Sexual Morbidity and Mindfulness in Long-Term Breast Cancer Survivors
Authors:   , Raggio Greer Alicia , Butryn Meghan L 
Published: July 2024

Background: Research indicates that sexual morbidity, characterized by disruptions in sexual activity, sexual function, body image, and sexual distress, is common among breast cancer (BC) survivors. Known correlates of sexual morbidity include younger age, chemotherapy treatment, lack of partner intimacy, and poor psychological health. Study Aims: The present study had three objectives: (1) to assess sexual morbidity in a sample of long-term BC survivors, (2) to examine the associations between sexual morbidity and medical and psychosocial variables, and (3) to evaluate mindfulness as a potential moderator between medical covariates and sexual morbidity. Method: Survey data were collected from BC survivors (N= 83) meeting the following criteria: age 18 to 75 years, received a BC diagnosis at least 3 years ago, completed treatment for BC, no recent history of other cancers, and currently cancer-firee or with stable BC. Statistical Analyses: Pearson's correlations, independent samples t-tests, and multiple linear regression analyses with interaction terms were performed to test the asserted hypotheses. Results: Of the total participant sample (N= 83, mean age 56.2 years, 83% Caucasian), 46% had mastectomy surgery, 58% received prior chemotherapy, 39% reported treatment-induced menopause, 62% experienced post-treatment weight gain, and 6% reported a BC recurrence. Among partnered participants (n = 58), 43% reported no partnered sexual activity in the previous 4 weeks, and between 61% and 74% met criteria for sexual dysfunction (based on sexual distress and physical sexual function scores, respectively). These rates, in addition to mean body change stress and body satisfaction scores, were worse than normative and several BC comparison groups (data cited in text). Sexual distress was significantly associated with worse scores on depression, marital satisfaction, and physical activity acceptance, and greater body satisfaction was significantly correlated with higher reported physical activity. Mindfulness was a significant psychosocial correlate; greater mindfulness was associated with less sexual distress (r = -.38,/p <.001), greater body satisfaction (r = .44,p <.001), less body change stress (r = -.35, p = .008), and better sexual function (r = .28, p = .040). Mindfulness remained significant on all accounts except body change stress after controlling for age, weight control, premature menopause, and mastectomy. Of the medical correlates, mastectomy predicted worse sexual function (B = -6.24, SEb = 2.82,/p = .032), and greater sexual distress (B = 1.67, SEb = -44,p <.001) and body change stress (B =1.80, SEb = .43, p <.001) in multiple regression analyses. Conclusions: The prevalence of sexual problems in this sample of BC survivors was higher than suggested by normative data. Dispositional mindfulness and mastectomy were significant correlates of sexual morbidity, with mindfulness serving a protective function and mastectomy posing a risk. BC patients should be aware of these elevated rates and risk factors and may consider preventive sexual counseling prior to and following cancer treatment. Therapy strategies employing mindfulness principles to promote positive body image and prevent disruptions in sexual function should be explored in future intervention research.