Research presented at the 17th AACR Conference on Cancer Health Disparities has revealed that sexual health symptoms significantly contribute to lower adherence to adjuvant endocrine therapy (AET) among Black women with early-stage breast cancer. The conference took place from September 21-24, 2024.
Patients diagnosed with hormone receptor-positive breast cancer typically undergo AET—treatment aimed at blocking estrogen signaling—following surgery, radiation, or chemotherapy. This regimen usually spans five to ten years to minimize the risk of cancer recurrence. However, many patients report side effects such as anxiety, depression, hot flashes, and joint pain, which can lead to treatment nonadherence, characterized by premature discontinuation or missed doses.
Dr. Janeane N. Anderson, an assistant professor at the University of Tennessee Health Science Center, noted that while previous studies indicate that Black women are more prone to experience adverse effects and treatment nonadherence than their white counterparts, the specific impact of sexual health symptoms had not been thoroughly investigated.
“Up to this point, we’ve mostly talked about AET symptoms as a collective,” Anderson stated. “But in interviews and conversations with over 100 women over the last seven years, sexual health emerged as one of the greatest unmet needs.”
Common sexual side effects from AET include vaginal dryness, reduced libido, and painful intercourse, yet these issues often go unaddressed, particularly among minority women. Anderson and her team hypothesized that these sexual health symptoms might be contributing to racial disparities in treatment adherence.
The researchers conducted a post-hoc analysis of the THRIVE clinical trial, which evaluated AET adherence at the West Cancer Center & Research Institute. Treatment adherence was tracked using electronic pillboxes, with patients reporting their medication intake over a year. Participants completed surveys assessing both physical and mental aspects of sexual health at various intervals.
The analysis included 102 Black and 173 white patients who provided survey data at enrollment, six months, and twelve months. Symptoms such as vaginal itchiness, discharge, painful intercourse, and loss of sexual interest correlated with lower mental quality of life in both groups. Notably, loss of interest in sex was specifically linked to reduced physical quality of life in Black patients.
For Black patients, vaginal dryness at six months, alongside decreased libido and sexual satisfaction at twelve months, were associated with lower adherence to AET, whereas similar associations were not found in white patients.
Dr. Anderson emphasized the importance of recognizing these symptoms and their differential impact. “Women are truly affected by these symptoms,” she remarked. “The takeaway is that Black and white women experience some of these symptoms differently.”
To address these challenges, Anderson highlighted the availability of both hormonal and non-hormonal treatments, including vaginal moisturizers and topical estrogen. She stressed the necessity for open dialogue about sexual health between patients and oncologists throughout treatment to effectively manage symptoms and improve adherence.
“If we start addressing these symptoms, we may see increased parity in AET adherence between Black and white women,” Anderson concluded. “Women should not have to choose between adhering to treatment and reclaiming their sexuality.”
The study acknowledges limitations, including its reliance on data from a single cancer center, which may not be representative of broader patient populations. Additionally, the recruitment of women from other minority groups was limited, leaving a gap in understanding sexual health symptoms in those demographics.
Funding for this research was provided by the National Cancer Institute of the National Institutes of Health.
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