Literature Review

on

Impact of the Breast Cancer Treatment on the Sexual Quality of Life of the Premenopausal Women in UK

By

Table of Contents

Introduction2

Clinical Significance and Pathophysiology3

Pathophysiology5

Clinical Presentation8

Relevance to Oncology Nurse8

Differential Diagnosis9

Evidence-based management strategies10

Pharmacologic10

Vaginal Dryness and Dyspareunia10

Sexual desire and libido10

Hot flashes11

Non-pharmacologic11

Hot flashes11

Vaginal dryness, dyspareunia, sexual desire and libido12

Sexual dysfunction after breast cancer treatment: Common problems, diagnosis, and management12

Sexual issues after treatment12

Diagnosing sexual dysfunction14

Treatment of sexual dysfunction16

Side-effects of treatment18

Sexual dysfunction following breast cancer19

Special Considerations in Quality of Life Measurement20

Recommendations22

Establish the frequency and severity of menopausal symptoms and their impact on QoL22

Establish what the patient wishes and expects from intervention23

Provide information about menopausal symptoms and possible treatments24

Assess lifestyle and environmental factors that may be exacerbating hot flashes24

Conclusion25

Future Directions26

References27

Literature Review

Introduction

Sexuality is a complex process coordinated by the body through its vascular, endocrine and neurologic systems. It also incorporates a wide spectrum of external factors, such as familial, societal and religious beliefs, health status and aging. In addition, each partner brings to the relationship a unique set of attitudes, needs and responses that together make up an individual sexual experience. Cancer and cancer therapy can cause a breakdown in any one of these aforementioned areas, which may lead to dyspareunia and sexual dysfunction. Dyspareunia is defined as painful sexual intercourse. It is a sensitive issue, as this type of pain involves emotionally charged behaviors, sexual intimacy and vaginal intercourse. This article focuses mainly on how dyspareunia affects sexuality in young, female breast cancer survivors. It highlights other presenting symptoms relating to chemotherapy-induced menopause and hormonal therapy, in addition to the negative effects of the disease process of breast cancer itself on sexuality. The research indicates that with these negative effects on sexuality, self-concept can be a challenge: the normal process of desire, arousal, enjoyment and the orgasmic experience is diminished and sometimes lost. (Sbitti, et al. 2011 29)

Breast cancer is an important disease and one where health care services have the potential to improve the quality and quantity of life. Breast cancer is also largely a disease of old age. By the year 2030, one in five women in the United Kingdom will be 65 years of age or older (hereinafter referred to as "older"). This demographic imperative, coupled with the dramatic increases in rates of breast cancer with advancing age, is expected to translate into a large absolute increase in the number of older women treated for and surviving breast cancer . These older breast cancer survivors are likely to be a physiologically, socially, and racially heterogeneous group with varying numbers of comorbid conditions and varying outcomes following treatment for their disease. (Miller 2006 335-341)

Older women diagnosed with breast cancer today have many different treatment options from which to choose. While most women will chose treatments that maximize survival, information about quality of life can be an important component in decision-making in several clinical situations. For instance, if a woman is considering two treatments with equivalent survival, such as mastectomy and breast conservation, then quality of life outcomes may be important considerations in her treatment ...