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Patient survey: Sexual dysfunction neglected in routine care
SAN FRANCISCO — Sexual dysfunction, a documented consequence of breast cancer treatment, was not fully addressed during follow-up routine care, according to findings of a patient survey.
Elizabeth Anne Block, MS, of Michigan State University’s College of Human Medicine, and colleagues conducted the study to determine the prevalence of patient-perceived sexual dysfunction.
They conducted an institutional review board-approved survey of 83 English-speaking women with stage zero to stage III breast cancer from 2008 to 2011. The patients ranged in age from 20 to 80 years.
The 30-question survey included sections related to breast cancer treatment, demographics, overall satisfaction with intimate relationships, perceived effect on sexual function due to treatment, and factors that interfered with intimate relationships.
According to the survey results, 64% of responders felt that treatment had a negative effect on their sexual function. Of the responders who expressed that sentiment, only 23% discussed the issue with a care provider, whereas 60% desired a physician-initiated conversation.
A negative opinion was associated with decreased satisfaction with intimate relationships (P<.001).
The prevalence of treatment-related factors — including breast tenderness, dyspareunia, fatigue, hot flashes and the presence of scars — were the most frequently cited factors interfering with sexual function.
The presence of scars was the only one of those factors researchers found to be significantly associated with a perceived negative effect on intimate relationships (P<.04).
Women who underwent breast conservation were less likely to perceive a negative effect than women who underwent mastectomy (P=.036), according to researchers.
“Our data demonstrates that patients do not feel [perceived sexual dysfunction] is addressed during routine care,” Block and colleagues wrote. “However, the majority of patients want this issue discussed with their physicians. Sexual dysfunction is independent of age, time post-surgery and interfering factors, making it difficult to identify high-risk populations. Therefore, sexual dysfunction should be identified in breast cancer patients during follow-up, with interventions made when appropriate.”
For more information:
Block EA. Abstract #67. Presented at: 2012 Breast Cancer Symposium; Sept. 13-15, 2012; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopInclusion criteria for this study included patients with breast cancer stage I to stage III, aged 20 to 80 years, who were accrued between 2008 and 2011 and were English-speaking. Of note in this study is that 64% of patients actually made mention that cancer treatment overall — from the diagnosis of cancer onward — had a negative impact on sexual function. If you look at what potential side effects occurred that could have influenced sexual desire and sexual dysfunction, the researchers report significant correlation between several factors, including fatigue, dyspareunia, scars, hot flashes and breast tenderness. We would expect that the type of surgery that the patient underwent also influenced sexual dysfunction. For example, patients who underwent mastectomy, to a larger extent, noted that cancer treatment influenced sexual function, whereas the reported influence on sexual function was significantly lower for patients who underwent lumpectomy. Additionally, you can see a shift over time that shows a decrease in sexual dysfunction after 6 months, but then an increase after 12 months. This may be due to several symptoms that may actually underlie sexual dysfunction, such as vaginal dryness and dyspareunia, which also continues over time and seems to increase after 1 year. The literature shows that many patients have a very strong desire to discuss these issues with their therapeutics. This is very interesting, as it seems to be age-dependent: The younger the patients are — younger than 35, for example — the more often they wish to discuss these issues with their physicians. However, if you look at other age categories, there is a gap between those patients who want to discuss and those who actually do discuss these issues with their physicians. It appears that patients need to be encouraged to do that, and physicians need to be encouraged to ask patients if they would like to discuss these issues. Essentially, what the researchers have basically computed is that evaluation management of sexual difficulties should be a standard component of the care for women treated for breast cancer.
Perspective
Back to Top
This survey of breast cancer patients found that 64% of responders felt treatment had a negative impact on their sexual function. Most intriguing was that the presence of scars and having had a mastectomy was significantly associated with perceived negative impact on intimate relationships, yet only 23% discussed the issue of sexual function with their care provider. Although the small sample size was a major limitation of this study, it demonstrated that women treated for breast cancer want to discuss sexual dysfunction concerns with their physicians and should be advised about appropriate interventions during their follow-up care.
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