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
Respondent Characteristics
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
Median age in years (range)
Aim
To assess attitudes, symptoms, experiences,
and health perceptions in men with a history
of breast cancer
Median years since diagnosis (range)
Stage at diagnosis
Hormonal Symptoms
N=36
Sexual Symptoms
64 (25-80)
One or more hot flashes per week
4 (11%)
“Poor” or “very poor” sexual desire
21 (57%)
1.8 (0.03-19.4)
Breast tenderness at least once per
week
Depressed at least once per week
“Poor” or “very poor” ability to have erection
18 (49%)
“Poor” or “very poor” ability to reach orgasm
13 (35%)
17 (47%)
Erection not adequate for intercourse
20 (54%)
27 (75%)
Erections not whenever desired
26 (70%)
Never awakened with erection
11 (30%)
No sexual activity
13 (35%)
No sexual intercourse
25 (68%)
“Poor” or “very poor” ability to function sexually
24 (65%)
“Moderate” or “big” problem with sexual desire
16 (43%)
25
“Moderate” or “big” problem with erection
16 (43%)
3
“Moderate” or “big” problem with orgasm
11 (30%)
“Moderate” or “big” problem with sexual functioning
17 (46%)
N=42
N (%)
0
3 (7%)
1
10 (24%)
2
15 (36%)
3
6 (14%)
4
4 (10%)
Unknown
4 (10%)
Lack of energy at least once per
week
Weight gain
6 (27%)
11 (31%)
Genetic Counseling/Testing
N=41
Referred for genetic counseling or
testing
Had genetic testing
Tested positive for hereditary
cancer syndrome
31 (74%)
Methods
Have had a cancer other than breast cancer
14 (33%)
Study Setting
• Online survey recruiting participants via three
websites focused on male breast cancer:
Cancer-free at time of survey
32 (74%)
Caucasian
41 (98%)
College/Post-college graduate
31 (74%)
Married or “living as married”
31 (74%)
Employed (full or part time)
14 (33%)
Stopped work for at least one month during treatment
7 (17%)
Financially comfortable (i.e., has “$ for special things”)
22 (52%)
Medically insured
41 (98%)
Before diagnosis, exercised less than once a week
9 (21%)
Reduced exercise since diagnosis
9 (21%)
Received chemotherapy
26 (62%)
Distress and Quality of Life
N=38
Had mastectomy (uni- or bilateral)
38 (90%)
Anxious (HADS Anxiety >10)
3 (8%)
Received radiation
10 (24%)
Depressed (HADS Depression >10)
2 (5%)
Currently taking tamoxifen
19 (45%)
EPIC Hormonal Score; Mean (SD)
81.3 (15.5)
www.outoftheshadowofpink.com
www.malebreastcancer.org www.malebreastcancer.ca
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
No biological children
Desire future biological children
Informed about risks to fertility from
treatment
Stored sperm
N=37
N=42
10 (24%)
2 (5%)
Limitations
Potential for sample bias, recall bias, and unmeasured confounders
3 (7%)
1 (2%)
Currently taking gonadotropin-releasing hormone agonist
1 (2%)
EPIC Sexual Score; Mean (SD)
44.5 (26.3)
Currently taking aromatase inhibitor
5 (12%)
FACT-B Total Score; Mean (SD)
111.1 (19.9)
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