Abstract P4-11-05: How to stay sexually active and sexually well-functioning after breast cancer - Reporting from the SWEET study
Authors: Solveig Katrine Smedsland, Kathrine Vandraas, Synne Bøhn, Alv Dahl, Cecilie Kiserud, Mette Brekke, Ragnhild Falk, Kristin Reinertsen
Journal: Cancer Research (2022)

Abstract Background: Sexual challenges are frequently reported by breast cancer survivors (BCSs). The treatment and associated side effects may all contribute to sexual problems in BCSs. Knowledge concerning sexual activity and functioning among long term BCSs (&amp;gt;5 years after diagnosis) is however limited. The aims of this study were therefore to assess the prevalence of sexual activity and to explore modifiable factors associated with reduced sexual functioning in BCSs 7-8 years after diagnosis, with the ultimate aim of improving follow-up care for BCSs. Methods: The SWEET (survivorship-work-sexual health) study is a cross-sectional nation-wide questionnaire study examining work and sexual health among long-term BCSs in Norway. All women diagnosed with early stage breast cancer (BC) at the age of 20-65 years in 2011 or 2012 without pre- or post- malignancies were identified by the Cancer Registry of Norway (CRN) and invited to study-participation during the fall 2019. Of 2803 BCSs invited, 1361(49%) returned the questionnaire. Of these, 54 were excluded due to incomplete questionnaire, inadequate consent or self-reported BC recurrence, resulting in a final sample of 1307 BCSs. Data were collected using validated questionnaires (Sexual Activity Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR23, Fatigue Questionnaire, The Patient Health Questionnaire-9 and Godin Leisure Time Questionnaire) and questions regarding socio-demography, general health, sleep and cancer treatment. Supplementary cancer related information was obtained from the CRN. Logistic regression analyses examined variables associated with partnered sexual activity. Linear regression analyses examined variables associated with sexual pleasure and sexual discomfort in sexually active BCSs. Results were presented as odds ratio (OR) and beta coefficients (B) with p-values (p). Results: Mean age of BCSs was 51.7 years at diagnosis and 59.7 years at survey. Most participants lived with a partner (74%) and had been treated for BC stage I (45%) or II (36%) with breast conserving surgery (59%), radiotherapy (80%), endocrine therapy (65%) and chemotherapy (69%), while 23 % reported current use of endocrine therapy. Forty-eight percent of the BCSs were sexually active with a partner. Living with a partner (OR 5.2, p&amp;lt;0.001) and having a better body image*(OR 1.01, p&amp;lt;0.001) were positively associated with sexual activity, while older age (OR 0.96, p&amp;lt;0.001) and treatment with aromatase inhibitor (OR 0.58, p=0.002) were negatively associated with sexual activity. Physical activity (B 0.61, p=0.04) was associated with more sexual pleasure, while living with a partner (B -1.68, p&amp;lt;0.001) and experiencing a major depression (B -1.04, p 0.046) were associated with less pleasure. Obesity (B -0.63, p=0.005) was associated with less sexual discomfort, while living with partner (B 0.87, p&amp;lt;0.001), treatment with aromatase inhibitor (B 0.61, p=0.003), sleep problems (B 0.37, p=0.03), breast symptoms* (B 0.01, p=0.01) and chronic fatigue (B 0.43, p=0.03) were associated with more discomfort. Conclusion: Almost 50% of BCSs were sexually active 7-8 years post diagnosis. Several modifiable factors associated with sexual challenges were identified, including a negative body image, physical inactivity, major depression, sleep problems, breast symptoms and chronic fatigue. In the follow-up of BCSs experiencing sexual problems, these factors should be assessed and handled appropriately. BCSs treated with aromatase inhibitor should be offered treatment for gynecological symptoms and a switch to tamoxifen may be discussed. *continuous variable with scale 0-100 Citation Format: Solveig Katrine Smedsland, Kathrine Vandraas, Synne Bøhn, Alv Dahl, Cecilie Kiserud, Mette Brekke, Ragnhild Falk, Kristin Reinertsen. How to stay sexually active and sexually well-functioning after breast cancer - Reporting from the SWEET study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-05.