1. Physical and Psychological Sequelae of Breast Cancer in Men
Kathryn J. Ruddy, MD MPH,1 Anita Giobbie-Hurder, MS,1 Sharon Giordano, MD,2 Shari Goldfarb, MD,3 Sandra Kereakoglow, BA,1 Eric P. Winer,1 MD, Ann H. Partridge, MD MPH1
1Dana-Farber Cancer Institute, Boston, MA; 2M.D. Anderson Cancer Center, Houston, TX; 3Memorial Sloan Kettering Cancer Center, New York, NY
Background
Little is known about the physical and emotional health of men with breast cancer; data are also lacking regarding their informational and supportive care needs
Respondent Characteristics
N=42
Median age in years (range)
64 (25-80)
Median years since diagnosis (range)
1.8 ( )
Stage at diagnosis
N (%)
3 (7%) 1
10 (24%) 2
15 (36%) 3
6 (14%) 4
4 (10%)
Unknown
Have had a cancer other than breast cancer
14 (33%)
Cancer-free at time of survey
32 (74%)
Caucasian
41 (98%)
College/Post-college graduate
31 (74%)
Married or “living as married”
Employed (full or part time)
Stopped work for at least one month during treatment
7 (17%)
Financially comfortable (i.e., has “$ for special things”)
22 (52%)
Medically insured
Before diagnosis, exercised less than once a week
9 (21%)
Reduced exercise since diagnosis
Received chemotherapy
26 (62%)
Had mastectomy (uni- or bilateral)
38 (90%)
Received radiation
Currently taking tamoxifen
19 (45%)
Currently taking gonadotropin-releasing hormone agonist
1 (2%)
Currently taking aromatase inhibitor
5 (12%)
Hormonal Symptoms
N=36
One or more hot flashes per week
4 (11%)
Breast tenderness at least once per week
6 (27%)
Depressed at least once per week
17 (47%)
Lack of energy at least once per week
27 (75%)
Weight gain
11 (31%)
Sexual Symptoms
N=37
“Poor” or “very poor” sexual desire
21 (57%)
“Poor” or “very poor” ability to have erection
18 (49%)
“Poor” or “very poor” ability to reach orgasm
13 (35%)
Erection not adequate for intercourse
20 (54%)
Erections not whenever desired
26 (70%)
Never awakened with erection
11 (30%)
No sexual activity
No sexual intercourse
25 (68%)
“Poor” or “very poor” ability to function sexually
24 (65%)
“Moderate” or “big” problem with sexual desire
16 (43%)
“Moderate” or “big” problem with erection
“Moderate” or “big” problem with orgasm
“Moderate” or “big” problem with sexual functioning
17 (46%)
Aim
To assess attitudes, symptoms, experiences, and health perceptions in men with a history of breast cancer
Genetic Counseling/Testing
N=41
Referred for genetic counseling or testing
Had genetic testing
Tested positive for hereditary cancer syndrome
31 (74%) 25 3
Methods
Study Setting
Online survey recruiting participants via three websites focused on male breast cancer:
Measurements
Anxiety and depression over prior month using Hospitalized Anxiety and Depression Scale (HADS), scored 0-21 for each subscale
Health-related quality of life (QOL) over prior 7 days using Functional Assessment of Cancer Therapy-Breast (FACT-B), scored 0-144
Hormonal and sexual symptoms over prior 4 weeks using the Expanded Prostate Cancer Index Composite (EPIC) Hormonal and Sexual Scales, each scored 0-100
Higher scores on the HADS indicate more symptoms; higher scores on FACT-B and EPIC imply better QOL
History of genetic and fertility counseling
Fertility Issues
N=42
No biological children
10 (24%)
Desire future biological children
2 (5%)
Informed about risks to fertility from treatment
3 (7%)
Stored sperm
1 (2%)
Limitations
Potential for sample bias, recall bias, and unmeasured confounders
Conclusions
Male breast cancer survivors experience substantial symptoms
Hormonal symptoms are prevalent in male breast cancer survivors; in men without cancer, mean EPIC Hormonal Score is 91.7 (SD 9.7)
Sexual functioning may be impaired in male breast cancer survivors; in men without cancer, mean EPIC Sexual Score is 61.4 (SD 23.6)
We plan to use data from this pilot study to inform a larger study and develop targeted interventions to reduce symptom burden in male breast cancer survivors
Distress and Quality of Life
N=38
Anxious (HADS Anxiety >10)
3 (8%)
Depressed (HADS Depression >10)
2 (5%)
EPIC Hormonal Score; Mean (SD)
81.3 (15.5)
EPIC Sexual Score; Mean (SD)
44.5 (26.3)
FACT-B Total Score; Mean (SD)
111.1 (19.9)