Assessment of sexual dysfunction in women diagnosed with breast cancer

Empirical thesis.Bibliography: pages 87-96.Chapter 1. General introduction -- Chapter 2. Systematic review -- Chapter 3. Empirical study 1 : The female sexual function index (FSFI) : evaluation of acceptibility, reliability, and validity in women with breat cancer -- Chapter 4. Empirical study 2 : Development and initial validation of the female sexual function index adaptation for breast cancer patients (FSFI-BC) -- Chapter 5. General discussion.Women with breast cancer frequently report sexual functioning difficulties that are directly or indirectly related to breast cancer and treatment. There are promising treatments for sexual dysfunction in women diagnosed with breast cancer, however, women who could benefit may not be identified as both practitioners and women find it difficult to initiate converstaions about sexual functioning. One way to identify these women is to routinely administer a self-report scale to screen for sexual dysfunction. Unfortunately, there are numerous scales that have been used in research, with no one scale identified as a 'gold standard'. This thesis addresses this issue by developing a sexual dysfunction measure suitable for use with breast cancer populations.An initial systematic review was conducted to identify potential scales for this purpose. Scales measuring sexual functioning in the breast cancer context were systematically evaluated to determine (1) evidence for acceptable psychometric properties; and, (2) the extent to which these scales cover the areas of sexual dysfunction defined by internationally-recognised diagnostic systems DSM-5 and ICD-10. The Female Sexual Function Index (FSFI) was identified as a promising measure.The FSFI has been used extensively in breast cancer research, but never validated in this population. The first empirical study entailed a validation of the FSFI within the breast cancer context. Sexually active women diagnosed with breast cancer (N=399) completed an on-line questionnaire containing the FSFI and measures of related constructs necessary for validity studies. Overall, the FSFI demonstrated excellent internal consistency and test-retest reliability. The confirmatory factor analysis provided evidence for six factors – Desire, Arousal, Lubrication, Orgasm, Pain and Satisfaction. Convergent, divergent and discriminant validities were also evident. Women with breast cancer provided positive feedback about the FSFI and they noted that the FSFI could be further improved by including questions that measure (1) reasons for sexual dysfunction; (2) the contributions of the partner’s difficulties; (3) the use of artificial lubricants; and, (4) pre-cancer sexual functioning.Following suggestions for improvements to the FSFI for use with women with breast cancer, the second empirical study reports on the development and validation of the breast cancer adaptation of the FSFI – the FSFI-BC. This new measure aims to overcome the commonly-cited limitations of the original scale regarding applicability to non-sexually active women and measuring distress. Women diagnosed with breast cancer, both sexually active and non-active (N=596) completed the FSFI-BC and other measures of related constructs used for validity studies. An exploratory factor analysis provided evidence for seven factors - Changes after cancer, Desire/arousal, Lubrication, Orgasm, Pain, Satisfaction and Distress. Acceptable internal consistency and test-retest reliability of the subscales were evident. The pattern of correlations with related constructs provided evidence for convergent and divergent validities. The participants provided positive feedback about the FSFI-BC. appropriate for this population.Overall, the systematic review and two empirical studies of this thesis contributed to the understanding of the assessment of sexual dysfunction in breast cancer populations. The resulting scale, the FSFI-BC can be used in routine clinical care and research to screen for sexual dysfunction in women diagnosed with breast cancer, as it is psychometrically sound and appropriate for this population.Mode of access: World wide web1 online resource (161 pages

Development and validation of the Female Sexual Function Index adaptation for breast cancer patients (FSFI-BC)

Sexual dysfunction following breast cancer treatment is common and screening for this is recommended. This study determined the reliability, validity, and acceptability of a breast cancer-specific adaptation of the Female Sexual Function Index, the FSFI-BC. This new measure addresses limitations in the FSFI when assessing sexual dysfunction of women with breast cancer regarding applicability to non-sexually active women, measuring distress and changes after cancer. Female breast cancer survivors (n = 596; 429 sexually active, 166 non-sexually active) completed an online survey including demographic/medical information, the FSFI-BC, and scales measuring sexual functioning, fatigue, body image, physical and mental health, and relationship adjustment (Time 1). Three weeks later, 326 women (245 sexually active; 81 non-sexually active) completed the Time 2 survey including the FSFI-BC, and questions regarding its acceptability and perceived change in sexual functioning. Reliability, construct validity, and acceptability were examined using standard scale validation techniques. Exploratory factor analysis delineated seven factors: Changes after cancer, desire/arousal, lubrication, orgasm, pain, satisfaction, and distress, accounting for 79.98 % (sexually active) and 77.19 % (non-active) variance in responses. Acceptable internal consistencies (non-active: α = 0.71–0.96; sexually active: α = 0.89–0.96) and test–retest reliabilities (non-active: r = 0.63–0.86; sexually active: r = 0.71–0.88) were evident. Inter-scale correlations provided evidence for convergent and divergent validities of the FSFI-BC. Both sexually active and non-active women provided positive feedback about the FSFI-BC. The optional partner questions demonstrated clinical utility. With desirable psychometric properties and acceptability to participants, the FSFI-BC is suitable for screening for sexual dysfunction in women with breast cancer.12 page(s

The Female Sexual Functioning Index (FSFI) : evaluation of acceptability, reliability, and validity in women with breast cancer

Purpose: Sexual dysfunction commonly arises for women following diagnosis and treatment of breast cancer. The aim of this study was to systematically evaluate the acceptability, reliability, and validity of the Female Sexual Functioning Index (FSFI) when used with these women. Methods: Sexually active women previously diagnosed with breast cancer (N = 399) completed an online questionnaire including the FSFI and measures of acceptability (ease of use, relevance), sexual functioning, body image, fatigue, impact of cancer, physical and mental health, and relationship adjustment. Reliability and validity were evaluated using standard scale validation techniques. Results: Participants indicated a high degree of acceptability. Excellent internal consistency (α = 0.83–0.96) and test–retest reliability (r = 0.74–0.86) of the FSFI were evident. According to the confirmatory factor analysis, the best fit was achieved with removal of item 14 (regarding the extent of emotional closeness with the partner) and six subscales (desire, arousal, lubrication, orgasm, satisfaction, pain), without a total score (TLI = 0.96, CFI = 0.97, RMSEA = 0.07). Correlations with measures of sexual functioning and related constructs provided evidence for convergent and divergent validities, respectively. All but one subscale (orgasm) discriminated between women who are, and are not, currently receiving treatment for breast cancer (discriminant validity). Conclusions: These findings indicate that not only is the FSFI psychometrically sound when used with women with breast cancer, but it is perceived as being easy to use and relevant. It is recommended that the FSFI subscale scores can be used in both clinical and research settings as a screening tool to identify women experiencing sexual dysfunction following breast cancer.9 page(s

Screening for sexual dysfunction in women diagnosed with breast cancer : systematic review and recommendations

Breast cancer patients are at increased risk of sexual dysfunction. Despite this, both patients and practitioners are reluctant to initiate a conversation about sexuality. A sexual dysfunction screening tool would be helpful in clinical practice and research, however, no scale has yet been identified as a "gold standard" for this purpose. The present review aimed at evaluating the scales used in breast cancer research in respect to their psychometric properties and the extent to which they measure the DSM-5/ICD-10 aspects of sexual dysfunction. A comprehensive search of the literature was conducted for the period 1992-2013, yielding 129 studies using 30 different scales measuring sexual functioning, that were evaluated in the present review. Three scales (Arizona Sexual Experience Scale, Female Sexual Functioning Index, and Sexual Problems Scale) were identified as most closely meeting criteria for acceptable psychometric properties and incorporation of the DSM-5/ICD-10 areas of sexual dysfunction. Clinical implications for implementation of these measures are discussed as well as directions for further research.13 page(s

A systematic review with evidence mapping of supportive care interventions for melanoma patients and caregivers

Abstract Aim We conducted a systematic review and evidence gap mapping to explore the existing supportive care interventions and their impact on well‐being outcomes for melanoma patients and caregivers. Methods We searched MEDLINE, Embase, Web of Science Index Medicus, CINAHL, Lilacs, CENTRAL (Cochrane Library) and PsycINFO in December 2022, including interventional studies assessing the effectiveness of any supportive care intervention among melanoma patients and/or their caregivers. Findings Twenty studies were included in this review. These studies consisted of randomised controlled trials (n = 11, 55%), pre‐post studies (n = 7, 35%) and quasi‐experimental trials (n = 2, 10%). All studies originated from high‐income countries and focused primarily on melanoma patients, with no studies identified that focused solely on caregivers. Educational interventions were the most common (n = 7, 35%), followed by psychoeducational interventions (n = 6, 30%) and psychotherapeutic interventions (n = 4, 20%). Nearly all included studies (n = 18, 90%) reported a positive effect of the intervention on the primary outcome of interest; however, most studies (n = 17, 85%) were judged to be at moderate or high risk of bias. Due to heterogeneity of study designs, intervention characteristics and outcome measures, meta‐analysis was not conducted. Implications Supportive care interventions have positive impacts on melanoma patient well‐being outcomes, while being acceptable and feasible to conduct. More research is needed regarding supportive care interventions for melanoma caregivers. Future research should focus on eliminating sources of bias through rigorous methodology, with the development of standardised outcome measures for psychosocial outcomes to facilitate future meta‐analyses

Telehealth follow‐up consultations for melanoma patients during the COVID‐19 pandemic: Patient and clinician satisfaction

Abstract Introduction The COVID‐19 pandemic caused rapid implementation of telehealth for melanoma follow‐up care in Australia. This study explores Australian melanoma patients and clinicians' level of satisfaction with telehealth. Methods A cross‐sectional study was conducted across three specialist melanoma centres in Sydney, Australia. Melanoma patients (all stages) and clinicians completed mixed methods surveys seeking socio‐demographic and clinical information and questionnaires to assess satisfaction with telehealth. Additionally, patients completed measures of quality of life, fear of cancer recurrence and trust in their oncologist. Patients and clinicians provided open‐ended responses to qualitative questions about their perceptions of telehealth. Results One hundred and fifteen patients and 13 clinicians responded to surveys. Telephone was used by 109 (95%) patients and 11 (85%) clinicians. Fifty‐seven (50%) patients and nine (69%) clinicians preferred face‐to‐face consultations, 38 (33%) patients and 3 (23%) clinicians preferred a combination of face‐to‐face and telehealth consultations. Five (4%) patients and nil clinicians preferred telehealth consultations. Patients diagnosed with early‐stage melanoma, using telehealth for the first time, who have lower trust in their oncologist, and having higher care delivery, communication and supportive care concerns were likely to report lower satisfaction with telehealth. Open‐ended responses were consistent between patients and clinicians, who reported safety, convenience and improved access to care as major benefits, while identifying personal, interpersonal, clinical and system‐related disadvantages. Discussion While telehealth has been widely implemented during COVID‐19, the benefits identified by patients and clinicians may extend past the pandemic. Telehealth may be considered for use in conjunction with face‐to‐face consultations to provide melanoma follow‐up care

Longitudinal trajectory of quality of life for patients with melanoma brain metastases: A secondary analysis from a whole brain radiotherapy randomized clinical trial

Purpose: Brain metastases are common in patients with advanced melanoma. This study describes 12-month quality of life (QoL) trajectories following local management of 1–3 melanoma brain metastases. Methods: This study assessed QoL data collected during a multi-center, prospective, open-label, phase III randomized controlled trial comparing the efficacy of adjuvant whole brain radiotherapy (WBRT) with observation after local treatment of 1–3 melanoma brain metastases. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Core (QLQ-C30) and Brain Tumour (BN-20) questionnaires at baseline and every 2 months, for 12 months.Using growth mixture modelling, QoL trajectories were identified for global health status, QLQ-C30 and BN-20 subscales for patients with baseline and at least one follow-up assessment. Multivariable logistic regression was used to examine associations between trajectories, demographic, and clinical factors. Results: After combining QoL data from observation and WBRT arms, QLQ-C30 and BN-20 trajectories were calculated for 139 and 137 patients respectively. Depending on the QoL domain, 9–54 % of patients reported a deterioration in QoL. Older age (≥65 years) was significantly associated with deterioration in global health status (OR = 2.88, 95 %CI = 1.27–6.54), physical (OR = 3.49, 95 %CI = 1.29–9.41), role (OR = 4.15, 95 %CI = 1.77–9.71), social (OR = 4.42, 95 % CI = 1.57–12.46), cognitive (OR = 6.70, 95 % CI = 1.93–23.29) and motor functioning (OR = 4.95, 95 %CI = 1.95–12.61) and increased future uncertainty (OR = 0.20, 95 %CI = 0.07–0.53). Female sex (OR = 0.10, 95 %CI = 0.02–0.41), not having neurosurgery at baseline (OR = 0.09, 95 %CI = 0.02–0.52), 2–3 brain metastases (OR = 5.75, 95 %CI = 1.76–18.85) or receiving adjuvant WBRT (OR = 6.77, 95 %CI = 2.00–22.99) were associated with poorer physical, emotional, cognitive and social outcomes respectively. Conclusions: Poorer QoL outcomes in the first 12 months after diagnosis of melanoma brain metastases were observed in patients aged ≥ 65 years, females, having 2–3 brain metastases, non-surgical treatment of metastases or adjuvant WBRT.Clinical Trial Registration Number:Whole Brain Radiotherapy Trial (WBRTMel) was registered with the Australian Clinical Trials Registry (ACTRN12607000512426) and ClinicalTrials.gov (NCT01503827).Study Support:This project was funded by Cancer Australia PdCCRS (Grants No. 512358, 1009485, and 1084046) and the National Helath and Medical Research Coucil of Australia (NHMRC; Grant No. 1135285).ADT was supported by a Cancer Australia Priority-driven Collaborative Cancer Research Scheme. Project #1046923. RLM was supported by an NHMRC Fellowship #1194703 and a University of Sydney, Robinson Fellowship. JFT was supported by an NHMRC Program Grant #1093017