The impact of curative cancer treatment on sexual health - clinical results from the EORTC QLQ-SH22 validation study

Anne S Oberguggenberger; Veronika I Engele; Claudia Schmalz; Andy Nordin; Vesna Bjelic-Radisic; Anne Lanceley; Karin Kuljanic; Pernille T Jensen; Ligita Paskeviciute Frøding; Carien L Creutzberg; Kristin Zimmermann; Samantha Serpentini; Juan I Arraras; Eva Nagele; Hilde Toelen; Elfriede Greimel; EORTC Quality of Life Group

doi:10.1186/s12885-024-13123-7

The impact of curative cancer treatment on sexual health - clinical results from the EORTC QLQ-SH22 validation study

BMC Cancer. 2024 Nov 11;24(1):1374. doi: 10.1186/s12885-024-13123-7.

Authors

Anne S Oberguggenberger^#¹, Veronika I Engele^#², Claudia Schmalz³, Andy Nordin⁴, Vesna Bjelic-Radisic⁵, Anne Lanceley⁶, Karin Kuljanic⁷, Pernille T Jensen^{8

9

10}, Ligita Paskeviciute Frøding¹¹, Carien L Creutzberg¹², Kristin Zimmermann¹³, Samantha Serpentini¹⁴, Juan I Arraras¹⁵, Eva Nagele^{16

17}, Hilde Toelen¹⁸, Elfriede Greimel¹⁶; EORTC Quality of Life Group

Collaborators

EORTC Quality of Life Group:
Dagmara Kulis, Chie Wie-Chu, Krzysztof A Tomaszewski, Razvan Galalae, Thierry Almont

Affiliations

¹ Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria. [email protected].
² Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
³ Department of Radiotherapy, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
⁴ East Kent Gynaecological Oncology Centre, Queen Elizabeth the Queen Mother Hospital, Margate, UK.
⁵ Breast Unit, Department of Obstetrics and Gynecology, Helios University Hospital Wuppertal, University Witten/Herdecke; Medical University of Graz, Graz, Austria.
⁶ UCL Elizabeth Garrett Anderson Institute for Women's Health, Dept Women's Cancer, University College London, London, UK.
⁷ Clinical Unversity Hospital Centre Rijeka, Rijeka, Croatia.
⁸ Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
⁹ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁰ Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹¹ Department of Gynecology, Copenhagen University Hospital, Copenhagen, Denmark.
¹² Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands.
¹³ Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany.
¹⁴ Unit of Psycho-Oncology/Breast Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy.
¹⁵ Complejo Hospitalario de Navarra, Pamplona, Spain.
¹⁶ Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
¹⁷ Division of Medical Psychology, Psychosomatics and Psychotherapy, Department of Psychiatry, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
¹⁸ University Hospitals Leuven, UZ Campus Gasthuisberg, Leuven, Belgium.

^# Contributed equally.

Abstract

Background: The European Organization of Research and Treatment of Cancer (EORTC) has recently developed and validated a patient-reported outcome measure (PROM) for sexual health (SH) in cancer patients. Here, we present results from a secondary analysis of the EORTC QLQ-SH22 validation study. The objective was to investigate the impact of cancer treatment on SH over the disease trajectory into survivorship in patients who underwent curative treatment.

Methods: Participants completed the EORTC QLQ-SH22 and the EORTC QLQ-C30 assessing SH and Quality of Life. We analyzed differences in SH of patients on active cancer treatment compared to patients off-treatment (cross sectional group comparison) as well as changes in SH during the course of treatment (from pre-treatment to follow-up).

Results: Our sample consisted of n = 394 (66.2% females) curatively treated cancer patients with 34% of patients being on-treatment and 66% of patients being in their follow-up after primary treatment (off-treatment group). Compared to patients off- treatment, patients on active cancer treatment experienced less sexual satisfaction (p = .021, Cohen's d = .36) and libido (p < .001, d = .60) and had higher levels of fatigue (p < .001, d = .50). Importance of sexual activity, masculinity and femininity did not differ between groups. Treatment effects on sexual activity decreased with treatment completion (p < .001, d = .50). Patients undergoing intensified treatment (chemotherapy, radiation, or endocrine treatment) reported more treatment effects (subscale EORTC QLQ-SH22) compared to patients undergoing surgery only.

Conclusion: Our results highlight the negative impact of oncological treatment on SH and how increasing treatment intensity further impair SH. Sexual satisfaction and libido improve after treatment completion while other aspects (e.g. masculinity/femininity) do not change during survivorship. We suggest monitoring of SH from the start of cancer treatment on and beyond into survivorship using PROMs as part of routine cancer care. Routine monitoring allows systematic identification of patient's SH problems and may improve awareness as well as target intervention for those in need of care.

Keywords: Cancer; EORTC QLG; Quality of Life; Sexual health.

Publication types

Validation Study

MeSH terms

Adult
Aged
Cancer Survivors / psychology
Cross-Sectional Studies
Female
Humans
Libido / drug effects
Male
Middle Aged
Neoplasms* / psychology
Neoplasms* / therapy
Patient Reported Outcome Measures*
Quality of Life*
Sexual Behavior / psychology
Sexual Health*
Surveys and Questionnaires