Sharon Bober - Academia.edu (original) (raw)

Papers by Sharon Bober

Journal of Cancer Survivorship, 2019

Purpose Each year, thousands of young breast cancer (BC) patients confront the difficult decision... more Purpose Each year, thousands of young breast cancer (BC) patients confront the difficult decision to medically suppress ovarian function and undergo abrupt, premature menopause to reduce risk of cancer recurrence. Unlike natural menopause, young women undergoing ovarian suppression (OS) face severe and disruptive side effects. Profound sexual dysfunction is one of the most prevalent, distressing side effects of OS treatment. Unmanaged sexual dysfunction is also a primary predictor of nonadherence to this potentially life-saving treatment. We developed and tested a brief, psychosexual intervention targeted to manage sexual dysfunction and psychological distress after OS in young BC survivors. Methods Twenty young BC survivors with sexual dysfunction received a single 4-h group intervention that included sexual health rehabilitation, body awareness exercises, and mindfulness-based cognitive therapy (MBCT) skills followed by a single tailored booster telephone call 1-month later. Assessment of female sexual function and psychological distress was completed at baseline and 2 months post-intervention. Results Analyses examined changes pre-to post-intervention. Female sexual health improved significantly from baseline to follow-up (n = 19, p < 0.02). Anxiety was also significantly improved at the 2-month (p < 0.000) timepoint, compared with baseline 1. Moderate-to-large effect sizes were observed regarding changes in sexual function and psychological distress. Conclusions Significant improvements in sexual functioning and psychological distress were observed 2 months postintervention. Implications for Cancer Survivors These results demonstrate that delivery of a targeted intervention in brief, low-intensity group setting is a promising model for reducing distressing sexual dysfunction in young BC survivors on OS treatment.

Journal of Cancer Survivorship, 2019

Purpose Sexual dysfunction is one of the most prevalent and distressing treatment-related side ef... more Purpose Sexual dysfunction is one of the most prevalent and distressing treatment-related side effects for both male and female cancer survivors. Survivorship care guidelines recommend therapeutic sexual aids to help improve sexual problems. However, little is known about the availability of sexual aids and resources at cancer centers. Methods Twenty-five comprehensive cancer centers affiliated with both the National Cancer Institute and the National Comprehensive Care Network were surveyed using the Bmystery shopper^method to determine whether various types of sexual aids were available at the centers. Staffs from cancer center staff retail stores and patient boutiques were queried in separate telephone calls regarding the availability of these aids for and women. Results Of the 25 centers contacted, 23 (92%) responded about aids for men, and 22 (88%) responded about aids for women. Eightyseven percent of the centers reported having no sexual aids available for men, and 72% of centers reported having no aids available for women. The most common advice given to mystery shoppers was a suggestion to use the internet. Only one center had numerous aids/ resources for both men and women. Conclusions The large majority of cancer centers reported having no sexual aids or other sexual health resources available for men or women. Implications for Cancer Survivors Results underscore the widespread lack of resources to promote sexual health rehabilitation at major cancer centers, both for male and female survivors.

Pediatric blood & cancer, 2018

Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients w... more Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice. Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, ...

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 6, 2018

Reproductive health is a common concern and often a source of distress for male childhood, adoles... more Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving repro...

Medical Clinics of North America, 2017

Most patients newly diagnosed with cancer are now likely to survive their disease. 1 With patient... more Most patients newly diagnosed with cancer are now likely to survive their disease. 1 With patients with cancer living longer lives following treatment, there is a clear need to address common survivorship challenges faced by the estimated 15 million cancer survivors currently living in the United States. 2 In particular, a survivor's sexuality is a fundamental, life-affirming experience that can be profoundly affected by cancer treatment. There are increasing efforts to understand the complex matter of The authors have nothing to disclose.

Supportive Care in Cancer, 2017

Purpose-Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with ... more Purpose-Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development.

Patient education and counseling, Dec 14, 2016

Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effec... more Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effects of treatment. Their interest/preferences for receiving information about addressing common sequelae is not well understood. We examined long-term PC survivors' level of interest, whether this differed based upon symptomatology, and their preferred coping information source. N=615 PC survivors (3-8 years post-diagnosis) completed a survey on physical and psychological health and their information interests and preferences related to late effects of cancer treatment. Over half of PC survivors reported interest in information about late effects of treatment or sexual health, while approximately a quarter were interested in emotional health information. Survivors preferred to receive information about late effects of treatment from their oncologists, sexual health information from their primary care providers (PCP), oncologist, or written/online resources, and emotional health informa...

Health Psychology, 2016

Objective-Sexual concerns continue to be poorly addressed for women treated for breast cancer and... more Objective-Sexual concerns continue to be poorly addressed for women treated for breast cancer and evidence-based interventions that adequately address these concerns are scarce. The objective of this study was to adapt a telephone-based Intimacy Enhancement intervention, previously tested in couples facing colorectal cancer, to the needs of women with breast cancer through qualitative focus groups, cognitive interviews, and expert review. Methods-Three semi-structured qualitative focus groups in partnered post-treatment breast cancer survivors (n=15) reporting sexual concerns were conducted to investigate experiences of breast cancer-related sexual concerns and intervention preferences. Focus group data were coded using the framework approach to qualitative analysis; 8 key themes were identified and used to

Translational andrology and urology, 2015

There is a large and growing population of long-term cancer survivors. Primary care physicians (P... more There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in orde...

Current Opinion in Supportive & Palliative Care, 2016

Purpose of review-As the number of female cancer survivors continues to grow, there is a growing ... more Purpose of review-As the number of female cancer survivors continues to grow, there is a growing need to bridge the gap between the high rate of women's cancer-related sexual dysfunction and the lack of attention and intervention available to the majority of survivors who suffer from sexual problems. Previously identified barriers that hinder communication for providers include limited time, lack of preparation, and a lack of patient resources and access to appropriate referral sources.

Current opinion in supportive and palliative care, 2015

Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysf... more Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysfunction as a result of their cancer-directed treatment. We will review the recent literature examining this critical challenge and discuss current efforts to address sexual dysfunction. In the period since 2013, the literature has focused on sexual issues that result from the premature onset of menopausal symptoms and changes in sexual health following breast surgery. The impact of premature menopause in young women with breast cancer is profound and can affect all aspects of the sexual experience, from desire to function, and quality of life. Furthermore, the surgical treatment of breast cancer also has significant implications with respect to sexual desire and body image. There is a paucity of sexual health intervention for this population, though recent efforts suggest that sexual health outcomes may be improved if women are offered the appropriate intervention opportunities. However,...

Cancer, 2014

Background-Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and a... more Background-Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life, however few studies have explored how treatment and other factors affect sexual functioning in young breast cancer survivors. Methods-461 pre-menopausal women with Stage 0-III breast cancer were surveyed an average of one year after diagnosis as part of a prospective cohort study of women aged 40 or younger at diagnosis. Sexual interest and dysfunction were assessed using the Cancer Rehabilitation Evaluation System (CARES). Mean CARES scores were compared and multiple regression models were fit to assess treatment and a range of menopausal and somatic symptoms in relation to sexual functioning. Results-Mean CARES sexual interest and dysfunction scores were both highest (indicating poorer functioning) among women who received chemotherapy and were amenorrheic from treatment. After accounting for menopausal and somatic symptoms, treatment-associated amenorrhea remained associated with decreased interest but was no longer an independent predictor of dysfunction. In the multivariable analysis, independent predictors of dysfunction included vaginal pain symptoms, poorer body image and fatigue. Sexual interest was associated with vaginal pain symptoms, body image and weight problems. Conclusion-Factors associated with decreased sexual functioning in young breast cancer survivors can often be ameliorated. Our findings have implications for pre-menopausal women

Supportive Care in Cancer, 2011

As the number of cancer survivors continues to grow, identification of brief, valid psychological... more As the number of cancer survivors continues to grow, identification of brief, valid psychological screening measures is critical for providing these survivors with appropriate psychosocial care. The distress thermometer (DT) is a one-item distress screening recommended by the National Comprehensive Cancer Network (NCCN) for screening cancer patients during their treatment. In this study, the validity of the DT for identifying psychological distress in cancer survivors was evaluated by comparing results of the DT to the Brief Symptom Inventory-18 (BSI-18) in a sample of 120 survivors of adult onset cancer. Results indicated that when using the NCCN suggested cutoff score of 5, the DT only identified 10 of the 21 BSI-18 positive cases of psychological distress (sensitivity 47.6%; specificity 90.9%). Using an alternative DT cutoff score of 4, 12 of the 21 BSI-18 positive cases were identified (sensitivity 51.7%; specificity 89.9%). The results do not support the validity of the DT in survivors of adult cancers.

The Journal of Sexual Medicine, 2013

Introduction. Of the approximately 12,000 children and adolescents that will be diagnosed with ca... more Introduction. Of the approximately 12,000 children and adolescents that will be diagnosed with cancer in 2013, it is expected that over 80% of them will become long-term adult survivors of childhood cancer. Although it has been well established that cancer treatment often has profound negative impact on sexual functioning, sexual functioning in adult survivors of childhood cancer is not well understood. Aim. The aim of the current study was to examine the report of sexual function in adult survivors of childhood cancer in relationship to both physical and emotional functioning. Methods. Two hundred ninety-one participants enrolled in Project REACH, a longitudinal study of childhood cancer survivors, completed questionnaires as part of an annual health survey. Main Outcome Measure. Primary outcome measures included the sexual functioning subscale of the Swedish Health-Related Quality of Life Survey, the SF-12, and the BSI-18. Results. Results indicate that 29% of young adult survivors reported two or more discrete symptoms of sexual dysfunction. Females were twice as likely to report sexual problems. Sexual problems were not related to specific types of childhood cancer treatments such as type of chemotherapy or radiation. Young adults with sexual dysfunction did report poorer functioning across the range of SF-12 subscales including physical functioning, general health, fatigue, and mental health. Conclusions. Significant sexual dysfunction is common in adult survivors of childhood cancer. A greater understanding of the particular relationship between sexual dysfunction and both physical and emotional well-being in this relatively young population is needed. Even when long-term cancer survivors are young adults and report generally good health, results underscore the need for clinicians to specifically assess sexual functioning. Bober SL, Zhou ES,

The Journal of Sexual Medicine, 2013

Introduction There are now almost 14 million cancer survivors in the United States, and for the m... more Introduction There are now almost 14 million cancer survivors in the United States, and for the majority of survivors, the bulk of post-cancer medical care is provided by community primary care providers (PCPs). Sexual dysfunction is one of the most common and distressing quality of life issues facing female cancer survivors yet it has become increasingly evident that women’s cancer-related sexual dysfunction often goes unaddressed, including in primary care treatment setting. Aim Building on a model that calls for an integrative approach to treatment, the aim is to concisely review barriers and challenges of managing cancer-related female sexual dysfunction for PCPs and to offer specific and effective strategies that PCPs may use to treat common sexual problems in their female cancer survivors. Methods Literature was reviewed for relevant publications on the topic of treating cancer-related sexual dysfunction and primary care, and interviews were conducted with experts on state-of-...

The Journal of Sexual Medicine, 2013

Introduction. There has been exponential growth in diagnoses of ductal carcinoma in situ (DCIS) i... more Introduction. There has been exponential growth in diagnoses of ductal carcinoma in situ (DCIS) in the past decade, yet little is known about sexual functioning and body image in women after diagnosis of DCIS. This is of particular importance because many of the parallel treatment modalities also used to treat invasive breast cancer, e.g., surgery and hormonal therapy, have been shown to have a detrimental effect on psychosexual function. Aim. The aim was to explore changes in sexual function and body image after diagnosis and treatment of in situ cancer. Main Outcome Measures. Evidence-based self-report measures assessing psychosexual functioning and body image. Methods. Women diagnosed with DCIS within the past 3 months and who reported being sexually active completed measures assessing various aspects of psychosocial and sexual functioning and body image. Outcomes were evaluated at baseline, 9-, and 18-month time points. All statistical tests were two sided. Results. Three hundred four women completed this prospective survey. Overall, sexual function in women with DCIS appears to be very similar to women in the general population and does not seem to be significantly disrupted by a diagnosis of DCIS. Sexual function and body image were notably stable across the 18-month length of follow-up. Of those patients who underwent mastectomy, there were no differences in sexual satisfaction for patients who had reconstruction compared with patients who did not. Conclusion. Although it has been shown that women with DCIS have a number of psychosocial challenges, results from this large-scale prospective study of women suggest that sexual function and body image may not be significantly negatively affected by this diagnosis. Of note, these results were also the case for women who underwent mastectomy and hormonal therapy. These findings are reassuring for both patients and physicians in the context of decision making about treatment options. Bober SL, A Giobbie-Hurder, Emmons KM, Winer E, and Partridge A. Psychosexual functioning and body image following a diagnosis of ductal carcinoma in situ. J Sex Med **;**:**-**.

Journal of Clinical Oncology, 2004

Purpose To explore the health-related and psychological factors that influence decision making ab... more Purpose To explore the health-related and psychological factors that influence decision making about tamoxifen (Nolvadex; AstraZeneca, Waltham, MA) chemoprevention in women at increased risk for developing breast cancer. Methods This study involves the assessment of 129 women eligible to take tamoxifen following cancer-risk counseling. Treatment decision and decision satisfaction were measured at 2 and 4 months following counseling. Health-related factors included physician recommendation, personal and family-related health history, and concern about side effects. Psychological factors included breast cancer–related anxiety, risk perception, and depression. Results At 2 months’ follow-up, 44% of participants declined tamoxifen treatment. This number increased to 49% at 4 months. Personal and family health history were not related to the decision, but history of abnormal biopsy did predict tamoxifen use. Physician recommendation was highly correlated with treatment decision. Concern ...

Journal of Clinical Oncology, 2020

TPS384 Background: Men with intermediate risk prostate cancer are often recommended external beam... more TPS384 Background: Men with intermediate risk prostate cancer are often recommended external beam radiation therapy (EBRT) with or without 4-6 months of androgen deprivation therapy (ADT). However, ADT can be associated with prolonged erectile dysfunction due to delayed testosterone recovery. Darolutamide is a second-generation androgen receptor with low blood-brain barrier penetration. We hypothesize that men who receive Darolutamide with RT rather than ADT with RT are able to achieve surrogate PSA endpoints indicative of long-term disease control while preserving erectile function. Methods: This is an open label, phase 2B, multi-center, randomized controlled trial. Eligibility criteria include intermediate risk prostate cancer, good erectile quality per the EPIC-26 questionnaire, and archival tissue suitable for submission to Decipher Biosciences (San Diego, CA). Men will be stratified by Decipher score (low/intermediate vs high), RT modality (EBRT vs Brachytherapy/stereotactic bo...

Journal of Pain and Symptom Management, 2017

Current Oncology Reports, 2016

There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result... more There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result in effects on vaginal health that may affect quality of life. These effects may impact sexual function, daily comfort, or the ability to perform a pelvic examination. Vulvovaginal atrophy, or genitourinary syndrome of menopause, may be treated with nonhormonal or hormonal measures. Breast cancer survivors who are menopausal and/or on endocrine therapy should be screened for issues with vaginal health and counseled about treatment options.

Journal of Cancer Survivorship, 2019

Purpose Each year, thousands of young breast cancer (BC) patients confront the difficult decision... more Purpose Each year, thousands of young breast cancer (BC) patients confront the difficult decision to medically suppress ovarian function and undergo abrupt, premature menopause to reduce risk of cancer recurrence. Unlike natural menopause, young women undergoing ovarian suppression (OS) face severe and disruptive side effects. Profound sexual dysfunction is one of the most prevalent, distressing side effects of OS treatment. Unmanaged sexual dysfunction is also a primary predictor of nonadherence to this potentially life-saving treatment. We developed and tested a brief, psychosexual intervention targeted to manage sexual dysfunction and psychological distress after OS in young BC survivors. Methods Twenty young BC survivors with sexual dysfunction received a single 4-h group intervention that included sexual health rehabilitation, body awareness exercises, and mindfulness-based cognitive therapy (MBCT) skills followed by a single tailored booster telephone call 1-month later. Assessment of female sexual function and psychological distress was completed at baseline and 2 months post-intervention. Results Analyses examined changes pre-to post-intervention. Female sexual health improved significantly from baseline to follow-up (n = 19, p < 0.02). Anxiety was also significantly improved at the 2-month (p < 0.000) timepoint, compared with baseline 1. Moderate-to-large effect sizes were observed regarding changes in sexual function and psychological distress. Conclusions Significant improvements in sexual functioning and psychological distress were observed 2 months postintervention. Implications for Cancer Survivors These results demonstrate that delivery of a targeted intervention in brief, low-intensity group setting is a promising model for reducing distressing sexual dysfunction in young BC survivors on OS treatment.

Journal of Cancer Survivorship, 2019

Purpose Sexual dysfunction is one of the most prevalent and distressing treatment-related side ef... more Purpose Sexual dysfunction is one of the most prevalent and distressing treatment-related side effects for both male and female cancer survivors. Survivorship care guidelines recommend therapeutic sexual aids to help improve sexual problems. However, little is known about the availability of sexual aids and resources at cancer centers. Methods Twenty-five comprehensive cancer centers affiliated with both the National Cancer Institute and the National Comprehensive Care Network were surveyed using the Bmystery shopper^method to determine whether various types of sexual aids were available at the centers. Staffs from cancer center staff retail stores and patient boutiques were queried in separate telephone calls regarding the availability of these aids for and women. Results Of the 25 centers contacted, 23 (92%) responded about aids for men, and 22 (88%) responded about aids for women. Eightyseven percent of the centers reported having no sexual aids available for men, and 72% of centers reported having no aids available for women. The most common advice given to mystery shoppers was a suggestion to use the internet. Only one center had numerous aids/ resources for both men and women. Conclusions The large majority of cancer centers reported having no sexual aids or other sexual health resources available for men or women. Implications for Cancer Survivors Results underscore the widespread lack of resources to promote sexual health rehabilitation at major cancer centers, both for male and female survivors.

Pediatric blood & cancer, 2018

Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients w... more Sexual and reproductive health (SRH) is identified by adolescent and young adult (AYA) patients with cancer as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to investigate the attitudes and perceptions of pediatric oncology clinicians towards discussing SRH with AYAs, and to understand perceived barriers to effective communication in current practice. Pediatric oncology clinicians (physicians, certified nurse practitioners, and physician assistants) participated in semi-structured qualitative interviews investigating attitudes about SRH communication with AYAs and barriers to such conversations. Twenty-two clinicians participated from seven institutions in the Northeastern United States. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Interviews with pediatric oncology clinicians revealed the following five primary themes: the role for pediatric oncology clinicians to discuss SRH, ...

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 6, 2018

Reproductive health is a common concern and often a source of distress for male childhood, adoles... more Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving repro...

Medical Clinics of North America, 2017

Most patients newly diagnosed with cancer are now likely to survive their disease. 1 With patient... more Most patients newly diagnosed with cancer are now likely to survive their disease. 1 With patients with cancer living longer lives following treatment, there is a clear need to address common survivorship challenges faced by the estimated 15 million cancer survivors currently living in the United States. 2 In particular, a survivor's sexuality is a fundamental, life-affirming experience that can be profoundly affected by cancer treatment. There are increasing efforts to understand the complex matter of The authors have nothing to disclose.

Supportive Care in Cancer, 2017

Purpose-Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with ... more Purpose-Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development.

Patient education and counseling, Dec 14, 2016

Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effec... more Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effects of treatment. Their interest/preferences for receiving information about addressing common sequelae is not well understood. We examined long-term PC survivors' level of interest, whether this differed based upon symptomatology, and their preferred coping information source. N=615 PC survivors (3-8 years post-diagnosis) completed a survey on physical and psychological health and their information interests and preferences related to late effects of cancer treatment. Over half of PC survivors reported interest in information about late effects of treatment or sexual health, while approximately a quarter were interested in emotional health information. Survivors preferred to receive information about late effects of treatment from their oncologists, sexual health information from their primary care providers (PCP), oncologist, or written/online resources, and emotional health informa...

Health Psychology, 2016

Objective-Sexual concerns continue to be poorly addressed for women treated for breast cancer and... more Objective-Sexual concerns continue to be poorly addressed for women treated for breast cancer and evidence-based interventions that adequately address these concerns are scarce. The objective of this study was to adapt a telephone-based Intimacy Enhancement intervention, previously tested in couples facing colorectal cancer, to the needs of women with breast cancer through qualitative focus groups, cognitive interviews, and expert review. Methods-Three semi-structured qualitative focus groups in partnered post-treatment breast cancer survivors (n=15) reporting sexual concerns were conducted to investigate experiences of breast cancer-related sexual concerns and intervention preferences. Focus group data were coded using the framework approach to qualitative analysis; 8 key themes were identified and used to

Translational andrology and urology, 2015

There is a large and growing population of long-term cancer survivors. Primary care physicians (P... more There is a large and growing population of long-term cancer survivors. Primary care physicians (PCPs) are playing an increasingly greater role in the care of these patients across the continuum of cancer survivorship. In this role, PCPs are faced with the responsibility of managing a range of medical and psychosocial late effects of cancer treatment. In particular, the sexual side effects of treatment which are common and have significant impact on quality of life for the cancer survivor, often go unaddressed. This is an area of clinical care and research that has received increasing attention, highlighted by the presentation of this special issue on Cancer and Sexual Health. The aims of this review are 3-fold. First, we seek to overview common presentations of sexual dysfunction related to major cancer diagnoses in order to give the PCP a sense of the medical issues that the survivor may present with. Barriers to communication about sexual health issues between patient/PCPs in orde...

Current Opinion in Supportive & Palliative Care, 2016

Purpose of review-As the number of female cancer survivors continues to grow, there is a growing ... more Purpose of review-As the number of female cancer survivors continues to grow, there is a growing need to bridge the gap between the high rate of women's cancer-related sexual dysfunction and the lack of attention and intervention available to the majority of survivors who suffer from sexual problems. Previously identified barriers that hinder communication for providers include limited time, lack of preparation, and a lack of patient resources and access to appropriate referral sources.

Current opinion in supportive and palliative care, 2015

Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysf... more Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysfunction as a result of their cancer-directed treatment. We will review the recent literature examining this critical challenge and discuss current efforts to address sexual dysfunction. In the period since 2013, the literature has focused on sexual issues that result from the premature onset of menopausal symptoms and changes in sexual health following breast surgery. The impact of premature menopause in young women with breast cancer is profound and can affect all aspects of the sexual experience, from desire to function, and quality of life. Furthermore, the surgical treatment of breast cancer also has significant implications with respect to sexual desire and body image. There is a paucity of sexual health intervention for this population, though recent efforts suggest that sexual health outcomes may be improved if women are offered the appropriate intervention opportunities. However,...

Cancer, 2014

Background-Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and a... more Background-Sexual dysfunction is a known complication of adjuvant therapy for breast cancer and an important determinant of quality of life, however few studies have explored how treatment and other factors affect sexual functioning in young breast cancer survivors. Methods-461 pre-menopausal women with Stage 0-III breast cancer were surveyed an average of one year after diagnosis as part of a prospective cohort study of women aged 40 or younger at diagnosis. Sexual interest and dysfunction were assessed using the Cancer Rehabilitation Evaluation System (CARES). Mean CARES scores were compared and multiple regression models were fit to assess treatment and a range of menopausal and somatic symptoms in relation to sexual functioning. Results-Mean CARES sexual interest and dysfunction scores were both highest (indicating poorer functioning) among women who received chemotherapy and were amenorrheic from treatment. After accounting for menopausal and somatic symptoms, treatment-associated amenorrhea remained associated with decreased interest but was no longer an independent predictor of dysfunction. In the multivariable analysis, independent predictors of dysfunction included vaginal pain symptoms, poorer body image and fatigue. Sexual interest was associated with vaginal pain symptoms, body image and weight problems. Conclusion-Factors associated with decreased sexual functioning in young breast cancer survivors can often be ameliorated. Our findings have implications for pre-menopausal women

Supportive Care in Cancer, 2011

As the number of cancer survivors continues to grow, identification of brief, valid psychological... more As the number of cancer survivors continues to grow, identification of brief, valid psychological screening measures is critical for providing these survivors with appropriate psychosocial care. The distress thermometer (DT) is a one-item distress screening recommended by the National Comprehensive Cancer Network (NCCN) for screening cancer patients during their treatment. In this study, the validity of the DT for identifying psychological distress in cancer survivors was evaluated by comparing results of the DT to the Brief Symptom Inventory-18 (BSI-18) in a sample of 120 survivors of adult onset cancer. Results indicated that when using the NCCN suggested cutoff score of 5, the DT only identified 10 of the 21 BSI-18 positive cases of psychological distress (sensitivity 47.6%; specificity 90.9%). Using an alternative DT cutoff score of 4, 12 of the 21 BSI-18 positive cases were identified (sensitivity 51.7%; specificity 89.9%). The results do not support the validity of the DT in survivors of adult cancers.

The Journal of Sexual Medicine, 2013

Introduction. Of the approximately 12,000 children and adolescents that will be diagnosed with ca... more Introduction. Of the approximately 12,000 children and adolescents that will be diagnosed with cancer in 2013, it is expected that over 80% of them will become long-term adult survivors of childhood cancer. Although it has been well established that cancer treatment often has profound negative impact on sexual functioning, sexual functioning in adult survivors of childhood cancer is not well understood. Aim. The aim of the current study was to examine the report of sexual function in adult survivors of childhood cancer in relationship to both physical and emotional functioning. Methods. Two hundred ninety-one participants enrolled in Project REACH, a longitudinal study of childhood cancer survivors, completed questionnaires as part of an annual health survey. Main Outcome Measure. Primary outcome measures included the sexual functioning subscale of the Swedish Health-Related Quality of Life Survey, the SF-12, and the BSI-18. Results. Results indicate that 29% of young adult survivors reported two or more discrete symptoms of sexual dysfunction. Females were twice as likely to report sexual problems. Sexual problems were not related to specific types of childhood cancer treatments such as type of chemotherapy or radiation. Young adults with sexual dysfunction did report poorer functioning across the range of SF-12 subscales including physical functioning, general health, fatigue, and mental health. Conclusions. Significant sexual dysfunction is common in adult survivors of childhood cancer. A greater understanding of the particular relationship between sexual dysfunction and both physical and emotional well-being in this relatively young population is needed. Even when long-term cancer survivors are young adults and report generally good health, results underscore the need for clinicians to specifically assess sexual functioning. Bober SL, Zhou ES,

The Journal of Sexual Medicine, 2013

Introduction There are now almost 14 million cancer survivors in the United States, and for the m... more Introduction There are now almost 14 million cancer survivors in the United States, and for the majority of survivors, the bulk of post-cancer medical care is provided by community primary care providers (PCPs). Sexual dysfunction is one of the most common and distressing quality of life issues facing female cancer survivors yet it has become increasingly evident that women’s cancer-related sexual dysfunction often goes unaddressed, including in primary care treatment setting. Aim Building on a model that calls for an integrative approach to treatment, the aim is to concisely review barriers and challenges of managing cancer-related female sexual dysfunction for PCPs and to offer specific and effective strategies that PCPs may use to treat common sexual problems in their female cancer survivors. Methods Literature was reviewed for relevant publications on the topic of treating cancer-related sexual dysfunction and primary care, and interviews were conducted with experts on state-of-...

The Journal of Sexual Medicine, 2013

Introduction. There has been exponential growth in diagnoses of ductal carcinoma in situ (DCIS) i... more Introduction. There has been exponential growth in diagnoses of ductal carcinoma in situ (DCIS) in the past decade, yet little is known about sexual functioning and body image in women after diagnosis of DCIS. This is of particular importance because many of the parallel treatment modalities also used to treat invasive breast cancer, e.g., surgery and hormonal therapy, have been shown to have a detrimental effect on psychosexual function. Aim. The aim was to explore changes in sexual function and body image after diagnosis and treatment of in situ cancer. Main Outcome Measures. Evidence-based self-report measures assessing psychosexual functioning and body image. Methods. Women diagnosed with DCIS within the past 3 months and who reported being sexually active completed measures assessing various aspects of psychosocial and sexual functioning and body image. Outcomes were evaluated at baseline, 9-, and 18-month time points. All statistical tests were two sided. Results. Three hundred four women completed this prospective survey. Overall, sexual function in women with DCIS appears to be very similar to women in the general population and does not seem to be significantly disrupted by a diagnosis of DCIS. Sexual function and body image were notably stable across the 18-month length of follow-up. Of those patients who underwent mastectomy, there were no differences in sexual satisfaction for patients who had reconstruction compared with patients who did not. Conclusion. Although it has been shown that women with DCIS have a number of psychosocial challenges, results from this large-scale prospective study of women suggest that sexual function and body image may not be significantly negatively affected by this diagnosis. Of note, these results were also the case for women who underwent mastectomy and hormonal therapy. These findings are reassuring for both patients and physicians in the context of decision making about treatment options. Bober SL, A Giobbie-Hurder, Emmons KM, Winer E, and Partridge A. Psychosexual functioning and body image following a diagnosis of ductal carcinoma in situ. J Sex Med **;**:**-**.

Journal of Clinical Oncology, 2004

Purpose To explore the health-related and psychological factors that influence decision making ab... more Purpose To explore the health-related and psychological factors that influence decision making about tamoxifen (Nolvadex; AstraZeneca, Waltham, MA) chemoprevention in women at increased risk for developing breast cancer. Methods This study involves the assessment of 129 women eligible to take tamoxifen following cancer-risk counseling. Treatment decision and decision satisfaction were measured at 2 and 4 months following counseling. Health-related factors included physician recommendation, personal and family-related health history, and concern about side effects. Psychological factors included breast cancer–related anxiety, risk perception, and depression. Results At 2 months’ follow-up, 44% of participants declined tamoxifen treatment. This number increased to 49% at 4 months. Personal and family health history were not related to the decision, but history of abnormal biopsy did predict tamoxifen use. Physician recommendation was highly correlated with treatment decision. Concern ...

Journal of Clinical Oncology, 2020

TPS384 Background: Men with intermediate risk prostate cancer are often recommended external beam... more TPS384 Background: Men with intermediate risk prostate cancer are often recommended external beam radiation therapy (EBRT) with or without 4-6 months of androgen deprivation therapy (ADT). However, ADT can be associated with prolonged erectile dysfunction due to delayed testosterone recovery. Darolutamide is a second-generation androgen receptor with low blood-brain barrier penetration. We hypothesize that men who receive Darolutamide with RT rather than ADT with RT are able to achieve surrogate PSA endpoints indicative of long-term disease control while preserving erectile function. Methods: This is an open label, phase 2B, multi-center, randomized controlled trial. Eligibility criteria include intermediate risk prostate cancer, good erectile quality per the EPIC-26 questionnaire, and archival tissue suitable for submission to Decipher Biosciences (San Diego, CA). Men will be stratified by Decipher score (low/intermediate vs high), RT modality (EBRT vs Brachytherapy/stereotactic bo...

Journal of Pain and Symptom Management, 2017

Current Oncology Reports, 2016

There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result... more There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result in effects on vaginal health that may affect quality of life. These effects may impact sexual function, daily comfort, or the ability to perform a pelvic examination. Vulvovaginal atrophy, or genitourinary syndrome of menopause, may be treated with nonhormonal or hormonal measures. Breast cancer survivors who are menopausal and/or on endocrine therapy should be screened for issues with vaginal health and counseled about treatment options.