The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer

Abstract

Purpose Colorectal cancer patients usually receive treatments (e.g., pelvic surgery or radiotherapy, colostomy) that increase their risk for sexual problems. Previous research has mainly focused on demographic and medical risk factors. Because little is known about the role of psychosocial variables in sexual dysfunction, this research sought to identify the contribution of demographic, medical and psychosocial factors to sexual dysfunction using multivariate analyses. Methods Male and female colorectal cancer survivors (N=261, mean: 2.5 years post-treatment) completed paper-pencil questionnaires assessing sexual function, psychosocial variables (e.g., depression, social support, body image, dyadic adjustment) and demographics. Medical information was obtained from patients’ self-report and medical records. Results Multiple regression analyses revealed that older age, having received destructive surgery (i.e., abdominoperineal resection), and poor social support were uniquely and significantly associated with low International Index of Erectile Function scores in men. For women, low Female Sexual Function Index scores were significantly associated with older age and poor global quality of life. Men, but not women, with rectal cancer reported worse sexual function compared to those with colon cancer. Conclusions Sexual dysfunction after colorectal cancer treatment is related to demographic, medical, and psychosocial factors. These associations can help to identify patients at high risk of sexual problems in order to assist restoring sexual functioning if desired.

Cancer survivorship: Advancing the concept in the context of colorectal cancer

“…CRC survivors' quality of life (QOL) may be negatively influenced by the presence of an ostomy, level of physical activity and the experience of chronic symptoms including pain, fatigue, anxiety, changes in bowel habit and sexual dysfunction, with some variation in these effects between genders (Chambers et al, 2012b;Di Fabio et al, 2008;Domati et al, 2011;Krouse et al, 2009;Lynch et al, 2007bLynch et al, , 2008aLynch et al, , 2011Milbury et al, 2013;Peddle et al, 2008a;Ristvedt and Trinkaus, 2009;Sun et al, 2015;ThraenBorowski et al, 2013). Despite this, survivors' rate their health and QOL positively, in some cases improving over time, with long-term survivors reporting QOL levels comparable to normative populations (Caravati-Jouvenceaux et al, 2011;Chambers et al, 2012aChambers et al, , 2012bDi Fabio et al, 2008;Jansen et al, 2011;Phipps et al, 2008;Ristvedt and Trinkaus, 2009;Serpentini et al, 2011;Soerjomataram et al, 2012;Steginga et al, 2009;Thong et al, 2011aThong et al, , 2011b.…”

“…Like other tumour groups, CRC survivors may experience pain, sleep disturbance and fatigue (Anderson et al, 2013;Domati et al, 2011;Grant et al, 2011;Grimmett et al, 2011;Jansen et al, 2011;McCaughan et al, 2012;Peddle et al, 2008a;Phipps et al, 2008;Schneider et al, 2007;Shun et al, 2011;Sisler et al, 2012;Stein et al, 2009;Thong et al, 2011bThong et al, , 2013. However, side-effects particular to CRC survivors include weight changes; sexual dysfunction (erectile problems, vaginal dryness, dyspareunia), upper gastrointestinal disturbances (food intolerance, nausea, vomiting, loss of appetite), and bowel dysfunction (constipation, diarrhoea, abdominal cramping, flatulence, incontinence, urgency, frequency) (Anderson et al, 2013;Bailey et al, 2015;Caravati-Jouvenceaux et al, 2011;Den Oudsten et al, 2012;Di Fabio et al, 2008;Ellis et al, 2010;Grant et al, 2011;Grimmett et al., 2011;Jansen et al, 2011;Lynch et al, 2008b;McMullen et al, 2008;Milbury et al, 2013;Nikoletti et al, 2008;Phipps et al, 2008;Ramirez et al, 2009;Ristvedt and Trinkaus, 2009;Sanoff et al, 2015;Schneider et al, 2007;Serpentini et al, 2011;Sisler et al, 2012;Thong et al, 2011aThong et al, , 2011b…”

“…Fear of recurrence, depression, anxiety and distress are enduring issues for some survivors, heightened around the time of clinical appointments (Appleton et al, 2013;Chambers et al, 2012b;Dunn et al, 2013;Esplen et al, 2007;Faul et al, 2012;Krouse et al, 2009;Lawsin et al, 2007;Loi, 2011;Lynch et al, 2008c;McCaughan et al, 2012;Milbury et al, 2013;Nikoletti et al, 2008;Phipps et al, 2008;Ristvedt and Trinkaus, 2009;Schneider et al, 2007;Shun et al, 2011;Stein et al, 2009;Thong et al, 2013). The physical effects of CRC treatment, including bowel dysfunction and peripheral neuropathy had significant negative effects on CRC survivors' psychological well-being, body image, and adaption to survivorship (Bailey et al, 2015;Desnoo and Faithfull, 2006;Ho et al, 2015;McMullen et al, 2008;Padman et al, 2015;Palmer et al, 2013;Phipps et al, 2008;Schneider et al, 2007;Serpentini et al, 2011;Thong et al, 2011b;Tofthagen, 2010).…”

“…The physical and psychological effects of treatment impacted upon sexual relationships, particularly for females, as some avoided intimacy due to pain, and fear of reaction from their partner Krouse et al, 2009;McMullen et al, 2008;Milbury et al, 2013;Ramirez et al, 2009). However, this was not a problem for all survivors, as they expressed gratitude for being alive and having a supportive family or spouse (Chambers et al, 2012b;Nikoletti et al, 2008;Ramirez et al, 2009).…”

Impact of Adjuvant Chemoradiotherapy for Rectal Cancer on the Long-Term Quality of Life and Late Side Effects: A Multicentric Clinical Evaluation by the Turkish Oncology Group

“…In addition; the gender, sociocultural background and age have a great impact on the perception of QOL. Younger patients may be more active and therefore experience the limitations resulting from the cancer to a greater extent, whereas older people may have more unwillingness to express unmet needs or problems with which they believe they should be able to DOI:http://dx.doi.org/10.7314/APJCP.2012.13.11.5741 QOL and Late Side Effects in Rectal Cancer cope (Milbury et al, 2012). Numerous studies concerning QOL in groups with different pathologies have reported better results for men versus women.…”