Sexual problems and menopause-like genital and urinary symptoms appear to be common among patients receiving endocrine therapy for breast cancer, though symptoms often go untreated, according to a review published recently in Supportive Care in Cancer.
The study also pointed to a wide range of factors that may influence these symptoms, from treatment history and physical side effects to emotional health and relationship concerns.
The analysis included 43 studies in English and Chinese, with a total of 18,099 participants. In studies that reported rates of sexual dysfunction, prevalence ranged from 51% to 93%. Vaginal dryness and pain during sex were among the most consistently reported concerns.
Sexual symptoms also differed by treatment type. Aromatase inhibitors, medicines that lower estrogen levels, were generally linked to worse symptoms than tamoxifen, which blocks estrogen from attaching to breast cancer cells. Both treatments are commonly used for hormone-sensitive breast cancer.
Several factors appeared to make sexual problems more likely or more difficult to manage. These include:
- Younger age
- Financial strain
- Relationship status
- Fatigue
- Poor sleep
- Joint pain
- Anxiety
- Depression
- Negative body image
Risk factors also included previous treatments, such as:
- Surgery
- Chemotherapy
- Radiotherapy
Researchers noted that these symptoms can affect quality of life and intimacy, and may also make it harder for some women to stay on endocrine therapy.
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Despite the high prevalence of sexual issues, the review found that sexual health was often not addressed in routine care. Many patients did not raise these concerns with clinicians, and many health care professionals did not routinely ask about them during endocrine therapy follow-up.
“Available evidence reveals a ‘silence gap’ in sexual health for patients during endocrine therapy follow-up,” the researchers wrote. One study included in the review found that 80.7% of patients wanted specialized sexual counseling, but fewer than 25% sought help.
Researchers said sexual health should be assessed more routinely in patients receiving endocrine therapy. They recommended comprehensive screening, treatment history assessments and targeted support that considers the cumulative effects of surgery, chemotherapy and radiotherapy. Couple-based support may also help address communication and intimacy concerns.
The findings should be interpreted with some caution because the included studies varied in design and in how they measured sexual health, and many did not fully report cancer stage. The authors noted that few studies focused specifically on younger or older people, highlighting the need for research and support strategies tailored by age.
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