Sexual Well-Being Among Survivors of Non-Hodgkin Lymphoma
Sexual Well-Being Among Survivors of Non-Hodgkin Lymphoma
Purpose/Objectives: To describe sexual well-being among non-Hodgkin lymphoma (NHL) survivors.
Design: Descriptive, correlational, cross-sectional study.
Setting: NHL survivors identified via the Los Angeles County Cancer Surveillance Program.
Sample: 222 NHL survivors two- to five-years postdiagnosis.
Methods: Data were collected via mailed questionnaire. Multivariate models were used to examine sexual well-being.
Main Research Variables: Three indices of sexual well-being were examined in relation to sociodemographic and medical variables: participation in sexual activity, satisfaction with sex life, and sexual function.
Findings: Most NHL survivors were participating in sexual activity; however, more than half were dissatisfied with their sex life. A substantial minority "usually or always" experienced problems with sexual function. Associations between study variables and outcomes differed across indices of sexual well-being and by gender; older age was associated with decreased participation, decreased satisfaction, and impaired sexual function for men as well as with decreased participation for women. Poorer physical functioning was associated with decreased participation for men and women as well as poorer sexual function for women. Finally, poorer mental functioning was associated with less satisfaction and poorer sexual function for men and women; shorter times since diagnosis were associated with poorer sexual function for women.
Conclusions: Most NHL survivors were sexually active, but many reported difficulties with satisfaction and function. Sexual well-being is a multifaceted construct that requires continued attention throughout survivorship.
Implications for Nursing: Oncology nurses are in an excellent position to ensure that survivors' sexual concerns are addressed. Survivorship care plans may help to facilitate communication about survivors' sexual well-being.
Non-Hodgkin lymphoma (NHL) ranks sixth in cancer incidence among women and seventh among men (American Cancer Society, 2011), with rising incidence rates documented since 1973 (Fisher & Fisher, 2004). Adult NHLs are divided into two main groups: indolent (low-grade lymphomas, which grow slowly) and aggressive (intermediate- and high-grade lymphomas, which grow quickly). Without intervention, aggressive NHL can be fatal within months (Johnston, 1999; Sehn & Connors, 2005). Individuals diagnosed with aggressive NHL undergo extensive treatment for the disease, including multi-agent chemotherapy regimens (with or without radiation) and, potentially, bone marrow or stem cell transplantation (Sehn & Connors, 2005). Although advances in NHL treatment have led to a rise in survival rates (Jemal et al., 2004; Mahadevan & Fisher, 2011; Sehn & Connors, 2005; Shipp et al., 1993) by months and even years postdiagnosis, survivors are at risk for significant adverse effects of their treatment, such as second cancers and cardiovascular complications (Andre et al., 2004; Brennan et al., 2005). In this way, aggressive treatment among NHL survivors may result in long-term complications that require both medical and psychosocial interventions. One such area that may be affected is survivors' sexual well-being (Hewitt, Greenfield, & Stovall, 2006; Institute of Medicine, 2008; Monga, 2002; Rowland & Bellizzi, 2008).
Sexual well-being includes factors associated with sexual experience (Taylor & Davis, 2007), such as participation in sexual activity, satisfaction with sexual experiences, and sexual function. Sexual well-being has been identified as a common concern among survivors (Baker, Denniston, Smith, & West, 2005) and as an area in need of continued attention in research (Hewitt et al., 2006). Previous studies have addressed sexual outcomes for cancer survivors, mainly among individuals diagnosed with breast, gynecologic, or prostate cancers (Andersen, Anderson, & deProsse, 1989; Beckjord & Campas, 2007; Can et al., 2008; Carmack Taylor, Basen-Engquist, Shinn, & Bodurka, 2004; Ganz, Desmond, Belin, Meyerowitz, & Rowland, 1999; Henson, 2002; Incrocci, 2006; Kao, Jani, & Vijayakumar, 2002; Kornblith & Ligibel, 2003; Lagana, MacGarvey, Classen, & Koopman, 2001; Oliffe, 2005; Rogers & Kristjanson, 2002; Stead, 2003; Wyatt et al., 1998), but survivors of aggressive NHL are not well represented in the literature. A general conclusion from the research is that survivors often report persistent sexual difficulties for years after diagnosis and treatment for their disease (Meyerowitz, Desmond, Rowland, Wyatt, & Ganz, 1999; Syrjala et al., 1998) and that addressing the sexual concerns of survivors is an important part of follow-up care (Hewitt et al., 2006; Monga, 2002).
Much has been learned about sexual well-being for cancer survivors and the association with medical, sociodemographic, and psychosocial variables (Monga, 2002; Syrjala et al., 1998; Tan, Waldman, & Bostick, 2002). The direct physical effects of cancer and its treatment can negatively impact sexual function (Monga, 2002). Consistent evidence exists that treatment with chemotherapy predicts poorer sexual outcomes among breast cancer survivors (Beckjord & Campas, 2007; Burwell, Case, Kaelin, & Avis, 2006; Ganz, Rowland, Desmond, Meyerowitz, & Wyatt, 1998), particularly for younger women experiencing premature chemotherapy-induced menopause (Burwell et al., 2006; Ganz et al., 1998; Rogers & Kristjanson, 2002). Longer time since diagnosis has been associated with a higher probability of participation in sexual activity (Carmack Taylor et al., 2004; Mumma, Mashberg, & Lesko, 1992), but also with poorer satisfaction with sexual experiences (Mumma et al., 1992).
Some evidence suggests that younger survivors experience more sexual difficulties than older gynecologic and breast cancer survivors (Stead, 2003), although null effects for age also have been observed (Beckjord & Campas, 2007). Survivors' race and ethnicity have been associated with variability in sexual outcomes; for example, African American survivors have reported less comfort with some sexual behaviors compared to Caucasian survivors, whereas Caucasian survivors have been more likely to report that breast cancer negatively impacted their sexual well-being (Wyatt et al., 1998). Finally, psychosocial variables such as poorer mental function or increased emotional distress have been consistently negatively associated with survivors' sexual well-being (Beckjord & Campas, 2007; Can et al., 2008; Ganz et al., 1999; Syrjala et al., 1998).
The current study investigates sexual well-being among survivors of aggressive NHL who were two- to five-years postdiagnosis. Specifically, the authors evaluated the association of survivors' sociodemographics, medical history, and psychosocial factors with three indicators of their sexual well-being: participation in sexual activity, satisfaction with sexual experiences, and sexual function. With a focus on survivors who are two- to five-years postdiagnosis, the authors were able to investigate sexual well-being at a time in the cancer trajectory when survivors are likely to begin experiencing late effects of cancer treatment, but less likely to have access to intensive psychosocial support (Hewitt et al., 2006; Institute of Medicine, 2008). Based on the results of previous research, the authors expected that sexual problems would be common among NHL survivors, particularly for those reporting difficulties with mental and physical function.
Abstract and Introduction
Abstract
Purpose/Objectives: To describe sexual well-being among non-Hodgkin lymphoma (NHL) survivors.
Design: Descriptive, correlational, cross-sectional study.
Setting: NHL survivors identified via the Los Angeles County Cancer Surveillance Program.
Sample: 222 NHL survivors two- to five-years postdiagnosis.
Methods: Data were collected via mailed questionnaire. Multivariate models were used to examine sexual well-being.
Main Research Variables: Three indices of sexual well-being were examined in relation to sociodemographic and medical variables: participation in sexual activity, satisfaction with sex life, and sexual function.
Findings: Most NHL survivors were participating in sexual activity; however, more than half were dissatisfied with their sex life. A substantial minority "usually or always" experienced problems with sexual function. Associations between study variables and outcomes differed across indices of sexual well-being and by gender; older age was associated with decreased participation, decreased satisfaction, and impaired sexual function for men as well as with decreased participation for women. Poorer physical functioning was associated with decreased participation for men and women as well as poorer sexual function for women. Finally, poorer mental functioning was associated with less satisfaction and poorer sexual function for men and women; shorter times since diagnosis were associated with poorer sexual function for women.
Conclusions: Most NHL survivors were sexually active, but many reported difficulties with satisfaction and function. Sexual well-being is a multifaceted construct that requires continued attention throughout survivorship.
Implications for Nursing: Oncology nurses are in an excellent position to ensure that survivors' sexual concerns are addressed. Survivorship care plans may help to facilitate communication about survivors' sexual well-being.
Introduction
Non-Hodgkin lymphoma (NHL) ranks sixth in cancer incidence among women and seventh among men (American Cancer Society, 2011), with rising incidence rates documented since 1973 (Fisher & Fisher, 2004). Adult NHLs are divided into two main groups: indolent (low-grade lymphomas, which grow slowly) and aggressive (intermediate- and high-grade lymphomas, which grow quickly). Without intervention, aggressive NHL can be fatal within months (Johnston, 1999; Sehn & Connors, 2005). Individuals diagnosed with aggressive NHL undergo extensive treatment for the disease, including multi-agent chemotherapy regimens (with or without radiation) and, potentially, bone marrow or stem cell transplantation (Sehn & Connors, 2005). Although advances in NHL treatment have led to a rise in survival rates (Jemal et al., 2004; Mahadevan & Fisher, 2011; Sehn & Connors, 2005; Shipp et al., 1993) by months and even years postdiagnosis, survivors are at risk for significant adverse effects of their treatment, such as second cancers and cardiovascular complications (Andre et al., 2004; Brennan et al., 2005). In this way, aggressive treatment among NHL survivors may result in long-term complications that require both medical and psychosocial interventions. One such area that may be affected is survivors' sexual well-being (Hewitt, Greenfield, & Stovall, 2006; Institute of Medicine, 2008; Monga, 2002; Rowland & Bellizzi, 2008).
Sexual well-being includes factors associated with sexual experience (Taylor & Davis, 2007), such as participation in sexual activity, satisfaction with sexual experiences, and sexual function. Sexual well-being has been identified as a common concern among survivors (Baker, Denniston, Smith, & West, 2005) and as an area in need of continued attention in research (Hewitt et al., 2006). Previous studies have addressed sexual outcomes for cancer survivors, mainly among individuals diagnosed with breast, gynecologic, or prostate cancers (Andersen, Anderson, & deProsse, 1989; Beckjord & Campas, 2007; Can et al., 2008; Carmack Taylor, Basen-Engquist, Shinn, & Bodurka, 2004; Ganz, Desmond, Belin, Meyerowitz, & Rowland, 1999; Henson, 2002; Incrocci, 2006; Kao, Jani, & Vijayakumar, 2002; Kornblith & Ligibel, 2003; Lagana, MacGarvey, Classen, & Koopman, 2001; Oliffe, 2005; Rogers & Kristjanson, 2002; Stead, 2003; Wyatt et al., 1998), but survivors of aggressive NHL are not well represented in the literature. A general conclusion from the research is that survivors often report persistent sexual difficulties for years after diagnosis and treatment for their disease (Meyerowitz, Desmond, Rowland, Wyatt, & Ganz, 1999; Syrjala et al., 1998) and that addressing the sexual concerns of survivors is an important part of follow-up care (Hewitt et al., 2006; Monga, 2002).
Much has been learned about sexual well-being for cancer survivors and the association with medical, sociodemographic, and psychosocial variables (Monga, 2002; Syrjala et al., 1998; Tan, Waldman, & Bostick, 2002). The direct physical effects of cancer and its treatment can negatively impact sexual function (Monga, 2002). Consistent evidence exists that treatment with chemotherapy predicts poorer sexual outcomes among breast cancer survivors (Beckjord & Campas, 2007; Burwell, Case, Kaelin, & Avis, 2006; Ganz, Rowland, Desmond, Meyerowitz, & Wyatt, 1998), particularly for younger women experiencing premature chemotherapy-induced menopause (Burwell et al., 2006; Ganz et al., 1998; Rogers & Kristjanson, 2002). Longer time since diagnosis has been associated with a higher probability of participation in sexual activity (Carmack Taylor et al., 2004; Mumma, Mashberg, & Lesko, 1992), but also with poorer satisfaction with sexual experiences (Mumma et al., 1992).
Some evidence suggests that younger survivors experience more sexual difficulties than older gynecologic and breast cancer survivors (Stead, 2003), although null effects for age also have been observed (Beckjord & Campas, 2007). Survivors' race and ethnicity have been associated with variability in sexual outcomes; for example, African American survivors have reported less comfort with some sexual behaviors compared to Caucasian survivors, whereas Caucasian survivors have been more likely to report that breast cancer negatively impacted their sexual well-being (Wyatt et al., 1998). Finally, psychosocial variables such as poorer mental function or increased emotional distress have been consistently negatively associated with survivors' sexual well-being (Beckjord & Campas, 2007; Can et al., 2008; Ganz et al., 1999; Syrjala et al., 1998).
The current study investigates sexual well-being among survivors of aggressive NHL who were two- to five-years postdiagnosis. Specifically, the authors evaluated the association of survivors' sociodemographics, medical history, and psychosocial factors with three indicators of their sexual well-being: participation in sexual activity, satisfaction with sexual experiences, and sexual function. With a focus on survivors who are two- to five-years postdiagnosis, the authors were able to investigate sexual well-being at a time in the cancer trajectory when survivors are likely to begin experiencing late effects of cancer treatment, but less likely to have access to intensive psychosocial support (Hewitt et al., 2006; Institute of Medicine, 2008). Based on the results of previous research, the authors expected that sexual problems would be common among NHL survivors, particularly for those reporting difficulties with mental and physical function.
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