Omslagsillustration: "Fjädern och kniven". illustration av Kajsa Åkeflo
Cover illustration: "The Feather and the Knife" by Kajsa Åkeflo. The feather symbolizes sexual health and well-being, and the knife a life-threatening event, such as cancer or some other serious condition that threatens existence and health

Linda Åkeflo - Radiotherapy-induced late effects among female pelvic cancer survivors - sexual health, wellbeing and impact of nurse-led interventions


On September 23, Linda Åkeflo is defending her thesis for Doctor of Medical Science at the Institute of Clinical Sciences, Sahlgrenska Academy, in the research subject of Oncology

The title of the thesis is:Radiotherapy-induced late effects among female pelvic cancer survivors - sexual health, wellbeing and impact of nurse-led interventions

OBS: Link directly to the doctoral thesis

Linda Åkeflo är specialistsjuksköterska i onkologi, verksam vid BäckencancerRehabiliteringen, Verksamheten Onkologi, Sahlgrenska
Linda Åkeflo is a specialist nurse in oncology, working at PelvicCancerRehabilitation, Oncology Department, Sahlgrenska University Hospital

This thesis addresses unmet needs concerning sexual health issues and low wellbeing in female cancer survivors treated with pelvic radiotherapy. The aim was to improve knowledge about sexual health, wellbeing and vaginal changes in female cancer survivors treated with pelvic radiotherapy, and study the impact of nurse-led interventions.

Illustration av Alva Skog
Illustration av Alva Skog

Methods/Results: Quantitative and qualitative methods were used. Studies I-III (n=605, n=260, n=570) are prospective, population-based cohort studies using study-specific questionnaires. Self-reported data concerning physical symptoms and psycho-social health were collected in a cohort of women treated with pelvic radiotherapy for gynecological, anal, or rectal cancer. Statistically significant improvements were shown in satisfaction with overall sexual health and quality of life, and reduced genital pain, depression, and anxiety following individualized nurse-led interventions. No improvements were shown in sexual function. Reduced urgency to defecate was associated with improved satisfaction with overall sexual health. Reduced fecal leakage was associated with lower anxiety. Depression, anxiety, and genital pain were statistically
significantly more common among women with than without a history of sexual abuse. In study IV, qualitative content analysis of interviews with women (n=12) revealed one overarching theme, being unprepared, for receiving information about and performing vaginal dilator therapy. Physical and emotional reactions arose, and complex psychological and practical barriers to motivating the therapy emerged. Some strategies were developed to enhance motivation.

Conclusions: The results indicate that individualized interventions using a biopsychosocial approach in a nurse-led clinic focusing on radiotherapy-induced physical late effects can improve sexual health and wellbeing. The high impact of sexual abuse on sexual health and wellbeing needs to be taken into account in supportive care. Improved follow-up concerning vaginal dilator therapy, information routines, and psychoeducation integrated in the cancer treatment, are needed.

More women with a previous history of sexual abuse reported vaginal pain 

Hälsoaspekter hos kvinnor som behandlats för cancer i bäckenområdet
Health aspects of women treated for pelvic cancer with and without a reported history of sexual abuse in a population-based cohort (570 study participants). For more information see page xx in the thesis.

Time: September 23 at 09:00 Place: Hjärtats Aula, Vita Stråket 12, Sahlgrenska University Hospital Gothenburg

OBS: The dissertation can also be followed via this link:

Supervisor:  Karin Bergmark
Co-Supervisor: Gail Dunberger, Eva Elmerstig, Gunnar Steineck
Opponent:  Maria Larsson, Karlstads universitet, Karlstad
Examining Committee: Annika Strandell, Karin Ahlberg och Preben Kjölhede