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The Influence of Endocrine Effects of Adjuvant Therapy on Quality of Life Outcomes in Younger Breast Cancer Survivors(五)

作者:来来来 整理:本网站论文网 录入时间:2011-12-13 23:15:34
h induced menopause and menopausal symptoms, which contribute to lower levels of physical functioning and poorer quality of life for young midlife women after breast cancer treatment [6, 40, 54, 56, 58, 6062]. Psychological distress is associated with the loss of menstrual function and loss of choice to have more children, even for those women who have completed their family planning, but is most significantly related to infertility for young women who have not yet started their families [46, 48, 56, 63].

  Menopausal symptoms reported by breast cancer survivors include vasomotor symptoms (hot flashes, night sweats), fatigue, sleep disturbances, joint pains, dyspareunia, mood swings, cognitive changes, and vaginal dryness [34, 35, 51, 64, 65]. Although vasomotor symptoms and vaginal dryness are reported as the only true physiologic effects of estrogen withdrawal [66], there are data suggesting a neuroendocrine link to other symptoms, such as cognitive changes, mood swings, and related symptomatology, such as insomnia due to hot flashes. More severe vasomotor symptoms have been reported by breast cancer survivors [35, 64], and the suspected etiology is the abrupt change in the hormonal environment of women and rapid decrease in estrogen. Women’s emotional, physical, and functional well-being are negatively impacted by the persistence and severity of menopausal symptoms after treatment [6, 32]. Women with more severe menopausal symptoms who did not feel that they were adequately prepared for the chemotherapy-induced menopause experience reported greater uncertainty and psychological distress [67].

  Young women who receive adjuvant chemotherapy and experience drug-induced menopause are at a greater risk for negative changes in sexuality and poorer sexual functioning outcomes [6, 48, 51, 6871]. As women gradually recover from therapy, sexuality and sexual function regain priority as a valued quality of life component [43, 63, 72]. Breast cancer survivors who received systemic adjuvant therapy report less sexual satisfaction than healthy women [73], lower levels of sexual function [68, 74], decreased libido [75], difficulty reaching orgasm, dyspareunia associated with vaginal dryness [71], and less sexual satisfaction [68, 71], and they don’t perceive themselves as feminine or sexually attractive as they did before treatment. Sexual functioning outcomes for women who receive adjuvant endocrine therapy are mixed, with some suggesting no effect [6, 33, 71] and others suggesting an adverse effect related to symptoms during therapy and the specific endocrine therapy taken [76, 77]. The negative impact of breast cancer treatment on the quality of life domain of sexuality for breast cancer survivors (Table 3) represents an important area for education, communication, support, and intervention, especially in younger women [43, 60, 65, 70, 74, 75].

  FERTILITY

  

  Uncertainty and Need for Contraceptive Counseling

  Follic

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