Sexual concerns are a major unaddressed need among survivors of BC with significant negative effect on quality of life.
Patients (pts) with stage I-III BC were prospectively included from CANTO providing data at diagnosis (T0), 1 (T1), and 2 (T2) years afterwards. Study outcomes were poor body image (score ≤91/100), poor sexual functioning (≤16/100) poor sexual enjoyment (≤66/100) and sexual inactivity (item 45=1) at T2 assessed by EORTCQLQ-B23 (Karsten EJC 2022). Multivariable logistic regression models assessed associations with sexual concerns adjusting for age, sociodemographic, tumor, treatment and clinical characteristics.
Analysis included 7,895 pts. At T0, 32.1% of pts already presented poor body image, 39.3% poor sexual functioning, 29.1% poor sexual enjoyment, and 39% were sexually inactive. The proportion of pts reporting sexual concerns increased over time: 52.6% and 38.1% reported poor body image and sexual enjoyment at T2, respectively. Factors consistently associated with sexual concerns at T2 included: presence of the same concern at T0, endocrine therapy (ET) use and emotional distress. Gynecologist consultation was associated with lower likelihood of reporting sexual concerns at T2 – Table. Dimension specific associations with poor body image included higher education (OR 1.4 [95%CI 1.1-1.8), prior smoking (1.3[1.1-1.6]), mastectomy (2[1.6-2.4]), receipt of chemotherapy (1.5[1.3-1.8]), fatigue (1.5[1.3-1.8]) and pain (1.3[1.0-1.5]) reported at T1, whereas poor sexual enjoyment was associated with lower education (1.6[1.0- 2.6]). Table: 1558MO
Associations with sexual concerns at T2: OR; 95% CI
|Variable||Body image||Sex functioning||Sex enjoyment||Sex inactivity|
|Concern T0 vs no||3.40; 2.93-3.95||10.83; 9.17-12.76||4.19; 3.37-5.21||10.50; 8.94-12.34|
|Age (<40 vs > 65y)||-||7.63; 4.90-12.04||2.46; 1.54-3.93||8.26; 5.31-12.80|
|Income (<1500 vs ≥3000)||-||1.49; 1.10-2.01||-||1.55; 1.15-2.07|
|BMI ≥ 25 vs <25||1.32; 1.11-1.59||1.39; 1.12-1.74||-||1.35; 1.09-1.68|
|ET vs no||1.24; 1.04-1.48||1.33; 1.06-1.66||1.49; 1.13-1.97||1.34; 1.08-1.67|
|Depression* vs no||1.95; 1.59-2.40||1.33; 1.05-1.68||1.75; 1.27-2.41||1.39; 1.10-1.74|
|Vaginal dryness* vs no||1.19; 1.04-1.37||-||1.74; 1.41-2.14||0.74; 0.63-0.80|
|Gynecologist* vs no||-||0.70; 0.59-0.84||0.74; 0.60-0.92||0.73; 0.61- 0.87|
Sexual concerns seem to substantially increase from BC to the after treatment period reaching more than half of pts 2y after diagnosis. This study identified a number of factors associated with sexual concerns. Communication on sexual health must exist across the whole cancer care continuum so that pts can be identified and receive proper multidisciplinary counselling.
Clinical trial identification
Legal entity responsible for the study
National Research Agency (grant ANR-10-COHO-0004 for the Cancer Toxicity study); Gustave Roussy Foundation (INTERVAL).
M. Lambertini: Financial Interests, Personal, Advisory Board: Roche, AstraZeneca, Lilly, Novartis, Exact Sciences, MSD, Seagen, Gilead; Financial Interests, Personal, Invited Speaker: Pfizer, Takeda, Sandoz, Ipsen, Libbs, Knight. F. Joly Lobbedez: Financial Interests, Personal, Advisory Board: GSK, AstraZeneca, MSD, Janssen, ipsen, BMS, Bayer, Esai; Financial Interests, Personal, Invited Speaker: GSK, AstraZeneca, MSD, Janssen, Ipsen, Amgen, Astellas; Financial Interests, Institutional, Invited Speaker: GSK, AstraZeneca; Financial Interests, Institutional, Research Grant: BMS; Travel: MSD, GSK. B. Pistilli: Financial Interests, Personal, Advisory Board: Puma, Pierre-Faber, Novartis, Myriad Genetics, AstraZeneca, Daiichi/Sankyo; Financial Interests, Institutional, Research Grant: Pfizer, Puma Biotechnology, Merus, Daiichi/Sankyo. I.V. Luis: Financial Interests, Institutional, Invited Speaker: Amgen, AstraZeneca, Pfizer/Edimark, Novartis. All other authors have declared no conflicts of interest.