| Objectives:1. To investigate Chinese cervical cancer survivors'quality of life and sexual life.2. To discuss cervical cancer survivors'quality of life and sexual life, and their impact factors.3. To discuss changes of cervical cancer survivors'sexuality and sexual experience, as well as their cognitions and attitudes, based on the treatments of cervical cancer.Methods:1. This study used the cross-sectional study design. Randomly chose4provincial tertiary hospitals having gynecological department in Hunan province as the research sites. We used the method of cluster sampling, selected cervical cancer patients who completed treatments and discharged in the recent three years from every hospital as the objects of the study. The main measurement tools included:Functional Assessment Cancer Therapy-Cervix (FACT-Cx) to investigate cervical cancer survivors'quality of life; the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) was used to measure meaning, quiet, inner strength and comfort, and spiritual beliefs; Female Sexual Functioning Index (FSFI) was used as the measurement of cervical cancer survivors'sexual function status.2. This study also used qualitative research method of phenomenology, with semi-structured interview to the cervical cancer survivors. The Tumor Hospital of Hunan Province was the research site. We used a purposive sampling method to select cervical cancer patients who were rich in information and had finished treatments of cancer as the interview objects. The participants were asked about their feelings about cancer treatments'effects on their sexual lifes and their feelings of themselves. The interview contents included:cancer treatments' influences on sexual life; on the self perception and body image; on partner communication mode; on intimate behavior ability. The methods of data collection included:individual in-depth interviews, observation, taking note. Interviews were taped and transcribed into text. Data collection, transcription and data analysis were carried on at the same time, so we used results of data analysis as guidance for the next step's criteria of participants and for modifing form and content of next interview. When the interview subjects'categories and information reached saturation, we stoped interview. A total of21participants were selected.Results:1. Results of quantitative survey:(1) Total score of Functional Assessment Cancer Therapy-Cervix (FACT-Cx) was124.45(70-157). The combined score of Functional Assessment Cancer Therapy-G (FACT-G) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) was112.39points (49-150).(2) The gastrointestinal symptoms, medical insurance, age, symptoms of sleep disorders, as well as the number of complications, were related to cervical cancer survivors's overall quality of life. The number of complications, medical insurance, decline in sexual function, age, and chemotherapy were related to TOI (influence of cervical cancer therapy on patients'physical symptom and function).(3) The total score of female sexual function Index (FSFI) was13.9(2-33.6). According to female sexual dysfunction point tested by FSFI, the rate of patients with incidence of sexual dysfunction in the investigation reached up to78%. Radiotherapy, age, type of surgery, sleep disorder, occupation types were found to be related to patients'sexual function status.2. Results of qualitative research:(1) After diagnosis of cervical cancer, patients'sexual lifes were in a stopped state. After completion of treatments, patients tried to start sexual life. Most of them and their sex partners adjusted to the changes of sexual life, and achieved the stable sexual life state. But for a small part of the patients and their sexual partners, in the process of restarting sexual life, it is difficult to adapt to each other and reach stable state, and they stayed in conflict and contradiction. The essences of cervical cancer survivors' sexual experiences included:dealing with information related to sex; physiological change; psychological changes; coping with changes of sexual life; the importance of sex.(2) After the cervical cancer treatments, survivors received a variety of information about sex. The information which patients were most concerned about was as a cervical cancer patient whether they could have sexual life and when to start sexual life. According to sources of information, it could be mainly divided into two types-objective sources of sexual knowledge and subjective sources of sexual information. Receiving all kinds of information, patients and their sexual partners would absorb and deal with the information, and form their own sexual life based on their physical condition, life condition and demands, to achieve an agreement.(3) The treatments of cervical cancer would make changes to the patient's body structure, including:decline of sexual function and abnormal feeling during sexual life. After experience physical changes caused by disease, sexual psychology of cervical cancer patients changed too. These changes included:anxiety caused by weakened female characteristics, sex related fears, compromise to the loyalty of partner, sexual repression related to negative experiences. (4) During the process of starting sexual life, patients and their sexual partners have to cope with the sexual life changes caused by the disease. Patients and their partners living in stable relationship usually could achieve a harmonious and stabe state of their sexual lifes. But in unstable relationship, these changes might lead to a rupture of their relationship or a deepen rift. In a long period of stable marriage, the importance of sex in marital life had gradually declined; but in the unstable relationships, sexual life was important for maintaining relationships. Its manifestations included:patients were worried about that they could not satisfy their partner, and they would reflect on the treatment decision making.Conclusion:1. The overall level of Chinese cervical cancer survivors'quality of life is similar to which was reported in the same type studies focus on similar patients, but in some dimensions the scores are lower than which was reported in similar studies.2. A variety of complications associated with the treatments are related to the decline of quality of life. The patients'age and health insurance are related to protective effects on their quality of life, while decline in sexual function and chemotherapy are related to negative effects on survivors'quality of life.3. The level of cervical cancer survivors'sexual functional is low, and the proportion of sexual dysfunction is higher than similar studies' reports.4. Radiotherapy and radical hysterectomy are related to negative impacts on patients' sexual function. Along with the age growth, patients' sexual function is declining. And occupation is related to survivors' sexual function, which may be partly explained by that different groups of people have different cognitive and communication skills.5. After diagnosis, cervical cancer survivors'sexual life is in a stopped state. After experiencing and completing treatments, they gradually start sexual life. Most of the patients and their sexual partners can achieve stable mutual adaptation state; but a small part of them and their sexual partners are in conflict and contradiction.6. The essences of cervical cancer survivors'sexual experiences include:dealing with relevant information; physiological changes; psychological changes; coping with sexual life changes; the importance of sexual life. The related information of sexual life includes the knowledge from objective sources and information fro subjective sources. Patients will deal with the information and form their own lifestyle. Cervical cancer survivors'physiological changes include the decline of sexual function, and abnormal somatic sense. Survivors show mental issues include:anxiety related to weakened female characteristics, sex related fears, compromise of companion's loyalty, and sexual repression related to negative experiences. In a stable marriage, survivors and their partners could achieve mutual adaptation in their sexual life, while in an unstable relationship, survivors and their partners often live in conflict and contradiction. In stable relationship, the importance of sexual life turn to be getting weak, while in unstable relationship, sexual life plays a very important role to maintain relationship. |
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