Patient and Partner Reported Sexual Satisfaction After Definitive Therapy for Organ-Confined Prostate Cancer Open Access

Mehta, Akanksha (2016)

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Introduction: Erectile dysfunction (ED) is the most common health-related quality of life complaint among prostate cancer survivors and their partners. The goal of this analysis was to identify predictors of patient- and partner-reported sexual satisfaction, and to evaluate concordance of sexual satisfaction between patients and partners two years after prostatectomy.

Methods: This cross-sectional analysis included men with organ confined prostate cancer, and without baseline ED, and their partners. Clinical and demographic characteristics were collected for all participants. Sexual satisfaction (five possible levels) was gauged by responses to the sexual domain of the EPIC-26 questionnaire, completed by study participants at baseline and 24-months post-operatively. The association between sexual satisfaction and patient and partner age, age difference, baseline EPIC sexual domain score, nerve sparing status, and post-operative use of erectile aids, was evaluated in multivariate logistic regression models. Patient and partner reported sexual satisfaction scores were categorized as two-level and five-level responses, and compared using weighted and unweighted kappa statistics. Differences in predictors of sexual satisfaction among concordant and discordant patient and partner pairs were evaluated using Chi-square and Fisher's exact tests. Statistical significance was defined as p<0.05.

Results: High EPIC sexual domain score (OR 2.68, 95%CI 1.41-5.10) and lack of use of erectile aids (OR 2.06, 95%CI 1.05-4.03), were significantly associated with patient sexual satisfaction in multivariate analyses. Lack of use of erectile aids was also significantly associated with partner sexual satisfaction (OR 2.90, 95%CI 1.47-5.72). Proportional concordance between patient- and partner-reported satisfaction was 0.63 (95% CI 0.56-0.70) and 0.37 (95% CI 0.30-0.44) for the two-level and five-level responses, respectively, corresponding to simple and weighted kappa statistics of 0.26 (95% CI 0.13-0.40) and 0.29 (95%CI 0.19-0.39), respectively. High baseline EPIC domain score was the only characteristic associated with concordant sexual satisfaction among patient and partner pairs.

Conclusions: Couples with good baseline erectile function, who either do not need, or do not wish to use erectile aids two years after prostatectomy, are most likely to report sexual satisfaction in the post-prostatectomy period. Good baseline sexual function is also a predictor of concordant sexual satisfaction among prostate cancer survivors and their partners.

Table of Contents

Introduction. 1

Background. 4

Methods. 6

Results. 12

Discussion. 15

References. 20

Tables. 22

Table 1: Descriptive analysis of patient and partner characteristics. 23

Table 2: Multivariate analysis of variablesassociated with patient sexual satisfaction. 24

Table 3: Multivariate analysis of variables associated with partner sexual satisfaction. 25

Table 4: Comparison of patient and partner satisfaction using (a) simple and (b) weighted Cohen's kappa statistic. 26

Table 5: Variables associated with concordant and discordant sexual satisfaction among patient and partner pairs. 27

Figures. 28

Figure 1: Analytical cohort of patient and partner pairs. 29

Figure 2: Distribution of patient- and partner-reported sexual satisfaction scores (unpaired). 30

Appendix. 31

A1: Expanded Prostate Cancer Index Composite Questionnaire (EPIC). 32

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