Sexual Rehabilitation Programme After Radiotherapy for Gynaecological Cancer (SPARC)

February 21, 2020 updated by: MMterKuile, Leiden University Medical Center

SPARC Study: A Nurse-led Sexual Rehabilitation Programme for Women With Gynaecological Cancers Receiving Radiotherapy: a Randomized Multicentre Trial

The aim of this randomized controlled trial is to demonstrate that a nurse-led sexual rehabilitation intervention significantly improves sexual recovery and functioning among gynaecological cancer (GC) patients treated with radiotherapy (RT), compared with usual care (i.e., oral information by a nurse or doctor and written information).

Women with GC (n=220) who receive RT in one of the participating Dutch GC centres (n=9) will be randomized to either the sexual rehabilitation intervention (n= 110) or usual care (n= 110), stratified for combined RTBT vs. RT alone, and for having a partner (yes/no). Women are eligible for participation if they: have been diagnosed with either cervical, endometrial, or vaginal cancer; are treated with radiotherapy; are 18 years or older; and wish to retain their sexual activity on the short or long term.

The intervention consists of four one-hour sessions at 1 month, 3, 6, and 12 months after RT. Women who received RTBT will receive an additional appointment with the nurse (2 months after RTBT) to promote regular use of vaginal dilators in order to prevent stenosis. Participants are requested to complete questionnaires at baseline and at 1, 3, 6, and 12 months post-RT.

The primary endpoint is sexual functioning at 12 months. Secondary endpoints include vaginal symptoms and body concerns, fear of coital and non-coital sexual activity, sexual distress, treatment-related distress, generic health-related quality of life, psychological distress, and relationship dissatisfaction.

Hypothesis: The investigators expect women who receive the nurse-led sexual rehabilitation programme to report a greater improvement in sexual functioning from immediate post-radiotherapy to 1 year post-radiotherapy than women in the control group.

Study Overview

Detailed Description

The primary objective of this randomized controlled trial is to evaluate if the nurse-led sexual rehabilitation intervention improves sexual recovery and functioning in patients with gynaecological cancers (GC) who are treated with either external pelvic radiotherapy only (i.e., RT) or external pelvic radiotherapy combined with brachytherapy (i.e., RTBT) compared with usual care (Q1).

The secondary objective is to evaluate if the nurse-led sexual rehabilitation program decreases vaginal symptoms and body image concerns, fear of (non-)coital sexual activity, treatment-related distress, psychological and sexual distress, and vaginal physical symptoms (assessed during physical examination by the radiation oncologist), and improves/increases generic-related health related quality of life related to gynaecological cancer, relationship satisfaction, and frequency of dilator use, (Q2); to evaluate the cost-effectiveness of the intervention (Q3); and to evaluate whether an improvement in sexual functioning is moderated by treatment characteristics and pre-treatment patient characteristics, such as age or sexual functioning, and mediated by reduction of vaginal symptoms (and by regular use of dilators in women treated with RTBT) (Q4).

Study Type

Interventional

Enrollment (Anticipated)

220

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • being diagnosed with on of the following gynaecological cancers: cervical cancer, endometrial cancer or vaginal cancer
  • 18 years or older
  • receiving radiotherapy for gynaecological cancer (RT/RTBT)
  • wish to retain sexual activity in the short- or long-term.

Exclusion Criteria:

  • being unavailable for follow-up
  • having insufficient knowlegde of the Dutch language
  • having a psychiatric disorder (e.g. major affective disorder, psychotic disorder, substance abuse disorder (i.e., alcohol, drugs), or posttraumatic stress disorder resulting from abuse in the pelvic floor and/or genitals (e.g., sexual abuse)).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Sexual rehabilitation programme
The intervention exists of a nurse-led sexual rehabilitation programme, which is provided in addition to the care as usual. The intervention consists of four one-hour sessions at 1 month, 3, 6, and 12 months after RT. Women treated with RTBT will receive an additional appointment with the nurse (2 months after RTBT). Furthermore, the latter group receives a vaginal dilator set.
The intervention consists of 4 patient/couple sessions (each max. 60 minutes) scheduled at 1, 3, 6 and 12 months post-RT. Patients treated with RTBT have an additional session 2 months post RT. If preferred, one extra session of 30 minutes can be scheduled between 6 and 12 months after RT. The intervention includes (1) education on the specific cancer diagnosis and treatment, (2) education on the importance of regular dilation for prevention of vaginal stenosis (if indicated), (3) discussing and resolving potential fears and experienced barriers to performing vaginal dilation (if indicated) and sexual activity,(4) promoting couples' mutual coping and support processes and (5) specific sexual therapy techniques to address sexual and body image concerns.
No Intervention: Care as usual
The control group receives the optimal care as usual, according to each participating hospital's guidelines. Additionally, all patients receive an information booklet including information concerning sexuality after RT for GC. Patients who underwent RTBT also receive a vaginal dilator set.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from 1 month in Sexual functioning at 12 months post RT/RTBT
Time Frame: 12 months
The primary outcome measure is sexual functioning and will be assessed with the Dutch version of the 19-item Female Sexual Function Index (FSFI) questionnaire. The FSFI consists of 6 subscales measuring sexual desire (scoring range: 0.6 - 6.0), arousal (scoring range: 0 - 6.0), lubrication (scoring range: 0 - 6.0), orgasm (scoring range: 0 - 6.0), satisfaction (scoring range: 0.8 - 6.0), and pain (scoring range: 0 - 6.0). The scores of the questions are added per subscale, after which they are multiplied by a factor depending on the subscale ( sexual desire: 0.6; arousal: 0.3; lubrication: 0.3; orgasm: 0.4; satisfaction: 0.4; pain: 0.4) to give them a subscale score. By adding all 6 subscales together, the total score of the FSFI is obtained. The total score reflects overall sexual functioning (scoring range: 2.0 - 36.0). Higher scores indicate better sexual functioning. (measured at 1, 3, 6, 12 months post RT/RTBT and retrospectively (sexual functioning before diagnosis) at baseline
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes from 1 month in Vaginal symptoms and body image concerns at 12 months post RT/RTBT
Time Frame: 12 months
Vaginal symptoms and body image concerns will be assessed with the Quality-of-Life Questionnaire (QLQ) Cervical Cancer Module (CX24) and Endometrial Cancer Module (EN24) of the Dutch version of the European Organization for Research and Treatment of Cancer (EORTC; EORTC-QLQ-CX24, EORTC-QLQ-EN24). The EORTC-QLQ-CX24 consists of 9 subscales: symptom experience (scoring range 11 - 44), lymphoedema (scoring range: 1-4), peripheral neuropathy (scoring range: 1-4), menopausal symptoms (scoring range: 1-4), sexual worry (scoring range: 1-4), body image (scoring range: 3-12), sexual activity (scoring range: 1-4), sexual enjoyment (scoring range: 1-4), sexual/vaginal functioning (scoring range: 4-16). Items 34, 38, 39, 40, 42, and 49 of the EORTC-QLQ-EN24 will be assessed (item range: 3). Lower scores indicate better sexual/vaginal functioning and lower body image concerns and relevant subscales. (measured at 1, 3, 6, 12 months post RT/RTBT).
12 months
Change from 1 month in Fear of coital and non-coital sexual activity at 12 months post RT/RTBT
Time Frame: 12 months
Fear of coital and non-coital sexual activity will be assessed with the 8-item Fear of Sexuality Questionnaire (FSQ). The FSQ consist of 2 subscales: fear of non-coital sexual activity (scoring range: 5-25), and fear of coitus (scoring range:3-15). A higher score indicates more fear. (measured at 1, 3, 6, 12 months post RT/RTBT).
12 months
Change from 1 month in Level of sexual distress at 12 months post RT/RTBT
Time Frame: 12 months
The level of sexual distress is assessed with the 12-item (scoring range: 0-48)Female Sexual Distress Scale (FSDS). Higher scores indicate more sexual dissatisfaction/distress. (measured at 1, 3, 6, 12 months post RT/RTBT and at baseline (retrospectively) concerning sexual functioning before diagnosis).
12 months
Change from 1 month in Treatment related distress at 12 months post RT/RTBT
Time Frame: 12 months
Treatment related distress is assessed with Dutch version of the 15-items Impact of Event Scale-revised (IES-R; in Dutch Schokverwerkingslijst (SVL)). The total scores on the IES-R have a possible range of 0-75, with higher scores indicating a greater frequency of intrusive thoughts and attempts at avoidance. Subscale scores can also be computed for the 7 intrusion items (scoring range: 0-35), and the 8 avoidance items (scoring range:0-40).
12 months
Change from 1 month Generic health-related quality of life related to gynaecological cancer at 12 months post RT/RTBT
Time Frame: 12 months
Generic health-related quality of life (QoL) related to gynaecological cancer is assessed with the Dutch version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30). The QLQ-C30 is composed of 5 functional scales (resp. physical, role, cognitive, emotional, and social functioning) and 9 symptom scales and/or items (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties), and a global health status/QoL scale. All scales/item measures have scoring ranges from 0-100. A high scale score for a functional scale represents a high/healthy level of functioning. A high scale score for a symptom scale/item scale represents a high level of symptomatology/problems. A high scale score for the global health status/QoL represents high QoL. For scoring principles, please see the EORTC QLQ-C30 Scoring Manual.
12 months
change from 1 month in Psychological distress at 12 months post RT/RTBT
Time Frame: 12 months
Psychological distress is assessed with the Dutch version of the 14-item Hospital Anxiety and Depression Scale (HADS). The HADS consists of two 7-item subscales, measuring anxiety (scoring range: 0-21) and depression (scoring range: 0-21). Higher scores on subscales indicate higher levels of anxiety and/or depression. (measured at 1, 3, 6, 12 months post RT/RTBT).
12 months
Change from 1 month in Relationship dissatisfaction at 12 months post RT/RTBT
Time Frame: 12 months
Relationship dissatisfaction is assessed with the 10-item relationship dissatisfaction subscale of the Maudsley Marital Questionnaire (MMQ; scoring range 0-80). Higher scores represent greater dissatisfaction. (measured at 1, 3, 6, 12 months post RT/RTBT).
12 months
Change from 1 month in Frequency of dilator use at 12 months post RTBT
Time Frame: 12 months
Patients treated with RTBT will in addition complete questions regarding the frequency of dilator use during the previous month. (measured at 1, 3, 6, 12 months post RTBT).
12 months
Change from baseline in Vaginal symptoms at 12 months post RT/RTBT
Time Frame: 12 months
Vaginal symptoms will be assessed during physical examination. Vaginal symptoms include grade of mucosal atrophy, dryness, fibrosis, and signs of vaginal shortening and/or stenosis. Vaginal symptoms will be recorded using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.037. (measured at 1, 3, 6, 12 months post RT/RTBT).
12 months
Cost-effectiveness
Time Frame: 12 months
A cost-effectiveness analysis will be conducted in which the costs of the intervention will be related to shifts in other health care costs and the impact on patient outcome. A cost-price analysis will be performed for the nurse-led intervention (including training, counselling hours and materials). Other health care use will be limited to sexuality-related health care utilization (including gynaecologist, radiation oncologist, general practitioner, psychologist, and sexologist), estimated from patient reports and valued using standard prices. the Dutch tariff for the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) will be used (measured at 1, 3, 6, 12 months post RT/RTBT).
12 months

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Treatment credibility and expectancy for improvement
Time Frame: at 1 month post RT/RTBT
Treatment credibility and expectancy for improvement will be assessed using the 4-item Credibility and Expectancy Questionnaire (CEQ; scoring range: 4-36). Higher scores indicate higher expectations of the intervention (for intervention group) or care as usual (for control group).
at 1 month post RT/RTBT

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Study Chair: Moniek M ter Kuile, PhD, Leiden University Medical Center
  • Principal Investigator: Carien L Creutzberg, MD, PhD, Leiden University Medical Center
  • Principal Investigator: Jan Willem M Mens, MD, Erasmus Medical Center

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 7, 2018

Primary Completion (Anticipated)

July 1, 2022

Study Completion (Anticipated)

July 1, 2022

Study Registration Dates

First Submitted

May 29, 2018

First Submitted That Met QC Criteria

August 1, 2018

First Posted (Actual)

August 2, 2018

Study Record Updates

Last Update Posted (Actual)

February 24, 2020

Last Update Submitted That Met QC Criteria

February 21, 2020

Last Verified

February 1, 2020

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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