Patient survey: Sexual dysfunction neglected in routine care

Cornelia Liedtke, MD, PhD

Inclusion 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.

Sandhya Pruthi, MD

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.