Sexual health in colon cancer patients: A systematic review

Beyond Survival: A Scoping Review on the Sexual Health of Sexual and Gender Minority Women Following Curative Cancer Treatment

INTRODUCTION

To explore the existing research on sexual health experiences of sexual and gender minority women (SGMW) post-curative cancer treatment.

METHODOLOGY

This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Four articles that focused on sexual health experiences of SGMW post-curative cancer treatment were included.

RESULTS

Four themes were identified: (a) sexual function; (b) sexual orientation and gender identity, including disclosure and health care provider reactions; (c) relationship dynamics, such as relationship status and the quality of romantic relationships; and (d) body image.

DISCUSSIONS

The findings underscore substantial challenges faced by SGMW cancer survivors in achieving optimal sexual well-being, impacting their access to post-treatment care. This study advocates for more expansive research efforts involving diverse participant cohorts, extending beyond breast cancer, to gain deeper insights into these critical issues.

Mechanisms of erectile dysfunction induced by aging: A comprehensive review

BACKGROUND

With the increasing trend ofpopulation aging, erectile dysfunction (ED) among elderly men has emerged as apressing health concern. Despite extensive research on the relationship betweenED and aging, ongoing discoveries and evidence continue to arise.

OBJECTIVE

Through this comprehensiveanalysis, we aim to provide a more nuanced theoretical framework for thedevelopment of preventive and therapeutic strategies for senile ED, ultimatelyenhancing the quality of life for elderly men.

METHODS

This review delves deeper into thecore mechanisms underlying ED in the context of aging and offers acomprehensive overview of published meta-analyses and systematic reviewspertinent to these conditions.

RESULTS AND CONCLUSION

Our findings revealthat local structural damage to the penis, vascular dysfunction, neuronalinjury, hormonal alterations, other physiological changes, and psychologicalbarriers all play pivotal roles in the pathogenesis of aging-related ED.Furthermore, more than 20 diseases closely associated with aging have beenimplicated in the occurrence of ED, further compounding the complexity of thisissue.

Non-gastrointestinal symptom burden following colorectal cancer treatment-a systematic review

BACKGROUND

Colorectal cancer is one of the most common malignancies worldwide. Improvements in screening and treatment have allowed for earlier detection and longer survival. However, treatments, which may involve surgery, radiotherapy and/or chemotherapy, often lead to patients developing both gastrointestinal and non-gastrointestinal symptoms that can persist long term. This systematic review aims to understand better the non-gastrointestinal symptoms that patients develop after colorectal cancer treatment and how these are identified and assessed through the use of questionnaires.

METHOD

The review was conducted according to PRISMA guidelines. Scopus, PubMed, Web of Science, PsycINFO and Cochrane Library were searched. Eligible studies evaluated the non-gastrointestinal symptoms that patients had developed and continued to have at 12 months or longer after treatment. Studies that were performed on patients who were within 12 months of treatment, who had a recurrent or a secondary cancer, had stage 4 cancer/were palliative or that looked solely at gastro-intestinal symptoms were excluded. Articles were limited to studies on human subjects written in English published between February 2012 and July 2024.

RESULTS

The searches identified 3491 articles. Thirty-seven articles met the inclusion criteria, of which, 33 were quantitative, 2 were qualitative and 2 were mixed methods study designs. Nearly two-thirds (n = 22) were cross-sectional studies, whereas 14 were longitudinal. One study had both a cross-sectional and longitudinal component to it. Most studies were of medium to high quality based on the Newcastle Ottawa Scale (n = 23) and were conducted in 14 countries, the majority of which were performed in the Netherlands (n = 14). The majority of participants in the included studies (n = 30/37) were men. There were also three studies that were performed with only female participants and one study that was performed with male participants only. The age range of research participants across all the studies was 29 to 89 years. Forty-five different validated questionnaires containing 5-125 question items were used to collect information on the side effects and impact of colorectal cancer treatment. Completion rate for questionnaires varied from 30 to 100% (median 63.5%). These determined effects on quality of life, emotional/psychological distress, sexual and urinary dysfunction, neuropathy, fatigue and hip pain.

CONCLUSION

This systematic review highlighted a wide range of longer-term non-gastrointestinal symptoms that frequently adversely affect QoL following treatment. These studies included highlighting the importance of nutrition/diet, physical activity, spirituality and communication in managing these long-term side effects.

Care for sexual health in oncology survey: Discussions about sexual health with people with cancer in the context of the obligation to provide informed consent

PURPOSE

The purpose of this paper is to describe the impacts of cancer treatment on sexual health in a sample of people who had been treated for mixed types of cancer; to describe discussions they had with professionals about sexual health that occurred during cancer care; and to consider the extent to which these discussions were sufficient to enable participants to give informed consent for the sexual side effect of cancer treatment.

METHOD

A cross-sectional, online survey using a convenience sample of people with cancer was recruited via UK cancer charities. Eligibility criteria included having received treatment and follow-up care for any type of cancer in the UK during the previous 10 years. Univariate analysis was conducted using SPSS.

RESULTS

136 people with cancer participated in this survey. The majority of participants reported having experienced a worsening of their sexual lives, which bothered them. Whilst 33.6% of the sample (n = 125) reported having discussed sexual health during their cancer care, only 5.4% reported that a healthcare professional initiated a pre-treatment discussion about the sexual side effects of cancer treatment.

CONCLUSIONS

These results suggest that the proportion of participants who were provided with sufficient information to give informed consent for the sexual side effects of cancer treatment was very low. This indicates that healthcare professionals may require specific advice on how to include this topic during the informed consent process.

Sexual Health and Quality of Life in Cancer Survivors With Pelvic Radiation Injuries

BACKGROUND

Little knowledge exists on how late radiation tissue injuries (LRTIs) affect sexual health and health-related quality of life (HRQOL) in pelvic cancer survivors.

OBJECTIVE

To explore sexual health and HRQOL in cancer survivors with pelvic LRTI.

METHOD

A descriptive cross-sectional study was conducted, including 83 pelvic cancer survivors with LRTI. Data on sexual health, LTRIs, and HRQOL were collected by validated questionnaires, whereas medical variables were collected from medical records.

RESULTS

Participants' sexual health was severely impaired. Bowel and urinary LRTIs correlated with most of the symptoms of impaired sexual health (Pearson r = -0.241 to -0.376, P < .05-.01). Men and women reported different sexual challenges related to functional and symptomatic variables but not on the gender-neutral aspects of sexual health. Younger survivors, gynecological cancer survivors, or those who received external and internal radiation or additional chemotherapy reported significantly ( P < .05-.001) higher levels of sexual impairment. Participants' HRQOL was impaired. Several dimensions of sexual health correlated significantly ( P < .05-.001) with the functional dimensions of reduced HRQOL.

CONCLUSION

Cancer survivors with pelvic LRTIs experience severely impaired sexual health across genders, with negative consequences for their HRQOL.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should include sexual health as an important part of individual patients' health and HRQOL throughout their treatment trajectory and follow-up, by screening sexual health, implementing measures and interventions to promote sexual health, and supporting survivors' coping and health-promoting strategies.

Sexual dysfunction in patients with cancer, a challenge in oncology practice: results of the CLARIFY project

BACKGROUND

Sexual dysfunction (SD) associated with oncological treatment is a common and understudied disorder. Our aim was to characterize SD in a cohort of Spanish patients.

METHODS

Analytic observational study in patients included in the CLARIFY H2020 project at the Hospital Universitario Puerta de Hierro. Clinical variables and validated measures of sexual function were collected from October 2020 to May 2022. Frequency and quality of sexual activity were assessed. Descriptive, trend associations, and logistic regression analyses were performed.

RESULTS

A total of 383 patients were included: breast cancer 68.14% (261), lung cancer 26.37% (101), and lymphoma 5.50% (21). Mean age was 56.5 years (range 33-88). 19.58% (75) were men and 80.42% (308) were women. 69% and 31% of men and women, respectively, reported being sexually active. The absolute frequency of overall sexual dissatisfaction was 76% in women and 24% in men. Women with breast cancer were most likely to have severe sexual dysfunction. Those with early disease had resolved complaints after 5 years. In multinomial logistic regression, significant associations were found in women with metastatic breast cancer and severe disorders of arousal (p 0.000), lubrication (p 0.002), orgasm (p 0.000), as well as dissatisfaction with sexual performance (p 0.000) and global sexual dissatisfaction (p 0.000). Women with lung cancer have severe arousal dysfunction (p 0.016) and global sexual dissatisfaction (p 0.044).

CONCLUSIONS

Our population has a high prevalence of SD, which supports the need to increase awareness of this disorder among the medical oncology team and the importance of including sexual health assessment in oncological patient follow-up.

The effect of psychosocial interventions for sexual health in patients with pelvic cancer: a systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer.

METHODS

Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers.

RESULTS

Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01).

DISCUSSION

There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.

Factors associated with sexual dysfunction in patients with colorectal cancer in Iran: a cross-sectional study

Sexual dysfunction is a prevalent issue among individuals diagnosed with colorectal cancer (CRC), significantly impacting their quality of life. However, limited research has explored the factors associated with sexual dysfunction in CRC patients in Iran. This cross-sectional study aimed to identify the demographic factors that may contribute to sexual dysfunction in this population. A cross-sectional study involving CRC patients was conducted from April 1, 2022, to May 1, 2022, in Tabriz, Iran. Ethical approvals were obtained, and convenience sampling was employed at outpatient chemotherapy centers in five Tabriz hospitals. Validated questionnaires, including participants characteristics form, the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males, were utilized. Data were analyzed using IBM SPSS Statistics version 24, employing descriptive statistics and stepwise linear regression to assess association between mentioned factors and sexual function. Among 256 participants, 50.4% were males, 49.6% were females, and 80.5% were married. The predominant age range was 50-60 years. The study findings revealed a high prevalence of sexual dysfunction among both female (Mean ± SD: 10.91 ± 8.67, Min-Max: 3.20-33.00) and male (Mean ± SD: 27.64 ± 16.28, Min-Max: 11-62) CRC patients. Factors such as the presence of a colostomy for FSFI (P < 0.001), type of treatment received for both FSFI and IIEF (P < 0.001), type of housing for both FSFI and IIEF (P < 0.001), occupation for FSFI (P < 0.001), presence of other diseases for FSFI (P = 0.047), and time since the last chemotherapy session for FSFI (P = 0.018), Education for IIEF (P = 0.026), and Age for IIEF (P = 0.002) were identified as significant factors of sexual dysfunction. These demographic factors demonstrated varying effects on sexual function, underscoring the complexity of this issue. The results underscore the significance of addressing sexual health concerns in CRC patients and highlight the necessity for tailored interventions to enhance their overall well-being. Healthcare providers should recognize the influence of demographic factors on sexual function and contemplate integrating sexual health assessments and interventions into the care of CRC patients. Further research is needed to comprehend better the underlying mechanisms and devise effective strategies for managing sexual dysfunction in this population.

Promoting Sexual Health in Colorectal Cancer Patients and Survivors: Results from a Systematic Review

BACKGROUND

Colorectal cancer diagnosis and treatment negatively impact sexual health. However, there is still a lack of interventions targeting the sexual healthcare needs of colorectal cancer patients and survivors. This systematic review aimed to identify and summarize the efficacy of available psychological interventions aimed at improving colorectal cancer patients' and survivors' sexual health.

METHODS

This review followed PRISMA guidelines for systematic reviews. A database search was conducted for studies published until July 2023 on EBSCO Host, Web of Science, PubMed, and the Cochrane Library. Manuscripts were screened according to inclusion and exclusion criteria. The risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies.

RESULTS

From the 1499 records screened, four studies describing psychological interventions to improve the sexual health of the target population were identified. All studies reported on e-health programs and showed evidence of their efficacy in the improvement of participants' sexual function. The studies presented low scores on the Quality Assessment Tool for Quantitative Studies.

CONCLUSIONS

Despite the evidence that tele/e-health psychological interventions have the potential to effectively promote sexual health in colorectal cancer patients and survivors, more robust research is needed to allow for generalization. Future research should further assess the efficacy of e-health interventions (eMental Health) in promoting sexual health in patients with colorectal cancer.

Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers

PURPOSE

To examine the prevalence of female sexual dysfunction (FSD), male erectile dysfunction (ED), and the prevalence and correlates of sexual health discussions between early-onset CRC survivors and their health care providers.

METHODS

An online, cross-sectional survey was administered in partnership with a national CRC advocacy organization. Respondents (n = 234; diagnosed < 50 years, 6-36 months from diagnosis/relapse) were colon (36.8%) and rectal (63.3%) cancer survivors (62.5% male). The Female Sexual Function Index (FSFI-6) was used to measure FSD, and the International Index of Erectile Function (IIEF-5) was used to measure ED. Survivors reported whether a doctor communicated with them about sexual issues during/after treatment.

RESULTS

Among females (n = 87), 81.6% had FSD (mean FSFI-6 score = 14.3 [SD±6.1]). Among males (n = 145), 94.5% had ED (mean IIEF-5 score = 13.6 [SD±3.4]). Overall, 59.4% of males and 45.4% of females reported a sexual health discussion. Among the total sample, older age of diagnosis and relapse were significantly associated with reporting a discussion, while female sex was negatively associated with reporting a sexual health discussion. Among males, older age at diagnosis and relapse, and among females, older age of diagnosis, were significantly associated with reporting a sexual health discussion.

CONCLUSION

The prevalence of FSD and ED were high (8 in 10 females reporting FSD, almost all males reporting ED), while reported rates of sexual health discussion were suboptimal (half reported discussion). Interventions to increase CRC provider awareness of patients at risk for not being counseled are needed to optimize long-term health outcomes.

Overview of sexual dysfunction in patients with cancer

Among survivor's patients with cancer, sexual dysfunction (SD) is a common treatment-related disturbance that significantly affects their quality of life. The disorder can be a short-term effect, but frequently it can be permanent and patients often do not receive adequate support to overcome the problem. The characteristics of SD may differ depending on the type of neoplasm and oncological treatment. The most common long-term effects are those related to treatment-induced menopause, ablative oncologic surgery, and altered gonadal function. Breast, prostate, and gynecologic cancers are the tumors most commonly associated with disturbances in sexual health, although there is evidence of SD in patients with other types of neoplasms. It is necessary for the healthcare team caring for oncological patients to be aware of the characteristics of sexual dysfunction in this population. This will make it possible to offer patients a comprehensive and personalized approach to improve their quality of life.

Sexual health problems of patients with cancer: A bibliometrics study and visualization analysis via CiteSpace

Purpose

This study aimed to conduct a bibliometric analysis of the data acquired and clarified the current research status of sexual health problems in patients with cancer, to provide a comprehensive visual perspective suitable as a reference for subsequent research.

Methods

We searched the Web of Science Core Collection (WoSCC) up to April 30, 2023 to identify studies associated with sexual health problems in patients with cancer. CiteSpace was used to create visualization networks for countries, institutions, authors, and journals.

Results

A total of 3183 publications related to sexual health problems in patients with cancer were collected from the WoSCC. In terms of volume, the USA (1259 papers) was the leading country, the Memorial Sloan Kettering Cancer Center (119 papers) was the leading institution, and Carter (39 papers) was the author with the most publications. The top-cited references and keywords were related to quality of life. The top five clusters of reference cocitation were 'brachytherapy', 'prostate cancer', 'radical prostatectomy', 'hypogonadism', and 'breast cancer'. Meanwhile, the top five clusters of keyword cocitation were 'breast cancer', 'prostate cancer', 'rectal cancer', 'testicular cancer', and 'sexual function'. The analysis of the top 25 references and keywords with the strongest citation bursts of published papers on sexual health problems in patients with cancer to reveal the research hotspots and trends.

Conclusions

Research on sexual health among patients with cancer is constantly developing. The current research focuses on the impact of different treatment options for sexual health and quality of life of patients with breast, rectal, and genitourinary neoplasms. Exploring the long-term changing regularities of sexual function among cancer survivors and formulating sexual health interventions toward patient-reported outcomes and needs are key research directions.

Comparison of sexual function of people with colorectal cancer with and without colostomy bag in Iran: a comparative cross-sectional study

The aim of this study was to investigate and compare sexual function in individuals with colorectal cancer, with and without a colostomy bag. A quantitative, descriptive-comparative design was employed, and a cluster random sampling method was used to recruit 252 patients with colorectal cancer. Data collection tools included a participants characteristics form, the International Index of Erectile Function (IIEF) for men, and the Female Sexual Function Index (FSFI) for women. The mean IIEF total score for men with a colostomy was 26.17 ± 15.30, and for men without a colostomy, it was 29.05 ± 17.14. The mean FSFI total score for women with a colostomy was 6.40 ± 7.21, and for women without a colostomy, it was 9.10 ± 14.67. There was no statistically difference in IIEF scores between men with and without colostomy bags (p > 0.05). However, women with colostomy bags had significantly lower FSFI scores compared to women without colostomy bags (p < 0.05). Addressing sexual concerns in individuals with colorectal cancer is crucial for enhancing their sexual well-being and overall quality of life. Comprehensive support, timely interventions, and targeted services are essential to help patients navigate the challenges and improve their overall well-being.

A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial

BACKGROUND

Despite the prevalence of sexual distress and dysfunction in older adults in general and stroke and colorectal cancer survivors in particular, access to specialized care is limited by organizational barriers and stigma, embarrassment, and discrimination. The internet allows reaching services that would otherwise be difficult or impossible to reach, and as smartphones are personal (intimate) technologies, they are a promising vehicle to close this gap. However, research focusing on smartphone-delivered sexual health promotion programs is scarce.

OBJECTIVE

This study aims to assess the acceptability, feasibility, and preliminary efficacy of Anathema, an 8-week, iOS/Android smartphone-delivered, individually tailored, cognitive-behavioral sexual health promotion program developed to improve relationship and sexual satisfaction, sexual functioning, sexual distress, sexual pleasure, and health-related quality of life (HRQoL) in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition.

METHODS

Two-arm, parallel, open-label, waiting list, feasibility, pilot randomized controlled trials (RCTs) will be conducted involving older adults, stroke survivors, and colorectal cancer survivors. The primary outcomes are the acceptability, usability, and feasibility of Anathema. Sexual function, relationship and sexual satisfaction, sexual pleasure, sexual distress, anxiety, depression, and HRQoL are the secondary outcomes. This study has been reviewed and approved by the ethics committees of Instituto Português de Oncologia do Porto Francisco Gentil, Europacolon Portugal, Faculty of Psychology and Educational Sciences, University of Porto, and Sigmund Freud University (approval numbers: CES218R/021, CES19/023, and 2022/01-05b).

RESULTS

This project is funded by the European Commission through the Active and Assisted Living (AAL) Programme (reference: AAL-2020-7-133-CP) from April 2021 to December 2023. Recruitment for the pilot RCTs started on January 2023 in Portugal, Austria, and the Netherlands and is currently ongoing. As of May 2023, we randomized 49 participants in the trials. We expect to complete the RCTs in September 2023. The results on the acceptability, feasibility, and preliminary efficacy of Anathema are expected in the second semester of 2023. We expect Anathema to be highly accepted by the populations under study; to prove feasible to scale up to parent RCTs; and to be potentially efficacious in improving sexual functioning, relationship and sexual satisfaction, sexual distress, sexual pleasure, and HRQoL in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. The study results will be published in open-access venues according to COREQ (Consolidated Criteria for Reporting Qualitative Research) and CONSORT EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines.

CONCLUSIONS

The study results will inform the refinement and scale-up of Anathema. Anathema's wider-scale implementation can potentially promote the sexual health of largely neglected user groups such as older adults, colorectal cancer survivors, and stroke survivors.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46734.

Effects of Nutritious Meal Combined with Online Publicity and Education on Postoperative Nutrition and Psychological State in Patients with Low Rectal Cancer After Colostomy

Objective

To investigate the effects of nutritious meal combined with online publicity and education on postoperative nutrition and psychological state in patients with low rectal cancer after colostomy.

Methods

The clinic data of 88 patients with low rectal cancer who received the colostomy in our hospital (August 2020-August 2021) were retrospectively reviewed. Among them, 44 patients received nutritious meal combined with online publicity and education and they made up the study group, and the others were given conventional care and they made up the reference group. The nutrition indicators, scores of the World Health Organization Quality of Life (WHOQOL)-BREF, and other materials of the patients in the two groups were compared.

Results

After intervention, the various nutrition indicators, immune indexes, and WHOQOL-BREF score of the study group were all prominently higher than those of the reference group (P < 0.001). Compared with the reference group, the study group after intervention achieved markedly lower self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) score (P < 0.001) and obviously lower total incidence of complications (P < 0.05).

Conclusion

Combining nutritious meal with online publicity and education can effectively improve the postoperative nutrition and immune function of the patients with low rectal cancer after colostomy, and this intervention contributes to releasing the patients' adverse emotions. Further study helps to provide these patients with favorable solutions.

Influence des facteurs individuels et dyadiques sur l’ajustement sexuel des couples lors d’un cancer du côlon

Contexte : Le cancer du côlon est le troisième cancer le plus diagnostiqué au monde et a un impact sur tous les aspects de la vie des patients et de leur partenaire. Jusqu’à présent, peu d’études ont étudié l’ajustement sexuel des patients et aucune n’a analysé les interactions entre les partenaires.

Objectif : Décrire les facteurs individuels et dyadiques liés à l’ajustement sexuel des couples.

Méthode : Treize couples ont répondu à un ensemble de questionnaires portant sur le soutien social, la communication et les stratégies de coping dyadique et la satisfaction sexuelle. Des analyses non paramétriques ont été réalisées sur les données quantitatives.

Résultats : Le soutien social, la communication et les stratégies d’adaptation dyadique jouent un rôle dans l’ajustement sexuel des couples. La satisfaction ressentie par les patients et leurs partenaires quant au soutien conjugal est corrélée positivement à l’ajustement sexuel du patient. La qualité de la communication des patients quant au stress engendré par la maladie est liée à la satisfaction sexuelle des partenaires. Le coping dyadique de soutien comme la gestion commune du stress favorisent l’ajustement sexuel des patients et des partenaires. Ces stratégies démontrent l’importance de l’unité au sein du couple, le cancer étant abordé comme une « maladie du couple ». Cet engagement mutuel semble favoriser la satisfaction sexuelle des couples.

Conclusion : Gérer la maladie et le stress lié aux traitements en tant que couple et percevoir son partenaire comme une source de soutien satisfaisante est particulièrement bénéfique pour la satisfaction sexuelle des couples dont un membre est atteint d’un cancer du côlon.

The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers

It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.

Frequency of Sexual Problems and Related Psychosocial Characteristics in Cancer Patients-Findings From an Epidemiological Multicenter Study in Germany

Background

Multimodal cancer treatments are often associated with sexual problems. Identifying patients with sexual problems could help further elucidate serious issues with their sexuality and thus promote or maintain patients’ sexual health. We aimed to assess the occurrence of sexual problems in patients across different tumor locations and to explore associated sociodemographic, medical and psychosocial factors.

Methods

We included 3,677 cancer patients (mean age 58 years, age range 18–75 years, 51.4% women) from a large epidemiological multicenter study in Germany on average 13.5 months after cancer diagnosis. The occurrence and frequency of sexual problems were assessed via a binary item on the problem checklist of the Distress Thermometer (DT). Controlled associations of these problems with sociodemographic, medical and psychosocial factors including distress (DT), anxiety (GAD-7), depression (PHQ-9), quality of life (EORTC-QLQ-C30), and social support (SSUK-8) are analyzed using logistic regression analysis.

Results

We found that 31.8% of patients reported sexual problems, with a significant higher proportion in men (40.5%) compared to women (23.7%), OR 2.35, 95% CI [1.80–3.07] and a higher proportion in patients with a partner (35.6%) compared to those without a partner (3.5%), OR 2.83, 95% CI [2.17–3.70]. Tumor location was associated with occurrence of sexual problems: patients with cancer, affecting the male genital organs had the highest chance for sexual problems, OR 2.65, 95% CI [1.18–3.95]. There was no significant difference in the occurrence of sexual problems between age groups OR 0.99, 95% CI [2.13–3.53] and type of therapy (e.g., operation OR 0.91, 95% CI [0.72–1.15]). Sexual problems were further associated with elevated levels of anxiety, OR 1.05, 95% CI [1.02–1.10], less social support, OR 0.93, 95% CI [0.90–0.97] and lower quality of life in terms of impaired functioning (e.g., social function, OR 0.99, 95% CI [0.99–1.00]).

Conclusions

Sexual problems are commonly reported by patients. Male patients and those living with a partner are more likely to report sexual problems. Sexual problems are associated with different aspects of well-being. The findings imply the practical relevance to screen for sexual problems among patients and identified groups that should be particularly monitored.

Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations

OBJECTIVE

The purpose of this study was to determine the association of physical and psychological symptoms with health care utilization in sexual minority and heterosexual colorectal cancer survivors.

METHODS

Four hundred eighteen colorectal cancer survivors who were in remission an average of 3 years after their diagnosis were surveyed about their non-emergency health care visits during the preceding 3 months. Survivors reported whether they had experienced any of 21 symptoms common among colorectal cancer survivors in the past week. The relation between having had two or more health care visits in the preceding 3 months and symptoms experienced was assessed using logistic regression, controlling for cancer registry, sexual orientation, sex, age, race/ethnicity, income, and comorbidities.

RESULTS

Of the survivors, 12% reported no symptoms, while 12% reported six or more symptoms. Sexual minority survivors reported significantly more weight concerns and more health-related and general anxiety as well as worse body image than heterosexual survivors. Frequent worrying about weight and experiencing sore skin around the anal area or stoma were the two symptoms that significantly contributed towards explaining survivors' increased health care utilization.

CONCLUSION

Weight concerns, which are more common among the heaviest survivors, may prompt survivors to seek help from health care providers, which may lead to more frequent visits. On the other hand, some symptoms, despite their prevalence, had no relationship with the frequency of health care visits, raising questions about whether survivors share these concerns with providers.