Sexual well-being among partnered women with breast cancer recurrence

Population-level impact of adjuvant trastuzumab emtansine on the incidence of metastatic breast cancer: an epidemiological prediction model of women with HER2-positive early breast cancer and residual disease following neoadjuvant therapy

PURPOSE

Treating early-stage breast cancer (eBC) may delay or prevent subsequent metastatic breast cancer (mBC). In the phase 3 KATHERINE study, women with human epidermal growth factor receptor 2 (HER2)-positive eBC with residual disease following neoadjuvant therapy containing trastuzumab and a taxane experienced 50% reductions in disease recurrence or death when treated with adjuvant trastuzumab emtansine (T-DM1) vs adjuvant trastuzumab. We predicted the population-level impact of adjuvant T-DM1 on mBC occurrence in five European countries (EU5) and Canada from 2021-2030.

METHODS

An epidemiological prediction model using data from national cancer registries, observational studies, and clinical trials was developed. Assuming 80% population-level uptake of adjuvant treatment, KATHERINE data were extrapolated prospectively to model projections. Robustness was evaluated in alternative scenarios.

RESULTS

We projected an eligible population of 116,335 women in Canada and the EU5 who may be diagnosed with HER2-positive eBC and have residual disease following neoadjuvant therapy from 2021-2030. In EU5, the cumulative number of women projected to experience relapsed mBC over the 10-year study period was 36,009 vs 27,143 under adjuvant trastuzumab vs T-DM1, a difference of 8,866 women, equivalent to 25% fewer cases with the use of adjuvant T-DM1 in EU5 countries from 2021-2030. Findings were similar for Canada.

CONCLUSION

Our models predicted greater reductions in the occurrence of relapsed mBC with adjuvant T-DM1 vs trastuzumab in the indicated populations in EU5 and Canada. Introduction of T-DM1 has the potential to reduce population-level disease burden of HER2-positive mBC in the geographies studied.

Coping With Changes to Sex and Intimacy After a Diagnosis of Metastatic Breast Cancer: Results From a Qualitative Investigation With Patients and Partners

Objective

Prior research examining sexual and intimacy concerns among metastatic breast cancer (MBC) patients and their intimate partners is limited. In this qualitative study, we explored MBC patients' and partners' experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.

Methods

We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.

Results

Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: (1) the heavy disease/treatment burden leads to significant, long-term sexual concerns (e.g., loss of interest and vaginal dryness/discomfort) and consequent heightened emotional distress for both patients (e.g., guilt around not being able to engage in intercourse) and partners (e.g., guilt around pressuring the patient to engage in sexual activity despite pain/discomfort); (2) viewing the relationship as having "an expiration date" (due to expected earlier mortality) influences patients' and partners' concerns related to sex/intimacy and complicates coping efforts; and (3) information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.

Conclusion

Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients' and partners' perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients' health and quality of life.

Understanding Sexual Help-Seeking for Women With Breast Cancer: What Distinguishes Women Who Seek Help From Those Who Do Not?

BACKGROUND

Sexual problems are extremely common for women after breast cancer (BC).

AIM

To determine, in a sample of BC outpatients, how commonly women sought help for sexual concerns, from a health care provider (HCP), from other individuals, or from alternate sources; and to examine whether help-seeking was associated with women's sexual function/activity, self-efficacy for clinical communication about sexual health, or sociodemographic/medical characteristics.

METHODS

BC patients participating in a sexual/menopausal health communication intervention trial completed web-based baseline self-report surveys. One-way analysis of variances compared effects of the level of sexual help-seeking (none; 1 outlet; 2-3 outlets) on sexual function domains. Chi-square or t-tests compared women seeking help with those not seeking help on other study variables.

MAIN OUTCOME MEASURES

Patient-reported outcome instruments assessed sexual help-seeking (past month), sexual function and activity (PROMIS Sexual Function and Satisfaction Brief Profile Version 2.0), and self-efficacy (confidence) for communicating with their BC clinician about sexual health.

RESULTS

144 women (mean age = 56.0 years; 62% partnered; 67% white; 27% black/African American; 4% Hispanic/Latina; 15% stage IV) participated in this study. 49% of women sought help for sexual concerns, most often from intimate partners, family and/or friends (42%), followed by HCPs (24%), or online/print materials (19%); very few women (n = 4; 3%) sought help only from a HCP. Women seeking help were younger and more likely to be partnered and sexually active than those not seeking help. Sexual function was impaired for all domains but was most impaired for sexual interest. Among sexually active women, those seeking help from 2 to 3 sources reported worse sexual function in certain domains (sexual interest, lubrication, vaginal discomfort, vulvar discomfort-labial, satisfaction). Women seeking help from outlets other than HCPs had significantly lower self-efficacy than those who did not.

CLINICAL IMPLICATIONS

BC patients with access to a partner and who are sexually active but find sex unsatisfying, uncomfortable, or lack interest may be in particular need of sexual help. Further, women may turn to outlets other than HCPs for sexual help partly because they lack the confidence to do so with a HCP. Sexual health information should be made available to women's partners, family, and friends, so they may effectively discuss such issues if needed.

STRENGTHS & LIMITATIONS

Strengths of the study included examination of a range of sexual function domains and a theoretical construct in relation to BC patients' sexual help-seeking and a medically diverse sample. Limitations include a cross-sectional design.

CONCLUSION

Women treated for BC should receive accurate and timely sexual health information. Reese JB, Sorice KA, Pollard W, et al. Understanding Sexual Help-Seeking for Women With Breast Cancer: What Distinguishes Women Who Seek Help From Those Who Do Not? J Sex Med 2020;17:1729-1739.

The Impact of Delaying Breast Reconstruction on Patient Expectations and Health-Related Quality of Life: An Analysis Using the BREAST-Q

PURPOSE

An understanding of patient expectations predicts better health outcomes following breast reconstruction. No study to date has examined how patient expectations for breast reconstruction and preoperative health-related quality of life vary with time since breast cancer diagnosis.

METHODS

Women consulting for breast reconstruction to a single surgeon's practice over a 13-month period were enrolled in this cross-sectional study. Patients were asked to prospectively complete the BREAST-Q expectations and preoperative reconstruction modules. A retrospective chart review was then performed on eligible patients, and patient demographics, cancer-related factors, and comorbidities were collected. BREAST-Q scores were transformed using the equivalent Rasch method. Multivariate linear regression models were constructed to assess the association between BREAST-Q scores and time since cancer diagnosis.

RESULTS

Sixty-five patients met inclusion criteria for analysis and are characterized by a mean age of 53 ± 11 (34-79) years and a mean body mass index of 28 ± 6 (19-49). Most patients were treated by mastectomy (58%) or lumpectomy (23%). At the time of retrospective chart review, 29 (43%) patients had undergone reconstruction, most of which were delayed (59%). The mean latency from cancer diagnosis to reconstruction was 685 ± 867 days (range: 28-3322 days). Latency from cancer diagnosis to reconstruction was associated with a greater expectation of pain (β = 0.5; standard error [SE] = 0.005; 95% confidence interval [CI]: 0.003-0.027; P < .05), and a slower expectation for recovery (β = -0.5; SE = 0.004; 95% CI: -0.021 to -0.001; P < .05) after breast reconstruction. Latency from cancer diagnosis to reconstruction was associated with an increase in preoperative psychosocial well-being (β = 0.578; SE 0.009; 95% CI: 0.002-0.046; P < .05).

CONCLUSION

Delaying breast reconstruction may negatively impact patient expectations of postoperative pain and recovery. Educational interventions aimed at understanding and managing patient expectations in the preoperative period may improve health-related quality of life and patient-related outcomes following initial breast cancer surgery.

Patient-clinician communication about sexual health in breast cancer: A mixed-methods analysis of clinic dialogue

OBJECTIVES

Breast cancer patients' sexual health needs are frequently unmet. We examined the prevalence and content of communication about sexual health between breast cancer patients and clinicians.

METHODS

Female breast cancer patients being seen in oncology clinic follow-up had a clinic visit audio recorded and self-reported sexual problems after the visit. Transcripts were coded for sexual health communication; data were analyzed descriptively or using Chi-square tests.

RESULTS

We recorded 67 patients (81% participation rate) interacting with one of 7 cancer clinicians (5 physicians; 2 advanced practice clinicians). Approximately 1/3 of women (n = 22) reported sexual problems; sexual health communication occurred with 10/22 of those women (45%). Across all 67 patients, 27 (40%) visits contained communication about sexual health. Seventy-percent of sexual health communication was clinician-initiated. When in-depth sexual health discussions occurred, the most common topics discussed were sexual inactivity (6), body image (5), vaginal dryness (4), and safety of sexual activity (2).

CONCLUSION

Communication about sexual health was uncommon even for women reporting sexual problems and was largely initiated by clinicians.

PRACTICE IMPLICATIONS

Because women with breast cancer often do not raise sexual concerns during clinic visits, breast cancer clinicians should raise the topic of sexual health for all patients.

Cancer in Europe: Death sentence or life sentence?

With so many adults and children receiving successful treatment for their cancer, survivorship is now a 'new' and critical issue. It is increasingly recognised that the growing numbers of survivors face new challenges in their bid to return to 'normal' life. What is not yet so widely recognised is the need for a broad response to help them cope-with stigmatisation, misunderstanding, lifelong issues of confidence and social adaptation, and even access to employment and to financial services. As a further stage in its programme of attention to this aspect of cancer, the European Organisation for Research and Treatment of Cancer (EORTC) brought survivors, researchers, carers, authorities and policymakers together at a meeting in Brussels in March/April 2016, to learn at first hand about the posttreatment experience of cancer survivors. The meeting demonstrated that while research is well advanced in many of the medical consequences of survivorship, understanding is still lacking of many non-clinical, personal and administrative issues. The meeting raised the discussion of survivorship research beyond the individual to a population-based approach, exploring the related socioeconomic issues. Its exploration of initiatives across Europe countries provoked new thinking on the need for effective collaboration, with a new focus on non-clinical issues, including effective dialogue with financial service providers and employers, improvements in collecting, exchanging and accessing data, and above all, ways of translating research outcomes into action. This will require wider recognition that, as Françoise Meunier, Director Special Projects, EORTC, said, 'It is time for a new mind set'.

Importance of sexuality in colorectal cancer: predictors, changes, and response to an intimacy enhancement intervention

PURPOSE

The primary objectives were (1) to examine the importance of sexuality within the self-view and cross-sectional correlates for 120 colorectal cancer patients and (2) to determine whether the importance of sexuality changed for 46 colorectal cancer patients and partners participating in an intimacy enhancement intervention.

METHODS

Two newly developed items assessed importance of sexuality within the self-view (1) currently and (2) before cancer; a calculated change score assessed perceived change. In the cross-sectional sample, associations between importance of sexuality and demographic and medical factors and sexual function status were examined. Intervention participants' importance ratings before and after participation were used to calculate effect sizes.

RESULTS

For patients, importance of sexuality before cancer was greater (M = 65.7) than current importance (M = 56.8, p = .001). Greater current importance of sexuality was associated with partnered status, non-metastatic disease, and not being in treatment. Scoring in the sexually functional range was associated with greater current importance of sexuality for men and a smaller perceived change in importance for both men and women (p values <.05). Sexual function status also significantly predicted current importance independent of covariates. Small to medium effect sizes for intervention patients (.37) and partners (.60) were found for increases in importance of sexuality. Items showed evidence of test-retest reliability and construct validity.

CONCLUSIONS

Coping with sexual concerns is important to those affected by colorectal cancer. Findings suggest that the importance of sexuality can decrease through colorectal cancer and associated sexual problems and can increase through participating in an intimacy-focused intervention.

Symptoms: Menopause, Infertility, and Sexual Health

By 2022, the number of survivors is expected to grow to nearly 18 million. Therefore, addressing acute and chronic negative sequelae of a cancer diagnosis and its treatments becomes a health imperative. For women with a history of breast cancer, one of the common goals of treatment and prevention of recurrence is to reduce circulating concentrations of estradiol, especially in women with hormone receptor positive breast cancer. Hormone deprivation after a diagnosis of breast cancer impacts physiological targets other than in the breast tissue and can result in unwanted side effects, all of which can negatively impact quality of life and function and cause distress. Symptoms that are most strongly linked by evidence to hormone changes after cancer diagnosis and treatment include hot flashes, night sweats, sleep changes, fatigue, mood changes, and diminishing sexual function, including vaginal atrophy (decreased arousal, dryness and dyspareunia), infertility, decreased desire and negative self-image. Weight gain and resulting body image changes are often concomitants of the abrupt onset of treatment-induced menopause. The purpose of this chapter is to briefly review what is known about the advent of premature menopause in women treated for breast cancer, menopausal symptoms that are exacerbated by endocrine treatments for breast cancer, and the associated concerns of hot flashes and related menopausal symptoms, sexual health and fertility issues. We will discuss limitations in the current research and propose strategies that address current limitations in order to move the science forward.

Sexualidade e câncer de mama: uma revisão sistemática da literatura

O objetivo deste estudo foi compreender como o câncer de mama e seus tratamentos afetam a vivência da sexualidade da mulher acometida. Foi realizada uma revisão sistemática qualitativa de artigos científicos, publicados entre 2000 e 2010, disponíveis nas bases de dados PubMed, Web of Science, LILACS e SciELO. Foram obtidos 50 artigos cujos textos foram categorizados segundo análise de conteúdo temática. Foram identificadas seis categorias temáticas: a cirurgia mamária e os demais tratamentos para o câncer de mama; a experiência da mulher acometida; o relacionamento afetivo-sexual; estudos sobre relação entre sexualidade e características específicas do câncer; os profissionais de saúde e a atenção à sexualidade; e propostas para amenizar as consequências negativas dos tratamentos na sexualidade. Há necessidade de novos estudos a respeito dos aspectos culturais da sexualidade, diversidade sexual, relacionamento com o parceiro, formação do profissional de saúde e intervenções em sexualidade no contexto do câncer de mama.

The experience of living with metastatic breast cancer--a review of the literature

Women's experiences with metastatic breast cancer have received little research attention. We reviewed published articles (1984-2013) reporting research examining women's experiences of metastatic breast cancer (n = 33). Findings from quantitative studies were categorized into three broad areas: adverse consequences, satisfaction with health care providers, and strategies for living. Themes identified from qualitative findings include living as a social outsider; importance of hope; health and quality of life; positive experiences; experiences at end of life; and strategies for living. More research is needed to explore experiences of subgroups to appropriately respond to women's diverse care needs.

Partner relationships after mastectomy in women not offered breast reconstruction

BACKGROUND

The present study assessed the degree to which undergoing a mastectomy without reconstructive surgery negatively impacts the patient's psychological state. We focus on body image and self-esteem as well as the influence of mastectomy on patient sex lives and partnership relations.

METHODS

The participants were 60 women, either married or in a relationship, who had had a mastectomy because of breast cancer and no subsequent reconstructive surgery. A marital happiness questionnaire was used to evaluate the research problem.

RESULTS

Surgery negatively impacted partnership relations for 33% of participants. In particular, 31% reported deterioration in attractiveness; 31%, a feeling of malaise; and 30%, that their partners perceived them as less attractive. Moreover, 80% in the youngest group reported that they covered their body during intimate contact, whereas 58% in the oldest age group reported the same behaviour. Deterioration in satisfaction with sex life and in the pleasure of sexual intercourse was indicated by 71% and 77%, respectively. Correspondingly, 71% also noticed a decrease in sexual activity, with 76% of participants aged 50-65 years reporting such a decline. The oldest women were also less satisfied with their sexual intercourse.

CONCLUSIONS

Breast excision due to cancer negatively impacted the quality of sexual life for 71% of participants. Partnership relations after surgery remained unchanged for 67% of them. There was significant impact of surgery on the perception of one's own body.

Quality of life and sexual functioning in young women with early-stage breast cancer 1 year after lumpectomy

BACKGROUND

The breast cancer (BC) and its treatment (mastectomy, radiotherapy, and chemotherapy) have considerable psychosexual impacts on women's life. This study evaluated sexual functioning, quality of life, and self-esteem in young women with early-stage BC.

METHODS

A total of 186 women with stage I or II BC and 204 age-matched controls aged 25-45 years were recruited. To be eligible, patients had to be disease-free and sexually active. They also had to have undergone lumpectomy at least 1 year previously and have completed chemotherapy and/or radiotherapy. Subjects completed Female Sexual Function Index, Short Form-36 Health Survey, and Rosenberg Self-Esteem questionnaire. Serum sex hormones were also measured in all subjects.

RESULTS

Of BC patients, 57% experienced lubrication disorder followed by satisfaction disorder in 53.8%, desire disorder in 42.5%, and arousal disorder in 37.0% (all patients vs. healthy controls <0.01). Hormone-treated patients were more likely to report sexual dysfunctions (p = 0.006). The radiotherapy + chemotherapy + hormone therapy was associated with an about sixfold increased risk of lubrication and satisfaction disorders (adjusted odds ratios = 6.4, 95%CI = 4.6-12.6, and adjusted odds ratios = 5.7, 95%CI = 3.4-11.4, respectively). Cancer patients had lower scores for all components of the Short Form-36 Health Survey, except for pain. Levels of self-esteem did not differ significantly between the two groups.

CONCLUSIONS

Young lumpectomized BC women reported a marked impairment in sexual functioning and quality of life.

Gynecologic care for breast cancer survivors: assisting in the transition to wellness

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.

Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function

Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.

Perceived partner support and psychosexual adjustment to breast cancer

Support from a partner can play a key role in a woman's emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a woman's sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partner's provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.

A multilevel investigation of inequalities in clinical and psychosocial outcomes for women after breast cancer

Background

In Australia, breast cancer is the most common cancer affecting Australian women. Inequalities in clinical and psychosocial outcomes have existed for some time, affecting particularly women from rural areas and from areas of disadvantage. We have a limited understanding of how individual and area-level factors are related to each other, and their associations with survival and other clinical and psychosocial outcomes.

Methods/Design

This study will examine associations between breast cancer recurrence, survival and psychosocial outcomes (e.g. distress, unmet supportive care needs, quality of life). The study will use an innovative multilevel approach using area-level factors simultaneously with detailed individual-level factors to assess the relative importance of remoteness, socioeconomic and demographic factors, diagnostic and treatment pathways and processes, and supportive care utilization to clinical and psychosocial outcomes. The study will use telephone and self-administered questionnaires to collect individual-level data from approximately 3, 300 women ascertained from the Queensland Cancer Registry diagnosed with invasive breast cancer residing in 478 Statistical Local Areas Queensland in 2011 and 2012. Area-level data will be sourced from the Australian Bureau of Statistics census data. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to diagnostic and treatment centres. Data analysis will include a combination of standard empirical procedures and multilevel modelling.

Discussion

The study will address the critical question of: what are the individual- or area-level factors associated with inequalities in outcomes from breast cancer? The findings will provide health care providers and policy makers with targeted information to improve the management of women with breast cancer, and inform the development of strategies to improve psychosocial care for women with breast cancer.

Auswirkungen einer psychoonkologischen Intervention für Paare auf die Sexualität bei einer Brustkrebserkrankung der Frau

Zusammenfassung. Die psychosozialen Auswirkungen einer Brustkrebsdiagnose und -behandlung auf die betroffenen Frauen und auch ihre Partner beinhalten neben emotionalen Schwierigkeiten auch sexuelle und partnerschaftliche Probleme. Diese randomisiert-kontrollierte Studie untersucht die Wirksamkeit einer kurzen partnerschaftlichen Intervention (Seite an Seite) bei Paaren, bei denen die Frau an Brustkrebs erkrankt ist, auf die sexuelle Funktionsfähigkeit des Paares über einen Zeitraum von 1.5 Jahren nach Diagnosestellung. Sexualität wird dabei auf mehreren Ebenen erfasst: Sexuelle Gedanken, sexuelle Erregung, sexuelle Erfahrung, Orgasmus und sexuelles Verlangen. An der Studie nahmen 72 Paare teil, von denen 38 ein partnerschaftliches Unterstützungstraining erhielten und 34 die Kontrollgruppe bildeten. Die Ergebnisse zeigen, dass Männer in den Bereichen sexuelle Erregung (signifikante Zunahme der Häufigkeit des Erlebens sexueller Erregung) und sexuelles Verlangen (stärkeres Interesse an Sexualität sowie höhere Zufriedenheit mit der Beziehung zur Partnerin und der eigenen sexuellen Funktionsfähigkeit) von der Intervention profitieren. In Bezug auf sexuelle Erfahrungen zeigte die Intervention sowohl bei den Patientinnen als auch bei ihren Partnern eine signifikante Zunahme der Häufigkeit sexueller Aktivitäten, die auch nach 6 Monaten noch stabil blieb. Trotz andauernder medizinischer Behandlung (Chemo-, Strahlen- bzw. Hormontherapie) findet sich eine Zunahme sexueller Aktivitäten bei Paaren in der Seite an Seite Intervention. Obwohl die sexuelle Funktionsfähigkeit ein wichtiger Aspekt der Lebensqualität ist, erhält das Thema Sexualität im klinischen Kontext nur wenig Aufmerksamkeit. Die Ergebnisse zeigen jedoch, dass der offene und routinemäßige Umgang mit dem Thema Sexualität ein wichtiger Aspekt psychoonkologischer Angebote sein sollte.

Assessing gynecologic and breast cancer survivors' sexual health care needs

BACKGROUND

The objective of this study was to identify patterns of interest in receiving care for sexual concerns among women who were survivors of gynecologic and breast cancers.

METHODS

Survey and medical records data were collected from June 2008 to March 2009 from 261 gynecologic and breast cancer patients. Logistic regression was used to estimate the effect of age and months since treatment on interest in receiving sexual healthcare.

RESULTS

The mean participant age was 55 years (range, 21-88 years). Only 7% of women had recently sought medical help for sexual issues, yet 41.6% were interested in receiving care. Greater than 30% responded that they would be likely to see a physician to address sexual matters, and 35% of all women were willing to be contacted if a formal program was offered. Compared with older women (aged >65 years), younger women (ages 18-47 years) were significantly more likely to report interest in receiving care to address sexual issues (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.14-7.54) and to see a physician to address sexual matters (OR, 4.51; 95% CI, 1.51-13.43), and they were more willing to be contacted for a formal program (adjusted OR [AOR], 5.00; 95% CI, 1.63-15.28). Compared with women who were currently in treatment, women who last received treatment >12 months previously were significantly more interested in receiving care (AOR, 2.02; 95% CI, 1.02-4.01) and were more willing to be contacted (AOR, 2.49; 95% CI, 1.18-5.26).

CONCLUSIONS

Greater than 40% of survivors expressed interest in receiving sexual healthcare, but few had ever sought such care. The current results indicated that there is an unmet need for attention to sexual concerns among women with gynecologic and breast cancers.

Sexual concerns in cancer patients: a comparison of GI and breast cancer patients

PURPOSE

Although sexual concerns have been examined in breast cancer (BC), these concerns remain understudied and undertreated for patients with gastrointestinal (GI) cancer. Objectives were to: (1) assess sexual concerns in GI cancer patients compared with breast cancer patients; (2) examine whether sexual concerns are stable over time in GI and breast cancer patients; and (3) evaluate whether sexual concerns in GI and breast cancer are significantly associated with quality of life, symptom severity, and disease interference, and whether these associations change over time.

METHODS

Data were collected from GI and breast cancer patients during four outpatient clinic visits over 6 months. Measures included sexual concerns (reduced sexual enjoyment, interest, or performance), quality of life (FACT-G), symptom severity, disease interference (MD Anderson Symptom Inventory), and disease-related distress (NCCN Distress Scale). Linear mixed model analyses were conducted.

RESULTS

Sexual concerns were common in both samples, with 57% of GI cancer patients and 53% of breast cancer patients reporting at least mild sexual concerns. Sexual concerns were stable over time and were significantly associated with lower levels of functioning in multiple domains (e.g., quality of life, symptom severity, disease interference, and disease-related distress), irrespective of length of time since diagnosis. Cancer type (GI/breast cancer) was not a moderator of this relationship.

CONCLUSIONS

Self-reported sexual concerns were common, stable, and related significantly to quality of life, symptom severity, disease interference, and disease-related distress for both GI and breast cancer patients. Limitations and implications for future research are discussed.

Coping with sexual concerns after cancer: the use of flexible coping

INTRODUCTION

Although cancer treatment commonly has a negative impact on sexual functioning, sexual concerns are still largely undertreated in routine cancer care. The medical model that guides current approaches to sexual care in cancer does not adequately address key patient needs.

METHODS

In this paper, we describe a broader approach to understanding and treating sexual concerns in cancer that focuses on the construct of flexibility in behavioral and cognitive coping strategies. We previously presented this model in the context of general medical conditions. We now adapt this model to the context of cancer, focusing on issues related to the benefits of flexible coping, interventions that shift perspectives following cancer, and on coping as a couple.

RESULTS

We argue that coping flexibly with sexual concerns is likely to lead to improvements in mood and sexual and relationship satisfaction. We present clinical applications of the flexible coping model, including suggestions for assessment and sexual concerns and methods of introducing flexible coping into both the content and process of clinical interactions with patients.

DISCUSSION

Finally, we discuss areas for future research, including the development of a validated instrument, the use of electronic methods of assessment, and intervention trials directly addressing flexibility in coping.

Urogenital atrophy in breast cancer survivors

PURPOSE/OBJECTIVES

To review the symptoms of urogenital atrophy in breast cancer survivors, influencing factors, and their effects on performance.

DATA SOURCES

Review of qualitative and quantitative research data that describe pain, function, satisfaction, and quality of life related to urologic, genital, and sexual function.

DATA SYNTHESIS

Breast cancer treatment can induce or exacerbate symptoms related to urogenital atrophy. The lower urinary and genital tracts are affected by physiologic alterations, the potential abrupt onset of menopause, and treatment side effects. Symptoms of urogenital atrophy often are more prevalent and severe in women treated for breast cancer than in age-matched women without breast cancer.

CONCLUSIONS

Symptoms related to urogenital atrophy are common in breast cancer survivors and can be affected by physiologic, situational, and psychological influences with negative effects on performance. Research is essential to the understanding of how transient or permanent hormonal alterations affect the urogenital system and the role of these symptoms on quality of life.

IMPLICATIONS FOR NURSING

Nurses must listen with sensitivity to breast cancer survivors and their descriptions of these significant and life-altering symptoms. Personalized discussion enables the nurse to explore issues, assess symptoms, recommend interventions, and evaluate at follow-up visits. Nurses are integral to the provision of survivorship care planning that can address the short- and long-term effects of a cancer diagnosis and related treatments.

Mastectomy, body deconstruction, and impact on identity: a qualitative study

OBJECTIVES

This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer.

DESIGN

Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen.

METHOD

Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article.

RESULTS

Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis.

CONCLUSION

With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Breast cancer in young women and its impact on reproductive function

BACKGROUND

Breast cancer is the most common cancer in women in developed countries, and 12% of breast cancer occurs in women 20-34 years. Survival from breast cancer has significantly improved, and the potential late effects of treatment and the impact on quality of life have become increasingly important. Young women constitute a minority of breast cancer patients, but commonly have distinct concerns and issues compared with older women, including queries regarding fertility, contraception and pregnancy. Further, they are more likely than older women to have questions regarding potential side effects of therapy and risk of relapse or a new primary. In addition, many will have symptoms associated with treatment and they present a management challenge. Reproductive medicine specialists and gynaecologists commonly see these women either shortly after initial diagnosis or following adjuvant therapy and should be aware of current management of breast cancer, the options for women at increased genetic risk, the prognosis of patients with early stage breast cancer and how adjuvant systemic treatments may impact reproductive function.

METHODS

No systematic literature search was done. The review focuses on the current management of breast cancer in young women and the impact of treatment on reproductive function and subsequent management. With reference to key studies and meta-analyses, we highlight controversies and current unanswered questions regarding patient management.

RESULTS

Chemotherapy for breast cancer is likely to negatively impact on reproductive function. A number of interventions are available which may increase the likelihood of future successful pregnancy, but the relative safety of these interventions is not well established. For those who do conceive following breast cancer, there is no good evidence that pregnancy is detrimental to survival. We review current treatment; effects on reproductive function; preservation of fertility; contraception; pregnancy; breastfeeding and management of menopausal symptoms following breast cancer.

CONCLUSION

This paper provides an update on the management of breast cancer in young women and is targeted at reproductive medicine specialists and gynaecologists.

In sickness and in health: maintaining intimacy after breast cancer recurrence

Sexual well-being after breast cancer recurrence has received little clinical attention. In discussing the sexual difficulties after recurrence we draw upon our longitudinal studies of newly diagnosed patients. It is noted that sexuality declines after a patient's initial diagnosis and treatment, with further decline after recurrence. However, data suggest that couples strive to maintain intimacy as the health of the patient falters, providing further evidence of the resilience of patients coping with a worsened prognosis.

Talking Cancer, Saving Lives: Breast Cancer Awareness Training for Health Professionals in Hong Kong

A two-day training program aimed at promoting breast cancer awareness and utilization of breast cancer screening in Hong Kong was presented to a group of breast cancer survivors and mid-level health and social services professionals ( n = 75). Using a training of trainer model, six modules were presented covering biological, psycho-social, sexual, and quality of life issues relating to breast cancer. Self-administered pre-test, post-test, and follow-up measures were used to determine participants' knowledge about breast cancer related issues and their self-perceived competence to discuss these issues professionally. The participant demographic profile was primarily female, mostly married with mean age of 38. Most of the participants attributed the causes of breast cancer to genetic, lifestyle risk, and environmental risk factors (over 60%). Their attitude, on average, was most positive regarding the difference between a support group and psychoeducational support group ( M > 8 on a 0–10 scale). Their knowledge, on average, was lowest regarding familiarity with the types and uses of alternative medicine in Hong Kong ( M < 5 on a 0–10 scale). Paired t-tests comparing pre-test to the first post-test indicated a statistically significant increase in composite scores of competence, cause recognition, and suggested frequency of breast self-exam. This training proved to be a culturally competent approach that facilitates health care providers' service provision to breast cancer survivors in Hong Kong.

Premature ovarian failure and its consequences: vasomotor symptoms, sexuality, and fertility

Premature ovarian failure is a common consequence of systemic treatment for premenopausal breast cancer. Vasomotor symptoms and sexual dysfunction occur frequently in women who have an abrupt menopause from chemotherapy or ovarian suppression. However, current fertility may be impaired even in women who are menstruating after chemotherapy, and survivors are at high risk for permanent ovarian failure at a young age. Hot flashes can be managed with venlaxafine, gabapentin, or-potentially-stress management. Providing advice on treating vaginal dryness and brief sexual counseling can often alleviate sexual dysfunction. Options for fertility preservation remain limited but are improving rapidly. Distress about interrupted childbearing has a long-term impact on the quality of life.