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LION-PAW (lymphadenectomy in ovarian neoplasm) sexual function assessment: a prospective sub-study of the LION trial
  1. Annette Hasenburg1,
  2. Jalid Sehouli2,
  3. Bjoern Lampe3,
  4. Alexander Reuss4,
  5. Barbara Schmalfeld5,6,
  6. Antje Kristina Belau7,
  7. Michaela Bossart8,
  8. Sven Mahner6,9,
  9. Peter Hillemanns10,
  10. Ulrich Petry11,
  11. Andreas du Bois12,
  12. Uwe Herwig13,
  13. Felix Hilpert14,15,
  14. Martina Gropp-Meier16,
  15. Volker Hanf17,
  16. Elfriede Greimel18,
  17. Uwe Wagner19 and
  18. Philipp Harter12
  1. 1 Department of Obstetrics and Gynecology, University Medical Center, Mainz, Germany
  2. 2 Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, New Hampshire, USA
  3. 3 Department of Gynecology and Obstetrics, Kaiserswerther Diakonie, Duesseldorf, Germany
  4. 4 Coordinating Centre for Clinical Trials, Philipps-Universität Marburg, Marburg, Germany
  5. 5 Department of Gynecology and Obstetrics, University Hospital Ludwig-Maximilians-University Munich, München, Bayern, Germany
  6. 6 Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  7. 7 Department of Gynecology and Obstetrics, University of Greifswald, Greifswald, Germany
  8. 8 Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
  9. 9 Department of Gynecology and Obstetrics, University Hospital, LMU Munich, München, Germany
  10. 10 Department of Gynecology and Obstetrics, Medizinische Hochschule, Hannover, Germany
  11. 11 Department of Gynecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg, Niedersachsen, Germany
  12. 12 Department of Gynecology and Gynecological Oncology, KEM, Kliniken Essen Mitte, Essen, Germany
  13. 13 Department of Gynecology and Obstetrics, Albertinen-Hospital Hamburg, Hamburg, Germany
  14. 14 Department of Gynecology and Obstetrics, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
  15. 15 Mammazentrum Hamburg, Krankenhaus Jerusalem, Hamburg, Germany
  16. 16 Department of Gynecology and Obstetrics, St. Elisabethenhospital, Ravensburg, Baden-Württemberg, Germany
  17. 17 Department of Gynecology and Obstetrics, Klinikum Fürth, Fürth, Bayern, Germany
  18. 18 Clinical Psychology Unit, Medical University Graz, Graz, Steiermark, Austria
  19. 19 Department of Gynecology and Obstetrics, University of Gießen and Marburg GmbH Site Marburg, Marburg, Germany
  1. Correspondence to Dr Annette Hasenburg, Department of Obstetrics and Gynecology, Mainz University, Mainz 55122, Germany; Annette.Hasenburg{at}unimedizin-mainz.de

Abstract

Background There is limited information about the impact of radical surgery including pelvic and para-aortic lymphadenectomy and subsequent platinum-based chemotherapy on sexuality in patients with advanced ovarian cancer.

Objective To evaluate the impact of radical surgery including pelvic and para-aortic lymphadenectomy and subsequent platinum-based chemotherapy on sexuality in patients with advanced ovarian cancer as a sub-protocol of the prospectively randomized LION trial.

Methods The Sexual Activity Questionnaire was applied to assess sexual function according to its sub-scales activity, pleasure, and discomfort. The 'orgasm' sub-scale from the Female Sexual Function Index was also added. The questionnaire was administered in combination with the EORTC QLQ-C30 questionnaire at baseline prior surgery, after 6, 12, and 24 months. The primary endpoint was changes in sexual function.

Results Overall, 495 patients received the questionnaires. 254 (51%) responded at baseline. Of these, 55 (22%) patients were sexually active, 182 (72%) were sexually inactive, and for 17 (7%) patients' data were not available. There was a total of 55/495 (11%) patients at 6 months, 139 (28%) patients at 12 months, and 81 (16%) patients at 24 months. Median age was 60.5 years (range 21.4–75.8). At baseline, sexually active responders were significantly younger (median age 51.5 years,) than sexually inactive responders (median age 61.8 years) and tended to have a better performance status. Discomfort evaluated as dryness of the vagina and pain during sexual intercourse was significantly worse at 12 months than at baseline (p<0.001); however, the surgical variable, lymphadenectomy, did not have any impact on this. The orgasm sub-scale showed diverging results with a deterioration from baseline to 12 months in the lymphadenectomy group compared with the no-lymphadenectomy group (p=0.02).

Conclusion The majority of patients were sexually inactive; however, in those who were sexually active, pain during intercourse was worse at 12 months. In addition, the orgasm sub-scale demonstrated worse results in patients who underwent complete lymphadenectomy. The study suggests that surgery in the retroperitoneal space may influence sexual function.

  • gynecologic surgical procedures
  • ovarian cancer
  • quality of life (PRO)/palliative care
  • SLN and lympadenectomy
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Footnotes

  • Contributors All authors: substantial contributions to the conception of the work, acquisition, and interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The LION trial was supported by the Deutsche Forschungsgemeinschaft (project WA 740/4) and the Austrian Science Fund (project KLI 176-B00).

  • Competing interests AH reports personal fees from Astra Zeneca, personal fees from MedConcept, personal fees from MedUpdate, personal fees from Pfizer, personal fees from Roche, personal fees from Streamedup!GmbH, personal fees from Pharma Mar, personal fees from Tesaro, outside the submitted work; BS reports grants and personal fees from Roche, grants and personal fees from AstraZeneca, grants and personal fees from Tesaro, personal fees from Clovis, personal fees from MSD, personal fees from Ethicon, outside the submitted work; SM reports personal fees from AbbVie, grants and personal fees from AstraZeneca, personal fees from Clovis, personal fees from GSK, grants and personal fees from Medac, personal fees from MSD, personal fees from Novartis, personal fees from OLYMPUS Europa, grants and personal fees from PharmaMar, grants and personal fees from Roche, personal fees from Sensor Kinesis, grants and personal fees from Tesaro, personal fees from Teva, outside the submitted work; AdB reports personal fees from Roche, personal fees from Clovis, personal fees from Astra Zeneca/MSD, personal fees from GSK/Tesaro, personal fees from BIOCAD, personal fees from Genmab/seattle genetics, personal fees from Pfizer, outside the submitted work; PH reports grants and personal fees from Astra Zeneca, grants and personal fees from Roche, personal fees from Sotio, grants and personal fees from Tesaro, personal fees from Stryker, personal fees from Zai Lab, personal fees from MSD, grants and personal fees from public funding (ASCO, DKH, DFG), personal fees from Clovis, personal fees from Immunogen, grants from GSK, grants from Boehringer Ingelheim, grants from Medac, grants from Genmab, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data are available fromannette.hasenburg@unimedizin-mainz.de.

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