Biopsychosocial predictors of sexual function and quality of sexual life: a study among patients with colorectal cancer

Patients' related sexual outcomes in colorectal surgery

Background

Patients undergoing colorectal surgery (CRS) have an increased risk of developing sexual disorders, attributed to different mechanisms. In this context, sexual function (SF) assessment of patients before and after surgery is essential: to identify risk factors for sexual disorders as well as to minimize their impact on overall quality of life (QoL), allowing them a satisfying relationship and sexual life.

Material and methods

Patients over 18 years of age who underwent a CRS in the University Hospital of Geneva, Switzerland, between June 2014 and February 2016 were included. Our main objective was to compare and analyze the evolution of SF, QoL, and marital satisfaction (MS) before and after CRS. Specific and standardized tests were used.

Results

A cohort of 72 patients with a median age of 58.73 was analyzed. The majority of CRS was elective (91.5%). A percentage of 52.8% of patients underwent surgery for oncological reasons. There was no statistical difference in SF, sexual QoL, and MS before and after elective or emergency CRS for men. Interestingly, a significant decrease in women's SF (FSFI) as well as their satisfaction within their couple (Locke-Wallace) until 12 months after surgery was found (p = 0.021). However, they showed a steady SF (GRISS) within their couple until 12 months after surgery.

Conclusion

Regarding knowledge about difficulties to talk about this intimate topic and gender differences, this general overview raises the question of the necessity to introduce in a long-course follow-up different methods of sexual health assessment with specific stakeholders.

Prevalence and predictors of poor sexual well-being over 5 years following treatment for colorectal cancer: results from the ColoREctal Wellbeing (CREW) prospective longitudinal study

OBJECTIVES

To describe prevalence and predictors of poor sexual well-being for men and women over 5 years following treatment for colorectal cancer.

DESIGN

Prospective longitudinal study, from presurgery to 5 years postsurgery, with eight assessment points. Logistic regression models predicted sexual well-being from presurgery to 24 months and 24 months to 60 months; time-adjusted then fully adjusted models were constructed at each stage.

SETTING

Twenty-nine hospitals in the UK.

PARTICIPANTS

Patients with Dukes' stage A-C, treated with curative intent, aged ≥18 years and able to complete questionnaires were eligible.

OUTCOME MEASURES

The dependent variable was the Quality of Life in Adult Cancer Survivors sexual function score. Independent variables included sociodemographic, clinical and psychosocial characteristics.

RESULTS

Seven hundred and ninety participants provided a sexual well-being score for at least one time point. Thirty-seven per cent of men and 14% of women reported poor sexual well-being at 5 years. Baseline predictors for men at 24 months included having a stoma (OR 1.5, 95% CI 1.02 to 2.20) and high levels of depression (OR 2.69/2.01, 95% CI 1.68 to 4.32/1.12 to 3.61); men with high self-efficacy (OR confident 0.33/0.48, 95% CI 0.18 to 0.61/0.24 to 1.00; very confident 0.25/0.42, 95% CI 0.13 to 0.49/0.19 to 0.94) and social support (OR 0.52/0.56, 95% CI 0.33 to 0.81/0.35 to 0.91) were less likely to report poor sexual well-being. Predictors at 60 months included having a stoma (OR 2.30/2.67, 95% CI 1.22 to 4.34/1.11 to 6.40) and high levels of depression (OR 5.61/2.58, 95% CI 2.58 to 12.21/0.81 to 8.25); men with high self-efficacy (very confident 0.14, 95% CI 0.047 to 0.44), full social support (OR 0.26; 95% CI 0.13 to 0.53) and higher quality of life (OR 0.97, 95% CI 0.95 to 0.98) were less likely to report poor sexual well-being. It was not possible to construct models for women due to low numbers reporting poor sexual well-being.

CONCLUSIONS

Several psychosocial variables were identified as predictors of poor sexual well-being among men. Interventions targeting low self-efficacy may be helpful. More research is needed to understand women's sexual well-being.

Self-reported sexual dysfunction in patients with rectal cancer

AIM

Patients with rectal cancer often experience sexual dysfunction after treatment. The aim of this study was to evaluate sexual function in a prospective cohort of patients regardless of treatment and tumour stage and explore what factors might affect sexual activity 1 year after diagnosis.

METHOD

The QoLiRECT study (Quality of Life in RECTal cancer) is a prospective study on the health-related quality of life in patients with rectal cancer in Denmark and Sweden. Questionnaires were completed at diagnosis and 1 year. Clinical data were retrieved from national quality registries.

RESULTS

Questionnaire data were available from 1085 patients at diagnosis and 920 patients at 1 year. Median age was 69 years (range 25-100). At diagnosis, 29% of the women and 41% of the men were sexually active, which was lower than an age-matched reference population. This was further reduced to 25% and 34% at 1 year. Risk factors for sexual inactivity were absence of sexual activity prior to the diagnosis and the presence of a stoma. Women experienced reduced lubrication and more dyspareunia at 1 year compared with the time of diagnosis. In men, erectile dysfunction increased from 46% to 55% at 1 year.

CONCLUSION

Sexual activity in patients with rectal cancer is lower at diagnosis compared with the population norm and is further reduced at 1 year. The presence of a stoma contributed to reduced sexual activity after operation. Sexual dysfunction was difficult to evaluate due to low sexual activity in the cohort. In men, erectile dysfunction is common.

Do male esophageal cancer patients have impaired sexual function after esophagectomy? A self-reported outcomes study

PURPOSE

Sexual function is a significant part of patients' quality of life, which is another important aspect of cancer. This study assessed and compared the sexual function of male esophageal cancer patients to that of age-matched normal controls through postoperative follow-up surveys.

METHODS

The study included 105 male esophageal cancer patients aged 38-81 years who underwent a curative-intent esophagectomy between April 2012 and May 2014. This observational study included sociodemographic and clinicopathological characteristics and responses to sexual function questionnaires International Index of Erectile Function (IIEF) at 6 and 12 months after surgery. An age-matched normal control group was recruited. Non-parametric tests were used when appropriate.

RESULTS

The median patient age was 59 years. The factors significantly associated with sexual dysfunction on the 6-month survey included older age, and postoperative complications. At 12 months after surgery, older age was significantly associated with poorer sexual function. The sexual function scores significantly increased from 6 to 12 months after surgery (P < 0.05); there was no difference in the patients' 12-month sexual function scores and those of the normal controls (P > 0.05). Notably, compared to older patients (age ≥60 years), the younger (age <60 years) patients reported a significantly better sexual function scores (P < 0.05).

CONCLUSIONS

Age, and postoperative complications were the factors significantly associated with sexual function. Impaired sexual function after primary treatment can be recovered in male esophageal cancer patients; younger patients may regain sexual function better than their older counterparts.