Sexuality in breast cancer survivors: sexual experiences, emotions, and cognitions in a group of women under hormonal therapy

Influence of breast cancer on life satisfaction in the elderly patient

PURPOSE

Due to increasing life expectancy and demographic trends in recent years, the specific needs of elderly patients have gained more and more attendance. The aim of this study is to determine the impact of adjuvant chemotherapy on health-related life satisfaction of elderly breast cancer patients while considering the conditions of comorbidities and global health status.

METHODS

All breast cancer patients over 60 years who had been treated at the Breast Center of the University Hospital of Munich, Germany between 2010 and 2013 were eligible for participation. Life satisfaction was assessed on the basis of validated questionnaires, with a self-developed questionnaire we assessed issues of the patients general health status and for the geriatric assessment.

RESULTS

Our research included data of 276 patients. Compared to a normal German population, our cohort reported significantly higher life satisfaction regardless of treatment with chemotherapy. Regardless of the type of therapy, the following factors are associated with a lower life health-related satisfaction: low educational level, obesity, high Charlson Comorbidity Index (CI) and low Barthel Index (BI) as well as polymedication. Obesity and the presence of comorbidities were significantly associated with reduced health-related life satisfaction.

CONCLUSION

This cross-sectional, retrospective analysis indicates, that chemotherapy does not impact the patients´ life satisfaction. BI and CCI as well as obesity, polymedication and level of education are significantly associated with a lower satisfaction. These data should be taken into account in the decision-making process to improve the medical care and support of elderly breast cancer patients.

Detection of differences in physical symptoms between depressed and undepressed patients with breast cancer: a study using K-medoids clustering

BACKGROUND

To detect the differences in physical symptoms between depressed and undepressed patients with breast cancer (BC), including common symptoms, co-occurring symptoms, and symptom clusters based on texts derived from social media and expressive writing.

METHODS

A total of 1830 texts from social media and expressive writing were collected. The Chi-square test was used to compare the frequency of physical symptoms between depressed and undepressed patients with BC. Symptom lexicon of BC and K-medoids Clustering were used for mining physical symptoms and cluster analysis.

RESULTS

The common physical symptoms reported by texts included general pains (59.38%), fatigue (26.60%), vomiting (24.82%), swelling of limbs (21.69%), difficulty sleeping (21.56%), nausea (16.78%), alopecia (15.14%), loss of appetite (13.78%), dizziness (11.60%), and concentration problems (11.19%). The frequency of difficulty sleeping (depressed 28.40%; undepressed 18.16%; P = 0.002) in depressed patients was higher than undepressed patients with BC. High co-occurrence was observed in both commonly mentioned symptoms and those less commonly mentioned but frequently co-occurring with them. There were 5 symptom clusters identified in depressed patients and 6 symptom clusters in undepressed patients. Pain-related symptom cluster and gastrointestinal symptom cluster were both identified in the depressed and undepressed patients. The novel immune system impairment symptom cluster consisting of bleeding and fever was found in the undepressed patients.

CONCLUSIONS

This study found that difficulty sleeping was reported more frequently, and identified difficulty sleeping-pain symptom cluster in depressed patients. The novel immune system impairment symptom cluster in undepressed patients was detected. Healthcare providers can provide targeted care to depressed and undepressed patients based on these differences. These findings demonstrate that social media can provide new perspectives on symptom experiences. The combination of digital tools and traditional clinical tools for symptom management in follow-up has great potential in the future.

CLINICAL TRIAL NUMBER

Not applicable.

Addressing sexual health in oncology: perspectives and challenges for better care at a national level

Introduction

The emotional impacts of oncological treatments can negatively affect sexual health and intimate relationships. Advances in cancer management have extended patient survival, underscoring the importance of addressing sexual health post-diagnosis.

Objectives

To explore physicians' practices regarding the approach to sexual health during oncological consultations; identifying barriers to addressing sexuality and assessing the need for sexual health training.

Methods

An observational, cross-sectional study that assessed the management of sexual health by physicians involved in oncological treatment, using an anonymous questionnaire distributed via SurveyMonkey.

Results

Of 133 physicians surveyed, 31.6% never or rarely address sexual health. Only 10.5% feel frequently prepared on this topic, while 24.8% almost never have the appropriate tools to address it. 97.7% of oncologists and 92.9% of otolaryngologists (ENTs) recognize the need for sexual health training. Sexual health was more frequently discussed among patients diagnosed with prostate, cervical and breast cancer, and less so among those with ENT, bladder and colorectal tumours. The approach was more frequent among patients treated with curative intent (77.4%) than those with palliative intent (5%). The main barriers identified were lack of training (46%), lack of time (39.8%) and patient discomfort (34.6%).

Conclusion

The majority of professionals dealing with oncological patients do not address their sexual health, with the lack of training, lack of time and patient discomfort being the main barriers identified. However, 92% indicate a need for sexual health training, which could contribute to early intervention, strategy establishment and timely referral to specialists in the field.

Beauty Therapy to Support Psychosocial Recovery from Oncological Care: A Qualitative Research on the Lived Experience of Women with Breast Cancer Treated with Chemotherapy

During the oncological care path, breast cancer patients treated with chemotherapy suffer from a number of psycho-physical changes, and appearance-related side effects are among the primary determinants of psychosocial impairment. Appropriate interventions are needed due to the fact that treatment-induced transformations have been associated with a decline in overall quality of life, interpersonal and sexual difficulties, and adverse effects on therapeutic adherence. In the framework of integrative oncology, beauty therapy is an affordable and straightforward intervention that could be used in the clinical management of breast cancer side effects. This study aims to comprehend the emotional and lived experiences of women undergoing chemotherapy after a brief beauty therapy intervention with licensed beauticians. The Interpretative Phenomenological Analysis was used as a methodological guideline. Sixteen women were purposefully recruited in a day hospital of a cancer unit, where the beauty therapy was implemented. At the end of the intervention, data were gathered using a semi-structured interview with open-ended questions. A thematic analysis was performed on verbatim transcriptions. Findings support the proposal of beauty therapy for patients undergoing chemotherapy. Assuming a relational viewpoint, beauty therapy could improve patients' feelings about themselves and the way they feel about others, even if they do not declare a specific interest in their outward appearance.

Unmet supportive care needs of breast cancer survivors: a systematic scoping review

BACKGROUND

Breast cancer is the most common type of cancer in women worldwide. Though improved treatments and prolonged overall survival, breast cancer survivors (BCSs) persistently suffer from various unmet supportive care needs (USCNs) throughout the disease. This scoping review aims to synthesize current literature regarding USCNs among BCSs.

METHODS

This study followed a scoping review framework. Articles were retrieved from Cochrane Library, PubMed, Embase, Web of Science, and Medline from inception through June 2023, as well as reference lists of relevant literature. Peer-reviewed journal articles were included if USCNs among BCSs were reported. Inclusion/exclusion criteria were adopted to screen articles' titles and abstracts as well as to entirely assess any potentially pertinent records by two independent researchers. Methodological quality was independently appraised following Joanna Briggs Institute (JBI) critical appraisal tools. Content analytic approach and meta-analysis were performed for qualitative and quantitative studies respectively. Results were reported according to the PRISMA extension for scoping reviews.

RESULTS

A total of 10,574 records were retrieved and 77 studies were included finally. The overall risk of bias was low to moderate. The self-made questionnaire was the most used instrument, followed by The Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34). A total of 16 domains of USCNs were finally identified. Social support (74%), daily activity (54%), sexual/intimacy (52%), fear of cancer recurrence/ spreading (50%), and information support (45%) were the top unmet supportive care needs. Information needs and psychological/emotional needs appeared most frequently. The USCNs was found to be significantly associated with demographic factors, disease factors, and psychological factors.

CONCLUSION

BCSs are experiencing a large number of USCNs in fearing of cancer recurrence, daily activity, sexual/intimacy, psychology and information, with proportions ranging from 45% to 74%. Substantial heterogeneity in study populations and assessment tools was observed. There is a need for further research to identify a standard evaluation tool targeted to USCNs on BCSs. Effective interventions based on guidelines should be formulated and conducted to decrease USCNs among BCSs in the future.

Factors associated with psychosocial adjustment in newly diagnosed young to middle-aged women with breast cancer: A cross-sectional study

PURPOSE

To examine the psychosocial adjustment of young to middle-aged women who were newly diagnosed with breast cancer and to determine the comprehensive risk factors contributing to psychosocial adjustment.

METHODS

This study was carried out on 358 young to middle-aged women who recently received a breast cancer diagnosis in two hospitals in Guangzhou, China. Participants reported data about sociodemographic characteristics, disease and treatment information, coping modes, social support, self-efficacy, and psychosocial adjustment. To analyze the data, the researchers utilized independent t-tests, one-way analysis of variance, and multiple linear regression.

RESULTS

The results showed that the participants exhibited a moderate level of psychosocial maladjustment, with a mean score of 42.44 ± 15.38. Additionally, 30.4% of the participants were classified as having severe psychosocial maladjustment. The study identified the coping mode of acceptance-resignation (β = 0.367, P < 0.001), mode of avoidance (β = -0.248, P = 0.001), social support (β = -0.239, P < 0.001), self-efficacy (β = -0.199, P = 0.001) as factors that impacted the level of psychosocial adjustment.

CONCLUSIONS

Psychosocial adjustment among young to middle-aged women who were newly diagnosed with breast cancer is affected by self-efficacy, social support, and coping modes. Healthcare professionals should pay attention to psychosocial adjustment in young to middle-aged women with breast cancer at the time of diagnosis, and could formulate effective interventions to improve their psychosocial adjustment by increasing self-efficacy, promoting social support, and encouraging effective coping.

The Future of Breast Cancer Research in the Survivorship Field

Prevalence of survivors of breast cancer has been steadily increasing in the last 20 years. Currently, more than 90% of women diagnosed with early-stage breast cancer are expected to be alive at 5 years from diagnosis thanks to early detection and breakthrough innovations in multimodal treatment strategies. Alongside this advancement in clinical outcomes, survivors of breast cancer might experience several specific challenges and present with unique needs. Survivorship trajectories after diagnosis and treatment of breast cancer can be significantly impacted by long-lasting and severe treatment-related side effects, including physical problems, psychological distress, fertility issues in young women, and impaired social and work reintegration, which add up to patients' individual risk of cancer recurrence and second primary malignancies. Alongside cancer-specific sequelae, survivors still present with general health needs, including management of chronic preexisting or ensuing conditions. Survivorship care should implement high-quality, evidence-based strategies to promptly screen, identify, and address survivors' needs in a comprehensive way and minimize the impact of severe treatment sequelae, preexisting comorbidities, unhealthy lifestyles, and risk of recurrence on quality of life. This narrative review focuses on core areas of survivorship care and discuss the state of the art and future research perspectives in key domains including selected long-term side effects, surveillance for recurrences and second cancers, well-being promotion, and specific survivors' needs.

Treating genitourinary syndrome of menopause in breast cancer survivors: main challenges and promising strategies

Many breast cancer survivors (BCS) suffer the consequences of antineoplastic treatments that induce a hypoestrogenic state, leading to chronic climacteric symptoms such as genitourinary syndrome of menopause (GSM), arousing significant alteration in their quality of life. Non-hormonal therapies (NHT) are first-line treatments, safe but with mild efficacy. When facing moderate-severe GSM, the options for BCS are limited: local estrogen therapy, considered the 'gold standard' but with concerns about safety; vaginal androgens and prasterone, which seem to trigger an activation of estrogen and androgen receptors of the vaginal epithelium layers, without activating estrogen receptors on other tissues, being potentially safe but still without strong evidence in favor of BCS; vaginal lasers, which appear to improve vascularization of vaginal mucosa by stimulating the remodeling of the underlying connective tissue, but with contradictory results of efficacy in recent randomized clinical trials; and ospemifene, an oral selective estrogen receptor modulator presenting mild vaginal estrogenic potency and anti-estrogenic effect at the endometrial and breast level, but still not recommended for use in BCS in recent North American Menopause Society guidelines. There is a need for further studies evaluating objectively the efficacy and safety of these promising therapeutic options. On the other hand, sexuality must be seen as a multifactorial issue, where GSM is only part of the problem; evidence shows that sexual counseling improves the quality of life of BCS. Finally, there is a need to limit the underdiagnosis and undertreatment of GSM in BCS; the primary goal of physicians treating BCS regarding this issue has to be the provision of information of what to expect regarding genital and sexual symptoms to BCS and to counsel on early first-line treatments that may help prevent more severe GSM.

Quality of sexual life and associated factors: a cross-sectional survey of Chinese breast cancer patients

PURPOSE

This study aimed to explore Chinese breast cancer patients' quality of sexual life (QSL) and factors associated with QSL.

METHODS

The questionnaires in this cross-sectional study include the general information questionnaire, cognition and assessment of sexual health questionnaire, Self-acceptance Questionnaire (SAQ), Medical Coping Modes Questionnaire (MCMQ), and Quality of Sexual Life Questionnaire (QSLQ); 201 breast cancer patients were required to complete the questionnaires assessing characteristic information, cognition and assessment of sexual health, QSL, self-acceptance, and coping style. Finally, hierarchical regression was used to analyze the factors associated with QSL in Chinese breast cancer patients.

RESULTS

The mean age (at the time of the survey) of the breast cancer patients was 48.31±9.15. The mean score of the QSLQ (range 28-140) was 75.14±16.57. Hierarchical regression analysis showed that the associated factors of breast cancer patients' QSL included age (at the time of the survey), education level, type of surgery, cognition and assessment of sexual health, self-acceptance, and avoidance and acceptance-resignation coping styles, that independent variables explained 60.4% of the variance.

CONCLUSION

The QSL among Chinese breast cancer patients needs to be improved. Our findings indicated that breast cancer patients with older age, lower education level, or modified radical mastectomy have poor QSL. Breast cancer patients learn correct information about sexual health, enhance self-acceptance, and reduce acceptance-resignation, and avoidance coping could be intervention strategies to improve their QSL.

Telenursing in the sexual function of women with breast cancer: A study protocol

INTRODUCTION

Most women with breast cancer have sexual function problems related to cancer diagnosis and treatment. These problems harm the quality of life and relationships. However, most patients do not receive care or guidance regarding sexuality from healthcare providers. This study aimed to test the effect of telenursing counseling on sexual functioning in women undergoing breast cancer treatment.

METHODS

This randomized clinical trial was conducted at 2 reference hospitals for cancer treatment. One hundred eight women with stage I-IV breast cancer undergoing treatment (surgery, chemotherapy, radiotherapy or hormone therapy) with a partner will be included in this study. The study was authorized by the Ethics Committee of the Federal University of Ceará (Opinion number: 46,13,609) and the Maternity School Assis Chateaubriand (Opinion number: 47,42,687). Patients will be allocated to the following groups: the control group, which will not receive an active intervention, and the intervention group, which will receive 3 telenursing counseling sessions for 6 weeks. The levels of sexual function in these patients before the intervention, soon after the intervention and at 12 weeks were compared and analyzed. All data will be collected and analyzed by the JASP program.

RESULTS

Differences in levels of sexual function among women allocated to the control and intervention groups in the analyzed periods.

CONCLUSION

This evidence-based nursing care strategy can be used to improve the sexual function of breast cancer patients and consequently their quality of life and marital relationship.

Impact of hormone therapy side effects on health-related quality of life, distress, and well-being of breast cancer survivors

To explore the modulatory role of Adjuvant Hormone Therapy (AHT) on health-related quality of life (QoL), subjective well-being and distress prevalence in Breast Cancer (BC) survivors, considering the survival phase. Cross-sectional study with control group. 616 BC survivors participated. Examination of interaction effect between AHT and time since end of primary treatment showed that many of the positive changes observed through the survival phases were experienced exclusively by survivors without AHT. When AHT was not prescribed, longer time elapsed was associated with a decrease in distress prevalence and an improvement in subjective well-being and QoL. It seems there is a turning point around the fifth year after finalization of primary treatment, from which the survivors without AHT significantly improve in several areas and those with AHT do so to a lesser extent. It is expected that the improvement in QoL throughout the different survival phases will have a significant impact on the adherence and maintenance of AHT and, consequently, the likelihood of survival. Thus, AHT side-effects should be routinely assessed by health care providers to gain accurate knowledge that allows improving the QoL of BC survivors.

Endometriosis and Sexual Functioning: How Much Do Cognitive and Psycho-Emotional Factors Matter?

Women with endometriosis often suffer from genito-pelvic pain. The objective of the present study was to analyze the relationship between cognitive and psycho-emotional factors and sexual functioning of women with endometriosis, comparing women with and without endometriosis. A total of 87 women with endometriosis (EG) and 100 women without endometriosis (CG) completed a socio-demographic questionnaire; the short-form of McGill Pain Questionnaire (SF-MPQ); the Female Sexual Functioning Index (FSFI); the Sexual Distress Scale (SDS); the Symptoms Checklist (SCL-90-R); the Toronto Alexithymia Scale (TAS-20); the Positive and Negative Affects Scale (PANAS); the Sexual Dysfunctional Belief Questionnaire (SDBQ); the Sexual Modes Questionnaire (SMQ); and the Questionnaire of Cognitive Schema Activation in Sexual Context (QCSASC). EG obtained worse scores than CG in SF-MPQ, Pain subscale of FSFI, and SDS. EG reached higher scores than CG on almost all scales of SCL-90-R and lower scores in the “Identifying Feelings” scale of TAS-20. Furthermore, EG reported more negative emotions toward sexuality than CG (PANAS) higher scores on the “Affection Primacy” scale of SDBQ and the “Helpless” sexual cognitive schema of QCSASC than CG. No significant differences were found in SMQ. Sexual health professionals should address psychological, emotional, and cognitive factors since they seem involved in patients’ sexual experiences.