Representations of Vaginal Symptoms in Cervical Cancer Survivors

Jennifer M. Tornatta MSN, RN; Janet S. Carpenter PhD, RN; Jeanne Schilder, MD; Higinia R. Cardenes, MD, PhD


Cancer Nurs. 2009;32(5):378-384. 

In This Article


This was a descriptive, cross-sectional survey. Cervical cancer survivors were recruited from August 2007 through January 2008 (6 months) from a cancer center in the urban Midwest, using both in-clinic recruitment and the cancer center's tumor registry. This study was approved by the local institutional review board and the cancer center's scientific review committee. All women gave written or verbal informed consent before providing data. All women signed a form to release medical records information.

Eligibility criteria included the following: (a) women with stage I, II, or III cervical carcinoma; (b) seen by at least 1 of 2 collaborating physicians; (c) within 3 months to 3 years posttreatment; (d) no current evidence of disease; (e) older than 18 years; (f) able to read, write, and speak English; and (g) willing and able to provide informed consent.

Women were recruited in 2 ways. In-clinic recruitment was completed by weekly review of clinic schedules for eligible women by the clinic nurse. Fourteen women were identified and were approached; 13 women (93%) completed the questionnaire, and 1 declined because of time constraints. A second recruitment strategy was to use the tumor registry at the cancer center. Women (n = 61) were identified based upon the eligibility criteria. The collaborating physicians reviewed the list and excluded 16 women based on ineligibility (>3 years posttreatment or current evidence of disease). This left 45 women eligible to be contacted. Of the 45 women, only 22 (49%) women could be contacted by telephone during the study recruitment period. Of those, 13 (59%) completed the study (7 not interested, 1 too sick, and 1 too busy). We were not able to determine if there were any differences between participants and nonparticipants. Thus, the total sample size was 26 women (13 from the clinic and 13 from the registry).


Representations of Vaginal Symptoms The SRQ assesses the 6 dimensions of symptom representations: identity, emotions/distress, timeline, consequences, cause, and cure/control. Part 1 of the original SRQ included 16 symptoms. Participants are asked to rate the severity (identity) of each symptom on a scale of 0 to 10 and then identify their 3 most bothersome symptoms. These symptoms are ranked as most, second most, and third most bothersome. For each of the those 3 most bothersome symptoms, the participant then responds to 18 additional questions specific to the remaining 5 dimensions. Response options for these 5 dimensions range from 0, strongly disagree, to 4, strongly agree, with 2 indicating a neutral response. Sample items addressing each dimension are the following: (1) "It is difficult to take my mind off this symptom" (emotions/distress). (2) "This symptom is likely to be permanent rather than temporary" (timeline). (3) "My symptom causes difficulties for those who are close to me" (consequences). (4) "Treatment for my cancer is causing this symptom" (cause). And (5) "I have power to influence this symptom" (cure/control). The original SRQ has test-retest reliabilities of  .65 to .82 over a 3-day time period and subscale reliabilities that are consistently .70 or greater.[29]

The SRQ was modified to be specific to vaginal symptoms. Nurse investigators generated a list of 17 vaginal symptoms through a review of literature. Collaborating physicians then reviewed the list for face validity. Consistent with the original SRQ, patients rated severity from 0 (do not have symptom) to 10 (as severe as I can imagine) and then listed their 3 most bothersome symptoms. The participant was also asked 3 questions in regards to sexual practice; this was done to better determine sexual practices and to check relevance of some questions that might be rated as not present (eg, pain with intercourse). Also consistent with the original SRQ, patients then completed the 18 representation items for each of the 3 most bothersome symptoms. This modified version was scored using standards set forth by Donovan and Ward.[29]

Quality of Life Women then completed the well-validated Functional Assessment of Cancer Therapy-General version (FACT-G), which is a 27-item compilation of general questions divided into 4 primary quality-of-life domains including physical well-being, social and family well-being, emotional well-being, and functional well-being.[33] The questionnaire uses responses on a 5-point scale from not at all to very much. Subscale items were summed to compute subscale scores. Two advantages of using the FACT-G were (1) the availability of comparison data and (2) it defined minimally important difference scores (the smallest difference or change in scores that is considered clinically important).

Data Analysis

Sample demographics and disease and treatment information were evaluated using descriptive and frequency statistics. Aim 1 (to describe symptom representations) and aim 2 (to describe quality of life) were analyzed using descriptive and frequency statistics. Aim 3 (to explore relationships between symptom representations and quality of life) was investigated using Pearson correlation coefficients.


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