Telemonitoramento e adesão ao uso de dilatadores e seus efeitos no volume vaginal, função sexual e qualidade de vida em mulheres submetidas à braquiterapia para câncer do colo uterino

Abstract

Cervical cancer is a public health problem, ranking fourth among the most diagnosed gynecological carcinomas in the world. Its treatment is mainly done by surgery or radiotherapy. Despite reducing local recurrence and improving survival, treatment with radiotherapy and brachytherapy can promote adverse events, including vaginal stenosis. The primary objective of this study was to compare two different interventions (telemonitoring and text messaging) on the outcome of adherence to the use of dilators in women undergoing brachytherapy. Concurrent with the literature review, a pilot study was conducted to assess whether there would be reproducibility of the vaginal measurement technique. After validation of the method, women previously submitted to brachytherapy treatment were evaluated for adherence to the use of dilators. Patients undergoing radiotherapy and brachytherapy were taken from the oncogynecology outpatient clinic of Hospital Universitário Pedro Ernesto (HUPE) and from Centro Universitário de Controle do Câncer (CUCC /HUPE). Participants were randomized into two groups for the use of vaginal dilators: one group guided by telemonitoring (Gt), and another by message application (Gm). The Gt group received a monthly phone call to obtain information about the use of dilators and to answer possible doubts, while the Gm group received a monthly message via application on the mobile phone in order to obtain the same information. Adherence to the use of dilators, vaginal volume, quality of life and sexual function were compared. As for the reproducibility of the vaginal measurement technique, there was slight variation in volume between the same woman who underwent measurements at different consultations (ICC 0.96; CI 95%) and by different examiners (ICC 0.98; CI 95%). The study of adherence to vaginal dilators found no significant association between adherence to dilators and types of follow-up (p = 0.79). Adherence to treatment showed that 43.3% of the participants adhered in the first month, with a drop to 36.6% in the third month and, at the end of the 6th month, 23% continued to undergo dilation. The high adherence group had higher final vaginal volume scores (M = 16.81; SD = 10.45) compared to the non-adherence group (M = 10.45; SD = 9.55) with a strong effect size (d = 1.68). There was no correlation between vaginal volume and quality of life (p = 0.48) and sexual function (p = 0.70). As there was no difference between adherence to dilators and the two types of monitoring, and increased vaginal volume is significantly related to high adherence, further studies are needed to determine which aspects of telemonitoring are critical to improving adherence