Sexual Life Importance in Patients with Reproductive Cancers: A Questionnaire-Based Study

Received: 04-Feb-2022, Manuscript No. ijmrhs-22-53492 (M); Editor assigned: 08-Feb-2022, Pre QC No. ijmrhs-22-53492 (P); Reviewed: 19-Feb-2022, QC No. ijmrhs-22-53492 (Q); Revised: 23-Feb-2022, Manuscript No. ijmrhs-22-53492 (R); Published: 28-Feb-2022

Introduction

Sexuality plays a crucial role in the life of every person since it encompasses the physical, psychological, social, and cultural dimensions of the individuals. Different studies recognized how a cancer diagnosis and its treatment can impact the self-image and physical changes of the patients [1-3]. In this regard, many cancer patients reported many sexual problems that can also persist after the treatment [4-9]. For example, one study reported that among 40% and 100% of cancer patients experienced sexual disorders for both women and men [10,11]. Specifically, among men, prostate cancer patients have erectile dysfunction after prostatectomy, radiation, or hormone therapy [11]. Furthermore, these cancer patients try to face major challenges in sorting through new remedies to impotence and in finding new sexual terrain with their partners [12-14]. Furthermore, women after breast or gynaecology cancers reported different sexual dysfunctions such as decreased libido, and vaginal dryness [15]. Other studies observed that both male and female patients received less information about the potential sexual risks of the therapy in oncology care settings [16-21]. In particular, Reese, et al., observed that a sexual consultation was offered only to 22% of men and 17% of women during cancer treatment [22]. Although practice guidelines include discussion of sexual life for cancer patients, most of them do not have discussions on these topics with oncologists/Healthcare Professionals (HCPs)/Oncological Nurses (ONs) [23-26]. In a study, 76% of breast cancer patients reported that it was important to discuss treatment-related sexual problems with their oncologists, yet only 33% received such information [27]. Moreover, many patients are reluctant to communicate their sexuality to oncologists/HCPs/ONs because they very often feel a strong embarrassment to talk about these topics [28]. In another study, Reese, et al., observed that approximately 1/3 (22/67 patients) of women with breast cancer had sexual problems, and only 45% (10/22 patients) of them were able to have sexual health communication [29]. Furthermore, the authors reported that the discussion on sexual health occurred only with 27 patients (40%) and generally, the oncologists started the discussion in 72% of cases. The authors concluded that communication about sexual health was uncommon even for women reporting sexual problems [29]. Furthermore, the Quality of Life (QoF) is a critical aspect related to different kinds of cancer. In this regard, cancer can produce negative consequences in several areas of a cancer patient’s life [30-33]. In this scenario, effective communication between a cancer patient and oncologist/HCP can help to identify the sexual problems of patients after a diagnosis of cancer [34- 38]. Many gaps are persisting in knowledge about patient-oncologists/HCPs/ONs communication on sexual health in reproductive cancers. Few studies have examined the importance of these discussions and their relationship with the health status (both physical and mental) of cancer patients. The primary aim of this study was to better understand, through a simple questionnaire, (1) the sexual life importance in patients with reproductive cancers and (2) the quality of communication about these topics with the oncologists/HCPs/ONs.

Materials and Methods

Sample

The study sample consisted of participants from 18 years on, with a diagnosis of different kinds of cancer (such as breast, cervix, or prostate and testicle), who were attending an oncology outpatient. The study was conducted in a sample of 251 cancer patients and approved by the Ethics Committee of the Medical Faculty of the University. Informed consent was obtained from all individual participants included in this study before the initial oncological consultation.

Recruitment and Data Collection

The recruitment period was from 2017 and 2019 in a sample of 251 cancer patients (144 females and 107 males with a mean age of 47 years). Of these, 253 respondents completed the written informed consent form, resulting in a 98.6% response rate. After excluding two subjects who did not answer or fill in a blank, 251 subjects were finally included in the analysis. One of the researchers (MGC) trained the research staff to seek participants’ consent and collect data for this study. The research staff explained the purpose and procedure of this study to the subjects who then agreed to participate. The questionnaire was then distributed to the subjects in a separate room at the outpatient department. The time required to complete the questionnaire was approximately 20 min. There was no incentive to participate in this study.

Instrument

A brief questionnaire was given to the participants, which consisted of two parts: the first, asking general information about the age, sex, education level, marital status, and job. The second consists of the analysis of (1) sexual life importance and (2) quality of communication with oncologists/HCPs/ONs on sexual issues. Sexual life importance and quality of communication were measured with 2 items using the EORTC SHQ-C22 questionnaire at first oncological consultation (T0) and another oncological consultation after 12 months (T12). All items were assessed with a fivepoint Likert scale ranging as follows; 1 (not at all), 2 (a little), 3 (moderate amount), 4 (much), 5 (very much). Details of cancer site, cancer stage, time, and treatment were obtained from patients’ medical records.

Moreover, some participants’ written comments in response to the Open-Ended Question (What do you think about sex life after diagnosis and during the therapy?) were reported during the two oncological consultations (in Italian language and translated into English). In these comments, the cancer patients tried freely to figure out their emotions, their fears, their concerns, and their plans for the future. The transcripts of answers to the open-ended question were analyzed by all investigators according to the themes that emerged and were reported in the supplementary data.

Statistical Analysis

All statistical analyses were performed using the Statistical Package for Social Sciences (version 23, SPSS Statistics, IBM Corp, Chicago IL, USA, 2016). The socio-demographic characteristics and disease characteristics of the cancer patients were analyzed by using descriptive statistics. The importance of sex life and quality of communication with oncologists/HCPs/ONs according to gender, age and education were analyzed by Chi-square and t-test methods. To secure more reliable statistical results-as for other variables like type and stage of cancer there is too little data-the analysis was concentrated on three macro variables: gender, age, and education.

Results

Socio-Demographic Characteristics

At the time of the first visit, all patients filled out a brief socio-demographic questionnaire. Among our patients (pts=251), the mean age was 47 years (S.D. 10.44) and there were more females (57.37% =144) than males (42.62% n=107), respectively (Table 1). 60.55% of participants were employed, while 29.44% were not employed. Furthermore, 40.23% of patients had low education, while 59.76% had a high education (Table 1). The most common cancer type was breast cancer (32.5%) among the female patients, followed by cervix cancer (19.92%). Of the 107 male patients, 24.5% (n=59) had prostate cancer, while 19.12% (n=48) had a testicular germ-cell cancer. Most patients had in situ (54.98%), in situ, and local (27.49%) in situ and distant (17.2%) cancers and they had received surgical, surgical/ chemotherapy, or surgical/radiological (72.49%) treatment (Table 1).

Sexual Life Importance of Cancer Patients in Two Different Consultations

In our study, all considered patients answered the questionnaire during two different consultations (T0 and T12). The sample at T0 consisted of 251 patients. The total average score for the first question on sexual life importance at the time T0 was 2.98. Considering sex, age, and education variables, the only significant difference was observed for sex, with the average score for females and males of 2.5 and 3.5 respectively (Figure 1A). Among female patients, 59% and 46.35% indicated that the sexual life was little important (score 2) or moderately important (score 3), respectively. Among male patients, 42% and 51% reported that their sexual life was moderately important (score 3) or much important (score 4), respectively. Significant differences were observed in the global scores of sexual life importance suggesting that male patients believed that the sex life was more important when compared with female patients (χ2= 9.1<0.01 t=11.8 <0.01) (Figure 1A) (Table 2).

Figure 1. The sexual life importance (A) and quality of communication (B) by gender during two different consultations (T0 and T12)

At the second consultation (T12) the sample was reduced as 25 female patients 22 male patients died, respectively and hence the total sample was composed of 172 patients. The importance attributed to sex life (question 1) increased for both male and female patients by reaching the total average of 3,4, whereas the average score for females was 3,04 and for males 3.9 (Figure 1A). 81% of female patients believed that the sexual life was moderately (score 3) or much important (score 4), while 95% of male patients believed that the sexual life was much (score 4) or very much important (score 5).

The difference between male and female patients about the importance of sexual life significantly reduced over the considered time (χ²= 3.9<0.01 t=12.8<0.01) (Figure 1 A) (Table 3). In both T0 and T12 consultations, the individual scores behaved in “normal ways” with the higher frequencies about the average. We did not find a significant difference in the sexual life importance of the patients considering the age or the education (data not shown) in both consultations.

Quality on Communication of Cancer Patients in Two Different Consultations

Participants were asked if they have had communication with their oncologists/HCPs/ONs about their sexual life (question 2). The total average score for the second question at the time T0 was 2.5. Specifically, the average score for females was 2.1 and for males 3.1 (Figure 1B). The majority of the female patients (91%) answered that they had little (2) or moderate amount (3) of communication on this topic, while the majority of the male patients (90%) answered that they had communication in moderate amount (3) on after first consultation (T0).

At the second consultation (T12), the quality of communication on sex life with their oncologists increased for both male and female patients by reaching a total average of 3.2, whereas the average score for females was 2.8 and for males 3.7 respectively (Figure 1B). The female patients (74%) answered that they had communication in moderate amount (3) on their sexual life, while the 14% and 75% of male patients answered that they had communication in moderate amount (3) or much important (4) on their sex life, respectively. The difference between male and female patients about the communication on their sexual life with their oncologists was highly significant (χ2=11<0.01 t=12.5<0.01) (Figure 1B) (Table 3) at the first consultation (T0). After one year (T12), we observed a decreased difference between female and male patients (χ2=4.4<0.05 t=12.2<0.01) (Table 3).

We did not find a significant difference in the quality of communication about the sexual life of the patients considering as variables the age or the education (data not shown) in both consultations.

Discussion

Different studies have pointed out that cancer may negatively impact the sexual function and sexual activity of cancer patients [39-41]. Generally, sexual health is correlated with physical, emotional, mental, and social wellbeing World Health Organization (WHO) [42]. This is a major issue for cancer patients who can often suffer from both sexual dysfunctions (such as erectile dysfunction or vaginal dryness) and psychological distress (such as body image and the formation relationships) [43-45]. Hence, these problems can be addressed through effective and emotional communication between oncologists/HCPs/ONs and patients [46-49].

Our study examined the sexual life importance and the quality of communication for reproductive cancers outpatients through a brief questionnaire in two different consultations at T0 and T12. At the beginning (T0), we observed that the sexual life importance of male patients was higher than those of female patients who (most of them) believed that their sexual life was not so important after a cancer diagnosis. We supposed that the female patients might be very embarrassed to talk about their sex life after a cancer diagnosis (T0). Therefore, oncologists/HCPs/ONs should support in particular female patients for coping with their sexual problems and their reluctance to ask for professional help. This result is following two previous studies showing that female patients talked less with oncologists/HCPs/ONs regarding sexual life than male patients [50,51]. The first study reported that only 4.8% of female patients talked with oncologists/HCPs/ONs about their sex life, whereas 21% of male patients did [50]. In the second study, Gilbert, et al., observed that approximately only 43% of female patients had communication with an oncologist/HCPs/ONs compared to 68% of male patients [51]. After one year, we noted that sex life importance become moderately or very important in most female patients (81%). This can happen because the emotional impact of cancer diagnoses, isolation, and loss of self-esteem can be reduced to face more easily their fear of sexual life after a year (T12). Furthermore, we reported the same result on the quality of communication on these topics: 1) the majority of the female patients (91%) had little communication with their oncologists/HCPs/ONs at T0; 2) the quality of communication increased for both sexes after a year. In this context, we could suppose that the behaviour of these patients can be linked both to increased confidence with their oncologist/HCPs/ONs and to a strong awareness of their sexual problems after treatment, evidenced by the short interviews given by some patients (Supplementary Data) [52-55]. Our results also suggest substantial room for improvement in clinical communication about sexual life for reproductive cancer patients [22,29,55]. In other words, it is necessary to support the emotional stability of all patients by providing good information and communication during cancer patient counselling. In this regard, the modifications that occur in the sexuality of cancer patients can be so profound and mutilating that the whole affective and sexual patients’ life can be impaired. Also, cancer could predispose to psychological and social isolation, based on negative feelings that permeate interpersonal relations. In this regard, both oncologists and other HCPs/ONs have to be aware of changes to sexuality and intimacy after cancer. Thus, they should be trained in communication skills to recognize the needs of patients [56-58]. On the other hand, oncologists/HCPs/ONs need more time to better understand what patients verbalize during oncological consultations [38,50,51]. In conclusion, oncologists/HCPs/ONs should not ignore the importance of sexuality for the physical and psychological well-being of the person with cancer. In the future, all oncological health professionals (oncologists/ HCPs/ONs) should ask themselves: is this person in need of factual knowledge, or is she/he more in need of emotional support? This is indeed a major challenge for future health care.

Conclusion

Discussion about sexual health for cancer patients is important for choosing the appropriate treatment pathways and improving the patient-oncologist/HCP/ON relationship. In this context, it will be possible to better address a range of sexual problems that patients with reproductive cancers experience during their treatment. In this way, clinical discussions of sexual health will lead to the implementation of effective solutions and better outcomes for patients.

Declarations

Acknowledgements

The research team wishes to thank all the people with cancer that participated in the study. All research staff who helped them complete the questionnaire after the oncological consultations The team also wishes to thank Vittoria De Santis for your help and methodological support.

Conflict of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

The authors declare that all the research meets the ethical guidelines.

Funding

The author(s) received no financial support for the research.

Authors’ Contributions

Maria Grazia Criscuolo and Stefania Perna conceived and planned the project. Gabriella Marfe, Carla Di Stefano, and Stefania Perna participated in study design in the development of methods for data collection and analysis. Arturo Hermann has developed a methodology, software, formal analysis, and data curation. All authors contributed to the refinement of the study protocol and approved the final manuscript.

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