Compliance of using Vaginal Dilator after Educational Intervention in Patients treated with Pelvic Radiotherapy for Gynecologic Cancers, Experience at a Tertiary Care University Hospital.

OBJECTIVES: To report the compliance of using vaginal dilator and reduction in the development of vaginal adhesions in patients receiving pelvic radiotherapy after providing an effective education of using a vaginal dilator. METHODS: A total of 287 patients receiving radiation therapy for gynecological malignancies from January 2008 to December 2014 were enrolled in the study. These patients were divided in two cohorts. In first cohort (Jan 2008 - Dec 2011), 111 patients were given verbal instructions and prescription of vaginal dilator to be purchased from market. In second cohort (Jan 2012 - Dec 2014), 176 patients were given a suitable sized dilator along with a written educational material and counseled by the nursing staff. Three months after completion of radiation, patients were called for vaginal examination by physician. The compliance of using the dilator was determined by interviewing the patient and the degree of development of vaginal adhesions were recorded according to RTOG Toxicity scale. RESULTS: Out of 287 patients, 195 (68%) had endometrial cancer, 90 (31%) had cervical cancer and 2 patients had vaginal melanoma and leiomyosarcoma of uterus. In first cohort 33 out of 111 patients (30%) followed the provided instructions and 55 out of 111 (50%) developed vaginal adhesions. All 55 patients had grade 3 vaginal adhesions. In second cohort 158 out of 176 patients (90%) were using vaginal dilators and 35 out of 176 (20%) developed vaginal adhesions. Only 9 out of 176 (5%) were found to have grade 3 adhesions. CONCLUSION: Effective patient education regarding the use of dilator after pelvic radiation is an important tool not only for better quality of life, but also for easy subsequent pelvic examination for early detection of recurrence. [ABSTRACT FROM AUTHOR]