Prevention and Reduction of Complications in Women with Vulvar Cancer: Development of an Algorithm for Safer Multidisciplinary Care

Beate Senn^1,2, Andrea Kobleder¹, Silvia Raphaelis³, Michael D. Mueller⁴, Beatrice Kammermann⁴, Kathryn White², Manuela Eicher⁵

¹Institute for Applied Nursing Sciences IPW-FHS, St. Gallen, Switzerland.
²Sydney Nursing School, The University of Sydney, Sydney, Australia.
³Department of Nursing Science, Vienna, Austria.
⁴Department of Obstetrics and Gynecology, Berne, Switzerland.
⁵School of Health Sciences, University of Applied Arts and Sciences Western Switzerland, Fribourg, Switzerland.

DOI: 10.4236/jct.2015.610090                

Abstract

Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.

Keywords

Vulvar Cancer, Post-Surgical Complications, Care Algorithm, Health Care Professionals

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Schuurman, M.S., van den Einden, L.C.G., Massuger, L.F.A.G., Kiemeney, L.A., van der Aa, M.A. and de Hullu, J.A. (2013) Trends in Incidence and Survival of Dutch Women with Vulvar Squamous Cell Carcinoma. European Journal of Cancer, 49, 3872-3880. http://dx.doi.org/10.1016/j.ejca.2013.08.003
[2]	Dittmer, C., Katalinic, A., Mundhenke, C., Thill, M. and Fischer, D. (2011) Epidemiology of Vulvar and Vaginal Cancer in Germany. Archives of Gynecology and Obstetrics, 284, 169-174. http://dx.doi.org/10.1007/s00404-011-1850-9
[3]	American Cancer Society (2012) Cancer Facts & Figures—2012. http://pressroom.cancer.org/download/2012+Cancer+Facts+%26+Figures.pdf
[4]	National Cancer Institute (2013) Vulvar Cancer Treatment—For Health Professionals. Stage Information for Vulvar Cancer. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#section/_16
[5]	McFadden, K.M., Sharp, L. and Cruickshank, M.E. (2009) The Prospective Management of Women with Newly Diagnosed Vulval Intraepithelial Neoplasia: Clinical Outcome and Quality of Life. Journal of Obstetrics and Gynaecology, 29, 749-753. http://dx.doi.org/10.3109/01443610903191285
[6]	Jefferies, H. and Clifford, C. (2011) A Literature Review of the Impact of a Diagnosis of Cancer of the Vulva and Surgical Treatment. Journal of Clinical Nursing, 20, 3128-3142. http://dx.doi.org/10.1111/j.1365-2702.2011.03728.x
[7]	van de Nieuwenhof, H.P., Massuger, L.F.A.G., van der Avoort, I.A.M., Bekkers, R.L.M., Casparie, M. and Abma, W. (2009) Vulvar Squamous Cell Carcinoma Development after Diagnosis of VIN Increases with Age. European Journal of Cancer, 45, 851-856. http://dx.doi.org/10.1016/j.ejca.2008.11.037
[8]	National Cancer Institute (2013) Vulvar Cancer Treatment—For Health Professionals. Cellular Classification of Vulvar Cancer. http://www.cancer.gov/types/vulvar/hp/vulvar-treatment-pdq#link/stoc_h2_1
[9]	Lai, K.W. and Mercurio, M.G. (2010) Medical and Surgical Approaches to Vulvar Intraepithelial Neoplasia. Dermatologic Therapy, 23, 477-484. http://dx.doi.org/10.1111/j.1529-8019.2010.01351.x
[10]	Reade, C.J., Eiriksson, L.R. and Mackay, H. (2014) Systemic Therapy in Squamous Cell Carcinoma of the Vulva: Current Status and Future Directions. Gynecologic Oncology, 132, 780-789. http://dx.doi.org/10.1016/j.ygyno.2013.11.025
[11]	Hockel, M. and Dornhofer, N. (2008) Vulvovaginal Reconstruction for Neoplastic Disease. The Lancet Oncology, 9, 559-568. http://dx.doi.org/10.1016/S1470-2045(08)70147-5
[12]	Bostelaar, R. (2006) Wundmanagement in der Klinik. Ein Ratgeber zum Umgang mit chronischen Wunden. Schluter (Schlutersche Pflege), Hannover. http://deposit.ddb.de/cgi-bin/dokserv?id=2756623&prov=M&dok_var=1&dok_ext=htm
[13]	Gaarenstroom, K.N., Kenter, G.G., Trimbos, J.B., Agous, I., Amant, F., Peters, A.A.W. and Vergote, I. (2003) Postoperative Complications after Vulvectomy and Inguinofemoral Lymphadenectomy Using Separate Groin Incisions. International Journal of Gynecological Cancer, 13, 522-527. http://dx.doi.org/10.1046/j.1525-1438.2003.13304.x
[14]	Gray, H.J. (2010) Advances in Vulvar and Vaginal Cancer Treatment. Gynecologic Oncology, 118, 3-5. http://dx.doi.org/10.1016/j.ygyno.2010.04.011
[15]	Baiocchi, G. and Rocha, R.M. (2014) Vulvar Cancer Surgery. Current Opinion in Obstetrics & Gynecology, 26, 9-17. http://dx.doi.org/10.1097/GCO.0000000000000033
[16]	Mitchell, S.A., Beck, S.L., Hood, L.E., Moore, K. and Tanner, E.R. (2007) Putting Evidence into Practice: Evidence-Based Interventions for Fatigue during and Following Cancer and Its Treatment. Clinical Journal of Oncology Nursing, 11, 99-113. http://dx.doi.org/10.1188/07.CJON.99-113
[17]	Poage, E., Singer, M., Armer, J., Poundall, M. and Shellabarger, M.J. (2008) Demystifying Lymphedema: Development of the Lymphedema Putting Evidence into Practice Card. Clinical Journal of Oncology Nursing, 12, 951-964. http://dx.doi.org/10.1188/08.CJON.951-964
[18]	Polit, D.F. and Beck, C.T. (2013) Essentials of Nursing Research. Appraising Evidence for Nursing Practice. 8th Edition, Wolters Kluwer Health /Lippincott Williams & Wilkins, Philadelphia.
[19]	Mitchell, H.K. (2010) Evaluating Clinical and Public Health Interventions. A Practical Guide to Study Design and Statistics. Cambridge University Press, Cambridge.
[20]	Stringer, E.T. (2004) Action Research in Education. 2nd Edition, Pearson Prentice Hall, Upper Saddle River.
[21]	Baartmans, P.C.M. and Geng, V. (2006) Qualitat nach Maβ. Entwicklung und Implementierung von Qualitatsver-besserungen im Gesundheitswesen. 2., vollst. uberarb. und erw. Aufl. Huber (Pflegemanage- ment), Bern.
[22]	Swiss Academy of Medical Sciences (SAMW) (2009) Forschung mit Mensch: Ein Leitfaden fur die Praxis. http://www.samw.ch/dms/de/Projekte/Forschung-mit-Menschen/d_Leitfaden_Forschung/LeitfForschMensch?_Web-_Nov09.pdf
[23]	Mayring, P. (2008) Qualitative Inhaltsanalyse. Grundlagen und Techniken. 11., aktualisierte und uberarb. Aufl. Beltz (Studium Paedagogik), Weinheim.
[24]	Bortz, J. and Doring, N. (2006) Forschungsmethoden und Evaluation. Fur Humanund Sozialwissenschaftler; mit 87 Tabellen. 4., uberarb. Aufl., [Nachdr.]. Springer-Lehrbuch Bachelor, Master, Springer-Medizin-Verl, Heidelberg. http://dx.doi.org/10.1007/978-3-540-33306-7
[25]	Gronkjaer, M., Eliasen, M., Skov-Ettrup, L.S., Tolstrup, J.S., Christiansen, A.H. and Mikkelsen, S.S. (2014) Preoperative Smoking Status and Postoperative Complications: A Systematic Review and Meta-Analysis. Annals of Surgery, 259, 52-71. http://dx.doi.org/10.1097/SLA.0b013e3182911913
[26]	Sorensen, L.T. (2012) Wound Healing and Infection in Surgery. The Clinical Impact of Smoking and Smoking Cessation: A Systematic Review and Meta-Analysis. Archives of Surgery, 147, 373-383.
[27]	Thomsen, T., Villebro, N. and Moller, A.M. (2010) Interventions for Preoperative Smoking Cessation. The Cochrane Database of Systematic Reviews, 7, CD002294. http://dx.doi.org/10.1002/14651858.cd002294.pub3
[28]	Oppedal, K., Moller, A.M., Pedersen, B. and Tonnesen, H. (2012) Preoperative Alcohol Cessation Prior to Elective Surgery. The Cochrane Database of Systematic Reviews, 7, CD008343. http://dx.doi.org/10.1002/14651858.cd008343.pub2
[29]	Nickelsen, T.N., Jorgensen, T. and Kronborg, O. (2005) Lifestyle and 30-Day Complications to Surgery for Colorectal Cancer. Acta Oncologica, 44, 218-223. http://dx.doi.org/10.1080/02841860510029707
[30]	Artioukh, D.Y., Smith, R.A. and Gokul, K. (2007) Risk Factors for Impaired Healing of the Perineal Wound after Abdominoperineal Resection of Rectum for Carcinoma. Colorectal Disease, 9, 362-367. http://dx.doi.org/10.1111/j.1463-1318.2006.01159.x
[31]	Gottrup, F., Melling, A. and Hollander, D.A. (2005) An Overview of Surgical Site Infections: Aetiology, Incidence and Risk Factors. EWMA Journal, 5, 11-15.
[32]	Senn, B., Gafner, D., Raphaelis, S., Meyer, G., Mayer, H. and White, K. (2013) Testing the Counsellig Program “WOMAN-PRO II”: An International Multicenter Mixed-Methods Study Protocol. Poster Presentation. 18th International Meeting of the European Society of Gynecological Oncology, Liverpool, 19-22 October 2013.
[33]	Maier, S., Korner, P., Diedrich, S., Kramer, A. and Heidecke, C-D (2011) Definition und Management der Wundinfektion. Der Chirurg, 82, 235-241. http://dx.doi.org/10.1007/s00104-010-2012-5
[34]	Senn, B., Mueller, M.D., Cignacco, E.L. and Eicher, M. (2010) Period Prevalence and Risk Factors for Postoperative Short-Term Wound Complications in Vulvar Cancer: A Cross-Sectional Study. International Journal of Gynecological Cancer, 20, 646-654. http://dx.doi.org/10.1111/IGC.0b013e3181d92723
[35]	Beesley, V., Janda, M., Eakin, E., Obermair, A. and Battistutta, D. (2007) Lymphedema after Gynecological Cancer Treatment. Prevalence, Correlates, and Supportive Care Needs. Cancer, 109, 2607-2614. http://dx.doi.org/10.1002/cncr.22684
[36]	de Hullu, J.A., van der Avoort, I.A.M., Oonk, M.H.M. and van der Zee, A.G.J. (2006) Management of Vulvar Cancers. European Journal of Surgical Oncology, 32, 825-831. http://dx.doi.org/10.1016/j.ejso.2006.03.035
[37]	Royal College of Obstetricians and Gynaecologist (2006) Guidelines for the Diagnosis and Management of Vulval Carcinoma. https://www.rcog.org.uk/globalassets/documents/guidelines/vulvalcancerguideline.pdf
[38]	Green, M.S., Naumann, R.W., Elliot, M., Hall, J.B., Higgins, R.V. and Grigsby, J.H. (2000) Sexual Dysfunction Following Vulvectomy. Gynecologic Oncology, 77, 37-77. http://dx.doi.org/10.1006/gyno.2000.5745
[39]	Thuesen, B., Andreasson, B. and Bock, J.E. (1992) Sexual Function and Somatopsychic Reactions after Local Excision of Vulvar Intra-Epithelial Neoplasia. Acta Obstetricia et Gynecologica Scandinavica, 71, 126-128. http://dx.doi.org/10.3109/00016349209007969
[40]	Likes, W.M., Russell, C. and Tillmanns, T. (2008) Women’s Experiences with Vulvar Intraepithelial Neoplasia. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37, 640-646. http://dx.doi.org/10.1111/j.1552-6909.2008.00291.x
[41]	Patrick, D.L., Ferketich, S.L., Frame, P.S., Harris, J.J., Hendricks, C.B. and Levin, B. (2003) National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15-17, 2002. Journal of the National Cancer Institute, 95, 1110-1117. http://dx.doi.org/10.1093/jnci/djg014
[42]	Bundesamt fur Gesundheit, Schweizerische Gesundheitsdirektorenkonferenz (2011) Nationales Krebsprogramm fur die Schweiz 2011-2015. http://www.oncosuisse.ch/file/oncosuisse/nkp/2011-2015/vollversion/NKP_Vollversion_d.pdf
[43]	Basch, E., Jia, X., Heller, G., Barz, A., Sit, L. and Fruscione, M. (2009) Adverse Symptom Event Reporting by Patient’s vs Clinicians: Relationships with Clinical Outcomes. Journal of the National Cancer Institute, 101, 1624-1632. http://dx.doi.org/10.1093/jnci/djp386
[44]	McNees, P. (2006) Skin and Wound Assessment and Care in Oncology. Seminars in Oncology Nursing, 22, 130-143. http://dx.doi.org/10.1016/j.soncn.2006.04.003
[45]	Mitic, W., Ben Abdelaziz, F. and Madi, H. (2012) Health Education. Theoretical Concepts, Effective Strategies and Core Competencies. World Health Organization, Regional Office for the Eastern Mediterranean, Cairo. http://applications.emro.who.int/dsaf/EMRPUB_2012_EN_1362.pdf
[46]	Leminen, A., Forss, M. and Paavonen, J. (2000) Wound Complications in Patients with Carcinoma of the Vulva. European Journal of Obstetrics & Gynecology and Reproductive Biology, 93, 193-197. http://dx.doi.org/10.1016/S0301-2115(00)00273-6
[47]	Rouzier, R., Haddad, B., Dubernard, G., Dubois, P. and Paniel, B.-J. (2003) Inguinofemoral Dissection for Carcinoma of the Vulva. Effect of Modifications of Extent and Technique on Morbidity and Survival. Journal of the American College of Surgeons, 196, 442-450. http://dx.doi.org/10.1016/S1072-7515(02)01895-1
[48]	Uyl-De Groot, C.A., Hartog, J.G.-D., Derksen, J.G.M., Symons, E.A., Buijt, I., van der Velden, J. and van Lindert, A.C.M. (2004) Cost-Effectiveness and Quality of Life of Granulocyte-Colony Stimulating Factor (Filgrastim) after Radical Vulvectomy and Bilateral Inguino-Femoral Lymphadenectomy: Results of a Randomized Clinical Trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 114, 77-82. http://dx.doi.org/10.1016/j.ejogrb.2003.09.018
[49]	Van der Zee, A.G.J., Oonk, M.H., de Hullu, J.A., Ansink, A.C., Vergote, I. and Verheijen, R.H. (2008) Sentinel Node Dissection Is Safe in the Treatment of Early-Stage Vulvar Cancer. Journal of Clinical Oncology, 26, 884-889. http://dx.doi.org/10.1200/JCO.2007.14.0566
[50]	Andersen, B.L. and Hacker, N.F. (1983) Psychosexual Adjustment after Vulvar Surgery. Obstetrics and Gynecology, 62, 457-462.
[51]	Janda, M., Obermair, A., Cella, D., Crandon, A.J. and Trimmel, M. (2004) Vulvar Cancer Patients’ Quality of Life: A Qualitative Assessment. International Journal of Gynecological Cancer, 14, 875-881. http://dx.doi.org/10.1111/j.1048-891X.2004.14524.x
[52]	Harbour, R. and Miller, J. (2001) A New System for Grading Recommendations in Evidence Based Guidelines. BMJ, 323, 334-336. http://dx.doi.org/10.1136/bmj.323.7308.334
[53]	Mead, P. (2000) Clinical Guidelines: Promoting Clinical Effectiveness or a Professional Minefield? Journal of Advanced Nursing, 31, 110-116. http://dx.doi.org/10.1046/j.1365-2648.2000.01254.x