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Cancer therapy–related vaginal toxicity: its prevalence and assessment methods—a systematic review

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Abstract

Purpose

In 2020, almost 9 million women were diagnosed with cancer worldwide. Despite advancements in cancer treatment strategies, patients still suffer from acute and long-term side effects. This systematic review aims to evaluate the most frequently reported adverse effects in the genitourinary system and compare them across cancer types, treatment modalities, and evaluation methods.

Methods

Pubmed Central, SCOPUS, and Cochrane Library were searched following the PRISMA guidelines to identify all prospective and retrospective observational cohort studies and randomized controlled trials assessing vaginal side effects of adult female cancer patients. The study quality was evaluated using The Newcastle–Ottawa Scale or the Risk of Bias 2 tool, as appropriate.

Results

The most prevalent population was breast cancer patients, followed by gynaecological cancer patients. Overall, the focus was on vaginal dryness, while vaginal stenosis was the primary outcome in gynaecological cancer patients. Significant discrepancies were found in the frequency and severity of the reported adverse events. Most studies in this review evaluated side effects using patient-reported outcome measures (PROMs).

Conclusions

Genitourinary syndrome of menopause following cancer treatment is most frequently documented in breast and gynaecological cancer patients, often focussing on vaginal dryness and vaginal stenosis based on PROMs. This review provides a complete overview of the literature, but more high-quality clinical trials are necessary to draw firm conclusions on acute and chronic vaginal toxicity following cancer treatment.

Implications for cancer survivors

This review could help improve the current preventive and curative management options for genitourinary complications, thereby increasing the patient’s QoL and sexual functioning.

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Data availability

No datasets were generated or analyzed during the current study.

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Acknowledgements

This research is part of the Limburg Clinical Research Center (LCRC) UHasselt-ZOL-Jessa, supported by the Limburg Sterk Merk Foundation, province of Limburg, Flemish government, Hasselt University, Jessa Hospital, and Ziekenhuis Oost-Limburg. Additionally, this research is funded by the Limburgs Kankerfonds.

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Authors and Affiliations

  1. Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium

    Marithé Claes, L. Tuts, J. Robijns & J. Mebis

  2. LCRC, Hasselt, Belgium

    Marithé Claes, L. Tuts, J. Robijns, K. Mulders, E. Van De Werf, P. Bulens & J. Mebis

  3. Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium

    Marithé Claes, L. Tuts, J. Robijns, K. Mulders & J. Mebis

  4. Dept. Radiation Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium

    E. Van De Werf & P. Bulens

  5. Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium

    Marithé Claes, L. Tuts, J. Robijns, K. Mulders, E. Van De Werf, P. Bulens & J. Mebis

  6. Dept. Radiation Oncology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium

    E. Van De Werf & P. Bulens

  7. Dept. Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium

    E. Van De Werf & P. Bulens

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  1. Marithé Claes
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Contributions

M.C.: Conceptualization, Methodology, Investigation, Writing - Original Draft. L.T.: Methodology, Investigation, Writing - Review & Editing. J.R.: Conceptualization, Methodology, Writing - Review & Editing, Supervision. K.M.: Writing - Review & Editing. E.V.: Writing - Review & Editing. P.B.: Conceptualization, Writing - Review & Editing. J.M.: Writing - Review & Editing, Supervision.

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Highlights

• Vaginal toxicity is a common side effect of cancer treatment.

• It is predominantly documented for breast and gynaecological cancer patients.

• Current research often focuses on vaginal dryness and vaginal stenosis post-treatment.

• The results are primarily based on non-validated patient-reported questionnaires.

• More high-quality research is necessary to draw firm conclusions.

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Claes, M., Tuts, L., Robijns, J. et al. Cancer therapy–related vaginal toxicity: its prevalence and assessment methods—a systematic review. J Cancer Surviv (2024). https://doi.org/10.1007/s11764-024-01553-y

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