Journal Article

Sexuality, body image and quality of life after high dose or conventional chemotherapy for metastatic breast cancer

Jenkins, Heather, Makar, Kami, Cumming, David C, Cumming, Ceinwen E, Nabholtz, Jean-Marc, Wentzel, Carolyn, Lees, Alan W, Hundleby, Marilyn, Kieren, Dianne K, Handman, Michael

1997

Overview

As survival has improved in patients with metastatic breast cancer, quality of life issues have become more important in clinical and research assessment of treatment. We examined psychological aspects of sexuality, body image and health-related quality of life (HRQOL) in 19 patients who had completed high dose chemotherapy and peripheral stem cell transfusion (HDC/PBSCT), and in 19 who had undergone conventional chemotherapy (CC). There were no differences in mean age, time since treatment or demographic variables except education level. We found no significant differences in HRQOL (Functional Living Index-Cancer) nor on the Body Image Scale. On a measure of sexual fears, 74% of the HDC/PBSCT patients and 63% of the CC patients thought that cancer would make them unattractive to their mates. As well, 68% of the HDC/PBSCT patients and 37% of the CC women were fearful of sex being painful as a result of their cancer (p<0.01). Sixty eight percent of HDC/PBSCT women and 47% of CCs had change in level of sexual desire since treatment following their diagnosis of metastatic disease. Eighty five per cent of HDC/PBSCT and all CC women experienced this as decreased desire. We found few significant differences between the groups, but there were noteworthy effects on body image and psychological aspects of sexuality with both treatments. Key words: Breast cancer, Sexuality, Body image, Health-related quality of life INTRODUCTION Breast cancer is the most common malignancy in women, responsible for 27% of malignant tumours and 20% of cancer deaths. Once metastatic disease is documented, it has been considered incurable, with a median survival time of less than 2 years (Henderson, 1991). Poor survival has lead to aggressive high dose chemotherapy regimes with autologous peripheral blood stem cell transplant support (HDC/PBSCT). Recently, it has been shown that at least 50% of women undergo remission with high dose chemotherapy, compared with 5-15% treated with multi-dose conventional chemotherapy (Booser & Hortobagyi, 1992). As length of survival following a cancer diagnosis has increased, there has been a shift in focus from dying of cancer to living with the disease. Interest has been directed, in general, toward the evaluation of the effects of breast cancer and related medical therapies on health-related quality of life (HRQOL) (Baum, Ebbs, Fallowfield, & Fraser, 1990; Boyd, Selby, Sutherland, & Hogg, 1988: Coates, Gebski, Stat, Bishop, Jeal, Woods, Snyder, Tatersall, Byrne, Harvey, & Gill. 1987; Hallgren, Paterson, & Arcand, 1984; Levine, Guyatt, Gent, De Pauw, Goodyear, Hryniuk, Arnold, Findlay, Skillings, Bramwell, Levin, Bush, Abu-Zahra, & Kotalik, 1988). The area of quality of life assessment is not without controversy, particularly in the definition of the construct. The present literature consensus defines \"health-related quality of life\" as encompassing three major domains: physical well-being, psychological state and social functioning. Other areas are also currently being included such as personal financial impacts, and sexuality and body image. There is an emerging literature on HRQOL in breast cancer patients during treatment in HDC/PBSCT programs (Ahles, Tope, Furstenburg, Hann & Mills, 1996; Larsen, Gardulf, & Nordstrom, 1996; Litwins, Rodrique, & Weiner, 1994; Weiner, 1994). McQuellon and colleagues (1976) have recently reported that long-term quality of life in breast cancer patients is unchanged following HDC/PBSCT. These authors also reported that in structured interviews, concerns about physical appearance and about personal and physical relations emerged. The substantial physical illness immediately after high-dose chemotherapy is reflected in poor HRQOL, but this rebounds to normal levels within one month following discharge (Cumming, Nabholtz, Wentzel, Handman, Clinch, Sansregret, & Cumming, 1996). There are no published comparisons of quality of life following conventional and high-dose chemotherapy in a population of breast cancer patients. Further, physicians dealing with clinical and research problems do not generally ask about side effects of treatment in which there is substantial subjective patient input. In particular, until recently researchers have placed little emphasis on sexuality and body image during and after either high-dose or conventional forms of treatment (Love, Levanthal, Easterling, Nerenz, 1989). Women believe themselves to be uninformed about the sexual side effects of cancer treatment (Kaplan, 1994) and about body image (Mathieson, 1994). They view these areas to be of major concern (Hopwood, 1993). The goal of the present study, therefore, was to examine health-related quality of life, sexuality, and body image in women with metastatic breast cancer who had undergone either conventional or high-dose chemotherapy. SUBJECTS AND METHODS SUBJECTS The subjects in the study were 38 women, age 30 to 63 years, from urban and rural areas of Western Canada.

• Publisher: SIECCAN, The Sex Information and Education Council of Canada,Sex Information and Education Council of Canada
• Subject: Age differences / Body image / Breast cancer / Canada / Cancer / Cancer patients / Chemotherapy / Clinical assessment / Clinical research / Correlation / Deaths / Desire / Disease / Drug effects / Educational attainment / Factor Analysis / Factors / Fear / Females / Health / Health aspects / Health status / Human body / Interviews / Likert Scales / Literature / Longitudinal Studies / Malignant / Medical care / Medical diagnosis / Medical treatment / Mental health / Methodological problems / Patients / Personal appearance / Personal finance / Physicians / Practitioner patient relationship / Psychological aspects / Psychological well being / Quality of care / Quality of life / Questionnaires / Remission (Medicine) / Representations of the body / Research Problems / Researcher subject relations / Rural areas / Rural communities / Rural urban differences / Self Concept / Sex (Psychology) / Sexual behavior / Sexual desire / Sexuality / Side effects / Social functioning / Stem cells / Subjectivity / Treatment methods / Tumors / Well being / Women