The current study was designed to evaluate the prevalence of sexual problems and the extent to which this impacted mood symptoms in cancer patients. Both the Institute of Medicine and the National Comprehensive Cancer Network (NCCN) identified quality psychologic care as a vital component of comprehensive cancer care (Adler & Page, 2008; Holland & Bultz, 2007). Sexual functioning is a quality of life issue that patients usually do not volunteer information about despite it being a major concern (Goncalves & Groninger, 2015)
Methods:
Adult patients seen from July 2014-February 2017 in an outpatient psychiatry oncology clinic who provided informed consent were included (N=2,130). Assessment tools include the Patient Health Questionnaire-9 (PHQ-9) to measure depression, the Generalized Anxiety Disorder scale (GAD-7) to measure anxiety, and the NCCN Distress Management Thermometer (DT) and Checklist to measure distress. Demographic variables included age, race/ethnicity, and marital status. Additional categorical variables included cancer diagnosis and psychiatric diagnosis. Data are presented as percentages or Mean±S.D.
Results:
Overall, more than one quarter (27.5%) of patients endorsed (checked Yes) “sexual problems” on the DT checklist. Patients who endorsed sexual problems were more likely to be male versus female (33.0% vs. 24.6%; χ2=16.7, p<.0001), younger (51.2±11.9 vs. 53.6±13.6 years, F1,2128=14.6, p=.0001), and more likely to be Black or Hispanic as compared to Caucasian (32.8% or 32.6%, vs. 25.8%; χ2=9.0, p=.03). Also, patients who endorsed sexual problems were more likely to be in a committed relationship (married or life partner) as compared to those who were single, separated, divorced or widowed (31.1% vs. 21.1%; χ2=24.5, p<.0001). Importantly, patients who endorsed sexual problems had significantly higher levels of depression (12.4±5.8 vs. 9.8±5.8, F1,2128=85.1, p<.0001), anxiety (11.0±5.9 vs. 8.6±5.7, F1,2128=74.2, p<.0001) and distress (6.1±2.7 vs. 5.2±2.9, F1,2128=44.4, p<.0001), but none of the demographic variables moderated these effects.
Conclusion:
The data indicate that one quarter of all patients seen at an outpatient psychiatric oncology clinic endorsed sexual problems and that these individuals exhibit significantly greater levels of depression, anxiety and distress. Patients who reported sexual problems tended to be male, younger and in a committed relationship. Since sexuality is a quality of life issue, it often does not surface until treatments are complete and the patient is in the survivorship stage of cancer. If a patient complains of depression or anxiety, it is important to also assess for sexual dysfunction. Conversely, if a patient reports sexual problems, he/she should be assessed for depression and anxiety. Funding: provided by the Hackett Family
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