Do Male Lymphoma Survivors Have Impaired Sexual Function? Cecilie E. Kiserud, Leslie R. Schover, Alv A. Dahl, Alexander Fosså, Trine Bjøro, Jon Håvard Loge, Harald Holte, Ying Yuan, and Sophie D. Fosså From the Departments of Clinical Cancer Research, Oncology, and Labo- ratory Medicine, Norwegian Radium Hospital, Oslo University Hospital; Faculty Division of Norwegian Radium Hospital and Faculty Division of Rikshospitalet, University of Oslo, Oslo; Faculty of Medicine, The National University for Science and Technology, Trondheim, Norway; and Departments of Behavioral Science and Biostatistics, The University of Texas M. D. Ander- son Cancer Center, Houston, TX. Submitted April 16, 2009; accepted June 24, 2009; published online ahead of print at www.jco.org on October 26, 2009. Supported by EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, The Norwegian Cancer Society, The Norwegian Research Council (Leiv Erikssons Mobility Program), and Fulbright Norway. Authors’ disclosures of potential con- flicts of interest and author contribu- tions are found at the end of this article. Corresponding author: Cecilie E. Kiserud, MD, Department of Clinical Cancer Research, The Norwegian Radium Hospital, 0310 Oslo, Norway; e-mail: cecilie.essholt.kiserud@ radiumhospitalet.no. The Acknowledgment is included in the full-text version of this article, available online at www.jco.org. It is not included in the PDF version (via Adobe® Reader®). © 2009 by American Society of Clinical Oncology 0732-183X/09/2735-6019/$20.00 DOI: 10.1200/JCO.2009.23.2280 A B S T R A C T Purpose Sexual function in male lymphoma survivors was examined and compared with that of age- matched controls. Patients and Methods This cross-sectional study included serum gonadal hormone levels (testosterone, sex hormone– binding globulin, luteinizing hormone [LH], and follicle-stimulating hormone) and responses to questionnaires assessing sexual function (Brief Sexual Function Inventory [BSFI]), socioeconomic factors, quality of life, emotional distress, and fatigue. The lymphoma group included 246 men  50 years old at diagnosis who were diagnosed from 1980 to 2002 and treated at the Norwegian Radium Hospital. For each lymphoma survivor, two age-matched controls (n = 492) were drawn from a normative sample with BSFI scores. Results The lymphoma survivors had a mean age at survey of 47.4 years, the mean duration of follow-up was 14.8 years, and 79% lived in committed relationships. All BSFI domain scores decreased significantly with age. Lymphoma survivors having low testosterone and/or elevated LH had lower BSFI scores than survivors with normal gonadal hormones. Multivariate analyses showed that increasing age, more emotional distress, poor physical health, and low testosterone and/or elevated LH were significantly associated with reduced sexual function within the lymphoma group. Lymphoma survivors had significantly lower BSFI domain scores than did controls on erection, ejaculation, and sexual satisfaction. Conclusion Lymphoma survivors had significantly poorer sexual function than normative controls. It is unclear whether the abnormal hormone levels directly cause the reduced sexual function within the lymphoma group or if a mediating factor is involved, such as aging, emotional distress, or perceived health status. J Clin Oncol 27:6019-6026. © 2009 by American Society of Clinical Oncology INTRODUCTION The sexual functioning of male lymphoma survivors has rarely been studied, in contrast to a more exten- sive literature about sexuality after treatment for tes- ticular or prostate cancer. 1-3 However, a few reports have been published. 4-8 In a survey of 459 Hodgkin’s lymphoma (HL) survivors, transient or long-term reduction of sexual interest and activity was re- ported by 28%. 4 Similarly, in another study, 24% reported at least one sexual problem. 8 Sexual inter- est and sexual activity had decreased compared with before treatment in approximately 20% of men a median of 9 years after treatment for HL. 6 In a study comparing male lymphoma and testicular cancer survivors, approximately 30% of both groups re- ported reduced sexual functions within one or more domains. 7 When using a standard questionnaire on erectile function, however, 36 (61%) of 59 lym- phoma survivors age 18 to 55 years reported reduced erectile function. 5 Thus, the prevalence of self- reported reduced sexual function may be higher when more detailed questionnaires are used. Both chemotherapy and radiotherapy can dam- age Leydig cell and/or pituitary function, 9-11 result- ing in subnormal testosterone levels that could potentially lead to sexual problems. 12 In a follow-up survey of 294 male lymphoma survivors, 30% had low testosterone and/or elevated luteinizing hor- mone (LH). 13 Variations in sex hormones, patient factors, duration of follow-up, and assessment methodology make it difficult to compare findings on sexual function from these studies. More data are needed to clarify the causes and prevalence of im- paired sexual function in male lymphoma survivors. Such studies must also take into account the high JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 27  NUMBER 35  DECEMBER 10 2009 © 2009 by American Society of Clinical Oncology 6019 Downloaded from jco.ascopubs.org on May 11, 2011. For personal use only. No other uses without permission. Copyright © 2009 American Society of Clinical Oncology. All rights reserved.