TRAIL-CC: Trachelectomy, Radical Hysterectomy, and Intimate Life After Cervical Cancer Study
TRAIL-CC: Trachelectomy, Radical Hysterectomy, and Intimate Life After Cervical Cancer Study
The objective of this study is to compare radical hysterectomy with trachelectomy on outcomes
 related to intimacy, sexual health, and mood immediately before, 1 month after, and 6 months
 after surgery.
Improvements in our treatment of these cancers has resulted in an increased focus on quality
 of life issues. Sexual health is one such important aspect of quality of life that is often
 disrupted in cervical cancer survivors. However, currently there are no established
 treatments for such sexual problems, often leaving women and their partners with long-term
 difficulties that interfere in other aspects of their relationship and lives.

 Treatment of cervical cancer involves hysterectomy (i.e. removal of the uterus), and commonly
 bilateral salpingo-oophorectomy (BSO; i.e. bilateral removal of the ovaries and fallopian
 tubes). Hysterectomy results in direct physical consequences to sexual function which have
 been attributed to probable autonomic nerve damage (Butler-Manuel et al., 2000; 2002; Weijmar
 Schultz et al., 1991). Depending on the extent of disease, hysterectomy may be either simple
 (i.e. surgical removal of the uterus without excision of adjoining tissue) or radical (i.e.
 surgical removal of the uterus, the parametria and uterosacral ligaments, the upper portion
 of the vagina, and the pelvic lymph nodes).

 In the last two decades, a new procedure known as trachelectomy, has surfaced to treat early
 stages of cervical cancer. Unlike radical hysterectomy, the trachelectomy procedure aims to
 preserve the fertility in young women who wish to have children post cervical cancer and
 treatment (Plante et al., 2004; 2005). This preservation of fertility in trachelectomy is a
 result of leaving the patient's uterus intact while removing the cervix, parametrium and
 upper one third of the vagina. With the uterus intact, the patients are capable of conceiving
 multiple births post-procedure (Bernardini et al., 2003, Plante et al., 2004; 2005), an
 option that was not present in the past for women after radical hysterectomy.

 The few dozen studies done looking at the outcomes of trachelectomy have mainly focused on
 medical outcomes such as fertility and cancer cure and recurrence. The findings show there is
 a 70-72% success rate in women who try to conceive post-trachelectomy (Boss et al., 2005,
 Plante et al., 2005). If a patient is eligible for a trachelectomy procedure, according to
 the criteria (Sonoda et al., 2004), recurrence-free survival is excellent at 95% (Plante et
 al., 2004).

 With such improvements in the identification and cure of cervical cancer and the use of
 fertility-sparing techniques, there has been an increase in the number of young patients in
 remission, raising a number of quality of life issues. Sexual health is recognized as an
 integral aspect of quality of life during survivorship and is increasingly receiving research
 and clinical attention (Juraskova et al., 2003; Wenzel et al., 2002). In the studies done on
 trachelectomy we find that there are a handful of women who, prior to the operation, wish to
 conceive a child, but post-operation lose this desire and do not try to conceive (Boss et
 al., 2005, Plante et al., 2005), but no further studies have been done in this area as to the
 reasons why. Although the studies have been very beneficial for medical information none of
 the studies examining the efficacy of trachelectomy have studied the impact on sexual health
 or quality of life. On the other hand, research on the effects of radical hysterectomy in
 women with cervical cancer finds approximately half of women experience negative sexual
 side-effects such as significantly more lubrication difficulties, reduced vaginal length and
 elasticity, and marked distress (Bergmark et al., 1999). Also distressing to 36% of the women
 in this group is the absence of genital swelling in more than half of their sexual
 encounters, despite no changes in sexual frequency or orgasmic experience (Bergmark et al.,
 1999). When a vaginal photoplethysmograph was used to document changes in genital blood flow
 (an indirect measure of sexual arousal), women with radical hysterectomy had more impairment
 in blood flow responses than either a control group or a simple hysterectomy group,
 suggesting involvement of autonomic nerves (Maas et al., 2002).

 Given that women, together with their partners and oncologists, may find themselves in a
 position of selecting one procedure over another, it seems important to better understand the
 relative effects of these procedures on intimate life and sexual health. The objective of
 this study, therefore, is to compare radical hysterectomy with trachelectomy in the effects
 on intimacy, sexual health, and mood immediately before, 1 month after, and 6 months after
 surgery.

 This study will help to identify patterns and outcomes on these aspects of quality of life in
 hopes of better informing women of the potential outcomes of their procedures. Cervical
 cancer and treatment are life-altering events; therefore it is desirable to identify and
 hopefully reduce any negative psychological and physical sequelae of treatment. We want to
 ensure that problems related to post-cervical cancer are diminished so that the survivor's
 quality of life can be maintained at an acceptable level, allowing the patients to continue
 living a fulfilling life, uninhibited by sexual and emotional distress.
Inclusion Criteria:

 1. Women who have a diagnosis of cervical cancer

 2. Women who are scheduled for either a radical hysterectomy or radical trachelectomy at
 the British Columbia Cancer Agency - Vancouver Cancer Centre

 3. Proficient in English

 Exclusion Criteria:

 No woman who meets the inclusion criteria will be excluded from participating.