Document 3954

FINDING HOPE
I N
T R E A T M E N T
says she focused on living and raising her 10-year-old
daughter, who is now 19. She also adjusted to seeing herself
without breasts. Crying after not finding a dress that fit her
properly Hampton decided to reclaim how she looked and
felt before cancer, describing breast reconstruction as "a
reunion with self."
Four years later, a recurrence brought up more challenges
with sexuality Hampton didn't want to lose her breasts
again. The hormonal changes from her treatments also
posed new problems. She found comfort in her breast cancer support group, where members talked openly about sexual concerns. After consulting with a gynecologist and a
psychiatrist, who prescribed estradiol vaginal tablets and
topical testosterone, Hampton says, "I got my sex life back!"
"Sexuality is an important aspect of human life and relationships. Not to address it adds one more loss to cancer,"
says Debbi Hampton, a r ~ - ~ e a r - o lbreast
d
cancer survivor
from Tennessee, who speaks from experience
After a modified radical mastectomy in 1994, Hampton
IMPACTS OF BREAST CANCER TREATMENTS
Chemotherapy disrupts female sexuality more than other
treatments, explains Patricia Ganz, MD, professor of health
services and medicine and director of the Division of
Cancer Prevention and Control Research, Jonsson
Comprehensive Cancer Center, Los Angeles.
"Chemotherapy can cause premature menopause.
T h s may result in ovarian failure, diminished androgens such as testosterone, libido changes, and lubrication problems. Vaginal dryness occurs independent of
age," says Dr. Ganz.
Chemotherapy is most likely to trigger menopause
for
who are
its
Onset but it can
younger
For
bearing age and their partners, fertility loss from premature menopause can be devastating.
Postmenopausal women &agnosed with breast cancer who stop taking hormone replacementtherapy
because of its association with cancer can experience
dramatic hormonal changes. "This challenge affects a
large number of healthy aging women,' notes Dr.
Ganz.
The Breast Cancer Prevention Trial, a study of
1 3 , 0 0 0 healthy
women, Suggests that the
hormonal agent NolvadexB(tamoxifen), which works
by bloclung estrogen from bin&ng to tumor receptors,
increases
discharge, hot flashes, and night
sweats, overall, however, D ~G~~
,
describes the side
effects of tamoxifen as "fairly limited "
She does have concern for the side effects of arowhich
Arimidex"
FemaraB(letroz0le), and Aromasin" (exemestane). This newer class of hormonal agents shuts down
the production of female hormones estrogen and progesterone in postmenopausal women UnlLke tamoxifen, there is little risk of developing uterine cancer and
blood ,-lotting with aromarase inhibitors, B~~
taking aromatase inhibitors for long periods of time
may be at a higher risk of developing osteoporosis.
Radiation is another type of breast cancer treatment
that can impact sexuality by possibly causing tiredness,
nausea, s h n changes, and hair loss. Some women
report that these side effects are a detriment to sexud
health.
Studies comparing breast-conserving surgery with
mastectomy indicate both treatments may have
My husband Paul loathes everything
assoelated with illness. Paul would
throw off the covers when hers hot
and throw them back on when he's
chilled. He'll heat up a can of soup for me
when I'm sick, but only because he's
hungry and doesn't know how to cook
'Ise.
As a result, I,ve been the one who
cleans up after our cat, Harry. Whenever I
1
: "When I'm taking care of pu,
it feel3 like taking care of
hear Paul retching, I grab the rags and
water, knowtng he's discovered hairballs.
vomit, or other substances that Harry .
occasionally deposits on the carpet.
When I discovered the lump in my
breast, Paul's response, like mine, was
disbelief. After obtaining my promise to
see the doctor right away, he left me to It.
But once I had the breast cancer diagnosls, he declared, "Thls 1s our illness, not
just yours. From now on I'm going to be
involved in every part of your treatment."
He was with me when I discussed
options with the surgeon. He was with me
when I had the lumpectomy and for the
postsurgical appointments. Hts support
made me feel safe and cared for. But it
was what Paul did the day after surgery
that rose above the call of duty.
In additton to the tumor, the surgeon
removed 19 lymph nodes to see if the cancer had spread-it had, to flve of them.
Afterwards, 1 was left with a tube dangling
from the drainingwound in my armpit, ending in a bulb that collected the rosecolored lymph fluid.
Every six hours, "someone" had to
remove the bulb, pour the contents into a
measuringcup, record the amount of fluid,
dispose of the contents, and reconnect
everything. Given the dual nature of the
discharge as blood and body ffuld, I
assumed this someone would be me.
Awakening from a nap, I beheld an
apparition-Paul loom~ngabove me with
rubber gloves on his hands. He carefully
emptied the bulb, measured the contents,
entered the pertinent information on an
elaborate spreadsheet, and reinserted
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the bulb, all before I knew it. The cat and
I stared at him, dumbfounded.
In six hours he, did r t again. Then over
and over again. As luck would have It, my
body decided it was going to drain a lot, so
Nurse Paul was on duty for two weeks. It
was hard to shower with the tube and bulb
in the way, but my nurse took care of that
by expeditious use of the washcloth.
After 1 started chemotherapy, Nurse
Paul invested himself with quaranthe
authority. Our oncologist told us that mrdway between treatments my white blood
cell count would be w l I y low and I'd be
susceptible to infection. He advised me
not to be around crowdoduring that tima.
Each morning, my nurse told me whether
today was a quarantine day. If it was, I
was housebound.
Before he left for work, Paul asked
about my plans, inserted rest breaks, and
called from work to see if I was obeying.
This may sound a Iittk heavy-handed, but
without the limits he set, E would have
tried to do too much. When 1 disobeyed
and "forgot" to rest or sneaked out to the
store, the consequences were Immediate.
Near the end of my treatment, I asked
Paul how he was able to assume nursing
duties so easily, especially the messy
parts. He ttlought a long time.
"When I'm taking care of you, it feels
like taking care of myself. But I'm glad you
haven't thrown up on the carpet!" C
Medical institutions should offer "proactive attention to educate
women about common side effects from treatments. "
,....
Ursula O f m a n , PsyD
increase moisture.
Estring" (estradiol),
which offers a slow
local release of estrogen, has been effective for many women.
PREDICTORS OF SEXUAL HEALTH
A testosterone supplement is another option, says Dr.
Dr. Ganz, who stuhed factors influencing sexual health
in women three years after their breast cancer diagnosis, Ganz. She notes women shouldn't use the more traditionfound vaginal dryness al estrogen creams because they can be absorbed into the
was the main predictor bloodstream and lead to increased levels of estrogen that
are possibly associated with an increased breast cancer risk.
of sexual dysfunction,
J
Women experiencing vaginal dryness should consider
according to results pubAYZkougk years &@Matithe progress mzrde In sexual
lished in the A~~~~~ dscussing it with their healthcare provider. "Someone
dysfvnetfon for men, researchers are now recognizing
from the healthcare team should be knowledgeable and
1999 issue of the journal
of~linicafoncology. other
sensitized to these issues. Patients need to make their
ft as an issue for women with recent findings showing
needs
known," explains Dr. Ganz.
inthe drug Wagcae [sildenafil citrate), whi@ was put on
However, before using any products, Dr. Ganz recomcluded emofional wellthe market in 1998to trmt male impotence, may work
being, body image, quali- mends, "Psychological, relationship, and other issues such
for women.
as fatigue should be addressed first."
ty of the couple's relaA study funded by Pfner lnc., whF& markets Magra,
tionship, and sexual
studied 202 postmenowusat W po&ystereaomy
problems of the woman's
BEHAVIORAL INTERVENTIONS
patients wRh female sexual arousat disorder. After
partner.
Ursula Ofman, PsyD, a sex therapist in New York City
who
works with cancer patients, believes women need to
With
or
without
canrandamking the wamen to rmeive eit31er a tIexibIe
communicate sexual problems to their healthcare
cer, "these prehctors of
close- of Wagra M placebo, the women on Viagm
sexual health are univer- provider, other survivors, and especially their partner.
reported significantly befter sexoak sattsfaction and
sd for women," Dr. Ganz Medical institutions should offer "proactive attention to
genitat sensation during irrkmourse of stimulation emphasizes. She explains
educate women about common side effects from treatcompared to those not taking Viagrzt,
there has been little ments," she says.
Numerous drug companies esre ~ u r r d rnvest&aty
research on men diagmWomenare often reluctant to address sexual difficulmg how to Greate a Viagra equivaent far wmen that nosed with breast cancer ties, and they need to talk about them. Women and their
and its potential sexual partners should discuss it outside of the bedroom with
will reiax vaginal muscles and result in bbrication.
side effects.
space for reflection and without pressure to act sexually,"
Psychological distress she adds.
because of cancer can also contribute to sexual dysfuncIn Dr. Ofman's clinical experience, the best predictor of
tion, leading to decreased sexual interest, challenges with
sexual function after cancer is sexual function before canarousal, and &Eculty achieving orgasm. Fatigue, pain, and
cer. Research also reflects this tendency. =Women who
physical inactivity can also diminish sexual functioning.
have a good sex life before cancer adjust better after," she
explains
VAGINAL PRODUCTS
A major challenge to sexual functioning can be avoidFor vaginal dryness, lubricants such as Astroglide" may ance. "Getting sexually started again can be extremely difbe helpful during intercourse. Women who have dryness ficult for women and men alike," notes Dr. Ofman.
independent of sex may use an estrogen-free product such "Women and their partners need to develop comfort to
as Replens" (polycarbophd) a few times a week to
explore sexually without expectation. Many couples learn
effects on sexual health and functioning. Yet, breast-conserving surgery (see CURE, Fall 2003) may leave women
with better body image, and therefore poses less impact on
sexuahty
The Pink Pift?
CURE- WINTER
2003
Male Sexual Dysfunction
While research suggests about half of breast cancer patlents expe-
and, more speclflcally, 50.70% of men wlth erectlle dysfunctlon brought
rlence long-term sexual dysfunct~on, up t o 90% of prostate cancer
on by a med~calc o n d ~ t ~ oreport
n
an ~mprovementw ~ t hVlagra. Common
patlents experlence erectlle dysfunctlon after radlcal prostatectomy and
srde effects for both Lev~traand V~agrainclude headaches, a flushlng
as many as 85% experlence thls s ~ d eeffect following external beam radr-
feel~ng,and Ind~gestlon.Men tak~ngnitrates, such as nitroglyerln tablets
ation Research has also shown that up to half of test~cular
for heart d~sease,should not take V~agraor Lev~traMore Infor
cancer patients report some type of sexual ~ m p a ~ r m e n t
matron can be found at www.v~agra.com and www lev~tracom
Another medlcat~onused
Erect~ledysfunct~on results when the blood supply and
IS
penlle lnject~ontherapy uslng a
nerves of the penls have been damaged. But doctors are hav-
medlclne called Caverject" (alprostad~l) The medlcat~onIS a
ing success In reduclng thls outcome thanks to nerve-spar~ng
prostaglandin that also relaxes the smooth muscles of the
techniques for prostate cancer surgery. Newer procedures and
pen~leblood vessels. It
surglcal Instruments allow the preservatlon of nerves and mus-
penls, and many urologists teach men thls procedure because
cles needed for a man to ach~evean erect~on
the lnjectlon
For those who require treatment to combat sexual dysfunct~on,the process
IS
Injected Into the s ~ d eor base of the
needed only mlnutes before sexual actlvlty.
Side effects can include prolonged erection, burning, and
scarring In the spongy t ~ s s u eof the penls More lnformat~on
twofold: physiological and psychologi-
cal. Men, just l ~ k ewomen, can become anxious and even fearful of hav-
IS
IS
can be found at www.~m~otent.com.
ing sex after treatment. In order to resolve poss~blesexual avo~dance,
S~m~larly,
alprostad~lcan be also lnserted as a pellet lnto the urethra
the Nat~onalCancer lnstltute suggests self-st~mulationto allow "the 1nd1-
using the MUSE system. Though more conven~ent,thls method may not
vidual to become comfortable wlth h~s/hersexual response and arousal
be as effectwe. For more deta~lson MUSE, go t o www.v~vus.com.
wlthout the added pressure of performance anxiety."
If Improvement does not occur after several months, other methods
can be used.
A penlle prosthes~s or lmplant prov~des men with an addit~onal
optlon. Surg~callyplaced rnslde the penls, scrotum, and publc area, the
lmplant is pumped full of a ~ or
r fluld from a small external dev~ce.There
Viagra" (slldenaf~l)and Levitra" (vardenaf~l)are oral medlcat~onsthat
IS
no loss of sensation or abllity to ach~eveorgasm, and a valve
IS
used
work by lncreaslng blood flow t o the penls and allowlng a man to ach~eve to release the erection.
and malntaln an erectlon durlng sexual st~mulat~on.
These drugs work by
Currently, numerous drugs are in the pipeline for treatment of erec-
blocklng the effect of an enzyme called phosphod~esterase5, whlch
tile dysfunction, one of which is Cialism(tadalafil). It apparently works for
helps relax the smooth muscles In the penlle blood vessels, thus
up to 36 hours.
lncreaslng blood flow.
Cialis is currently available by prescription in Europe and Mexico, and
Studles have shown that Levltra, approved In August 2003 for erec-
as of publication the drug i s under review by the U.S. Food and Drug
tile dysfunct~on,helped up to 85% of men achleve ~mprovederect~ons.
Administration with a decision expected soon. To learn more, visit
And stud~eswlth V~agraboast ~mprovementIn up to four out of flve men;
www.icos.com. G
sexual pleasure comes from new activities and routines."
Dr. Ofman encourages partners to be compassionate and gently
inquisitive. 'A supportive partner who is interested without placing
demands helps women gain acceptance for feeling desirable and
capable again."
Hampton's husband, Steve, says, ^The hardest part for me was
that my wife might become disappointed in herself. I learned to
place Debbi's needs before my own and adjusted my expectations."
The need for psychological counseling depends upon the rela-
tionship. "Many couples dealing with sexual challenges resulting
from cancer don't require sex therapy It is more an issue of helping
couples adjust to altered physical realities," says Dr. Ofman. "Some
couples who feel stuck often overcome their problems after a few
sessions."
For the Hamptons, the key was talking about sexual intimacy
"Without open communication, our relationship could have been
destroyed," says Steve Harnpton. Instead, they both affirm personal
growth from their sexual challenges. c
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