Purpose To assess sexual/vaginal health issues and educational intervention preferences in women with a history of breast or gynecologic cancer. Methods Patients/survivors took a cross-sectional survey at their outpatient visits. Main outcome measures were sexual dysfunction prevalence, type of sexual/vaginal issues, awareness of treatments, and preferred intervention modalities. Descriptive frequencies were performed, and results were dichotomized by age, treatment status, and disease site. Results Of 218 eligible participants, 109 (50%) had a history of gynecologic and 109 (50%) a history of breast cancer. Median age was 49 years (range, 21–75); 61% were married/cohabitating. Seventy percent (n=153) were somewhat-to-very concerned about sexual function/vaginal health, 55% (n=120) reported vaginal dryness, 39% (n=84) vaginal pain, and 51% (n=112) libido loss. Many had heard of vaginal lubricants, moisturizers, and pelvic floor exercises (97%, 72%, 57%, respectively). Seventy-four percent (n=161) had used lubricants, 28% moisturizers (n=61), and 28% pelvic floor exercises (n=60). Seventy percent (n=152) preferred the topic to be raised by the medical team; 48% (n=105) raised the topic themselves. Most preferred written educational material followed by expert discussion (66%, n=144/218). Compared to women ≥50 years old (41%, n=43/105), younger women (54%, n=61/113) preferred to discuss their concerns face-to-face (p=0.054). Older women were less interested in online interventions (52%, p<0.001), despite 94% having computer access. Conclusion Female cancer patients/survivors have unmet sexual/vaginal health needs. Preferences for receiving sexual health information vary by age. Improved physician-patient communication, awareness, and educational resources using proven sexual health promotion strategies can help women cope with treatment side effects.

Introduction Surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, reproductive function, and overall quality of life (QOL) (e.g., sexual dysfunction, infertility, lymphedema). However, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae. Aim To provide an overview of the standards of care and major advancements in gynecologic cancer surgery, with a focus on their direct physical impact, as well as emotional, sexual, and QOL issues. This overview will aid researchers and clinicians in the conceptualization of future clinical care strategies and interventions to improve sexual/vaginal/reproductive health and QOL in gynecologic cancer patients. Main Outcome Measures Comprehensive overview of the literature on gynecologic oncology surgery. Methods Conceptual framework for this overview follows the current standards of care and recent surgical approaches to treat gynecologic cancer, with a brief overview describing primary management objectives and the physical, sexual, and emotional impact on patients. Extensive literature support is provided. Results The type and radicality of surgical treatment for gynecologic cancer can influence sexual function and play a significant role in QOL. Psychological, sexual, and QOL outcomes improve as surgical procedures continue to evolve. Procedures for fertility preservation, laparoscopy, sentinel lymph node mapping, and robotic and risk-reducing surgery have advanced the field while reducing treatment sequelae. Nevertheless, interventions that address sexual and vaginal health issues are limited. Conclusions It is imperative to consider QOL and sexuality during the treatment decision-making process. New advances in detection and treatment exist; however, psycho-educational interventions and greater patient–physician communication to address sexual and vaginal health concerns are warranted. Large, prospective clinical trials including patient-reported outcomes are needed in gynecologic oncology populations to identify subgroups at risk. Future study designs need clearly defined samples to gain insight about sexual morbidity and foster the development of targeted interventions.

IMPORTANCE Increasingly complex surgical procedures are being performed in the outpatient setting, increasing the burden on patients and caregivers to manage their postoperative symptoms. Electronic patient-reported symptom tracking may reduce this burden and help patients distinguish between expected symptoms and those requiring intervention.OBJECTIVE To determine whether electronic symptom reporting with clinical alerts for 10 days after ambulatory cancer surgery is associated with a reduction in potentially avoidable urgent care visits, defined as a visit not leading to admission. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted at the Josie Robertson Surgery Center (JRSC), Memorial Sloan Kettering Cancer Center's ambulatory surgery center with overnight stay capacity from September 20, 2016, to December 31, 2018. Patients undergoing prostatectomy, nephrectomy, mastectomy with or without immediate reconstruction, hysterectomy, or thyroidectomy at the surgery center before (n = 4195) and after (n = 2970) implementation of the Recovery Tracker (RT) electronic postoperative symptom survey were included. Data analyses were conducted from February 1 to November 24, 2020.EXPOSURES A short electronic survey assessing symptoms daily for 10 days after surgery, administered via the patient portal, with alerts to the clinical team and follow-up for concerning responses. MAIN OUTCOMES AND MEASURESThe main outcome was Memorial Sloan Kettering urgent care center visits with and without readmission and any readmission within 30 days after surgery. Nursing workload was measured by patient phone calls, emails, and secure messages as documented in the electronic medical record.RESULTS A total of 7165 patients were analyzed, including 4195 (median age, 53 [interquartile range (IQR), 44-63] years; 3490 women [83%]) from the pre-RT implementation period and 2970 (median age, 56 [IQR,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] years; 2221 women [75%]) from after full implementation. On multivariable, intent-to-treat analysis by study period, having surgery in the post-RT period was associated with a 22% decrease in the odds of an urgent care center visit without readmission (OR, 0.78; 95% CI, 0.60-1.00; P = .047). Having responded to at least 1 survey was associated with a 42% reduction in the odds of an urgent care center visit without readmission (OR, 0.58; 95% CI, 0.39-0.87; P = .007). There was no change in the risk of admission. Nursing calls increased by a mean of 0.86 (95% CI, 0.75-0.98) calls per patient after RT implementation (P < .001), a 34% increase. CONCLUSIONS AND RELEVANCEIn this cohort study, electronic symptom reporting with nursing follow-up for clinical alerts was associated with a reduction in potentially avoidable urgent care visits. The low risk and high benefit of this intervention suggest that these systems should be more broadly implemented.

Purpose We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program, and identify improvements of physical symptoms, per patient and clinical evaluation. Methods Evalubility criteria included gynecologic exam at initial visit; at least one follow-up with gynecologic exam within 8 months of initial visit; and all consecutive follow-ups <6 months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least 1 follow-up from 09/12–10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n=90, 53%), gynecologic (n=54, 32%), or colorectal/anal (n=15, 9%) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes. Results Mean number of visits was 3.43. Mean age was 55.4 years; 92% (n=155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy and function) associated with cancer treatment and support. At last assessment, 89% had complied with the clinical recommendation (moisturize 2–5+ times/week). Vaginal pH scores >6.5 declined over time (p=0.03). VAS scores improved by last assessment (p<0.001), as did VuAS scores (p=0.001). Sexual function scores significantly improved (p<0.001), confidence about future sexual activity increased (p=0.004), and sexual/vaginal health concerns decreased (p=0.00003). Conclusion Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and intimacy confidence. Implications for Cancer Survivors These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting.

Introduction: Treatments for colorectal and anal cancers can have a detrimental impact on sexual function. Type of treatment, which may include surgery, radiation and/or chemotherapy, varies by disease site and severity. Treatment and long-term side effects can impact sexual function and intimacy for patients and their partners. Aim: To review the literature regarding treatment for colorectal/anal cancer and its impact on female sexual function, and to provide an assessment of medical outcomes and patient-reported outcomes (PROs) of women with a history of colon, rectal, or anal cancer seeking sexual health treatment. Methods: We performed a PubMed search to identify peer-reviewed, English-language articles, published from 2008 to 2018, using the following search terms: "colorectal cancer," or "rectal cancer," or "anal cancer" and "sexual function," or "sexual dysfunction." We also assessed the medical outcomes and PROs from our recent cross-sectional cohort study of 99 women with a history of colon, rectal, or anal cancer seeking sexual health treatment. Main Outcome Measures: Sexual function, quality of life, and PROs after colorectal/anal cancer Results: Twenty-three studies were identified. Study designs included 15 cross-sectional survey studies, 5 longitudinal studies, 2 psychoeducational interventions, and 1 pilot study. Ten studies included women and 13 included both men and women. The literature and our cohort confirmed