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Nelson CJ, Schuler TA, Reiner AS, Baser RE, Demirjian CC, Mulhall J, Temple L, Schover L, Jandorf L, DuHamel KN. A psychoeducational intervention to improve sexual functioning in male rectal and anal cancer patients: A pilot randomized controlled trial study. Palliat Support Care 2024:1-9. [PMID: 38389458 DOI: 10.1017/s1478951523001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Male rectal and anal cancer patients demonstrate high rates of sexual dysfunction. This pilot randomized controlled trial tested a psychoeducational intervention designed to improve psychosexual adjustment. METHODS Rectal or anal cancer patients were randomized to a Sexual Health Intervention for Men (intervention) or to a referral and information control (control). The intervention included control activities plus 4 sexual health intervention sessions every 4-6 weeks and 3 brief telephone calls timed between these sessions. Assessments were completed pre-intervention (baseline) and 3 months (follow-up 1) and 8 months (follow-up 2) post-intervention. Differences were assessed with statistical significance and Cohen's d effect sizes (d = 0.2, small effect; d = 0.5, moderate effect; d = 0.8, large effect). RESULTS Ninety subjects enrolled. Forty-three participants completed at least 1 follow-up assessment (intervention, n = 14; control n = 29). At follow-up 1, men in intervention, compared to control, improved on all domains of the International Index of Erectile Function (IIEF) (p < 0.001 to p < 0.05) and demonstrated large effects (d = 0.8 to d = 1.5). Similarly, at follow-up 2, changes in all domains of the IIEF except the orgasm domain were either statistically significant or marginally statistically significant (p = 0.01 to p = 0.08) and demonstrated moderate to large treatment effects for intervention versus control (d = 0.5 to d = 0.8). Men in the intervention, compared to control, demonstrated decreased sexual bother at follow-up 1 (p = 0.009, d = 1.1), while Self-Esteem and Relationship (SEAR) total scores and the SEAR sexual relationship subscale demonstrated moderate increases for intervention versus control (d = 0.4 to d = 0.6). SIGNIFICANCE OF RESULTS This study provides initial evidence for combining a psychoeducational intervention with medical interventions to address sexual dysfunction following rectal and anal cancer. Trials register number: NCT00712751 (date of registration: 7/10/2008).
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tammy A Schuler
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caraline C Demirjian
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larissa Temple
- Division of Colon & Rectal Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Lina Jandorf
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kuiper ST, Zweers D, Suelmann BBM, Meijer RP, Vervoort SCJM. Perspectives and Concerns on Late Effects Regarding Sexuality among Adolescents and Young Adults Treated for Testicular Germ Cell Tumor: The PRICELESS-Study-A Qualitative Study. Cancers (Basel) 2024; 16:715. [PMID: 38398106 PMCID: PMC10886665 DOI: 10.3390/cancers16040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to explore perspectives and concerns regarding sexuality among adolescents and young adults (AYAs) possibly experiencing late effects after testicular germ cell tumor (TGCT) treatment. A qualitative study was performed in which semi-structured interviews were held with thirteen AYAs from a center of expertise for TGCT in the Netherlands. Data were analyzed using Braun and Clark's thematic analysis method. Seven interacting and interconnected themes were found: desire to have children, rediscovering sexuality, insecurity about sexual performance, acceptance of physical change, loss of masculinity, burden on relationship, and openness in discussing sexuality. Concerns about the desire to have children seem to play a significant role. In conclusion, TGCT patients face multiple changes (physical, emotional, relational, and sexual), followed by a difficult period of acceptance, after which a new phase of rediscovering sexuality appeared. These findings can help to make healthcare professionals aware of the underlying mechanisms and concerns about sexuality. Furthermore, insights can help to develop sexuality-themed items for a broader monitoring tool to structurally assess the late effects to support discussing sexuality.
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Affiliation(s)
- Stefan T. Kuiper
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Daniëlle Zweers
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Britt B. M. Suelmann
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Richard P. Meijer
- Oncological Urology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sigrid C. J. M. Vervoort
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
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Haas S, Mikkelsen AH, Kronborg CJS, Oggesen BT, Møller PF, Fassov J, Frederiksen NA, Krogsgaard M, Graugaard-Jensen C, Ventzel L, Christensen P, Emmertsen KJ. Management of treatment-related sequelae following colorectal cancer. Colorectal Dis 2023; 25:458-488. [PMID: 35969031 DOI: 10.1111/codi.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/08/2023]
Abstract
AIM Colorectal cancer survivors are one of the most rapidly growing groups of patients living with and beyond cancer. In a national multidisciplinary setting, we have examined the extent of late treatment-related sequelae in colorectal cancer survivors and present the scientific evidence for management of these conditions in this patient category with the aim of facilitating identification and treatment. METHOD A systematic search for existing guidelines and relevant studies was performed across 16 and 4 databases, respectively, from inception to 2021. This yielded 13 guidelines and 886 abstracts, of which 188 were included in the finalized guideline (231 included for full text review). Secondarily, bibliographies were cross-referenced and 53 additional articles were included. RESULTS Symptoms have been divided into overall categories including psychosocial, bowel-related, urinary, sexual (male and female), pain/neuropathy and fatigue symptoms or complaints that are examined individually. Merging and grading of data resulted in 22 recommendations and 42 management strategies across categories. Recommendations are of a more general character, whereas management strategies provide more practical advice suited for initiation on site before referral to specialized units. CONCLUSION Treatment-related sequelae in colorectal cancer survivors are common and attention needs to be focused on identifying patients with unmet treatment needs and the development of evidence-based treatment algorithms.
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Affiliation(s)
- Susanne Haas
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | | | | | | | - Pia F Møller
- Department of Surgery, Vejle Hospital, Vejle, Denmark
| | - Janne Fassov
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Lise Ventzel
- Department of Oncology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine Jøssing Emmertsen
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
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Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. 'Because Everybody is so Different': a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021; 11:e043245. [PMID: 34011586 PMCID: PMC8137244 DOI: 10.1136/bmjopen-2020-043245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 03/08/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To (1) characterise (A) the lived experiences and (B) information needs of patients with rectal cancer; and (2) compare to the perceived lived experiences and information needs of colorectal surgeons. DESIGN We conducted 1-hour semistructured qualitative interviews, dual independent transcript coding and thematic analysis. SETTING/PARTICIPANTS Interviews included rectal cancer survivors (stages I-III), some accompanied by caregivers, at Dartmouth-Hitchcock Medical Center and experienced colorectal surgeons. RESULTS We performed 25 interviews involving 30 participants, including 15 patients with 5 caregivers, plus 10 physicians. Two major themes emerged. First, patients reported major impacts on their lives following rectal cancer, including on their everyday lives and leisure activities; identity, self-confidence and intimacy; mental health, especially anxiety. These impacts were mediated by their medical experiences, lifestyle and attitudes. Second, the diversity of effects on patients' lives means that care, counselling and information needs should be personalised for a better medical experience and outcomes. Surgeons did not report knowledge of the full range of patient experiences and reported limited counselling in key areas, particularly concerning intimacy and mental health. CONCLUSION Rectal cancer diagnosis, treatment and survivorship dramatically affect all people, regardless of which surgical treatment they undergo. Effects are varied and necessitate customised care, counselling and information, which surgeons are not currently providing. Because rectal cancer affects every part of patients' lives, they need holistic support and information. Patients would benefit from substantial support after treatment as they establish a new normal.
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Affiliation(s)
- Catherine H Saunders
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jackson T Read
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- Dartmouth College, Hanover, New Hampshire, USA
| | - Srinivas J Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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Lim CYS, Laidsaar-Powell RC, Young JM, Kao SCH, Zhang Y, Butow P. Colorectal cancer survivorship: A systematic review and thematic synthesis of qualitative research. Eur J Cancer Care (Engl) 2021; 30:e13421. [PMID: 33733545 DOI: 10.1111/ecc.13421] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/06/2020] [Accepted: 01/15/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION With rapid changes in treatments for colorectal cancer (CRC), qualitative research into CRC survivorship requires greater synthesis. This paper aims to fill this gap through a systematic review (PROSPERO CRD42019131576) and thematic synthesis of the qualitative literature on survivorship experiences across early-stage and advanced CRC survivors. METHODS CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched for qualitative CRC survivorship papers. Titles, abstracts and full texts were screened. Included articles (n = 81) underwent data extraction, CASP qualitative bias ratings and thematic synthesis. RESULTS Bowel dysfunction caused functional limitations and negative quality of life (QoL), while stomas posed threats to body image and confidence. Physical symptoms hindered return to work, increasing financial burdens. Survivors' unmet needs included information regarding symptom expectations and management, and ongoing support throughout recovery. Advanced and early-stage survivors shared similar experiences. Advanced survivors struggled with fear of cancer recurrence/progression and feelings of powerlessness. Functional limitations, financial impacts and sexuality in advanced survivors were underexplored areas. CONCLUSION CRC and its treatments impact survivors' QoL in all areas. A coordinated supportive care response is required to address survivors' unmet needs. Future qualitative studies should explore advanced CRC subpopulations, treatment-specific impacts on QoL and long-term (>5 years) impacts on CRC survivors.
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Affiliation(s)
- Chloe Yi Shing Lim
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Clare Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Jane M Young
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,RPA Institute of Academic Surgery (IAS) and Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Sydney, NSW, Australia
| | - Steven Chuan-Hao Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Yuehan Zhang
- National Centre for Epidemiology and Population Health, Australian National University Research School of Population Health, Canberra, ACT, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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Johnsen NV, Cohn E, Johnson T, Vavilala MS, Rivara FP, Moore M. Sexual dysfunction following traumatic pelvic fracture. J Trauma Acute Care Surg 2021; 90:550-556. [PMID: 33093291 DOI: 10.1097/ta.0000000000003001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND While sexual dysfunction (SD) in men following traumatic pelvic fracture is common, little is known of how men experience changes in their sexual health after injury. The aims of the present study were to explore the personal and interpersonal impacts of SD in men after pelvic injury and to understood how interactions with the health care system can be optimized to improve patient-centered trauma survivorship care. METHODS Fifteen semistructured interviews were conducted with men who had a history of traumatic pelvic fracture and self-reported SD. Interviews were audio recorded, transcribed, and uploaded to a web-based qualitative analysis platform. A codebook was developed, and intercoder reliability was verified. Inductive thematic analysis was performed to identify notable themes related to patient postinjury sexual health experiences. RESULTS Median age of interviewees was 46 years (interquartile range, 44-54 years), with a median time since injury of 41 months (interquartile range, 22-55 months). Five primary themes were identified from the analysis: (1) effects on self-image and romantic relationships, (2) unknown care pathways and lack of communication, (3) inconsistencies with health care provider priorities, (4) provision of sexual health information and resources, and (5) the importance of setting expectations. Interviewees suggested that improved communication, provision of information related to possible adverse effects of their injuries, and expectation setting would improve posttrauma experiences. CONCLUSION Men's experiences with SD after pelvic trauma can be heavily influenced by their interactions with health care providers and the value that is placed on sexual health as a component of survivorship. Incorporating these findings into a patient-centered trauma survivorship program may improve patient experiences. LEVEL OF EVIDENCE Therapeutic, level V.
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Affiliation(s)
- Niels V Johnsen
- From the Department of Urology (N.V.J.), Vanderbilt University Medical Center, Nashville, Tennessee; Harborview Injury Prevention and Research Center (N.V.J., E.C., T.J., M.S.V., F.P.R., M.M.), Department of Anesthesiology and Pain Medicine (M.S.V.), Department of Pediatrics (F.P.R.), and School of Social Work (M.M.), University of Washington, Seattle, Washington
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Frankland J, Wheelwright S, Permyakova NV, Wright D, Collaço N, Calman L, Winter J, Fenlon D, Richardson A, Smith PW, Foster C. Prevalence and predictors of poor sexual well-being over 5 years following treatment for colorectal cancer: results from the ColoREctal Wellbeing (CREW) prospective longitudinal study. BMJ Open 2020; 10:e038953. [PMID: 33184080 PMCID: PMC7662451 DOI: 10.1136/bmjopen-2020-038953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To describe prevalence and predictors of poor sexual well-being for men and women over 5 years following treatment for colorectal cancer. DESIGN Prospective longitudinal study, from presurgery to 5 years postsurgery, with eight assessment points. Logistic regression models predicted sexual well-being from presurgery to 24 months and 24 months to 60 months; time-adjusted then fully adjusted models were constructed at each stage. SETTING Twenty-nine hospitals in the UK. PARTICIPANTS Patients with Dukes' stage A-C, treated with curative intent, aged ≥18 years and able to complete questionnaires were eligible. OUTCOME MEASURES The dependent variable was the Quality of Life in Adult Cancer Survivors sexual function score. Independent variables included sociodemographic, clinical and psychosocial characteristics. RESULTS Seven hundred and ninety participants provided a sexual well-being score for at least one time point. Thirty-seven per cent of men and 14% of women reported poor sexual well-being at 5 years. Baseline predictors for men at 24 months included having a stoma (OR 1.5, 95% CI 1.02 to 2.20) and high levels of depression (OR 2.69/2.01, 95% CI 1.68 to 4.32/1.12 to 3.61); men with high self-efficacy (OR confident 0.33/0.48, 95% CI 0.18 to 0.61/0.24 to 1.00; very confident 0.25/0.42, 95% CI 0.13 to 0.49/0.19 to 0.94) and social support (OR 0.52/0.56, 95% CI 0.33 to 0.81/0.35 to 0.91) were less likely to report poor sexual well-being. Predictors at 60 months included having a stoma (OR 2.30/2.67, 95% CI 1.22 to 4.34/1.11 to 6.40) and high levels of depression (OR 5.61/2.58, 95% CI 2.58 to 12.21/0.81 to 8.25); men with high self-efficacy (very confident 0.14, 95% CI 0.047 to 0.44), full social support (OR 0.26; 95% CI 0.13 to 0.53) and higher quality of life (OR 0.97, 95% CI 0.95 to 0.98) were less likely to report poor sexual well-being. It was not possible to construct models for women due to low numbers reporting poor sexual well-being. CONCLUSIONS Several psychosocial variables were identified as predictors of poor sexual well-being among men. Interventions targeting low self-efficacy may be helpful. More research is needed to understand women's sexual well-being.
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Affiliation(s)
- Jane Frankland
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Sally Wheelwright
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Natalia V Permyakova
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - David Wright
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Nicole Collaço
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Winter
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Deborah Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Alison Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Peter W Smith
- Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, UK
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Ramos N, Ramos R, Silva E. Anterior resection of the rectum vs radical prostatectomy. Are there any differences in sexual rehabilitation? ACTA ACUST UNITED AC 2020; 47:e20202469. [PMID: 32491031 DOI: 10.1590/0100-6991e-20202469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/29/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the impact of penile rehabilitation in restoring erectile function in patients submitted to anterior resection of the rectum (ARR) or radical prostatectomy (RP), comparing the results between these two groups. MATERIALS AND METHODS We performed a unicenter retrospective cohort study, on patients evaluated in our multidisciplinary oncosexology consultation, between January 2015 and January 2018, submitted to RP or ARR (males) and presenting sexual dysfunction. We evaluate the patient and oncologic characteristics, the type of sexual dysfunction, marital status, assessed the International Index of Erectile Function (IIEF-5) on the first and last consultation and the therapeutic approach. A statistical analysis was performed. RESULTS A total of 55 patients were included, 60% (33) performed ARR and 40% (22) RP. Regarding the sexual dysfunction after surgery, erectile dysfunction (ED) was found in the majority of patients (>95%). On the initial IIEF-5 scoring, ARR and RP patients had, most frequently, severe or moderate ED (score 5-11), 78.8% and 59.1% respectively. When reassessed the IIEF-5 scoring of each patient during follow-up, there was an improvement in 69.7% of ARR patients and 72.7% of RP patients (p=0.81). Regarding the therapeutic approach, 84.8% of ARR patients used phosphodiesterase-5 inhibitors (PDE5I) exclusively, 3% used Alprostadil injection, while RP patients used 63.6% and 31.8%, respectively (p<0.05). CONCLUSIONS Despite the technical differences of these surgeries, from the sexual point of view these patients benefit with a penile rehabilitation.
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Affiliation(s)
- Nuno Ramos
- Garcia de Orta Hospital, Almada, Portugal
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Rodler S, von Büren J, Buchner A, Stief C, Elkhanova K, Wülfing C, Jungmann S. Epidemiology and Treatment Barriers of Patients With Erectile Dysfunction Using an Online Prescription Platform: A Cross-Sectional Study. Sex Med 2020; 8:370-377. [PMID: 32434669 PMCID: PMC7471089 DOI: 10.1016/j.esxm.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Erectile dysfunction (ED) is a highly common sexual dysfunction of men but often undertreated as patients experience high treatment barriers. Aim The aims of this study were to characterize patients with ED using an online prescription platforms (OPPs) and determine treatment barriers that might prevent patients from seeking care in conventional health care settings. Methods Data from a German OPP were retrospectively analyzed with focus on patients suffering from ED with at least one online prescription of phosphodiesterase-5 (PDE5) inhibitors between May 2019 and November 2019. In addition, a voluntary questionnaire was used to assess additional social features and prior treatment barriers. Main Outcome Measure The main outcome measures were the epidemiological data, prescription metadata, and follow-up questionnaires. Results A total of 11,456 male patients received prescriptions via the OPP (mean age: 49 years [95% CI 46.92–47.45]). Patients lived mainly in rural areas (69%) and frequently sought prescriptions outside the average office times of German urologists (49%). From all patients that responded to a follow-up questionnaire (n = 242), the majority were employed full-time (81%), married (50%), and native German (94%); 63.5% had not used PDE5 inhibitors before. From all repeat users, 41% had received them from unreliable sources. Reasons to seek treatment via the OPP were convenience (48%), shame (23%), and lack of discretion (13%). Conclusion In this first study, to epidemiologically characterize ED patients of an OPP, it was confirmed that inconvenience is a treatment barrier, along with shame and perceived lack of discretion. This is the first evidence that OPPs reduce treatment barriers and ease access for patients to the medical system. Rodler S, von Büren J, Buchner A, et al. Epidemiology and Treatment Barriers of Patients With Erectile Dysfunction Using an Online Prescription Platform: A Cross-Sectional Study. Sex Med 2020;8:370–377.
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Affiliation(s)
- Severin Rodler
- Department of Urology, University of Munich, Munich, Germany.
| | | | | | - Christian Stief
- Department of Urology, University of Munich, Munich, Germany
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Rutherford C, Müller F, Faiz N, King MT, White K. Patient-reported outcomes and experiences from the perspective of colorectal cancer survivors: meta-synthesis of qualitative studies. J Patient Rep Outcomes 2020; 4:27. [PMID: 32335745 PMCID: PMC7183519 DOI: 10.1186/s41687-020-00195-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is prevalent in the developed world. Favourable survival rates highlight the need to better understand CRC survivors' experiences of long-term impacts of treatment, which can in turn inform decision making. This systematic review aimed to identify and synthesise CRC survivors' experiences of long-term impacts on health-related quality of life. METHODS We searched Medline, Embase and PsychINFO from inception to January 2019. Qualitative studies describing CRC survivors' experiences at least 1-year post-treatment were included. Study eligibility, quality assessment (COREQ guidelines), and data synthesis was performed independently by two reviewers and discussed with the study team. RESULTS Of 1363 papers retrieved, 20 reporting 15 studies met eligibility. Thematic synthesis produced 12 themes: symptoms, physical, social, psychological and sexual functioning, impact on relationships, informal care needs provided by family/friend, supportive care needs provided by healthcare professional, health care experiences, health behaviour, financial toxicity and occupational experiences. Stoma problems (e.g. leakage, skin irritation) were common in ostomates. Survivors with no/reversed stoma experienced unexpected, long-term altered and unpredictable bowel functioning. Survivors often regulated timing, amount and foods consumed to manage bowel functioning. Less common symptoms included fatigue, impaired sleep and anal pain. Stoma problems and altered bowel functioning impaired survivors' physical, social, sexual and psychological functioning. Cognitive functioning and heredity issues were not reported in any paper. CONCLUSION CRC survivors experience ongoing symptoms and functioning impairments more than 1-year post-treatment completion. Many survivors find their own ways to manage symptoms rather than seek professional help. Follow-up care for CRC survivors should integrate screening for long-term effects and provide targeted supportive care.
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Affiliation(s)
- Claudia Rutherford
- The University of Sydney, School of Psychology, Quality of Life Office, Faculty of Science, Sydney, Australia.
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia.
| | - Fabiola Müller
- The University of Sydney, School of Psychology, Quality of Life Office, Faculty of Science, Sydney, Australia
| | - Nasiba Faiz
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia
| | - Madeleine T King
- The University of Sydney, School of Psychology, Quality of Life Office, Faculty of Science, Sydney, Australia
| | - Kate White
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, Sydney, Australia
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Men with serious chronic illnesses and malignancies are less likely to seek treatment for erectile dysfunction. Int J Impot Res 2019; 32:180-185. [DOI: 10.1038/s41443-019-0139-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/02/2019] [Accepted: 03/11/2019] [Indexed: 11/09/2022]
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Shaffer KM, Nelson CJ, DuHamel KN. Barriers to participation in a sexual health intervention for men following treatment for rectal and anal cancer. Psychooncology 2017; 27:1082-1085. [PMID: 29172234 DOI: 10.1002/pon.4593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/19/2017] [Accepted: 11/14/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Kelly M Shaffer
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
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13
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Brotto LA, Dunkley CR, Breckon E, Carter J, Brown C, Daniluk J, Miller D. Integrating Quantitative and Qualitative Methods to Evaluate an Online Psychoeducational Program for Sexual Difficulties in Colorectal and Gynecologic Cancer Survivors. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:645-662. [PMID: 27592509 DOI: 10.1080/0092623x.2016.1230805] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sexual health is an integral component of quality of life for cancer survivors, and is often negatively impacted by treatment. Geographic limitations often prohibit survivors from accessing sexual health programs designed to address their needs. This study examined the efficacy of an online, 12-week psychoeducational program, which included elements of mindfulness meditation, for sexual difficulties in survivors of colorectal or gynecologic cancer. Complete pre- and postintervention data were available for 46 women (mean age 55.0, SD 9.6) and 15 men (mean age 59.7, SD 6.8). Women experienced significant improvements in sex-related distress (p < .001), sexual function (p < .001 and p < .01), and mood (p < .001); these results were maintained at six months follow-up. Men's improvement in desire was not significant (p = .06), whereas intercourse satisfaction was (p < .05) immediately after the program, but not at follow-up. In order to more fully explore women's experiences, interviews were carried out with six participants and analyzed using narrative inquiry. Women shared a feeling of renewed hope for regaining their sex lives, and expressed that they would have valued an interactive component to the program. These findings suggest that an online, unidirectional psychoeducational program is feasible, and may be effective for women survivors of gynecologic and colorectal cancer, but further work is needed to ensure that online interventions address the sexual health needs of male survivors.
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Affiliation(s)
- Lori A Brotto
- a Department of Gynaecology , University of British Columbia , Vancouver , BC , Canada
| | - Cara R Dunkley
- b Department of Psychology , University of British Columbia , Vancouver , BC , Canada
| | - Erin Breckon
- c Department of Educational and Counselling Psychology, and Special Education , University of British Columbia , Vancouver , BC , Canada
| | - Jeanne Carter
- d Departments of Surgery and Psychiatry , Memorial Sloan Kettering Cancer Center , New York , New York , USA
| | - Carl Brown
- e Division of General Surgery , St. Paul's Hospital , Vancouver , BC , Canada
| | - Judith Daniluk
- c Department of Educational and Counselling Psychology, and Special Education , University of British Columbia , Vancouver , BC , Canada
| | - Dianne Miller
- a Department of Gynaecology , University of British Columbia , Vancouver , BC , Canada
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14
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Albaugh JA, Sufrin N, Lapin BR, Petkewicz J, Tenfelde S. Life after prostate cancer treatment: a mixed methods study of the experiences of men with sexual dysfunction and their partners. BMC Urol 2017; 17:45. [PMID: 28619019 PMCID: PMC5472970 DOI: 10.1186/s12894-017-0231-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate cancer is the most common non-skin cancer in men and sexual dysfunction is the most frequently reported long-term side effect of prostate cancer surgery or radiation. The aim of this study was to examine the experiences of men with sexual dysfunction and their partners following prostate cancer treatment. METHODS Men with sexual dysfunction from either surgical removal or radiation therapy 1-5 years after treatment were interviewed, as well as their partners. A mixed method design was used to determine the lived experience of men with sexual dysfunction. Open-ended questions guided the interviews. RESULTS Twenty seven men completed the study with a mean age of 61 years (SD = 8.0; range = 44-77 years). Nine partners also participated. The majority of men (92.6%) had surgery. The average time from treatment to the interview was 23.5 months (SD = 11.7). Themes were frustration with sexual dysfunction, importance of support and understanding from others, depression and anxiety related to sexual dysfunction, importance of intimacy with partner, factors that impact treatment satisfaction, and education and comprehensive information about sex. CONCLUSIONS Prostate cancer survivors and partners need accurate information about sexual side effects before during and after treatment. Men and partners required individualized help and guidance to manage sexual dysfunction. Support and understanding from partners, family, and others was also identified as an important aspect of healing and adjustment after prostate cancer treatment. Prostate cancer education/support groups played a key role in helping men and partners gain advocacy, education, and support. Psychological problems such as depression and anxiety need to be identified and addressed in men after prostate cancer treatment. Men and partners need assistance in understanding and navigating their way through intimacy to move forward with connectedness in their relationship. Satisfaction with treatment and with providers is dependent on patient education and understanding of all aspects of prostate cancer treatment including sexual side effects and incontinence.
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Affiliation(s)
- Jeffrey A Albaugh
- John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, 2180 Pfingsten Road, Suite 3000, Glenview, Illinois, 60026, USA.
| | - Nat Sufrin
- The Doctoral Program in Clinical Psychology, The City College of the City University of New York, New York, NY, USA
| | | | - Jacqueline Petkewicz
- John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, 2180 Pfingsten Road, Suite 3000, Glenview, Illinois, 60026, USA
| | - Sandi Tenfelde
- The Marcella Niehoff School of Nursing, Loyola University of Chicago, Maywood, IL, USA
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Abstract
There are many reasons why gender-concordant care benefits patients and is requested by them. For training hospitals, however, such requests present challenges as well as opportunities in providing patient-centered care. Responding to a case in which a female patient who is having a routine exam refuses care from a male medical student, we discuss ethical principles involved in gender-concordant care requests, when it is appropriate to question such requests, and a team-based approach to responding to them.
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Affiliation(s)
- Monica Peek
- Associate professor in the Section of General Internal Medicine at the University of Chicago, and serves as director of research at the MacLean Center for Clinical Medical Ethics and executive medical director of community health innovation for University of Chicago Medicine, and Greenwall Foundation Faculty Scholar, the associate director of the Chicago Center for Diabetes Translation Research, and an inaugural faculty fellow of the Bucksbaum Institute for Clinical Excellence
| | - Bernard Lo
- President of the Greenwall Foundation in New York, and a professor emeritus of medicine and director emeritus of the Program in Medical Ethics at the University of California, San Francisco
| | - Alicia Fernandez
- Professor of medicine at the University of California, San Francisco, and an attending physician at the Richard H. Fine People's Clinic and the medical wards at Zuckerberg San Francisco General Hospital and Trauma Center
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16
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Sarabi N, Navipour H, Mohammadi E. Sexual Performance and Reproductive Health of Patients with an Ostomy: A Qualitative Content Analysis. SEXUALITY AND DISABILITY 2017. [DOI: 10.1007/s11195-017-9483-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Mardani-Hamooleh M, Heidari H. Perception of Iranian Patients with Cancer Regarding Sexual Health: A Content Analysis Study. SEXUALITY AND DISABILITY 2016. [DOI: 10.1007/s11195-016-9467-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Cataldo PA. Role of local excision in the management of rectal cancer: what does the future hold? Tech Coloproctol 2016; 20:731-734. [PMID: 27766435 DOI: 10.1007/s10151-016-1530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- P A Cataldo
- University of Vermont Medical Center, Burlington, VT, USA.
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Mardani-Hamooleh M, Heidari H. Cancer patients' effort to return to normal life: a hermeneutic study. Scand J Caring Sci 2016; 31:351-358. [DOI: 10.1111/scs.12354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Marjan Mardani-Hamooleh
- School of Nursing and Midwifery; Department of Nursing; Iran University of Medical Sciences; Tehran Iran
| | - Haydeh Heidari
- Faculty of Nursing and Midwifery; Modeling in Health Research Center; Shahrekord University of Medical Sciences; Shahrekord Iran
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20
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Deng H, Liu D, Mao X, Lan X, Liu H, Li G. Phosphodiesterase-5 Inhibitors and Vacuum Erection Device for Penile Rehabilitation After Laparoscopic Nerve-Preserving Radical Proctectomy for Rectal Cancer: A Prospective Controlled Trial. Am J Mens Health 2016; 11:641-646. [PMID: 27561925 DOI: 10.1177/1557988316665084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The current study sought to clarify the role of phosphodiesterase type 5 inhibitors (PDE-5i) and a vacuum erection device (VED) in penile rehabilitation after laparoscopic nerve-preserving radical proctectomy (LNRP) for rectal cancer. Participants were assigned to one of the following arms-no-intervention, nightly use of sildenafil 25 mg for 3 months after surgery, or concurrent use of nightly sildenafil 25 mg/day for 3 months and a vacuum erection device (VED) 10 to 15 minutes/day for 3 months-in a nonrandomized fashion. All participants had a follow-up of over 12 months prospectively, and patients had baseline, 3-, 6-, and 12-month assessment based on the International Index of Erectile Function-5 (IIEF-5). Seventy-one cases were included in final analyses. In the no-intervention group, the mean baseline IIEF-5 score of 21.9 decreased rapidly to 5.0 at 3 months ( p < .001), 9.2 at 6 months ( p < .001), and stayed at 10.9 at 12 months ( p < .001). In the single therapy group, the mean baseline IIEF-5 score of 22.4 decreased dramatically to 9.0 at 3 months ( p < .001), 14.9 at 6 months ( p = .005), and stayed at 15.1 at 12 months ( p = .005). In the combined therapy group, the mean baseline IIEF-5 score of 23.0 decreased slightly to 15.0 at 3 months ( p = .005), 18.0 at 6 months ( p = .038), and maintained at 18.7 at 12 months ( p = .163). Findings suggested an over 50% decline in the quality of erection function of the patients after LNRP. The early use of PDE-5i alone or combined use of PDE-5i and VED after LNRP maintained erectile function at 12 months.
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Affiliation(s)
- Haijun Deng
- 1 NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Dong Liu
- 1 NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangming Mao
- 2 Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoliang Lan
- 1 NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- 1 NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- 1 NanFang Hospital, Southern Medical University, Guangzhou, China
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El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, Cannady RS, Wong SL, Rose J, Barbour AL, Stein KD, Sharpe KB, Brooks DD, Cowens-Alvarado RL. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin 2015; 65:428-55. [PMID: 26348643 PMCID: PMC5385892 DOI: 10.3322/caac.21286] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.
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Affiliation(s)
- Khaled El-Shami
- Assistant Professor of Medicine, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Kevin C Oeffinger
- Director, Cancer Survivorship Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nicole L Erb
- Program Manager, National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Anne Willis
- Director, Patient-Centered Programs, The George Washington University Cancer Institute, Washington, DC
| | - Jennifer K Bretsch
- Director, Performance Improvement, American Society of Clinical Oncology, Alexandria, VA
| | | | - Rachel S Cannady
- Behavioral Scientist, Behavioral Research Center/National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Sandra L Wong
- Associate Professor of Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Johnie Rose
- Assistant Professor, Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine/Case Comprehensive Cancer Center, Cleveland, OH
| | - April L Barbour
- Associate Professor of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kevin D Stein
- Vice President, Behavioral Research, Director, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Katherine B Sharpe
- Senior Vice President, Patient and Caregiver Support, American Cancer Society, Atlanta, GA
| | - Durado D Brooks
- Director, Cancer Control Intervention, American Cancer Society, Atlanta, GA
| | - Rebecca L Cowens-Alvarado
- Vice President, Behavioral Research, South Atlantic Health Systems, American Cancer Society, Atlanta, GA
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22
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Prevalence of Physiologic Sexual Dysfunction Is High Following Treatment for Rectal Cancer: But Is It the Only Thing That Matters? Dis Colon Rectum 2015; 58:736-42. [PMID: 26163952 DOI: 10.1097/dcr.0000000000000409] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although several studies have reported high rates of sexual dysfunction in patients treated for rectal cancer, most studies have been limited by retrospective design, failure to use validate instruments, and a limited number of female patients. OBJECTIVES The objectives of this study were to 1) prospectively assess changes in sexual function before and after treatment for rectal cancer and 2) identify potential areas for improved care of patients who have rectal cancer with sexual dysfunction. DESIGN This study is a prospective, longitudinal survey. SETTINGS This study was conducted at 4 tertiary care academic hospitals. PATIENTS The patients included had newly diagnosed rectal cancer. MAIN OUTCOME MEASURES Subjects completed the European Organization for Research and Treatment Quality of Life Cancer Module and Colorectal Cancer Module, International Index of Erectile Function, and Female Sexual Function Index questionnaires before the start of treatment, after the completion of preoperative chemoradiotherapy, and 1 year after surgery. RESULTS Forty-five patients completed the study, and the overall results showed significant sexual dysfunction in both male and female subjects that continued to increase from baseline up to 1 year after surgery. In male subjects, sexual activity, interest, and enjoyment remained relatively stable, despite increasing sexual problems. However, for female patients, although sexual activity and interest remained relatively stable, sexual enjoyment worsened as sexual problems increased. LIMITATIONS The study closed before reaching the target sample size owing to lower than anticipated accrual rates. Post hoc analysis included qualitative interviews with patients to explore reasons for low recruitment. CONCLUSIONS The results of this study show that sexual problems continue to increase up to 1 year after surgery. Despite this, sexual interest in both male and female patients remained relatively unchanged suggesting that other aspects of sexuality, not just physiologic function, also need to be evaluated. Future studies to assist and educate physicians on how to initiate a discussion about sexuality and identify patients in "distress" because of sexual problems are important.
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