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Sexual quality of life, body image distress, and psychosocial outcomes in colorectal cancer: a longitudinal study

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Abstract

Purpose

The objectives were to assess changes in sexual QOL and body image distress over time and to examine longitudinal associations between sexual QOL and body image variables with psychosocial outcomes in a sample of colorectal cancer patients.

Methods

Participants (N = 141) completed a mail-based survey assessing sexual QOL [sexual distress (ISS), treatment impact on sexual function (SFQ), sexual function (FSFI; IIEF)], body image distress (BIS), and psychosocial outcomes [relationship quality (DAS-4), depressive symptoms (CESD-SF), and health-related QOL (HRQOL; FACT-C)]; 88 patients completed 6-month follow-up surveys (62%). Gender and cancer subgroups (male vs. female; rectal vs. colon cancer) were compared and longitudinal models examined associations between sexual QOL and body image variables with psychosocial outcomes over time and by subgroup.

Results

Impairments in sexual QOL and body image distress were common. Women and patients with rectal cancer reported worse body image distress compared to men (p = .005) and those with colon cancer (p = .03), respectively; compared to patients with colon cancer, those with rectal cancer reported worse treatment impact (p < .001) and marginally worse sexual function and HRQOL (p’s = .05). At 6-month follow-up, body image distress decreased (p = .02), while sexual QOL was stable (e.g., 58% classified as dysfunctional at both time points, p = .13). For most sexual and body image predictors, worse impairment was associated with worse psychosocial outcomes over time. Several significant gender and cancer subgroup effects were found.

Conclusions

Sexual QOL and body image are compromised after colorectal cancer and tend to remain impaired if unaddressed. Sexual concerns should be addressed early to limit broader-reaching psychosocial effects.

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Notes

  1. Because age was positively correlated with time since diagnosis at baseline (r = .25, p = .003), to avoid redundancy, age was excluded from longitudinal models. In addition, because a diagnosis of rectal cancer strongly overlapped with ostomy use (p < .001), to avoid redundancy, we selected cancer site for inclusion in the regression analyses.

  2. Given that the association between cancer site and marital/partnered status were significant, we examined whether group differences on sexual QOL variables were due to partnered status differences by re-rerunning comparisons by both cancer site and gender on sexual QOL variables relevant to partnered sexual activity (sexual distress, treatment impact on sexual function, and sexual function) only in the partnered subsample (N = 121). Because the findings were similar, data from the total sample were retained for analyses.

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Acknowledgements

This study was supported by American Cancer Society Postdoctoral Fellowship PF-09-154-01-CPPB (Reese). Jennifer Barsky Reese is currently supported by a Mentored Research Scholar Grant (MRSG-14-031-01-CPPB) from the American Cancer Society and by P30CA006927 from the National Cancer Institute.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA

    Jennifer Barsky Reese

  2. Department of Biostatistics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA

    Elizabeth Handorf

  3. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Asthma and Allergy Center Suite 100, Baltimore, MD, 21224, USA

    Jennifer A. Haythornthwaite

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  1. Jennifer Barsky Reese
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Correspondence to Jennifer Barsky Reese.

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Institutional Review Board approval was obtained and patients provided informed consent through completing the baseline survey.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Reese, J.B., Handorf, E. & Haythornthwaite, J.A. Sexual quality of life, body image distress, and psychosocial outcomes in colorectal cancer: a longitudinal study. Support Care Cancer 26, 3431–3440 (2018). https://doi.org/10.1007/s00520-018-4204-3

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