title: Comparative patient-centered outcomes (health state and adverse sexual symptoms) between adjuvant brachytherapy versus no adjuvant brachytherapy in early stage endometrial cancer.
abstract: OBJECTIVE
  To determine a relationship between sexual functioning and health state among survivors of stage I endometrial cancer, and to examine whether adjuvant intravaginal radiotherapy (IVRT) affects these measures compared to hysterectomy alone.
  
  
  METHODS
  Two hundred five survivors (>1 year from surgery) completed questionnaires containing the EuroQol (EQ5D) and the Female Sexual Function Index (FSFI). A total of 136 (66.3 %) underwent surgery alone, and 69 (33.7 %) received IVRT. Pearson correlation was used to correlate FSFI and EQ5D-Health State scores. Multivariable regression was performed to measure the impact of IVRT on sexual functioning and health state.
  
  
  RESULTS
  A majority of patients (80 %) met criteria for sexual dysfunction by FSFI < 26.5. A significant correlation was detected between FSFI and EQ5D scores (Pearson correlation = 0.21, p = 0.003). Compared to the IVRT group, the surgery group was younger (p = 0.001) and trended toward more frequent use of minimally invasive surgery versus laparotomy (p = 0.08). Otherwise, the two groups were well balanced with respect to demographics, comorbidities, and baseline sexual activity. Controlling for age and surgery type, IVRT was not associated with poorer health state or sexual function. Receipt of laparotomy was associated with both poorer health state and sexual function (p = 0.0156 and p = 0.0247, respectively).
  
  
  CONCLUSIONS
  Sexual functioning was generally poor among endometrial cancer survivors; however, those with improved FSFI scores tended to have superior health states. IVRT was not a significant risk factor; however, receipt of laparotomy appeared to be associated with poorer sexual functioning and health state.
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA, shari.damast@yale.edu.
authors.forename: Shari
authors.initials: S
authors.lastname: Damast
authors.forename: Kaled
authors.initials: K
authors.lastname: Alektiar
authors.forename: Anne
authors.initials: A
authors.lastname: Eaton
authors.forename: Naamit Kurshan
authors.initials: NK
authors.lastname: Gerber
authors.forename: Shari
authors.initials: S
authors.lastname: Goldfarb
authors.forename: Sujata
authors.initials: S
authors.lastname: Patil
authors.forename: Rachel
authors.initials: R
authors.lastname: Jia
authors.forename: Mario
authors.initials: M
authors.lastname: Leitao
authors.forename: Jeanne
authors.initials: J
authors.lastname: Carter
authors.forename: Ethan
authors.initials: E
authors.lastname: Basch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D017741:Survivors