The majority of Danish breast cancer survivors on adjuvant endocrine therapy have clinically relevant sexual dysfunction: a cross-sectional study

Figures & data

Figure 1. Flowchart. AUH: Aarhus University Hospital; AAUH: Aalborg University Hospital; BCSs: breast cancer survivors; AET: adjuvant endocrine therapy; FSFI: Female Sexual Function Index; SCS-W: Sexual Complaint Screener – Women; SD: sexual dysfunction. *At AAUH; the number of women invited to participate was not registered.

Table 1. Sociodemographic, health-related and clinical characteristics of the total study cohort.

Variable	Total study cohort (N = 333)
	N (%)^d
Age, years
<50	65 (20)
≥50	268 (80)
Mean ± SD (range)	58.74 ± 10.13 (22–80)
Education, years
≤13	130 (39)
>13	202 (61)
Missing	1
Relationship status
Living with a partner	262 (79)
Single	71 (21)
Among BCS with a partner
New partner since BC	11 (4)
Menopause status
- at time of BC diagnosis
Premenopausal^a	98 (30)
Perimenopause^b	22 (6)
Postmenopausal^c	212 (64)
Missing	1
- at time of study entry
Premenopausal^a	8 (2)
Perimenopause^b	11 (3)
Postmenopausal^c	313 (95)
Missing	1
BMI
16–25	157 (47)
25–30 (overweight)	118 (36)
>30 (obese)	56 (17)
Missing	2
Mean ± SD (range)	25.98 ± 4.64 (16.4–53.9)
Use of medication (>3 days in the past month)
Sleep medication	25 (8)
Antidepressants	31 (9)
Anxiety medication	18 (6)
Median time since surgery (range), months	26.91 (3–144)
New primary BC	23 (7)
Tumor grading
I	70 (21)
II	180 (54)
III	60 (18)
NA^e	23 (7)
Mean tumor size ± SD (range), mm	18.00 ± 11.30 (0–100)
Axillary lymph node involvement
Yes	59 (29)
No	142 (71)
Median no. involved (range)	2 (1–31)
Type of surgery
Lumpectomy	217 (65)
Mastectomy	116 (35)
Breast reconstruction	39 (12)
Treatment
AET only	15 (5)
AET in combination with
Chemotherapy	206 (62)
Radiation therapy	279 (84)
Trastuzumab	47 (14)
Current AET
Letrozole	209 (63)
Tamoxifen	124 (37)
Duration of AET, months
3–12	85 (26)
13–36	128 (38)
>36	120 (36)
Median treatment time (range)	22.93 (3–120)

BMI: body mass index; BCS: breast cancer survivors; BC: breast cancer; AET: adjuvant endocrine therapy.

^a Regular menstruation.

^b Irregular menstruation.

^c Menstruation stopped.

^d Calculated based on received responses (excluded missing values).

^e Patient had mucinous or micropapillary carcinoma of the breast, or received neoadjuvant chemotherapy.

Table 2. Urogenital symptoms prior to the breast cancer diagnosis and at time of study entry.

Urogenital symptoms	Prior to BC^a	At time of study entry^b
	N (%)^c	N (%)^c
Vaginal dryness
Yes	43 (13)	154 (47)
No	285 (87)	172 (53)
Missing	5	7
Urinary symptoms (e.g. pain, incontinence)
Yes	20 (6)	76 (24)
No	308 (94)	243 (76)
Missing	5	14
Dyspareunia
Yes	25 (8)	123 (38)
No	303 (92)	205 (62)
Missing	5	5
None of the above symptoms	244 (74)	84 (26)
Do not recall	22 (7)	–

BC: breast cancer.

^a Urogenital symptoms were reported as ‘yes’ (present) or ‘no’ (not present).

^b Urogenital symptoms were present if BCSs answered ‘a little’, ‘somewhat’ or ‘a lot’ in the ICIQ-FLUTSsex. If they answered ‘not at all’ the symptoms were not present.

^c Calculated based on received responses (excluded missing).

Table 3. Odds ratios for sexual dysfunction according to selected covariates among sexually active women (N = 227).

	N (%)^a	OR (95% CI)	p
Age, range	24–80 years
≤50 years	51 (22)	ref
>50 years	176 (78)	1.53 (0.82–2.86)	.19
Continuous	227	1.01 (0.98–1.03)	.66
Type of surgery
Lumpectomy	148 (65)	ref
Mastectomy	79 (35)	0.95 (0.55–1.65)	.86
Type of AET
Letrozole	127 (56)	- ref
Tamoxifen	100 (44)	0.80 (0.47–1.36)	.41
Duration of AET
3–12 months	60 (27)	- ref
13–36 months	80 (35)	1.38 (0.70–2.72)	.35
36–120 months	87 (38)	1.36 (0.70–2.65)	.36
Continuous	227	1.00 (0.99–1.01)	.81
Chemotherapy
Yes	151 (67)	- ref
No	76 (33)	0.73 (0.42–1.28)	.27
Radiotherapy
Yes	192 (85)	- ref
No	35 (15)	2.24 (1.00–5.05)	.05
Herceptin
Yes	35 (15)	- ref
No	192 (85)	0.71 (0.34–1.52)	.38
Education
Short education: ≤13 yrs	81 (36)	- ref
Long education: >13 yrs	146 (64)	1.46 (0.84–2.53)	.18
BMI
16–25	116 (51)	- ref
25–30 (overweight)	78 (35)	1.53 (0.85–2.78)	.16
>30 (obese)	32 (14)	1.04 (0.47–2.30)	.91
Missing	1
Menopause status at time of diagnosis
Pre/peri	100 (44)	- ref
Post	126 (56)	1.37 (0.81–2.35)	.24
Missing	1
Prior vaginal dryness
No	198 (87)	- ref
Yes	29 (13)	1.64 (0.71–3.78)	.25
Current vaginal dryness^b
Continuous	227	2.41 (1.68–3.47)	<.01^†
Prior urinary symptoms
No	212 (93)	- ref
Yes	15 (7)	1.99 (0.61–6.45)	.25
Current urinary symptoms^b
Continuous	207	1.56 (0.66–3.71)	.31
Missing	20
Psychological well-being^c
Continuous	225	1.12 (1.06–1.18)	<.01^†
Missing	2
Body image^d
Continuous	227	1.24 (0.90–1.72)	.19
Relationship satisfaction^d
0–0.22 (median)	98 (45)	- ref
0.22–2.89 (max score)	119 (55)	1.90 (1.10–3.29)	.02^†

BMI: body mass index; AET: adjuvant endocrine therapy.

^a Calculated based on received responses (excluded missing).

^b ICIQ-FLUTSsex item score ranging from 0 to 3.

^c BDI sum score ranging from 0 to 63.

^d CARES subscale score ranging from 0 to 4.

^† Level of significance (p < .05).

Table 4. Adjusted odds ratios for sexual dysfunction according to age, vaginal dryness, psychological well-being, relationship satisfaction and duration of adjuvant endocrine therapy.

Variable	N (%)	OR (95% CI)	p
Age^a	216	1.03 (1.00–1.07)	.06
Vaginal dryness^a	216	2.25 (1.52–3.34)	<.01^†
Psychological well-being^a	216	1.11 (1.03–1.18)	<.01^†
Relationship satisfaction
0–0.22 (median)	97 (45)	- ref
0.22–2.89 (max score)	119 (55)	1.27 (0.67–2.42)	.46
Duration of AET^a	216	1.00 (0.99–1.01)	.59

AET: Adjuvant endocrine therapy.

^a Continuous scale.

^† Level of significance (p < .05).