For cancer patients, sexual dysfunction is often a long-term side effect of treatment, and can have a significant impact on quality of life. To better understand long-term sexual dysfunction in cancer patients, and develop therapies tailored to their needs, researchers from Duke University argue that there is a “need for a flexible, psychometrically robust measure of sexual function for use in oncology settings.” To that end, the researchers conducted a focus-group based study with cancer patients and cancer survivors to learn more about which aspects of treatment have the most detrimental impact, and how, despite these drawbacks, many patients say they have experienced more fulfilling sexual intimacy after beating cancer.
Authors of this new study, published in the journal Psycho-Oncology, suggest that better methods for incorporating discussion or therapy relating to sexuality may be particularly important for cancer patients—not only during treatment, but in the years that follow. They write: “Sexuality and body image are concerns for patients at all stages of disease progression. Unlike many other side effects of cancer treatment, sexual problems commonly do not resolve in the first 2 years of disease-free survival but may remain constant and relatively severe.”
The researchers recruited cancer patients or cancer survivors ages 18 and older to discuss how treatment had impacted their sexual intimacy in a series of 16 single-gender focus groups. After four initial focus group sessions—each involving four to 12 patients—researchers then narrowed the discussion to four main subjects: the magnitude and importance of sexual issues to cancer patients; the way cancer treatment impacted different aspects of intimacy (desire, arousal, intercourse, orgasm); the impact of cancer treatments on intimacy and body image; and, for younger patients, how cancer treatment impacted fertility.
The study authors found that, unsurprisingly perhaps, the vast majority of patients said that sexual intimacy was less important than basic survival, but that it was still a critical component of quality of life. People who suffered from different types of cancer (and therefore received different types of treatment) expressed varying concerns about the way in which treatment interfered with intimacy—prostate cancer patients struggled with impotence or incontinence, for example, women who’d been treated for gynecological cancers often suffered from “compromised sexual functioning” as a result of surgical or radiation therapy, and lung cancer patients struggled with shortness of breath—but overall, most groups found that fatigue, hair loss, body image and discomfort limited sexual enjoyment. (Women tended to express more concern over fertility than men, are were more likely to consider fertility preservation in treatment, but both genders said that, broadly, sexual intimacy was a separate issue from fertility.)
In spite of the common symptoms that many cancer patients shared that limited sexual functioning researchers found that, in many cases, patients who were most content with their sexual relationships had come to separate sexual intimacy from sexual function. That is, they wrote, “[o]verall evaluations of satisfaction with sex life did not necessarily correspond to specific aspects of functioning, as many participants described satisfaction with sex life and intimacy despite decreased sexual function.” As one focus group participant battling breast cancer put it: “We can enjoy each other without having sex, and a lot of times, it’s the closeness, the intimacy, more so than it is the actual act of intercourse… [Sex] was intended but both of us were so tired that we would lie in bed and hold hands and say, “Oh, is that good for you?”
Based on these findings, the researchers hope to develop a specific measurement expands on the existing Patient-Reported Outcomes Measurement Information System (PROMIS)—an initiative run by the National Institutes of Health and seven universities aimed at improving patient-outcome data—to focus specifically on the impact of treatment on sexual fulfillment, dubbed PROMIS Sexual Function. In keeping with the finding that, in many cases, cancer patients’ notions of sexual fulfillment and intimacy changed and grew, apart from basic physical functioning, study authors say that an important next step in the research is analyzing the role of committed partners and long-term relationships on cancer patients’ sexual satisfaction. Previous studies have found that people who are married may have a better chance of surviving cancer—perhaps maintaining sexual intimacy plays a part.