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Henkelman MS, Toivonen KI, Tay J, Beattie S, Walker LM. Characterizing sexuality and assessing predictors of sexual satisfaction in patients with multiple myeloma and other hematological cancers. Support Care Cancer 2025; 33:85. [PMID: 39786637 DOI: 10.1007/s00520-024-09038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 11/20/2024] [Indexed: 01/12/2025]
Abstract
PURPOSE Existing studies documenting cancer-related sexual concerns among hematological cancer patients tend to group all types of hematological cancer together, overlooking potentially unique concerns associated with multiple myeloma (MM). This study is the first to characterize sexuality in MM and to examine predictors of sexual satisfaction for MM, comparatively with participants with other hematological cancer types. METHODS We conducted a cross-sectional self-report survey-based study. Adult participants were eligible to participate, provided they were sexually active (alone or with a partner) and had a diagnosis of hematological cancer. RESULTS Men and women with MM (N = 44) and other hematological cancers (N = 37) participated. MM survivors exhibited poor sexual function but low sexual distress and endorsed mid-high scores on measures of sexual flexibility, sexual communication, and sexual satisfaction. No group differences were observed on sexuality variables. Results indicate that for MM and other hematological cancer survivors, lower sexual distress (b = -.72, p < .001) and higher sexual communication (b = .45, p < .001) were associated with higher sexual satisfaction, while sexual flexibility and sexual function were not significantly associated with sexual satisfaction. CONCLUSION Despite experiencing poor sexual function, many MM patients have low levels of sexual distress. Similar interventions to improve distress and communication may be appropriate for both groups of patients and may be valuable for efforts to improve sexual satisfaction.
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Affiliation(s)
- Megan S Henkelman
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Department of Psychology, Queens University, Kingston, Canada
| | - Kirsti I Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jason Tay
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Sara Beattie
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Lauren M Walker
- Department of Psychology, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
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Nørskov KH, Schjoedt I, Tolver A, Jarden M. Sexual health in patients with malignant hematological disease: a Danish cross-sectional study. Sex Med 2024; 12:qfae053. [PMID: 39281809 PMCID: PMC11398875 DOI: 10.1093/sexmed/qfae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/28/2024] [Accepted: 07/31/2024] [Indexed: 09/18/2024] Open
Abstract
Background Patients who undergo treatment for hematologic malignancies may experience a decline in sexual health, alterations in sexual functioning, and reproductive capacity during survivorship. Aim This study investigated the prevalence of sexual dysfunction and factors influencing sexual activity and functioning in patients with hematologic malignancies, to identify potential targets for interventions in clinical practice. Methods This nationwide cross-sectional study included adult patients diagnosed with a hematologic malignant disease in Denmark in the period from January 20, 2013, to August 20, 2022. Eligible participants received electronic questionnaires through their officially assigned digital mailbox. Outcomes Outcomes included the Female Sexual Function Index, International Index of Erectile Function, Female Sexual Distress Scale-Revised, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Sexual Health, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Results A total of 362 patients, on average 5.7 ± 3.4 years postdiagnosis, completed the questionnaires. Of these, 52.5% women and 73.2% men reported sexual dysfunction, with more women (40.9%) than men (34.1%) being sexually inactive. Across gender, this was significantly more prevalent in patients >65 years of age and in those with a low quality of life. In addition, for women a significant association with fatigue and sleep difficulties was observed. In total, 40.3% reported sexual-related personal distress, with the highest proportion among patients 40 to 65 years of age. Most patients (98.7%) with sexual dysfunction had not discussed sexual issues with their healthcare professional. Clinical implications It is hoped that knowledge from this study will help healthcare professionals in clinical practice and encourage them to proactively address and discuss sexual health issues with their patients, irrespective of age. Strengths and Limitations Sexually inactive participants may reduce the overall score of sexual function in the scoring of both the Female Sexual Function Index and International Index of Erectile Function. We therefore analyzed sexual function in a subgroup analysis in only those being sexually active to emphasize that level of dysfunction persists in sexually active participants. Conclusion Patients report a high prevalence of sexual dysfunction, sexual distress, and gender-specific sexual symptoms following diagnosis and treatment of a malignant hematologic disease, impacting their quality of life.Sexual Health in Patients With Hematologic Malignancies; NCT05222282; https://clinicaltrials.gov/study/NCT05222282.
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Affiliation(s)
| | - Ida Schjoedt
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø 2100, Denmark
| | - Anders Tolver
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen N 2200, Denmark
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen N 2100, Denmark
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Hammond N, Chantry A, Cheeseman M, Peng A. Disrupted biographies and gendered identities: A qualitative study exploring sexuality and blood cancer. Eur J Oncol Nurs 2024; 70:102544. [PMID: 38513454 DOI: 10.1016/j.ejon.2024.102544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE This study examines how blood cancer impacts patients' sexuality and sense of gendered identity. METHODS An interpretive epistemological framework necessitated a qualitative study design. Participants (6 male and 6 female), recruited from a hospital Haematology department in a large Northern English City, took part in semi-structured in-depth interviews to gather rich data about their subjective experiences. RESULTS A key theme from the qualitative data was a sense of disruption in relation to several aspects of their gendered identities and sexual life. Participants explained disruption to their sexual function and sexual sense of self. They narrated concerns about future imagined relationships. The emotional burden of sexuality related concerns was strongly articulated. A gendered perspective enabled the similarities and differences between men and women to be explored. CONCLUSION This study, drawing on rich qualitative data, documents the sexuality concerns of blood cancer patients; for some such concerns arise many years post treatment. The findings highlight the need for gender appropriate care around sexuality which should continue to be accessible well after diagnosis and treatment phases have ceased.
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Crist N, Egert MC, Bernie HL. Sexual dysfunction in male childhood cancer survivors and adolescent and young adult survivors of hematologic malignancies. Sex Med Rev 2023; 11:106-113. [PMID: 36744841 DOI: 10.1093/sxmrev/qeac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 02/07/2023]
Abstract
Sexual Health is an important aspect of overall health and quality of life (QoL) among adolescent and young adult (AYA) as well as childhood cancer survivors (CCS). Sexual health encompasses psychosocial, physical, developmental, emotional and relationship factors that impact sexual function. Cancer and its associated treatments are associated with negative effects on sexual health, body image, relationships, as well as overall physical and mental health. Data shows that CCS are known to experience diminished QoL compared to their peers. However, limited information is available to guide the assessment and treatment of sexual dysfunction in AYA and CCS. Further, exploration into specific cancer types, treatment methods and their resultant effects on sexual function within these populations is far more limited. We conducted an extensive review of the literature that focused on sexual dysfunction in male survivors of hematologic malignancies (HM). Our review identified an increased incidence of sexual dysfunction within male AYA and CCS of HM, and the negative impact this has on overall QoL. Our results show the degree to which survivors of HM experience increased sexual dysfunction, and the therapies and pathophysiologic mechanisms that may contribute to the development of sexual dysfunction within this population. These findings highlight the lack of research on this topic and need for further exploration into AYA and CCS sexual health to improve patient care and close the knowledge gaps to better assess and treat sexual dysfunction in this patient population.
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Affiliation(s)
- Nikos Crist
- Department of Urology, Indiana University School of Medicine, Indianapolis, IA, United States
| | - Melissa C Egert
- Department of Urology, Indiana University School of Medicine, Indianapolis, IA, United States
| | - Helen L Bernie
- Department of Urology, Indiana University School of Medicine, Indianapolis, IA, United States
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Tsatsou I, Mystakidou K, Adamakidou T, Konstantinidis T, Kalemikerakis I, Galanos A, Prapa PM, Panagou E, Govina O. Sexual Function of Male Survivors of Hematological Malignancy Treated by Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Controlled Observational Study. JOURNAL OF SEX & MARITAL THERAPY 2023:1-13. [PMID: 36644982 DOI: 10.1080/0092623x.2023.2167756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
A multicenter, observational, cross-sectional study was conducted to assess the sexual function of male survivors of hematological malignancy treated by autologous hematopoietic stem cell transplantation (AHSCT) and to compare it with that of healthy male controls. By convenience sampling, 71 sexually active male survivors of hematological malignancy who underwent AHSCT were recruited, as well as 74 healthy men. A questionnaire with demographic and clinical data and the International Index of Erectile Function (IIEF) were completed. Survivors had a median age of 47 years, a median time since transplant of 3 years, and 46.5% had Hodgkin lymphoma. Based on the IIEF, they had a high level of sexual function, with best functioning domain "erection" and worst "overall satisfaction". Healthy men had statistically significantly higher scores in all domains of the IIEF, except for "orgasm" (p = 0.205). There was a statistically significant association between sexual function and age (p < 0.0005), years since transplantation (p = 0.006), functional status (p < 0.0005), having children (p < 0.0005), relationship status (p = 0.001), education (p < 0.0005), diagnosis (p < 0.0005) and disease relapse (p = 0.017). Multivariate analysis showed that only age was a strong prognostic factor of sexual function (p < 0.0005). After age was excluded from the model, because of the strong effect it had on the dependent variable, functional status (p = 0.015), education (p = 0.002) and diagnosis (p = 0.001) had a statistically significant association with sexual function. These findings indicate the importance of sexual function for survivors' well-being and the need for implementation of integrated care plans for survivors of hematological malignancy.
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Affiliation(s)
- Ioanna Tsatsou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Antonis Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Maria Prapa
- 3rd Department of Internal Medicine, General Hospital for Chest Diseases, Athens, Greece
| | | | - Ourania Govina
- Department of Nursing, University of West Attica, Athens, Greece
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Partnership, sexuality, and fertility-related communication: findings from a register-based study among long-term hematological cancer survivors. Support Care Cancer 2023; 31:26. [PMID: 36513784 PMCID: PMC9747843 DOI: 10.1007/s00520-022-07495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/25/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Even though the number of hematological cancer survivors suffering from long-term and late consequences of their disease is growing, knowledge about their situation regarding partnership, sexuality, and fertility-related communication is sparse to date. METHODS We recruited survivors of hematological malignancies (≥ 3 years after diagnosis) from two cancer registries in Germany. We applied validated instruments and study-specific items on satisfaction with partnership, sexual functioning, and fertility-related communication with physicians. We provided descriptive statistics and conducted multiple regression analyses to identify associations of the outcomes with patient factors and well-being (anxiety, depression, and quality of life). RESULTS Of 2001 eligible survivors, 922 (46%) participated. Fifty-seven percent were male, and the mean age was 64 years. Ninety percent and 60% reported to be satisfied with their partnership and sexual life, respectively. However, 81% and 86% reported being sexually impaired by physical or mental symptoms, respectively. Seventy-four percent of those with incomplete family planning had a fertility-related conversation with a physician. Female gender (p < .05, Beta = - .09), older age (p < .01, Beta = .10), and chemotherapy (p < .01, Beta = .10) were associated with less sexual pleasure caused by physical impairment. Satisfaction with partnership (p < .001, Beta = .22), satisfaction with sexual life (p < .001, Beta = .28), and conversation about fertility (p < .05, Beta = .26) were associated with better quality of life. CONCLUSION Even though long-term survivors seem to be generally satisfied with their partnership and sexual life, they may suffer from specific impairments. Our findings need to be verified in longitudinal studies.
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Schoenbeck KL, Flynn KE. Health-Related Quality of Life of Patients with Chronic Myeloid Leukemia as Measured by Patient-Reported Outcomes: Current State and Future Directions. Curr Hematol Malig Rep 2021; 16:491-499. [PMID: 34648119 DOI: 10.1007/s11899-021-00656-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Tyrosine kinase inhibitors (TKIs) allow many patients with chronic myeloid leukemia (CML) to live normal life spans but have the potential to impact patients' health-related quality of life (HRQOL). Patient-reported outcome (PRO) measures can provide valuable information to inform treatment decision-making. Here, we review pivotal studies that used PRO measures to evaluate HRQOL of patients with CML in the first-line and treatment-free remission (TFR), and identify areas for future research. RECENT FINDINGS PRO measures commonly studied in patients with CML include the SF-36, FACT-Leu, EORTC QLQ-CML24, and MDASI CML. Cohort or cross-sectional studies provide the most data on PRO measures in patients with CML, with less information available from randomized controlled trials (RCTs). Patients with CML taking TKIs have worse HRQOL compared to matched controls, with a few studies seeing a larger effect in younger patients (< 60 years old). No single TKI consistently has better HRQOL compared to other agents. Fatigue is a predominant symptom associated with impaired HRQOL across many studies. Studies evaluating TFR show stable or improved HRQOL after TKI discontinuation. There are areas of HRQOL detrimental to patients with other types of cancer (e.g., cognition, sexuality) that warrant further evaluation in patients with CML. Understanding the HRQOL of patients with CML is increasingly important as patients live near-normal life expectancies. PRO measures have the potential to inform treatment decisions in this patient population. Future research opportunities include using PRO measures in RCTs and expanding the HRQOL topics studied in patients with CML.
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Affiliation(s)
- Kelly L Schoenbeck
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, 505 Parnassus Ave, Room M1286, Mailbox 1270, San Francisco, CA, 94143, USA.
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Schoenbeck KL, Atallah E, Lin L, Weinfurt KP, Cortes J, Deininger MWN, Kota V, Larson RA, Mauro MJ, Oehler VG, Pinilla-Ibarz J, Radich JP, Schiffer CA, Shah NP, Silver RT, Thompson JE, Flynn KE. Patient-Reported Functional Outcomes in Patients with Chronic Myeloid Leukemia after Stopping Tyrosine Kinase Inhibitors. J Natl Cancer Inst 2021; 114:160-164. [PMID: 34491344 DOI: 10.1093/jnci/djab184] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/14/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022] Open
Abstract
Treatment-free remission (TFR) is a goal for patients with chronic myeloid leukemia (CML). Functional outcomes after discontinuing Tyrosine Kinase Inhibitor (TKI) treatment have not been described. PROMIS patient-reported outcome measures (PROMs) of social, physical, cognitive, and sexual function were assessed over 36 months in 172 adult patients with chronic phase CML from 14 sites at baseline (on TKI) and after discontinuation. Linear mixed-effects models described the average trajectories for each PROM after discontinuation and in those who restarted TKI. Of 112 patients in TFR at 12 months, 103 (92.0%) had a ≥ 3-point improvement in social function, 80 (71.4%) in social isolation, 11 (9.8%) in satisfaction with sex life, 4 (3.6%) in physical function, and no patients had a ≥ 3-point improvement in cognitive function or interest in sexual activity. Patients' scores worsened after restarting TKI. This novel information on functional outcomes in TFR can help guide patient and clinician decision-making.
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Affiliation(s)
| | - Ehab Atallah
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Li Lin
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jorge Cortes
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | | | - Vamsi Kota
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Richard A Larson
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Michael J Mauro
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivian G Oehler
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Jerald P Radich
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Charles A Schiffer
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Neil P Shah
- University of California San Francisco, San Francisco, California, USA
| | - Richard T Silver
- Weill Medical College of Cornell University, New York, New York, USA
| | - James E Thompson
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Eeltink CM, Incrocci L, Leeuw IMVD, Zweegman S. Recommended patient information sheet on the impact of haematopoietic cell transplantation on sexual functioning and sexuality. Ecancermedicalscience 2020; 13:987. [PMID: 32010211 PMCID: PMC6974367 DOI: 10.3332/ecancer.2019.987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 12/30/2022] Open
Abstract
Sexual concerns are common after haematopoietic cell transplantation (HCT). Exposure to total body irradiation (TBI), alkylating agent and graft versus host disease (GvHD) can all affect sexual function, leading to problems in sexual desire, arousal and the orgasm phase of the sexual response cycle. In high-risk haematological malignancies, such as acute leukaemia and myelodysplastic syndromes, HCT often offers the highest chance for long-term survival. In addition, these haematological diseases and HCT can have an impact on body image, self-esteem, (sexual) relationship and psychosocial factors, all of which are able to affect sexuality and sexual function. Five years post HCT, 80% of the female survivors and 46% of the male survivors report sexual dysfunction. It has been shown that these patients cope better after having discussed sexual health. While healthcare providers (HCPs) have the responsibility to address sexual issues, it has been demonstrated that 48%–82% HCT recipients reported not having discussed sexual issues with their HCPs and that only one-third of the HCPs routinely discussed sexual issues with their patients. HCPs describe a lack of knowledge and being uncomfortable with the topic as the most important reasons for not addressing sexual functioning. Even so, it would help >90% HCPs if the patient initiated discussing sexual issues. However, to empower patients addressing sexual issues, adequate comprehensive patient information is needed. In an effort to better meet the patients’ need, a patient information sheet: ‘Information for patients undergoing Hematopoietic Cell Transplantation: the impact of the disease and treatment on sexual function and sexuality’, has been created. In this review, we describe what is known about the impact of HCT on sexual function and briefly the management of sexual problems.
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Affiliation(s)
- Corien M Eeltink
- Amsterdam University Medical Center, Cancer Center Amsterdam, Department of Hematology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam, Department of Clinical Psychology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.,Department of Otolaryngology, Amsterdam University Medical Centers (Amsterdam UMC), location VUmc, 1105 AZ Amsterdam, The Netherlands.,Cancer Center Amsterdam, EMGO+ Institute, 1081 HV Amsterdam, The Netherlands
| | - Sonja Zweegman
- Amsterdam University Medical Center, Cancer Center Amsterdam, Department of Hematology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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Sexual function in long-term male lymphoma survivors after high-dose therapy with autologous stem-cell transplantation. Bone Marrow Transplant 2019; 55:891-905. [PMID: 31745250 DOI: 10.1038/s41409-019-0745-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
Reduced sexual function may have negative implications on health related quality of life among lymphoma survivors. A national cross-sectional study among long-term lymphoma survivors after high-dose therapy with autologous stem-cell transplantation auto-SCT treated during 1987-2008 was conducted in 2012-2014. The current study explored sexual functioning among these survivors. Sixty-six percent (n = 159) of eligible men with complete questionnaire data were included, median age was 55 years. The Brief Sexual Function Inventory (BSFI) was used to assess sexual function and sexual satisfaction, compared with age-matched controls. In addition, sexual problems were defined based on predetermined cutoff values for BSFI domain scores. Sexual drive and erections firm enough to have sexual intercourse were reported to be present only a few days or less last month among 30% and 41% of survivors, respectively. Sexual satisfaction was reported by 39% of survivors. The survivors had significantly lower scores on all BSFI domains and an increased risk of problems with sexual drive and erection compared with controls. In multivariable models, cardiovascular disease was significantly associated with worse erectile function, while age > 55 years, chronic fatigue, and physical inactivity were significantly associated with lower sexual functioning overall. Chronic fatigue and anxiety were related to lower sexual satisfaction.
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