Prevalence of trauma history and symptoms in patients who have received vaginal brachytherapy as part of their endometrial cancer treatment

Anjali L Saripalli; Dylan H Ross; Elizabeth Murphy; Kayéromi Gomez; Sarah Thilges; Matthew M Harkenrider

doi:10.1016/j.ygyno.2024.02.007

Prevalence of trauma history and symptoms in patients who have received vaginal brachytherapy as part of their endometrial cancer treatment

Gynecol Oncol. 2024 Feb 17:185:68-74. doi: 10.1016/j.ygyno.2024.02.007. Online ahead of print.

Authors

Anjali L Saripalli¹, Dylan H Ross¹, Elizabeth Murphy², Kayéromi Gomez³, Sarah Thilges², Matthew M Harkenrider⁴

Affiliations

¹ Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA.
² Department of Psychiatry and Behavioral Neurosciences, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA.
³ Biostatistics Collaborative Core, Clinical Research Office, Center for Translational Research and Education, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.
⁴ Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA. Electronic address: mharkenrider@lumc.edu.

PMID: 38368815
DOI: 10.1016/j.ygyno.2024.02.007

Abstract

Objective: Vaginal brachytherapy (VBT) is an essential component of curative intent treatment for many patients with endometrial cancer. The prevalence of trauma history in this population is unknown and important to understand considering VBT requires patients to have an instrument vaginally inserted while in the vulnerable lithotomy position. We aim to identify patients treated with intracavitary VBT and collect survey data to assess trauma endpoints.

Methods: We retrospectively identified patients with endometrial cancer who underwent intracavitary VBT at our institution between 01/2017 and 08/2022. Patients were mailed and/or electronically mailed a survey that included demographics, psychosocial background, and validated trauma surveys to be filled out as they relate to their trauma experiences prior to VBT and again considering any trauma symptomatology related to VBT. Electronic medical record review was performed. Descriptive statistics as well as multivariate analysis were performed.

Results: 206 patients met inclusion criteria, 66 (32.1%) of whom returned the survey and were included for analysis. Thirty-two percent of patients self-reported a personal history of any prior mental health diagnosis. Eighty-eight percent of patients screened positive for a history of trauma exposure, 23% endorsed symptoms of PTSD related to their VBT experience, and 5% screened positive for a likely PTSD diagnosis from VBT.

Conclusion: A majority of included patients had a history of trauma exposure prior to VBT. In a subset of patients, VBT re-induced trauma and was considered to be an independent traumatic event. This study highlights the importance of practicing trauma informed care, particularly in this patient population.

Keywords: Endometrial cancer; Radiation therapy; Sexual trauma; Trauma; Trauma informed care; Vaginal brachytherapy.