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Sexual problems in patients with hematological diseases: a systematic literature review

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Abstract

Purpose

Sexual problems are frequently reported by recipients of hematopoietic stem cell transplantation (HCT). However, little is known about the impact of hematological malignancies and their treatments, without HCT being a part of the treatment regimen. The goal of this systematic review was to examine the prevalence of various sexual problems among patients treated for hematological malignancies without HCT.

Methods

The work focused on online databases available from their inception until 11 November 2020. The data related to sexuality in adult patients diagnosed with hematological malignancies. Selected studies were appraised for methodological quality.

Results

Twenty-four studies were included. Twenty-two studies were observational cross-sectional cohort studies, and two studies had a prospective longitudinal design; fourteen studies used non-validated instruments; only two studies used the multidimensional concept of sexuality; six studies compared sexual problems in the target population with reference data. Based on the few high-quality studies, sexual problems occurred in 18–50% of acute leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma patients.

Conclusion

Understanding sexual problems in patients treated for hematological malignancies without HCT is not only hampered by the variability in methodology, but also by the lack of research on patients using novel therapies. The exact impact of the diagnosis and treatment of a hematological malignancy on sexual function remains to be answered. Longitudinal studies focusing on the effects of the diagnosis and treatment of hematological malignancies on sexuality using validated questionnaires and comparison with normative data are hugely needed.

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References

  1. Sant M, Minicozzi P, Mounier M et al (2014) Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study. Lancet Oncol 15:931–942. https://doi.org/10.1016/s1470-2045(14)70282-7

    Article  PubMed  Google Scholar 

  2. Majhail NS (2017) Long-term complications after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther 10:220–227. https://doi.org/10.1016/j.hemonc.2017.05.009

    Article  PubMed  PubMed Central  Google Scholar 

  3. Schover L (2019) Sexual quality of life in men and women after cancer. Climacteric 22:553–557. https://doi.org/10.1080/13697137.2018.1526893

    Article  CAS  PubMed  Google Scholar 

  4. El-Jawahri A, Fishman SR, Vanderklish J et al (2018) Pilot study of a multimodal intervention to enhance sexual function in survivors of hematopoietic stem cell transplantation. Cancer 124(11):2438–2446

    Article  Google Scholar 

  5. Masters WH, Johnson VE (1966) Human sexual response. Bantam Books, Toronto/New York

    Google Scholar 

  6. Kaplan HS (1979) Disorders of sexual desire: a new concept and techniques in sex therapy. Ballier Tindall, London

    Google Scholar 

  7. Basson R (2015) Human sexual response. Handb Clin Neurol 130:11–18. https://doi.org/10.1016/b978-0-444-63247-0.00002-x

    Article  PubMed  Google Scholar 

  8. Sadovsky R, Basson R, Krychman M et al (2010) Cancer and sexual problems. J Sex Med 7:349–373. https://doi.org/10.1111/j.1743-6109.2009.01620.x

    Article  PubMed  Google Scholar 

  9. Nappi RE, Cucinella L, Martini E et al (2019) Sexuality in premature ovarian insufficiency. Climacteric 22:289–295. https://doi.org/10.1080/13697137.2019.1575356

    Article  CAS  PubMed  Google Scholar 

  10. Kenney LB, Antal Z, Ginsberg JP et al (2018) Improving male reproductive health after childhood, adolescent, and young adult cancer: progress and future directions for survivorship research. J Clin Oncol 36:2160–2168. https://doi.org/10.1200/jco.2017.76.3839

    Article  CAS  PubMed  Google Scholar 

  11. Manitta V, Zordan R, Cole-Sinclair M et al (2011) The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manage 42(3):432–442. https://doi.org/10.1016/j.jpainsymman.2010.12.008

    Article  PubMed  Google Scholar 

  12. Schover LR (2005) Sexuality and fertility after cancer. Hematology Am Soc Hematol Educ Program. https://doi.org/10.1182/asheducation-2005.1.523

    Article  PubMed  Google Scholar 

  13. Rowland DL, Kolba TN (2018) The burden of sexual problems: perceived effects on men’s and women’s sexual partners. J Sex Res 55:226–235. https://doi.org/10.1080/00224499.2017.1332153

    Article  PubMed  Google Scholar 

  14. Krouwel EM, Albers LF, Nicolai MPJ et al (2020) Discussing sexual health in the medical oncologist’s practice: exploring current practice and challenges. J Cancer Educ 35(6):1072–1088. https://doi.org/10.1007/s13187-019-01559-6.41

    Article  CAS  PubMed  Google Scholar 

  15. Eeltink CM, Witte BI, Stringer J et al (2018) Health-care professionals’ perspective on discussing sexual issues in adult patients after haematopoietic cell transplantation. Bone Marrow Transplant 53:235–245. https://doi.org/10.1038/s41409-017-0027-y

    Article  PubMed  Google Scholar 

  16. Eeltink CM, Rood JAJ, Nauta IH et al (2020) Reply to: “Discussing sexuality in cancer care: towards personalized information for cancer patients and survivors.” Support Care Cancer 29:535–537. https://doi.org/10.1007/s00520-020-05625-4

  17. Gilbert E, Perz J, Ussher JM (2016) Talking about sex with health professionals: the experience of people with cancer and their partners. Eur J Cancer Care 25(2):280–93. https://doi.org/10.1111/ecc.12216

    Article  CAS  Google Scholar 

  18. Flynn KE, Reese JB, Jeffery DD et al (2012) Patient experiences with communication about sex during and after treatment for cancer. Psychooncology 21(6):594–601. https://doi.org/10.1002/pon.1947

    Article  PubMed  Google Scholar 

  19. Morgan S, Davies S, Palmer S et al (2010) Sex, drugs, and rock ‘n’ roll: caring for adolescents and young adults with cancer. J Clin Oncol 28(32):4825–30. https://doi.org/10.1200/JCO.2009.22.5474

    Article  PubMed  Google Scholar 

  20. Humphreys CT, Tallman B, Altmaier EM et al (2007) Sexual functioning in patients undergoing bone marrow transplantation: a longitudinal study. Bone Marrow Transplant 39:491–496. https://doi.org/10.1038/sj.bmt.1705613

    Article  CAS  PubMed  Google Scholar 

  21. Kim IR, Jang SY, Shin HS et al (2020) Association between sexuality knowledge and sexual dysfunction in hematopoietic stem cell transplantation patients and their partners. Patient Educ Couns 103(8):1630–1636. https://doi.org/10.1016/j.pec.2020.03.007

    Article  PubMed  Google Scholar 

  22. Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162:777–784. https://doi.org/10.7326/m14-2385

    Article  PubMed  Google Scholar 

  23. Greaves P, Sarker SJ, Chowdhury K et al (2014) Fertility and sexual function in long-term survivors of haematological malignancy: using patient-reported outcome measures to assess a neglected area of need in the late effects clinic. Br J Haematol 164:526–535. https://doi.org/10.1111/bjh.12651

    Article  PubMed  Google Scholar 

  24. Watson M, Wheatley K, Harrison GA et al (1999) Severe adverse impact on sexual functioning and fertility of bone marrow transplantation, either allogeneic or autologous, compared with consolidation chemotherapy alone: analysis of the MRC AML 10 trial. Cancer 86:1231–1239

    Article  CAS  Google Scholar 

  25. Homewood J, Watson M, Richards SM et al (2003) Treatment of CML using IFN-alpha: impact on quality of life. Hematol J 4(4):253–262. https://doi.org/10.1038/sj.thj.6200251

    Article  CAS  PubMed  Google Scholar 

  26. Chapman RM, Sutcliffe SB, Malpas JS (1979) Cytotoxic-induced ovarian failure in Hodgkin’s disease. II. Effects on sexual function. JAMA 242(17):1882–1884

    Article  CAS  Google Scholar 

  27. Messerer D, Engel J, Hasford J et al (2008) Impact of different post-remission strategies on quality of life in patients with acute myeloid leukemia. Haematologica 93(6):826–833. https://doi.org/10.3324/haematol.11987

    Article  PubMed  Google Scholar 

  28. Behringer K, Muller H, Gorgen H et al (2013) Sexual quality of life in Hodgkin Lymphoma: a longitudinal analysis by the German Hodgkin Study Group. Br J Cancer 108(1):49–57. https://doi.org/10.1038/bjc.2012.550

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kreuser ED, Xiros N, Hetzel WD et al (1987) Reproductive and endocrine gonadal capacity in patients treated with COPP chemotherapy for Hodgkin’s disease. J Cancer Res Clin Oncol 113(3):260–266

    Article  CAS  Google Scholar 

  30. Eeltink CM, Incrocci L, Witte BI et al (2013) Fertility and sexual function in female Hodgkin lymphoma survivors of reproductive age. J Clin Nurs 22(23–24):3513–3521. https://doi.org/10.1111/jocn.12354

    Article  PubMed  Google Scholar 

  31. van Tulder MW, Aaronson NK, Bruning PF (1994) The quality of life of long-term survivors of Hodgkin’s disease. Ann Oncol 5(2):153–158

    Article  Google Scholar 

  32. Eeltink CM, Lissenberg-Witte BI, Incrocci L et al (2020) Self-reported sexual function in sexually active male hodgkin lymphoma survivors. Sex Med 8(3):428–435. https://doi.org/10.1016/j.esxm.2020.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  33. Specht L, Geisler C, Hansen MM et al (1984) Testicular function in young men in long-term remission after treatment for the early stages of Hodgkin’s disease. Scand J Haematol 33(4):356–362

    Article  CAS  Google Scholar 

  34. Abrahamsen AF, Loge JH, Hannisdal E et al (1998) Socio-medical situation for long-term survivors of Hodgkin’s disease: a survey of 459 patients treated at one institution. Eur J Cancer 34(12):1865–1870

    Article  CAS  Google Scholar 

  35. Kornblith AB, Herndon JE 2nd, Zuckerman E et al (1998) Comparison of psychosocial adaptation of advanced stage Hodgkin’s disease and acute leukemia survivors. Cancer and Leukemia Group B. Ann Oncol 9(3):297–306

    Article  CAS  Google Scholar 

  36. Kornblith AB, Anderson J, Cella DF et al (1990) Quality of life assessment of Hodgkin’s disease survivors: a model for cooperative clinical trials. Oncology 4(5):93–101; discussion 104

    CAS  PubMed  Google Scholar 

  37. McFarland DC, Shaffer KM, Polizzi H et al (2018) Associations of physical and psychologic symptom burden in patients with Philadelphia chromosome-negative myeloproliferative neoplasms. Psychosomatics 59(5):472–480. https://doi.org/10.1016/j.psym.2018.01.006

    Article  PubMed  PubMed Central  Google Scholar 

  38. Recklitis CJ, Varela VS, Ng A et al (2010) Sexual functioning in long-term survivors of Hodgkin’s lymphoma. Psychooncology 19(11):1229–1233. https://doi.org/10.1002/pon.1679

    Article  PubMed  Google Scholar 

  39. Bloom JR, Fobair P, Gritz E et al (1993) Psychosocial outcomes of cancer: a comparative analysis of Hodgkin’s disease and testicular cancer. J Clin Oncol 11(5):979–988. https://doi.org/10.1200/jco.1993.11.5.979

    Article  CAS  PubMed  Google Scholar 

  40. Hannah MT, Gritz ER, Wellisch DK et al (1992) Changes in marital and sexual functions in long-term survivors and their spouses: testicular cancer versus Hodgkin’s disease. Psychooncology 1(2):89–103. https://doi.org/10.1002/pon.2960010206

    Article  Google Scholar 

  41. Fobair P, Hoppe RT, Bloom J et al (1986) Psychosocial problems among survivors of Hodgkin’s disease. J Clin Oncol 4(5):805–814. https://doi.org/10.1200/jco.1986.4.5.805

    Article  CAS  PubMed  Google Scholar 

  42. Beckjord EB, Arora NK, Bellizzi K et al (2011) Sexual well-being among survivors of non-Hodgkin lymphoma. Oncol Nurs Forum 38(5):E351-9. https://doi.org/10.1188/11.onf.e351-e359

    Article  PubMed  Google Scholar 

  43. Kiserud CE, Schover LR, Fossaa A et al (2009) Sexual function in male lymphoma survivors versus matched controls: relationship to age, gonadal hormones, and quality of life. J Clin Oncol 27:9510–9510

    Article  Google Scholar 

  44. Geyer HL, Andreasson B, Kosiorek HE et al (2016) The role of sexuality symptoms in myeloproliferative neoplasm symptom burden and quality of life: an analysis by the MPN QOL International Study Group. Cancer 122(12):1888–1896. https://doi.org/10.1002/cncr.30013

    Article  PubMed  Google Scholar 

  45. Kim IR, Kim SH, Ok ON et al (2017) Sexual problems in male vs. female non-Hodgkin lymphoma survivors: prevalence, correlates, and associations with health-related quality of life. Ann Hematol 96(5):739–747. https://doi.org/10.1007/s00277-017-2940-y

    Article  PubMed  Google Scholar 

  46. Aksoy S, Harputluoglu H, Kilickap S et al (2008) Erectile dysfunction in successfully treated lymphoma patients. Support Care Cancer 16(3):291–229. https://doi.org/10.1007/s00520-007-0307-y

    Article  PubMed  Google Scholar 

  47. Brierley JD, Rathmell AJ, Gospodarowicz MK et al (1998) Late effects of treatment for early-stage Hodgkin’s disease. Br J Cancer 77(8):1300–1310

    Article  CAS  Google Scholar 

  48. Arrindell WA, Schaap C (1985) The Maudsley Marital Questionnaire (MMQ): an extension of its construct validity. Br J Psychiatry 147:295–299. https://doi.org/10.1192/bjp.147.3.295

    Article  CAS  PubMed  Google Scholar 

  49. Thirlaway K, Fallowfield L, Cuzick J (1996) The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res 5(1):81–90. https://doi.org/10.1007/bf00435972

    Article  CAS  PubMed  Google Scholar 

  50. Flynn KE, Lin L, Cyranowski JM et al (2013) Development of the NIH PROMIS ® Sexual Function and Satisfaction measures in patients with cancer. J Sex Med 10 Suppl 1(0 1):43–52. https://doi.org/10.1111/j.1743-6109.2012.02995.x

    Article  CAS  PubMed  Google Scholar 

  51. Flynn KE, Reeve BB, Lin L et al (2013) Construct validity of the PROMIS® sexual function and satisfaction measures in patients with cancer. Health Qual Life Outcomes 11:40. https://doi.org/10.1186/1477-7525-11-40

    Article  PubMed  PubMed Central  Google Scholar 

  52. Weinfurt KP, Lin L, Bruner DW et al (2015) Development and initial validation of the PROMIS(®) Sexual Function and Satisfaction measures version 2.0. J Sex Med 12(9):1961–1974. https://doi.org/10.1111/jsm.12966

    Article  PubMed  Google Scholar 

  53. Oberguggenberger AS, Nagele E, Inwald EC et al (2018) Phase 1–3 of the cross-cultural development of an EORTC questionnaire for the assessment of sexual health in cancer patients: the EORTC SHQ-22. Cancer Med 7(3):635–645. https://doi.org/10.1002/cam4.1338

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD et al (2010) Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 7(42):1598–1607. https://doi.org/10.1111/j.1743-6109.2010.01778.x

    Article  PubMed  Google Scholar 

  55. Ponholzer A, Temml C, Mock K, Marszalek M et al (2005) Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire. Eur Urol 47(1):80–85; discussion 85-86. https://doi.org/10.1016/j.eururo.2004.08.017

    Article  PubMed  Google Scholar 

  56. Lee DM, Nazroo J, O’Connor DB et al (2016) Sexual health and well-being among older men and women in England: findings from the English Longitudinal Study of Ageing. Arch Sex Behav 45(1):133–144. https://doi.org/10.1007/s10508-014-0465-1

  57. McCabe MP, Sharlip ID, Lewis R et al (2016) Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med 13(2):144–152. https://doi.org/10.1016/j.jsxm.2015.12.034

    Article  PubMed  Google Scholar 

  58. Mitchell KR, Mercer CH, Ploubidis GB, Jones KG et al (2013) Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet 382(9907):1817–1829. https://doi.org/10.1016/S0140-6736(13)62366-1

    Article  PubMed  PubMed Central  Google Scholar 

  59. Hawkins Y, Ussher J, Gilbert E et al (2009) Changes in sexuality and intimacy after the diagnosis and treatment of cancer: the experience of partners in a sexual relationship with a person with cancer. Cancer Nurs 32:271–280. https://doi.org/10.1097/NCC.0b013e31819b5a93

    Article  PubMed  Google Scholar 

  60. Langer SL, Yi JC, Storer BE, at al, (2010) Marital adjustment, satisfaction and dissolution among hematopoietic stem cell transplant patients and spouses: a prospective, five-year longitudinal investigation. Psychooncology 19:190–200. https://doi.org/10.1002/pon.1542

    Article  PubMed  PubMed Central  Google Scholar 

  61. Scherber R, Dueck AC, Johansson P et al (2011) The Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF): international prospective validation and reliability trial in 402 patients. Blood 118(2):401–408. https://doi.org/10.1182/blood-2011-01-328955.P

    Article  CAS  PubMed  Google Scholar 

  62. Jackson SE, Yang L, Koyanagi A et al (2020) Declines in sexual activity and function predict incident health problems in older adults: prospective findings from the English Longitudinal Study of Ageing. Arch Sex Behav 49(3):929–940. https://doi.org/10.1007/s10508-019-1443-4

    Article  PubMed  Google Scholar 

  63. Park ER, Norris RL, Bober SL (2015) Sexual health communication during cancer care: barriers and recommendations. Psychooncology 24(9):1167–1173. https://doi.org/10.1002/pon.3736

    Article  PubMed  Google Scholar 

  64. Dyer K, das Nair R. Why don’t healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United Kingdom. J Sex Med 10(11):2658-2670. https://doi.org/10.1111/j.1743-6109.2012.02856.x

  65. Hatzichristou D, Kirana PS, Banner L et al (2016) Diagnosing sexual dysfunction in men and women: sexual history taking and the role of symptom scales and questionnaires. J Sex Med 13(8):1166–1182. https://doi.org/10.1016/j.jsxm.2016.05.017

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands

    Corien Eeltink & Sonja Zweegman

  2. Department of Hematology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands

    Corien Eeltink & Sonja Zweegman

  3. Department of Clinical Pharmacology, Netherlands Cancer Institute, Antoni van Leeuwenhoekziekenhuis, Amsterdam, The Netherlands

    Alaa Embaby

  4. Department of Radiotherapy-Oncology/Sexology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Luca Incrocci

  5. Medical Library, Vrije Universiteit, Amsterdam, The Netherlands

    Johannes C. F. Ket

  6. IEO, European Institute of Oncology IRCCS, Milan, Italy

    Sarah J. Liptrott

  7. Ente Ospedaliero Cantonale, via Gallino 12, 6500, Bellinzona, Switzerland

    Sarah J. Liptrott

  8. Department of Otolaryngology–Head and Neck Surgery, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Irma Verdonck-de Leeuw

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  1. Corien Eeltink
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Contributions

CE, AE, LI, JK, SL, IV, and SZ were responsible for the design of the study. JK performed the literature search. CE and AE were both responsible for the collection, analyses, and interpretation of the data. All authors participated in writing the paper and were responsible for the final approval of the manuscript.

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Correspondence to Corien Eeltink.

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Corien Eeltink and Alaa Embaby contributed equally to the work.

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Eeltink, C., Embaby, A., Incrocci, L. et al. Sexual problems in patients with hematological diseases: a systematic literature review. Support Care Cancer 30, 4603–4616 (2022). https://doi.org/10.1007/s00520-021-06731-7

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