Adjuvant therapy for breast cancer impacts sexual function over many years

By Karla Gale

NEW YORK (Reuters Health) – Breast cancer survivors often enjoy a high quality of life years after treatment, but over time those who receive systemic therapies may have some decline in physical functioning, particularly sexual functioning, new research suggests.

These findings could help in making treatment decisions for women with very small breast tumors, researchers report in the January 2nd issue of the Journal of the National Cancer Institute.

Dr. Patricia A. Ganz, of the University of California Los Angeles, and associates evaluated 763 disease-free women who had been treated for stage I or stage II breast cancer 5 to 9.5 years earlier. Those who received added chemotherapy or tamoxifen or both scored worse on certain measures of physical health than did women who received no adjuvant therapy.

Dr. Ganz's team found that the study participants' overall physical and emotional well being remained excellent. Most declines in functioning were what would be expected in an aging population.

After adjusting for age, scores on the Global Quality of Life were significantly better among the 190 women who received no systemic adjuvant therapy (p = 0.005). On the SF-36, women who received adjuvant therapy scored significantly worse for bodily pain (p = 0.01), social functioning (p = 0.02) and general health (p = 0.03). However, adjuvant treatment was not related to poorer emotional well being or depression, the researchers report.

"We're talking about subtle differences; we're not talking about impaired or disabled women. And we do not want to say that adjuvant agents are not worthwhile; they are life-saving and appropriate in many cases," Dr. Ganz told Reuters Health.

However, she added, for women with very small tumors (no more than 1 cm) who may not be at risk for recurrence, adjuvant therapy "may contribute to some subtle decline in functioning."

The issue she is most likely to counsel these patients about is poorer sexual functioning. "The patient at least needs be forewarned that this might happen."

J Natl Cancer Inst 2002;94:39-49.

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