Sexuality, Body Image and Quality of Life after High Dose or Conventional Chemotherapy for Metastatic Breast Cancer

Article excerpt

Kami Maker Ceinwen E. Cumming Alan W Lees Marilyn Hundleby Jean-Marc Nabholtz Dianne K. Kieren Heather Jenkins Carolyn Wentzel

Michael Handman & David C. Cumming

Departments of Oncology, Human Ecology and Obstetrics/Gynaecology

Cross Cancer Institute and the University of Alberta

Edmonton, Alberta

Correspondence concerning this paper should be addressed to Dr. C.E. Cumming, Department of Psychology, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2. Tel: (403) 432-8766; Fax: (403) 432-8357.

ABSTRACT: As survival has improved in patients with metastatic breast cancer, quality of life issues have become more important in clinical and research assessment of treatment. We examined psychological aspects of sexuality, body image and health-related quality of life (HRQOL) in 19 patients who had completed high dose chemotherapy and peripheral stem cell transfusion (HDC/PBSCT), and in 19 who had undergone conventional chemotherapy (CC). There were no differences in mean age, time since treatment or demographic variables except education level. We found no significant differences in HRQOL (Functional Living Index-Cancer) nor on the Body Image Scale. On a measure of sexual fears, 74% of the HDC/PBSCT patients and 63% of the CC patients thought that cancer would make them unattractive to their mates. As well, 68% of the HDC/PBSCT patients and 37% of the CC women were fearful of sex being painful as a result of their cancer (p<0.01). Sixty eight percent of HDC/PBSCT women and 47% of CCs had change in level of sexual desire since treatment following their diagnosis of metastatic disease. Eighty five per cent of HDC/PBSCT and all CC women experienced this as decreased desire. We found few significant differences between the groups, but there were noteworthy effects on body image and psychological aspects of sexuality with both treatments.

Key words: Breast cancer Sexuality Body image Health-related quality of life

INTRODUCTION

Breast cancer is the most common malignancy in women, responsible for 27% of malignant tumours and 20% of cancer deaths. Once metastatic disease is documented, it has been considered incurable, with a median survival time of less than 2 years (Henderson, 1991). Poor survival has lead to aggressive high dose chemotherapy regimes with autologous peripheral blood stem cell transplant support (HDC/PBSCT). Recently, it has been shown that at least 50% of women undergo remission with high dose chemotherapy, compared with 5-15% treated with multi-dose conventional chemotherapy (Booser & Hortobagyi, 1992).

As length of survival following a cancer diagnosis has increased, there has been a shift in focus from dying of cancer to living with the disease. Interest has been directed, in general, toward the evaluation of the effects of breast cancer and related medical therapies on health-related quality of life (HRQOL) (Baum, Ebbs, Fallowfield, & Fraser, 1990; Boyd, Selby, Sutherland, & Hogg, 1988: Coates, Gebski, Stat, Bishop, Jeal, Woods, Snyder, Tatersall, Byrne, Harvey, & Gill. 1987; Hallgren, Paterson, & Arcand, 1984; Levine, Guyatt, Gent, De Pauw, Goodyear, Hryniuk, Arnold, Findlay, Skillings, Bramwell, Levin, Bush, Abu-Zahra, & Kotalik, 1988). The area of quality of life assessment is not without controversy, particularly in the definition of the construct. The present literature consensus defines "health-related quality of life" as encompassing three major domains: physical well-being, psychological state and social functioning. Other areas are also currently being included such as personal financial impacts, and sexuality and body image. There is an emerging literature on HRQOL in breast cancer patients during treatment in HDC/PBSCT programs (Ahles, Tope, Furstenburg, Hann & Mills, 1996; Larsen, Gardulf, & Nordstrom, 1996; Litwins, Rodrique, & Weiner, 1994; Weiner, 1994). …