Communication and sexual function and frequency in breast cancer patients 2 years after diagnosis: results from the VICAN 2 study.

BACKGROUND: Breast cancer treatments may have impacts on several aspects of sexual health, including psychological, psychosexual, physiological, physical, and relational. AIM: In this study we sought to assess sexual function and sexual frequency in breast cancer patients 2 years after diagnosis. METHODS: We selected all breast cancer participants from the the French national VIe après le CANcer 2 (VICAN 2) longitudinal study. Data sources included patient and medical questionnaires, along with medico-administrative databases. OUTCOMES: Outcomes assessed were the dimensions of sexual function and frequency from the Relationship and Sexuality Scale and communication about sexuality with healthcare providers. RESULTS: Out of 1350 participating women, 60.2% experienced a decrease in sexual desire, 61.4% reported a lower frequency of intercourse, and 49.5% faced decreased ability to orgasm. In contrast, 64.8% had engaged in sexual intercourse in the previous 2 weeks, 89.5% were "Somewhat" to "Very much" satisfied with the frequency of intimate touching and kisses with their partner, and 81.6% expressed satisfaction with their intercourse frequency. However, a mere 15% of women discussed sexuality with the healthcare providers. Independent factors associated with increased communication about sexuality included age younger than 50 years (OR = 1.90 95% CI [1.28-2.82], P = .001), being in a partner relationship (OR = 2.53 95% CI [1.28-2.82], P = .003), monthly income above 1,500 euros (OR = 1.73 95% CI [1.15-2.60], P = .009), and absence of diabetes (OR = 6.11 95% CI [1.39-26.93], P = .017). CLINICAL TRANSLATION: The study findings underscore the need for continuing education in oncosexology and dedicated sexual health interventions that should involve a holistic approach that takes into consideration age, treatments, relationship status, and whether the patient has diabetes. STRENGTHS AND LIMITATIONS: Strengths of the study are the sample size, the national representativeness, and data reliability. However, the cross-sectional design could introduce potential recall, recency, or social desirability biases. Also, social determinants influencing sexual health, such as ethnicity or geographic locations, have not been considered in the analyses. CONCLUSIONS: This study revealed that sexual disorders persist 2 years after a breast cancer diagnosis, with a noticeable communication gap regarding sexuality between patients and medical teams. These findings underscore the necessity for tailored sexual health interventions, particularly designed for women who are single, older aged, and diabetes patients.

Advance Approval of Outpatient Chemotherapy via Phone Call Optimizes Healthcare Delivery without Compromising Patient Satisfaction with Care.

Patient satisfaction is linked to the amount of time spent with the physician. At the same time, long waiting times in hospitals are a major source of patient dissatisfaction. The aim of this study was to determine whether advance approval of outpatient chemotherapy (CT) via phone call can optimize healthcare delivery without compromising patient satisfaction with care. Between 2013 and 2016, 343 patients with breast/gynecological cancer scheduled to undergo CT on day 8 and/or day 15 of the CT cycle were enrolled in a before-after study conducted in a French comprehensive cancer center. In the control group, 168 patients received a face-to-face consultation with an oncologist on the day of CT for approval of the upcoming CT session. In the intervention group, 175 patients received a phone call from a healthcare provider the day before CT, where assessment of toxicity from the previous CT session was recorded and submitted to an oncologist for approval of the upcoming CT session. At the end of the 6th CT cycle, patient satisfaction was evaluated using EORTC IN-PATSAT32. A total of 233 questionnaires were analyzed (response rate: 77.7%). Satisfaction with care was similar between the two groups. No differences in perceived health status were observed, but self-reported time in hospital was lower in the intervention group than in the control group (p = 0.007). Advance approval of outpatient CT via phone call is feasible and particularly relevant in the current context of immunotherapy development.

Use of non-conventional medicine and lifestyle change among cancer survivors: evidence from the national VICAN survey.

PURPOSE: This study aimed to investigate the use of non-conventional medicine (NCM) among long-term cancer survivors and its links with healthy behavior. METHODS: This study used data from the VICAN survey, conducted in 2015-2016 on a representative sample of French cancer survivors 5 years after diagnosis. RESULTS: Among the 4174 participants, 21.4% reported using NCM at the time of the survey, including 8.4% who reported uses not associated with cancer. The most frequently cited reasons for using NCM were to improve their physical well-being (83.0%), to strengthen their body (71.2%), to improve their emotional well-being (65.2%), and to relieve the side effects of treatment (50.7%). The NCM users who reported using NCM to cure cancer or prevent relapses (8.5% of the participants) also used NCM for other reasons. They had more often experienced cancer progression, feared a recurrence, and had a poorer quality of life because of sequelae, pain, and fatigue. They also consulted their general practitioners more frequently and had changed their lifestyle by adopting more healthy practices. CONCLUSION: The use of NCM is not an alternative but a complementary means of coping with impaired health. Further research is now required to determine whether the use of NCM reflects a lifestyle change or whether it assists survivors rather to make behavioral changes. IMPLICATIONS FOR CANCER SURVIVORS: The use of NCM should alert physicians to survivors' impaired quality of life. It might be useful to provide patients with NCM guidelines in order to inform their decision and to prevent unrealistic expectations.

Use of non-conventional medicine two years after cancer diagnosis in France: evidence from the VICAN survey.

PURPOSE: The purpose of this study was to assess the use of non-conventional medicine (NCM) in a representative sample of French patients 2 years after cancer diagnosis. METHODS: The study was based on data obtained in the VICAN survey (2012) on a representative sample of 4349 patients 2 years after cancer diagnosis. Self-reported data were collected at telephone interviews with patients. The questionnaire addressed the various types of non-conventional treatments used at the time of the survey. RESULTS: Among the participants, 16.4% reported that they used NCM, and 45.3% of this group had not used NCM before cancer diagnosis (new NCM users). Commonly, NCMs used were homeopathy (64.0%), acupuncture (22.1%), osteopathy (15.1%), herbal medicine (8.1%), diets (7.3%) and energy therapies (5.8%). NCM use was found to be significantly associated with younger age, female gender and a higher education level. Previous NCM use was significantly associated with having a managerial occupation and an expected 5-year survival rate ≥80% at diagnosis; recent NCM use was associated with cancer progression since diagnosis, impaired quality of life and higher pain reports. CONCLUSION: This is the first study on NCM use 2 years after cancer diagnosis in France. In nearly half of the NCM users, cancer diagnosis was one of the main factors which incited patients to use NCM. Apart from the NCM users' socioeconomic profile, the present results show that impaired health was a decisive factor: opting for unconventional approaches was therefore a pragmatic response to needs which conventional medicine fails to meet during the course of the disease. IMPLICATIONS FOR CANCER SURVIVORS: Better information of patients and caregivers is needed to allow access to these therapies to a larger population of survivors.

Complementary or alternative medicine as possible determinant of decreased persistence to aromatase inhibitor therapy among older women with non-metastatic breast cancer.

PURPOSE: Aromatase inhibitor therapy (AI) significantly improves survival in breast cancer patients. Little is known about adherence and persistence to aromatase inhibitors and about the causes of treatment discontinuation among older women. METHODS: We constituted a cohort of women over 65 receiving a first AI therapy for breast cancer between 2006 and 2008, and followed them until June 2011. Women were selected in the population-based French National Health Insurance databases, and data was collected on the basis of pharmacy refills, medical records and face-to-face interviews. Non-persistence to treatment was defined as the first treatment discontinuation lasting more than 3 consecutive months. Time to treatment discontinuation was studied using survival analysis techniques. RESULTS: Overall among the 382 selected women, non-persistence to treatment went from 8.7% (95%CI: 6.2-12.1) at 1 year, to 15.6% (95%CI: 12.2-19.8) at 2 years, 20.8% (95%CI: 16.7-25.6) at 3 years, and 24.7% (95%CI: 19.5-31.0) at 4 years. In the multivariate analysis on a sub-sample of 233 women with available data, women using complementary or alternative medicine (CAM) (HR = 3.2; 95%CI: 1.5-6.9) or suffering from comorbidities (HR = 2.2; 95%CI: 1.0-4.8) were more likely to discontinue their treatment, whereas women with polypharmacy (HR = 0.4; 95%CI: 0.2-0.91) were less likely to discontinue. In addition, 13% of the women with positive hormonal receptor status did not fill any prescription for anti-hormonal therapy. CONCLUSION: AI therapy is discontinued prematurely in a substantial portion of older patients. Some patients may use CAM not as a complementary treatment, but as an alternative to conventional medicine. Improving patient-physician communication on the use of CAM may improve hormonal therapy adherence.

Two years after cancer diagnosis, what is the relationship between health-related quality of life, coping strategies and spirituality?

This study aimed to analyze the relationship between spirituality, coping strategies and health-related quality of life (HRQL) among a large representative sample of patients two years after cancer diagnosis. Using a cross-sectional design, medical and self-reported data were collected by physicians and a patient telephone interview, respectively. Among 4270 participants, 54.6% reported that spirituality was not a source of comfort at all during the disease, 23.4% stated that it was a source of moderate comfort and 22.5% a source of great comfort. After adjustment for age, gender, educational level and living in a couple, a multivariate analysis showed that a lower mental HRQL score was independently associated with finding moderate comfort in spirituality when compared with finding no comfort at all. After multiple adjustment, a lower score of physical HRQL and a higher score of fighting spirit were independently associated with having found great comfort in spirituality when compared with those who found no comfort at all. This study aimed to understand the dynamics of religious beliefs among cancer patients over the disease duration and to understand how these beliefs could be considered and utilized by patients as a source of comfort and support. The results highlight not only the role spirituality may play in disease management and the extent to which it may be a valuable source of comfort during the follow-up of cancer patients, but also its role in the evaluation of the different dimensions of HRQL.