Surgical modality and receipt of chemotherapy or radiotherapy are not associated with sexual function, as measured by the Female Sexual Function Index (FSFI). Patients receiving endocrine therapy with an aromatase inhibitor had significantly lower sexual function scores than those who received no endocrine therapy or those on tamoxifen, said a group of U.S. researchers who presented their findings during a poster session on Saturday, December 10, at the San Antonio Breast Cancer Symposium.

The group anonymously surveyed 585 patients who were in surveillance after breast cancer therapy. Median FSFI (mFSFI) results were stratified by surgery type and by receipt of chemotherapy, radiation, and endocrine therapy. Of the respondents, 55.3% were younger than 60 years and 51.3% were sexually active. Surgical modalities included lumpectomy (n = 406), mastectomy with reconstruction (n = 129), and mastectomy without reconstruction (n = 50). For adjuvant therapy, 405 patients received radiation, 276 received chemotherapy, 117 reported tamoxifen (TAM) use, and 189 reported aromatase inhibitor (AI) use.

For all patients stratifying for receipt of adjuvant chemotherapy or radiation therapy, no difference was seen in mFSFI scores (radiation was 26.7 versus 28, p = 0.2, and chemotherapy was 26.5 versus 27.5, p = 0.1). Regarding endocrine therapy, patients receiving AIs had statistically significant lower mFSFI compared to those receiving no endocrine therapy or TAM (22.2, 27.9, and 29.6, respectively; p ≤ 0.0001).

Table 1. Median FSFI Scores by Adjuvant Therapy

Variable	n	mFSFI	Range	IQR	p
Radiation: Yes	207	26.7	7.2–36.0	21.5–30.5	–
Radiation: No	71	28.0	10.7–34.8	22.4–31.7	0.2
Chemotherapy: Yes	133	26.5	7.2–36.0	21.0–30.5	–
Chemotherapy: No	145	27.5	10.8–35.7	22.2–31.2	0.1
TAM and AI	2	23.1	21.5–24.6	21.5–24.6	0.2
TAM Only	74	29.6	11.6–35.7	24.6–32.3	0.07
AI Only	85	22.2	7.2–35.7	18.1–28.3	< 0.0001
Neither	112	27.9	9.8–36.0	23.2–31.0	Ref

AI=aromatase inhibitor; IQR—interquartile range; mFSFI—median Female Sexual Function Index; TAM—tamoxifen

Patients receiving AIs had significantly lower scores in all FSFI domains except for orgasm. For patients receiving TAM, the desire and lubrication domains showed statistically significantly lower scores compared to nonusers of endocrine therapy (p = 0.03). Radiation and chemotherapy did not have statistically significant effects on sexual function.

Lumpectomy and tamoxifen use resulted in a significantly higher mFSFI than those with AI use (29.4 versus 23.7, p = 0.005). For patients who had mastectomy with reconstruction and reported AI use, mFSFI was significantly lower than those on no endocrine therapy (18.1 versus 29.6, p < 0.0001).

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