Chapter 24: Radionuclide therapy
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Complications
Early complications include pain, post‐treatment fatigue, increased bowel activity, urinary urgency or frequency, dysuria, nocturia, vaginal discharge and perineal irritation (Faithfull and Wells [17]). Severe reactions, although uncommon, can include severe or prolonged proctitis in patients with pre‐existing bowel disease and late complications, including bowel and bladder complications, vaginal dryness, vaginal narrowing, vaginal stenosis, dyspareunia, premenopausal symptoms and early menopause (Chen et al. [11], Jefferies et al. [36], Lancaster [43]).
The vaginal canal is included in the radiation field, therefore side‐effects from treatment can be significant on the delicate tissue in the vagina. All patients need to be aware of possible complications associated with the treatment causing alteration to the elasticity and lubrication within the vagina, changes in sensation, vaginal stenosis and tissue fibrosis. It is therefore important, as stated earlier, for this patient population to be supported by a clinical nurse specialist to provide supportive care and intervention strategies that have the potential to reduce some of the short‐ and long‐term toxicities associated with this treatment (Jefferies et al. [36], Muscari Lin et al. [48], White and Faithful [77], White et al. [76]).
Possible interventions
- Women who are sexually active should be advised to continue intimate relations as tolerated with the use of analgesia as required.
- A provision for assessing discomfort and/or pain.
- Provide adequate and appropriate analgesia.
- Allow for radiation reactions to resolve, providing specific information on using vaginal dilators and personal hygiene care (Jefferies et al. [36]).
- The lifelong use of vaginal dilators (Jefferies et al. [36]).
- The use of water‐soluble lubricants to help alleviate the dry mucosa (Muscari Lin et al. [48]).
- Short courses of localized hormone therapy to increase natural lubrication (Blake et al. [5]).
A review of 107 patients who had received radiotherapy found that advice from healthcare professionals was valuable in managing complications of treatment (Gami et al. [22]). Syed et al. ([64]) completed a 20‐year evaluation of the long‐term survival and safety of interstitial and intracavity brachytherapy in the treatment of carcinoma of the cervix and found a reasonable chance of cure with acceptable morbidity. Teruya et al. ([67]) found that all patients included in a retrospective review of HDR micro‐Selectron brachytherapy reported vaginal mucosal changes but few complaints regarding sexual functioning.
However, this specific cancer treatment can cause persistent changes to the vagina, resulting in considerable distress by compromising sexual activity (Bergmark et al. [4]). Patients need to be reassured that many women regain their capacity for sexual activity and enjoyment. Extra support in the form of counselling or psychosexual counselling may help this patient population if difficult issues arise. Follow‐up strategies focusing on specific areas such as self‐esteem, body image and sexuality can provide a mechanism to identify these specific issues over the longer term (Farrell [19]).
Male partners of women with cancer reported difficulty in knowing how to behave and how to communicate with their partners (Lalos et al. [42]). Almost all male partners were given the news of the diagnosis exclusively by their ill partner, which provoked feelings of anger and bitterness (Lalos [41]). Coping improved if the men were integrated in the patient's care from the time the diagnosis of cancer was made (Lalos et al. [42]). See Chapter c27 for further information about responding to female sexual concerns related to cancer treatment.
