title: Significant changes in sexual behavior after a diagnosis of human papillomavirus-positive and human papillomavirus-negative oral cancer.
abstract: Sexual behavior and oral human papillomavirus (HPV) infection are risk factors for oral squamous cell carcinoma (OSCC). The effects of OSCC diagnosis and treatment on subsequent relationship stress and sexual behavior are unknown.
  
  
  
  Incident cases of HPV-positive or HPV-negative OSCC in patients who had a partnered relationship and partners of patients with oropharyngeal cancer were eligible for a study in which surveys were administered at diagnosis and at the 6-month follow-up time point to assess relationship distress, HPV transmission and concerns about health consequences, and sexual behavior. The frequency distributions of responses, stratified by tumor HPV status, were compared at baseline and follow-up.
  
  
  
  In total, 262 patients with OSCC and 81 partners were enrolled. Among the patients, 142 (54.2%) had HPV-positive OSCC, and 120 (45.8%) had HPV-negative OSCC. Relationship distress was infrequently reported, and 69% of patients felt that their relationship had strengthened since the cancer diagnosis. Both HPV-positive patients (25%) and their partners (14%) reported feelings of guilt or responsibility for the diagnosis of an HPV-caused cancer. Concern over sexual, but not nonsexual, HPV transmission to partners was reported by 50%. Significant declines in the frequency of vaginal and oral sexual behaviors were reported at follow-up, regardless of tumor HPV status. From baseline to 6 months, significant increases in abstinence from vaginal sex (from 10% to 34%; P < .01) and oral sex (from 25% to 80%; P < .01) were reported.
  
  
  
  Diagnosis and treatment of OSCC are associated with significant declines in the frequency of vaginal and oral sex, regardless of tumor HPV status. Sexual behavior is an important quality-of-life outcome to assess within clinical trials. [See related editorial on pages 000-000, this issue.] Cancer 2017. © 2017 American Cancer Society. Cancer 2017;123:1156-1165. © 2016 American Cancer Society.
authors.affiliation: Department of Medical Oncology, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain.|Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain.|Department of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Miren
authors.initials: M
authors.lastname: Taberna
authors.affiliation: Medical Scientist Training Program, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Inglehart
authors.affiliation: Department of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Robert K L
authors.initials: RK
authors.lastname: Pickard
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, Maryland.
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, Ohio.
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.|Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Mira L
authors.initials: ML
authors.lastname: Katz
authors.affiliation: Department of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Maura L
authors.initials: ML
authors.lastname: Gillison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D009367:Neoplasm Staging; D009820:Ohio / Q000453:epidemiology; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D011159:Population Surveillance; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D055815:Young Adult
keywords: HPV worries; head and neck cancer; human papillomavirus (HPV) transmission; mouth neoplasm; oral cancer; patient relationships; quality of life; sexual behavior