculated for thematic categories. A limited waiver of authorization was obtained for medical chart review of these patients (who underwent RT) for 2years before (January 2006 to December 2007) and 2 years after (January 2008 to December 2009) implementation of the checklist to evaluate its feasibility.Results:In response to "how successful you feel you will be at conceiving in the future?" on a scale of 0% to 100%, scores ranged from 54% to 60%. Approximately 70% of the patients reported concerns about conceiving; however, these lessened with time-88% at 6months to 73% at 24 months. Six percent of women were trying to conceive by 12 months; this increased to 21% by 24 months. Five primary themes emerged from the qualitative analysis that were found to be prevalent across all exploratory items inquiring about difficulties or the hardest adjustment to treatment, recovery, and problems associated with RT; these included menstrual/vaginal issues, emotional impact, life interruptions/return to normalcy, general pain, and recovery process. The PCL identified higher rates of neocervical stenosis (58%), encroachment (54%), vaginal scarring (50%), and dyspareunia (33%) than medical charts, and increased documentation of reproductive consults (54%) and assistance (21%).Conclusion:Global themes expressed by our patients are consistent with those of other cancer survivors. The PCL is an excellent supplement to medical charts by documenting important survivorship issues.