Abstract
BACKGROUND: Studies that have gathered patient experiences of radiotherapy for gynaecological cancers have described anguish related to body image, lack of control, social isolation, lack of social support, mystification and self-criticism. Frequently, outward experiences of side effects are presented as 'necessary suffering' hampering opportunities to improve care and support. OBJECTIVES: This project aimed to address gaps in the understanding of how radiotherapy impacts patient bodies and social, personal and sexual lives and to identify priorities for more patient-centred support. DESIGN: Qualitative narrative study informed by feminist health activism. METHODS: Narratives (written, audio-recorded or video recorded journal entries) were collected in the United Kingdom between August 2020 and September 2021. Thirty-four women who had received radiotherapy treatment for cervical, endometrial, vulval or ovarian cancer (up to 25 years previously) submitted written, audio-recorded or video-recorded accounts. Data were analysed thematically through collaborative, feminist-informed approaches. RESULTS: The most prominent feature of the narratives related to patients not being listened to or not being heard. Seven principal areas for developing conversations for support were identified, which were grouped into four overarching and interlinking themes: Living Through Treatment and Its Physical Impacts; Shifts in Identity, Sexuality and Intimacy; Navigating Emotional and Psychological Wellbeing; and Communication, Dignity and the Practices that Support or Undermine Them. Physical effects were deeply intertwined with emotional, relational and identity challenges, and gaps in communication often compounded distress. CONCLUSIONS: Radiotherapy for gynaecological cancer can have enduring and multi-dimensional impacts that are often poorly addressed in current care models. Improving services requires embedding patient voices in care planning, prioritising dignity and addressing long-term effects through open, ongoing conversations. The findings inform practical recommendations and highlight priorities for future research and policy to embed patient perspectives in radiotherapy services.