Sexual functioning in young women in the context of breast cancer treatment

Quality of life and its predictors among breast cancer patients treated with surgery-a retrospective minimum 3-year follow-up study

Aim

Quality of life (QoL) has been identified as an important indicator of positive outcomes among breast cancer (BC) survivors. However, the status and predictors of QoL in China remain unclear. This retrospective follow-up study aimed to examine the QoL levels among BC patients following surgery and to assess the influence of sociodemographic, clinical, and psychological factors on QoL.

Methods

An institution-based retrospective follow-up study was conducted among 714 BC patients who received surgery at the First Affiliated Hospital of Guangxi Medical University between January 2016 and December 2019. Our primary outcome measure was QoL, assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30). Anxiety and depression were evaluated by the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), respectively. Data on the patient demographics and clinical were derived from medical records. Results are presented as means (SD), medians [Q1, Q3], or percentage (%). We used R 4.2.2 software to identify factors associated with QoL after BC surgery. AMOS 28.0 was used to construct a structural equation model (SEM) to predict QoL outcomes.

Results

The overall QoL score was 43.30 ± 4.77 (mean ± SD). Predictive factors were: surgery type, radiotherapy, anxiety, and depression (p<0.05). The results of the SEM indicated that anxiety and depression had a direct negative effect on QoL (effect value was -0.46, -0.84, respectively, p<0.05), radiotherapy had a direct positive effect on QoL (effect value was 0.71, p<0.05). The type of surgery (mastectomy) impacted QoL both directly and indirectly through its association with depression, with direct and indirect effect values of -0.96 and -0.66, respectively (p < 0.05).

Conclusion

The QoL of BC patients after surgery is generally moderate to low. Medical staff should prioritize early identification and rehabilitation management for patients experiencing anxiety, depression, radiotherapy, and mastectomy to enhance their QoL. Our findings provide a strong foundation for developing nursing intervention plans and assessment guidelines for practitioners caring for BC patients.

Health-related quality of life of premenopausal young breast cancer survivors undergoing endocrine therapy

PURPOSE

The incidence of breast cancer in premenopausal women in South Korea is higher compared to the West. This study aimed to identify factors associated with the health-related quality of life (HRQoL) among survivors with premenopausal young breast cancer undergoing endocrine therapy by examining the effects of menopausal symptoms, social support, and resilience on HRQoL.

METHODS

Cross-sectional study was used to select survivors with breast cancer undergoing endocrine therapy. The study instruments used included a basic information questionnaire, Menopause Rating Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and Health-Related Quality of Life Instrument with 8 items. Researchers utilized independent t-tests, one-way analysis of variance, Pearson's correlation coefficients, and multiple linear regression to analyze the data. The data were collected from August to September 2021, and the questionnaire was administered via a link posted on a bulletin board of an online breast cancer survivors community. Finally, 133 questionnaires were included in the final analysis.

RESULTS

Among 150 participants, 133 completed the questionnaires. HRQoL was higher in the groups with a monthly income of ≥5 million KRW (β = 0.231, p = .011), fewer menopausal symptoms (β = -0.399, p < .001), and higher social support (β = 0.170, p = .038), and lower in the group receiving endocrine therapy and OFS (β = -0.192, p = .010). The explanatory power for HRQoL of premenopausal young breast cancer survivors undergoing endocrine therapy was 38.3% (F = 10.634, p < .001).

CONCLUSION

Breast cancer survivors should be supported to participate in economic activity, utilize rehabilitation and intervention programs to alleviate menopausal symptoms, and benefit from a social support network formed by the hospital, community, and government.

Sexual function index adaptation for breast cancer patients (FSFI-BC)- translation and psychometric properties of Persian version

BACKGROUND

Effective interventions to improve sexual dysfunction in breast cancer survivors need screening of these dysfunctions with a suitable instrument. The aim of present study was translation and identifying psychometric properties of Female Sexual Function Index - Adapted for Breast Cancer (FSFI-BC) which has been specifically developed for breast cancer survivors.

METHOD

This methodological study was performed between February 2017 and October 2018. 200 breast cancer survivors in stage 1 or 2 who were selected through convenience sampling method, completed the questionnaire. Reliability was assessed by Cronbach's alfa and test re-test analysis and construct validity was performed through confirmatory (CFA) and exploratory factor analysis( EFA).

RESULTS

Six factors were extracted in exploratory factor analysis (EFA). These factors explained 74.6% of the total variance in in NSA group and 0.821 in SA group. Reliability evaluation indicated high internal consistency and good test re-test reliability. Cronbach's alpha coefficient in all areas of the tool was above 0.7 (the lowest and the highest measures were 0.885 and 0.945, respectively), which is a good indicator for reliability of an instrument. Confirmatory factor analysis showed an acceptable fitness for seven factors of FSFI-BC questionnaire (Normed Fit Index or NFI = 0.9 for both groups, Comparative of Fit Index or CFI = 0.93 and 0.92, χ 2/df = 1.68 and 1.71 for SA(Sexually Active) and NSA(No Sexually Active) individuals, respectively) .

CONCLUSION

Study findings suggest that Persian version of FSFI-BC is a suitable instrument for sexual dysfunction screening in breast cancer survivors.

Optimizing sexuality of young women with breast cancer: how can the breast clinic help?

BACKGROUND

Breast cancer treatment can lead to sexual dysfunction which, in general, impacts younger women more. Being well informed and having good social support are important elements in dealing with this dysfunction.

AIMS

This study aims to explore how specialized breast clinics can help young women with questions or problems regarding their sexual health by fulfilling their information and social support needs.

METHOD

A thematic analysis was used for 16 interviews with young women (18-45 years) diagnosed with breast cancer, in Belgium.

RESULTS

Participants report a lack of information on sexual issues and find the information insufficiently tailored to young women. The empathy of healthcare providers and their communication skills play an important role in whether sexual issues can be discussed. Finally, they indicate that more attention should be paid to their partner (relationship).

CONCLUSION

The breast clinic might help young women by giving more specific advice on what is sexually allowed (or not) during treatment, by informing them about lubricants and sex toys, by adapting brochures and information sessions to young women, by investing in the partner's well-being and their relationship, and by training healthcare providers better.

Investigation on sexual function in young breast cancer patients during endocrine therapy: a latent class analysis

Backgrounds

The aim of this study was to investigate the sexual function status of young breast cancer patients during endocrine therapy, identify potential categories of sexual function status, and analyze the factors affecting the potential categories of sexual function status during endocrine therapy.

Methods

A cross-sectional survey was conducted on 189 young breast cancer patients who underwent postoperative adjuvant endocrine therapy in Shanghai Ruijin Hospital. The latent class analysis was used to identify potential categories of patient sexual function characteristics with respect to the FSFI sex health measures. Logistic regression analysis was used to analyze the influencing factors for the high risk latent class groups. A nomogram prognostic model were then established to identify high risk patients for female sexual dysfunction (FSD), and C-index was used to determine the prognostic accuracy.

Results

Patients were divided into a "high dysfunction-low satisfaction" group and a "low dysfunction-high satisfaction" group depending on the latent class analysis, accounting for 69.3% and 30.7%, respectively. Patients who received aromatase inhibitors (AI) combined with ovarian function suppression (OFS) treatment (p = 0.027), had poor body-image after surgery (p = 0.007), beared heavy medical economy burden(p < 0.001), and had a delayed recovery of sexual function after surgery (p = 0.001) were more likely to be classified into the "high dysfunction-low satisfaction" group, and then conducted into the nomogram. The C-index value of the nomogram for predicting FSD was 0.782.

Conclusion

The study revealed the heterogeneity of sexual function status among young breast cancer patients during endocrine therapy, which may help identify high-risk patients and provide early intervention.

Lived experiences of breast cancer in patients under the age of 40: A phenomenological study

PURPOSE

The purpose of this study was to understand and describe the experiences of breast cancer in patients under age 40 years in South Korea.

METHODS

Data were collected from December 2020 to January 2021 through individual in-depth semi-structured interviews with 10 patients aged <40 years less than one year after they had completed treatment for breast cancer. We performed a qualitative study using Colaizzi's phenomenological method.

RESULTS

The six theme clusters for intrapersonal, interpersonal, and sociocultural categories were as follows: 1) physical pain, 2) psychological response and need, 3) positive relationships with family members, 4) non-familial support system, 5) age stereotypes of cancer, and 6) Confucian culture in Korea.

CONCLUSIONS

The study provides insights into the specific issues and major concerns of young breast cancer patients from multiple perspectives. Based on the results, optimized support should be developed to relieve the physical, psychological, and social burden on young breast cancer patients. Specific information and communication training should be offered to oncology nurses to provide counseling in order to reduce patient anxiety and fear related to these issues. The study emphasizes the importance of positive relationships with family and the non-familial support system and suggests that nursing intervention can help support these relationships to prevent social isolation.

Sexual functioning and self-esteem in women after mastectomy - a single-centre, non-randomised, cross-sectional study

Aim of the study

The goal of our study was to assess the sexual functioning of patients undergoing mastectomy, five years after surgery, compared to a control group.

Material and methods

A cross-sectional study included 170 patients five years post mastectomy (group A1) and 149 healthy women (group A2) who had never been diagnosed with breast cancer. The study was conducted at the Oncology Centre in Bydgoszcz, at the Amazon Clubs, and at the University of the Third Age by the University of Economy in Bydgoszcz. Standardised questionnaires: the Female Sexual Function Index (FSFI) and Rosenberg’s SES (self-esteem scale) were used.

Results

Our study results show significantly worse sexual functioning in the domains pertaining to desire (p = 0.0015), arousal (p = 0.0052), lubrication (p = 0.0026), ability to reach orgasm (p = 0.0417), sexual satisfaction (p = 0.0142), and the presence of clinically significant sexual dysfunction (p = 0.0028) among patients after amputation of the mammary gland. On the scale of pain relating to sexuality, there were no significant differences between the two groups (p> 0.05). The overall score in the FSFI questionnaire was also lower (p = 0.0066) among women after mastectomy. Highly statistically significant (p < 0.0001) differences in self-esteem were also noted between the two groups, with worse results observed in patients after mastectomy.

Conclusions

Diagnosis of sexual dysfunction in patients treated for breast cancer allows timely implementation of counselling and interventional therapy depending on the causal factors and individual preferences of patients.

Young Women With Breast Cancer in Mexico: Results of the Pilot Phase of the Joven & Fuerte Prospective Cohort

PURPOSE

The pilot-phase report of the Joven & Fuerte prospective cohort broadly characterizes and assesses the needs of Mexican young women with breast cancer (YWBC).

PATIENTS AND METHODS

Women age ≤ 40 years with nonmetastatic primary breast cancer were consecutively accrued from 2 hospitals. Data were collected at the first/baseline oncology visit and 2 years later using a sociodemographic survey, European Organisation for Research and Treatment of Cancer Quality-of-Life (QOL) Questionnaire Core 30 (QLQ-C30) and Breast Cancer-Specific QOL Questionnaire (QLQ-BR23), Hospital Anxiety and Depression Scale (HADS), Female Sexual Functioning Index (FSFI), Sexual Satisfaction Inventory, and patients' medical records. Pearson χ2 and 2-sided t tests were used for statistical analysis. An unadjusted P value < .05 was considered significant.

RESULTS

Ninety patients were included, all with government health care coverage. Most had low monthly household incomes (98%) and at least a high school education (59%). There was a considerable prevalence of unpartnered patients (36%) and unmet parity (25%). Patients' most common initial symptom was a palpable mass (84%), and they were most frequently diagnosed with stage III disease (48%), with 51% having had a physician visit ≤ 3 months since detection but 39% receiving diagnosis > 12 months later. At baseline, 66% of patients were overweight/obese, and this proportion had significantly increased by 2 years (P < .001). Compared with baseline, global QLQ-C30 had improved significantly by 2 years (P = .004), as had HADS-Anxiety (P < .001). However, both at baseline and at 2 years, nearly half of patients exhibited FSFI sexual dysfunction.

CONCLUSION

These preliminary findings demonstrate that YWBC in Mexico have particular sociodemographic and clinicopathologic characteristics, reinforcing the necessity to further describe and explore the needs of these young patients, because they may better represent the understudied and economically vulnerable population of YWBC in limited-resource settings.

Stress, Social Support, and Sexual Adjustment in Married Female Patients with Breast Cancer in Korea

OBJECTIVE

This study identified the level of stress, social support, and sexual adjustment in married women with breast cancer in Korea.

METHODS

This study used a subgroup analysis, prospective, cross-sectional, and descriptive correlation design. Data were obtained using the perceived stress scale, multidimensional scale of perceived social support, and sexual adjustment subscale of the Korean version of the psychosocial adjustment to illness scale. From May 2015 to April 2016, 272 married female patients who had been diagnosed with breast cancer were recruited at a university hospital in Korea. Data were analyzed using SPSS Win 21.0.

RESULTS

The mean score of stress level was 17.53 ± 4.13, social support was 5.37 ± 1.07, and sexual adjustment was 6.36 ± 3.29. A significant positive correlation emerged between sexual adjustment and stress (r = 0.161, P = 0.008). Significant negative correlations were observed among sexual adjustment and family support (r = -0.177, P = 0.003) and friends' support (r = -0.205, P = 0.001).

CONCLUSIONS

The assessment of stress level and social support may be used in planning sexual-adjustment interventions appropriate for married female breast cancer patients in Korea.

Sexual dysfunction in female cancer survivors: A narrative review

OBJECTIVES

Due to improvements in earlier detection and expansions in available treatments, the number of individuals surviving with cancer is steadily increasing. Sexual dysfunction is a common and often persistent complication for cancer survivors, affecting >60% of women diagnosed with cancer. Although highly prevalent, issues related to sexual health are often not addressed among survivors, with women reporting less discussion with providers compared to men.

METHODS

In this narrative review, we present a case series of three women seen in a psycho-oncology clinic who experienced sexual dysfunction following a cancer diagnosis. We then review existing literature on the presentation and management of sexual issues associated with cancer and its treatment.

RESULTS

The three cases highlight different mechanisms of sexual dysfunction after cancer, including anatomic changes, hormonal alterations, psychiatric conditions and medication side effects. The literature review includes discussion of the prevalence and course of sexual dysfunction in female cancer survivors. Tools for screening and assessment are then reviewed, as well as contributing factors and common presenting symptoms. We conclude with a discussion of both pharmacologic and non-pharmacologic approaches to management.

CONCLUSIONS

Despite its high prevalence and considerable impact on quality of life, the complication of sexual dysfunction after cancer diagnosis and treatment is still under recognized and undertreated. Improving awareness, communication, and screening, as well as appropriate referral to treatment, could have a profound impact on the ever growing number of women surviving with cancer with sexual health concerns.

Influencing Factors of Sexual Intimacy and Satisfaction among Women within 1 Year after Mastectomy

PURPOSE

The purpose of this study was to identify the levels of body image, sexual intimacy, and sexual satisfaction, and to explore factors affecting sexual intimacy and satisfaction among women within one year of mastectomy.

METHODS

The present study was a cross-sectional survey and involved 101 women who had undergone mastectomy at a University hospital of D city, Korea. Measurement included the scales of body image, sexual intimacy, and sexual satisfaction.

RESULTS

Mean age of the subjects was 51 years. Scores of the body image, sexual intimacy, and sexual satisfaction were 59.62, 90.69, and 69.04, respectively. Body image, sexual intimacy, and sexual satisfaction were significantly related to each other. Sexual intimacy was higher when women were of young age (β=-.32), had a shorter period since surgery (β=-.24), and with higher levels of body image (β=.37). Sexual satisfaction was higher when women had higher levels of body image (β=.19) and greater levels of sexual intimacy (β=.74).

CONCLUSION

Higher levels of body image and greater levels of sexual intimacy were identified as the significant factors influencing sexual satisfaction among these women. Future research with a mixed-method research is needed to gain a deep understanding of the sexuality between women and their husbands.

The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial

BACKGROUND

Considering different dimensions of life, special sex life for survivors of breast cancer (BC) is important because their life expectancy has increased.

OBJECTIVE

We designed this study to improve the sexual function, satisfaction and quality of sexual life.

METHODS

In a randomized controlled clinical trial study, from a total 286 breast cancer survivors (BCS), 118 women enrolled to the study. After providing informed consent, the participants were randomly assigned either to the intervention group or to the waitlist control group. The intervention consisted of six weekly psychosexual counseling sessions that lasted from 90 to 120 min. Data were collected by the demographic and clinical forms, Beck Depression Inventory, Female Sexual Function Index (FSFI), Larson Sexual Satisfaction Questionnaire and sexual quality of life-female (SQOL-F) questionnaire.

RESULTS

Mean age of patients in control and intervention groups were 43.8 ± 6.6 and 44.84 ± 6.7, respectively. More than 65% of the patients in the both groups were either normal or showed a low level of depression. Sexual function (FSFI) scores and sexual quality of life (SQOL-F), showed a significant statistic differences after intervention (P < 0.001 in both tools). Sexual satisfaction (Larson) has showed improvement in some subclasses, however, change in total score was not statistically significant (P = 0.073).

CONCLUSIONS

The psychosexual intervention program was effective in improving sexual function and quality of sexual life among BCS. This intervention has clinical significance as it provided an opportunity for the women to discuss their sexual issues.

A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors

BACKGROUND

The objective of this study is to develop, implement, and evaluate a training program for healthcare providers to improve ability to provide psychosocial support to breast cancer survivors in Korea.

METHODS

Based on a needs assessment survey and in-depth interviews with breast cancer survivors, a multidisciplinary team developed two-day intensive training program as well as education materials and counseling notes. Participants' overall satisfaction was evaluated after the training.

RESULTS

The training program included a total of 16 lectures held over the course of seven sessions. Forty-one nurses and 3 social workers participated in the training program. Mean age was 37.5(± 6.4) years, and on average, they had 11.1 (± 5.6) years of experience. Participants' overall satisfaction was good as following: program contents (4.04), trainee guidebook (3.82), location and environment (4.10), and program organization (4.19). Among the participants, 31 (70.4%) received certification after submitting real consultation cases after the training.

CONCLUSION

Two day intensive training can provide a comprehensive and coordinated education to healthcare professionals for implementing survivorship care with an emphasis on psychosocial support. Furthermore, the program should resume as a periodic continuing education course for healthcare providers. Similar education for graduate students in oncology nursing would be beneficial.

Breast cancer in young women: an overview

Despite dramatic advances in cancer research setting, breast cancer remains a major health problem and represents currently a top biomedical research priority. Worldwide, breast cancer is the most common cancer affecting women, and its incidence and mortality rates are expected to increase significantly the next years. Recently the researchers' interest has been attracted by breast cancer arising in young women. Current evidence suggests that in women aged <45 years, breast cancer is unquestionably the leading cause of cancer-related deaths. This type of cancer seems to be highly heterogeneous and has potentially aggressive and complex biological features. However, management strategies, recommendations and options are not age based and the 'complex' biology of this type of cancer remains uncertain and unexplored. In this review, we summarize the latest scientific information on breast cancer arising in young women highlighting the heterogeneity and the complex nature of this type of cancer.

A Model of Engagement Promotion in a Professionally Facilitated Online Intervention for Couples Affected by Breast Cancer

Professionally facilitated web-based interventions for couples affected by an illness such as cancer are growing in popularity. Attrition rates for such online programs, however, are substantially higher than what is observed in face-to-face therapeutic contexts, and lower levels of participant engagement are associated with poorer outcomes. In the present investigation, a task analysis was employed to develop a model of engagement promotion in an online intervention for couples affected by breast cancer called "Couplelinks." Results indicated that facilitators utilized a variety of meta-processes, such as humanizing the technology, and associated "eBehaviors," to maintain three relationships involved in promoting online engagement: (a) between the facilitator and couple; (b) between the intervention and couple; and (c) between the partners within the couple.

Managing premature menopause and sexual dysfunction

PURPOSE OF REVIEW

Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysfunction as a result of their cancer-directed treatment. We will review the recent literature examining this critical challenge and discuss current efforts to address sexual dysfunction.

RECENT FINDINGS

In the period since 2013, the literature has focused on sexual issues that result from the premature onset of menopausal symptoms and changes in sexual health following breast surgery. The impact of premature menopause in young women with breast cancer is profound and can affect all aspects of the sexual experience, from desire to function, and quality of life. Furthermore, the surgical treatment of breast cancer also has significant implications with respect to sexual desire and body image. There is a paucity of sexual health intervention for this population, though recent efforts suggest that sexual health outcomes may be improved if women are offered the appropriate intervention opportunities. However, the sexual function of young breast cancer patients is an under-discussed and under-treated health issue that warrants greater research and clinical focus.

SUMMARY

Further intervention trials must be completed in this population of young women for whom sexual function plays such a critical role in their personal and relationship well being.

Breast cancer in young women in southern Tunisia: Anatomical study and clinical prognostic factors: About a series of 83 patients

PURPOSE

To define epidemiological, clinical, therapeutic and prognostic factors influencing survival of breast cancer in young women younger than 35 in southern Tunisia.

MATERIAL AND METHODS

This is a retrospective study of 83 patients younger than 35 years and treated within tumors mammary committee of Sfax.

RESULTS

The mean age was 31.7 years. T2 stage, high grade with positive node tumors were frequent. Breast surgery was performed for 73 patients. Chemotherapy was neo-adjuvant, adjuvant and palliative for respectively 10, 62 and 13 patients. Radiotherapy was delivered for 65 patients with curative intent and for 8 metastatic patients. Endocrine therapy was adjuvant in 38 patients and palliative in 6 cases. The overall survival (OS) at 5 years was 66.8%. Pejorative prognostic factors in uni-variate analysis were clinical T stage (T3, T4), and the number of involved lymph nodes.

CONCLUSION

Despite adequate treatment, the prognosis of breast cancer in young women remains worse. Early diagnosis is necessary to promote outcome.