Hematological Cancer Survivors May Experience Sexual Impairment

Although long-term survivors of hematological cancers appear to be generally satisfied in terms of partnership, sexuality, and fertility-related communication, they may experience specific impairments related to overall sexual pleasure, according to findings from a register-based study.

"We conclude that more attention should be paid to sexual health in oncological settings...Female patients, those who are older or treated with chemotherapy, may be particularly impaired and thus need to be focused on," according to the study authors.

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Of the survivors included in the study, 90% and 60% reported feeling satisfied with their partnership and sexual life, respectively. However, 81% and 86% reported experiencing sexual impairment due to physical or mental symptoms, respectively, stemming from hematological cancer survivorship. Additionally, 51% of survivors described their sexual life as being worse compared with pre-diagnosis.

Forty percent of survivors described being satisfied with their attractiveness compared with 35% who were unsatisfied. Additionally, 74% of survivors who were unable to complete family planning had conversations with a physician about fertility.

“We found that patients rated their satisfaction with sexual life overall positive, but also reported high perceived impairments since diagnosis,” the study authors stated. “Therefore, clinicians should not only rely on general questions on satisfaction but should ask more for specific problems in sexual life to offer adequate symptom management.”

Investigators of this register-based study enrolled 2001 hematological cancer survivors between the ages of 18 years at time of diagnosis and 85 years at time of assessment. Recruitment was done via 2 German cancer registries. Investigators used descriptive statistics and multiple regression analyses to identify associations between outcomes, patient factors, and wellbeing such as anxiety, depression, and quality of life.

Outcome measures for the study included satisfaction with partnership, satisfaction with sexuality, fertility-related communication, quality of life, depressive symptomatology, anxious symptomatology, and sociodemographic and medical data. Investigators assessed these measures using different German questionnaires to gauge survivor responses.

Investigators evaluated the association of partnership, sexuality, and fertility with well-being by applying separate univariate regression analyses to assess their respective relationships with global quality of life and depressive and anxious symptomatology. To examine the robustness of these analyses, investigators re-completed analyses while controlling for sociodemographic and medical variables.

Of 2001 eligible survivors, 922 participated in the study. The mean patient age was 63.9 years (standard deviation [SD], 13.4), 57% were male, and 80% reported that they were living in a partnership.

The most common cancer types for survivors included non-follicular lymphoma (27%), lymphoid leukemia (15%), multiple myeloma (13%), follicular lymphoma (13%), Hodgkin lymphoma (11%), and Myeloid leukemia (10%). The median years since diagnosis was 9.1 years (SD, 4.2). Most survivors in the study had cancer that went into remission (73%) and most previously received chemotherapy (79%).

Investigators indicated that neither sociodemographic nor medical factors significantly correlated with partnership satisfaction. Additionally, gender and remission status correlated with all variables. However, receipt of radiotherapy was not associated with any sexuality items. Notably, the associations were small, with investigators reporting that all factors together added up to a variance of 5.1%.

Investigators indicated that female gender (P <.05; Beta = –.09), older age (P <.01; Beta = .10), and chemotherapy (P <.01, Beta = .10) correlated with less sexual pleasure due to physical impairment. Additionally, satisfaction with partnership (P <.001; Beta = .22), sexual life satisfaction (P <.001; Beta = .28), and conversations about fertility (P <.05; Beta = .26) were associated with improved quality of life.

“We conclude that more attention should be paid to sexual health in oncological settings,” the study authors stated. “Female patients, those who are older or treated with chemotherapy, may be particularly impaired and thus need to be focused on.”

The study had several limitations. For example, the trial's cross-section design did not allow for findings to be interpreted in a casual way. Moreover, sexual outcomes were internally developed and not validated due to a lack of available instruments, although questions and discussions were pulled from other studies were possible.

Investigators also reported a low response rate of 46% which could be indicative of bias.

“A possible reason might be the intimacy and anticipated stigmatization of the topics may have hindered patients to answer the questions,” the investigators wrote. “Assuming that patients with high distress in these topics may have felt less comfortable to answer these questions, our results may have been biased towards a more positive evaluation. Future studies may use a small introduction text to validate the difficulty to report about this subject together with the importance to do so.”

Reference

Lohmann B, Kuba K, Götze H, Mehnert‐Theuerkauf A, Heyne S, Esser P. Partnership, sexuality, and fertility‐related communication: findings from a register‐based study among long‐term hematological cancer survivors. Support Care Cancer. 2022;31(1):26. doi:10.1007/s00520-022-07495-4