Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes

Abstract

Background: Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes.

Methods: Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics.

Results: Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)_{poor body image} 3.48 [95% confidence interval (CI) 3.11-3.89]; OR_{sexual inactivity} 9.94 (95% CI 8.84-11.18), OR_{poor sexual function} 9.75 (95% CI 8.67-10.95), OR_{poorsexual enjoyment} 3.96 (95% CI 3.34-4.69)], endocrine therapy use [OR_{poor body image} 1.15 (95% CI 1.01-1.31); OR_{sexual inactivity} 1.19 (95% CI 1.02-1.39), OR_{poor sexual function} 1.17 (95% CI 1.01-1.37), OR_{poor sexual enjoyment} 1.23 (95% CI 1.00-1.53)], and depression [OR_{poor body image} 2.00 (95% CI 1.72-2.34); OR_{sexual inactivity} 1.66 (95% CI 1.40-1.97), OR_{poor sexual function} 1.69 (95% CI 1.43-2.00), OR_{poor sexual enjoyment} 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified.

Conclusions: Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.

Keywords: body image; breast cancer; patient-reported outcomes; sexual enjoyment; sexual functioning; sexual health; sexual inactivity; survivorship.