Latest / Healthy Vitals / Life After Gynecologic Cancer: Pelvic Health, Intimacy & Survivorship

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Life After Gynecologic Cancer: Pelvic Health, Intimacy & Survivorship · Healthy Vitals

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  Scott Webb (Host): Today, we're discussing pelvic health and intimacy
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  for gynecologic cancer survivors and the emotional and physical
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  effects of cancer and survivorship.
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  I'm joined today by Dr.
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  Clarissa Polen-De.
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  She's a gynecological oncologist with Summa Health.
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  This is Healthy Vitals, a podcast from Summa Health.
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  I'm Scott Webb.
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  Host: Doctor, it's nice to have you here today.
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  We're going to go beyond treatment, if you will, and talk about what it means
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  to be a gynecologic cancer survivor.
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  So when you think about survivorship, how do you define it and when does
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  it really begin for your patients?
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  Dr. Clarissa Polen-De:
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  Yeah.
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  Thank you.
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  That's a really good question.
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  So, we oftentimes think of survivorship as being something that starts after
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  someone is treated or gets surgery or chemotherapy for their cancer.
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  But really, it starts the day the person is diagnosed, not
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  the day that the treatment ends.
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  Host: Yeah, I think you're right.
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  It's natural for us, right, to just assume, "Well, now we're done.
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  Now is when the survivorship part really kicks in."
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  But it's from diagnosis on.
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  And you as a surgeon, I'm sure the treatment decisions you make,
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  especially around surgery, impact the quality of life for the months
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  or years for these survivors.
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  Maybe you can talk us through that a bit.
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  How do you make those decisions, you know, in the best interest of your patients?
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  Dr. Clarissa Polen-De:
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  Every surgery, every operation, you know, that we do, especially
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  for patients that have a cancer or possible cancer diagnosis, has to
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  balance two really critical things.
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  So, both providing the best possible cancer outcomes for the patients, but
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  also trying to minimize any lasting effects or lasting cost of that treatment.
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  So, things that we have to decide, including whether or not we can
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  do a minimally invasive surgery.
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  So, say, laparoscopic or robotic surgery through small incisions, or if it
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  needs to be a larger incision, which can take a little bit longer to heal.
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  Whether or not we can do sentinel lymph nodes, which is evaluating and removing
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  just one or two lymph nodes, or if we have to remove all of the lymph nodes to make
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  sure that a patient has a better outcome.
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  And then, other things like whether or not we can keep the ovaries, whether
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  or not we have to take more tissue, all of those things can have a big
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  impact on patients down the line.
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  Host: Right.
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  Yeah.
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  And it's so good that patients have experts like yourself, because it sounds
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  like a lot to think about and a lot to sort through and making the best
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  decisions for patients and their families.
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  And kind of along those lines, Doctor, like, what are the most common physical or
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  emotional changes that patients experience after treatment that might surprise them?
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  Dr. Clarissa Polen-De:
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  I think one of the biggest things that surprises patients with and after
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  treatment is how long recovery from both surgery and chemotherapy can take.
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  And it may not be just the physical side of it, it may be
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  the mental side of it, right?
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  May be able to do some of those things like before, you know, you were
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  diagnosed and had treatment, but you can still have an increase in fatigue.
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  You can have a decrease in like your stamina.
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  You might have neuropathy or numbness and tingling afterwards that's limiting.
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  You could have some brain fog or sleep changes.
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  A lot of things that can linger on after your treatment that we still
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  have to, you know, work on and help you recover with over time.
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  Host: Right.
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  Yeah, I see what you mean.
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  Like, physical, sure, emotional, mental.
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  Patients are going to go through a lot during this process from diagnosis on
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  and especially into survivorship, like, surviving the surgery and so forth.
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  So, from a surgical perspective, as best you can anyway in audio form
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  here, what actually happens to the pelvic floor during treatment such as
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  bladder, bowel pressure, discomfort?
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  And how can maybe all those things lead to the long-term symptoms?
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  Dr. Clarissa Polen-De:
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  Yeah.
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  So, the pelvic floor is really a key structure that helps to support
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  all of the organs in the pelvis.
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  So, it's not just one muscle, but it's all of the muscles, nerves, all of
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  the connective tissues, all of that support and structure that helps support
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  the bladder, the vagina, the rectum, the uterus if it's still present.
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  And different treatments that are needed for cancers, for gynecologic cancers
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  can affect them in different ways.
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  Surgery obviously can sometimes weaken those areas, cause
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  changes or scar tissue to form.
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  Radiation can make the tissues in the pelvis sometimes a little bit, like,
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  drier or less elastic, more fibrotic.
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  And chemotherapy and some of those other treatments like radiation can
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  also induce menopause, which can cause changes in the quality of the tissue
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  and the muscle, make things drier.
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  And so, sometimes those things can result in feeling more pressure,
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  sometimes weakening of the pelvic floor, but oftentimes it's all of
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  those things together that can cause some of the pelvic floor symptoms.
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  And so, a lot of our treatments help to, and a lot of the things that we
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  recommend try to help coordinate all of those things back together, kind of
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  retrain the nerves, retrain the muscles to help with like Kegels, things like that.
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  Host: Yeah.
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  So, Doctor, maybe a little myth-busting here.
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  Like, which symptoms do patients often think they're going to
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  have to live with, but they're actually really are very treatable?
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  Dr. Clarissa Polen-De:
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  Often many of the symptoms related to the pelvic floor, like pressure, urinary
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  incontinence, pelvic floor prolapse, even sometimes like fecal incontinence, all
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  of those things, sometimes scarring or pain or issues with urination or having
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  intercourse, all of those things are things that we encourage our patients
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  to talk to us about, talk to their providers about, because we may not
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  be able to completely eliminate all of them, but oftentimes there's things that
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  we can do that will at least help with the symptoms and can help improve the
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  quality of life related to, you know, experiencing those and decreasing those.
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  Host: Right.
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  Yeah.
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  And I'm sure, Doctor, intimacy, sexual health, I'm sure these are
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  things on people's minds, right?
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  Patient's minds.
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  So, what do you wish every patient knew before treatment about how
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  it may affect or change intimacy and sexual health for them?
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  Dr. Clarissa Polen-De:
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  Yeah.
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  I think that one of the biggest things is that, you know, when
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  patients are diagnosed, it might not be necessarily the thing that's
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  at the forefront of their mind.
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  Sometimes patients are worried to ask about it, but it's important, right?
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  So people should feel comfortable asking about it.
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  I want patients to know that intimacy may change after a cancer
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  diagnosis and treatment, but it does not have to disappear.
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  It may be somewhat different.
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  If you're still able to have intercourse, intercourse may be slightly different.
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  We can help get people back to a place that they were, but that intimacy
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  might not have to be the same.
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  It can mean a lot of other things outside of just the intercourse
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  sexual function part of it.
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  Host: Sure.
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  Yeah.
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  And it sounds to me, doctor, like a big part of this, this whole journey,
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  if you will, through survivorship, is really about speaking up, right?
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  Dr. Clarissa Polen-De:
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  Yes.
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  Host: And I'm sure many patients feel embarrassed talking
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  about pelvic floor symptoms.
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  Not always an easy conversation to have.
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  So, how do you encourage them to speak up, and what sort of language do you recommend
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  they use to start that conversation?
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  Dr. Clarissa Polen-De:
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  So, I agree.
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  I think it's something that we talk about all the time, right?
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  But patients oftentimes aren't gong to necessarily feel comfortable and don't
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  want to be embarrassed about something.
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  But talking about any symptoms or any concerns, we try to ask questions
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  about are you having any issues with like leakage, any pressure,
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  any changes in bowel movements?
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  Are you having intercourse?
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  Are you having issues with vaginal dryness?
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  To be able to have patients be able to talk to us about those things.
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  But we always encourage our patients to feel comfortable talking about it.
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  Sometimes it's when they have the opportunity to meet with one of our
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  APPs, like our supporting staff, that they might feel more comfortable,
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  and then we are able to then again have a conversation when we meet.
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  Host: Yeah.
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  And I'm sure, Doctor, that body image and we've talked a little bit about
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  the mental emotional side of this, but I'm sure emotional recovery, you know,
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  these are huge things and probably not talked about enough, though we
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  are talking about them right now.
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  So, what are the most common emotional or relationship changes you see, and maybe
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  what helps people to move through them?
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  Dr. Clarissa Polen-De:
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  Yes, gynecologic cancers definitely affect parts of the body that women
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  hold close to their femininity, their fertility, their sexuality, right?
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  Sometimes their identity.
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  It's very private.
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  Some patients go through almost a grieving of the loss of
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  fertility and of those organs.
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  Other things like hair loss can be really significant to patients, and that can be
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  one of the harder things they deal with.
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  But being able to openly talk to us, you know, the concerns, the fears
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  that they have about that being able to talk to our therapists and
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  counselors, being able to talk to their partners or if their partners
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  have specific concerns and questions.
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  And like you said, being open about those feelings and allowing us to
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  help people understand that it's okay to have those feelings, right?
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  And you're allowed to grieve the loss of those things.
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  It's not a failure at all, and it's very common.
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  Host: Yeah, I hadn't thought of it from that perspective.
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  Again, good that we have experts like yourself because the way you explain it
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  there, of course, it would be natural for them, for patients to suffer some
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  grief and grieving the loss of hair and other things, and it's so good to hear
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  that there's counseling available, that there's folks they can talk to, right?
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  Dr. Clarissa Polen-De:
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  Yeah.
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  Yes, definitely.
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  Host: That's great.
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  I feel like we're just scratching the surface here today, doctor, but hopefully
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  this helps folks who are listening.
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  Just want to finish up here and give folks a sense, patients or family
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  members, you know, friends, whomever, they want to feel like themselves again.
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  What next step look like, and who should be a part of their care team?
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  Dr. Clarissa Polen-De:
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  Yeah.
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  So bringing up questions, concerns to their primary care doctors, their
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  GYN oncologists, their gynecologists, and starting with the thing that
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  is bothering them the most, right?
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  What can we focus on first to help you feel like yourself again?
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  And what might those next steps be?
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  Might that be therapy or medication or physical therapy to help get
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  you back to where you want to be.
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  Host: Yeah, it's like you want to just let's go for that
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  low-hanging fruit, so to speak.
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  You know, let's check off a couple of the easier ones and get them on the right road
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  to recovery and full survivorship, right?
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  Dr. Clarissa Polen-De:
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  Yes.
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  Start that journey, right, one step at a time.
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  It can be a little bit overwhelming if you start looking
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  at kind of all of the things.
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  But trying to do one step at a time, focusing on what pieces we can help with,
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  and then making little improvements to get you back to rebuilding strength,
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  trust in your body and your confidence.
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  Host: That's great.
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  Well, I sure appreciate your time, your expertise, your compassion today.
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  Thank you so much.
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  Dr. Clarissa Polen-De:
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  Thank you so much.
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  I really appreciate it.
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  Host: And for more information, go to summahealth.org/cancer.
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  And if you enjoyed this episode of Healthy Vitals, we'd love
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  it if you'd leave us a review.
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  Your review helps others find our educational content.
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  I'm Scott Webb.
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  Thanks for listening, and we'll talk again next time.