title: Recovery issues of fertility-preserving surgery in patients with early-stage cervical cancer and a model for survivorship: the physician checklist.
abstract: BACKGROUND
  To present a qualitative data analysis of items exploring the treatment, adjustment, and recovery of 33 patients who underwent radical trachelectomy (RT), and to determine the feasibility of using a physician checklist (PCL) as a model for survivorship assessment.
  
  
  METHODS
  This prospective study was approved by the Memorial Sloan-Kettering Cancer Center's Institutional Review Board. Participants completed a survey including exploratory items focused on fertility issues and reproductive concerns, treatment, adjustment, and recovery over 2 years. All responses to the exploratory questions were transcribed verbatim; thematic analysis was used to identify, evaluate, and show patterns within the data set; and descriptive statistics were calculated for thematic categories. A limited waiver of authorization was obtained for medical chart review of these patients (who underwent RT) for 2 years before (January 2006 to December 2007) and 2 years after (January 2008 to December 2009) implementation of the checklist to evaluate its feasibility.
  
  
  RESULTS
  In response to "how successful you feel you will be at conceiving in the future?" on a scale of 0% to 100%, scores ranged from 54% to 60%. Approximately 70% of the patients reported concerns about conceiving; however, these lessened with time-88% at 6 months to 73% at 24 months. Six percent of women were trying to conceive by 12 months; this increased to 21% by 24 months. Five primary themes emerged from the qualitative analysis that were found to be prevalent across all exploratory items inquiring about difficulties or the hardest adjustment to treatment, recovery, and problems associated with RT; these included menstrual/vaginal issues, emotional impact, life interruptions/return to normalcy, general pain, and recovery process. The PCL identified higher rates of neocervical stenosis (58%), encroachment (54%), vaginal scarring (50%), and dyspareunia (33%) than medical charts, and increased documentation of reproductive consults (54%) and assistance (21%).
  
  
  CONCLUSIONS
  Global themes expressed by our patients are consistent with those of other cancer survivors. The PCL is an excellent supplement to medical charts by documenting important survivorship issues.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, and Surgery,Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. gynbreast@mskcc.org
authors.forename: Jeanne
authors.initials: J
authors.lastname: Carter
authors.forename: Leigh
authors.initials: L
authors.lastname: Raviv
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000601:surgery; D057189:Checklist; D005260:Female; D005298:Fertility; D005306:Fertilization; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000523:psychology*; D006801:Humans; D007246:Infertility / Q000517:prevention & control; D010820:Physicians; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D043762:Reproductive Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000523:psychology* / Q000601:surgery