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Dinesh AA, Helena Pagani Soares Pinto S, Brunckhorst O, Dasgupta P, Ahmed K. Anxiety, depression and urological cancer outcomes: A systematic review. Urol Oncol 2021; 39:816-828. [PMID: 34503900 DOI: 10.1016/j.urolonc.2021.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The interplay between physical and mental aspects of a cancer diagnosis are well recognised. However, little consensus exists on the impact of depression and anxiety on urological cancer outcomes. Therefore, this systematic review aimed to investigate the relationship between these conditions and functional or oncological outcomes in urological malignancy. MATERIALS AND METHODS A systematic search was conducted using PubMed, Embase, PsycINFO and Global Health databases up to June 2020. Studies evaluating the relationship of anxiety and depression disorders or symptoms on functional and mortality outcomes were included. Outcome measures included validated urinary, sexual, body image questionnaire scores and all-cause or disease-specific mortality. RESULTS Of 3,966 studies screened, 25 studies with a total of 175,047 urological cancer patients were included. Significant anxiety and depressive symptoms and disorders were found to impact functional outcomes in several cancer types. A consistent negative association existed for sexual function in prostate, testicular and penile cancer patients. Additionally, poorer urinary function scores were seen in prostate cancer, with increased body image issues in testicular and prostate cancer. Importantly, both overall and disease-specific mortality outcomes were poorer in bladder and prostate cancer patients. CONCLUSIONS Co-existing depression and anxiety appears to be negatively associated with functional and mortality outcomes in urological cancers. This appears especially evident in male cancers, including prostate and testicular cancer. Although not proving causation, these findings highlight the importance of considering mental wellbeing during follow-up for early recognition and treatment. However, current evidence remains heterogenous, with further studies required exploring patients at risk.
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Affiliation(s)
- Ayushi Anna Dinesh
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | | | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom; Department of Urology, King's College Hospital, London, United Kingdom.
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2
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Dincer AN, Brunckhorst O, Genel O, Dasgupta P, Muneer A, Ahmed K. Quality of life, anxiety and depression patient-reported outcome measures in testicular cancer: A systematic review. Psychooncology 2021; 30:1420-1429. [PMID: 33934434 DOI: 10.1002/pon.5700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Several patient-reported outcome measures (PROMs) are available for the assessment of quality of life (QoL), anxiety and depression for testicular cancer (TCa); however, these PROMs have uncertain validation of their psychometric properties for TCa-only cohorts. This systematic review aims to critically analyse and evaluate the psychometric properties of these QoL, anxiety and depression PROMs. METHODS PubMed, EMBASE and PsycInfo were searched by two independent reviewers from inception to August 2020. Evaluative studies that assessed measurement properties of PROM(s) tools used for measuring QoL, anxiety and depression in TCa patients were included. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) updated criteria for good measurement properties were used in the evaluation of PROM psychometric quality. This systematic review was registered on the PROSPERO database (CRD42020160232). RESULTS Of 4,305 abstracts screened, a final eight full-text articles were included in this review. Five general and two TCa-specific PROMs were identified (depression, n = 1; anxiety and depression, n = 2; QoL, n = 4). All studies were incomplete in the validation of nine measurement properties and the modal methodological quality was 'indeterminate'. The European Organisation for Research and Treatment of Cancer Quality -Testicular Cancer 26 questionnaire and CAYA-T had the highest psychometric validation with three out of nine measurement properties being 'sufficient'. CONCLUSION This systematic review identifies a paucity of PROM-validation studies assessing anxiety, depression and QoL in TCa-only cohorts. We recommend further comprehensive and standardised psychometric validation studies of QoL, anxiety and depression PROMs in TCa-only study populations.
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Affiliation(s)
- Amine Nur Dincer
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oktay Genel
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Asif Muneer
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,Department of Urology, King's College Hospital, London, UK
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3
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Okada K, Fujita K, Fukuhara S, Kiuchi H, Uemura M, Imamura R, Nonomura N. Erectile Dysfunction in Germ Cell Tumor Survivors. World J Mens Health 2020; 39:533-540. [PMID: 32777864 PMCID: PMC8255390 DOI: 10.5534/wjmh.200042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose Germ cell tumors (GCTs) are the most common malignant neoplasms in adolescents and young adults, and most patients with these tumors can be completely cured. Therefore, maintaining quality of life (QOL) is important. Erectile dysfunction (ED) is one factor that reduces the QOL of GCT survivors. We aimed to clarify the relationship between ED and age, follow-up period, serum levels of hormones, and treatment methods for GCT survivors. Materials and Methods We evaluated ED using the Sexual Health Inventory for Men questionnaire (SHIM) and measured serum levels of hormones in survivors after GCT treatment. The relationships between the SHIM score responses and age, serum levels of hormones, follow-up period, and treatment methods were assessed using a logistic analysis. Results Fifty-two GCT survivors were enrolled and 46 survivors completed the SHIM. The median age, follow-up period, and SHIM score were 38 years, 35 months, and 18, respectively. Regarding the SHIM scores, 85% had scores <22 and 46% had scores <17. The percentage of SHIM scores <17 was 69% in patients with under 2 years of follow-up. It significantly improved to 33% in patients with over 2 years of follow-up. The multivariate analysis identified the follow-up period as an independent factor for SHIM scores <17. Age, serum levels of hormone, and treatment method were not significant factors for SHIM scores <17. Conclusions Improvement of SHIM score can be expected after GCT treatment regardless of age, serum levels of hormone, and treatment method.
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Affiliation(s)
- Koichi Okada
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Talking about sexual health during survivorship: understanding what shapes breast cancer survivors' willingness to communicate with providers. J Cancer Surviv 2019; 13:932-942. [PMID: 31741248 DOI: 10.1007/s11764-019-00809-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 09/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Breast cancer survivor (BCS)-provider communication about sexual health (SH) is often absent or inadequate. Patients report wanting providers to broach the topic, but providers cite barriers to initiating discussions. While the health care community works to address barriers, it is unrealistic to rely solely on provider initiation of SH conversations. This research investigates willingness to communicate about sexual health (WTCSH) to better understand what may interfere with survivors' ability to self-advocate and receive care for these concerns. METHODS (N = 305) BCSs completed online surveys. Hierarchical multiple regression determined the relationship between Sexual Quality of Life-Female (SQOL-F), which measures psychological and social dimensions of SH and WTCSH. Interviews were then conducted with forty BCSs. The constant comparative method was used to thematically analyze the transcripts. RESULTS The mean SQOL score was 53.4 out of 100. No statistically significant differences in SQOL or WTCSH were found by age or survivorship length. The positive relationship between WTCSH and SQOL was significant, F (6,266) = 4.92, p < .000, adj. R2 = .080). Five themes illustrated factors that shape WTCSH: (1) comfort discussing SH; (2) perception of demographic similarity/discordance; (3) patient-centered communication; (4) belief that SH is (un)treatable, and (5) ability to access timely/coordinated care. CONCLUSIONS Findings establish the significance of SH concerns and provide an in-depth understanding of intrapersonal, interpersonal, and organizational issues informing WTCSH. IMPLICATIONS FOR CANCER SURVIVORS Age and gender dynamics, perceptions of provider SQOL messaging, and futility influence survivor openness. Addressing these areas may encourage disclosure among women who would otherwise continue to suffer in silence.
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La Vignera S, Cannarella R, Duca Y, Barbagallo F, Burgio G, Compagnone M, Di Cataldo A, Calogero AE, Condorelli RA. Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review. Front Endocrinol (Lausanne) 2019; 10:264. [PMID: 31133982 PMCID: PMC6513875 DOI: 10.3389/fendo.2019.00264] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/09/2019] [Indexed: 11/13/2022] Open
Abstract
Testicular tumor is the most common malignancy in men of reproductive age. According to the tumor histology and staging, current treatment options include orchiectomy alone or associated with adjuvant chemo- and/or radiotherapy. Although these treatments have considerably raised the percentage of survivors compared to the past, they have been identified as risk factors for testosterone deficiency and sexual dysfunction in this subgroup of men. Male hypogonadism, in turn, predisposes to the development of metabolic and cardiovascular impairment that negatively affects general health. Accordingly, longitudinal studies report a long-term risk for cardiovascular diseases after radiotherapy and/or cisplatin-based chemotherapy in testicular tumor survivors. The aim of this review was to summarize the current evidence on hypogonadism and sexual dysfunction in long-term cancer survivors, including the epidemiology of cardiovascular and metabolic disorders, to increase the awareness that serum testosterone levels, sexual function, and general health should be evaluated during the endocrinological management of these patients.
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Affiliation(s)
- Sandro La Vignera
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Ylenia Duca
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Barbagallo
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Burgio
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michele Compagnone
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Di Cataldo
- Unit of Pediatric Hematology and Oncology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E. Calogero
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A. Condorelli
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Pallotti F, Petrozzi A, Cargnelutti F, Radicioni AF, Lenzi A, Paoli D, Lombardo F. Long-Term Follow Up of the Erectile Function of Testicular Cancer Survivors. Front Endocrinol (Lausanne) 2019; 10:196. [PMID: 31001201 PMCID: PMC6453999 DOI: 10.3389/fendo.2019.00196] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 12/16/2022] Open
Abstract
The diagnosis of testicular cancer (TC) can have a considerable and persistent impact on a patient's sexuality, especially given its location. The high prevalence of TC in young adults, and the good prognosis, explain the great interest in sexual dysfunction and its influence on post-treatment quality of life. The aim of this study was to evaluate the impact of the diagnosis and treatments (inguinal orchiectomy and chemotherapy) on sex life. For this purpose, we recruited 241 TC patients attending the Laboratory of Seminology-Sperm Bank "Loredana Gandini" for sperm cryopreservation (mean age 31.3 ± 6.9 years) and 223 cancer-free healthy men who were undergoing andrological screening (mean age 32.0 ± 7.7 years). The IIEF-15 questionnaire was administered at the baseline (post-orchiectomy, pre-chemotherapy-T0) and at 6 (T1), 12 (T2), 18 (T3), 24 (T4), 48 months (T5) and >5 years (T6, median 96 months) after chemotherapy to all patients, to evaluate the following domains: erectile function (EF), orgasmic function (OF), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A subgroup of patients also underwent blood sex hormone analysis for further correlations with IIEF scores. At the baseline, 37.7% of patients had erectile dysfunction (EF score <26) and all IIEF domains except OF showed significantly lower scores than in controls (p < 0.001). Long-term follow-up revealed persistently lower scores in TC survivors than in controls for EF, SD, IS, and OS. Furthermore, most IIEF domains did not improve significantly in TC patients during the duration of the follow-up, with the exception of EF, which showed a significant improvement from T2. Finally, no significant correlation was found between hormone levels (gonadotropin and testosterone) and IIEF-15 scores. In conclusion, TC and its treatment have a significant effect on sexuality. The absence of a clear correlation with biochemical hypogonadism suggests that this may to a large extent be due to the surgical procedure itself, or to the psychological impact of a cancer diagnosis.
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Affiliation(s)
- Francesco Pallotti
- Laboratory of Seminology–Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Petrozzi
- Laboratory of Seminology–Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cargnelutti
- Laboratory of Seminology–Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Lenzi
- Laboratory of Seminology–Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Donatella Paoli
- Laboratory of Seminology–Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- *Correspondence: Donatella Paoli
| | - Francesco Lombardo
- Laboratory of Seminology–Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Bandak M, Lauritsen J, Johansen C, Kreiberg M, Skøtt JW, Agerbaek M, Holm NV, Daugaard G. Sexual Function in a Nationwide Cohort of 2,260 Survivors of Testicular Cancer after 17 Years of Followup. J Urol 2018; 200:794-800. [PMID: 29730199 DOI: 10.1016/j.juro.2018.04.077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Evidence on the long-term impact of testicular cancer treatment on sexual function is not clear. Our aim was to estimate the effect of testicular cancer treatment on the risk of sexual dysfunction in long-term survivors of testicular cancer. MATERIALS AND METHODS We performed a cross-sectional study of 2,260 long-term survivors of testicular cancer with a median followup of 17 years (IQR 12-24), including 1,098 who underwent orchiectomy alone (surveillance), 788 treated with bleomycin, etoposide and cisplatin alone or post-chemotherapy retroperitoneal surgery, 300 treated with abdominal radiotherapy and 74 who received more than 1 line of treatment. Sexual function was evaluated by the IIEF-15 (International Index of Erectile Function-15) questionnaire. Results were compared between treatment groups using logistic regression analysis with the results on each of the 5 IIEF-15 dimensions as the outcome and treatment as exposure using surveillance as the referent. RESULTS The risk of erectile dysfunction was increased in all treatment groups compared to surveillance, including bleomycin, etoposide and cisplatin alone (OR 1.5, 95% CI 1.0-2.1, p <0.05), bleomycin, etoposide and cisplatin with post-chemotherapy surgery (OR 2.1, 95% CI 1.4-3.4, p <0.005), radiotherapy (OR 1.7, 95% CI 1.1-2.5, p <0.05) and more than 1 line of treatment (OR 3.2, 95% CI 1.6-6.3, p <0.005). Orgasmic dysfunction was associated with radiotherapy, bleomycin, etoposide and cisplatin with post-chemotherapy surgery and more than 1 line of treatment. CONCLUSIONS Treatment with bleomycin, etoposide and cisplatin, radiotherapy and more than 1 treatment line increased the risk of erectile dysfunction in long-term survivors of testicular cancer compared to surveillance. Patients should be informed about this as part of the information on treatment related late effects.
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Affiliation(s)
- Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julie Wang Skøtt
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mads Agerbaek
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels V Holm
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Smith AB, Rutherford C, Butow P, Olver I, Luckett T, Grimison P, Toner G, Stockler M, King M. A systematic review of quantitative observational studies investigating psychological distress in testicular cancer survivors. Psychooncology 2018; 27:1129-1137. [PMID: 29171109 DOI: 10.1002/pon.4596] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/28/2017] [Accepted: 11/05/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Testicular cancer (TC) affects young men and may cause psychological distress despite a good prognosis. This systematic review evaluated the prevalence, severity, and correlates of anxiety, depression, fear of cancer recurrence (FCR), and distress in TC survivors. METHODS A systematic search of literature published 1977 to 2017 was conducted to find quantitative studies including TC survivor-reported outcomes relevant to review objectives. The quality of included articles was assessed, and a narrative synthesis conducted. RESULTS Of 6717 articles identified, 66 (39 good, 20 fair, and 7 poor quality) reporting results from 36 studies were included. Testicular cancer survivors' mean anxiety levels were higher than in the general population, while mean depression and distress were no different. Clinically significant anxiety (≈1 in 5) and to a lesser extent distress (≈1 in 7), but not depression, were more prevalent in TC survivors than the general population. Approximately 1 in 3 TC survivors experienced elevated FCR. Poorer psychological outcomes were more common among TC survivors who were single, unemployed/low socio-economic status, suffering from co-morbidities, experiencing worse symptoms/side effects, and using passive coping strategies. CONCLUSIONS Many TC survivors do not experience significant psychological morbidity, but anxiety and FCR are prevalent. Inadequate coping resources (eg, low socio-economic status and social support) and strategies (eg, avoidance) and greater symptoms/side effects were associated with poorer outcomes. Theoretically driven prospective studies would aid understanding of how outcomes change over time and how to screen for risk. Age and gender appropriate interventions that prevent and manage issues specific to TC survivors are also needed.
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Affiliation(s)
- Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia
| | - Claudia Rutherford
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Ian Olver
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Tim Luckett
- Improving Palliative, Chronic and Aged Care through Clinical Trials Research and Translation (ImPaCCT), South Western Sydney Clinical School, Faculty of Health, University of New South Wales and University of Technology Sydney, Sydney, NSW, Australia
| | - Peter Grimison
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Guy Toner
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, VIC, Australia
| | - Martin Stockler
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group Limited (ANZUP), Sydney, NSW, Australia
- Sydney Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Madeleine King
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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9
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Acquati C, Zebrack BJ, Faul AC, Embry L, Aguilar C, Block R, Hayes-Lattin B, Freyer DR, Cole S. Sexual functioning among young adult cancer patients: A 2-year longitudinal study. Cancer 2017; 124:398-405. [PMID: 29149503 DOI: 10.1002/cncr.31030] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cancer-related sexual dysfunction has been reported among adolescents and young adults (AYAs); however, its prevalence over time has not been examined. This longitudinal study investigated sexual dysfunction in AYAs over the course of 2 years after the initial diagnosis. METHODS Young adult patients (18-39 years old) completed the Medical Outcomes Study Sexual Functioning Scale within the first 4 months of their diagnosis (n = 123) and again 6 (n = 107) and 24 months later (n = 95). An ordered multinomial response model analyzed changes in the probability of reporting sexual dysfunction over time and the independent effects of demographic, clinical, and psychosocial variables. RESULTS More than half of the participants reported sexual functioning to be problematic at each assessment. The probability of reporting sexual dysfunction increased over time (P < .01) and was greater for cancer patients who were female (P < .001), older (P < .01), married or in a committed relationship (P < .001), treated with chemotherapy (P < .05), and reporting comorbid psychological distress (P < .001) and lower social support (P < .05). For women, being in a relationship increased the likelihood of reporting sexual problems over time; for men, the likelihood of reporting sexual problems increased regardless of their relationship status. CONCLUSIONS A substantial proportion of young adults report ongoing problems with sexual functioning in the first 2 years after their cancer diagnosis. These findings justify the need to evaluate and monitor sexual functioning throughout a continuum of care. Cancer 2018;124:398-405. © 2017 American Cancer Society.
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Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas
| | - Brad J Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Anna C Faul
- Kent School of Social Work, University of Louisville, Louisville, Kentucky.,Department of Social Work, University of the Free State, Bloemfontein, South Africa
| | - Leanne Embry
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Christine Aguilar
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | | | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steve Cole
- Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, California
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10
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Matheson L, Watson EK, Nayoan J, Wagland R, Glaser A, Gavin A, Wright P, Rivas C. A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28382745 DOI: 10.1111/ecc.12676] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Abstract
Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.
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Affiliation(s)
- L Matheson
- Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - E K Watson
- Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - J Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - A Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - P Wright
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - C Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Capogrosso P, Boeri L, Ferrari M, Ventimiglia E, La Croce G, Capitanio U, Briganti A, Damiano R, Montorsi F, Salonia A. Long-term recovery of normal sexual function in testicular cancer survivors. Asian J Androl 2016; 18:85-9. [PMID: 26112476 PMCID: PMC4736362 DOI: 10.4103/1008-682x.149180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Testicular cancer (TC) is the most common solid cancer in men between the third and fourth decade of life. Due to successful treatment approaches, TC survivors (TCSs) have long life expectancy, but with numerous potential long-term sequelae, including sexual dysfunction. We investigated predictors of long-term normal sexual function (SF) recovery in TCSs. Sociodemographic, medical, and psychometric data were analyzed in 143 Caucasian-European TCSs, who underwent orchiectomy at a single institution. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). Statistical models tested the association between predictors (including age at surgery, body mass index, CCI, and adjuvant therapy: radiotherapy [RT], chemotherapy [CT], CT followed by retroperitoneal lymph node dissection [RPLND] and RPLND alone) and the long-term recovery of normal SF (defined as IIEF-erectile function [EF] ≥26, and sexual desire [SD], intercourse satisfaction [IS] orgasmic function [OF], and overall satisfaction [OS] domain scores in the upper tertiles). At a mean follow-up of 86 months, 35 (25.5%) TCSs had erectile dysfunction (ED), with 16 (11.2%) experiencing severe ED. Median time of EF recovery was 60, 60, and 70 months after CT, RT, and RPLND, respectively. Only adjuvant RT emerged as an independent predictor of nonrecovery of normal EF (HR: 0.55, P= 0.01). Neither adjuvant CT nor CT plus RPLND or RPLND alone significantly impaired the recovery of normal erections. Adjuvant therapy was not associated with impaired recovery of normal sexuality as a whole, considering the IIEF-SD, -OF, -IS, and OS domains.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andrea Salonia
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
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12
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Vehling S, Mehnert A, Hartmann M, Oing C, Bokemeyer C, Oechsle K. Anxiety and depression in long-term testicular germ cell tumor survivors. Gen Hosp Psychiatry 2016; 38:21-5. [PMID: 26439320 DOI: 10.1016/j.genhosppsych.2015.09.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Despite a good prognosis, the typically young age at diagnosis and physical sequelae may cause psychological distress in germ cell tumor survivors. We aimed to determine the frequency of anxiety and depression and analyze the impact of demographic and disease-related factors. METHOD We enrolled N=164 testicular germ cell tumor survivors receiving routine follow-up care at the University Cancer Center Hamburg and a specialized private practice (mean, 11.6 years after diagnosis). Patients completed the Generalized Anxiety Disorder Screener-7, the Patient Health Questionnaire-9 and the Memorial Symptom Assessment Scale-Short Form. RESULTS We found clinically significant anxiety present in 6.1% and depression present in 7.9% of survivors. A higher number of physical symptoms and having children were significantly associated with higher levels of both anxiety and depression in multivariate regression analyses controlling for age at diagnosis, cohabitation, socioeconomic status, time since diagnosis, metastatic disease and relapse. Younger age at diagnosis and shorter time since diagnosis were significantly associated with higher anxiety. CONCLUSION Although rates of clinically relevant anxiety and depression were comparably low, attention toward persisting physical symptoms and psychosocial needs related to a young age at diagnosis and having children will contribute to address potential long-term psychological distress in germ cell tumor survivors.
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Affiliation(s)
- S Vehling
- Department of Medical Psychology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany.
| | - A Mehnert
- Department of Medical Psychology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany; Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Germany
| | - M Hartmann
- Department of Urology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - K Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
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Ussher JM, Perz J, Gilbert E. Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study. BMC Cancer 2015; 15:268. [PMID: 25885443 PMCID: PMC4407322 DOI: 10.1186/s12885-015-1243-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/23/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes. METHOD This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview. RESULTS Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer. CONCLUSION The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.
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Affiliation(s)
- Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Emilee Gilbert
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
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14
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Interpersonal Sensitivity and Sexual Functioning in Young Men with Testicular Cancer: the Moderating Role of Coping. Int J Behav Med 2015; 22:709-16. [DOI: 10.1007/s12529-015-9472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Averyt JC, Nishimoto PW. Addressing sexual dysfunction in colorectal cancer survivorship care. J Gastrointest Oncol 2014; 5:388-94. [PMID: 25276411 DOI: 10.3978/j.issn.2078-6891.2014.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/01/2014] [Indexed: 12/27/2022] Open
Abstract
Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction.
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Affiliation(s)
- Jennifer C Averyt
- 1 Department of Behavioral Health, 2 Department of Oncology/Hematology, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA
| | - Patricia W Nishimoto
- 1 Department of Behavioral Health, 2 Department of Oncology/Hematology, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA
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Perz J, Ussher JM, Gilbert E. Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer. BMC Cancer 2014; 14:228. [PMID: 24673768 PMCID: PMC3986691 DOI: 10.1186/1471-2407-14-228] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Changes to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study. METHOD Six hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships. RESULTS Men and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer. CONCLUSION These results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.
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Affiliation(s)
- Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
| | - Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
| | - Emilee Gilbert
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
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Huang SS, Lin CH, Chan CH, Loh EW, Lan TH. Newly diagnosed major depressive disorder and the risk of erectile dysfunction: a population-based cohort study in Taiwan. Psychiatry Res 2013; 210:601-6. [PMID: 23850431 DOI: 10.1016/j.psychres.2013.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/04/2013] [Accepted: 06/12/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The primary aim of this study was to explore the incidence rate of erectile dysfunction (ED) among major depressive disorder (MDD) patients in an Asian country. The second aim was to compare the risk of ED in MDD patients that were treated using antidepressants with a high risk-ED, antidepressants with a low risk-ED, or without treatment. METHODS We identified 4339 male patients with newly diagnosed MDD using the National Health Database. Four matched controls per case were selected for the study. RESULTS The mean age of the participants was 42.3 ± 16.9. A higher crude HR of 3.6 (95% CI: 2.8-4.6) was seen in the male patients with MDD. After adjusting for obesity, monthly income, urbanization level, and comorbidity, the MDD patients had a 3.2-fold higher HR for an ED diagnosis than the controls. Patients with untreated depression had the highest risk of ED, compared to the control group (HR=3.9). Patients treated with IHiRA had a medium risk of developing ED (HR=3.6), and patients treated with ILoRA had the lowest risk of ED (HR: 2.5). CONCLUSION This prospective cohort study found an association between ED and prior MDD. Patients with untreated depression may have the highest risk of developing ED.
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Affiliation(s)
- Shiau-Shian Huang
- Department of Psychiatry, Taichung Veterans General Hospital, Taiwan
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18
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19
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Crawshaw M. Male coping with cancer-fertility issues: putting the ‘social’ into biopsychosocial approaches. Reprod Biomed Online 2013; 27:261-70. [DOI: 10.1016/j.rbmo.2013.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/18/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
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Gilbert E, Ussher JM, Perz J, Wong WKT, Hobbs K, Mason C. Men's experiences of sexuality after cancer: a material discursive intra-psychic approach. CULTURE, HEALTH & SEXUALITY 2013; 15:881-895. [PMID: 23656602 DOI: 10.1080/13691058.2013.789129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Men can experience significant changes to their sexuality following the onset of cancer. However, research on men's sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on men's sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, men's intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of 'normal' masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Men's relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.
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Affiliation(s)
- Emilee Gilbert
- a Centre for Health Research , University of Western Sydney , Sydney , Australia
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21
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Peleg-Sagy T, Shahar G. The prospective associations between depression and sexual satisfaction among female medical students. J Sex Med 2013; 10:1737-43. [PMID: 23651294 DOI: 10.1111/jsm.12176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The direction of the relationships between depression and sexual dissatisfaction is unclear. Possibly, these relationships are influenced by different elements/components of depression represented by different measures (i.e., Center for Epidemiologic Studies Depression Scale [CES-D], which highlights mood, vs. Beck Depression Inventory version II [BDI-II], which focuses on cognition and physical symptoms). High-achieving women--such as female medical students, interns, and residents--might be particularly prone to both depression and sexual dissatisfaction. AIM The aim of this study is to examine the direction of the longitudinal associations between depressive symptoms and sexual dissatisfaction in high-achieving, romantically involved female Israeli medical students and interns/residents using both CES-D and BDI-II. METHODS One hundred ninety-four female medical students from the first, fourth, and seventh (internship) years from all medical schools in Israel who were currently involved in romantic relationships were assessed twice over a 1-year interval using both CES-D and BDI-II. Cross-lagged structural equation modeling analyses were employed. MAIN OUTCOME MEASURES Depressive symptoms were measured by the CES-D and the BDI-II. Sexual satisfaction was assessed by the "partner-satisfaction" factor of the Pinney Sexual Satisfaction Inventory. RESULTS Elevated levels of CES-D-measured depression were found (26% at T1 and 13% at T2 above the stricter cutoff point). The direction of the longitudinal association between depressive symptoms and sexual dissatisfaction changed according to the depression measure used: baseline CES-D-measured depression predicted an increase in sexual dissatisfaction over time (β = 0.148, P = 0.016). Baseline sexual satisfaction predicted an increase in BDI-II-measured depression (β = 0.136, P = 0.045). CONCLUSION High-achieving, "fully-functioning" female medical students suffer from elevated levels of CES-D-measured depressed mood. Depressed mood might lead to sexual dissatisfaction, which in turn is likely to bring about "clinical," BDI-II-measured depression. We recommend a routine assessment of depressed mood and sexual dissatisfaction in this population, as well as increased access to tailored intervention for both clinical challenges.
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Affiliation(s)
- Tal Peleg-Sagy
- Department of Psychology, Ben-Gurion University of Negev, Beersheva, Israel. neshikotal@hotmail
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22
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Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: A population-based study. Eur J Cancer 2012; 48:3161-70. [DOI: 10.1016/j.ejca.2012.04.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 04/03/2012] [Accepted: 04/11/2012] [Indexed: 01/07/2023]
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Rossen P, Pedersen AF, Zachariae R, von der Maase H. Sexuality and body image in long-term survivors of testicular cancer. Eur J Cancer 2011; 48:571-8. [PMID: 22197218 DOI: 10.1016/j.ejca.2011.11.029] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 11/15/2011] [Accepted: 11/28/2011] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study explores sexual function and the influence of different treatment modalities on sexual function and body image among long-term survivors of testicular cancer (TCSs). METHODS A long-term follow-up assessment of all testicular cancer patients treated at Aarhus University Hospital, Denmark, from 1990 to 2000 was conducted. A total of 401 survivors (mean age: 46.6years; response rate: 66%) completed questionnaires concerning sexuality and changes in body image. Based on the treatment received, patients were categorised into one of four groups: surveillance, radiotherapy, chemotherapy, or chemotherapy supplemented with retroperitoneal lymph node dissection (RPLND). RESULTS Sexual dysfunctions were reported: 24% reduced sexual interest, 43% reduced sexual activity, 14% reduced sexual enjoyment, 18% erectile dysfunction, 7% ejaculatory problems and 3% increased sexual discomfort. Seventeen percent of the long-term TCSs reported changes in body image, and this was significantly associated with all six parameters of sexual dysfunction. When comparing treatments, only the RPLND procedure was associated with sexual dysfunction in the form of ejaculatory dysfunction. CONCLUSION Apart from RPLND, which was associated with ejaculatory dysfunction, treatment strategies for testicular cancer appeared not to influence sexual dysfunction. The level of erectile dysfunction seen in this sample of TCSs seemed to be higher than the level observed in the general male population and high levels of erectile dysfunction were associated with negative changes in body image. The results suggest that changes in body image are of importance when explaining the variation in sexual dysfunctions, but further prospective studies are needed to clarify this issue.
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Affiliation(s)
- P Rossen
- Department of Oncology, Aarhus University Hospital, Denmark.
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Jankowska M. Sexual functioning of testicular cancer survivors and their partners - A review of literature. Rep Pract Oncol Radiother 2011; 17:54-62. [PMID: 24376997 DOI: 10.1016/j.rpor.2011.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/24/2011] [Accepted: 11/05/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Testicular cancer (TC) is the most common cancer in the 25-40 age group, with peak morbidity at around 30 years of age. It is a period of highest productivity, when sexual sphere is an important aspect of life. The disease, invasive treatment and its consequences interfere with this sphere. AIM The aim of this paper was to review the most recent studies on the sexual functioning of patients treated for testicular cancer and their partners published in English language scientific journals in the period of 1989-2010. RESULTS Numerous studies report that men cured from testicular cancer are at risk of sexual disorders. Agents of psychological nature play an important role in the occurrence and persistence of sexual dysfunctions. Being in permanent relationship is a protective factor, while single persons are marked with particular predisposition to such dysfunctions. Sexual and marital satisfaction of TC survivors and their partners are mutually correlated. CONCLUSION With a growing number of TC survivors, a thorough investigation is required into their sexuality, both in an individual and dyadic dimension, so as to improve the quality of life of the affected young men, who take on their new social and professional roles in the period of highest reproductiveness.
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Affiliation(s)
- Monika Jankowska
- Clinical Psychology Unit, Greater Poland Cancer Centre, Poznan, Poland
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Carpentier MY, Fortenberry JD. Romantic and sexual relationships, body image, and fertility in adolescent and young adult testicular cancer survivors: a review of the literature. J Adolesc Health 2010; 47:115-25. [PMID: 20638003 PMCID: PMC2907366 DOI: 10.1016/j.jadohealth.2010.04.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/17/2010] [Accepted: 04/15/2010] [Indexed: 11/16/2022]
Abstract
This review presents a summary of existing knowledge regarding the effect of testicular cancer along four broad domains, including romantic and sexual relationships, body image, and fertility. A total of 37 studies were reviewed. Of note, most research consists of older adult testicular cancer survivors, with very little research attention afforded to adolescent and young adult survivorship. Relationship status (i.e., partnered versus unpartnered) appears to play an important role as it relates to adjustment outcomes in testicular cancer survivors. In addition, sexual function (and thereby fertility) and body image are also frequently compromised. Implications regarding a lack of developmentally focused research on adolescent and young adult testicular cancer survivorship are discussed, along with recommendations for new research.
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Affiliation(s)
- Melissa Y Carpentier
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Carpentier MY, Fortenberry JD, Ott MA, Brames MJ, Einhorn LH. Perceptions of masculinity and self-image in adolescent and young adult testicular cancer survivors: implications for romantic and sexual relationships. Psychooncology 2010; 20:738-45. [PMID: 20878864 DOI: 10.1002/pon.1772] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 04/06/2010] [Accepted: 04/08/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine adolescent and young adult (AYA) testicular cancer survivors' subjective understanding of the impact of cancer in adolescence and young adulthood, with a particular emphasis on romantic and sexual relationships. METHODS Twenty-one AYA testicular cancer survivors, aged 18 to 34 years, were recruited from outpatient testicular cancer follow-up clinics and completed a semi-structured qualitative interview that assessed the impact of testicular cancer on their romantic and sexual relationships. RESULTS Four themes were identified that reflected survivors' understanding of the impact of cancer in adolescence and young adulthood: (1) embarrassment leads to delays in care-seeking, (2) testicular cancer makes you feel different from others, (3) being different from others makes you damaged goods, and (4) cancer disclosure is difficult. CONCLUSIONS As these themes represent important components of being in a romantic/sexual relationship, either currently or in the future, AYA testicular cancer survivors would benefit from the development of tailored interventions focused on improving these relevant domains.
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