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Partnered breast cancer survivors better manage sexual side effects after endocrine therapy
Among postmenopausal women with hormone receptor positive breast cancer prescribed adjuvant endocrine therapies, those with an intimate partner are more likely to report a higher psychosocial quality of life despite sexual symptoms related to treatment when compared with similar, unpartnered women, according to findings from a cross-sectional study published in Menopause.
“Research has found partnered breast cancer survivors to have better quality of life than unpartnered survivors, and support from one’s partner may facilitate adjustment to cancer-related sexual problems,” Caroline Dorfman, PhD, an assistant professor in the department of psychiatry and behavioral sciences at Duke University in Durham, North Carolina, and colleagues wrote in the study background. “Although research suggests that unpartnered breast cancer survivors are interested in initiating new intimate relationships, the presence of sexual problems may result in the avoidance of sexual relationships. This is problematic, as initiating a new relationship may result in improved quality of life.”
Dorfman and colleagues analyzed data from 112 postmenopausal women diagnosed with hormone receptor-positive breast cancer (stages I to IIIA) who completed surgery, chemotherapy or radiation and were currently taking adjuvant endocrine therapy , recruited from a comprehensive cancer center in North Carolina (mean age, 64 years; 81.3% white). Researchers obtained information on breast cancer treatments and current and past endocrine therapies via medical records. Sexual problems were assessed via the sexual subscale of the Menopause-Specific Quality of Life q uestionnaire (MENQOL); a single item assessed sexual self-efficacy. The psychosocial subscale of the MENQOL assessed psychosocial quality of life in the past month. Women’s sexual satisfaction was assessed via the Functional Assessment of Cancer Therapy-General que st ionnaire. Researchers used multiple linear regression analyses to examine sexual problems and sexual self-efficacy as predictors of psychosocial quality of life, as well as partner status and sexual satisfaction as moderators of those relationships.
Among the 68.8% of women who reported cohabitating with an intimate partner, 96.1% were married. More than 80% of the cohort were prescribed an aromatase inhibitor and 17. 9 % of women were prescribed tamoxifen (average time on endocrine therapy, 25.47 months).
In bivariate analyses, researchers found that women who lived with an intimate partner reported more sexual problems vs. unpartnered women (P = .004). Additionally, women prescribed an aromatase inhibitor reported lower sexual self-efficacy vs. women prescribed tamoxifen (P = .047) and women with more severe comorbidities reported worse psychosocial quality of life (P = .02), according to researchers.
In multiple regression analyses, researchers found that partner status moderated the relationship between sexual problems and psychosocial quality of life (P = .02), particularly among women reporting high levels of sexual problems.
“Results suggest a significant, positive relationship between sexual problems and psychosocial quality of life for both partnered and unpartnered women, such that women with fewer sexual problems had better psychosocial quality of life; however, at high levels of sexual problems, unpartnered women experienced poorer psychosocial quality of life when compared with partnered women,” the researchers wrote.
Partner status also moderated the relationship between sexual self-efficacy and psychosocial quality of life (P = .01), according to researchers. For unpartnered women, low sexual self-efficacy was associated with worse quality of life (P = .003); however, researchers did not observe a similar association in partnered women.
“This suggests that self-efficacy for managing sexual problems is unrelated to psychosocial quality of life for partnered women, whereas for unpartnered women, low self-efficacy is associated with poorer psychosocial quality of life.”
The researchers noted that the results highlight a need to intervene with unpartnered, postmenopausal breast cancer survivors prescribed adjuvant endocrine therapies, as well as women reporting more sexual problems or low self-efficacy for managing sexual problems.
“Members of the health care team can use this information to inform their discussions and recommendations for interventions or referrals and, ultimately, assist with improving patients’ quality of life,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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Dorfman CS, et al. Menopause. 2019; doi:10.1097/GME.00000000000001337.