title: Prospective study of vaginal dilator use adherence and efficacy following radiotherapy.
abstract: OBJECTIVE
  Vaginal stenosis (VS) after pelvic radiotherapy (RT) can impair long-term quality of life. We prospectively assessed adherence and efficacy of vaginal dilator (VD) use in women after pelvic RT.
  
  
  METHODS
  Women with gastrointestinal (n=63) and gynecologic (n=46) cancers self-reported use and VD size in monthly diaries for 12months after radiotherapy. Adherence was measured as actual VD use out of recommended times over 12months (3×/week×52weeks=156).
  
  
  RESULTS
  Among 109 participants, aged 28-81years (median, 58years), mean percent adherence over 12months was 42% (95% confidence interval [CI], 36-48%). Adherence was highest in the first quarter (56%), but fell to 25% by the fourth. Disease type, treatment sequence, and chemotherapy were predictors of adherence (all P<.05). Eighty-two percent maintained pre-RT VD size at 12months; of 49% with a decrease in VD size at 1month post-RT, 71% returned to pre-RT VD size at 12months. Disease type, younger age, and increased adherence at 6months were associated with maintaining or returning to pre-RT size at 12months (all P⩽.05).
  
  
  CONCLUSIONS
  VD use is effective in minimizing VS, but adherence at 12months was poor. Studies evaluating methods of improving adherence and determining the optimal frequency and duration of use are needed.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States. Electronic address: lawe@mskcc.org.
authors.forename: Ethel
authors.initials: E
authors.lastname: Law
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Kelvin
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Bridgette
authors.initials: B
authors.lastname: Thom
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Elyn
authors.initials: E
authors.lastname: Riedel
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Ashlyn
authors.initials: A
authors.lastname: Tom
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Carter
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Kaled M
authors.initials: KM
authors.lastname: Alektiar
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, United States.
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000532:radiotherapy; D005833:Genital Neoplasms, Female / Q000532:radiotherapy; D006801:Humans; D008875:Middle Aged; D010388:Pelvis; D011446:Prospective Studies; D011788:Quality of Life; D014621:Vagina
keywords: Gastrointestinal cancers; Late effects; Pelvic radiotherapy; Sexual function; Vaginal dilator