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Alinejad Mofrad S, Green H, Sawleshwarkar S, Alananzeh I, Fernandez R. Experiences Relating to Sexual Well-Being Among Muslim Gynecological Cancer Survivors: A Systematic Review of Qualitative Studies. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:530-545. [PMID: 39035138 PMCID: PMC11257125 DOI: 10.1089/whr.2023.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 07/23/2024]
Abstract
Background Gynecological cancers are one of the most important threats to women's health worldwide. The objective of this review is to synthesize and present the best available evidence on the experiences relating to sexual well-being among Muslim women with gynecological cancer. Methods The databases searched included Web of Science, Scopus, SID, Google Scholar, ProQuest, MEDLINE, and CINAHL from the inception of the database until August 2021. The review was guided by the JBI methodology used for qualitative systematic reviews. Findings were collated using the meta-aggregation method through JBI SUMARI. Results Eight studies involving Muslim women cancer survivors were included in the review. Meta-synthesis of the eight included studies generated 59 findings, which were organized into 14 categories and combined into four synthesized findings. Conclusions Gynecological cancer and its treatment results in numerous challenges with sexual well-being among Muslim women cancer survivors. Providing information about sexual activity following gynecological cancer, better communication from health care professionals, and support from the husband is essential to overcome the struggle with intimacy and femininity experienced by the women, thus improving the sexual quality of life of Muslim gynecological cancer survivors.
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Affiliation(s)
- Samaneh Alinejad Mofrad
- Department of Nursing and Midwifery, School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Heidi Green
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Shailendra Sawleshwarkar
- Faculty of Medicine and Health, Sydney Infectious Diseases Institute, The University of Sydney, Westmead, Australia
| | - Ibrahim Alananzeh
- University of Wollongong Dubai, School of Humanities, Social Sciences and Health, Dubai, United Arab Emirates
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
- Centre for Transformative Nursing, Midwifery, and Health Research: A JBI Affiliate Centre
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Breistig S, Thorkildsen KM, Werner HMJ, Nordgreen T, Sekse RJT. Redefining sexual health after gynaecological cancer: Lived experiences from Gynea, a digital rehabilitation programme. J Clin Nurs 2024; 33:1110-1121. [PMID: 37984464 DOI: 10.1111/jocn.16923] [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: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Gynaecological cancer illness and treatment have a significant impact on women's sexual health and concerns regarding sexual health are known to be an unmet need in survivors. The digital support programme Gynea was designed to enhance women's health, including sexual health, after gynaecological cancer treatment. This study aimed to explore how cancer survivors experienced participation in Gynea. METHODOLOGY This is a phenomenological hermeneutic study. Individual, in-depth semi-structured interviews were conducted to explore lived experiences. Twenty women were interviewed after completing the Gynea programme. The transcripts were analysed using Lindseth and Norberg's phenomenological hermeneutic method. FINDINGS Three main themes (with subthemes) emerged from the analysis: (1) A silent existential trauma; (2) Redefining sexual health; (3) Communicating with a partner about sexuality. The women redefined sexual health rather than just being sexual intercourse, being a rediscovery of the body. The women's increased awareness and understanding of their own sexual health empowered their communication about their sexuality with their partners. This was important for regaining sexual health and intimacy in their relationships. CONCLUSION Participation in Gynea helped to strengthen the women's sexual integrity. Knowledge and support empowered them to take care of their sexual needs and communicate these with their partners. IMPLICATIONS FOR PATIENT CARE Healthcare services and nurses need to be aware that sexual health is an existential state of being, in which good sexual health does not necessarily equate to sexual function, but rather to sexual empowerment. Digital support with nurse guidance can support women in caring for their sexual health after cancer illness by thematizing sexual health with a holistic approach and should be part of the medical treatment. PATIENT OR PUBLIC CONTRIBUTION Twenty gynaecological cancer survivors contributed by sharing their experiences from the sexual health module in Gynea.
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Affiliation(s)
- Sigrund Breistig
- Centre of Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
| | - Kari Marie Thorkildsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Henrica Maria Johanna Werner
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW - School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ragnhild Johanne Tveit Sekse
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Pillay B, Ritchie D, Panek-Hudson Y, Jefford M, Garcia T, Shields C, Gniel J, Phipps-Nelson J, Drosdowsky A, Ellen S, Ftanou M. Evaluating the Feasibility and Acceptability of a Psychosexual Intervention for Couples Post-allogeneic Hematopoietic Stem Cell Transplantation. Integr Cancer Ther 2024; 23:15347354241230956. [PMID: 38426395 PMCID: PMC10908224 DOI: 10.1177/15347354241230956] [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: 08/05/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Allogeneic hematopoietic stem cell transplantation (HSCT) can have a long-term impact on patients' sexual functioning and consequently, their relationship satisfaction. This study aimed to examine the feasibility and acceptability of a 5-session psychosexual intervention for HSCT survivors and their partners. METHODS To be eligible patients were required to be more than 3 months post-allogeneic HSCT. The intervention comprised 2 components: (1) A psychosexual education session exploring medical/behavioral treatment options for sexual dysfunction, delivered by a specialist nurse; (2) A 4-session Emotionally-Focused Therapy-based relationship education program for couples delivered by a clinical psychologist. Measures assessing relationship quality, sexual functioning, anxiety, and depression were administered pre- and post-intervention. Feasibility was measured via participation rate, adherence and compliance with completing main measures. Acceptability of the intervention was assessed via patient/partner satisfaction surveys. RESULTS Eight of 85 (9.4%) eligible patients and their partners participated in the study. Reasons for declining participation included: feeling uncomfortable due to sensitive nature of intervention; did not have any relationship/sexual function issues; and experiencing ongoing medical issues. Six of 8 couples (75%) attended at least 4 intervention sessions and 5 of 8 (62.5%) completed the main study measures post-intervention. Four couples reported that sexual satisfaction and relationship satisfaction was somewhat or much better post-intervention; 1 reported no change. CONCLUSION Feasibility criteria were not met, with low enrolment rate, however the intervention was deemed acceptable. Couples who participated adhered to the intervention and considered it beneficial. Further strategies to identify and manage sexual concerns are required.
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Affiliation(s)
- Brindha Pillay
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yvonne Panek-Hudson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Jefford
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Teresa Garcia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cassandra Shields
- University of Queensland, Queensland, Australia
- The Australian Centre for Emotionally Focused Therapy, Queensland, Australia
| | - Jo Gniel
- Landscape of Life, Melbourne, Victoria, Australia
| | - Jo Phipps-Nelson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Steve Ellen
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
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Physical and psychosocial factors associated with sexual satisfaction in long-term cancer survivors 5 and 10 years after diagnosis. Sci Rep 2023; 13:2011. [PMID: 36737619 PMCID: PMC9898518 DOI: 10.1038/s41598-023-28496-1] [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: 10/05/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Our study provides data on sexual satisfaction among long-term cancer survivors 5 and 10 years after diagnosis, and identifies factors detrimental (e.g. psychosocial and physical symptom burden) or beneficial (e.g. social support) to survivors' sexual satisfaction. We measured sexual satisfaction among cancer survivors recruited via the local clinical cancer registry across a wide range of tumor sites 5 years (cohort 1) and 10 years (cohort 2) after diagnosis. We further assessed chronic comorbidity index (CCI) and symptom scales (EORTC QLQ-C30), depression (PHQ-9) and anxiety (GAD-7), satisfaction with partnership (PFB), quality of life (EORTC QLQ-C30), and social support (OSSS). 924 patients (5-year cohort = 608/10-year cohort = 316) participated in the study (53% men, 80% cohabiting, mean age 66 years, range 18-85). We found that nearly half of the respondents perceived their sexual life as less satisfying than before cancer. High sexual satisfaction was associated with a low chronic comorbidities index (r = - 0.27, p < .001), less fatigue (r = - 0.35, p<.001), less nausea/vomiting (r = - 0.13, p<.001) and less pain (r = - 0.23, p<.001), r ; less depression (r = - 0.24, p < .001), less anxiety(r = - 0.23, p < .001); a high level of social support (r = 0.16, p < .001), a high level of satisfaction with their relationship (r = 0.24, p < .001), and high quality of life (r = 0.33, p < .001). Sexual satisfaction may be affected by both psychosocial and physical symptom burden, with the latter having a greater impact on sexual satisfaction. It is essential for health care providers that sexual health issues are understood, evaluated, and treated, including those of long-term cancer survivors.
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Chin C, Damast S. Brachytherapy impacts on sexual function: An integrative review of the literature focusing on cervical cancer. Brachytherapy 2023; 22:30-46. [PMID: 36567175 DOI: 10.1016/j.brachy.2022.10.012] [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: 08/02/2022] [Revised: 10/17/2022] [Accepted: 10/27/2022] [Indexed: 12/24/2022]
Abstract
There is growing awareness of the importance of sexual health in the quality of life of cancer patients and survivors. Brachytherapy, a vital component for the curative treatment of cervical cancer, leads to both direct and indirect sequelae that result in vaginal and sexual morbidity. The emergence of 3D image-guided adaptive brachytherapy has led to a better understanding of dose-and-effect relationships for critical organs-at-risk and there are new recommendations for vaginal dose reporting in the ongoing EMBRACE II study. An understanding of the vagina as an organ-at-risk and its dose-and-effect relationships can help brachytherapists limit dose to the vagina and improve sexual morbidity. Brachytherapists play a critical role in the primary and secondary prevention of vaginal and sexual sequelae resulting from treatment. Through close surveillance and recognition of common symptoms, brachytherapists can intervene with effective strategies to prevent and treat vaginal and sexual symptoms. This review summarizes the current literature on dosimetric factors that may predict for vaginal morbidity. It will focus on quantitative and qualitative reports of brachytherapy-related vaginal toxicity and sexual dysfunction. Lastly, it will review the available evidence supporting clinical interventions to mitigate the development and progression of vaginal and sexual sequelae to improve functional quality post-treatment.
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Affiliation(s)
- Christine Chin
- Radiation Oncology, Columbia University Irving Medical Center New York, New York, NY.
| | - Shari Damast
- Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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Arthur EK, Menon U, Reese JB, Browning K, Overcash J, Rose K, Wills CE. Profiles of women's adjustment after cancer based on sexual and psychosocial wellbeing: results of a cluster analysis. BMC Cancer 2022; 22:1003. [PMID: 36131276 PMCID: PMC9491007 DOI: 10.1186/s12885-022-10093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual wellbeing is a critical yet often overlooked aspect of overall wellbeing for women across cancer diagnoses. OBJECTIVE We identified profiles of women cancer survivors by sexual and psychosocial outcomes and compared groups for differences in relevant outcomes and individual characteristics. METHODS Partnered women treated for cancer (n = 226; M age = 51.1 (12.6); 54% breast cancer; 86% White) completed a cross-sectional survey assessing sexual and psychosocial wellbeing. K-means cluster analysis modeled subgroups (clusters) with similar response patterns on measures of sexual wellbeing (sexual function, distress, sexual communication, and self-efficacy for communication), psychosocial wellbeing (quality of life (QOL), anxiety and depressive symptoms), and time since treatment. ANOVAs with Tukey post-hoc analyses and chi-square analyses tested cluster mean differences. RESULTS Three distinct clusters of women differed by levels of adjustment in sexual and psychosocial wellbeing: higher-adjustment (32.7%), intermediate (37.6%), and lower-adjustment (29.6%). Significant differences among the clusters were found for all outcomes, with largest effect sizes for sexual distress (η2p = 0.66), sexual communication (η2p = 0.51), sexual satisfaction (η2p = 0.44), and anxiety and self-efficacy for communication (η2p = 0.32). The intermediate adjustment group was characterized by lower adjustment on measures of sexual and relationship function, and better adjustment on measures of QOL and mood. CONCLUSIONS Findings suggest that for women cancer survivors, measures of sexual and psychosocial wellbeing can model distinct profiles to inform targeted interventions to meet women's needs. Evidence-based targeted interventions could lead to better sexual function, and ultimately to better QOL and overall wellbeing. IMPLICATIONS FOR PRACTICE A stepped intervention approach to sexual health care for women with cancer, where content and format depend on degree of sexual and psychosocial adjustment after cancer, may be most appropriate. Interdisciplinary teams may address sexual, emotional, and relationship functioning.
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Affiliation(s)
- Elizabeth K Arthur
- The Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, OH, 43210, USA.
| | - Usha Menon
- University of South Florida, College of Nursing, 12901 Bruce B. Downs, MDN 22, Tampa, FL, 33612-4742, USA
| | - Jennifer Barsky Reese
- Fox Chase Cancer Center, Cancer Prevention and Control Program, 333 Cottman Ave, Philadelphia, PA, 19093, USA
| | - Kristine Browning
- The Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - Janine Overcash
- The Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - Karen Rose
- The Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - Celia E Wills
- The Ohio State University, College of Nursing, 1585 Neil Ave, Columbus, OH, 43210, USA
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Okpo E, Othieno R, Eleje GU, Oragwu CI, Eke AC. Interventions to improve psychosexual function in women treated for gynaecological cancers. Hippokratia 2022. [DOI: 10.1002/14651858.cd014674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emmanuel Okpo
- Regional Health Protection Team, North East England; UK Health Security Agency (UKHSA); Newcastle UK
| | - Richard Othieno
- NHS Lothian, Directorate of Public Health and Health Policy; Edinburgh UK
| | - George U Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynaecology; Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus; PMB 5001, Nnewi Nigeria
| | | | - Ahizechukwu C Eke
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics; Johns Hopkins University School of Medicine; Baltimore Maryland USA
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da Silva Lara LA, Rufino AC, Oliveira FF, Rossato S, Borges CS, Reis RM. Female sexual dysfunctions: an overview on the available therapeutic interventions. Minerva Obstet Gynecol 2022; 74:249-260. [PMID: 35147017 DOI: 10.23736/s2724-606x.22.04966-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
INTRODUCTION There are different types of female sexual dysfunctions (FSDs), and FSD in general has a high prevalence worldwide. Studies of FSD should consider it as a multifactorial disorder that has biological, psychological, environmental, and relational aspects. In this review we discuss the available therapeutic interventions for FSD. EVIDENCE ACQUISITION For the current narrative review the PubMed database was searched to identify all publications up to 30 March 2021 that were systematic reviews and meta-analyses which examined therapeutic interventions for FSDs based on the diagnostic classifications of ICD-10 and ICD-11. EVIDENCE SYNTHESIS Thirty systematic reviews and meta-analyses were included in this review. Hormone therapy (HT) and testosterone are effective to improve sexual desire in menopausal women. In these women HT and ospemiphene may improve pain during intercourse. Flibanserin may improve sexual desire and may reduce desire-related distress in premenopausal women. Bremelanotide is effective to improve desire, arousal, and orgasm scores. Evidence are still limited on the efficacy of psychoactive drugs, phosphodiesterase type 5 (PDE5), oxytocin, herbal drugs, and tibolone to treat FSDs. Psychological interventions such as cognitive-behavior therapy, mindfulness training, sensate focus, bibliotherapy are effective for the management of several different FSDs. CONCLUSIONS The management of FSDs may require multidisciplinary and interdisciplinary approaches. Pharmacological and nonpharmacological interventions appears to have potential as a treatment for FSDs, but there are currently no gold standards regarding recommended treatment modalities, and the duration, frequency, and intensity of therapy sessions.
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Affiliation(s)
- Lucia A da Silva Lara
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil -
| | - Andrea C Rufino
- Faculty of Medicine, State University of Piauí, Piauí, NE, Brazil
| | - Flávia F Oliveira
- Endometriosis Sector, Faculty of Medicine, Hospital das Clínicas, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Serena Rossato
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Charles S Borges
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rosana M Reis
- Reproduction Center, Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
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Reese JB, Zimmaro LA, McIlhenny S, Sorice K, Porter LS, Zaleta AK, Daly MB, Cribb B, Gorman JR. Coping With Changes to Sex and Intimacy After a Diagnosis of Metastatic Breast Cancer: Results From a Qualitative Investigation With Patients and Partners. Front Psychol 2022; 13:864893. [PMID: 35465532 PMCID: PMC9019080 DOI: 10.3389/fpsyg.2022.864893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Prior research examining sexual and intimacy concerns among metastatic breast cancer (MBC) patients and their intimate partners is limited. In this qualitative study, we explored MBC patients' and partners' experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences. Methods We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software. Results Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: (1) the heavy disease/treatment burden leads to significant, long-term sexual concerns (e.g., loss of interest and vaginal dryness/discomfort) and consequent heightened emotional distress for both patients (e.g., guilt around not being able to engage in intercourse) and partners (e.g., guilt around pressuring the patient to engage in sexual activity despite pain/discomfort); (2) viewing the relationship as having "an expiration date" (due to expected earlier mortality) influences patients' and partners' concerns related to sex/intimacy and complicates coping efforts; and (3) information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences. Conclusion Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients' and partners' perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients' health and quality of life.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lauren A. Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Sarah McIlhenny
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Kristen Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Laura S. Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Alexandra K. Zaleta
- Research and Training Institute, Cancer Support Community, Philadelphia, PA, United States
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Beth Cribb
- Cancer Support Community of Greater Philadelphia, Philadelphia, PA, United States
| | - Jessica R. Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
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Interventions to Improve Sexual Health in Women Living with and Surviving Cancer: Review and Recommendations. Cancers (Basel) 2021; 13:cancers13133153. [PMID: 34202477 PMCID: PMC8268945 DOI: 10.3390/cancers13133153] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/15/2023] Open
Abstract
Sexual health concerns, both physical and psychological, are common and represent an unmet need among women with and surviving cancer. Sexual challenges and conditions negatively impact body image, satisfaction, relationships, well-being, and quality of life, yet are widely reported to be under-recognized and undertreated. To guide clinical care and future research on sexual function in women with cancer, we performed a scoping review of interventions for sexual health concerns, including sexual function, body image, genitourinary symptoms, and hot flashes. Relevant publications between 2005 and 2020 were identified by searching PubMed with a combination of medical subject headings and keywords. Articles were included if they focused on the aforementioned topics, were primary research publications, and included female cancer survivors. Studies focusing on women receiving hormone therapy for breast cancer were also included. A total of 91 investigations conducted in the US and abroad were reviewed. Most commonly, interventions included a component of psychoeducation, although pharmacologic, exercise, and other approaches have been evaluated. Many studies have focused on survivors of breast or gynecologic cancer, among other sampling and methodological limitations. These limitations underscore the need for more work on this vital survivorship issue. Recommendations for future research in this area are also offered.
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Brandt C. Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1538. [PMID: 34192209 PMCID: PMC8182461 DOI: 10.4102/sajp.v77i1.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/05/2021] [Indexed: 11/06/2022] Open
Abstract
Background Pelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education. Objectives My study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM). Method Various databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements. Results My study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another. Conclusion Biomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice. Clinical implications Incorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.
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Affiliation(s)
- Corlia Brandt
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ye M, Yu L, She Y, Wang S, Wang M, Zhao Q, Gu C, Bian L, Wen N, Gong J, Li L, Meng Y. Healing effects of a protein scaffold loaded with adipose-derived mesenchymal stem cells on radiation-induced vaginal injury in rats. J Int Med Res 2021; 48:300060520958826. [PMID: 33115306 PMCID: PMC7607296 DOI: 10.1177/0300060520958826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives Cervical cancer, the most common female cancer after breast cancer, is
typically treated using radiotherapy. However, pelvic radiotherapy can cause
irreversible damage to the vagina, seriously affecting patients’ quality of
life. In this study, protein scaffolds loaded with rat adipose-derived
mesenchymal stem cells (ADSCs) were implanted into irradiated tissue to
assess their healing potential. Methods We established a rat model of radiation-induced vaginal injury. Complexes
(consisting of protein scaffolds loaded with ADSCs) were implanted into
injury sites. Histological analysis were used to assess regeneration of the
vaginal epithelium. RNA sequencing was used to study the therapeutic
mechanism of the complexes. Results The complexes promoted vaginal epithelial cell regeneration, vaginal tissue
repair and improved vaginal stenosis and contracture. Compared with rats
transplanted with ADSCs, rats transplanted with complexes achieved better
therapeutic effects. Conclusions Protein scaffold-ADSC complexes had a beneficial therapeutic effect on
radiation-induced vaginal injury in rats and may serve as the basis of a
novel therapeutic approach for radiation dermatitis.
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Affiliation(s)
- Mingxia Ye
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling Yu
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yujia She
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shufang Wang
- Blood Transfusion Department, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Min Wang
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qingdong Zhao
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chenglei Gu
- The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lihua Bian
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Na Wen
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Gong
- Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Lian Li
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuanguang Meng
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Ramli FF, Azizi MH, Syed Hashim SA. Treatments of Sexual Dysfunction in Opioid Substitution Therapy Patients: A Systematic Review and Meta-Analysis. Int J Med Sci 2021; 18:2372-2380. [PMID: 33967614 PMCID: PMC8100642 DOI: 10.7150/ijms.57641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/30/2021] [Indexed: 11/05/2022] Open
Abstract
Sexual dysfunction is a common condition in the opioid substitution therapy (OST) population. We aimed to determine the efficacy and safety of treatment for sexual dysfunction in the OST population. We searched for interventional studies from Medline, PubMed, and Scopus. Three independent authors conducted a risk-of-bias assessment (RoB 2). A total of seven studies (five randomized-controlled trials, two quasi-experimental), including 473 patients with sexual dysfunction, were identified. Among these, three bupropion (n=207), one trazodone (n=75), two rosa Damascena (n=100), and one ginseng (n=91) studies had reported significantly improve various sexual functioning domains in both genders. In a meta-analysis, bupropion significantly increased male sexual function with standardized mean difference of 0.53; 95% confidence interval of 0.19-0.88; P < 0.01; I2=0. The adverse effects were minor for all agents, and no significant difference between treatment and placebo groups in randomized-controlled trials. These agents have a promising future as therapy for sexual dysfunction in the OST population. However, given the limited sample size and number of studies, further studies should be conducted to confirm the use of these agents.
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Affiliation(s)
- Fitri Fareez Ramli
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Muhammad Hasif Azizi
- Unit of Urology, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Syed Alhafiz Syed Hashim
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia
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14
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Delrieu L, Bouaoun L, Fatouhi DE, Dumas E, Bouhnik AD, Noelle H, Jacquet E, Hamy AS, Coussy F, Reyal F, Heudel PE, Bendiane MK, Fournier B, Michallet M, Fervers B, Fagherazzi G, Pérol O. Patterns of Sequelae in Women with a History of Localized Breast Cancer: Results from the French VICAN Survey. Cancers (Basel) 2021; 13:1161. [PMID: 33800346 PMCID: PMC7962808 DOI: 10.3390/cancers13051161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Breast cancer (BC) remains complex for women both physically and psychologically. The objectives of this study were to (1) assess the evolution of the main sequelae and treatment two and five years after diagnosis in women with early-stage breast cancer, (2) explore patterns of sequelae associated with given sociodemographic, clinical, and lifestyle factors. The current analysis was based on 654 localized BC patients enrolled in the French nationwide longitudinal survey "vie après cancer" VICAN (January-June 2010). Information about study participants was collected at enrollment, two and five years after diagnosis. Changes over time of the main sequelae were analyzed and latent class analysis was performed to identify patterns of sequelae related to BC five years after diagnosis. The mean age (±SD) of study participants at inclusion was 49.7 (±10.5) years old. Six main classes of sequelae were identified two years and five years post-diagnosis (functional, pain, esthetic, fatigue, psychological, and gynecological). A significant decrease was observed for fatigue (p = 0.03) and an increase in cognitive sequelae was reported (p = 0.03). Two latent classes were identified-functional and esthetic patterns. Substantial sequelae remain up to five years after BC diagnosis. Changes in patient care pathways are needed to identify BC patients at a high risk.
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Affiliation(s)
- Lidia Delrieu
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
| | - Liacine Bouaoun
- International Agency for Research on Cancer, 69372 Lyon, France;
| | - Douae El Fatouhi
- Center of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, 94807 Villejuif, France; (D.E.F.); (G.F.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, 75006 Paris, France
| | - Anne-Deborah Bouhnik
- INSERM, IRD, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, 13007 Marseille, France; (A.-D.B.); (M.-K.B.)
| | - Hugo Noelle
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
| | - Emmanuelle Jacquet
- Oncology and Blood Diseases Department, University Hospital Center, Joseph Fourier University, CEDEX 9, 38043 Grenoble, France;
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
| | - Florence Coussy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Medical Oncology, Institut Curie, 75005 Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France; (E.D.); (A.-S.H.); (F.C.); (F.R.)
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France; (P.-E.H.); (M.M.)
| | - Marc-Karim Bendiane
- INSERM, IRD, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Aix Marseille University, 13007 Marseille, France; (A.-D.B.); (M.-K.B.)
| | - Baptiste Fournier
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
| | - Mauricette Michallet
- Department of Medical Oncology, Léon Bérard Cancer Center, 69008 Lyon, France; (P.-E.H.); (M.M.)
| | - Béatrice Fervers
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Cancer Research Center of Lyon, INSERM UA8, Léon Bérard Cancer Center, 69008 Lyon, France
| | - Guy Fagherazzi
- Center of Research in Epidemiology and Population Health, UMR 1018 Inserm, Institut Gustave Roussy, Paris-Sud Paris-Saclay University, 94807 Villejuif, France; (D.E.F.); (G.F.)
- Department of Population Health, Luxembourg Institute of Health (LIH), 1445 Strassen, Luxembourg
| | - Olivia Pérol
- Department Prevention, Cancer, Environment, Léon Bérard Cancer Center, 69008 Lyon, France; (L.D.); (H.N.); (B.F); (B.F.)
- Cancer Research Center of Lyon, INSERM UA8, Léon Bérard Cancer Center, 69008 Lyon, France
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15
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Mendoza N, Carrión R, Mendoza-Huertas L, Jurado AR. Efficacy and Safety of Treatments to Improve Dyspareunia in Breast Cancer Survivors: A Systematic Review. Breast Care (Basel) 2021; 15:599-607. [PMID: 33447234 DOI: 10.1159/000506148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To analyse all available evidence to validate the effectiveness of a local intervention in the treatment of dyspareunia in breast cancer survivors (BCS). Methods We searched the Institute of Scientific Information Web of Knowledge, MEDLINE, PubMed, Scopus, and Cochrane databases for all articles published in peer-reviewed journals up to April 2019. The PICOS standards were: (population) BCS with dyspareunia; (intervention) any type of vulvovaginal treatment; (main outcome) frequency and severity of dyspareunia; (study design) clinical studies. Results The literature search strategy identified 252 articles, of which 233 were excluded at various stages of the search. Finally, we systematically reviewed 19 studies, 8 with local hormonal therapies, 7 with local non-hormonal therapies, 3 with laser therapy, and 1 with other interventions. Of the studies, 7 were randomized control trials and 11 were prospective observations. Most of the interventions were shown to be effective and safe in the improvement of dyspareunia. Conclusion In addition to the traditional options already analysed in other current reviews, other interesting options are highlighted (such as laser or local dehydroepiandrosterone [DHEA]). Further work on dyspareunia should make use of high-quality trials with large numbers of samples to obtain evidence that could adequately demonstrate key methodological characteristics and harmful effects.
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Affiliation(s)
- Nicolás Mendoza
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, Spain
| | - Rosalía Carrión
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, Spain
| | | | - Ana Rosa Jurado
- Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, Spain.,Instituto Europeo de Sexologia, Marbella, Spain
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Endocrine Toxicities of Antineoplastic Therapy. Cancers (Basel) 2021; 13:cancers13020294. [PMID: 33466843 PMCID: PMC7830439 DOI: 10.3390/cancers13020294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, the prognosis of many solid tumors has improved markedly thanks to new treatment strategies, including tyrosine kinase inhibitors (TKIs) and immunotherapy [...].
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17
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Sexual function and rehabilitation after radiation therapy for prostate cancer: a review. Int J Impot Res 2021; 33:410-417. [PMID: 33408347 DOI: 10.1038/s41443-020-00389-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
The treatment of prostate cancer is partly guided by patient preferences. Radical prostatectomy and radiation therapy are the standard radical therapies for localized disease and render comparable oncologic outcomes. Considering that survival is high regardless of the chosen treatment, factors such as treatment-related toxicities affecting the patients' quality of life play an important role in their decision. Notably, post-treatment sexual dysfunction, which includes decreased libido, erectile dysfunction, and ejaculatory dysfunction has been shown to be an important and prevalent concern of prostate cancer survivors. In this literature review, we sought to characterize the sexual complications associated with radiation therapy and map the available sexual rehabilitation options for prostate cancer survivors experiencing sexual dysfunction as a result of radiation therapy. We identified medical, non-biomedical, counseling, and lifestyle modification options for prostate cancer survivors seeking sexual rehabilitation. Future research in this area should address the standardization of sexual side-effect reporting and investigate sexual outcomes and rehabilitation in more diverse groups and of transgender and nonheterosexual prostate cancer survivors.
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18
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Stein B, Müller MM, Meyer LK, Söllner W. Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: A Systematic Review and Meta-Analysis of Effects on Symptoms of Depression and Anxiety. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:6-16. [PMID: 31639791 DOI: 10.1159/000503177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychiatric and psychosomatic consultation-liaison services (CL) are important providers of diagnosis and treatment for hospital patients with mental comorbidities and psychological burdens. OBJECTIVE To perform a systematic review and meta-analysis investigating the effects of CL on depression and anxiety. METHODS Following PRISMA guidelines, a systematic literature search was conducted until 2017. Included were published randomized controlled trials using CL interventions with adults in general hospitals, treatment as usual as control groups, and depression and/or anxiety as outcomes. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Level of integration was assessed using the Standard Framework for Levels of Integrated Healthcare. Meta-analyses were performed using random effects models and meta-regression for moderator effects. RESULTS We included 38 studies (9,994 patients). Risk of bias was high in 17, unclear in 15, and low in 6 studies. Studies were grouped by type of intervention: brief interventions tailored to the patients (8), interventions based on specific treatment manuals (19), and integrated, collaborative care (11). Studies showed small to medium effects on depression and anxiety. Meta-analyses for depression yielded a small effect (d = -0.19, 95% CI: -0.30 to -0.09) in manual studies and a small effect (d = -0.33, 95% CI: -0.53 to -0.13) in integrated, collaborative care studies, the latter using mostly active control groups with the possibility of traditional consultation. CONCLUSIONS CL can provide a helpful first treatment for symptoms of depression and anxiety. Given that especially depressive symptoms in medically ill patients are long-lasting, the results underline the benefit of integrative approaches that respect the complexity of the illness.
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Affiliation(s)
- Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany,
| | - Markus M Müller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Lisa K Meyer
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
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19
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Pöttgen J, van de Vis W, van Nunen A, Rose A, Engelbrecht J, Pirard M, Lau S, Heesen C, Köpke S. Psychobehavioral Treatment Options for Sexual Dysfunction in Multiple Sclerosis: A Systematic Review. Int J MS Care 2020; 22:276-284. [PMID: 33424483 PMCID: PMC7780698 DOI: 10.7224/1537-2073.2020-012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sexual dysfunction in multiple sclerosis (MS) is a significant but overlooked impairment, and treatment options are rare. The aims of this systematic review were to identify psychological interventions used to treat sexual dysfunction in MS, to estimate their benefit, and to note appropriate treatment approaches for research projects and clinical use. METHODS A systematic review update was conducted to find psychological interventions aiming to improve sexual dysfunction in MS. A comprehensive search and review of MEDLINE, PsycINFO, CINAHL, and PubMed were completed, and the effects and quality of selected studies were reported. RESULTS Six publications with 295 participants were identified. All selected studies assessed the effectiveness of psychological interventions on sexual dysfunction or sexual satisfaction in people with MS; four studies directly targeted sexual dysfunction in MS, one was a mindfulness yoga program to improve fatigue and quality of life, and one other presented a secondary analysis of a study targeting depression in MS. All six studies reported significant improvements in sexual dysfunction or sexual satisfaction and somewhat in psychological variables. CONCLUSIONS A pressing need for development and adequate evaluation of psychological interventions for sexual dysfunction in MS remains. In addition, assessment of sexual dysfunction in MS and its treatment should be more focused in clinical care.
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20
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Pillay B, Ftanou M, Ritchie D, Panek-Hudson Y, Jefford M, Garcia T, Shields C, Gniel J, Phipps-Nelson J, Drosdowsky A, Blaschke S, Ellen S. Study protocol of a pilot study evaluating feasibility and acceptability of a psychosexual intervention for couples postallogeneic haematopoietic stem cell transplantation. BMJ Open 2020; 10:e039300. [PMID: 33130569 PMCID: PMC7783613 DOI: 10.1136/bmjopen-2020-039300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Sexual dysfunction is one of the most common side effects of allogeneic haematopoietic stem cell transplantation (HSCT) for haematological cancers. Problems can persist between 5 and 10 years post-transplant and impact mood, couple intimacy and relationship satisfaction. Few intervention studies, however, target sexual dysfunction in patients post-HSCT. This pilot study aims to examine the feasibility and acceptability of implementing a psychosexual intervention for HSCT survivors and their partners post-transplantation. METHODS AND ANALYSIS Fifteen allogeneic HSCT survivors and their partners will be recruited. Patients who are more than 3 months post-transplantation will be sent invitation letters describing the couples' psychosexual intervention that will be offered through this study. The intervention will comprise two components: (1) psychosexual education about medical and behavioural treatment options for sexual dysfunction delivered by a haematology nurse consultant; (2) emotionally focused therapy-based relationship education programme for couples delivered by a clinical psychologist (four sessions of 1.5 hours each). Couples who consent to participate will be administered a series of measures assessing mood, relationship satisfaction and sexual dysfunction preintervention and post-intervention, as well as satisfaction with the intervention postintervention. Feasibility of the intervention will be examined via recording enrolment rate, adherence, compliance with completing outcome measures and fidelity of intervention delivery. ETHICS AND DISSEMINATION Ethics approval has been obtained at the Peter MacCallum Cancer Centre in Melbourne, Australia. Results will be presented at national and international conferences and published in a peer-reviewed journal so that in can be accessed by clinicians involved in the care of allogeneic HSCT patients. If this intervention is found to be feasible and acceptable, its impact will be examined in a future randomised controlled trial and subsequently implemented as part of routine care in the allogeneic HSCT population.
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Affiliation(s)
- Brindha Pillay
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Ritchie
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yvonne Panek-Hudson
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Teresa Garcia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cassandra Shields
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- The Australian Centre for Emotionally Focused Therapy, Brisbane, Queensland, Australia
| | - Jo Gniel
- Landscape of Life, Melbourne, Victoria, Australia
| | - Jo Phipps-Nelson
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarah Blaschke
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Steve Ellen
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Bagherzadeh R, Sohrabineghad R, Gharibi T, Mehboodi F, Vahedparast H. Effect of Mindfulness-Based Stress Reduction Training on Revealing Sexual Function in Iranian Women with Breast Cancer. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09660-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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22
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Gessler S, King M, Lemma A, Barber J, Jones L, Dunning S, Madden V, Pilling S, Hunter R, Fonagy P, Summerville K, MacDonald N, Olaitan A, Lanceley A. Stepped approach to improving sexual function after gynaecological cancer: the SAFFRON feasibility RCT. Health Technol Assess 2020; 23:1-92. [PMID: 30798790 DOI: 10.3310/hta23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women affected by gynaecological cancer are often unaware of the sexual consequences of both the cancer and its treatment. Most do not receive appropriate advice or help to recover sexual function, and the effect on their sexuality may be profound, both physically and emotionally. However, several potential therapies can be effective in helping recover some sexual engagement and change self-perception around sex. A major initial challenge is informing and involving patients in an appropriate and sensitive manner, and a further issue is delivering therapies in busy gynaelogical oncology clinics. This study was conceived in response to a National Institute for Health Research (NIHR) Health Technology Assessment (HTA) call asking for proposals to improve sexual functioning in women treated for gynaecological cancer while taking into account associated issues of mood. Existing evidence-based therapies for improving sexual function after cancer treatment were adapted and placed within a 'stepped care' model for delivering these in the NHS setting. An assessment and treatment stepping algorithm was developed in parallel, both to assign women to a treatment level at assessment and to follow their progress session by session to advise on changing intervention level. The assessment tool was applied to all participants on the principle that the problem was sexual difficulty, not the cancer of origin. PARTICIPANTS Women aged > 18 years (with partners at their choice) treated for any gynaecological malignancy with surgery and/or chemotherapy and/or radiation at University College London Hospital or Bristol Gynaecological cancer centres, minimally 3 months post end of treatment, of any sexual orientation, with sexual function difficulties identified by three initial screening questions. DESIGN A feasibility two-arm, parallel-group randomised controlled pilot trial. SETTING Two NHS gynaecological cancer centres, one in London and one in Bristol. INTERVENTIONS A three-level stepped care intervention. OBJECTIVE To assess the feasibility of conducting a full-scale investigation of stepped therapy and indicate the potential benefits to patients and to the NHS generally. PRIMARY OUTCOME MEASURES Recruitment to study, proportion of women stepping up, number of usable data points of all measures and time points over length of trial, and retention of participants to end of trial. RESULTS Development of the intervention and accompanying algorithm was completed. The study was stopped before the recruitment stage and, hence, no randomisation, recruitment, numbers analysed, outcomes or harms were recorded. LIMITATIONS As the study did not proceed, the intervention and its accompanying algorithm have not been evaluated in practice, and the capacity of the NHS system to deliver it has not been examined. CONCLUSIONS None, as the study was halted. FUTURE WORK The intervention could be studied within a clinical setting; however, the experience of the study group points to the need for psychosocial studies in medical settings to establish pragmatic and innovative mechanisms to ensure adequate resource when extending staff clinical skills and time to deliver any new intervention for the duration of the trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN12010952 and ClinicalTrials.gov NCT02458001. FUNDING This project was funded by the NIHR HTA programme and will be published in full in Health Technology Assessment; Vol. 23, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sue Gessler
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Michael King
- PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Alessandra Lemma
- Psychological Therapies Development Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | | | - Stephen Pilling
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Karen Summerville
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Nicola MacDonald
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Adeola Olaitan
- Gynaecological Cancer Centre, University College London Hospitals, London, UK
| | - Anne Lanceley
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
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Kozul C, Stafford L, Little R, Bousman C, Park A, Shanahan K, Mann GB. Breast Cancer Survivor Symptoms: A Comparison of Physicians' Consultation Records and Nurse-Led Survivorship Care Plans. Clin J Oncol Nurs 2020; 24:E34-E42. [PMID: 32441685 DOI: 10.1188/20.cjon.e34-e42] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Survivorship care plans (SCPs) have been used to address ongoing health problems associated with the diagnosis and treatment of early-stage breast cancer. OBJECTIVES The aim of this article was to determine whether nurse-led consultations using SCPs, as compared with a standard medical consultation, identify more side effects and supportive care needs and lead to appropriate referral patterns. METHODS The study audited 160 retrospective medical clinic and nursing SCP records in a sample of patients receiving treatment for early-stage breast cancer at a tertiary-level breast service in Australia. FINDINGS Breast care nurses (BCNs) undertaking SCPs at a nurse-led consultation were significantly more likely than physicians to record symptoms related to menopausal/hormonal therapy, psychosocial/mental health, lifestyle, bone health, and sexuality. BCNs were also significantly more likely to refer patients for concerns related to psychosocial/mental health, lifestyle, and sexuality.
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24
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Sörensson M, Asplund D, Matthiessen P, Rosenberg J, Hallgren T, Rosander C, González E, Bock D, Angenete E. Self-reported sexual dysfunction in patients with rectal cancer. Colorectal Dis 2020; 22:500-512. [PMID: 31713295 PMCID: PMC7317395 DOI: 10.1111/codi.14907] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023]
Abstract
AIM Patients with rectal cancer often experience sexual dysfunction after treatment. The aim of this study was to evaluate sexual function in a prospective cohort of patients regardless of treatment and tumour stage and explore what factors might affect sexual activity 1 year after diagnosis. METHOD The QoLiRECT study (Quality of Life in RECTal cancer) is a prospective study on the health-related quality of life in patients with rectal cancer in Denmark and Sweden. Questionnaires were completed at diagnosis and 1 year. Clinical data were retrieved from national quality registries. RESULTS Questionnaire data were available from 1085 patients at diagnosis and 920 patients at 1 year. Median age was 69 years (range 25-100). At diagnosis, 29% of the women and 41% of the men were sexually active, which was lower than an age-matched reference population. This was further reduced to 25% and 34% at 1 year. Risk factors for sexual inactivity were absence of sexual activity prior to the diagnosis and the presence of a stoma. Women experienced reduced lubrication and more dyspareunia at 1 year compared with the time of diagnosis. In men, erectile dysfunction increased from 46% to 55% at 1 year. CONCLUSION Sexual activity in patients with rectal cancer is lower at diagnosis compared with the population norm and is further reduced at 1 year. The presence of a stoma contributed to reduced sexual activity after operation. Sexual dysfunction was difficult to evaluate due to low sexual activity in the cohort. In men, erectile dysfunction is common.
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Affiliation(s)
- M. Sörensson
- Department of SurgeryKarlstad HospitalKarlstadSweden
| | - D. Asplund
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - P. Matthiessen
- Department of SurgeryFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - J. Rosenberg
- Department of SurgeryHerlev HospitalUniversity of CopenhagenHerlevDenmark
| | - T. Hallgren
- Department of SurgeryKarlstad HospitalKarlstadSweden
| | - C. Rosander
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - E. González
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - D. Bock
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - E. Angenete
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
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Afiyanti Y, Setyowati, Milanti A, Young A. 'Finally, I get to a climax': the experiences of sexual relationships after a psychosexual intervention for Indonesian cervical cancer survivors and the husbands. J Psychosoc Oncol 2020; 38:293-309. [PMID: 32093583 DOI: 10.1080/07347332.2020.1720052] [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] [Indexed: 10/24/2022]
Abstract
Purpose: The purpose of this study was to describe the experiences of sexual relationship after a nurse-led psychosexual intervention for Indonesian cervical cancer survivors and their husbands.Design: A qualitative descriptive study was conducted.Participants and methods: Sixteen cervical cancer survivors and their husbands who had participated in the nurse-led psychosocial intervention were invited for semi-structured in-depth interviews. Data were analyzed using thematic analysis.Findings: Four themes were identified: (1) lessening suffering; (2) supporting each other to regain sexual life (2a) finding reasons to do or undo sexual intercourse, (2 b) "How can I bring back my wife's sexual desire?," (2c) "Finally, I get to a climax;" (3) getting more intimate and caring about each other, and (4) "Now I'm getting more confident." Cervical cancer survivors and their husbands experienced overall positive outcomes in their sexual and intimate relationship after a psychosexual intervention.Conclusions: The psychosexual intervention helped the survivors and their husbands adapt and manage sexual dysfunction following cancer treatment. Nurses and other healthcare professionals should initiate psychosexual care by assessing the concerns and needs of women diagnosed with cervical cancer, as an integral part of their care plan.
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Affiliation(s)
- Yati Afiyanti
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Setyowati
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | | | - Annie Young
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom
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26
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La Rosa VL, De Franciscis P, Barra F, Schiattarella A, Tropea A, Tesarik J, Shah M, Kahramanoglu I, Marques Cerentini T, Ponta M, Ferrero S. Sexuality in women with endometriosis: a critical narrative review. Minerva Med 2019; 111:79-89. [PMID: 31726815 DOI: 10.23736/s0026-4806.19.06299-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endometriosis is a chronic gynecological disease that generally affects young and sexually active women in different stages of their development and sexual life. Because endometriosis affects about 5-10% of women in reproductive age, it is possible to estimate that about 2-4% of those who are sexually active may suffer from sexual dysfunction caused by this disease. Surgical and pharmacological treatments of endometriosis can improve the patient's sexual function in the medium and long term, but not necessarily lead to a definitive resolution of the sexual issue. For this reason, the ideal treatment should be conducted by a multidisciplinary team, with the aim to improve overall sexual functioning and not only to reduce the painful symptoms during intercourse. In light of these considerations, the aim of this narrative review was to provide a general overview about the impact of endometriosis on sexuality of women affected and the effectiveness of surgical and pharmacological treatments in improving sexual function.
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Affiliation(s)
- Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy -
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | | | - Marco Ponta
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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27
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Arthur EK, Wills CE, Menon U. A Systematic Review of Interventions for Sexual Well-Being in Women With Gynecologic, Anal, or Rectal Cancer. Oncol Nurs Forum 2019; 45:469-482. [PMID: 29947348 DOI: 10.1188/18.onf.469-482] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Treatments for cancer in the lower pelvis often cause lasting effects on women's sexual well-being. The purpose of this review is to describe interventions to improve sexual well-being in gynecologic, anal, or rectal cancer survivors. LITERATURE SEARCH This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 checklist and guidelines. A literature search was conducted using PubMed, CINAHL®, PsycINFO, and Cochrane Library. DATA EVALUATION Articles were original intervention research studies of women treated for gynecologic, anal, or rectal cancer and included sexual well-being outcomes. Study characteristics were extracted and compared in a table for analysis and synthesis. SYNTHESIS Of the 16 included studies, 1 focused on genitourinary rehabilitation, 12 focused on psychoeducational interventions, and 3 focused on combination interventions. Most interventions reported at least one positive sexual well-being outcome. Intervention format, delivery, dose, and outcome variables varied widely. IMPLICATIONS FOR RESEARCH Preliminary efficacy and feasibility of interventions are promising, but larger studies designed to discern optimal content, delivery format, dose, and timing are needed.
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28
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Reese JB, Smith KC, Handorf E, Sorice K, Bober SL, Bantug ET, Schwartz S, Porter LS. A randomized pilot trial of a couple-based intervention addressing sexual concerns for breast cancer survivors. J Psychosoc Oncol 2018; 37:242-263. [PMID: 30580675 DOI: 10.1080/07347332.2018.1510869] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose was to test the feasibility, acceptability, and preliminary efficacy of a 4-session couple-based Intimacy Enhancement (IE) intervention addressing breast cancer survivors' sexual concerns delivered via telephone. Twenty-nine post-treatment breast cancer survivors reporting sexual concerns and their intimate partners were randomized (2:1) to the IE intervention or to an educational control condition, both of which were delivered by trained psychosocial providers. Feasibility and acceptability were measured through recruitment, retention, session completion, and post-intervention program evaluations. Couples completed validated sexual, relationship, and psychosocial outcome measures at pre- and post-intervention. Between-group effect sizes and 95% confidence intervals were calculated using the Hedges g. Data supported intervention feasibility and acceptability. For survivors, the IE intervention had medium to large positive effects on all sexual outcomes and most psychosocial outcomes. Effects were less visible for relationship outcomes and were similar but somewhat smaller for partners. The IE intervention demonstrated feasibility, acceptability, and promise in addressing breast cancer survivors' sexual concerns and enhancing their and their partners' intimate relationships and psychosocial well-being. Implications for Psychosocial Oncology Practice The IE intervention demonstrated feasibility and acceptability, suggesting it could be well-received by breast cancer survivors with sexual concerns and their partners. Effects of the IE intervention on breast cancer survivors' sexual concerns and on their and their partners' intimate relationships and psychosocial well-being could not be attributed to therapist time and attention. Interventions that psychosocial providers can use to address breast cancer survivors' sexual concerns are important to the growing number of breast cancer survivors living for many years after their diagnosis.
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Affiliation(s)
- Jennifer Barsky Reese
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA.,b Department of Social and Behavioral Sciences; Temple University College of Public Health , Philadelphia , Pennsylvania , USA
| | - Katherine Clegg Smith
- c Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore , Maryland , USA
| | - Elizabeth Handorf
- e Department of Biostatistics and Bioinformatics , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA
| | - Kristen Sorice
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA
| | - Sharon L Bober
- f Department of Psychosocial Oncology and Palliative Care; Sexual Health Program, Dana-Farber Cancer Institute/Harvard Medical School , Boston , Massachusetts , USA
| | - Elissa T Bantug
- d Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore , Maryland , USA
| | - Sharon Schwartz
- g Department of Gynecology , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA
| | - Laura S Porter
- h Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
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29
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Mayer S, Iborra S, Grimm D, Steinsiek L, Mahner S, Bossart M, Woelber L, Voss PJ, Gitsch G, Hasenburg A. Sexual activity and quality of life in patients after treatment for breast and ovarian cancer. Arch Gynecol Obstet 2018; 299:191-201. [PMID: 30386993 DOI: 10.1007/s00404-018-4922-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sexual activity (SA) and functioning (SF) are important factors influencing quality of life (QoL). Anticancer treatment can cause or promote sexual dysfunctions. In this study we analyzed the SA, SF and QoL in patients after completion of treatment for breast cancer (BC) and ovarian cancer (OC). METHODS In this retrospective multicenter study 396 BC patients and 93 OC patients aged between 18 and 70 years were surveyed at least 24 months after cancer diagnosis and compared to 60 healthy women. Data were collected through validated questionnaires (Sexual Activity Questionnaire, Female Sexual Function Index-d, EORTC Quality of Life Questionnaire-C30). RESULTS 45.9% of BC patients and 56.5% of OC patients reported SA. SF and well-being of sexually active BC patients were not influenced by the type and radicality of surgery or the administration of chemotherapy. Patients who received antihormonal therapy at the time of evaluation showed a lower frequency of SA (p = 0.007), less satisfaction (p = 0.003) and more discomfort during SA (p = < 0.001) compared to healthy controls but no differences in experiencing orgasms, health status, QoL and global health status. In contrast, BC patients without antihormonal therapy showed only a higher discomfort score (p = 0.028) than healthy controls and estimated their health status and QoL significantly better than patients who received antihormonal therapy (p = 0006). In general, SA was associated with a better health status (p = 0.007), a better QoL (p = 0.004) and a better global health status (p = 0.004) in BC patients. Sexually active OC patients showed no significant differences in SF, QoL and health status compared to healthy controls. CONCLUSIONS Compared to healthy controls BC patients showed limitations in SF with a lower SA rate and more discomfort. Antihormonal therapy was an important factor influencing SF and well-being. Breast and OC survivors reported good physical and psychical health without differences in QoL and health status compared to controls. This might be explained by a change of perspective on life difficulties and altered priorities through a life threatening disease.
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Affiliation(s)
- Sebastian Mayer
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, Freiburg, Germany
| | - Severine Iborra
- Department of Obstetrics and Gynecology, University Medical Center Aachen, Aachen, Germany
| | - Donata Grimm
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Steinsiek
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Michaela Bossart
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, Freiburg, Germany
| | - Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Gerald Gitsch
- Department of Obstetrics and Gynecology, University Medical Center Freiburg, Freiburg, Germany
| | - Annette Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany.
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30
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Gambardella A, Esposito D, Accardo G, Taddeo M, Letizia A, Tagliafierro R, Esposito K, Pasquali D. Sexual function and sex hormones in breast cancer patients. Endocrine 2018; 60:510-515. [PMID: 29138989 DOI: 10.1007/s12020-017-1470-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/06/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Breast cancer patients (BCP) are at risk of female sexual dysfunction (FSD). Our aim was to clarify the effects of treatment strategies, and steroid hormones levels on FSD. METHODS We enrolled 136 BCP (46.9 ± 0.8 years), and 122 completed questionnaires. BCP were divided into four groups: 22 women with advanced breast cancer on neoadjuvant therapy (NAT), 48 on adjuvant therapy (AT), 30 taking hormonal therapy (HT) and 22 with metastatic cancer on first line chemotherapy (FLT). Fifty-eight healthy women (43 ± 2.8 years) were enrolled as controls. FSD was evaluated by FSFI, and sexual distress was assessed with FSDS-R. We have collected demographic data, laboratory values, and LH, FSH, total testosterone (T), and estradiol (E2) levels. RESULTS BCP showed a prevalence of FSD of 69%, total FSFI score was 17. FSDS-R was 8.3. FSD had a prevalence of 72 % in NAT, 65% in AT, 77% in metastatic BCP under FLT, 67% in HT, compared with a prevalence of 20% in controls. BCP showed lower E2 than normal values, as well as T. LH and FSH were significantly elevated than normal values. Total FSFI score was positively correlated with T in 122 BCP, no significant correlation was found between E2 and FSFI. Significant differences were found between NAT and HT in lubrication, pain domains and total FSDS-R score, AT and HT in pain domain, AT and NAT in lubrication domain. CONCLUSIONS BCP are at high risk of developing FSD both for treatment choice and hormonal status, but they have not sexually related personal distress.
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Affiliation(s)
- Antonio Gambardella
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Daniela Esposito
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Giacomo Accardo
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Marianna Taddeo
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Antonietta Letizia
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Rossella Tagliafierro
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Katherine Esposito
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Daniela Pasquali
- Department of Medical, Neurological and Metabolic Sciences of Ageing, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy.
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31
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Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev 2018; 1:CD011292. [PMID: 29376559 PMCID: PMC6491330 DOI: 10.1002/14651858.cd011292.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health-related quality of life (HRQoL), and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. OBJECTIVES To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Group (CBCG) Specialised Registry, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform, on 18 September 2015. We also searched OpenGrey and Healthcare Management Information Consortium databases. SELECTION CRITERIA We searched for randomised and quasi-randomised trials comparing physical activity interventions versus control (e.g. usual or standard care, no physical activity, no exercise, attention control, placebo) after adjuvant therapy (i.e. after completion of chemotherapy and/or radiation therapy, but not hormone therapy) in women with breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when needed. We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome and used GRADE to assess the quality of evidence for the most important outcomes. MAIN RESULTS We included 63 trials that randomised 5761 women to a physical activity intervention (n = 3239) or to a control (n = 2524). The duration of interventions ranged from 4 to 24 months, with most lasting 8 or 12 weeks (37 studies). Twenty-eight studies included aerobic exercise only, 21 involved aerobic exercise and resistance training, and seven used resistance training only. Thirty studies described the comparison group as usual or standard care, no intervention, or control. One-fifth of studies reported at least 20% intervention attrition and the average physical activity adherence was approximately 77%.No data were available on effects of physical activity on breast cancer-related and all-cause mortality, or on breast cancer recurrence. Analysis of immediately postintervention follow-up values and change from baseline to end of intervention scores revealed that physical activity interventions resulted in significant small-to-moderate improvements in HRQoL (standardised mean difference (SMD) 0.39, 95% CI 0.21 to 0.57, 22 studies, 1996 women; SMD 0.78, 95% CI 0.39 to 1.17, 14 studies, 1459 women, respectively; low-quality evidence), emotional function (SMD 0.21, 95% CI 0.10 to 0.32, 26 studies, 2102 women, moderate-quality evidence; SMD 0.31, 95% CI 0.09 to 0.53, 15 studies, 1579 women, respectively; low-quality evidence), perceived physical function (SMD 0.33, 95% CI 0.18 to 0.49, 25 studies, 2129 women; SMD 0.60, 95% CI 0.23 to 0.97, 13 studies, 1433 women, respectively; moderate-quality evidence), anxiety (SMD -0.57, 95% CI -0.95 to -0.19, 7 studies, 326 women; SMD -0.37, 95% CI -0.63 to -0.12, 4 studies, 235 women, respectively; low-quality evidence), and cardiorespiratory fitness (SMD 0.44, 95% CI 0.30 to 0.58, 23 studies, 1265 women, moderate-quality evidence; SMD 0.83, 95% CI 0.40 to 1.27, 9 studies, 863 women, respectively; very low-quality evidence).Investigators reported few minor adverse events.Small improvements in physical activity interventions were sustained for three months or longer postintervention in fatigue (SMD -0.43, 95% CI -0.60 to -0.26; SMD -0.47, 95% CI -0.84 to -0.11, respectively), cardiorespiratory fitness (SMD 0.36, 95% CI 0.03 to 0.69; SMD 0.42, 95% CI 0.05 to 0.79, respectively), and self-reported physical activity (SMD 0.44, 95% CI 0.17 to 0.72; SMD 0.51, 95% CI 0.08 to 0.93, respectively) for both follow-up values and change from baseline scores.However, evidence of heterogeneity across trials was due to variation in intervention components (i.e. mode, frequency, intensity, duration of intervention and sessions) and measures used to assess outcomes. All trials reviewed were at high risk of performance bias, and most were also at high risk of detection, attrition, and selection bias. In light of the aforementioned issues, we determined that the evidence was of very low, low, or moderate quality. AUTHORS' CONCLUSIONS No conclusions regarding breast cancer-related and all-cause mortality or breast cancer recurrence were possible. However, physical activity interventions may have small-to-moderate beneficial effects on HRQoL, and on emotional or perceived physical and social function, anxiety, cardiorespiratory fitness, and self-reported and objectively measured physical activity. The positive results reported in the current review must be interpreted cautiously owing to very low-to-moderate quality of evidence, heterogeneity of interventions and outcome measures, imprecision of some estimates, and risk of bias in many trials. Future studies with low risk of bias are required to determine the optimal combination of physical activity modes, frequencies, intensities, and durations needed to improve specific outcomes among women who have undergone adjuvant therapy.
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Affiliation(s)
- Ian M Lahart
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - George S Metsios
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - Alan M Nevill
- University of WolverhamptonFaculty of Education, Health and WellbeingGorway RoadWalsallWest MidlandsUKWS1 3BD
| | - Amtul R Carmichael
- Queen's HospitalDepartment of SurgeryBelvedere RoadBurton on TrentStaffordshireUK
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Reese JB, Bober SL, Daly MB. Talking about women's sexual health after cancer: Why is it so hard to move the needle? Cancer 2017; 123:4757-4763. [PMID: 29116655 PMCID: PMC5716835 DOI: 10.1002/cncr.31084] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center
- Department of Social and Behavioral Sciences, College of Public Health, Temple University
| | - Sharon L. Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center
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33
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Peritoneal cavity lavage reduces the presence of mitochondrial damage associated molecular patterns in open abdomen patients. J Trauma Acute Care Surg 2017; 83:1062-1065. [PMID: 28806285 DOI: 10.1097/ta.0000000000001676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Mitochondrial damage-associated molecular patterns (mtDAMPs), such as mitochondrial DNA and N-formylated peptides, are endogenous molecules released from tissue after traumatic injury. mtDAMPs are potent activators of the innate immune system. They have similarities with bacteria, which allow mtDAMPs to interact with the same pattern recognition receptors and mediate the development of systemic inflammatory response syndrome (SIRS). Current recommendations for management of an open abdomen include returning to the operating room every 48 hours for peritoneal cavity lavage until definitive procedure. These patients are often critically ill and develop SIRS. We hypothesized that mitochondrial DAMPs are present in the peritoneal cavity fluid in this setting, and that they accumulate in the interval between washouts. METHODS We conducted a prospective pilot study of critically ill adult patients undergoing open abdomen management in the surgical and trauma intensive care units. Peritoneal fluid was collected daily from 10 open abdomen patients. Specimens were analyzed via quantitative polymerase chain reaction (qPCR) for mitochondrial DNA (mtDNA), via enzyme immunoassay for DNAse activity and via Western blot analysis for the ND6 subunit of the NADH: ubiquinone oxidoreductase, an N-formylated peptide. RESULTS We observed a reduction in the expression of ND6 the day after lavage of the peritoneal cavity, that was statistically different from the days with no lavage (% change in ND6 expression, postoperative from washout: -50 ± 11 vs. no washout day, 42 ± 9; p < 0.05). Contrary to expectation, the mtDNA levels remained relatively constant from sample to sample. We then hypothesized that DNAse present in the effluent may be degrading mtDNA. CONCLUSION These results indicate that the peritoneal cavity irrigation reduces the presence of mitochondrial DAMPs in the open abdomen. It is possible that increased frequency of peritoneal cavity lavage may lead to decreased systemic absorption of mtDAMPs, thereby reducing the risk of SIRS. LEVEL OF EVIDENCE Prospective study, Case Series, Level V.
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34
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Sexual health after breast cancer: Recommendations from the Spanish Menopause Society, Federación Española de Sociedades de Sexología, Sociedad Española de Médicos de Atención Primaria and Sociedad Española de Oncología Médica. Maturitas 2017; 105:126-131. [DOI: 10.1016/j.maturitas.2017.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/10/2017] [Accepted: 02/14/2017] [Indexed: 12/11/2022]
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Carroll AJ, Baron SR, Carroll RA. Couple-based treatment for sexual problems following breast cancer: A review and synthesis of the literature. Support Care Cancer 2016; 24:3651-9. [PMID: 27154014 DOI: 10.1007/s00520-016-3218-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 04/17/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Although there are many physical and psychological impacts on women's sexuality following breast cancer diagnosis and treatment, sexual problems often remain unaddressed in these cancer survivors. Given the crucial role of the partner in sexual issues, couple-based sex therapy would appear to be a logical first-line treatment for this population, but there is scant research on the efficacy of couple-based treatments and/or sex therapy in breast cancer survivors. METHODS A review of the literature was conducted using the PMC, PsycINFO, EMBASE, and MEDLINE databases. Articles were included that presented the results of an experimental or quasi-experimental clinical trial evaluating a psychosexual intervention for couples, targeted women diagnosed with breast cancer and their partners, and included outcome measures of sexual function and sexuality. Studies were excluded if the primary intervention was not focused on sexual problems or if they were published in a language other than English. RESULTS From 2231 records, five articles met criteria for inclusion in the present review. Couple-based sex therapy appears to be an effective and highly accepted treatment for addressing sexual problems in breast cancer patients. These interventions were associated with improvements in sexual physiology, sexual functioning, sexual self-image, and sexual relationships, as well as improved psychological well-being of both breast cancer patients and their partners. CONCLUSIONS Based on this review, the authors address clinical implications, particularly incorporating psychological treatment for sexual problems in comprehensive cancer care, and provide recommendations for further study.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive Suite 1400, Chicago, IL, 60611, USA.
| | - Shirley R Baron
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Suite 7-100, Chicago, IL, 60611, USA.,Program in Integrative Sexual Medicine for Women and Girls with Cancer, Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Richard A Carroll
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario Suite 7-100, Chicago, IL, 60611, USA
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