Comparisons of Depression, Sexual Function, and Quality of Life Between Women With Gynecological Cancers and Race-Matched Healthy Controls

Bai, Jinbing; Belcher, Sarah M.; Meador, Rebecca; Daniel, Gaea; Shelton, Joseph; Patel, Pretesh; Dolan, M. Eileen; Arluck, Jessica; Khanna, Namita; Horowitz, Ira; Liu, Tian; Bruner, Deborah Watkins

doi:10.1097/ncc.0000000000000744

Cited by 10 publications

(7 citation statements)

References 39 publications

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“…Additionally, for the sexually active cancer participants, lack of lubrication and vaginal pain significantly increased over baseline then slightly improved with time, although these symptoms were still reported at much higher levels than in healthy controls. These observations are consistent with previous reports that show that radiation therapy significantly deteriorates sexual function, as measured by the FSFI scoring system ( Bai et al., 2021 ). Additionally, while there is some gradual improvement, cancer patients are disproportionately affected by sexual dysfunction even one year after the completion of radiation, when compared to healthy women.…”

Section: Discussionsupporting

confidence: 93%

Changes in the Vaginal Microbiome and Associated Toxicities Following Radiation Therapy for Gynecologic Cancers

Tsementzi

Meador

Eng

et al. 2021

Front. Cell. Infect. Microbiol.

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Postmenopausal women often suffer from vaginal symptoms associated with atrophic vaginitis. Additionally, gynecologic cancer survivors may live for decades with additional, clinically significant, persistent vaginal toxicities caused by cancer therapies, including pain, dyspareunia, and sexual dysfunction. The vaginal microbiome (VM) has been previously linked with vaginal symptoms related to menopause (i.e. dryness). Our previous work showed that gynecologic cancer patients exhibit distinct VM profiles from healthy women, with low abundance of lactobacilli and prevalence of multiple opportunistic pathogenic bacteria. Here we explore the association between the dynamics and structure of the vaginal microbiome with the manifestation and persistence of vaginal symptoms, during one year after completion of cancer therapies, while controlling for clinical and sociodemographic factors. We compared cross-sectionally the vaginal microbiome in 134 women, 64 gynecologic patients treated with radiotherapy and 68 healthy controls, and we longitudinally followed a subset of 52 women quarterly (4 times in a year: pre-radiation therapy, 2, 6 and 12 months post-therapy). Differences among the VM profiles of cancer and healthy women were more pronounced with the progression of time. Cancer patients had higher diversity VMs and a variety of vaginal community types (CTs) that are not dominated by Lactobacilli, with extensive VM variation between individuals. Additionally, cancer patients exhibit highly unstable VMs (based on Bray-Curtis distances) compared to healthy controls. Vaginal symptoms prevalent in cancer patients included vaginal pain (40%), hemorrhage (35%), vaginismus (28%) and inflammation (20%), while symptoms such as dryness (45%), lack of lubrication (33%) and dyspareunia (32%) were equally or more prominent in healthy women at baseline. However, 24% of cancer patients experienced persistent symptoms at all time points, as opposed to 12% of healthy women. Symptom persistence was strongly inversely correlated with VM stability; for example, patients with persistent dryness or abnormally high pH have the most unstable microbiomes. Associations were identified between vaginal symptoms and individual bacterial taxa, including: Prevotella with vaginal dryness, Delftia with pain following vaginal intercourse, and Gemillaceaea with low levels of lubrication during intercourse. Taken together our results indicate that gynecologic cancer therapy is associated with reduced vaginal microbiome stability and vaginal symptom persistence.

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Section: Discussionsupporting

confidence: 93%

Changes in the Vaginal Microbiome and Associated Toxicities Following Radiation Therapy for Gynecologic Cancers

Tsementzi

Meador

Eng

et al. 2021

Front. Cell. Infect. Microbiol.

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“…In cancer patients close to/during treatment, a recent study found that Black and White patients both reported worse outcomes than their race-matched healthy controls. 31 And a longitudinal study found that White survivors showed improvements in perceived distress from diagnosis to 6 months posttreatment and then remained stable, while Black survivors had persistent high distress until the 18 months follow-up. 32 Along with the results of the current study, this suggests that ethnic minority and majority groups might both be negatively affected in the acute phase of cancer, as compared to their cancer-free peers, but differ in their recovery in the long-term.…”

Section: Discussionmentioning

confidence: 99%

Emotional distress in cancer survivors from various ethnic backgrounds: Analysis of the multi‐ethnic HELIUS study

et al. 2023

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PurposeInsight into emotional distress of cancer survivors from ethnic minority groups in Europe is scarce. We aimed to compare distress levels of survivors from ethnic minorities to that of the majority population, determine whether the association between having cancer (yes vs. no) and distress differs among ethnic groups and investigate sociocultural correlates of distress.MethodsCross‐sectional data were derived from HELIUS, a multi‐ethnic cohort study conducted in the Netherlands. Of 19,147 participants, 351 were diagnosed with cancer (n = 130 Dutch, n = 75 African Surinamese, n = 53 South‐Asian Surinamese, n = 43 Moroccan, n = 28 Turkish, n = 22 Ghanaian). Distress (PHQ‐9, MCS‐12) and correlates were assessed by self‐report. Cancer‐related variables were derived from the Netherlands Cancer Registry.ResultsSurvivors were on average 7 years post‐diagnosis. Survivors from South‐Asian Surinamese, Moroccan, Turkish and Ghanaian origin reported more distress than survivors from Dutch origin (effect sizerange: 0.44–1.17; adjusted models). The association between having cancer or not with distress differed in direction between Dutch and the non‐Dutch ethnic groups: Non‐Dutch cancer patients tended to have more distress than their cancer‐free peers, whereas Dutch cancer patients tended to have less distress than their cancer‐free peers. For Moroccan and Turkish patients, the acculturation style of separation/marginalization, compared to integration/assimilation, was associated with higher depressive symptoms. In analyses pooling data from all ethnic minorities, lower health literacy, lower emotional support satisfaction and younger age at the time of migration were associated with higher depressive symptoms. Lower health literacy, fewer emotional support transactions, and more frequent attendance at religious services were associated with worse mental health.ConclusionCancer survivors from ethnic minorities experience more distress than those from the majority population. Culturally sensitive supportive care should be considered.

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“…Thirty-three percent reported significant sexual distress. The consequences of the cancer and its treatment force couples to redefine their sexual relationship, to explore alternative possibilities with regard to sexual behavior [27]. Lack of information and couple's challenges to communication about sexual issues may lead to lack of understanding of the situation and distress whereas an open and constructive communication enhances better coping with the new sexual life [28,29].…”

Section: Discussionmentioning

confidence: 99%

Sexual, psychological, interpersonal well-being and (unmet) supportive care needs of couples after a gynecological cancer treatment

Pernelle¹,

Kaneez²,

Manuela³

et al. 2021

European Journal of Gynaecological Oncology

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To assess the sexual and psychosocial functioning of couples after a gynecological cancer treatment and their (unmet) supportive care needs. Methods: Patients treated for a gynecological cancer at the Geneva University Hospitals in Switzerland between January 2012 and September 2019 and their partners completed selfreported validated questionnaires on anxiety, depression, sexual function, relationship satisfaction, sexual communication and (unmet) supportive care needs. Results: Sixteen couples participated in the study. Mean age was 59.5 (range 46-72) for women and 63 (range 50-76) for men. The mean duration since treatment was 3 years (range = 1-7). 38% of women and 33% of men reported moderate to high levels of anxiety whereas 18, 75% of women and no men suffered from moderate to severe depression. Sixty percent of patients reported a sexual dysfunction and 40% reported significant sexual distress. Eighteen percent of men reported an erectile dysfunction and 33% reported a significant sexual distress. Whereas most couples were satisfied about their relationship, difficulties in sexual communication were expressed. Receiving psychological support, information and help with the changes in the sexual life were the most widely supported care needs. Although the highest domains of unmet needs were in the informational, relational and physical domain, more than 50% of couples reported unmet needs in the sexual domain. Conclusion: Gynecological cancer negatively affects the psychosexual well-being of couples. Support during and after treatment should take psychological and sexual aspects and the partner perspective into account.

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Comparisons of Depression, Sexual Function, and Quality of Life Between Women With Gynecological Cancers and Race-Matched Healthy Controls

Cited by 10 publications

References 39 publications

Changes in the Vaginal Microbiome and Associated Toxicities Following Radiation Therapy for Gynecologic Cancers

Changes in the Vaginal Microbiome and Associated Toxicities Following Radiation Therapy for Gynecologic Cancers

Emotional distress in cancer survivors from various ethnic backgrounds: Analysis of the multi‐ethnic HELIUS study

Sexual, psychological, interpersonal well-being and (unmet) supportive care needs of couples after a gynecological cancer treatment

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