Sexual problems after treatment, interventions that help 1 tokyo

Sexual Problems after Treatment and Interventions that Help Juntendo Hospital, Oct 22, 2010 Patricia Fobair, LCSW, MPH Stanford University Hospital    In 2006, we published an article in the journal, Psycho-Oncology 15: 579-594 (2006) on the subject of-“Body Image and Sexual Problems in Young Women w/ Breast Cancer,” The Body Image article was # on the top Psycho-Oncology article, Jan 2006 & Nov 2007 Why was it so popular? *Pat Fobair, Susan L Stewart, Subo Chang, Carol D’Onofrio, Priscilla J Banks and Joan Bloom  Over 50% of survivors of breast, gynecology, prostate, testicular, rectal cancer have enduring problems with sexual functioning reducing for many their quality of life  Effective interventions have been elusive for survivors and their partners  Pharmaceutical solutions,  Internet interventions,  Couples counseling, and all of the above  There is a need for more -attention   1) What are the key sexual problems found among cancer survivors by diagnosis 2) What are the interventions that improve sexual functioning? What helps?     Literature search of English language abstracts and databases, 1980-2006 International studies, using standardized measures, re: psychosocial problems that trouble cancer survivors following diagnosis and treatment Intervention research re: physical exercise, group supports, journal writing, yoga, meditation and imagery Personal experience     Distress (25-62%) Depression (1638%) Energy loss/fatigue (30-76%) Cognitive changes (20- 45%)    Body image (2570%) Sexual satisfaction (36-67%) Sexual problems (45-88%) In our study in the San Francisco Bay area50% of the 546 women reported or more problems with body image Body image improved at five years (Bloom, et al 2004) 52% of 360 Brca pts, all stages, 0-7 months post diagnosis, reported problems w/sex functioning (Fobair et al 2006, Psychooncology) 56% of 185 of the same Brca pts years post treatment continued to have a lack of sexual desire (Bloom et al 2004, Psychooncology) **Result: Sexual functioning remained a problem over time   36% of 187 Brca pts w/benign tumors = deterioration in sexual life Bukovic et al 2004, Coll Antropol Croatia 50% of 98 Brca w/br conserv surgery = dissatisfied w/sex life after treatment vs 27% before Bukovic et al 2005, Onkologie Croatia  56% of 108 Brca pts w/mastectomy & adjuv treatment = dissatisfied w/sex life after treatment vs 30% before Bukovic et al 2005, Onkologie, Croatia  19% or 6/39 pts w/rectal ca recovered normal ejaculatory function 1st year postop Hojo et al 1991, Dis Colon Rectum Japan  31% or 12/39 pts w/ rectal ca recovered erectile function 1st year postop Hojo et al 1991, Dis Colon Rectum Japan  32% of 81 women w/ rectal ca were sexually active after surgery vs 61% active before Hendren et al 2005, Ann Surg.Canada  50% of 99 men w/rectal ca were sexually active after surgery vs 91% before Hendren et al 2005, Ann Surg.Canada Effects of Sexual Problems on Intimate Relationships    Interpersonal relationships are vulnerable after a cancer diagnosis; continuity in life is challenged (Mages et al 1979, 1981) Couples facing breast cancer reported greater decreases in marital functioning, & more adjustment problems compared with couples adjusting to benign breast disease (Northouse et al 1998) Patient’s ability to be open in communication with partner predicted outcome in studies (Walker, 1997; Wimberly et al 2005) Types of Counseling   Educational booklet, “Sexuality and Cancer: For the Woman Who Has Cancer and Her Partner (2007) distributed by American Cancer Society is an excellent source Brief sexual counseling interventions have been helpful sessions (Schover et al 1987; Schover & Jensen 1988)   Brief intervention (4 mo.’s) was successful in helping women with problems in sexual functioning using nurse practitioner with individual patients Reduced symptoms (P=0.0004); improved sexual functioning (P=0.04) (Ganz et al 2000) Partner support using psycho-educational group program improved marital satisfaction (Bultz et al 2000) Types of Counseling  Emotionally focused marital therapy helps patients suffering isolation or post-traumatic stress or recurrent anxiety from diagnosis (Johnson & Talitman 1997)   Support groups are most available source of assistance (Fobair 1997a,1997b; Antoni et al 2006) Weekly physical activity is helpful in improving fatigue, mood, cardiopulmonary, and quality of life, comparing patients with control groups (Holick et al 2008; Irwin et al 2008; Courneya et al 2003; Aiello et al 2004; Pinto & Trunzo 2004)   Emotionally focused marital therapy has been helpful to couples dealing with posttraumatic stress Johnson SM, Talitman E J Marital Fam Ther 1997; 23(2):135 Therapy concentrates on the creation of secure attachment Johnson SM, Williams-Keeler L J Marital Fam Ther 1998; 24(1): 25-40   An attachment injury occurs when one partner violates the expectation that the other will offer comfort and caring in times of danger or distress Johnson SM, Makinen JA, Millikin JW J Marital Fam Ther 2001; 27(2): 145-155Joh  Disappointments occur with spouses who fail to communicate their concern or withdraw from the patient following diagnosis or treatment Johnson SM, et al J Marital Fam Ther 2001;27(2):145-  Among the couples dealing with trauma, the female partner’s trust, her faith in her husband predicted the couples’ satisfaction at follow-up Johnson SM, Talitman E J Marital Fam Ther 1997;23  When wives showed trust in their husbands, husbands were more comfortable with physical intimacy in relationship As above, 23(2):135  Meta-Analysis of 116 studies found benefits for adults w/ cancer in relation to anxiety, depression mood , nausea, vomiting, pain and knowledge Devine & Westlake 1995, Oncol Nurs Forum USA  303 Brca pts, in yr study found trend (p=0.05) w/ intervention group having reduced anxiety vs.controls Kissane et al 2003, Psychooncology Australia  181 Brca pts.were assigned to support group (SG) or complementary/alternative interventions (CAM) 91% SG & 80% CAM improved symptoms of PTSD; only support group had significant decreases in overall stress Levine et al 2005, Psychooncology USA  154 Brca pts assessed for emotion regulation and adjustment over pts time 12 week Interv 54 group, 56 decliners, 44 control At mo’s Interv.pts.+ better emotional well-being & at 12 mo’s + decrease in emotional suppression = showing delayed impact Cameron et al 2006, Psychooncology, New Zealand  151 Brca pts, week interv.,46 completed study.Group had fewer problems with mood and +higher scores vigor vs controls Fukui et al 2000, Cancer Japan  151 Brca pts, week interv 46 participants, Interv group = lower scores for loneliness, and higher scores number of confidants vs controls Fukui et al 2003, Oncol Nurs Forum, Japan  134 Ca pts offered 10 weekly hour groups in 10 cities in Switzerland QL assessed x QL improved anxiety (p=0.0005), depression (p[...]... Support  Yoga, Groups Meditation, Imagery  11 1 ca pts randomized to 14 week training or to controls The fatigue score decreased x 17 pts in control group and 5.8 in active group Thorsen et al 2005 JCO Norway  11 1 w/ prostate ca & radiotherapy, (18 mo’s) found that higher level physical activity = better sexual functioning Dahn et al 2005, Urology USA  91 ca pts on chemo & 54 hour exercise program... 3 QL improved anxiety (p=0.0005), depression (p ... for more -attention   1) What are the key sexual problems found among cancer survivors by diagnosis 2) What are the interventions that improve sexual functioning? What helps?     Literature... enduring problems with sexual functioning reducing for many their quality of life  Effective interventions have been elusive for survivors and their partners  Pharmaceutical solutions,  Internet interventions, ... 45%)    Body image (2570%) Sexual satisfaction (36-67%) Sexual problems (45-88%) In our study in the San Francisco Bay area50% of the 546 women reported or more problems with body image Body