What Is Known About Sexual Dysfunction After Breast Cancer?

Marine Cygler

September 26, 2022

PARIS—What do doctors know about their patients' sexual health? Not a lot. What about oncologists who treat women with breast cancer? Not much more. Yet sexual dysfunction has a significant impact on the quality of life of patients during and after cancer.

To determine the extent of sexual dysfunction among women with breast cancer, Maria Alice Franzoi, MD,an oncologist at Gustave Roussy Hospital in Villejuif, France, analyzed data concerning sexuality from the CANTO cohort study. She showed that sexual dysfunction often predates the cancer diagnosis and doesn't improve but rather worsens in the following 2 years. She presented her results at the ESMO 2022 conference.

Present at Diagnosis

Franzoi, whose research projects have focused on patient monitoring post cancer, drew her conclusions from the data provided by CANTO, a longitudinal, prospective cohort study that monitors women being treated for localized breast cancer. Study participants answered the EORTC-QLQ-BR23 quality-of-life questionnaire at the time of diagnosis (T0), 1 year after diagnosis (T1), and 2 years after diagnosis (T2). Four factors were employed to better define women's sex-related problems: poor body image, poor sexual functioning (activity and desire), lack of sexual pleasure, and a complete lack of sexual activity.

The analysis focused on the responses of 7895 patients in the CANTO cohort study on sexual activity; 4523 of those patients answered questions about sexual pleasure. Female respondents who reported engaging in no sexual activity did not have to answer the questions in this second section.

"Seventy-five percent of patients reported at least one of the four concerns during the study," noted Franzoi during her presentation. This finding highlights the fact that "sexual problems are already present at the time of diagnosis in a considerable number of patients," she said. More than a third of participants complained of at least one of the four items.

Developments After Diagnosis

The proportion of women who reported no arousal or poor sexual function remained stable at around 30% over time, meaning that the sexual problems were reported in similar numbers at T0, T1, and T2. "However, after cancer, more patients are worried about a lack of sexual pleasure (38.7% at T1 and 38.1% at T2, vs 29.1% at T0) or report having a negative body image (57.8% at T1 and 52.5% at T2, vs 32.1% at T0)," said Franzoi.

She identified the following three variables as being associated with sexual dysfunction 2 years after diagnosis: the existence of this problem at the time of diagnosis, the use of adjuvant hormone therapy, and severe depression or a very high stress level after the first year of treatment.

Inadequate Specific Treatment

"Sexual dysfunction is a major unmet need with a significant impact on quality of life," said Maryam Lustberg, MD, an oncologist at Yale School of Medicine in New Haven, Connecticut, who was invited to discuss the results at the conference.

Franzoi observed that most participants with sexual dysfunction that had continued 2 years after diagnosis had not been referred to a doctor for this problem. "In terms of sexual function, it's better at T2 than at T1, but only 41% of these women have been seen by a gynecologist, and only 15% have received specific treatment," she reported, emphasizing the need to assess and treat these issues "proactively" at the time of diagnosis and during and after treatment.

"Now we need to work out what the best treatment approach is," commented Lustberg. She said that cancers other than breast and gynecologic cancers should also be taken into consideration. She cited the Sexual Health Assessment in Women With Lung Cancer study, which recently revealed that after being diagnosed with lung cancer, female patients experienced a drop in sexual desire (31% vs 15% before diagnosis) and an increase in vaginal discomfort or dryness (43% vs 13% before diagnosis). This study, presented in August to the International Association for the Study of Lung Cancer World Conference on Lung Cancer 2022, also revealed that different parameters affect satisfaction in one's sex life, including fatigue, sadness, relationship problems with a partner, and even breathing. Lustberg concluded from this study that a multidisciplinary approach is needed for cancer survivors.

Franzoi received research funding from Resilience Care. Lustberg has links with AstraZeneca, Pfizer, Novartis, Sanofi, and Lilly.

This article was translated from the Medscape French edition.

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