May 21, 2016
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Sexual dysfunction common among patients with myeloproliferative neoplasms

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More than two-thirds of patients with myeloproliferative neoplasms reported experiencing some degree of sexual dysfunction, according to prospective study results from the Myeloproliferative Neoplasms Quality of Life International Study Group.

The researchers observed the most severe sexual dysfunction symptoms in older patients, those with cytopenias and transfusion requirements, and patients receiving steroids or immunomodulators.

“The impact of having a chronic hematological malignancy on important quality of life issues, such as sexuality, have been poorly studied and appreciated,” Ruben A. Mesa, MD, FACP, professor of medicine and chair of the division of hematology and medical oncology at Mayo Clinic in Phoenix, as well as a HemOnc Today Editorial Board member, told HemOnc Today. “After fatigue, challenges with intimacy are the most prevalent symptom patients with myeloproliferative neoplasms [MPN] complain of.”

Mesa and colleagues sought to determine the degree to which patients with MPN — a diverse group of hematologic malignancies that include polycythemia vera, essential thrombocytopenia and myelofibrosis — experience sexual dysfunction, as well as its relation to quality of life, patient characteristics, disease features, treatment and symptom burden.

The researchers prospectively evaluated a multinational cohort of 1,971 patients with MPN (essential thrombocytopenia, n = 827; polycythemia vera, n = 682; myelofibrosis, n = 456; other, n = 6). Fifty-two percent of patients (n = 1,024) were aged 60 years or older (median age, 59.2 years), and 53.2% (n = 1,060) were female.

The researchers analyzed responses to the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, as well as individual disease characteristics and laboratory data. They compared sexuality scores with an age-matched, healthy control population from Sweden (n = 401).

Overall, 64% (n = 1,259) of patients with MPN reported experiencing some degree of sexual dysfunction, with 43% (n = 839) experiencing severe symptoms (MPN-SAF item score 4). Patients with MPN had a significantly higher rate of sexual dysfunction than the healthy population (MPN-SAF score, 3.6 vs. 2; P < .001).

Patients with myelofibrosis experienced the most problematic MPN-SAF sexuality scores (4.38), followed by patients with polycythemia vera (3.61) and essential thrombocytopenia (3.12; P < .0001).

Univariate analysis showed patients with laboratory abnormalities had more problematic sexuality symptom scores than patients without (4.34 vs. 3.27; P < .0001). This included patients with anemia (4.86 vs. 3.38; P < .0001), leukopenia (4.1 vs. 3.44; P = .035) and thrombocytopenia (4.42 vs. 3.39; P = .0004).

Further, patients requiring red blood cell transfusions had more problematic sexuality scores (5.03 vs. 3.49; P < .0001).

A final multivariate analysis showed that age older than 60 years correlated with severe sexuality symptoms (P < .0001).

A multivariate analysis evaluating patient language groups showed Chinese language was most closely associated with sexuality-related symptoms (P < .0001). Conversely, patients with MPN who spoke Swedish did not have a significant difference in sexuality scores compared with controls who spoke Swedish (2.4 vs. 2).

Patients who experienced sexuality symptoms also had impairments in physical functioning, social functioning, role functioning, cognitive functioning, emotional functioning and overall global health (P < .001 for all), as well as an increased incidence of financial problems (P < .01).

Sexuality scores correlated highly with sad mood (Pearson correlation, 0.38), inactivity (Pearson correlation, 0.34), correlation problems (Pearson correlation, 0.33), dizziness (Pearson correlation, 0.32) and insomnia (Pearson correlation, 0.31).

Sexual dysfunction symptoms correlated with impaired quality of life (P < .0001).

The researchers also drew correlations between sexual dysfunction and modes of treatment, with more problematic sexuality scores observed among patients currently receiving interferon (4.06 vs. 3.47; P = .009), immunomodulators (5.31 vs. 3.45; P < .0001) and steroids (5.36 vs. 3.49; P < .0001) compared with patients not receiving those treatments.

The researchers acknowledged limitations of their study. The MPN-SAF sexuality question did not specify any singular aspect of the term, which could potentially produce broad interpretations. Further, they could not determine whether the similarity in scores between patients and controls from Sweden were due to the small sample size or other factors.

“Our study identifies the significant prevalence of challenges with intimacy that can include not only physical limitations, such as impotence, but the loss of sexual desire and the impact of other symptoms on feelings of intimacy,” Mesa said.

The frequency of sexual dysfunction among patients with MPN may be due in part to clinicians who feel uncomfortable broaching the subject during treatment, Aaron T. Gerds, MD, MS, assistant professor of medicine at Cleveland Clinic Taussig Cancer Center, wrote in a related editorial.

“Physicians may have a fear of causing patient distress, a feeling that it is not their responsibility, a lack of time or training, the perception that sexuality is not important to address at the time of the initial oncology visit, or the belief that patients will or should raise the issues if they have concerns,” Gerds wrote.

More awareness of the importance of sexual functioning may alleviate this issue, Gerds concluded.

“One potential solution is incorporating questions regarding sexuality-related concerns on a clinic intake form completed by the patient at the time of the consultation,” Gerds wrote. “Because it already includes a question regarding ‘problems with sexual desire or function,’ routine symptom assessment with the MPN-SAF could be used as a simple tool to prompt a physician–patient discussion of sexuality-related symptoms.” – by Cameron Kelsall

For more information:

Ruben A. Mesa, MD, FACP, can be reached at mesa.ruben@mayo.edu.

Disclosure: Mesa reports grants from CTI Biopharma, Gilead and Incyte, as well as a consultant role with Novartis, for work performed outside of the current study. Please see the full study for a list of all other researchers’ relevant financial disclosures. Gerds reports advisory board positions with AstraZeneca, CTI Biopharma, Incyte and Roche.