Leon-Carlyle Marisa, Schmocker Selina, Victor J Charles, Maier Barbara-Anne, O'Connor Brenda I, Baxter Nancy N, McLeod Robin S, Kennedy Erin D
1 Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada 2 Zane Cohen Centre for Digestive Diseases, Toronto, Ontario, Canada 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada 4 Department of Diagnostic Assessment, Grand River Hospital, Kitchener, Ontario, Canada 5 Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada 6 Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada 7 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Dis Colon Rectum. 2015 Aug;58(8):736-42. doi: 10.1097/DCR.0000000000000409.
Although several studies have reported high rates of sexual dysfunction in patients treated for rectal cancer, most studies have been limited by retrospective design, failure to use validate instruments, and a limited number of female patients.
The objectives of this study were to 1) prospectively assess changes in sexual function before and after treatment for rectal cancer and 2) identify potential areas for improved care of patients who have rectal cancer with sexual dysfunction.
This study is a prospective, longitudinal survey.
This study was conducted at 4 tertiary care academic hospitals.
The patients included had newly diagnosed rectal cancer.
Subjects completed the European Organization for Research and Treatment Quality of Life Cancer Module and Colorectal Cancer Module, International Index of Erectile Function, and Female Sexual Function Index questionnaires before the start of treatment, after the completion of preoperative chemoradiotherapy, and 1 year after surgery.
Forty-five patients completed the study, and the overall results showed significant sexual dysfunction in both male and female subjects that continued to increase from baseline up to 1 year after surgery. In male subjects, sexual activity, interest, and enjoyment remained relatively stable, despite increasing sexual problems. However, for female patients, although sexual activity and interest remained relatively stable, sexual enjoyment worsened as sexual problems increased.
The study closed before reaching the target sample size owing to lower than anticipated accrual rates. Post hoc analysis included qualitative interviews with patients to explore reasons for low recruitment.
The results of this study show that sexual problems continue to increase up to 1 year after surgery. Despite this, sexual interest in both male and female patients remained relatively unchanged suggesting that other aspects of sexuality, not just physiologic function, also need to be evaluated. Future studies to assist and educate physicians on how to initiate a discussion about sexuality and identify patients in "distress" because of sexual problems are important.
尽管多项研究报告称直肠癌患者性功能障碍发生率较高，但大多数研究存在回顾性设计、未使用经过验证的工具以及女性患者数量有限等局限性。
本研究的目的是：1）前瞻性评估直肠癌治疗前后性功能的变化；2）确定改善直肠癌伴性功能障碍患者护理的潜在领域。
本研究是一项前瞻性纵向调查。
本研究在4家三级医疗学术医院进行。
纳入的患者为新诊断的直肠癌患者。
受试者在治疗开始前、术前放化疗完成后以及术后1年完成欧洲癌症研究与治疗组织生活质量癌症模块和结直肠癌模块、国际勃起功能指数以及女性性功能指数问卷。
45名患者完成了研究，总体结果显示男性和女性受试者均存在明显的性功能障碍，且从基线到术后1年持续增加。在男性受试者中，尽管性问题增加，但性活动、兴趣和愉悦感保持相对稳定。然而，对于女性患者，尽管性活动和兴趣保持相对稳定，但随着性问题增加，性愉悦感恶化。
由于入组率低于预期，研究在达到目标样本量之前结束。事后分析包括对患者进行定性访谈，以探讨招募率低的原因。
本研究结果表明，术后1年内性问题持续增加。尽管如此，男性和女性患者的性兴趣保持相对不变，这表明不仅生理功能，性的其他方面也需要评估。未来开展研究以协助并教育医生如何就性问题展开讨论以及识别因性问题而“痛苦”的患者很重要。
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