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Paschou SA, Athanasiadou KI, Hafford-Letchfield T, Hinchliff S, Mauskar M, Rees M, Simon JA, Armeni E, Erel CT, Fistonic I, Hillard T, Hirschberg AL, Meczekalski B, Mendoza N, Mueck AO, Simoncini T, Stute P, van Dijken D, Lambrinoudaki I. Sexual health and wellbeing and the menopause: An EMAS clinical guide. Maturitas 2024; 189:108055. [PMID: 39226624 DOI: 10.1016/j.maturitas.2024.108055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care. AIM To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond. MATERIALS AND METHODS Review of the literature and consensus of expert opinion. RESULTS AND CONCLUSION The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.
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Affiliation(s)
- Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Kleoniki I Athanasiadou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Sharron Hinchliff
- School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
| | - Melissa Mauskar
- Department of Dermatology and Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - James A Simon
- Department of Obstetrics & Gynecology, George Washington University, IntimMedicine Specialists, Washington, DC, USA
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece; Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - C Tamer Erel
- Istanbul-Cerrahpaşa University, Cerrahpaşa School of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ivan Fistonic
- Faculty for Health Studies, University of Rijeka, Rijeka, Croatia
| | - Timothy Hillard
- Department of Obstetrics and Gynaecology, University Hospitals Dorset, Poole, UK
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Nicolás Mendoza
- Department of Obstetrics and Gynecology, University of Granada, Spain
| | - Alfred O Mueck
- Department of Women's Health, University Hospital Tuebingen, Germany
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital, Bern, Switzerland
| | - Dorenda van Dijken
- Department of Obstetrics and Gynecology, OLVG Hospital, Amsterdam, the Netherlands
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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Marzorati C, Masiero M, Pravettoni G. "Perspective: An integrated vision of the quality of life in breast cancer survivorship trajectory". Breast 2024; 77:103785. [PMID: 39208546 PMCID: PMC11401158 DOI: 10.1016/j.breast.2024.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Dominici LS, Laws A, Lagendijk M, Grossmith S, Hughes M, Lin N, Mittendorf EA, King TA. Patient-Reported Outcomes 10 Years After Breast-Conserving Surgery for Early-Stage Breast Cancer. Ann Surg Oncol 2024; 31:6831-6840. [PMID: 39048900 PMCID: PMC11416309 DOI: 10.1245/s10434-024-15876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are a critical component of value-based care. Limited data exist describing long-term PROs in patients undergoing breast-conserving surgery (BCS). PATIENTS AND METHODS Patients undergoing surgery for stage 0-III breast cancer at our institution from 2002 to 2012 who agreed to be contacted were invited to participate in a cross-sectional PRO study. Health-related quality of life outcomes using BREAST-Q, EORTC QLQ-C30, and EORTC QLQ-BR45 were collected. Patients reporting chemotherapy within 6 months of receiving the survey were excluded. For this work, we focused on patients who underwent BCS. Multivariable linear regression was performed to identify factors associated with PRO scores, adjusting for age, time since surgery, anatomic stage, molecular subtype, receipt of systemic and/or radiation therapy (RT), locoregional recurrence, or contralateral breast cancer. RESULTS Among 562 interested and eligible patients, 437 (78%) responded; median time from surgery to survey completion was 10.4 years (interquartile range: 8.0-13.5). Median age at surgery was 53 years (standard deviation 9.8 years), ≥ 90% were white, had upfront surgery for early-stage disease, and completed adjuvant RT. Physical and psychological well-being scores were generally high, with more variation seen for sexual well-being and satisfaction with breasts. CONCLUSION This study provides long-term PRO data for patients treated with BCS, demonstrating the ongoing association of breast cancer surgery with quality of life in the survivorship period and highlighting the importance of examining PROs beyond the perioperative period. These data also provide important reference values for the interpretation of PROs among women treated with BCS as we move towards value-based care.
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Affiliation(s)
- Laura S Dominici
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alison Laws
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Mirelle Lagendijk
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Samantha Grossmith
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Melissa Hughes
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Nancy Lin
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Ali M, Fraker J, Sobel T, Vegunta S. Beyond the discomfort: understanding and managing sexual pain in women, a comprehensive case-based discussion. Sex Med Rev 2024; 12:551-558. [PMID: 38850562 DOI: 10.1093/sxmrev/qeae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/25/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Sexual pain has a profound impact on individuals, regardless of their sexual orientation or gender identity, and affects women more often than men. It adversely affects both sexual function and interpersonal relationships. Despite its prevalence, sexual pain in women often remains unaddressed and untreated. Various underlying causes contribute to sexual pain, sometimes involving multiple factors. We explore treatment options and offer clinical insights into the evaluation and management of 4 common conditions which cause sexual pain in women. In this article, we use the term "women" to indicate cisgender women. OBJECTIVES Our aim is to highlight the most common clinical scenarios of sexual pain and provide comprehensive discussions on each, to improve patient care and outcomes in the management of sexual pain. METHODS We conducted a comprehensive review of literature and clinical cases to explore the various causes and management strategies for sexual pain in women. We systematically searched databases such as PubMed, Google Scholar, and relevant medical journals. We included peer-reviewed articles, case studies, and clinical trials published between 2000 and 2023. Additionally, we analyzed real-life cases from our clinical practice at our academic institution. RESULTS Our review identified various factors contributing to sexual pain in women, ranging from hormonal imbalances to neuroproliferative and inflammatory conditions affecting the genitourinary system. Each case should be approached individually to offer optimal management strategies accordingly. CONCLUSION The management of sexual pain in women requires a comprehensive approach that addresses the multifactorial nature of the condition. Patient education and counseling play a crucial role in the management of sexual pain, empowering individuals to advocate for their own health and well-being. The collaboration between healthcare providers and patients can improve our understanding and management of this complex condition.
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Affiliation(s)
- Muna Ali
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
| | - Jessica Fraker
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
| | - Talia Sobel
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85260, United States
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Kim M, Ali B, Graziano FD, Colvin K, Boe LA, Allen RJ, Nelson JA, Disa J. Analyzing mastectomy and reconstruction weight in immediate autologous breast reconstruction: A preliminary study. J Surg Oncol 2024; 129:1466-1474. [PMID: 38637992 DOI: 10.1002/jso.27647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This study aims to explore the ideal breast size by assessing the relationship between mastectomy to free flap weight ratio and complications as well as patient-reported outcomes in autologous breast reconstruction (ABR). METHOD A retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights. The patients were grouped as "maintained" if the flap weight was within 10% of the mastectomy weight. Patients with a weight difference greater than 10% were used to declare "downsized" or "upsized." Outcomes included complications and four domains of the BREAST-Q at 1-year postoperatively. RESULTS Three hundred and fifty-nine patients were included in the analysis, of which 112 were downsized, 91 maintained, and 156 upsized, respectively. Presence of complications did not significantly differ among the groups. At 1-year postoperatively, Sexual Well-being significantly differed (p = 0.033). Between preoperative and 1 year, patients who upsized experienced an improvement in Satisfaction with Breasts by 16 points (p < 0.001), while patients who downsized experienced a decline in Physical Well-being of the Chest by 7 points (p = 0.016). Multivariable linear regression model showed that Sexual Well-being was 13 points lower in the downsized cohort than in the maintained cohort (β = -13, 95% confidence interval: -21 to -5.4; p = 0.001). CONCLUSION Although complication rates do not significantly differ between the three cohorts, patients who downsize may have lower Sexual Well-being postoperatively. Surgeons should consider our preliminary findings to counsel patients preoperatively about the predicted breast size and the impact of downsizing on sexual health.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barkat Ali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis D Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kate Colvin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lillian A Boe
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Kim M, Carter J, Tadros AB, Abuhdra N, Nelson JA, Stern CS. A guide for addressing sexual health in breast cancer patients. J Surg Oncol 2024; 129:1034-1040. [PMID: 38385690 DOI: 10.1002/jso.27602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Sexual health concerns are common in breast cancer surgery but often overlooked. Yet, breast cancer patients want more sexual health information from their providers. We aimed to share ways for providers to address sexual health concerns with their breast cancer patients at different stages of the treatment process. METHODS Experts in breast cancer treatments, surgeries, and sexual health at Memorial Sloan Kettering Cancer Center assembled to review the literature and to develop the recommendations. RESULTS Providers should provide sexual health information for their breast cancer patients throughout the continuum of care. Conversations should be initiated by the providers and can be brief and informative. Whenever appropriate, patients should be referred to Sexual Medicine experts and/or psychosocial support. There are various recommendations and tools that can be utilized at diagnosis, endocrine and chemotherapy, and breast surgery to identify patients with sexual health concerns and to improve their sexual functioning. CONCLUSION In this paper, we sought to provide providers with some insights, suggestions, and tools to address sexual health concerns. We encourage healthcare providers to initiate the conversation throughout the continuum of care beginning as early as diagnosis and refer patients to additional services if available.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeanne Carter
- Gynecology Service, Department of Psychiatry, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nour Abuhdra
- Breast Oncology, Department of MedicineMemorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Abdel-Razeq H, Mansour A. Challenges and Opportunities in Breast Cancer Care in Low-Resourced Countries, Jordan as An Example. Cancers (Basel) 2024; 16:1751. [PMID: 38730701 PMCID: PMC11083275 DOI: 10.3390/cancers16091751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Jordan is a relatively small country with a rapidly growing population and a challenged economy. Breast cancer is the most diagnosed cancer among women worldwide and also in Jordan. Though the age-standardized rate (ASR) of breast cancer incidence is still lower than that in Western societies, the number of newly diagnosed cases continues to increase, involving younger women, and new cases are usually detected at more advanced stages. Improvements in breast cancer care across the health care continuum, including early detection, prevention, treatment, and survivorship and palliative care, have become very visible, but may not match the magnitude of the problem. More organized, goal-oriented work is urgently needed to downstage the disease and improve awareness of, access to, and participation in early detection programs. The cost of recently introduced anti-cancer therapies poses a great challenge, but the impact of these therapies on treatment outcomes, including overall survival, is becoming very noticeable. Though the concept of a multidisciplinary approach to breast cancer treatment is often used at most health care facilities, its implementation in real practice varies significantly. The availability of breast reconstruction procedures, survivorship programs, germline genetic testing, counselling, and palliative care is improving, but these are not widely practiced. In this manuscript, we review the status of breast cancer in Jordan and highlight some of the existing challenges and opportunities.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman 11941, Jordan;
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Buyuksimsek M, Gulmez A, Pirinci O, Tohumcuoglu M, Kidi MM. Are depression and poor sleep quality a major problem in Turkish Women receiving chemotherapy for breast cancer? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231377. [PMID: 38656011 DOI: 10.1590/1806-9282.20231377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate depression and sleep quality in Turkish women receiving neoadjuvant or adjuvant chemotherapy for breast cancer and investigate their relationship. METHODS This cross-sectional, descriptive, and analytical study included 183 patients who received chemotherapy for non-metastatic breast cancer. Data were collected using the Beck Depression Inventory-II, the Pittsburgh Sleep Quality Index, and a disease-related/sociodemographic information form. RESULTS The mean age of the participants was 50.2 years, and 50.3% were in menopause. The mean Beck Depression Inventory-II score was 19.64±10.4. Mild depression was detected in 25.7% (n=47) of the women, and moderate or severe depression in 55.2% (n=101). The mean global score of sleep quality was found to be 8.28±2.62, and the majority of the participants (79.7%, n=146) had poor sleep quality. There was a positive correlation (p<0.001, r=0.43) between depression and sleep quality scores. While a negative correlation was found between depression scores and age (p<0.001, r=0.26), the surgical procedure performed did not significantly affect depression scores (p=0.705). Additionally, depression scores were positively correlated with sleep duration (p<0.001, r=0.42) and sleep latency (p=0.01, r=0.48). CONCLUSION Very high rates of depression and poor sleep quality were detected among Turkish women receiving neoadjuvant or adjuvant chemotherapy for breast cancer. The entire healthcare team involved in the treatment process should take this relationship into consideration and use the necessary preventive and therapeutic methods.
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Affiliation(s)
- Mahmut Buyuksimsek
- University of Health Sciences, Adana Health Practice and Research Center, Department of Medical Oncology - Adana, Turkey
| | - Ahmet Gulmez
- University of Health Sciences, Adana Health Practice and Research Center, Department of Medical Oncology - Adana, Turkey
| | - Okan Pirinci
- University of Health Sciences, Adana Health Practice and Research Center, Department of Internal Medicine - Adana, Turkey
| | - Mert Tohumcuoglu
- University of Health Sciences, Adana Health Practice and Research Center, Department of Medical Oncology - Adana, Turkey
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Almont T, Sougué PO, Houpert R, Beaubrun-Renard M, Montabord C, Joachim C, Véronique-Baudin J, Bouhnik AD, Bendiane MK, Mancini J, Huyghe É. Communication and sexual function and frequency in breast cancer patients 2 years after diagnosis: results from the VICAN 2 study. J Sex Med 2024; 21:333-341. [PMID: 38410031 DOI: 10.1093/jsxmed/qdae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 12/18/2023] [Accepted: 12/30/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Breast cancer treatments may have impacts on several aspects of sexual health, including psychological, psychosexual, physiological, physical, and relational. AIM In this study we sought to assess sexual function and sexual frequency in breast cancer patients 2 years after diagnosis. METHODS We selected all breast cancer participants from the the French national VIe après le CANcer 2 (VICAN 2) longitudinal study. Data sources included patient and medical questionnaires, along with medico-administrative databases. OUTCOMES Outcomes assessed were the dimensions of sexual function and frequency from the Relationship and Sexuality Scale and communication about sexuality with healthcare providers. RESULTS Out of 1350 participating women, 60.2% experienced a decrease in sexual desire, 61.4% reported a lower frequency of intercourse, and 49.5% faced decreased ability to orgasm. In contrast, 64.8% had engaged in sexual intercourse in the previous 2 weeks, 89.5% were "Somewhat" to "Very much" satisfied with the frequency of intimate touching and kisses with their partner, and 81.6% expressed satisfaction with their intercourse frequency. However, a mere 15% of women discussed sexuality with the healthcare providers. Independent factors associated with increased communication about sexuality included age younger than 50 years (OR = 1.90 95% CI [1.28-2.82], P = .001), being in a partner relationship (OR = 2.53 95% CI [1.28-2.82], P = .003), monthly income above 1,500 euros (OR = 1.73 95% CI [1.15-2.60], P = .009), and absence of diabetes (OR = 6.11 95% CI [1.39-26.93], P = .017). CLINICAL TRANSLATION The study findings underscore the need for continuing education in oncosexology and dedicated sexual health interventions that should involve a holistic approach that takes into consideration age, treatments, relationship status, and whether the patient has diabetes. STRENGTHS AND LIMITATIONS Strengths of the study are the sample size, the national representativeness, and data reliability. However, the cross-sectional design could introduce potential recall, recency, or social desirability biases. Also, social determinants influencing sexual health, such as ethnicity or geographic locations, have not been considered in the analyses. CONCLUSIONS This study revealed that sexual disorders persist 2 years after a breast cancer diagnosis, with a noticeable communication gap regarding sexuality between patients and medical teams. These findings underscore the necessity for tailored sexual health interventions, particularly designed for women who are single, older aged, and diabetes patients.
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Affiliation(s)
- Thierry Almont
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, INSERM, Université de Montpellier, CHRU 34295 Montpellier, Université Toulouse 3 Paul Sabatier, CHU 31300, Toulouse, Occitanie, France. https://www.defe.fr
| | - Prisca Ouowéné Sougué
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Rémi Houpert
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Murielle Beaubrun-Renard
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Christelle Montabord
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Clarisse Joachim
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
| | - Jacqueline Véronique-Baudin
- RESEARCH on Cancer Unit UF3596, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- General Cancer Registry of Martinique UF1441, Oncology Departmxent, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Oncosexology Unit, Oncology Department, Martinique University Hospital (CHU Martinique), 97261 Fort-de-France, Martinique
- Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, INSERM, Université de Montpellier, CHRU 34295 Montpellier, Université Toulouse 3 Paul Sabatier, CHU 31300, Toulouse, Occitanie, France. https://www.defe.fr
| | - Anne-Déborah Bouhnik
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ, INSERM, IRD, ISSPAM, 13385, Marseille, France
| | - Marc-Karim Bendiane
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ, INSERM, IRD, ISSPAM, 13385, Marseille, France
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France
- ORS PACA, Observatoire Régional de la Santé, 27 Bd Jean Moulin, 13005 Marseille, Provence-Alpes-Côte d'Azur, France
| | - Julien Mancini
- Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ, INSERM, IRD, ISSPAM, 13385, Marseille, France
- Public Health Department, Service Biostatistique et Technologies de l'Information et de la Communication (BIOSTIC), hôpital Timone, APHM, 13005 Marseille, France
| | - Éric Huyghe
- Laboratoire Développement Embryonnaire, Fertilité et Environnement (DEFE) UMR 1203, INSERM, Université de Montpellier, CHRU 34295 Montpellier, Université Toulouse 3 Paul Sabatier, CHU 31300, Toulouse, Occitanie, France. https://www.defe.fr
- Urology Department, Centre Hospitalier Universitaire de Toulouse, 1, avenue du Professeur Jean Poulhès - TSA 50032 - 31059 Toulouse, France
- Francophone Association for Supportive Care in Cancer (AFSOS), 33130 Bègles, France
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10
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Kandi LA, Hostler AC, Howard M, Teven CM. Breast Cancer Survivorship: Understanding Breast Tissues' Potentiating Role in Precipitating Deviations from Baseline Sexual Function Post Oncologic Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5573. [PMID: 38313592 PMCID: PMC10836896 DOI: 10.1097/gox.0000000000005573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Lyndsay A. Kandi
- From the Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, Ill
- Department of Surgery, College of Medicine—Tucson, University of Arizona, Tucson, Ariz
| | - Andrew C. Hostler
- Department of Surgery, College of Medicine—Tucson, University of Arizona, Tucson, Ariz
| | - Michael Howard
- Department of Surgery, Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Chad M. Teven
- Department of Surgery, Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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11
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Jehan M, Azam S, Taimuri MA, Sumbal A, Azhar A, Amir A, Oduoye MO, Zainab A, Ikram A, Ali T. Care for breast cancer survivors in Asian countries: A review of sexual dysfunction. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241237687. [PMID: 38481086 PMCID: PMC10938604 DOI: 10.1177/17455057241237687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/21/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
Breast cancer accounts for one in three new cancer cases in women each year. Despite having a higher survival rate than other cancers, it is associated with various side effects, including anorgasmia, vaginismus, hair loss, and decreased libido. This review aims to explore trends in the incidence of sexual dysfunction in breast cancer survivors, the etiology of sexual dysfunction, and the role of factors such as family history, age, duration of marriage, and depression in predisposing patients. We summarize the limitations of the treatment modalities already used to cater to sexual dysfunction in breast cancer survivors and patients. The authors conducted searches on databases such as PubMed and Google Scholar using relevant search terms: sexual dysfunction, breast cancer, breast cancer survivors, chemotherapy, dyspareunia, vaginismus, and anorgasmia from 1997-2023. The inclusion criteria encompassed all types of articles with abstracts or titles indicating research on sexual dysfunction in breast cancer survivors in Asia. A total of 64 articles were included out of which 10 were systematic reviews and meta-analyses. The literature search yielded results showing high incidence rates of breast cancer in Asia (45.4%), with 31.6%-91.2% of breast cancer survivors likely to experience sexual dysfunction. Regional differences were noted, as female sexual dysfunction occurred in 74.1% of Asian breast cancer women. Further randomized controlled trials should be conducted to assess the effectiveness of treatment modalities. Personalized approaches should be tailored to address beliefs, such as the potential impact of sexual activity on disease recovery. Utilizing a family history of breast cancer as a preemptive tool can help reduce the risk of developing female sexual dysfunction in survivors, and factors such as age and depression should be considered when formulating solutions.
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Affiliation(s)
- Minal Jehan
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Sumran Azam
- Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Anusha Sumbal
- Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Azhar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Alina Amir
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asra Zainab
- Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Ikram
- Dow University of Health Sciences, Karachi, Pakistan
| | - Tehreem Ali
- Dow University of Health Sciences, Karachi, Pakistan
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12
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Jahan N, Cathcart-Rake E, Vierkant RA, Larson N, Loprinzi C, O'Sullivan CC, Faubion S, Kuhle C, Vencill JA, Couch F, Olson JE, Ruddy KJ. Sexual Dysfunction in Patients With Metastatic Breast Cancer. Clin Breast Cancer 2024; 24:72-78.e4. [PMID: 37867114 DOI: 10.1016/j.clbc.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Sexual well-being is a key determinant of quality of life. Sexual dysfunction in patients with metastatic breast cancer (MBC) is understudied. PATIENTS AND METHODS Patients were eligible for this study if they participated in the Mayo Clinic Breast Disease Registry (MCBDR), had a diagnosis of de novo MBC, and responded to a question about sexual dysfunction at the baseline MCBDR survey. Participants reported their sexual dysfunction on a scale of 0 (no dysfunction) to 10 (severe dysfunction) at baseline and then annually for 4 years. Participants answered additional sexual symptom questions in years 2 and 4. Associations between patient attributes and the presence and severity of sexual dysfunction, changes in sexual dysfunction from baseline to subsequent surveys, and associations between specific sexual symptoms and severity of sexual dysfunction were assessed. RESULTS One hundred three patients with de novo MBC answered the sexual dysfunction question at baseline. The prevalence of any sexual dysfunction (score of 1-10) was 56.3% at baseline (n = 103), 57.1 % at year 1 (n = 77), 80.4% at year 2 (n = 46), 65.8% at year 3 (n = 38), and 85% at year 4 (n = 20). Vaginal dryness was reported by approximately 49% and 39% of patients in years 2 and 4 respectively. Vaginal dryness was associated with higher severity of sexual dysfunction. CONCLUSIONS Self-reported sexual dysfunction is frequent in women with de novo MBC. Vaginal dryness is a frequently reported treatable symptom associated with higher severity of sexual dysfunction. Clinicians should assess patients with MBC for sexual dysfunction and discuss potential treatment strategies.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology and Oncology, University Alabama at Birmingham, Birmingham, AL
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nicole Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Carol Kuhle
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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13
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Cucinella L, Tiranini L, Cassani C, Martella S, Nappi RE. Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy. Int J Womens Health 2023; 15:1261-1282. [PMID: 37576184 PMCID: PMC10422970 DOI: 10.2147/ijwh.s414509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks-24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS San Matteo Foundation, Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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