Sexual activity and functioning in long-term breast cancer survivors; exploring associated factors in a nationwide survey

Abstract

Purpose Sexual health is a key quality of life issue. Knowledge concerning sexual health in long-term breast cancer survivors (BCSs) is limited. Within a nationwide sample, we aimed to assess the prevalence of sexual inactivity and to explore factors associated with sexual inactivity and reduced sexual functioning among long-term BCSs. Methods Long-term BCSs aged 20–65 years when diagnosed with early-stage breast cancer in 2011–2012 were identified by the Cancer Registry of Norway in 2019 (n = 2803) and invited to participate in a nationwide survey. Sexual health was measured using the multidimensional Sexual Activity Questionnaire. Factors associated with sexual inactivity and reduced sexual functioning were explored using multivariable logistic- and linear regression analyses with adjustments for relevant sociodemographic, health-, and cancer-related variables. Results The final sample consisted of 1307 BCSs with a mean age of 52 years at diagnosis. Fifty-two percent of the BCSs were sexually inactive. Lack of interest was the most common reason for sexual inactivity. Treatment with aromatase inhibitor (OR 1.73, 95% CI 1.23, 2.43) and poor body image (OR 0.99, 95% CI 0.99, 0.995) were associated with sexual inactivity. Among sexually active BCSs, depression (B − 1.04, 95% CI − 2.10, − 0.02) and physical inactivity (B − 0.61, 95% CI − 1.21, − 0.02) were inversely related to sexual pleasure. Treatment with aromatase inhibitor (B 0.61, 95% CI 0.20, 1.01), sleep problems (B 0.37, 95% CI 0.04, 0.70), breast symptoms (B 0.01, 95% CI 0.003, 0.02), and chronic fatigue (B 0.43, 95% CI 0.05, 0.81) were associated with sexual discomfort. Chemotherapy (OR 1.91, 95% CI 1.23, 2.97), current endocrine treatment (OR 1.98, 95% CI 1.21, 3.25), and poor body image (OR 0.98, 95% CI 0.98, 0.99) were associated with less sexual activity at present compared to before breast cancer. Conclusion Treatment with aromatase inhibitor seems to affect sexual health even beyond discontinuation. Several common late effects were associated with sexual inactivity and reduced sexual functioning. To identify BCSs at risk of sexual dysfunction, special attention should be paid to patients treated with aromatase inhibitor or suffering from these late effects.

Quality of life in Spanish postmenopausal breast cancer patients with localized disease who finish endocrine treatment: a prospective study

“…The severe limitations in joint symptoms were in line with those found in postmenopausal women with breast cancer who completed 5 years of AI (FACT-ES questionnaire) 4 . Joint symptoms have also been found as a long-term ET follow-up problem in breast cancer survivors 15 . Moreover, the lack of differences in joint symptoms between age groups (<65 vs >65 y) indicates that these symptoms are not age related.…”

“…4 Joint symptoms have also been found as a long-term ET follow-up problem in breast cancer survivors. 15 Moreover, the lack of differences in joint symptoms between age groups (<65 vs >65 y) indicates that these symptoms are not age related. Moreover, lower joint stiffness scores (QLQ-ELD14) were observed in older patients with a primary tumor at other sites.…”

“…12,13 Patients who received ET as a group have reported progressive improvements after ET cessation in several areas (in the Functional Assessment of Cancer Therapy-Breast [FACT-B] with endocrine symptom subscale [ES] questionnaire global score 13 and in hot flushes 12 ), with no worsening in any area and no QOL changes in most. 12,14 On the other hand, limitations in areas such as menopause and sexual symptoms 15,16 have been reported after ET cessation.…”

Factors associated with worsening sexual function during adjuvant endocrine therapy in a prospective clinic-based cohort of women with early-stage breast cancer

“…[1,7,21,22,24,29,57,58] In a recent large cross-sectional study, sleep problems and fatigue were associated with sexual function problems, supporting this hypothesis. [59] We also found that worsening physical function was associated with worsening sexual function during adjuvant endocrine therapy. The link between poor physical function and sexual function problems has previously been reported, although not consistently; however, prior studies were limited by cross-sectional design.…”

“…The link between poor physical function and sexual function problems has previously been reported, although not consistently; however, prior studies were limited by cross-sectional design. [17,22,26,59] It is possible that physical function limitations are attributable to joint discomfort in the setting of endocrine therapy, which we hypothesize may, in turn, affect multiple domains on the MOS-SP, such as sexual interest and ability to relax and enjoy sex; however, further study is needed to con rm this association and assess the mechanism by which physical function impairment during endocrine therapy impacts sexual function.…”