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Patient reported improvement in sexual health outcomes following care in a sexual health clinic for women with cancer. Support Care Cancer 2023; 31:171. [PMID: 36795172 DOI: 10.1007/s00520-023-07635-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Sexual health concerns are common among female cancer survivors. Few data exist regarding patient-reported outcomes following interventions in this population. We aimed to determine patient-reported adherence and impact of interventions provided in an academic specialty clinic for treatment of sexual health problems. METHODS A cross-sectional quality improvement survey regarding sexual problems, adherence with recommended therapies, and improvement following intervention was administered to all women seen at the Women's Integrative Sexual Health (WISH) program at the University of Wisconsin-Madison between November 2013 and July 2019. Descriptive and Kruskal-Wallis tests were used to explore differences between groups. RESULTS Two hundred twenty women (median age at first visit = 50 years, 53.1% breast cancer) were identified; N =113 surveys were completed (response rate = 49.6%). The most common presenting complaints were pain with intercourse (87.2%), vaginal dryness (85.3%), and low libido (82.6%). Menopausal women were more likely than premenopausal women to present with vaginal dryness (93.4% vs. 69.7%, p = .001) and pain with intercourse (93.4% vs. 76.5%, p = .02). Nearly all women adhered to recommendations for vaginal moisturizers/lubricants (96.9-100%) and vibrating vaginal wands (82.4-92.3%). A majority found recommended interventions helpful regardless of menopausal status or cancer type and reported persistent improvement. Nearly all women had improvement in understanding sexual health (92%) and would recommend the WISH program to others (91%). CONCLUSION Women with cancer report integrative sexual health care to address sexual problems that are helpful and result in long-term improvement. Patients are overall highly adherent to recommended therapies, and nearly all would recommend the program to others. IMPLICATIONS FOR CANCER SURVIVORS Dedicated care to address sexual health in women after cancer treatment improves patient-reported sexual health outcomes across all cancer types.
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2
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Patel F. Follow Up and Rehabilitation in Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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3
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Lai S, Rozen G, Polyakov A. Sexual function in reproductive-aged women following radiotherapy: a cross sectional study. Sex Health 2021; 18:358-365. [PMID: 34742363 DOI: 10.1071/sh20227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Background While female sexual dysfunction post-radiation therapy has been previously described, much of the literature is focused on older, often postmenopausal, women; and neglects the experiences of younger populations. Our study aims to describe the changes in sexual functioning following radiotherapy among women of a reproductive age. Methods A cross-sectional survey was conducted on reproductive-aged women post-radiation therapy. Information on sexual frequency, pleasure, discomfort and habit was collected and compared to responses from healthy women of comparable ages. Results Reproductive-aged women post-radiotherapy experienced decreased pleasure, more discomfort and had less sexual activity than healthy controls. However, sexual habit was comparable. Conclusions Our findings illustrated that most domains of sexual function are negatively affected in our study population. Understanding the sexual sequelae of radiation therapy may help guide clinicians in counselling their patients and planning their future needs.
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Affiliation(s)
- Shimona Lai
- Monash Women's, Monash Health, 246 Clayton Road, Clayton, Vic., Australia
| | - Genia Rozen
- Reproductive Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic., Australia; and Gynaecology Research Unit, The University of Melbourne, Parkville, Vic., Australia; and Melbourne IVF, Melbourne, Vic., Australia
| | - Alex Polyakov
- Reproductive Services, The Royal Women's Hospital, 20 Flemington Road, Parkville, Vic., Australia; and Melbourne IVF, Melbourne, Vic., Australia
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4
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Aptecar L, Fiteni F, Jarlier M, Delaine S, Guillerme V, Jacot W, D'Hondt V. Prospective evaluation of sexual health in breast cancer women during the first year of adjuvant hormonal treatment using a cancer patient's dedicated questionnaire: A glaring gap of communication between health professionals and patients. Breast Cancer Res Treat 2021; 186:705-713. [PMID: 33452553 DOI: 10.1007/s10549-020-06062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Sexual quality of life (QoL) is affected during and after breast cancer (BC) treatment and is not specifically evaluated with the general health-related quality-of-life questionnaires EORTC QLQ-C30 or QLQ-BR23. A specific questionnaire, the EORTC SHQ-C22, including physical, psychological, and social aspects of sexuality, was recently developed to address this issue in cancer patients. METHODS A prospective bicentric study was conducted to evaluate the sexual QoL of women with BC during the first year of adjuvant hormonal treatment. RESULTS A total of 106 women completed the 3 questionnaires at baseline and 92 of them, at 12 months. At baseline, we showed low sexual satisfaction and importance given to sexual activity and a very low communication with healthcare professionals about this issue. Twelve months later, the importance given to sexuality had increased. While the communication with professionals had improved, it remained at a very low level. We were unable to identify specific clinical factors (chemotherapy, menopausal status, type of surgery or radiotherapy) that would negatively affect the global sexual well-being in BC patients. CONCLUSION The analysis of sexual QoL of BC patients during the first year of hormonal treatment with a recently developed, cancer-dedicated, standardized tool pointed out the need for deeper communication between professionals and patients regarding sexual issues to fill the current gap in care of cancer patients and help patients with adequate intervention and support.
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Affiliation(s)
- Leticia Aptecar
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | - Frederic Fiteni
- Medical Oncology Department, Centre Hospitalier Universitaire de Nimes, Nimes, France.,Institut Desbrest d'Epidemiologie et de Sante Publique, University of Montpellier, Montpellier, France
| | - Marta Jarlier
- Biometrics Unit, Institut du Cancer de Montpellier, Montpellier, France
| | - Stephanie Delaine
- Medical Research Unit, Institut du Cancer de Montpellier, Montpellier, France
| | | | - William Jacot
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France.,Institut de Recherche en Cancerologie de Montpellier (IRCM), INSERM, University of Montpellier, Montpellier, France
| | - Veronique D'Hondt
- Medical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France. .,Institut de Recherche en Cancerologie de Montpellier (IRCM), INSERM, University of Montpellier, Montpellier, France.
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5
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Bober SL, Kingsberg SA, Faubion SS. Sexual function after cancer: paying the price of survivorship. Climacteric 2019; 22:558-564. [PMID: 31090466 DOI: 10.1080/13697137.2019.1606796] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sexual dysfunction is one of the most prevalent and distressing treatment side effects for millions of female cancer survivors, yet the majority of survivors do not receive necessary information, support, or treatment for these sexual consequences. Cancer can devastate the body and impair sexual function and body image. Furthermore, all primary modalities of cancer treatment (surgery, radiotherapy, chemotherapy, and hormonal therapy) have the potential to negatively impact sexual function. Assessment and identification by clinicians can be done efficiently and easily with short validated tools using a style of inquiry which starts by acknowledging how common sexual dysfunction is amongst cancer survivors rather than asking direct questions. Sexual concerns are impacted by psychological, biological, and interpersonal factors, and a multidisciplinary approach to treatment allows clinicians to comfortably inquire, assess, and refer if treatment is beyond their comfort or expertise.
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Affiliation(s)
- S L Bober
- Dana-Farber Cancer Institute, Brigham and Women's Hospital , Boston , MA , USA.,Department of Psychosocial Oncology and Palliative Care, Harvard Medical School , Boston , MA , USA
| | - S A Kingsberg
- Department of Obstetrics and Gynecology, MacDonald Women's Hospital, University Hospitals Cleveland Medical Center , Cleveland , OH , USA
| | - S S Faubion
- Mayo Clinic Center for Women's Health and Department of General Internal Medicine, Mayo Clinic , Rochester , MN , USA
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6
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Bober SL, Michaud AL, Recklitis CJ. Finding sexual health aids after cancer: are cancer centers supporting survivors' needs? J Cancer Surviv 2019; 13:224-230. [PMID: 30815783 DOI: 10.1007/s11764-019-00744-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Sexual dysfunction is one of the most prevalent and distressing treatment-related side effects for both male and female cancer survivors. Survivorship care guidelines recommend therapeutic sexual aids to help improve sexual problems. However, little is known about the availability of sexual aids and resources at cancer centers. METHODS Twenty-five comprehensive cancer centers affiliated with both the National Cancer Institute and the National Comprehensive Care Network were surveyed using the "mystery shopper" method to determine whether various types of sexual aids were available at the centers. Staffs from cancer center staff retail stores and patient boutiques were queried in separate telephone calls regarding the availability of these aids for and women. RESULTS Of the 25 centers contacted, 23 (92%) responded about aids for men, and 22 (88%) responded about aids for women. Eighty-seven percent of the centers reported having no sexual aids available for men, and 72% of centers reported having no aids available for women. The most common advice given to mystery shoppers was a suggestion to use the internet. Only one center had numerous aids/resources for both men and women. CONCLUSIONS The large majority of cancer centers reported having no sexual aids or other sexual health resources available for men or women. IMPLICATIONS FOR CANCER SURVIVORS Results underscore the widespread lack of resources to promote sexual health rehabilitation at major cancer centers, both for male and female survivors.
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Affiliation(s)
- Sharon L Bober
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
| | - Alexis L Michaud
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, USA
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7
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Boa R, Grénman S. Psychosexual health in gynecologic cancer. Int J Gynaecol Obstet 2018; 143 Suppl 2:147-152. [DOI: 10.1002/ijgo.12623] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rosalind Boa
- Department of Obstetrics and Gynecology; University of Cape Town; Cape Town South Africa
| | - Seija Grénman
- Department of Obstetrics and Gynecology; Turku University Hospital; Turku Finland
- University of Turku; Turku Finland
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8
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Oberguggenberger AS, Nagele E, Inwald EC, Tomaszewski K, Lanceley A, Nordin A, Creutzberg CL, Kuljanic K, Kardamakis D, Schmalz C, Arraras J, Costantini A, Almont T, Wei-Chu C, Dehandschutter S, Winters Z, Greimel E. Phase 1-3 of the cross-cultural development of an EORTC questionnaire for the assessment of sexual health in cancer patients: the EORTC SHQ-22. Cancer Med 2018; 7:635-645. [PMID: 29436144 PMCID: PMC5852351 DOI: 10.1002/cam4.1338] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/09/2017] [Accepted: 12/08/2017] [Indexed: 12/29/2022] Open
Abstract
To develop and pretest an European Organization for the Research and Treatment of Cancer Sexual Health Questionnaire (EORTC SHQ-22) for the assessment of physical, psychological, and social aspects of sexual health (SH) in male and female cancer patients and survivors. Questionnaire construction started with creating a list of relevant SH issues based on a comprehensive literature review. Issues were subsequently evaluated for relevance and prioritization by 78 healthcare professionals (HCP) and 107 patients from 12 countries during in-depth interviews (phase 1). Extracted issues were operationalized into items (phase 2). Phase 3 focused on pretesting the preliminary questionnaire in a cross-cultural patient sample (n = 171) using debriefing interviews. Psychometric properties were preliminary determined using a principal component analysis and Cronbach's alpha. We derived 53 relevant SH issues from the literature. Based on HCP and patient interviews, 22 of these 53 issues were selected and operationalized into items. Testing the preliminary 22-item short questionnaire resulted in a change of wording in five items and two communication-related items; no items were removed. Preliminary psychometric analysis revealed a two-factor solution and 11 single items; both scales showed good reliability indicated by a Cronbach's alpha of 0.87 (sexual satisfaction) and 0.82 (sexual pain). Cross-cultural pretesting of the preliminary EORTC SH questionnaire has indicated excellent applicability, patient acceptance, and comprehensiveness as well as good psychometric properties. The final development phase, that is psychometric validation (phase four) including large-scale, cross-cultural field testing of the EORTC SHQ-22, has commenced.
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Affiliation(s)
| | - Eva Nagele
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elisabeth C Inwald
- Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany
| | - Krzysztof Tomaszewski
- Health Outcomes Research Unit, Department of Gerontology, Geriatrics, and Social Work, Faculty of Education, Ignatianum Academy, Krakow, Poland
| | - Anne Lanceley
- Department of Women's Cancer, University College, London, UK
| | | | - Carien L Creutzberg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karin Kuljanic
- Department of Gynaecology and Obstetrics, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University of Patras Medical School, Patras, Greece
| | - Claudia Schmalz
- Department of Radiotherapy, Christian-Albrechts-University Hospital Kiel, Kiel, Germany
| | - Juan Arraras
- Oncology Department Hospital of Navarre, Pamplona, Spain
| | - Anna Costantini
- Psychoncology Unit, Sant'Andrea Hospital, Sapienza University Rome, Italy
| | | | - Chie Wei-Chu
- Institute of Preventive Medicine, National Taiwan University, Taipei City, Taiwan
| | | | - Zoe Winters
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Elfriede Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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9
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How does adjuvant chemotherapy affect menopausal symptoms, sexual function, and quality of life after breast cancer? Menopause 2018; 23:1000-8. [PMID: 27272225 DOI: 10.1097/gme.0000000000000664] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine the association between adjuvant chemotherapy for breast cancer and menopausal symptoms, sexual function, and quality of life. METHODS Participants attended a menopause clinic with a dedicated service for cancer survivors at a large tertiary women's hospital. Information about breast cancer treatments including adjuvant chemotherapy was collected from medical records. Menopausal symptoms were recorded with the Greene Climacteric Scale and Functional Assessment of Cancer Therapy, Breast Cancer, and Endocrine Symptom Subscales. Sexual symptoms were recorded using Fallowfield's Sexual Activity Questionnaire. Quality of life was measured with Functional Assessment of Cancer Therapy scales. RESULTS The severity of vasomotor, psychological, or sexual symptoms (apart from pain) did not differ between those who had received adjuvant chemotherapy (n = 339) and other breast cancer survivors (n = 465). After adjustment for current age, time since menopause, and current use of antiestrogen endocrine therapy, the risk of "severe pain" with sexual intercourse was twice as common after chemotherapy (31.6% vs 20.0%, odds ratio [OR] 2.18, 95% CI 1.25-3.79). Those treated with chemotherapy were more likely to report "severe problems" with physical well-being (OR 1.92, 95% CI 1.12-3.28) and lower breast cancer-specific quality of life (OR 1.89 95% CI 1.13-3.18), but did not differ in other quality of life measures. CONCLUSIONS In this large study of breast cancer patients presenting to a specialty menopause clinic, previous chemotherapy was not associated with current vasomotor or psychological symptoms. Severe pain with intercourse was significantly more common in those treated with adjuvant chemotherapy.
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Nam SY, Lee H, Kim S, Lee RA. Factors Affecting Body Image and Sexual Life for the Colorectal Cancer Patients with Stoma. ASIAN ONCOLOGY NURSING 2018. [DOI: 10.5388/aon.2018.18.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sun Young Nam
- Department of nursing, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Korea
| | - Hyangkyu Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, Korea
| | - Sue Kim
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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11
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Reese JB, Bober SL, Daly MB. Talking about women's sexual health after cancer: Why is it so hard to move the needle? Cancer 2017; 123:4757-4763. [PMID: 29116655 PMCID: PMC5716835 DOI: 10.1002/cncr.31084] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/06/2023]
Abstract
Despite increasing calls to integrate sexual health into routine cancer care, the majority of women diagnosed with cancer do not receive information about how their cancer treatments will affect their sexual health. With the significant challenges that exist to clinical discussion of sexual health, efforts on multiple fronts are needed to close the gap in the care of women diagnosed with cancer.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center
- Department of Social and Behavioral Sciences, College of Public Health, Temple University
| | - Sharon L. Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center
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12
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Hertrampf RS, Wärja M. The effect of creative arts therapy and arts medicine on psychological outcomes in women with breast or gynecological cancer: A systematic review of arts-based interventions. ARTS IN PSYCHOTHERAPY 2017. [DOI: 10.1016/j.aip.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Assessing the utility of a distress screening tool at capturing sexual concerns in a gyne-oncology follow-up clinic. Support Care Cancer 2017; 26:887-893. [DOI: 10.1007/s00520-017-3905-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022]
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Bretschneider CE, Doll KM, Bensen JT, Gehrig PA, Wu JM, Geller EJ. Sexual Health Before Treatment in Women with Suspected Gynecologic Malignancy. J Womens Health (Larchmt) 2017; 26:1326-1332. [PMID: 28829666 DOI: 10.1089/jwh.2016.6307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Sexual health in survivors of gynecologic cancer has been studied; however, sexual health in these women before treatment has not been thoroughly evaluated. The objective of our study was to describe the pretreatment characteristics of sexual health of women with suspected gynecologic cancer before cancer treatment. MATERIALS AND METHODS We performed a cross-sectional analysis of women with a suspected gynecologic cancer, who were prospectively enrolled in a hospital-based cancer survivorship cohort from August 2012 to June 2013. Subjects completed the validated Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire. Pretreatment sexual health was assessed in terms of sexual interest, desire, lubrication, discomfort, orgasm, enjoyment, and satisfaction. RESULTS Of 186 eligible women with suspected gynecologic cancer, 154 (82%) completed the questionnaire pretreatment. Mean age was 58.1 ± 13.3 years. Sexual health was poor: 68.3% reported no sexual activity, and 54.7% had no interest in sexual activity. When comparing our study population to the general U.S. population, the mean pretreatment scores for the subdomains of lubrication and vaginal discomfort were similar, while sexual interest was significantly lower and global satisfaction was higher. In a linear regression model, controlling for cancer site, age remained significantly associated with sexual function while cancer site did not. CONCLUSIONS Problems with sexual health are prevalent in women with suspected gynecologic malignancies before cancer treatment. Increasing awareness of the importance of sexual health in this population will improve quality of life for these women.
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Affiliation(s)
- C Emi Bretschneider
- 1 Division of Urogynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Kemi M Doll
- 2 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jeannette T Bensen
- 3 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Paola A Gehrig
- 2 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jennifer M Wu
- 1 Division of Urogynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Elizabeth J Geller
- 1 Division of Urogynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Shankar A, Prasad N, Roy S, Chakraborty A, Biswas AS, Patil J, Rath GK. Sexual Dysfunction in Females after Cancer Treatment: an Unresolved Issue. Asian Pac J Cancer Prev 2017; 18:1177-1182. [PMID: 28610399 PMCID: PMC5555520 DOI: 10.22034/apjcp.2017.18.5.1177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cancer besides being a leading cause of mortality also creates a myriad of morbidities in survivors whether treated
or untreated. Among women surviving after gynecological malignancies sexual dysfunction is a morbidity unexplored
in Indian context because of cultural barriers. With the increasing proportion of women surviving carcinoma of the
cervix, quality of life has become an important clinical issue. Despite the immense distress it causes in patients, sexual
dysfunction is neither screened nor treated in Indian scenario. Despite this recognition, the area is not well researched
and there is a paucity of information on the impact of cancer treatment on sexual health in Indian Context. Research
has shown that up to 50% of women treated for cervix cancers have sexual dysfunction as they recover and become
cancer survivors. This article aims to review the phases of sexual response and how each may be affected by the physical
and emotional stress of cancer diagnosis and treatment. We will then discuss existing tools for assessment of sexual
function and approaches to their treatment. Finally, we will conclude with advice to health care professionals based on
current research and suggest questions for future study.
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Affiliation(s)
- Abhishek Shankar
- Department of Preventive Oncology, Dr B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India.
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16
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Bretschneider CE, Bensen JT, Geller EJ, Gehrig PA, Wu JM, Doll KM. Perioperative sexual interest in women with suspected gynecologic malignancies. Gynecol Oncol 2017; 146:109-113. [PMID: 28410756 DOI: 10.1016/j.ygyno.2017.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES For women with gynecologic cancer, the impact of surgery on sexual interest and desire in the immediate and later postoperative period is not well characterized. The objective of this study was to report the perioperative trends of changing sexual interest and desire in a cohort of women undergoing surgery for suspected gynecologic malignancies. METHODS This is an ancillary analysis of a cohort study analyzing health-related outcomes in women who underwent primary surgical management of a suspected gynecologic malignancy between 10/2013 and 10/2014. Subjects completed the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire (PROMIS-SFQ) preoperatively and questions on sexual interest and desire at one, three, and six months postoperatively. Bivariate tests and multiple linear regression were used to analyze data. RESULTS Of 231 women who completed a baseline PROMIS-SFQ, 187 (81%) completed one-month, 170 (74%) three-month, and 174 (75%) six-month follow-up interviews. Following surgery, 71% of enrolled subjects were diagnosed with a malignancy. Women age <55 had a greater decrease in sexual interest from baseline to one month than women age >55 (-5.5±1.0 vs -2.3±0.9, p=0.02). In a multivariable analysis, age <55 remained associated with a larger decrease in sexual interest at one month postoperatively (-4.6, 95% CI: -1.8, -7.4), as did having cancer vs benign disease for women of all ages (-5.6, 95% CI: -9.6, -1.5). CONCLUSIONS This study provides new data regarding the timing and magnitude of changes in sexual interest following gynecologic oncology procedures.
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Affiliation(s)
- C E Bretschneider
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of North Carolina at Chapel Hill, United States.
| | - Jeannette T Bensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, United States
| | - Elizabeth J Geller
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of North Carolina at Chapel Hill, United States
| | - Paola A Gehrig
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, United States
| | - Jennifer M Wu
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of North Carolina at Chapel Hill, United States; Center for Women's Health Research, University of North Carolina at Chapel Hill, United States
| | - Kemi M Doll
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, United States
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Wang Y, Chen L, Ruan JY, Cheung WY. Discussions about reproductive and sexual health among young adult survivors of cancer. Cancer Med 2016; 5:1037-46. [PMID: 26899556 PMCID: PMC4924361 DOI: 10.1002/cam4.666] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/23/2015] [Accepted: 01/18/2016] [Indexed: 12/17/2022] Open
Abstract
Fertility preservation and sexual health are increasingly important as more young cancer patients survive their disease. Our aims were to describe the frequency with which reproductive and sexual health discussions occur, and to identify clinical factors associated with these discussions. Medical records of patients aged 20–39 diagnosed with solid tumors from 2008–2010 who survived ≥2 years were retrospectively reviewed. Multivariate logistic models were used to explore the relationship between clinical factors and occurrence of discussions. We analyzed 427 survivors: median age was 35 years, 29% were men, 88% had baseline [Eastern Cooperative Oncology Group (ECOG)] ECOG 0, and 79% were in a relationship. Only 58% and 7% of patients received discussions about reproductive and sexual health, respectively, at their initial oncology consultation, most of which were led by medical oncologists. There was a significant association between reproductive and sexual health conversations, in that those who engaged in dialog about one topic were more likely to participate in discussions about the other (P = 0.01). Patients with gynecologic malignancies (P < 0.0001) were more inclined to engage in sexual health discussions. Only a minority (19%) of patients took specific action toward fertility preservation, but the receipt of reproductive health discussions was a strong and independent driver for pursuing fertility preservation (P < 0.0001). The impact of cancer and its treatment on fertility and sexual health was inadequately addressed at the time of diagnosis among young cancer survivors. This warrants specific attention since having reproductive health discussions was strongly predictive of patients pursuing fertility preservation strategies.
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Affiliation(s)
- Ying Wang
- British Columbia Cancer Agency, Vancouver, Canada
| | - Leo Chen
- British Columbia Cancer Agency, Vancouver, Canada
| | - Jenny Y Ruan
- British Columbia Cancer Agency, Vancouver, Canada
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Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol 2016; 140:359-68. [PMID: 26556768 PMCID: PMC4835814 DOI: 10.1016/j.ygyno.2015.11.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues. METHODS A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant. RESULTS Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy-negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm. CONCLUSION Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems.
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Affiliation(s)
- Laura B Huffman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ellen M Hartenbach
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jeanne Carter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Joanne K Rash
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - David M Kushner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.
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Matzo M, Troup S, Hijjazi K, Ferrell B. Evaluating a Sexual Health Patient Education Resource. J Adv Pract Oncol 2015; 6:242-8. [PMID: 26557411 PMCID: PMC4625630 DOI: 10.6004/jadpro.2015.6.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncology professionals are committed to addressing quality-of-life concerns for patients across the trajectory of illness. Sexuality is a key concern for patients and impacts relationships and overall quality of life. Through careful assessment, patient education, and support, clinicians can ensure that sexuality is respected as an essential part of patient-centered care.
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Affiliation(s)
- Marianne Matzo
- College of Nursing and Stephenson Cancer Center, University of Oklahoma Sciences Center, Oklahoma City, Oklahoma
| | - Sandi Troup
- Stephenson Cancer Center, University of Oklahoma Sciences Center, Oklahoma City, Oklahoma
| | - Kamal Hijjazi
- College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Aubin S, Perez S. The Clinician's Toolbox: Assessing the Sexual Impacts of Cancer on Adolescents and Young Adults with Cancer (AYAC). Sex Med 2015; 3:198-212. [PMID: 26468383 PMCID: PMC4599557 DOI: 10.1002/sm2.75] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Adolescents and young adults aged 15-39 years who have been diagnosed with cancer (AYAC) have unique medical and psychosocial needs. Following their cancer treatments, AYAC must learn to manage the sometimes irreversible general side effects of cancer treatments including side effects that impact their sexuality. These side effects include but are not limited to: infertility, altered body/physical appearance, and sexual dysfunction. Such effects may hinder AYAC efforts to date and experiment sexually, limiting sexual maturation and confidence, as well as the formation or maintenance of meaningful couple and sexual relationships. It is clear that we need to tailor our clinical approaches to ensure that we assess the unique needs and concerns faced by AYAC. AIMS Based on consistent study findings substantiating the distinctive needs of AYAC, the main objective of this article is to present the core clinical components involved in assessing sexuality among AYAC. METHODS The clinical recommendations are based on the authors and experts' clinical experiences coupled with a thorough examination of the literature related to AYAC sexuality. MAIN OUTCOME MEASURES This article first describes the three components (clinical interview, review of chart notes, and self-report questionnaires) of a sexuality assessment and the seven core domains that highlight target areas of focus. RESULTS A detailed outline of each of the core domains of assessment (socio-demographics; medical history; fertility and sexually transmitted infection; sexual functioning; sexual coping style; body and self-image; and sexual history and dating/couple experience) is presented. A "toolbox" table containing useful resources for clinicians (e.g., questionnaires and red flags) and direct resources for AYAC patients are included. CONCLUSION Cancer can have a significant impact on numerous domains of AYAC sexuality. The assessment of and attention to the impact of sexuality on AYAC is crucial in order to provide effective and comprehensive quality patient cancer care.
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Affiliation(s)
- Sylvie Aubin
- Lady Davis Institute, Jewish General HospitalMontreal, QC, Canada
- Department of Psychology, McGill UniversityMontreal, QC, Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General HospitalMontreal, QC, Canada
| | - Samara Perez
- Lady Davis Institute, Jewish General HospitalMontreal, QC, Canada
- Department of Psychology, McGill UniversityMontreal, QC, Canada
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Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Broomans E, Aaronson NK. Internet-based cognitive behavioral therapy for sexual dysfunctions in women treated for breast cancer: design of a multicenter, randomized controlled trial. BMC Cancer 2015; 15:321. [PMID: 25927495 PMCID: PMC4423483 DOI: 10.1186/s12885-015-1320-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/16/2015] [Indexed: 02/02/2023] Open
Abstract
Background Sexual dysfunction is a prevalent, long-term complication of breast cancer and its treatment and can be treated effectively with face-to-face sexual counselling. However, relatively few women actually opt for face-to-face sex therapy, with many women indicating that it is too confronting. Internet-based interventions might be a less threatening and more acceptable approach, because of the convenience, accessibility and privacy it provides. Recent studies have demonstrated the efficacy of internet-based programs for improving sexual functioning in the general population. The objective of the current study is to investigate the efficacy of an internet-based cognitive behavioral therapy (CBT) program in alleviating problems with sexuality and intimacy in women who have been treated for breast cancer. Methods/design In a multicenter, randomized controlled trial we are evaluating the efficacy of an internet-based CBT program in reducing problems with sexuality and intimacy in breast cancer survivors. Secondary outcomes include body image, marital functioning, psychological distress, menopausal symptoms, and health-related quality of life. We will recruit 160 breast cancer survivors (aged 18-65 years) with a formal DSM-IV diagnosis of sexual dysfunction from general and academic hospitals in the Netherlands. Women are randomized to either an intervention or waiting-list control group. Self-report questionnaires are completed by the intervention group at baseline (T0), ten weeks after start of therapy (T1), post-treatment (T2), 3 months post-treatment (T3), and 9 months post-treatment (T4). The control group completes questionnaires at T0, T1 and T2. Discussion There is a need for accessible and effective interventions for the treatment of sexual dysfunctions in breast cancer survivors. This study will provide evidence about the efficacy of an internet-based approach to delivering a CBT intervention targeted specifically at these sexual health issues. If proven to be effective, internet-based CBT for problems with sexuality and intimacy will be a welcome addition to the care offered to breast cancer survivors. Hopefully this therapy will lower the barrier to seeking help for these problems, resulting in improved quality of life after breast cancer. Trial registration The study is registered at ClinicalTrials.gov (NCT02091765).
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Affiliation(s)
- Susanna B Hummel
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Jacques J D M van Lankveld
- Faculty of Psychology and Educational Sciences, Open University, Valkenburgerweg 177, 6419 AT, Heerlen, The Netherlands.
| | - Hester S A Oldenburg
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Daniela E E Hahn
- Department of Psychosocial Counseling, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Eva Broomans
- Department of Adult Care, Virenze Institute of Mental Health Care, 't Goylaan 7, 3525 AA, Utrecht, The Netherlands.
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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Stabile C, Gunn A, Sonoda Y, Carter J. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer. Transl Androl Urol 2015; 4:169-85. [PMID: 26816823 PMCID: PMC4708131 DOI: 10.3978/j.issn.2223-4683.2015.04.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/20/2015] [Indexed: 12/29/2022] Open
Abstract
The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention.
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Shridhar R, Shibata D, Chan E, Thomas CR. Anal cancer: current standards in care and recent changes in practice. CA Cancer J Clin 2015; 65:139-62. [PMID: 25582527 DOI: 10.3322/caac.21259] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Answer questions and earn CME/CNE The management of squamous cell carcinomas of the anal canal has evolved from surgery as first-line treatment to curative chemoradiation, with surgery reserved for salvage. Significant progress has been made in understanding how to most effectively deliver chemotherapy and reduce toxicity through advancements in radiation delivery. The purpose of this article is to review the multimodality approach to the diagnosis and management of anal cancer based on a review of the published data and in light of available guidelines.
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Affiliation(s)
- Ravi Shridhar
- Associate Professor, Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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24
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Cho J, Jung SY, Lee JE, Shim EJ, Kim NH, Kim Z, Sohn G, Youn HJ, Kim KS, Kim H, Lee JW, Lee MH. A review of breast cancer survivorship issues from survivors' perspectives. J Breast Cancer 2014; 17:189-99. [PMID: 25320616 PMCID: PMC4197348 DOI: 10.4048/jbc.2014.17.3.189] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
Despite the fact that more breast cancer survivors are currently enjoying longer lifespans, there remains limited knowledge about the factors and issues that are of greatest significance for these survivors, particularly from their perspectives. This review was based on the concept that the topics addressed should focus on the perspectives of current survivors and should be extended to future modalities, which physicians will be able to use to gain a better understanding of the hidden needs of these patients. We intended to choose and review dimensions other than the pathology and the disease process that could have been overlooked during treatment. The eight topics upon which we focused included: delay of treatment and survival outcome; sexual well-being; concerns about childbearing; tailored follow-up; presence of a family history of breast cancer; diet and physical activity for survivors and their families; qualitative approach toward understanding of breast cancer survivorship, and; mobile health care for breast cancer survivors. Through this review, we aimed to examine the present clinical basis of the central issues noted from the survivors' perspectives and suggest a direction for future survivorship-related research.
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Affiliation(s)
- Jihyoung Cho
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - So-Youn Jung
- Breast Cancer Center, National Cancer Center, Goyang, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, Sookmyung Women's University, Seoul, Korea
| | - Eun-Jung Shim
- Department of Psychology, Pusan National University School of Medicine, Busan, Korea
| | - Nam Hyoung Kim
- Department of Advertising and Branding, Kaywon University of Art and Design, Uiwang, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Guiyun Sohn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jo Youn
- Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Ku Sang Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hanna Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Hyuk Lee
- Department of Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
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Psychosexual support for gynecological cancer survivors: professionals’ current practices and need for assistance. Support Care Cancer 2014; 23:831-9. [DOI: 10.1007/s00520-014-2433-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
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26
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Aktaş D, Terzioğlu F. Effect of Home Care Service on the Sexual Satisfaction of Patients with Gynecologic Cancer. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-014-9370-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pillai-Friedman S, Ashline J. Women, breast cancer survivorship, sexual losses, and disenfranchised grief – a treatment model for clinicians. SEXUAL AND RELATIONSHIP THERAPY 2014. [DOI: 10.1080/14681994.2014.934340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Matzo M, Graham C, Troup CL, Ferrell B. Development of a Patient Education Resource for Women With Gynecologic Cancers. Clin J Oncol Nurs 2014; 18:343-8. [DOI: 10.1188/14.cjon.343-348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bartula I, Sherman KA. Screening for sexual dysfunction in women diagnosed with breast cancer: systematic review and recommendations. Breast Cancer Res Treat 2013; 141:173-85. [PMID: 24013707 PMCID: PMC3824351 DOI: 10.1007/s10549-013-2685-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 08/26/2013] [Indexed: 12/24/2022]
Abstract
Breast cancer patients are at increased risk of sexual dysfunction. Despite this, both patients and practitioners are reluctant to initiate a conversation about sexuality. A sexual dysfunction screening tool would be helpful in clinical practice and research, however, no scale has yet been identified as a "gold standard" for this purpose. The present review aimed at evaluating the scales used in breast cancer research in respect to their psychometric properties and the extent to which they measure the DSM-5/ICD-10 aspects of sexual dysfunction. A comprehensive search of the literature was conducted for the period 1992-2013, yielding 129 studies using 30 different scales measuring sexual functioning, that were evaluated in the present review. Three scales (Arizona Sexual Experience Scale, Female Sexual Functioning Index, and Sexual Problems Scale) were identified as most closely meeting criteria for acceptable psychometric properties and incorporation of the DSM-5/ICD-10 areas of sexual dysfunction. Clinical implications for implementation of these measures are discussed as well as directions for further research.
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Affiliation(s)
- Iris Bartula
- />Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2019 Australia
| | - Kerry A. Sherman
- />Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW 2019 Australia
- />Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW Australia
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Carter J, Stabile C, Gunn A, Sonoda Y. The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med 2013; 10 Suppl 1:21-34. [PMID: 23387909 DOI: 10.1111/jsm.12002] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, reproductive function, and overall quality of life (QOL) (e.g., sexual dysfunction, infertility, lymphedema). However, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae. AIM To provide an overview of the standards of care and major advancements in gynecologic cancer surgery, with a focus on their direct physical impact, as well as emotional, sexual, and QOL issues. This overview will aid researchers and clinicians in the conceptualization of future clinical care strategies and interventions to improve sexual/vaginal/reproductive health and QOL in gynecologic cancer patients. MAIN OUTCOME MEASURES Comprehensive overview of the literature on gynecologic oncology surgery. METHODS Conceptual framework for this overview follows the current standards of care and recent surgical approaches to treat gynecologic cancer, with a brief overview describing primary management objectives and the physical, sexual, and emotional impact on patients. Extensive literature support is provided. RESULTS The type and radicality of surgical treatment for gynecologic cancer can influence sexual function and play a significant role in QOL. Psychological, sexual, and QOL outcomes improve as surgical procedures continue to evolve. Procedures for fertility preservation, laparoscopy, sentinel lymph node mapping, and robotic and risk-reducing surgery have advanced the field while reducing treatment sequelae. Nevertheless, interventions that address sexual and vaginal health issues are limited. CONCLUSIONS It is imperative to consider QOL and sexuality during the treatment decision-making process. New advances in detection and treatment exist; however, psycho-educational interventions and greater patient-physician communication to address sexual and vaginal health concerns are warranted. Large, prospective clinical trials including patient-reported outcomes are needed in gynecologic oncology populations to identify subgroups at risk. Future study designs need clearly defined samples to gain insight about sexual morbidity and foster the development of targeted interventions.
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Affiliation(s)
- Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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31
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Philip EJ, Nelson C, Temple L, Carter J, Schover L, Jennings S, Jandorf L, Starr T, Baser R, DuHamel K. Psychological correlates of sexual dysfunction in female rectal and anal cancer survivors: analysis of baseline intervention data. J Sex Med 2013; 10:2539-48. [PMID: 23551928 DOI: 10.1111/jsm.12152] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Sexual dysfunction represents a complex and multifactorial construct that can affect both men and women and has been noted to often deteriorate significantly after treatment for rectal and anal cancer. Despite this, it remains an understudied, underreported, and undertreated issue in the field of cancer survivorship. AIM This study examined the characteristics of women enrolled in an intervention trial to treat sexual dysfunction, and explored the relationship between sexual functioning and psychological well-being. METHODS There were 70 female posttreatment anal or rectal cancer survivors assessed as part of the current study. Participants were enrolled in a randomized intervention trial to treat sexual dysfunction and completed outcome measures prior to randomization. MAIN OUTCOMES MEASURES The main outcome measures are quality of life (QOL) (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC-QLQ-C30] and Colorectal Cancer-Specific Module [QLQ-CR38]), sexual functioning (Female Sexual Functioning Index), and psychological well-being (Brief Symptom Inventory Depression/Anxiety, Impact of Events Scale-Revised, CR-38 Body Image). RESULTS Women enrolled in the study intervention were on average 55 years old, predominantly Caucasian (79%), married (57%), and a median of 4 years postprimary treatment. For those reporting sexual activity at baseline (N=41), sexual dysfunction was associated with a range of specific measures of psychological well-being, all in the hypothesized direction. The Sexual/Relationship Satisfaction subscale was associated with all measures of psychological well-being (r=-0.45 to -0.70, all P<0.01). Body image, anxiety, and cancer-specific posttraumatic distress were notable in their association with subscales of sexual functioning, while a global QOL measure was largely unrelated. CONCLUSIONS For sexually active female rectal and anal cancer survivors enrolled in a sexual health intervention, sexual dysfunction was significantly and consistently associated with specific measures of psychological well-being, most notably Sexual/Relationship Satisfaction. These results suggest that sexual functioning may require focused assessment by providers, beyond broad QOL assessments, and that attention to Sexual/Relationship Satisfaction may be critical in the development and implementation of interventions for this cohort of patients.
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Affiliation(s)
- Errol J Philip
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Matzo M, Ehiemua Pope L, Whalen J. An integrative review of sexual health issues in advanced incurable disease. J Palliat Med 2013; 16:686-91. [PMID: 23537196 DOI: 10.1089/jpm.2012.0416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The sexual health needs of people with advanced incurable diseases are underexplored and under assessed by health care practitioners and under studied by researchers. The loss of sexual health can impact a person's overall quality of life and well-being. This integrative review of the literature presents the current state of the science and was conducted to identify and summarize publications in the professional literature related to the sexual health needs of people with advanced illness. A systematic search of 18 databases for studies conducted between 1960 and April 2012 in the English language that focused on the sexual health needs of people with life-limiting illnesses was conducted. Findings document that studies regarding the sexual health of patients with life limiting illnesses are generally narrative reviews, expert opinions, or exploratory in nature. Of the 30 possibly relevant abstracts and titles identified, there was only one prospective or case control trial focusing on sexual health in this population thereby offering the practitioner little research evidence to inform clinical practice. Increasing our understanding of the sexual health needs of people facing the end of their lives is crucial if we are to conduct appropriate assessments and initiate relevant treatments. Further prospective research is required to assess and establish the sexual health concerns of people along the disease trajectory of incurable illness as well as those imminently facing the end of their lives.
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Affiliation(s)
- Marianne Matzo
- College of Nursing, University of Oklahoma, Oklahoma City, Oklahoma, USA.
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Althof SE, Parish SJ. Clinical Interviewing Techniques and Sexuality Questionnaires for Male and Female Cancer Patients. J Sex Med 2013; 10 Suppl 1:35-42. [DOI: 10.1111/jsm.12035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Milbury K, Badr H. Sexual problems, communication patterns, and depressive symptoms in couples coping with metastatic breast cancer. Psychooncology 2012; 22:814-22. [PMID: 22565300 DOI: 10.1002/pon.3079] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/09/2012] [Accepted: 03/17/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND The treatment of breast cancer tends to result in physical side effects (e.g., vaginal dryness, stomatitis, and atrophy) that can cause sexual problems. Although studies of early-stage breast cancer have demonstrated that sexual problems are associated with increased depressive symptoms for both patients and their partners, comparatively little is known about these associations in metastatic breast cancer (MBC) and how patients and partners cope together with sexual problems. We examined the links between sexual problems, depressive symptoms, and two types of spousal communication patterns (mutual constructive and demand-withdraw) in 191 couples in which the patient was initiating treatment for MBC. METHODS Patients and partners separately completed paper-and-pencil surveys. RESULTS Multilevel models indicated that high levels of sexual problems were significantly associated with more depressive symptoms only for patients who reported low levels of mutual constructive communication (p < 0.01) and high levels of demand-withdraw communication (p < 0.0001). In contrast, for partners, greater sexual problems were associated with more depressive symptoms regardless of the communication pattern reported. These associations remained significant when we controlled for patients' reports of average pain and functional and physical well-being and couples' dyadic adjustment. CONCLUSIONS Sexual problems were associated with depressive symptoms for both MBC patients and their partners. The way in which patients and partners talk with one another about cancer-related problems seems to influence this association for patients. MBC patients may benefit from programs that teach couples how to minimize demand-withdraw communication and instead openly and constructively discuss sexual issues and concerns.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA.
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Salani R, Andersen BL. Gynecologic care for breast cancer survivors: assisting in the transition to wellness. Am J Obstet Gynecol 2012; 206:390-7. [PMID: 22177185 PMCID: PMC3752900 DOI: 10.1016/j.ajog.2011.10.858] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 10/12/2011] [Accepted: 10/18/2011] [Indexed: 12/27/2022]
Abstract
Currently, there are >2 million survivors of breast cancer in the United States. Two years after cancer treatment, patients may transition to primary care providers and/or gynecologists. Many of these survivors may have difficulties with menopausal symptoms. If they do not know already, some of these women may want or need risk assessment for hereditary- or treatment-induced second cancers. At least 20% will also have significant psychologic, sexual, and/or relationship difficulties that require attention. All of the women will need assistance to learn and follow recommendations for surveillance, detecting recurrence, and promoting wellness. Thus, gynecologists play a critical role in helping these patients in their health care transitions. To assist the gynecologists, we have reviewed the evaluation and management of common sequelae of breast cancer diagnoses and treatments.
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Affiliation(s)
- Ritu Salani
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 43210, USA
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Ferguson SE, Urowitz S, Massey C, Wegener M, Quartey N, Wiljer D, Classen CC. Confirmatory factor analysis of the Sexual Adjustment and Body Image Scale in women with gynecologic cancer. Cancer 2011; 118:3095-104. [DOI: 10.1002/cncr.26632] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 09/26/2011] [Indexed: 11/07/2022]
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Bessede T, Massard C, Albouy B, Leborgne S, Gross-Goupil M, Droupy S, Patard JJ, Fizazi K, Escudier B. Sexual life of male patients with advanced renal cancer treated with angiogenesis inhibitors. Ann Oncol 2011; 22:2320-4. [DOI: 10.1093/annonc/mdq766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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The effect of a sexual life reframing program on marital intimacy, body image, and sexual function among breast cancer survivors. Cancer Nurs 2011; 34:142-9. [PMID: 20885305 DOI: 10.1097/ncc.0b013e3181f1ab7a] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite increasing awareness related to sexual health for breast cancer survivors, health care providers are passive in addressing their sexual issues. OBJECTIVE The aims were to develop and investigate the effect of a sexual life reframing program on marital intimacy, body image, and sexual function (interest, dysfunction, and satisfaction) among breast cancer survivors. METHODS Breast cancer survivors participated in this quasi-experimental study. The sexual life reframing program focused on the physical, psychological, and relational aspects of sexual health elements, and it consisted of 6 weekly 2-hour sessions. RESULTS The participants reported poor body image and sexual function. There were no statistically significant differences in marital intimacy, body image, sexual interest, and sexual dysfunction following the program, although all the variables in the intervention group were improved. The sexual life reframing program was effective in increasing sexual satisfaction among breast cancer survivors. CONCLUSION This study suggests that the quality of sexual life in breast cancer survivors could be improved with the sexual life reframing program provided as part of supportive group care. This program may be more effective if targeted at couples rather than survivors only and if delivered earlier and for a longer period. IMPLICATIONS FOR PRACTICE The sexual life reframing program offers an opportunity to facilitate small-group dynamics that lay the ground for further contacts leading to earlier recognition of sexual problems and active involvement for sexual health improvement for breast cancer survivors and nurses. It could be utilized for survivor education or support groups to increase sexual satisfaction.
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Understanding sexuality in women with gynaecological cancer. Eur J Oncol Nurs 2011; 15:38-45. [DOI: 10.1016/j.ejon.2010.05.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 03/22/2010] [Accepted: 05/30/2010] [Indexed: 11/23/2022]
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Evaluation of Sexual Function in Patients with Gynecologic Cancer and Evidence-Based Nursing Interventions. SEXUALITY AND DISABILITY 2010. [DOI: 10.1007/s11195-010-9188-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Unlike hot flushes and night sweats which resolve spontaneously in time, atrophic symptoms affecting the vagina and lower urinary tract are often progressive and frequently require treatment. The prevalence of vaginal dryness increases as a woman advances through the postmenopausal years, causing itching, burning and dyspareunia, and sexual activity is often compromised. But, despite the various safe and effective options, only a minority (about 25% in the Western world and probably considerably less in other areas) will seek medical help. Some of this reluctance is due to the adverse publicity for hormone replacement therapy (HRT) over recent years that has suggested an increased risk of breast cancer, heart disease and stroke. But, regardless of whether these scares are justified, local treatment of vaginal atrophy is not associated with these possible risks of systemic HRT. Other reasons for the continued suffering in silence may be cultural and an understandable reluctance to discuss such matters, particularly with a male doctor, but the medical profession must also take much of the blame for failing to enquire of all postmenopausal women about the possibility of vaginal atrophic symptoms. Vaginal dryness can be helped by simple lubricants but the best and most logical treatment for urogenital atrophy is to use local estrogen. This is safe, effective and with few contraindications. It is hoped that these guidelines and recommendations, produced to coincide with World Menopause Day 2010, will help to highlight this major cause of distress and reduced quality of life and will encourage women and their medical advisers all over the world to seek and provide help.
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Affiliation(s)
- D W Sturdee
- Department of Obstetrics & Gynaecology, Heart of England NHS Foundation Trust, Solihull Hospital, UK
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Brotto LA, Yule M, Breckon E. Psychological interventions for the sexual sequelae of cancer: A review of the literature. J Cancer Surviv 2010; 4:346-60. [DOI: 10.1007/s11764-010-0132-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 06/07/2010] [Indexed: 10/19/2022]
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Das P, Cantor SB, Parker CL, Zampieri JB, Baschnagel A, Eng C, Delclos ME, Krishnan S, Janjan NA, Crane CH. Long-term quality of life after radiotherapy for the treatment of anal cancer. Cancer 2010; 116:822-9. [PMID: 20041481 PMCID: PMC6455911 DOI: 10.1002/cncr.24906] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radiotherapy is the current standard of care for patients with localized squamous cell cancer of the anal canal. The goal of the current study was to evaluate long-term quality of life (QoL) in patients after this treatment. METHODS Questionnaires were mailed to 80 patients treated with definitive radiotherapy, with or without concurrent chemotherapy, for anal cancer, with a minimum 2-year interval after the completion of radiotherapy. The questionnaire included the Functional Assessment of Cancer Therapy-Colorectal (FACT-C), the Medical Outcomes Study (MOS) Sexual Problems Scale, and questions regarding demographic characteristics and comorbidities. RESULTS A total of 32 (40%) patients completed the questionnaire. There were no significant differences noted with regard to clinical and demographic characteristics between the survey responders and nonresponders. Among the 32 responders, the median dose of radiotherapy was 55 Grays (Gy), and 97% had received concurrent chemotherapy. The median interval between radiotherapy and survey participation was 5 years (range, 3-13 years). The median total FACT-C score was 108 (range, 47-128), of a maximum (best possible) score of 136. Patients who reported depression or anxiety and younger patients were found to have significantly lower total FACT-C scores. The median scores on the Physical, Social/Family, Emotional, Functional, and Colorectal subscales of the FACT-C were 20, 23, 21, 22, and 21, respectively, of maximum (best possible) scores of 28, 28, 24, 28, and 28, respectively. The median score on the MOS Sexual Problems Scale was 67 (range, 0-100), of a maximum (worst possible) score of 100. CONCLUSIONS Patients treated with radiotherapy for anal cancer reported acceptable overall QoL scores, but poor sexual function scores. Investigations are warranted into more modern radiation techniques that could potentially reduce late toxicity from radiotherapy.
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Affiliation(s)
- Prajnan Das
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston1515 Holcombe Boulevard, Unit 97, Houston, TX 77030, USA.
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Koczwara B. Addressing fertility needs of breast cancer patients: oncology perspective. Expert Rev Anticancer Ther 2008; 8:1323-30. [PMID: 18699768 DOI: 10.1586/14737140.8.8.1323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Premenopausal women represent approximately 23% of women diagnosed with breast cancer. As the medial age of first pregnancy increases in developed countries, a greater proportion of women are diagnosed with breast cancer at a time when they have not yet completed their family. For these women, the impact of breast cancer treatment on their reproductive capacity can be of significant concern and may influence their treatment decisions. Despite these concerns only a proportion of premenopausal women with breast cancer are informed about their treatment choices in light of their reproductive needs. The diagnosis of cancer itself as well as systemic cancer treatments, including chemotherapy and hormonal therapy, can delay and/or reduce the reproductive capacity. Treatment decisions need to consider not only adjuvant treatment efficacy but also its risks, including impact on fertility. The risk of chemotherapy-associated amenorrhea varies according to the regime and is age-dependent. Hormonal treatments may delay reproduction further. A variety of fertility preservation strategies have been tried including gonadal protection during chemotherapy, ovarian cryopreservation and in vitro fertilization, but their potential benefits need to be considered in light of risks and, for most of them, the evidence for efficacy is limited. Special fertility considerations are required in women with family history and/or evidence of genetic predisposition to breast cancer as strategies for risk reduction may impact on their fertility choices. Finally, as survival of women with metastatic breast cancer increases, women with advanced cancer who become pregnant pose unique management challenges for oncologists and obstetricians alike.
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Affiliation(s)
- Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park SA 5042, Australia.
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Traitements des problèmes sexuels après un cancer : intégration des approches médicales et psychologiques. PSYCHO-ONCOLOGIE 2007. [DOI: 10.1007/s11839-007-0047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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