TAMPA, Fla. -- Older female cancer survivors had less interest in sex and less frequent sex, but otherwise had sexual interests and problems similar to those of age-matched women who were cancer-free, according to a national survey.
Significantly fewer cancer survivors reported having a current sexual partner or having sex within the previous year, but they were similar to the control group in terms of sexual preferences and practices.
The cancer patients had the same sexual problems and similar frequency of the problems reported by women with no cancer history, including vaginal dryness, inability to climax, and pain with intercourse, Sudeshna Chatterjee, MD, of Yale University, reported here at the Society of Gynecologic Oncology meeting.
"We observed little difference in sexual behavior between older cancer survivors and their noncancer counterparts," Chatterjee said. "However, women with a history of cancer were less likely to be in a current relationship or have had sexual activity in the previous 12 months.
"Sexuality continues along a spectrum and varies depending on the age of the cancer survivor. Sexuality also varies in cancer survivors relative to the time interval since diagnosis."
An estimated 7.2 million female cancer survivors live in the U.S., and the number will continue to rise as long as survival improves. The 5-year survival for 1975 to 1977 was 50%, increasing to 65.4% in 2002-2008.
Aside from the physical changes and threat to survival, cancer often causes social and emotional upheaval in a patient's life and in the lives of family members and friends. In older patients, the physiologic effects of aging add to those brought about by cancer.
Many patients take antidepressants to manage depression and anxiety, and the selective serotonin reuptake inhibitors have a well recognized potential to affect sexual function. Changes in relationship dynamics also have implications for sexual function, such as an intimate partner becoming the primary caregiver, Chatterjee said.
To acquire contemporary information about older female cancer survivors' sexual function, investigators conducted a secondary analysis of the National Social Life, Health, and Aging Project database. The survey elicited information about sexuality from a representative sample of 3,005 community-dwelling adults, ages 57 to 85.
The database afforded Chatterjee and colleagues an opportunity to study the sexuality of older cancer survivors as compared with older adults without cancer. Outcomes included sexual partnership, activity, frequency, attitudes and beliefs, and problems.
The survey sample included 1,550 women, 198 of whom were cancer survivors. The survivor subgroup included 76 (38.6%) women who had a history of breast cancer and 63 (32.4%) with a history of cancer of the ovary, uterus, or cervix.
The cancer survivors had a mean age of 70 versus 68 for the cancer-free group, and the duration since cancer diagnosis averaged 15.3 years.
A similar proportion of women in both groups reported having poor, fair, good, very good, and excellent health.
About 90% of the cancer survivors and control group were married. An additional 7% of cancer survivors were cohabiting compared with 3.5% of the cancer-free groups.
Half of the survivors reported having a current sexual partner compared with 62.6% of the control group (P=0.004). The proportion of women who reported having sexual ideations at least once a month was 45.3% among cancer survivors and 51.1% of the noncancer group, a nonsignificant difference. A third of the survivors reported having sex within the previous 12 months versus 43.9% of the control group (P=0.026).
Among women who reported being sexually active, 30% of cancer survivors and 38.2% of the control group described the frequency of sexual activity as once a month or less often. Proportions reporting two to three times per month were 45.2% and 28.8%, and the proportions reporting sexual activity one or two times a week or more often were 24.8% and 33%.
Similar percentages of women in each group reported common sexual problems, including vaginal dryness, inability to climax, dyspareunia, lack of pleasure, performance anxiety, and avoidance of sex because of problems. The investigators also found no significant differences between the two groups with regard to the frequency of sexual activities, including foreplay, vaginal intercourse, receiving or giving oral sex, and masturbation.
Chatterjee and colleagues did find changes in sexual activity by the time since cancer diagnosis. Masturbation became more common in cancer survivors as they reached 5 years or more from diagnosis. Lack of interest in sex, inability to climax, and lack of pleasure also increased in frequency with the time since diagnosis. The frequency of vaginal intercourse or sexual encounters within the past 12 months did not vary by time since diagnosis.
Invited discussant Don Dizon, MD, of Massachusetts General Hospital in Boston, said the study showed that cancer does not adversely affect many aspects of sexual health in older women. He encouraged clinicians to be open about discussing sexual health with female cancer survivors.
"Sexual health is a human right," Dizon said. "Even treatment for cancer can't take that away. Women are sexual beings and age is irrelevant."
"We must be advocates for our patients," he added.
Primary source: Society of Gynecologic Oncology
Source reference: Chatterjee S, et al "Sexuality among older female cancer survivors" SGO 2014; Abstract 14.