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Sexuality Challenges, Intimacy, and MPN Symptom Burden: An Analysis By The MPN Quality Of Life International Study Group (MPN-QOL ISG)
Journal article

Sexuality Challenges, Intimacy, and MPN Symptom Burden: An Analysis By The MPN Quality Of Life International Study Group (MPN-QOL ISG)

  • Geyer, Holly Lynn Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA,
  • Dueck, Amylou C. Mayo Clinic, Scottsdale, AZ, USA,
  • Emanuel, Robyn M. Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA,
  • Cannon, Keith Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA,
  • Kiladjian, Jean-Jacques Hôpital Saint-Louis et Université Paris Diderot, Paris, France,
  • Slot, Stephanie Department of Hematology, VU University Medical Center, Amsterdam, Netherlands,
  • Zweegman, Sonja Department of Hematology, VU University Medical Center, Amsterdam, Netherlands,
  • Boekhorst, Peter Erasmus MC, Rotterdam, Netherlands,
  • Commandeur, Suzan Department of Dermatology, LUMC, Leiden, Netherlands,
  • Schouten, Harry C. Academische Ziekenhuis Maastricht, Maastricht, Netherlands,
  • Sackmann, Federico GATLA, Grupo Argentino de Tratamiento de Leucemia Aguda, Buenos Aires, Argentina,
  • Fuentes, Ana Kerguelen Department of Haematology,, University Hospital La Paz, Madrid, Spain,
  • Hernandez, Dolores Hematology, Hospital Universitario La Paz, Madrid, Spain,
  • Pahl, Heike L. Department of Hematology/Oncology, University Hospital Freiburg, Freiburg, Germany,
  • Griesshammer, Martin Hämatologie und Onkologie, Hämostaseologie und Palliativmedizin, Johannes Wesling Klinikum Minden, Minden, Germany,
  • Stegelmann, Frank Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany,
  • Döhner, Konstanze Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany,
  • Lehmann, Thomas Hematology, University Hospital Basel, Basel, Switzerland,
  • Ranta, Dana Department of Hematology, Nancy University Hospital, Vandoeuvre-Les-Nancy, France,
  • Reiter, Andreas Hämatologie und Onkologie, Universitätsmedizin Mannheim, III. Medizinische Klinik, Mannheim, Germany,
  • Boyer, Françoise Centre Hospitalier Universitaire, Angers, France,
  • Etienne, Gabriel Institut Bergonié, Bordeaux, Bordeaux, France,
  • Ianotto, Jean-Christophe Hematology, CHU Brest, Brest, France,
  • Roy, Lydia CHU de Poitiers et INSERM CIC 802, Poitiers University Hospital, Poitiers, France,
  • Cahn, Jean-Yves Department of Hematology, University Hospital, Grenoble, France,
  • Harrison, Claire N Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom,
  • Radia, Deepti H Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom,
  • Muxi, Pablo J. Unidadde Hematología, Hospital Británico, Montevideo, Uruguay,
  • Maldonado, Norman I School of Medicine, University of Puerto Rico, San Juan, PR, PR,
  • Besses, Carlos Hematology, Hospital del Mar, Barcelona, Spain,
  • Cervantes, Francisco Hematology Department, Hospital Clinic, Hospital Clinic, IDIBAPS, Barcelona, Spain,
  • Johansson, Peter Department of Medicine, Hematology and Coagulation Section, Gothenburg, Sweden,
  • Barbui, Tiziano Ospedale Papa Giovanni XXIII, Bergamo, Italy,
  • Barosi, Giovanni Center for the Study of Myelofibrosis, Biotechnology Research Area, IRCCS Policlinico San Matteo Foundation, Pavia, Italy,
  • Vannucchi, Alessandro M University of Florence, Florence, Italy,
  • Passamonti, Francesco Fondazione Policlinico San Matteo, Pavia, Italy,
  • Andreasson, Bjorn Internal Medicine, NU Hospital Organization, Uddevalla, Sweden,
  • Ferrari, Maria Ospedali Riuniti di Bergamo, Bergamo, Italy,
  • Rambaldi, Alessandro Div of Hematology, Ospedali Riuniti, Bergamo, Italy,
  • Samuelsson, Jan Department of Internal Medicine, Stockholm South Hospital, Stockholm, Sweden,
  • Birgegard, Gunnar Department of Medical Sciences, Uppsala University, Uppsala, Sweden,
  • Xiao, Zhijian MDS & MPN Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China,
  • Xu, Zefeng MDS & MPN Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China,
  • Sun, Xiujuan MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,
  • Xu, Junqing MDS and MPN Centre, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China,
  • Zhang, Peihong Department of Pathology, Institute of Hematology, Blood Disease Hospital, Chinese Academy of Medical Sciences, Tianjin, China,
  • Gale, Robert Peter Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom,
  • Mesa, Ruben A Hematology/Oncology, Mayo Clinic, Scottsdale, AZ, USA
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Published in:
  • Blood. - American Society of Hematology. - 2013, vol. 122, no. 21, p. 4088-4088
Immunology
Cell Biology
Biochemistry
Hematology
English Abstract

Background
We have previously reported on the high prevalence and severity of challenges with intimacy and sexuality amongst a large international cohort of MPN patients (Emanuel JCO 2012). We sought to further analyze the relationships between issues of intimacy (sexual desire and function), their relationships to MPN disease features, individual MPN symptom prevalence and severity, language, and overall quality of life.


Methods
Data was collected among an international cohort of patients with MPNs. Subjects completed the BFI, MPN-SAF, and EORTC QLQ-C30 instruments. Surveyed symptoms on the MPN-SAF included the patient’s perceptions of common MPN-related symptoms and overall quality of life (QOL) on a 0 (absent) to 10 (worst imaginable) scale. Specifically, the MPN-SAF sexuality item asked about “problems with sexual desire or function”. Total symptom score (TSS) was computed based on 10 symptom items using the published scoring algorithm on a 0 (all reported symptoms absent) to 100 (all reported symptoms worst imaginable) scale. Pairwise associations between the MPN-SAF sexuality item and continuous and categorical covariates were investigated using Pearson correlations and analysis of variance/t-tests, respectively. Multivariate regression models were used to investigate impact of groups of covariates on the sexuality item with the final multivariate model selected using forward regression.


Results

Demographics
A total of 1908 MPN patients (essential thrombocythemia=799, polycythemia vera=671, myelofibrosis=432, missing=6) completed the sexuality item. Participants were of typical age (median=60, range 15-94) and gender (female=53%). Overall, 1218 subjects described sexuality related complaints (score >0) with an overall mean symptom score of 3.5 (median=2.0, SD=3.7, range 0-10); 725/1908 (38%) patients had severe sexuality related complaints (score >4).


Univariate Analysis
Among the QLQ-C30 functioning scales, all domains had similar statistically significant correlations (r=-.26 to -.32, all p<0.001). Among QLQ-C30 symptom scales, all QLQ-C30 symptoms displayed correlations ranging between .08 and .29 (all p<0.001). Among MPN-SAF items, the MPN-SAF sexuality item correlated most significantly with the TSS (r=.41, p<0.001), along with MPN-SAF symptoms (r=.16 to .39; all p<0.001). MPN-SAF sexuality measure significantly differed by anemia (means: absent 3.3, present 4.5; p<0.001), leukopenia (means: absent 3.4, present 4.4; p=0.01), thrombocytopenia (means: absent 3.3, present 4.5; p<0.001), red cell transfusion (means: no 3.5, yes 5.0; p<0.001), MPN subtype (ET mean 3.1, PV mean=3.6, MF mean=4.4; p<0.001) and language (means ranged from 2.4 [Swedish] to 4.6 [Chinese]; p<0.001). MPN-SAF sexuality did not significantly differ by age, gender, prior thrombosis or prior hemorrhage.


Multivariate Analysis
In a multivariate model of MPN-SAF sexuality containing all QLQ-C30 functioning scales, physical (p=0.001), emotional (p=0.01), cognitive (p=0.005) and social (p=0.002) functioning were all statistically significant. Numerous symptoms were also significant in a multivariate model of MPN-SAF sexuality containing all other MPN-SAF symptoms (all p<0.05; abdominal pain, inactivity, dizziness/vertigo/lightheadedness, insomnia, depression/sad mood, cough, night sweats and overall QOL). The final multivariate model based on forward regression starting with all demographics, clinical variables, and patient-reported QLQ-C30 scales and MPN-SAF items found age, language, QLQ-C30 role functioning and MPN-SAF items (insomnia, depression/sad mood, night sweats and QOL) to be significant (p<0.05).



Conclusions
Sexuality related complaints have been linked to both physiologic and psychologic origins and are highly prevalent within the MPN population. The results of this study congruently identified close associations between sexuality and function within emotional, cognitive and social domains. Additionally, the correlations of sexuality issues with MPN symptoms and disease features further suggest this item is a key correlate of overall functionality and quality of life. Future investigations into the causative factors and biological correlates of this complaint may assist in addressing this ongoing challenge.


Disclosures:
Etienne: novartis: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Pfizer: Membership on an entity’s Board of Directors or advisory committees; Ariad: Membership on an entity’s Board of Directors or advisory committees. Roy:Novartis, BMS: Honoraria. Harrison:Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Sanofi: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; YM Bioscience: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Celgene: Honoraria; Shire: Speakers Bureau; S Bio: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Birgegard:Vifor Pharma: Honoraria. Mesa:Eli Lilly and Co: Research Funding; Genetech: Research Funding; Gilead: Research Funding; Incyte: Research Funding; Sanofi: Research Funding; NS pharma: Research Funding; Celgene: Research Funding.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/2710
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