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Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer

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Abstract

Purpose

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer.

Methods

We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis.

Results

Participants’ median age was 59 (range 40–78 years, SD = 9.0). Adverse sexual symptoms hindered participants’ AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists’ disinterest in Black women’s sexual health, perceptions of male oncologists’ biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust.

Conclusions

Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence.

Implications for Cancer Survivors

Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors wish to extend our sincerest gratitude to the breast cancer survivors who participated in this study. We thank each of them for their willingness to share their lived experiences navigating sexual health during breast cancer survivorship. We also thank Ms. Julia Brewer, Ms. Daphne Brown, Mrs. Hiawatha Cullens, Ms. Yolanda Dillard, Mrs. Regenia Dowell, and Ms. Sandra Ford for their active participation on our community advisory council.

Funding

This work was supported by funding from the National Institutes of Health/National Cancer Institute (3R01CA218155-01S1).

Author information

Authors and Affiliations

  1. College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA

    Janeane N. Anderson & Ryan Blue

  2. College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38103, USA

    Andrew J. Paladino

  3. Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW #308, Washington, D.C, 20037, USA

    Derek T. Dangerfield II

  4. Department of Oncology, School of Medicine, Wayne State University, 87 E. Canfield, Detroit, MI, 48201, USA

    Susan Eggly

  5. Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN, 38163, USA

    Michelle Y. Martin

  6. Renown Oncology/Hematology, 75 Pringle Way, Reno, NV, 89502, USA

    Lee S. Schwartzberg

  7. West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN, 38138, USA

    Gregory A. Vidal

  8. Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA

    Ilana Graetz

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  1. Janeane N. Anderson
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Contributions

Janeane N. Anderson: Conceptualization, Methodology, Investigation, Writing-Original Draft

Andrew J. Paladino: Software, Investigation, Data curation, Writing-Review & Editing

Ryan Blue: Software, Investigation, Data curation, Writing-Review & Editing

Derek T. Dangerfield, II: Writing-Review & Editing

Susan Eggly: Writing-Review & Editing

Michelle Y. Martin: Writing-Review & Editing

Lee S. Schwartzberg: Writing-Review & Editing

Gregory A. Vidal: Writing-Review & Editing

Ilana Graetz: Funding acquisition, Supervision, Writing-Review & Editing

Corresponding author

Correspondence to Janeane N. Anderson.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the University of Tennessee Health Science Center (18-06058-XP IAA).

Consent to participate

Written informed consent was obtained from all individual participants included in this study.

Competing interests

The authors declare no competing interests.

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I/We confirm all patient/personal identifiers have been removed or disguised so the patient/person(s) described are not identifiable and cannot be identified through the details of the story.

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Anderson, J.N., Paladino, A.J., Blue, R. et al. Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01511-0

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