Abstract P6-12-25: Sexual function in breast cancer survivors stratified by adjuvant therapies and surgical modalities
Authors: Gandhi C , Butler EC , Pesek S , Kwait R , Clark M , Raker C , Stuckey A , Gass J 
Published: February 2018

Abstract
Background: Breast cancer survivors comprise the largest group of cancer survivors in the United States. With increasing duration of recurrence-free survival, more women sustain the long-term consequences of treatment affecting quality of life. Our study aims to investigate associations of surgical modality, chemotherapy, radiation and endocrine therapy on sexual function of breast cancer survivors.
Methods: An anonymous, cross-sectional survey of 585 patients in surveillance after breast cancer therapy was conducted at a single academic breast cancer center. The survey questions included surgical modality, adjuvant therapies, and sexual function using the Female Sexual Function Index (FSFI). Median FSFI (mFSFI) results were stratified by surgery type and by receipt of chemotherapy, radiation, and endocrine therapy. Statistical analysis was performed using Fisher's exact and the Wilcoxon rank-sum tests or the Kruskal-Wallis test.
Results: Of the 585 respondents, 55.3% were &lt; 60 years old and 51.3% were sexually active. Surgical modalities included lumpectomy (L=406), mastectomy with reconstruction (MR=129) and mastectomy without reconstruction (M=50). For adjuvant therapy, 405 patients received radiation, 276 received chemotherapy, 117 reported tamoxifen (TAM) use, and 189 reported aromatase inhibitor (AI) use.
For all patients stratifying for receipt of adjuvant chemotherapy or radiation therapy, there was no difference in mFSFI scores (radiation: 26.7 vs 28 p=0.2, chemo: 26.5 vs. 27.5 p=0.1). Regarding endocrine therapy, AI patients had statistically significant lower mFSFI compared to no endocrine therapy or TAM (22.2 vs. 27.9 vs 29.6, p &lt;= .0001).
mFSFI Scores by Adjuvant TherapiesVariablenmFSFIRangeIQRP valueRadiation: Yes20726.77.2-36.021.5-30.5 Radiation: No7128.010.7-34.822.4-31.70.2 Chemo: Yes13326.57.2-36.021.0-30.5 Chemo: No14527.510.8-35.722.2-31.20.1 TAM and AI223.121.5-24.621.5-24.60.2TAM Only7429.611.6-35.724.6-32.30.07AI Only8522.27.2-35.718.1-28.3&lt;0.0001Neither11227.99.8-36.023.2-31.0Ref
Patients on AI had significantly lower scores in all FSFI domains except for orgasm. For patients on TAM, the desire and lubrication domains showed statistically significantly lower scores compared to nonusers of endocrine therapy (p= 0.03).
There was no significant difference in mFSFI by surgical type, although patients with MR had the highest score at 28.5. Controlling for surgical modality and stratifying by adjuvant treatment, radiation and chemotherapy did not have statistically significant effects on sexual function. Patients reporting L and TAM use had mFSFI significantly higher than those with AI use (29.4 vs 23.7, p=0.005). For MR patients reporting AI use, mFSFI was significantly lower than those on no endocrine therapy (18.1 vs 29.6, p&lt;0.0001).
Conclusions: Our study does not show an association of surgical modality, receipt of chemotherapy or radiotherapy and sexual function as measured by FSFI. Patients receiving endocrine therapy with an AI had significantly lower sexual function scores, than those who received no endocrine therapy or those on tamoxifen. These data may guide clinicians in counseling sexually active breast cancer patients in surgical planning and in survivorship.
Citation Format: Gandhi C, Butler EC, Pesek S, Kwait R, Clark M, Raker C, Stuckey A, Gass J. Sexual function in breast cancer survivors stratified by adjuvant therapies and surgical modalities [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-25.