Sexual functioning in young women with breast cancer.

Abstract

9100 Background: Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life. Little is known about the frequency and magnitude of this problem among very young women with breast cancer during the year following diagnosis. Methods: 298 sexually-active women enrolled in an ongoing multi-center cohort study with Stage 0-III breast cancer at or before age 40 were included in this analysis. Treatment data was self-reported on a survey mailed to participants at enrollment. Sexual functioning was assessed using the sexual interest and dysfunction subscales from the Cancer Rehabilitation Evaluation System (CARES). Scores range from 0-4, with higher scores indicative of poorer function. The survey included a measure of anxiety and depression (Hospital Anxiety and Depression Scale), of body image (CARES) and of physical and menopausal symptoms (Breast Cancer Prevention Trial Symptom Checklist). Mean differences in CARES scores between treatment groups (chemotherapy vs. none; hormone therapy vs. none; lumpectomy vs. mastectomy vs. mastectomy + reconstruction vs. no surgery; radiation vs. none) were compared using T-tests and ANOVA. Multiple regression models were fit to assess symptoms thought to be mediators of the treatment-sexual functioning association. Results: Mean age at diagnosis was 36 (range: 22-40) years and mean time from diagnosis to survey completion was 5 months (range: 1-16). Mean CARES sexual interest and dysfunction scores were higher in women who received chemotherapy compared to those who did not (p<0.0001). In the multivariate analysis, chemotherapy was no longer associated with decreased sexual interest or function. Anxiety, depression, musculoskeletal pain, and poorer body image were predictive of both decreased sexual interest and function. Vaginal pain symptoms were associated with greater dysfunction, while unhappiness with appearance was associated with decreased interest. Conclusions: Young women who receive chemotherapy are at risk for problems related to sexual functioning early in the survivorship period. This effect appears to be mediated through several physiologic and psychologic mechanisms, underscoring the need for interventions that target both.