Sexual function in male lymphoma survivors in relationship to age, gonadal hormones and psychosocial issues, and compared to matched controls

Reviewer: Christine Hill-Kayser, MD
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 3 de junio del 2009

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Presenter: Cecilie E. Kiserud
Presenter's Affiliation: The Norwegian Radium Hospital, Oslo, Norway
Type of Session: Scientific

Background

  • As improved cancer screening and treatments continue to result in higher rates of cancer survival, issues of quality of life, including sexual function, are of utmost importance.
  • Sexual dysfunction is a common late effect following cancer treatment. Male sexual dysfunction is most commonly associated with treatments for cancers of the prostate and other organs of the male genitourinary system; however, even in these populations, issues of sexuality may not be discussed as often as they are present.
  • Although sexual dysfunction in association with lymphoma survivorship may be discussed even less frequently, it remains prominent, with 20-30% of male Hodgkin’s lymphoma survivors reporting decreased sexual interest and function 10 years after having completed cancer treatment (Fobair, 1986), and over 50% of lymphoma survivors describing some degree of sexual dysfunction (Aksoy, Support Care Cancer, 2008).
  • Despite the relative prominence of sexual dysfunction in the lymphoma survivor population, studies regarding the topic are relatively sparse. The study described here was designed to examine self-reported sexual dysfunction in male lymphoma survivors, and to identify factors associated with self-described sexual dysfunction; in addition, this study aimed to compare sexual dysfunction rates in the lymphoma survivor population to those in an age-matched Norwegian population.

Materials and Methods

  • The study described here was designed to assess subjects in a cross-sectional manner. Subjects completed questionnaires on a one-time basis regarding sexual function (Brief Sexual Function Inventory [BSFI]), socioeconomic factors, mental distress (Hospital Anxiety and Depression Scale [HADS]), Fatigue (Fatigue Questionnaire [FQ]), and physical/mental health (Short-Form 36 Health Survey [SF-36]). Additionally, serum gonadal hormone assays were performed (testosterone, LH, FSH, SHBG levels).
    • Brief Male Sexual Function Inventory
      • 11 item questionnaire, requiring response of 0 (poor function) to 4 (excellent function) per question, and regarding sexual drive, sexual function, ejaculatory function, problem assessment, and overall sexual satisfaction.
  • Participants were required to meet the following eligibility criteria:
    • History of Hodgkin’s or non-Hodgkin’s lymphoma, age 50 years or less at time of diagnosis and 18 years or more at time of survey, diagnosis between 1980 and 2002, diagnosis performed at the Norwegian Radium Hospital, and presence of available gonadal hormone assays.
  • Normal controls were selected in the following manner:
    • Questionnaires, including the BSFI, were sent to 3500 Norwegian men, aged 20 – 79 years, in 2004.
    • With a response rate of 34%, 1185 surveys were returned.
    • From this population, two age-matched controls were selected for each lymphoma survivor participant.
  • Using these methods, 246 survivors and 492 controls participated in this study.
  • Of the 246 survivor participants, 138 were survivors of Hodgkin’s lymphoma (HL), and 108 of non-Hodgkin’s lymphoma (NHL).
    • The mean age at the time of the survey was 47.4 years [(45.7 for HL survivors, and 49.6 for NHL survivors (p < 0.01)].
    • The mean time since diagnosis was 14.8 years (15.2 years for HL survivors, and 14.3 years for NHL survivors).
    • 79% of survivors reported being in committed relationships (77% of HL survivors and 81% of NHL survivors).

Results

  • Mean BSFI scores were not significantly different for survivors of HL versus NHL in any question category.
  • Mean BSFI scores were significantly higher for younger lymphoma survivors, with improved sexual function being statistically significant for comparison of 21-39 year olds, 40-49 year olds, 50-59 year olds, and 60-69 year olds
  • Survivors with low testosterone and elevated LH levels (n = 70) had lower mean BSFI scores than those with normal gonadal hormones (p < 0.001)
  • Factors that were significantly associated with BSFI scores in the lymphoma survivor group included age at the time of survey, testosterone/LH levels, HADS score (assessing mental distress), and SF-36 score (assessing physical/mental health). Specific lymphoma diagnoses, FSH levels, total fatigue score, and follow-up did not appear to affect BSFI scores.
  • Mean BSFI scores in categories of erection, ejaculation, and sexual satisfaction were significantly higher in the control population than the survivor population (p < 0.02). Mean scores for sexual drive did not differ between controls and survivors.

Author's Conclusions

  • The authors conclude that long-term male lymphoma survivors have reduced sexual function when compared to normative controls.
  • They note that factors associated with reduced sexual function in male lymphoma survivors include older age, increased mental distress, lower self-reported physical health, and abnormal gonadal hormone levels (low testosterone and/or elevated LH).

Clinical/Scientific Implications

  • As the number of living cancer survivors around the world increases, survivorship issues continue to gain importance. As time since diagnosis increases for an individual survivor, and risk of progressive/recurrent disease decreases, quality of life concerns may become particularly important.
  • Sexual side effects remain an underdiscussed aspect of survivor care, potentially due to both physician and survivor embarrassment, as well as underrecognition of sexual problems in cancer survivors.
  • Although survivors of prostate and testicular cancers may routinely be provided with questionnaires regarding sexual function, other survivor groups may not be.
  • For all of these reasons, the study described here is important, and a valuable contribution to the literature.
  • The authors have undertaken a comprehensive assessment of sexual dysfunction in male lymphoma survivors, and have utilized an adequate, case-matched control population. Neither of these accomplishments being simple or easy to come by, the authors are to be commended for their efforts.
  • Their findings, while not entirely unexpected, are one of the few documented commentaries on sexual function in this survivor population, and demonstrate that sexual dysfunction is a real and prominent concern in the lymphoma survivor population.
  • Clinical efforts may focus on further discussion of sexual dysfunction in follow-up of lymphoma survivors, as well as initiation of therapy when indicated.
  • Further more, the authors’ findings may be extrapolated to other underrepresented survivor groups in the absence of confirmatory data to support discussion of sexual function in all follow-up visits for cancer survivors.

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