Quality of life, self-esteem, fatigue, and sexual function in young men after cancer: a controlled cross-sectional study.
BACKGROUND
Androgen deficiency is increasingly recognized in young male cancer survivors; however, its impact on quality of life (QOL) is not established. The authors investigated the relationship between androgen levels, QOL, self-esteem, fatigue, and sexual function in young male cancer survivors compared with control subjects.


METHODS
A cross-sectional, observational study of 176 male cancer survivors and 213 male controls aged 25 to 45 years was performed. Subjects completed 3 QOL scales (Medical Outcomes Study 36-Item Short-Form Health Survey version 2, the 12-item General Health Questionnaire [GHQ-12], and Aging Male Scale), and measures of self-esteem (Rosenberg Self-Esteem Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and sexual function (Derogatis Interview for Sexual Functioning-II Self-Report-Male).


RESULTS
Cancer survivors had lower scores for all components of the Short-Form Health Survey, Aging Male Scale, and Functional Assessment of Chronic Illness Therapy-Fatigue, and for 4 of 5 subsections of the Derogatis Interview for Sexual Functioning than controls. The majority of these differences remained after adjusting by linear regression analysis. Levels of psychiatric disorder or self-esteem did not differ between the 2 groups. In cancer survivors, those with androgen deficiency (serum testosterone < or = 10 nmol/L) had lower scores than those without for all components of the Short-Form Health Survey, the General Health Questionnaire, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Derogatis Interview for Sexual Functioning. Serum testosterone only weakly correlated with health measures.


CONCLUSIONS
Young male cancer survivors self-report a marked impairment in QOL, energy levels, and quality of sexual functioning, and this was exacerbated in those with androgen deficiency. However, psychological distress was not elevated, self-esteem was normal, and sexual relationships were not impaired. The relationship with testosterone is complex, and appears dependent on a threshold level rather than direct correlation. Interventional trials are needed to determine whether testosterone replacement would improve QOL in young male cancer survivors.
Greenfield
Diana M
DM
Academic Unit of Clinical Oncology, University of Sheffield, Sheffield, United Kingdom.
Walters
Stephen J
SJ
Coleman
Robert E
RE
Hancock
Barry W
BW
Snowden
John A
JA
Shalet
Stephen M
SM
DeRogatis
Leonard R
LR
Ross
Richard J M
RJ
D000328:Adult; D000728:Androgens / Q000172:deficiency*; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology*; D006304:Health Status; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology*; D011788:Quality of Life; D012649:Self Concept; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D017741:Survivors
D000728:Androgens