Sexuality following breast cancer

Partner presence in clinical conversations about sexual health: Breast cancer survivors', partners', and providers' perspectives of triadic interactions

PURPOSE

Breast cancer survivors' (BCSs') sexual health (SH) clinical conversations are rarely studied from a dyadic perspective let alone from a triadic perspective. Using a triadic approach, we evaluated BCSs' comfort discussing SH with partners present and identified factors that can contribute to their comfort level.

DESIGN

Qualitative approach using in-depth interviews.

PARTICIPANTS

93 BCSs, partners, and providers involved in BCS care.

METHODS

In-depth interviews with BCSs, partners, and providers explored triadic perspectives to understand factors informing BCSs' comfort level. Thematic analysis was used to analyze data.

FINDINGS

Four themes characterize potential benefits of partner presence: 1) partner facilitates information exchange, 2) partner realizes BCS's SH concerns are "a real thing," 3) partner better understands SH challenges, and 4) partner presence encourages relational communication about SH. Five themes illustrate potential complications of partner presence: 1) partner feels/becomes embarrassed, 2) partner is/becomes defensive, 3) partner presence constrains BCS's agency in clinical conversations, 4) partner presence threatens partner's view of BCS as a sexual being, and 5) partner presence increases partner burden.

IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY

Providers should (1) initiate conversations about BCS comfort with partner presence, (2) be aware of the interaction between BCS primary and secondary goals, (3) consider how BCS/partner goal conflicts obstruct BCS agency and sexual/relational health, and (4) offer opportunities to clarify goals and expectations, and coordinate therapeutic options.

Sexual Activity in Couples Dealing With Breast Cancer. A Cohort Study of Associations With Patient, Partner and Relationship-Related Factors

Objective

Breast cancer may profoundly affect a couple’s sex life. The present study examines whether patient-, partner- and relationship-related characteristics are associated with sexual activity of couples following breast cancer diagnosis in the treatment phase and over time.

Methods

Women with breast cancer and their male cohabiting partners participated in a longitudinal study in Denmark. Logistic regression was used to examine associations of patient-, partner- and relationship-related characteristics at baseline (≤4 months following surgery) with couples’ sexual activity at baseline, 5 and 12 months later. The longitudinal analyses were stratified for couples’ sexual activity status at baseline.

Results

A total of 722, 533 and 471 couples were included in the analyses at baseline, 5- and 12-months follow-up, respectively. Older age, depressive symptoms and lower vitality of patients were associated with lower odds of couples’ sexual activity at baseline; chemotherapy treatment and older age of patients were associated with lower odds at 5-months follow-up in couples who were not sexually active at baseline. Higher ratings of emotional closeness, affectionate behavior and satisfaction with dyadic coping were associated with higher odds for sexual activity at baseline and over time in couples who were sexually active at baseline.

Conclusion

Sexual counseling during cancer treatment and rehabilitation should include a couple perspective. Relationship-related variables may be a protective factor for remaining sexually active after breast cancer diagnosis. Interventions could focus on strengthening these factors. Health professionals also need to consider the patients’ breast cancer treatment, vitality, and emotional distress in counselling on sexuality.

Why do breast cancer survivors decline a couple-based intimacy enhancement intervention trial?

Recruitment challenges hinder behavioral intervention research in cancer survivors. The purpose was to examine the reasons for declining and intervention preferences of study-eligible breast cancer survivors declining a trial of a four-session couple-based Intimacy Enhancement intervention (refusers) and explore whether refusers differed from participants on key characteristics. Partnered, post-treatment breast cancer survivors reporting sexual concerns who were eligible for but declined participation in the intervention trial were approached to complete a standardized 5-min telephone survey assessing reasons for declining and support preferences. Demographic, clinical, and sexual concerns information were collected during screening. Trial participants and refusers were compared on key variables of age, race, hormone therapy use, time since treatment, level of sexual concerns, and recruitment method using t-tests or chi-square tests. Among the 31 women who declined the trial and completed the survey, the most common reasons for declining were time commitment (74%) and partner noninterest (32%). Most (61%) reported that the telephone format played little to no role in their refusal. Eighty-one percent wanted their partners involved in a program addressing sexual concerns. The two most preferred resources were informational websites (45%) and meeting with a professional (26%). Trial participants and refusers did not differ on any key factors examined. Developing intimacy interventions that are very brief, partner-optional, or that use stepped care may bolster uptake. The methods used to examine study-eligible candidates' needs and preferences could be employed in other health populations, thus having broader implications for research design.

Construction of an integrated sexual function questionnaire for women with breast cancer

OBJECTIVE

With the increasing incidence of breast cancer in young women, its side effects have extended into the sexual lives of women. However, an appropriate tool to measure the sexual function is nonexistent. The aim of this study was to develop a suitable tool to measure sexual function in women with breast cancer.

MATERIALS AND METHODS

After conducting literature reviews regarding the sexual function characteristics of women with breast cancer, this study designed a set of integrated sexual function questionnaires, which included pertinent information and three scales. The validity of the scales was examined under the guidance of three gender studies experts and two gynecologists who are also professors. Regarding the construct validity, researchers conducted exploratory factor analysis on the measurement results of 196 women with breast cancer.

RESULTS

The integrated sexual function questionnaires included the following three scales: "Breasts' Role Self-Checklist," "Scales for Breasts' Role in the Foreplay," and "Female Sexual Function Scale for BCSs." The questionnaire tool consisted of the longitudinal time change, patients' and their partners' situation, information related to the recovery process, participants' perspective toward objectification of women's breasts, the role of breasts in foreplay during sexual activities, sexual desire, sexual satisfaction, sexual obstacle, and other self-evaluations. We first derived one factor from six questions in "Breasts' Role Self-Checklist" and named it as "The Importance of Breasts for Women." The other two factors were obtained from eight questions in "Scales for Breasts' Role in the Foreplay" and named as "Sexual Attraction to Breasts" and "Function of Breasts in Foreplay." In addition, three factors were derived from 16 questions in "Female Sexual Function Scale for BCSs" and named as "Sexual Desire," "Sexual Satisfaction," and "Sexual Obstacle."

CONCLUSION

This study determined that these integrated scales for breast cancer survivors are suitable due to their content validity, construct validity, and high internal consistency reliability, with a Cronbach's alpha of higher than 0.9 for all the three scales.

Pre-Treatment and Post-Treatment Anxiety, Depression, Sleep and Sexual Function Levels in Patients with Breast Cancer

Objective

In the phase of diagnosis and treatment of breast cancer cases, patients can usually experience sexual dysfunctions, sleep disorders and psychiatric disorders such as anxiety and depression. The main objective of our research is to study of the pre-treatment and post-treatment anxiety, depression, sleep and sexual function levels in the patients with breast cancer.

Materials and Methods

Fifty-six patients with breast cancer and 52 healthy women have participated in our study. In order to determine the anxiety, depression, sleep and sexual function levels, Sociodemographic and Clinical Data Form, Hospital Anxiety Depression Scale (HADS), Pittsburgh Sleep Quality Scale (PSQI) and Arizona Sexual Experiences Scale (ASEX) scores are utilized at pre-treatment and post-treatment phases for patients with breast cancer and our control group.

Results

According to scale scores applied to patients and control group, it has been determined that patients with breast cancer HADS sexual and sleep disorders, that their HADS and PSQI scores were higher and that ASEX scores decreased significantly (p<0.05). According to the scale scores calculated before and after treatment, there was a significant decrease in HADS and PSQI scores, whereas SEX scores have been increased significantly (p<0.05).

Conclusion

According to the findings of our study, anxiety, depression, sexual dysfunction and sleep disorders in patients with breast cancer are far more explicit in the pre-treatment phase than post-treatment phase. Therefore, it is crucial to psycho-socially support patients with breast cancer in the early periods before starting the treatment after diagnosis.

Evaluating a couple-based intervention addressing sexual concerns for breast cancer survivors: study protocol for a randomized controlled trial

Background

Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes.

Methods

This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4).

Discussion

Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation.

Trial registration

ClinicalTrials.gov, NCT03930797. Registered on 24 April 2019.

Physical symptoms in long-term survivors of rare cancer

PURPOSE

Advances in cancer detection and treatment have resulted in a growing population of long-term survivors, but even years after treatment has concluded, many survivors report physical symptoms that interfere with daily living. While there are studies of late effects following common cancers, less is known about these complications in rare cancers. This study focuses on the physical symptoms reported by long-term survivors enrolled in the NIH-sponsored Rare Cancer Genetics Registry.

METHODS

The Rotterdam Symptom Checklist-Modified was administered to evaluate the severity of physical symptoms commonly reported by long-term cancer survivors. Logistic regression was used to assess association between symptoms and demographic and clinical factors.

RESULTS

In 309 subjects with a median time of 7.6 years from a diagnosis of one or more rare cancers, the median number of symptoms present per participant was 7. The most prevalent symptom reported was tiredness/lack of energy, which was present/very bothersome in 70%/25% of registrants. Women, non-whites, current smokers, and upper GI cancer survivors are particularly affected. Overall, symptom prevalence was similar across rare cancer types, time since diagnosis, and type of treatment.

CONCLUSIONS

Rare cancer survivors continue to experience troublesome symptoms many years after diagnosis, regardless of cancer type or treatment modality.

IMPLICATIONS FOR CANCER SURVIVORS

There is a need for continued emphasis on smoking cessation in cancer survivors as well as enhanced monitoring of long-term complications in female, non-white, and upper GI cancer survivors.

Talking about women's sexual health after cancer: Why is it so hard to move the needle?

Despite increasing calls to integrate sexual health into routine cancer care, the majority of women diagnosed with cancer do not receive information about how their cancer treatments will affect their sexual health. With the significant challenges that exist to clinical discussion of sexual health, efforts on multiple fronts are needed to close the gap in the care of women diagnosed with cancer.

Self-reported sexual health: Breast cancer survivors compared to women from the general population - an observational study

Background

Cancer survivorship is of increasing importance in post-treatment care. Sexual health (SH) and femininity can be crucial issues for women surviving cancer. We aimed to determine a more complete understanding of the contribution that a breast cancer (BC) diagnosis and its treatment exert on patients’ follow-up SH. For this purpose, self-reported levels and predictors of SH in breast cancer survivors (BCS) were compared with those of women with no previous or current BC (WNBC).

Methods

BCS and WNBC underwent a comprehensive, cross-sectional patient-reported outcome (PRO) assessment. Validated PRO instruments were used to measure SH, body image, anxiety and depression and menopausal symptoms. Assessments were performed within the routine clinical setting.

Instruments used were the Sexual Interest and Desire Inventory - Female, Sexual Activity Questionnaire, Body Image Scale, Hospital Anxiety and Depression Scale and the Menopause-Specific Quality of Life Questionnaire.

Results

One hundred five BCS (average time since diagnosis of 3 years) and 97 WNBC with a mean age of 49 years completed the assessment. SH was significantly worse in BCS compared to WNBC (p = 0.005; BCS SIDI-F mean = 24.9 vs. WNBC mean = 29.8). 68.8% of BCS and 58.8% of WNBC met criteria of a hypo-active sexual desire disorder. Higher depressive symptoms, higher age and lower partnership satisfaction were predictive for poorer SH in BCS.

Conclusion

SH problems are apparent in BCS and differ significantly from those seen in the general population. Consequently, BC survivorship care should include interventions to ameliorate sexual dysfunction and provide help with depressive symptoms and partnership problems, which are associated with poor BCS SH.

Partner social constraints and early-stage breast cancer: Longitudinal associations with psychosexual adjustment

Women with breast cancer (BC) who perceive social constraints on their disclosure of cancer-related concerns are more likely to experience distress and have difficulty adjusting after diagnosis. Much of the existing research on psychosocial adjustment is cross-sectional in nature and an important area of concern that has received little attention is psychosexual adjustment to cancer surgery and treatment. This study examined whether perceived partner social constraints were associated with psychosexual adjustment over time in 108 BC survivors. Early-stage BC patients completed measures of partner social constraints, psychosexual adjustment, and relationship dissatisfaction approximately 1 month, 8 months, and 4 years after initial surgery. Latent growth curve modeling revealed partner social constraints to be a significant time-varying, within-person predictor of psychosexual adjustment at each time point after controlling for relationship dissatisfaction. BC surgery type, reconstructive surgery, cancer stage, chemotherapy, or antihormonal adjuvant treatment did not moderate this effect. Findings point to a long-term link between social constraints and psychosexual outcomes in BC patients and clinical implications for women coping with BC. (PsycINFO Database Record

Women's experiences of sexual functioning in the early weeks of breast cancer treatment

This study describes women's sexual functioning in the early weeks of breast cancer treatment and the possible sexual changes that women may experience compared with pre-treatment functioning. Seventy-five patients filled out a questionnaire on sexual functioning and participated in a semi-structured interview on changes in sexual life and intimacy after treatment. Sixty-two women were sexually active before treatment; three post-treatment patterns of sexual behaviour were identified: 22.6% of these women were as active as before treatment, 35.5% stopped any sexual activity and 41.9% experienced quantitative and qualitative changes. Analyses showed that each pattern had specific characteristics regarding current sexual functioning, the kinds of changes reported (e.g. decreased frequency and increased tenderness) and the reasons for these changes (e.g. tiredness and sex not a priority). Even in the immediate post-surgical period, women may react in very different ways to treatment in terms of sexual functioning. Most women experience changes, but cessation of sexual activity is not inevitable. Positive changes (growing tenderness and affection) also exist. These important interindividual differences require a person-centred approach when the topic of sexuality is being addressed, and practitioners need to be sensitive to individual perceptions of change. Early detection of sexual changes may prevent the crystallisation of difficulties over time.

Interrupção e Retomada da Vida Sexual após o Câncer de Mama

RESUMO Investigou-se a interrupção/retomada da vida sexual após o tratamento do câncer de mama e sua relação com a satisfação e outros aspectos valorizados em um relacionamento. Foram empregados métodos mistos de pesquisa com a análise dos dados de uma survey realizada com 139 mulheres e dados provenientes de entrevistas com roteiro semiestruturado realizadas com 24 participantes. Um percentual expressivo de mulheres (66%) sexualmente ativas interrompeu as atividades sexuais durante o tratamento. Observou-se que a interrupção e retomada da vida sexual relacionou-se às concepções pessoais de sexualidade, influenciadas pelas relações de gênero e pela qualidade do relacionamento amoroso. A identificação de necessidades relacionadas à intimidade sexual pelo profissional de saúde pode contribuir para a assistência apropriada no processo de reabilitação psicossocial da mulher.

Satisfaction with fertility- and sexuality-related information in young women with breast cancer--ELIPPSE40 cohort

Background

Young breast cancer survivors are often dissatisfied with the information provided on fertility and sexuality. Our aim was to discuss possible contributing factors and to propose strategies to increase patient satisfaction with such information.

Methods

Using the French National Health Insurance System database, we constituted the ELIPPSE40 regional cohort of 623 women, aged 18–40, diagnosed with breast cancer between 2005 and 2011. As of January 2014, 319 women had taken part in the 10-, 16-, 28 and 48-month telephone interviews. Satisfaction with the information provided about the potential impact of cancer and its treatment on fertility and sexuality was assessed at 48 months after diagnosis on 5-point Likert scales.

Results

Four years after diagnosis, only 53.0 and 42.6 % of women were satisfied with fertility- and sexuality-related information, respectively, without any significant change over the 2009–2014 period (P = 0.585 and P = 0.676 respectively). The two issues were moderately correlated (ρ = 0.60; P <0.001). General satisfaction with medical follow-up was the only common correlate. Irrespective of sociodemographic and medical characteristics, satisfaction with fertility-related information was greater among women with a family history of breast/ovarian cancer who had the opportunity to ask questions at the time of cancer disclosure. Satisfaction with sexuality-related information increased with the spontaneous provision of information by physicians at cancer disclosure.

Conclusions

Promoting both patients’ question asking behavior and more systematic information could improve communication between caregivers and young breast cancer survivors and address distinct unmet needs regarding fertility- and sexuality- related information.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1542-0) contains supplementary material, which is available to authorized users.

Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study

BACKGROUND

Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes.

METHOD

This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview.

RESULTS

Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer.

CONCLUSION

The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.

Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer

BACKGROUND

Changes to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study.

METHOD

Six hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships.

RESULTS

Men and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer.

CONCLUSION

These results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.

Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

OBJECTIVE

Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.

DESIGN/OUTCOME MEASURES

Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).

RESULTS

Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.

CONCLUSIONS

Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.

After breast cancer: sexual functioning of sexual minority survivors

Research on sexual difficulties after cancer has neglected sexual minority women (SMW); for example, lesbian and bisexual women. Clinicians treating these women are therefore at a disadvantage as they lack information about sexual problems in this population. This study tested the hypothesis that SMW with breast cancer have poorer sexual function than SMW without breast cancer, distinguishing partnered from unpartnered women. Using convenience sample recruitment, we conducted a case-control study to compare survivors of breast cancers who are SMW, in other words, cases to controls, that is, SMW without cancer. Anonymous survey data were collected from 85 cases after they had completed active cancer treatment and 85 age- and partner-status matched controls with no history of any cancer. Participants' self-reported sexual frequency and sexual function measured by the Female Sexual Function Index were evaluated. Cases and controls did not differ in risk of sexual dysfunction or the level of overall sexual functioning; however, cases had lower sexual frequency and scored lower on desire and ability to reach orgasm, and higher on pain compared to controls. Results inform clinicians about sexual minority survivors' sexual domains affected by cancer. When discussing sexual problems and therapeutic options, sexual orientation should be ascertained.

Explanatory factors of sexual function in sexual minority women breast cancer survivors

BACKGROUND

The sexual function of sexual minority women (women with female partners) who are breast cancer survivors is mostly unknown. Our objective is to identify explanatory factors of sexual function among sexual minority women with breast cancer and compare them with a control sample of sexual minority women without cancer.

PATIENTS AND METHODS

Using a conceptual framework that has previously been applied to heterosexual breast cancer survivors, we assessed the relationship of each explanatory factor to sexual function in sexual minority women. Using generalized estimating equations, we identified explanatory factors of sexual function and identified differences by case and control status.

RESULTS

Self-perception of greater sexual attractiveness and worse urogenital menopausal symptoms explain 44% of sexual function, after controlling for case and control status. Focusing only on partnered women, 45% of sexual function was explained by greater sexual attractiveness, postmenopausal status, and greater dyadic cohesion.

CONCLUSIONS

All of the relevant explanatory factors for sexual function among sexual minority survivors are modifiable as has been suggested for heterosexual survivors. Sexual minority survivors differ from heterosexual survivors in that health-related quality of life is less important as an explanatory factor. These findings can guide adaptation of interventions for sexual minority survivors.

Quality of life outcomes in patients with breast cancer

Health-related quality of life is now considered an important endpoint in cancer clinical trials. It has been shown that assessing quality of life in cancer patients could contribute to improved treatment and could even serve as a prognostic factor along with medical parameters. This paper presents a review of quality of life outcomes in patients with breast cancer according to previous descriptive findings. This is a bibliographic review of the literature covering publications that appeared in English language biomedical journals between 1987 and 2008. The search strategy included a combination of the key words quality of life and breast cancer in the titles of published articles. The major findings are summarized and presented under different headings: evaluation of health-related quality of life i) at the time of diagnosis, ii) during treatment, and iii) after the completion of treatment. Breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that have a negative effect on their quality of life. Also adjuvant hormonal therapies were found to have a similar negative impact on quality of life. Psychological distress-anxiety and depression were found to be common among breast cancer patients. Symptoms-pain, fatigue, and insomnia were among the most common symptoms reported. There was quite an extensive body of literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care.

Perceived partner support and psychosexual adjustment to breast cancer

Support from a partner can play a key role in a woman's emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a woman's sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partner's provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.

If I am in the mood, I enjoy it: an exploration of cancer-related fatigue and sexual functioning in women with breast cancer

BACKGROUND

We recently reported that cancer-related fatigue (CRF) after adjuvant breast cancer therapy was prevalent and disabling, but largely self-limiting within 12 months. The current paper describes sexual functioning (SF) and its relationship to CRF, mood disorder, and quality of life (QOL) over the first year after completion of adjuvant therapy.

METHODS

Women were recruited after surgery, but prior to commencing adjuvant treatment, for early-stage breast cancer. Self-reported validated questionnaires assessed SF, CRF, mood, menopausal symptoms, disability, and QOL at baseline, completion of therapy, and at 6 months and 12 months after treatment.

RESULTS

Of the 218 participants, 92 (42%) completed the SF measure (mean age, 50 years). They were significantly younger, more likely to be partnered, and less likely to be postmenopausal than nonresponders. At baseline, 40% reported problems with sexual interest and 60% reported problems with physical sexual function. SF scores declined across all domains at the end of treatment, then improved but remained below baseline at 12 months, with a significant temporal effect in the physical SF subscale and a trend for overall satisfaction. There were significant correlations between the SF and QOL domains (physical and emotional health, social functioning, and general health) as well as overall QOL. The presence of mood disorder, but not fatigue, demographic, or treatment variables, independently predicted worse overall sexual satisfaction.

CONCLUSIONS

Sexual dysfunction is common after breast cancer therapy and impacts QOL. Interventions should include identification and treatment of concomitant mood disorder.

Permanent stoma not only affects patients' quality of life but also that of their spouses

BACKGROUND

Living with a permanent colostomy can significantly diminish a patient's quality of life. However, little is known about the effects on the patient's spouse. Therefore, the aim of the present study was to evaluate the quality of life of spouses whose partners had undergone sphincter-sacrificing surgery for rectal carcinoma.

METHODS

We studied 56 couples after one partner underwent sphincter-sacrificing surgery for rectal carcinoma: female spouses (n = 30) and male spouses (n = 26). To identify how surgery affected the life standards of the spousal population, questionnaires were constructed by the Department of Public Health, General Surgery and Psychology at the University of Ankara.

RESULTS

Sixteen of 26 male spouses increased time spent at home, whereas 10 of 30 female spouses increased time spent at home (p < 0.05, male spouses versus female spouses). All of the spouses had been sexually active before their partners' operation; however 20 of 26 male spouses and 10 of 30 female spouses were sexually inactive afterward (p < 0.05, male spouses versus female spouses). Ten male patients and 3 female patients wanted their colostomy care to be managed by their spouses (p < 0.01, female spouses versus male spouses).

CONCLUSIONS

In a patient with a colostomy, the social and sexual aspects of the life of the patient's spouse are affected. This observation needs to be taken into account when patients are preoperatively counseled. Therefore, preoperative counseling regarding the possible problems after surgery should not only include the patient but also the spouse.

Changes in sexual problems over time in women with and without early-stage breast cancer

OBJECTIVE

We aimed to evaluate whether age-matched women with and without early-stage breast cancer differentially experience sexual problems over time and whether changes in patients' problems differ by type of surgical procedure.

METHODS

We conducted four interviews (4-6 wk, 6 mo, and 1 and 2 y) after tumor resection (patients) or after a negative/benign screening mammogram (controls). Mixed-effects models with repeated ordinal measurements tested the effects of time and diagnostic group (stages 0, I, and IIA vs controls) and, for patients, the effects of time and type of surgical procedure (mastectomy vs lumpectomy) using a newly developed nine-item sexual-problem measure. Two-sided P values < 0.05 were considered significant.

RESULTS

Using data from 1,033 women (17.3% stage 0, 33.4% stage I/IIA, and 49.3% controls; mean age, 57.1 y; 23.1% nonwhite; 64.7% married), two factors measuring problems with sexual attractiveness and sexual interest/enjoyment emerged in exploratory factor analysis (alpha > or = 0.74 for each subscale and the nine-item measure). Patients and controls reported few sexual problems on average, but controls were more likely to report sexual problems on the nine-item measure over time and stage I patients were less likely to report problems with sexual attractiveness over time (each P < 0.05) compared with at baseline. Patients who underwent mastectomy (35.7%) were 2.7 times more likely to report sexual problems on the nine-item measure at 2-year follow-up compared with baseline (P = 0.0339).

CONCLUSIONS

Patients and controls experienced few sexual problems over time, and in fact, controls were more likely to report sexual problems at subsequent interviews, whereas patients were not.

Sexuality and quality of life of breast cancer patients post mastectomy

AIM

To evaluate the sexual functioning of breast cancer patients post mastectomy and its association with their quality of life, the personal characteristics of women and their partners, breast reconstruction, cancer staging and adjuvant therapies.

METHODS

A cross-sectional study was carried out in a University hospital located in the SouthEast of Brazil. A total of 100 women were included in the study. The parameters evaluated were sexual functioning, which was assessed based on the Sexual Quotient - Female Version (SQ-F), quality of life (QoL), evaluated by the Medical Outcomes Study 36-item Short Form (SF-36), cancer staging, breast reconstruction, adjuvant therapies and the personal characteristics of patients (age, years of study and years of marriage) and their partners (age, years of study).

RESULTS

The majority (40.48%) of women had an unfavorable to regular SQ-F score. A significant positive correlation (p<0.05) was found between the SQ-F score and years of education (p=0.03), and the following SF-36 domains: functional capacity (p=0.03), vitality (p=0.06), emotional limitations (p=0.00) and mental health (p=0.03). A significant negative correlation was found between SQ-F score and the age of the partners (p=0.03). SQ-F mean value was significantly higher (p=0.04) among women who underwent breast reconstruction.

CONCLUSIONS

Women with low educational level, who have older partners, and who did not have a breast reconstruction should receive special attention with respect to their sexuality, and the effects of mastectomy on the sexuality of patients should be assessed. Oncology nurses are best qualified to recognize issues related to sexuality and quality of life, and can offer specific and meaningful support for breast cancer patients.

Sexual concerns in cancer patients: a comparison of GI and breast cancer patients

PURPOSE

Although sexual concerns have been examined in breast cancer (BC), these concerns remain understudied and undertreated for patients with gastrointestinal (GI) cancer. Objectives were to: (1) assess sexual concerns in GI cancer patients compared with breast cancer patients; (2) examine whether sexual concerns are stable over time in GI and breast cancer patients; and (3) evaluate whether sexual concerns in GI and breast cancer are significantly associated with quality of life, symptom severity, and disease interference, and whether these associations change over time.

METHODS

Data were collected from GI and breast cancer patients during four outpatient clinic visits over 6 months. Measures included sexual concerns (reduced sexual enjoyment, interest, or performance), quality of life (FACT-G), symptom severity, disease interference (MD Anderson Symptom Inventory), and disease-related distress (NCCN Distress Scale). Linear mixed model analyses were conducted.

RESULTS

Sexual concerns were common in both samples, with 57% of GI cancer patients and 53% of breast cancer patients reporting at least mild sexual concerns. Sexual concerns were stable over time and were significantly associated with lower levels of functioning in multiple domains (e.g., quality of life, symptom severity, disease interference, and disease-related distress), irrespective of length of time since diagnosis. Cancer type (GI/breast cancer) was not a moderator of this relationship.

CONCLUSIONS

Self-reported sexual concerns were common, stable, and related significantly to quality of life, symptom severity, disease interference, and disease-related distress for both GI and breast cancer patients. Limitations and implications for future research are discussed.

Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey

OBJECTIVE

The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early-stage breast cancer survivors (BCS).

METHODS

Eight hundred and fifty eligible, post-treatment (6 months-5 years) female patients, aged 18-70 years, randomly selected from a consultation list, were invited to fill in questionnaires exploring quality of life (EORTC QLQ-C30 and QLQ-BR23), body image scale, and sexuality (Sexual Activity Questionnaire-SAQ; Relationship and Sexuality Scale; French Sexual Behaviour Survey-CSF).

RESULTS

Fifty-three percent of BCS agreed to participate. Participating women (n=378) were younger, more often premenopausal at diagnosis and with a more recent diagnosis than non-respondents. The prevalence of sexual problems was significantly higher in BCS compared with adjusted data from a French female representative sample (p<0.0001). In logistic regression, no sexual activity (R(2) =0.37) or sexual dissatisfaction (R(2) =0.28) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, poorer body image, or co-morbidities. In sexually active women (71% of respondents), lower frequency of sexual activity (R(2) =0.26), lower sexual pleasure (R(2) =0.22), or higher sexual discomfort (R(2) =0.22) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, age (>50 years), nausea, or insomnia (all Hosmer-Lemeshow tests: p=NS).

CONCLUSIONS

Psychological factors including the perception of the couple relationship appeared prominent in BCS women's experience of sexual problems.

Sexuality after breast cancer: a review

It is widely recognised that women's sexuality can be particularly complex after breast cancer, with sexual changes often becoming the most problematic aspect of a woman's life. The impact of such changes can last for many years after successful treatment, and can be associated with serious physical and emotional side-effects. The objective of this paper is to review research on breast cancer and sexuality from the years 1998 to 2010. Research has documented a range of physical changes to a woman's sexuality following breast cancer, including disturbances to sexual functioning, as well as disruptions to sexual arousal, lubrication, orgasm, sexual desire, and sexual pleasure, resulting from chemotherapy, chemically induced menopause, tamoxifen, and breast cancer surgery. Women's intrapsychic experience of changes to sexuality includes a fear of loss of fertility, negative body image, feelings of sexual unattractiveness, loss of femininity, depression and anxiety, as well as alterations to a sense of sexual self. The discursive construction of femininity and sexuality shapes the way women construct and experience their illness and their body - leading many women to try to appear 'normal' to others post-breast surgery. Finally, the quality of a woman's partnered relationship consistently predicts sexual health post-breast cancer - reinforcing the importance of recognising the intersubjective nature of issues surrounding breast cancer and sexuality. It is concluded that analyses of sexuality in the context of breast cancer cannot conceptualise the physical body separately from women's intrapsychic negotiation, her social and relational context, and the discursive constructions of sexuality and femininity: a material-discursive-intrapsychic interaction.

Urogenital atrophy in breast cancer survivors

PURPOSE/OBJECTIVES

To review the symptoms of urogenital atrophy in breast cancer survivors, influencing factors, and their effects on performance.

DATA SOURCES

Review of qualitative and quantitative research data that describe pain, function, satisfaction, and quality of life related to urologic, genital, and sexual function.

DATA SYNTHESIS

Breast cancer treatment can induce or exacerbate symptoms related to urogenital atrophy. The lower urinary and genital tracts are affected by physiologic alterations, the potential abrupt onset of menopause, and treatment side effects. Symptoms of urogenital atrophy often are more prevalent and severe in women treated for breast cancer than in age-matched women without breast cancer.

CONCLUSIONS

Symptoms related to urogenital atrophy are common in breast cancer survivors and can be affected by physiologic, situational, and psychological influences with negative effects on performance. Research is essential to the understanding of how transient or permanent hormonal alterations affect the urogenital system and the role of these symptoms on quality of life.

IMPLICATIONS FOR NURSING

Nurses must listen with sensitivity to breast cancer survivors and their descriptions of these significant and life-altering symptoms. Personalized discussion enables the nurse to explore issues, assess symptoms, recommend interventions, and evaluate at follow-up visits. Nurses are integral to the provision of survivorship care planning that can address the short- and long-term effects of a cancer diagnosis and related treatments.

Sexual health issues in Sudanese women before and during hormonal treatment for breast cancer

OBJECTIVE

Recent Sudanese studies have focused on depression and anxiety in women treated for breast cancer (BrCa). Less is known about whether such women suffer from sexual disturbances due to different cancer treatments. This study compares BrCa patients with a healthy control group and assessed the impact of cancer treatment types.

METHODS

The BrCa group included women treated for BrCa with mastectomies, chemotherapy and radiotherapy (N=100). Some received hormonal therapy (N=60) and others had not yet received it (N=40). The control group comprised women who had never had BrCa, non-BrCa (N=100). Outcomes were assessed using the Watts Sexual Function Questionnaire.

RESULTS

It was found that many women treated for BrCa suffered from sexual disturbances before hormonal treatment while some regained sexual activity during hormonal treatment. Demographic data show negative correlation (P=0.03) between sexual function and age of the patients, positive correlation (P=0.002) between sexual function and educational level and positive correlation (P=0.031) as well between sexual function and the patient's length of marriage.

CONCLUSION

This study helps to fill the gap in the literature about Sudanese women's sexuality, as many studies indicate the effect of some psychological disturbance (depression and anxiety) and ignoring the effect of sexual function in enhancing patient's quality of life.

Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention

While quality of life for most breast cancer survivors (BCS) returns to normal by 1 year post-treatment, problems in sexual function and intimacy often persist. The present study tested the efficacy of a 6-week psycho-educational group intervention in improving BCS's sexual well-being. We conducted a mailed survey of BCS 1-5 years post-diagnosis to identify a sample of women who reported moderately severe problems in body image, sexual function or partner communication, and were deemed eligible for the randomized intervention trial. Using a pre-randomized design, 70% (n = 284) were assigned to a 6-week psycho-educational group intervention and 30% (n = 127) were assigned to a control condition (print material only); however, only 83 BCS agreed to participate in the intervention. Four months post-intervention, the intervention and control groups were not significantly different on the primary outcome of emotional functioning; however, BCS randomized to the intervention group were more likely to report improvements in relationship adjustment and communication as well as increased satisfaction with sex compared to controls. Members of the intervention group who were the least satisfied with their sexual relationship appeared to improve the most. Although modest in its effects, this intervention can be delivered in standard clinical settings. Having an identified treatment may help reduce physician reluctance to ask BCS about problems in intimacy and as appropriate, refer them for timely help.

Concerns of former breast cancer patients about disease recurrence: a validation and prevalence study

OBJECTIVE

The present study has three aims: first, to evaluate the psychometric properties of the Dutch version of the CARS (CARS-DLV). Second, to measure the prevalence of concerns about disease recurrence in former breast cancer patients and identify potential predictors and third, to establish how fear of recurrence was effecting quality of life.

METHODS

A prospective study was carried out on breast cancer patients (n=136) who had undergone curative treatment. Eligible patients completed an extensive questionnaire consisting of the CARS (fear of recurrence), HADS (anxiety and depression), BPI (pain), RAND (quality of life), LOT (optimism) and the PCS (catastrophizing).

RESULTS

This study confirmed the good internal consistency, test-retest stability and construct validity of the CARS (Dutch Language version). Moderate to high levels of fear of disease recurrence were found in 56% of 136 breast cancer survivors. Worries about health and death were the most prominent. Pain was a strong predictor of overall fear and of fear on the four sub domains of the CARS. The prevalence of fear decreased significantly with age. Education level, living arrangements and time since the last treatment did not predict the prevalence of overall fear. Fear of recurrence was negatively correlated with quality of life.

CONCLUSION

The CARS-DLV proved to be a valuable instrument to measure women's' concerns about breast cancer recurrence. More than half of former breast cancer patients indicated moderate to severe concerns about disease recurrence. Health and death worries were the most prominent. The levels of worry were independent of the time since diagnosis.