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Sexual concerns in cancer patients: a comparison of GI and breast cancer patients

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Abstract

Purpose

Although sexual concerns have been examined in breast cancer (BC), these concerns remain understudied and undertreated for patients with gastrointestinal (GI) cancer. Objectives were to: (1) assess sexual concerns in GI cancer patients compared with breast cancer patients; (2) examine whether sexual concerns are stable over time in GI and breast cancer patients; and (3) evaluate whether sexual concerns in GI and breast cancer are significantly associated with quality of life, symptom severity, and disease interference, and whether these associations change over time.

Methods

Data were collected from GI and breast cancer patients during four outpatient clinic visits over 6 months. Measures included sexual concerns (reduced sexual enjoyment, interest, or performance), quality of life (FACT-G), symptom severity, disease interference (MD Anderson Symptom Inventory), and disease-related distress (NCCN Distress Scale). Linear mixed model analyses were conducted.

Results

Sexual concerns were common in both samples, with 57% of GI cancer patients and 53% of breast cancer patients reporting at least mild sexual concerns. Sexual concerns were stable over time and were significantly associated with lower levels of functioning in multiple domains (e.g., quality of life, symptom severity, disease interference, and disease-related distress), irrespective of length of time since diagnosis. Cancer type (GI/breast cancer) was not a moderator of this relationship.

Conclusions

Self-reported sexual concerns were common, stable, and related significantly to quality of life, symptom severity, disease interference, and disease-related distress for both GI and breast cancer patients. Limitations and implications for future research are discussed.

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Notes

  1. To examine the possibility that metastatic/recurrent disease state might be related to the reporting of sexual concerns, we conducted an LMM in which we estimated the effects of time, disease state (dummy coded as metastatic/recurrent disease vs. nonmetastatic/recurrent disease), and time X disease state effects in the combined GI and breast cancer dataset. Neither the effect of disease state (p = 0.68) nor the time X disease state effect was significant (p = 0.38).

  2. In order to further examine the possible effect of gender on sexual concerns, we examined both the stability of sexual concerns over time and the relationships between sexual concerns and multiple domains of functioning in female patients only (i.e., female GI cancer patients and all breast cancer patients). We ran the identical two LMM analyses initially conducted in the mixed gender sample in which we: (1) estimated the effects of time, cancer type (GI vs. breast cancer), and the time X cancer-type interaction effect on sexual concerns and (2) estimated the effects of time, cancer type, sexual concerns, and all two- and three-way interaction terms on four domains of functioning (i.e., quality of life, symptom severity, disease-related interference, and disease-related distress). The results generally paralleled those obtained using both genders in the GI sample. For the first analysis on the outcome of sexual concerns, the time, cancer type, and time X cancer-type interaction effects were nonsignificant (all p values > 0.51). For the analyses examining the effects of time, cancer type, and sexual concerns on the domains of functioning, sexual concerns was the only significant predictor of quality of life, disease-related interference, and disease-related distress (all p values < 0.01) and these relationships did not vary over waves of assessment or by cancer type, as was found in the mixed gender sample. The effect of sexual concerns on symptom severity, however was not significant (p = 0.18).

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Acknowledgements

This study was a subanalysis of data collected through an outcomes research service agreement with Pfizer, Inc. focusing on the use of e/Tablets to collect patient-reported data in the clinic. Pfizer does not have access to individual data. SOS, Inc. served as vendor for the e/Tablets in this project; the vendor provided the hardware and programmed the software. Duke University Medical Center provided the wireless system and associated technical support. Dr. Abernethy had a nominal consulting arrangement with SOS, Inc., ending in April 2008. None of this funding or these relationships are specifically related to the topic of the manuscript, sexual concerns. This work was funded in part by the National Institutes of Health through the NIH Roadmap for Medical Research, Grant (U 5 U01 AR052186). This work was supported in part by the National Institute of Mental Health Clinical Research Training in Geriatric Mood Disorders, Grant (MH070448).

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (DUMC), 2200 W. Main St., Suite 340, Durham, NC, 27705, USA

    Jennifer Barsky Reese, Rebecca A. Shelby, Francis J. Keefe & Laura S. Porter

  2. Department of Medicine, Division of Medical Oncology, Duke University Medical Center (DUMC), Durham, NC, USA

    Amy P. Abernethy

  3. Duke Comprehensive Cancer Center, DUMC, Durham, USA

    Amy P. Abernethy

  4. Department of Medicine, Center for Clinical Health Policy Research, DUMC, Durham, USA

    Amy P. Abernethy

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  1. Jennifer Barsky Reese
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  2. Rebecca A. Shelby
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  5. Amy P. Abernethy
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Correspondence to Jennifer Barsky Reese.

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Reese, J.B., Shelby, R.A., Keefe, F.J. et al. Sexual concerns in cancer patients: a comparison of GI and breast cancer patients. Support Care Cancer 18, 1179–1189 (2010). https://doi.org/10.1007/s00520-009-0738-8

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  • DOI: https://doi.org/10.1007/s00520-009-0738-8

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