title: Biopsychosocial predictors of sexual function and quality of sexual life: a study among patients with colorectal cancer.
abstract: OBJECTIVE
  A low sexual function (SF) has been reported in patients with colorectal cancer. However, research often focusses on clinical predictors of SF, hereby omitting patients' subjective evaluation of SF [i.e., the quality of sexual life (QoSL)] and psychosocial predictors of SF and QoSL. In addition, research incorporating a biopsychosocial approach to SF and QoSL is scarce. Therefore, this study aimed to evaluate (I) relatedness between SF and the QoSL, (II) the course of SF and QoSL, and (III) biopsychosocial predictors of SF and QoSL.
  
  
  METHODS
  Patients completed questionnaires assessing sociodemographic factors (i.e., age, sex) and personality characteristics (i.e., neuroticism, trait anxiety) before surgery. Questionnaires assessing psychological (i.e., anxious and depressive symptoms, body image, fatigue) and social (i.e., sexual activity, SF, non-sensuality, avoidance of sexual activity, non-communication, relationship function) aspects were measured preoperative and 3, 6, and 12 months after surgery. Clinical characteristics were obtained from the Eindhoven Cancer Registry (ECR). Bivariate correlations evaluated relatedness between SF and QoSL. Linear mixed-effects models examined biopsychosocial predictors of SF and QoSL.
  
  
  RESULTS
  SF and QoSL are related constructs (r=0.206 to 0.642). Compared to preoperative scores, SF did not change over time (P>0.05). Overall, patients' QoSL decreased postoperatively (P=0.001). A higher age (β=-0.02, P=0.006), fatigue (β=-0.02, P=0.034), not being sexually active (β=-0.081, P<0.001), and having a stoma (β=0.37, P=0.035) contributed to a lower SF. Having rectal cancer (β=-1.64, P=0.003), depressive symptoms (β=-0.09, P=0.001), lower SF (β=1.05, P<0.001), and more relationship maladjustment (β=-0.05, P=0.027) contributed to a lower QoSL (P<0.05). In addition, partners' SF (β=0.24, P<0.001) and QoSL (β=0.30, P<0.001) were predictive for patients' SF and QoSL, respectively. A significant interaction between time and gender was reported for both outcomes (P's=0.002).
  
  
  CONCLUSIONS
  SF and QoSL are related but distinctive constructs. The course of SF and QoSL differed. Different biopsychosocial predictors were found for SF and QoSL. The contribution of partner-related variables to patients' outcomes suggests interdependence between patients and partners. Men and women showed different SF and QoSL trajectories. We recommend that health care professionals, when discussing sexuality, realize that SF and QoSL are no interchangeable terms and should, therefore, be discussed as two separate entities. In addition, it is favored that clinicians focus not only on biological predictors of SF and QoSL, but obtain a broader perspective in which they also pay attention to psychosocial factors that may impair SF and QoSL. More in depth research on interdependence between patients and partners, biopsychosocial predictors of partners' SF and QoSL, and gender effects is needed.
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Marjan Johanna
authors.initials: MJ
authors.lastname: Traa
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Jan Anne
authors.initials: JA
authors.lastname: Roukema
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: De Vries
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Harm Jozef Theodorus
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Barbara
authors.initials: B
authors.lastname: Langenhoff
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Walther
authors.initials: W
authors.lastname: Jansen
authors.affiliation: 1 Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands ; 2 Department of Surgery, 3 Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands ; 4 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands ; 5 Research Institute for Growth & Development, Maastricht University Medical Center, Maastricht, The Netherlands ; 6 Department of Surgery, TweeSteden Hospital, Tilburg/Waalwijk, The Netherlands.
authors.forename: Brenda Leontine
authors.initials: BL
authors.lastname: Den Oudsten
keywords: Colorectal cancer; predictors; sexual function (SF)
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