Women shouldn’t put on a brave face while enduring a painful and traumatizing medical procedure — that’s the lesson learned by a researcher whose surprising findings led to improved care for local cervical cancer patients.
University of Windsor sociologist Eleanor Maticka-Tyndale was given $60,000 in Seeds4Hope funding starting in 2009 to study the experiences of women — their quality of life and sexuality — during and after high-dose rate brachytherapy. It’s an effective internal radiation therapy that involves inserting narrow hollow tubes through the vagina to the cervix and uterus, and loading tiny radiated pellets into the tubes to deliver high doses to a smaller target area compared to external beam radiation.
Up until 2009, patients at the Windsor cancer centre usually weren’t given anesthetic for brachytherapy, which involves four to six hour-long treatments. Instead they got narcotic painkillers like morphine and dilaudid to keep them comfortable.
But what Maticka-Tyndale discovered after interviewing these women, was that the procedure was far from comfortable.
“We had quotations about severe pain, severe anxiety,” she said. Regardless of the pills they were given, “this was an excruciating procedure for them.”
And the memories from it — the pain and anxiety — lingered on, and had a long term effect on their sexual relations with their spouses and partners, she said.
Women told her: “If it was up to me I’d never have sex again because it brings up with memories of the pain,” or “It’s so painful, but I know my husband, my partner, wants it, needs it and it’s important to our relationship, so I just cringe and bear it.”
When she shared how women described their experience in “such a very horrific, negative way,” the Windsor cancer centre’s chief oncologist, Dr. Ken Schneider, who treated these women, was shocked.
Though he knew the procedure certainly wasn’t pleasant, he had no idea how traumatizing it truly was. While delivering the treatment, he would always ask them how it was going, but the women tended to play down any discomfort. So when he heard from Maticka-Tyndale about the women’s true feelings, he was shocked. “It was very unsettling for me.”
There was one woman Maticka-Tyndale interviewed who received conscious sedation, a combination of medicines delivered by an anesthetist to block pain and help you relax. Though you may be awake during the procedure, you usually have no memory of it. It’s what most people get prior to a colonoscopy.
That one woman reported that her brachytherapy was pain-free and anxiety-free, said Maticka-Tyndale.
After learning about Maticka-Tyndale’s findings, Schneider, who had already been planning to transition to conscious sedation, did the transition very quickly. The anesthetists at Windsor Regional Hospital were able to fit the brachytherapy patients in by having the procedures scheduled for 7 a.m.
And the experience of women clearly improved, according to Schneider. “No question about that,” he said. “I’d say probably 95 per cent of women will have a better experience because they get this conscious sedation.”
He said they wake up quickly afterwards. “They might say something was going on, but no, it was fine.”
Schneider and Maticka-Tyndale, who worked together on the research project, agree that women put on a brave face because they were grateful for the lifesaving care they were getting.
“Think about it, when you’re going through something that’s very painful and people are treating you very kindly and respectfully, you’re thankful and you appropriately express that thanks,” said Maticka-Tyndale. “But what (Schneider) didn’t realize was they were putting on a brave face, while enduring a lot of pain.”
The fact this research brought about a significant change for the 12 to 15 cervical cancer patients needing brachytherapy annually shows how important it is to have research done locally, said Maticka-Tyndale, who is associate dean of research and graduate studies in the university’s faculty of arts and social sciences.
She said that what she learned from this research is that as patients, “we shouldn’t put on a brave face.”
We don’t need to scream and kick. “But we need to communicate our distress.”
Source: The Windsor Star