(010) Correlates of Sexual Dysfunction in Young Adult Cancer Survivors: A Project REACH Study
Authors: Chevalier L , Bober S , Bice B , Mccormick K , Recklitis C 
Published: May 2023

Abstract

Introduction
Cancer treatment early in life contributes to a wide range of late effects such as sexual dysfunction, fatigue, sleep disturbances, and widespread pain. Although these concerns have been found to be related in older survivors, research is limited in young adult cancer survivors (YACS), particularly using validated measures of sexual dysfunction.

Objective
The current study aims to address this gap in research by describing relationships between sexual dysfunction and fatigue, sleep, and pain in YACS.

Methods
164 young women (aged 18-39) previously treated for pediatric cancer completed self-report measures on sexual function, fatigue, sleep, and pain through Project REACH, a prospective cohort study. Sexual function was assessed using the Female Sexual Function Index (FSFI-6); participants were classified as experiencing significant sexual dysfunction if they scored ≤ 19 on this measure. Participants also completed the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and items adapted from the Brief Pain Inventory. Of note, lower FACIT-F, higher PSQI, and higher pain scores represent more impaired functioning. T-tests were used to compare participants with and without sexual dysfunction on fatigue (FACIT-F total score), sleep (PSQI total score), and pain (days of severe pain in the last week). A logistic regression was also performed to understand the effects of fatigue, sleep, and pain on the likelihood that participants would have sexual dysfunction.

Results
Over half (56%) of participants were classified as experiencing significant sexual dysfunction. Participants with sexual dysfunction had significantly more severe fatigue (p&lt;.001), significantly worse sleep (p=.02), and significantly more days of severe pain (p=.006) than those without sexual dysfunction. The logistic regression model with fatigue, sleep, and pain was significant (p&lt;.001) and correctly classified 69% of participants. In this model, more severe fatigue was significantly associated with an increased likelihood of having sexual dysfunction (OR=0.93, 95% CI [0.88-0.98]). More frequent severe pain was associated with an increased likelihood of having sexual dysfunction (OR=2.49, 95% CI [0.99-6.28]), although this finding was only marginally significant (p=.053). Sleep was not significantly associated with sexual dysfunction in the model.

Conclusions
As hypothesized, female YACS with sexual dysfunction had higher levels of fatigue, worse sleep, and more frequent severe pain than those without sexual dysfunction. However, when included in a logistic model, fatigue but not sleep was significantly associated with an increased likelihood of sexual dysfunction. This suggests that consistent with previous research on cancer survivors, fatigue in this population is more than simply the result of poor sleep. Fatigue may need to be directly addressed to improve sexual function in YACS. Although only marginally significant, overall pain may also contribute to sexual dysfunction in this population; as severe pain was infrequent and the sample small, future research should examine this relationship in larger samples. Additionally, as the current study examined general pain, more research is necessary to determine whether sexual or non-sexual pain is driving the potential relationship between sexual dysfunction and frequency of severe pain.

Disclosure
No