An observational study investigating the objective and subjective impact of a structured gynaecology service for women who have undergone allogeneic haematopoietic stem cell transplant.

Abstract

Hypothesis: The hypothesis for this study is that the provision of consultative gynaecological care and the delivery of gynaecological information to women undergoing allogeneic stem cell transplant will mean a better informed and better satisfied female transplant population. The specific aims of the study were: 1. To determine the type of information women have been given about vaginal GVHD, sexuality and fertility before they had their transplants. 2. To discover the kind of information women would like to receive about these issues before and after HSCT. 3. To assess if a gynaecology service designed especially for women undergoing HSCT is helpful with early detection and treatment of vaginal graft versus host disease. 4. To assess if a gynaecology service designed especially for women undergoing HSCT is beneficial when fertility and sexuality issues arise. 5. To discover whether the gynaecology services being provided meet the emotional, psychosocial and physical needs of the woman undergoing allogeneic stem cell transplantation.

Method: This is a retrospective observational study in which women were recruited in the following groups: • Eligible women from Wellington Hospital who had an allogeneic haematopoietic stem cell transplant (HSCT) from 1999 to July 2004 and had no exposure to a gynaecology service. • Eligible women from Wellington Hospital who had an allogeneic HSCT from 1 August 2004 who had exposure to a gynaecology service for HSCT recipients. • Eligible women from the Royal Melbourne Hospital, Australia who had an allogeneic HSCT after January 1999. This group had been exposed to a gynaecology service. This group was split into two cohorts following the date lines of the Wellington cohorts. The first cohort was transplanted between 1999 and July 2004 and the second was transplanted after 1st August 2004. This was a questionnaire-based study that asked questions about gynaecology services, genital graft versus host disease, sexuality and fertility. There was a response rate of 63% with 72 women signing consent and completing the questionnaire.

Conclusion: The results of the study showed that the provision of a gynaecology service for women pre and post HSCT was important in diagnosing and treating genital GVHD and for addressing post HSCT issues around sexuality and fertility. Significant numbers of women had problems with genital GVHD and sexuality post HSCT and better resolution of symptoms was seen in the cohorts that had exposure to gynaecology services. Women who were under the care of a structured and comprehensive HSCT related gynaecology programme were more informed and satisfied than women who did not have access to such a programme. The study results showed that the information and education about genital GVHD, sexuality and fertility currently provided for women needs to be significantly improved and a combination of written material and verbal information developed and made available.