Prevalence, Classifications and Factors Associated With Sexual Dysfunction among Adult Cancer Patients on Chemotherapy at Uganda Cancer Institute, Mbarara

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Chemotherapeutics used among cancer patients are potential risk factors for development of SD and such understanding of these risk factors can lead to numerous interventions to bypass their effects on sexual life. Objective: The goal of this study was to determine the prevalence, classifications and factors associated with sexual dysfunctions among cancer patients on chemotherapy. Methods: A cross-sectional study was conducted among 214 cancer patients at the Mbarara Regional Referral Hospital in south western Uganda for a period of 3 months from August to October 2023. A systematic sampling technique was employed in the study; a questionnaire was used to collect patient data. Standardized female sexual function index and international index of erectile function tools were used to classify types of sexual dysfunctions among women and men respectively. Sexual dysfunction associated factors were analyzed by logistic regression using stata version 17. Results: Two hundred and fourteen participants were enrolled 127 males and 87 females with a median age of 50 years; overall 90 (42.06%) of the patients, 68 (54.33 %) of males and 21 (24.14%) of females) experienced at least one domain of sexual dysfunction. At presentation majority of men 43 (33.86%) reported overall sexual dissatisfaction, while majority of the female 15 (18.39%) patients reported decreased sexual desire others being reduced arousal and vaginal pain. The multivariate logistic regression identified the independent risk factors for sexual dysfunctions: female gender (aOR 3.99, 95% CI 1.93-8.25; p value =0.001), Gastro intestinal cancers (aOR 3.46, 95% CI 1.34-8.93; p value =0.010) and anthracyclines (aOR 4.26, 95% CI 1.02, 17.76; p value=0.047) were statistically significant independent risk factors of sexual dysfunctions. Conclusions: Our findings suggest that there is a high prevalence of sexual dysfunctions among cancer patients at the Mbarara Regional Referral Hospital. In male patients, the overall sexual dissatisfaction is the most prevalent while decreased sexual desire is prevalent in female. Routine screening of sexual functions should be encouraged among all patients receiving chemotherapies. Female patients, those diagnosed with gastro-intestinal cancers, and those on regimens containing anthracyclines should be more closely monitored for sexual dysfunction. anorgasmia dyspareunia erectile dysfunction anthracyclines and chemotherapy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Globally in the year 2020 it was estimated that 19.3 new cancer cases were reported, with almost 10.0 million cancer deaths, these burdens are expected to increase to 28.4 new cases by the year 2040 which accounts for a 47% rise from the 2020 value. Furthermore it is projected that by 2028 Over the next six years, more than 1,700,000 people will be diagnosed with cancer and over 600,000 more people with cancer will lose their lives ( 1 ). While this condition keeps ravaging the world Uganda is no exception as its cancer incidence was 34,008 in the year 2020, 15% of the population in the country has a risk of developing cancer before 75 years of age with the mortality on the same year being 22,992 ( 2 ) . But with timely diagnosis and advanced treatment most of cancer patients have high survival rates ( 3 ).However with the improved survival rates, it is necessary to focus on patients' quality of life, which is complications from delayed diagnosis or treatment modalities employed especially their sexual desirability that requires thoughtfulness ( 4 ). Sexual dysfunctions (SDs) are strains and distresses that take place during a sexual reaction that hinders an individual from experiencing satisfaction from sexual activity ( 5 ). Most functionality and dysfunctions are subjective and thus SDs as a result of chemotherapy and radiotherapy decreases after treatment is completed ( 6 ). To determine the prevalence of sexual dysfunction a study in Germany reported a combined prevalence of sexual dysfunction among all genders at 31.8% of which 40.5% of the male and 23.07% of the female had sexual dysfunctions ( 7 ). Elsewhere among Turkish women 55.9% had their sexuality negatively affected by chemotherapy treatment ( 8 ). A study in Nigeria show that six ( 6 ) months post treatment in breast cancer patients, 67.9% of women felt inadequate as women and 70.0% experience a decreased conjugal frequency ( 9 ). While In Kenya 85% of cancer patients had SD while 65% of these had discussed their sexuality with the physician ( 10 ). Further studies found that both male and female cancer patients had reduced sexual frequency, decreased sexual satisfaction, reduced penetration and non-penetrative sexual activities across all cancer types. Vaginal dryness, tiredness and feeling unattractive were reported by female and erectile dysfunction by male, ( 11 ). While both male and female patients with colorectal cancer had a 61% decrease in sexual desire, decreased sexual frequency stood at 48%, and orgasm possibility at 48% two years after diagnosis ( 12 ). Reproductive and non-reproductive cancer caused an incidence of sexual displeasure in equal measures in more than a third of adolescents and young adults ( 13 ) .Whilst a study grounded on international index of erectile function (IIEF) found group under cisplatin treatment had a notable decline in erectile function after treatment ( 13 ). While erectile dysfunction affects 40.72% of prostate cancer patients and has been linked to cancer treatment regimens, cancer site, and age of these patients ( 14 ). Hodgkin lymphoma patients on alkylating based chemotherapy had sixty three 63% percent report sexual dysfunction while twenty two 22% percent had the perception of being infertile ( 15 ). These lost sexual functions(SF) bring about disappointment due to intimacy loss, frustration, anger, sadness, feelings of inadequacy, shift in feminity and masculinity, relationship strains, difficulty in forming new relationships, on the opposite side it increased patients confidence, reprioritizing sex, renegotiating sex while some relationship and marriages are strengthened ( 11 ). Therefore increased focus on sexual functions may give rise to increased clinical awareness, service development, and research on underserved aspects of cancer care ( 16 ). An indicator that sexual functions of patients can be achieved by timely interventions and understanding of the risk factors among cancer patients. In Uganda cancer patients report to have experienced sexual dysfunctions but the extent is not known particularly in Uganda. No study has been done to evaluate these dysfunctions among cancer patients in Uganda. Our study therefore aimed at determining the prevalence and factors associated with sexual dysfunction among cancer patients who were on chemotherapy. Methods Study design and setting The study was a descriptive cross-sectional study conducted among adult cancer patients visiting the Mbarara regional referral hospital cancer unit to evaluate prevalence, factors associated with and classifications of chemotherapy induced sexual dysfunctions. The study was carried out from August 2023 to October 2023. The oncology Centre has two ( 2 ) units, the pediatric and adult units respectively, the adult unit has a 20 bed capacity while pediatric has approximately 20 beds and they were established in 2017, they offer both in and outpatient services to cancer patients. The Cancer Centre also boosts of two ( 2 ) oncologists, one ( 1 ) oncology pharmacist, one ( 1 ) pharmacist, 5 Nurses. Study population All male and female adult cancer patients visiting Mbarara Regional Referral Hospital Cancer Center outpatient clinic, who meet the inclusion criteria. The study included all Adult male and female patients with cancer visiting the cancer unit for treatment. Patients who have had at least one chemotherapy cycle within the previous 21 days were included. Patients with prior SD diagnosis before cancer diagnosis, those with advanced cancer, and who withdrew from the study were excluded. Data collection A semi structured Interview Questionnaire both in English and Runyankole were developed administered by the principal researcher and research assistants after signing of informed consent forms to collect primary (demographic data) and secondary data (disease and treatment data). A pretest of data collection tool was conducted on 5% of the sample size (10 patients) before the actual data collection these patients were tagged to ensure they are not sampled again in the actual data collection, and the pretest data was not included in the final analysis. It contained a cover letter with research aim, and the researchers’ contact each interview lasted a maximum of one hour. Trained research assistants a nurse and a pharmacist were trained on ethical considerations and data collection before commencement of the study and together with the principal researcher reviewed patient’s charts to obtain relevant disease types and treatment regimens. A female sexual function index FSFI tool was used by the principal investigator to classify female sexual dysfunctions, it has a scale with values to a maximum score of 36 and a value below 26 is deemed a as sexual dysfunction which were measured in six different domain: sexual desire maximum score of 6, arousal maximum score of 6, lubrication maximum score of 6, orgasm maximum score of 6, satisfaction maximum score of 6 and pain maximum score of 6. While international index of erectile function IIEF tool was used to classify male sexual dysfunctions, it had scale value between 0–75 with 5 different domains between A-E each sexual classification is classified according to the domain it lies on as: erectile function maximum score of 30, orgasmic function maximum score of 10, sexual desire maximum score of 10, intercourse satisfaction maximum score of 15 and overall satisfaction maximum score of 10. Data management and analysis Statistics and data (Stata) software version 17 was used to analyze and interpret the data information .Both descriptive and inferential analysis was done and presented as means, medians and percentages .the prevalence of SD was calculated by counting number of participants with SD then divided by sample size and converted into percentage by multiplying with 100. This prevalence was also stratified by gender. Classifications of SD identified was reported in percentages and stratified by gender. To determine independent associated factors of SD logistic regression was employed whereby variables with a p value of < 0.25 in the bivariate logistic regression were adopted for multivariate analysis to cater for co-founding factors, and variables with a p value of < 0.05 were considered statistically significant independent risk factors for SD at the multivariate analysis. Results Participant characteristics A total of 214 patients were interviewed with 3 who withdrew from the study. Over half (127, 59.35%) were male, while majority (105, 49.09%) were above 50 years of age. The median age was 50 IQR45; 58, whereas over two thirds (181, 84.58%) were married (Table 1 ). Table 1 Demographic and clinical classifications of participants at MRRH. Classifications Category Frequency n (%) Gender Male 127(59.35) Female 87(40.65) Age Median = 50 IQR: 45;58 > 50years 105(49.09) 41-50yrs 61(28.50) 31-40yrs 39(18.22) 21-30yrs 9(4.21) Religion Anglican 96(44.86) Catholic 86(40.19) Muslim 20(9.35) Others 12(5.61) Comorbidity Hypertension 29(13.55) Hiv 26(12.15) Diabetes 8(3.74) None 151(70.56) Marital Married 181(84.58) Widowed 15(7.01) Separated 9(4.21) Not married 6(2.80) Divorced 3(1.40) Cancers ICD-11 Reproductive cancers 94(43.93) GIT Cancers 85(39.72) Hematological cancers 17(7.94) Sarcomas 18(8.41) Cancer Stage Stage 3 96(44.86) Stage 2 61(28.51) Not staged 50(23.36) Stage 1 7(3.27) Types of cancers documented Reproductive organ cancers (94, 43.93%) majorly prostate cancer (46, 21.96%). Gastro intestinal cancers (85 39.72%) majorly esophageal cancer (27, 12.62%) were the most diagnosed neoplasms (Fig. 1 , Fig. 2 ). Classes of chemotherapy agents used Out of 8 (eight) classes of chemotherapeutic drugs nearly half of the participant were on taxanes (101, 47.2%), followed by platinum analogues being used by (72, 33.64%) of participants with the least used regimen being plant alkaloids (7, 3.27%) (Fig. 3 ). Prevalence of sexual dysfunction among adult cancer patients The prevalence of sexual dysfunction among adult cancer patients at MRRHCU was 42.52%, with 21(24.14%) of female having sexual dysfunction while 68 (54.23%) of male having sexual dysfunction (Fig. 4 ). Classifications of sexual dysfunctions among cancer patients The most affected sexual domain in men was overall sexual dissatisfaction (33.86%), while female reported low sex desire (18.39%) as the most presenting sexual dysfunction (Table 2 ). Table 2 Description of classification of sexual dysfunction identified among participants at MRRHCU Gender Classification Percentage Male Overall sex dissatisfaction 33.86% Erectile dysfunction 32.28% Decreased orgasm 28.35% Intercourse dissatisfaction 27.56% Reduced sexual desire 25.98% Female Low sex desire 18.39% Decreased sexual arousal 17.24% Decreased satisfaction 16.09% Painful penetration 13.79% Decreased orgasm 11.49% Reduced lubrication 8.05% Among male participants with SD, 19 (27.94%) had three sexual domains affected followed by 15 (22.06%) of participants who had four sexual domains affected (Fig. 5 ). Among female participants with SD majority (8, 38.1%) of participants had four affected sexual domains, (4, and 19.05%) of participants exhibited three classes of sexual dysfunctions (Fig. 6 ). Factors associated with sexual dysfunctions At bivariate logistic regression analysis, five variables including female gender (cOR 3.75 [2.05–6.82 at 95%CI]; p value = 0.000), hormonal therapy (cOR 3.13 [1.41-7.00 at 95%CI]; p value = 0.005), on anthracyclines (cOR 5.92 [1.71–20.50 at 95%CI]; p value = 0.005), having gastro-intestinal cancers (cOR 2.75 [1.49–5.05 at 95%CI]; p value = 0.001), age bracket of 31–40 years (cOR 1.56 [0.73–3.34 at 95%CI]; p value = 0.000) were significantly associated with sexual dysfunction. These five variables were adapted to the multivariate logistic regression. At multivariate logistic regression only three variables: female gender (aOR 3.99 [1.93–8.25 at 95%CI]; p value = 0.001), using anthracyclines (aOR 4.26 [1.02–17.76 at 95%CI]; p value = 0.047), and having gastro-intestinal cancers (aOR 3.46 [1.34–8.93 at 95%CI]; p value = 0.010) (Table 3 ). Table 3 Logistic analysis of factors associated with sexual dysfunctions among adult cancers patients at MRRH. Classification Level Presence of SD cOR P value 95% CI aOR 95% CI P value yes no Age > 51 49 56 Ref 21–30 1 8 7 0.71 0.85–57.96 31–40 14 25 1.56 0.25 0.73–3.34 41–50 26 35 1.18 0.61 0.62–2.22 Gender Male 69 58 Ref Female 21 66 3.74 0.000 2.05–6.82 3.99 1.93–8.25 < 0.001 Taxanes No 42 71 Ref Yes 48 53 0.65 0.126 0.38–1.13 Platinum analogues No 65 77 Ref Yes 25 47 1.59 0.123 0.88–2.85 Alkylating agents No 84 110 Ref Yes 6 14 1.78 0.25 0.66–4.83 Hormonal therapy No 81 92 ref Yes 9 32 3.13 0.005 1.41-7.00 Anthracyclines No 87 103 Ref Yes 3 21 5.91 0.005 1.71–20.50 4.26 1.02–17.76 0.047 GIT cancer No 62 126 Ref GIT 28 57 2.75 0.001 1.49–5.05 3.46 1.34–8.93 0.010 Education Primary 40 52 Ref None 18 41 1.75 0.111 0.87–3.50 Hypertension No 73 112 Ref Yes 17 12 0.46 0.056 0.21–1.02 Diabetes No 85 121 Ref Yes 5 3 0.42 0.25 0.10–1.81 Discussion The prevalence of sexual dysfunctions among adult cancer patients at MRRHCU was 42.52% (95% CI: 35–49%) with prevalence among male and female patients at 54.33% and 24.14 respectively. This shows there exists a burden of sexual dysfunctions among adult cancer patients at MRRHCU. This study findings are similar to 39.02% reported by a study done in United States of America by ( 17 ). Reasons could be due to the use of similar tools which are the FSFI and IIEF tools and an almost equal sample size. The findings of this study however is higher compared with a study done in Germany that documented a prevalence of 31.8% with men reporting a higher proportion 40.5% than women 23.7% ( 18 ). This is because the German study had a higher sample size compared to ours. The current prevalence 42.06% is lower compared to the findings of studies in Kenya 85% and Denmark that gave an overall higher prevalence of 60% ( 19 ) ( 20 ). This difference may have resulted from the different methods where a body images scale and multidimensional social support scale were used in addition to use of FSFI and IIEF tools, also difference in inclusion criteria where these studies included participants with advanced cancers which were excluded in our study. African cultures that consider sexuality talk a taboo hinders Africans especially women from reporting and discussing their sexual functions with health care workers. Our study revealed that among male adult patients the highly affected sexual domains was overall sex dissatisfaction findings are similar to a study done in Sweden with others affected being erectile dysfunction, orgasmic dysfunction that had comparable results with studies done in Germany by ( 21 ) ( 22 ) ( 14 ). All these sexual dysfunctions in men have nearly a similar pathophysiology and therefore these could be attributed to the use of chemotherapeutic agents that interfere with erection mechanism and psychological distress that these patients undergo which could interfere with their sexual life and also presence of reproductive cancers. While assessing the classifications of female sexual dysfunctions the most affected domain that we noted was decreased sexual desire that is similar to a study in Guinea ( 23 ). Decreased sexual arousal and vaginal pain, these affected sex domains are similar to numerous studies like those conducted in Sweden, Canada and Australia ( 21 ) ( 22 ) ( 24 ). This could be attributed to psychological distress that patients go through and most importantly dyspareunia can be due to cytotoxic chemotherapy that alters the reproductive systems morphology as well as hormonal therapy that is used in women with gynecological cancer that alters their sex hormone status. Some of the factors associated with sexual dysfunction among cancer patients on chemotherapy from at logistic regression were female gender, GIT cancer, chemotherapy agents anthracyclines were statistically significant at (p = 0.05). Although from the observation the overall prevalence is high, gender plays a role in sexual dysfunctions, as from our study findings females are 3.99 times likely to develop sexual dysfunction than men, this findings are similar to a study in China and another related study in Netherlands that found being a female is a risk factor for developing sexual dysfunction ( 25 ) ( 26 ). Surgical procedure such as hysterectomy interferes with cervix and vaginal innervation, atherosclerosis in women affects pudendal arterial bed decreasing blood flow to clitoris and vagina. Estrogen regulation decreases its vasoprotective and vasodilation effects on the vagina ( 27 ). Gastro intestinal cancer patients were 3.46 times likely to developing sexual dysfunction as opposed to those who don’t have GIT cancer. This finding is similar to a study in France that reported GIT cancers to be a significant risk factors for developing SD among cancer patients ( 12 ). Lower tumor location that compress genital nerves such as pudendal nerve and presence of stoma in some colorectal cancer patients that cause anxiety and distress have been fronted as reasons for sexual dysfunction ( 28 ) ( 29 ). The chemotherapy agents that were independently associated with sexual dysfunction among cancer patients are the anthracyclines, whereby patients on anthracyclines were 4.26 times likely to develop sexual dysfunctions than those who did not receive anthracyclines therapy. This findings is similar to a study done in Netherlands that reported anthracyclines to be associated with development of sexual dysfunctions ( 30 ). Anthracyclines have systemic effects, vaginal and rectal mucosal toxicities that reduces sexual desire and sexual arousal ( 31 ). The carditoxicity symptoms of anthracyclines can be exacerbated during sexual intercourse resulting in one or more sexual dysfunction. The strength of the study included a relatively high number of participants, Use of validated sexual dysfunction tools to assess sexual functions. Limitations Breast and prostate being the prevalent cancers cannot be generalized to other cancers. The study was limited by the cross-sectional study design where we relied on patient’s self-reported dysfunction that could have potential recall bias. These could be improved by doing a prospective study that has SD baseline assessed before initiation of chemotherapy. The study was also done in a single Centre. CONCLUSION Our findings suggest that nearly half of the adult cancer patients on chemotherapy at the Mbarara Regional Referral Hospital Cancer Centre develop sexual dysfunctions. The most affected sexual domain in men was overall sexual satisfaction and erectile dysfunctions while the female reported decreased sexual desire as the most presenting type of sexual dysfunction. Being female, having gastro intestinal cancer and chemotherapy agents anthracyclines were independent risk factors of sexual dysfunction. Routine screening of sexual functions in cancer patients. Sexual rehabilitation as well as establishment of sexual rehabilitation clinic. Enhanced heath care workers pharmacovigilance on cancer clinics. Research on sexual dysfunction and its relation to quality of life. Abbreviations ADT : Androgen deprivation therapy; ED: Erectile dysfunction; FSFI: Female sexual function index; GIT: Gastro intestinal; GVHD: Graft-versus-host disease; IIEF: International index of erectile function; MRRH: Mbarara regional referral hospital; SD: Sexual dysfunction; SF: Sexual function; MRRRHCU: Mbarara regional referral hospital cancer unit Declarations Availability of data and materials All the data that support the conclusion of the study as well as the manuscript are incorporated in this manuscript any required data will be availed if and when requested. Ethics declarations This study was carried out in accordance with the Helsinki Declaration. Approval was sought from the pharmacy department. Research approval from Mbarara University faculty research ethic committee was obtained before commencing the study. Ethical approval was sort from MUST research and ethics committee Institutional review board (IRB) Approval number (MUST-2023-876). Request and approval from relevant authorities at Mbarara regional referral hospital to carry out the study at the facility was obtained. Full consent was obtained from the participants prior to the study on a voluntary basis and with a right of withdrawal any anytime during the study. For data confidentiality unique patient identifiers instead of patients name were used and the data was only accessible to the principle researcher and research assistants only. With softcopies being password protected and hard copies kept under lock and in key in a secured cupboard. Acknowledgement The authors do hereby extend their sincere appreciation the all the study participants and the healthcare workers at MRRHCU. We are also thankful to the study participant for their cooperation throughout the data collection period. We would also like to acknowledge Mbarara Regional Referral Hospital for enabling us to carry out this study in their facility. Funding As there was not external funding for the study, the research was fully funded by the researchers. Contributions All the authors made significant contributions to the work reported in this study, from proposal conception, study design, reviewing and revising literatures data collection, analysis and results interpretation. All the authors also gave their final approval for the version to be published as well as an agreement on the journal to which the manuscript has been submitted. They agreed to be accountable for every details of the work. Consent for publication All authors agreed to the submission of this manuscript for publication in addition to the consent to publish which was included in the informed consent form and attained ethical and participant approval. Data sharing The dataset is available for sharing upon reasonable request to the corresponding author Competing interest The authors declare that they have no competing interests. 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Krouwel EM, Kramer Z, Gordijn R, Nicolai MPJ, Osanto S, Putter H, et al. Sexual and fertility-related adverse effects of medicinal treatment for cancer; a national evaluation among medical oncologists. Support Care Cancer. 2022;30(5):4035–47. Krychman ML, Carter J, Aghajanian CA, Dizon DS, Castiel M. Chemotherapy-induced dyspareunia: a case study of vaginal mucositis and pegylated liposomal doxorubicin injection in advanced stage ovarian carcinoma. Gynecol Oncol. 2004;93(2):561–3. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Sep, 2024 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Revision requested 30 Apr, 2024 Editor assigned by journal 30 Apr, 2024 Submission checks completed at journal 30 Apr, 2024 First submitted to journal 29 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4342382","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":297332497,"identity":"d3d94b79-6e25-4493-9fb4-3b252e6d3e84","order_by":0,"name":"Joel Nyanchiri Oenga","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBACxgbGBgYGAwZmBnYgzWBgQZSWxgawFp4DIC0SRFoEpiQSwCRh9cz9i9sf8xQwsMtHPr+64UeBBAN/e3cCfitmPGxs5gE6zPB2TtnNHqDDJM6c3UBAy0Goltk5aTd4gFoMJHKJ1TLzTNrNP0Rp6W+EaJGXYD92m0hbGBtnzjGQYDbgyWG7LWMgwUPQL4b9xx98ePPHJlm+/fizm0CGHH97LwEtMxJAlESywQGg84CAB69yEJDnPwCm7eQb2B8QVD0KRsEoGAUjEwAAD9BGNRgOQAIAAAAASUVORK5CYII=","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Joel","middleName":"Nyanchiri","lastName":"Oenga","suffix":""},{"id":297332498,"identity":"e2ef2c9d-f317-4c59-bf7d-ee645f56a32f","order_by":1,"name":"Robert Tamukong","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Tamukong","suffix":""},{"id":297332499,"identity":"a53ad656-6740-433d-a7a0-11b091cb3938","order_by":2,"name":"John Isiiko","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Isiiko","suffix":""},{"id":297332500,"identity":"3f7df210-76ad-4ffb-8f36-ea3342670f31","order_by":3,"name":"Sibali Gidimali Gibu","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sibali","middleName":"Gidimali","lastName":"Gibu","suffix":""},{"id":297332501,"identity":"9f5180dd-e8d6-4dc1-9309-c3eaa11c97af","order_by":4,"name":"Tadele Mekuriya Yadesa","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tadele","middleName":"Mekuriya","lastName":"Yadesa","suffix":""},{"id":297332502,"identity":"89d9b85d-8eba-4aa6-8ad7-5e7dfb0af1c6","order_by":5,"name":"Gidion Kule","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gidion","middleName":"","lastName":"Kule","suffix":""}],"badges":[],"createdAt":"2024-04-29 11:09:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4342382/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4342382/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12885-024-12987-z","type":"published","date":"2024-09-30T15:58:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56023710,"identity":"df4a433d-3218-4325-b33e-36bb71edb9e9","added_by":"auto","created_at":"2024-05-07 16:44:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11490,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of cancer of reproductive organ among adult cancer patients studied.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/8a936ef1395ca967dfa4cb7e.png"},{"id":56024627,"identity":"9647906a-057b-43d7-9eba-ae0550143c25","added_by":"auto","created_at":"2024-05-07 16:52:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22019,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of other cancers affecting study participants at the Mbarara regional referral hospital cancer unit.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/2164f95825d326ebc2fdfac5.png"},{"id":56025681,"identity":"ff45fa09-bc3f-4fae-b9a3-e4cc6a5a01e0","added_by":"auto","created_at":"2024-05-07 17:00:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16112,"visible":true,"origin":"","legend":"\u003cp\u003eCancer drugs classification that participants were on at the Mbarara regional referral hospital.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/6c3c169c9e18ac1e37163a8b.png"},{"id":56023708,"identity":"d37d4a5c-30e2-43e0-8eb7-944e2fff6e02","added_by":"auto","created_at":"2024-05-07 16:44:19","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":15053,"visible":true,"origin":"","legend":"\u003cp\u003eprevalence of sexual dysfunction among cancer patients at MRRHCU\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/5fe4cda6c4eac8834e2469ff.png"},{"id":56023714,"identity":"d3a05a0f-35e9-4640-87c7-0002b1ddcae9","added_by":"auto","created_at":"2024-05-07 16:44:19","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":14511,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of number of sexual dysfunction among male adult cancer patients at the n=68 MRRHCU.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/1c16416bd6b47f6f68ecacfd.png"},{"id":56023713,"identity":"36142711-1d6d-4769-9e9b-e6183f118d1b","added_by":"auto","created_at":"2024-05-07 16:44:19","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":9495,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of number of sexual dysfunctions among female adult cancer patients at the MRRHCU n=21\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/2cb244dda6f8fe0130fc92cf.png"},{"id":66097474,"identity":"1feb9268-590a-4ffb-ba30-c9e52f51df97","added_by":"auto","created_at":"2024-10-07 16:14:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":786903,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4342382/v1/c3880536-acf5-4131-892d-87dff49ed5ab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, Classifications and Factors Associated With Sexual Dysfunction among Adult Cancer Patients on Chemotherapy at Uganda Cancer Institute, Mbarara","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally in the year 2020 it was estimated that 19.3 new cancer cases were reported, with almost 10.0\u0026nbsp;million cancer deaths, these burdens are expected to increase to 28.4 new cases by the year 2040 which accounts for a 47% rise from the 2020 value. Furthermore it is projected that by 2028 Over the next six years, more than 1,700,000 people will be diagnosed with cancer and over 600,000 more people with cancer will lose their lives (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). While this condition keeps ravaging the world Uganda is no exception as its cancer incidence was 34,008 in the year 2020, 15% of the population in the country has a risk of developing cancer before 75 years of age with the mortality on the same year being 22,992 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eBut with timely diagnosis and advanced treatment most of cancer patients have high survival rates (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).However with the improved survival rates, it is necessary to focus on patients' quality of life, which is complications from delayed diagnosis or treatment modalities employed especially their sexual desirability that requires thoughtfulness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Sexual dysfunctions (SDs) are strains and distresses that take place during a sexual reaction that hinders an individual from experiencing satisfaction from sexual activity (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Most functionality and dysfunctions are subjective and thus SDs as a result of chemotherapy and radiotherapy decreases after treatment is completed (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo determine the prevalence of sexual dysfunction a study in Germany reported a combined prevalence of sexual dysfunction among all genders at 31.8% of which 40.5% of the male and 23.07% of the female had sexual dysfunctions (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Elsewhere among Turkish women 55.9% had their sexuality negatively affected by chemotherapy treatment (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). A study in Nigeria show that six (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) months post treatment in breast cancer patients, 67.9% of women felt inadequate as women and 70.0% experience a decreased conjugal frequency (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). While In Kenya 85% of cancer patients had SD while 65% of these had discussed their sexuality with the physician (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurther studies found that both male and female cancer patients had reduced sexual frequency, decreased sexual satisfaction, reduced penetration and non-penetrative sexual activities across all cancer types. Vaginal dryness, tiredness and feeling unattractive were reported by female and erectile dysfunction by male, (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). While both male and female patients with colorectal cancer had a 61% decrease in sexual desire, decreased sexual frequency stood at 48%, and orgasm possibility at 48% two years after diagnosis (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eReproductive and non-reproductive cancer caused an incidence of sexual displeasure in equal measures in more than a third of adolescents and young adults (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) .Whilst a study grounded on international index of erectile function (IIEF) found group under cisplatin treatment had a notable decline in erectile function after treatment (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). While erectile dysfunction affects 40.72% of prostate cancer patients and has been linked to cancer treatment regimens, cancer site, and age of these patients (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Hodgkin lymphoma patients on alkylating based chemotherapy had sixty three 63% percent report sexual dysfunction while twenty two 22% percent had the perception of being infertile (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese lost sexual functions(SF) bring about disappointment due to intimacy loss, frustration, anger, sadness, feelings of inadequacy, shift in feminity and masculinity, relationship strains, difficulty in forming new relationships, on the opposite side it increased patients confidence, reprioritizing sex, renegotiating sex while some relationship and marriages are strengthened (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Therefore increased focus on sexual functions may give rise to increased clinical awareness, service development, and research on underserved aspects of cancer care (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). An indicator that sexual functions of patients can be achieved by timely interventions and understanding of the risk factors among cancer patients.\u003c/p\u003e \u003cp\u003eIn Uganda cancer patients report to have experienced sexual dysfunctions but the extent is not known particularly in Uganda. No study has been done to evaluate these dysfunctions among cancer patients in Uganda. Our study therefore aimed at determining the prevalence and factors associated with sexual dysfunction among cancer patients who were on chemotherapy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThe study was a descriptive cross-sectional study conducted among adult cancer patients visiting the Mbarara regional referral hospital cancer unit to evaluate prevalence, factors associated with and classifications of chemotherapy induced sexual dysfunctions. The study was carried out from August 2023 to October 2023. The oncology Centre has two (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) units, the pediatric and adult units respectively, the adult unit has a 20 bed capacity while pediatric has approximately 20 beds and they were established in 2017, they offer both in and outpatient services to cancer patients. The Cancer Centre also boosts of two (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) oncologists, one (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) oncology pharmacist, one (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) pharmacist, 5 Nurses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eAll male and female adult cancer patients visiting Mbarara Regional Referral Hospital Cancer Center outpatient clinic, who meet the inclusion criteria. The study included all Adult male and female patients with cancer visiting the cancer unit for treatment. Patients who have had at least one chemotherapy cycle within the previous 21 days were included. Patients with prior SD diagnosis before cancer diagnosis, those with advanced cancer, and who withdrew from the study were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eA semi structured Interview Questionnaire both in English and Runyankole were developed administered by the principal researcher and research assistants after signing of informed consent forms to collect primary (demographic data) and secondary data (disease and treatment data). A pretest of data collection tool was conducted on 5% of the sample size (10 patients) before the actual data collection these patients were tagged to ensure they are not sampled again in the actual data collection, and the pretest data was not included in the final analysis. It contained a cover letter with research aim, and the researchers\u0026rsquo; contact each interview lasted a maximum of one hour. Trained research assistants a nurse and a pharmacist were trained on ethical considerations and data collection before commencement of the study and together with the principal researcher reviewed patient\u0026rsquo;s charts to obtain relevant disease types and treatment regimens. A female sexual function index FSFI tool was used by the principal investigator to classify female sexual dysfunctions, it has a scale with values to a maximum score of 36 and a value below 26 is deemed a as sexual dysfunction which were measured in six different domain: sexual desire maximum score of 6, arousal maximum score of 6, lubrication maximum score of 6, orgasm maximum score of 6, satisfaction maximum score of 6 and pain maximum score of 6. While international index of erectile function IIEF tool was used to classify male sexual dysfunctions, it had scale value between 0\u0026ndash;75 with 5 different domains between A-E each sexual classification is classified according to the domain it lies on as: erectile function maximum score of 30, orgasmic function maximum score of 10, sexual desire maximum score of 10, intercourse satisfaction maximum score of 15 and overall satisfaction maximum score of 10.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003e Statistics and data (Stata) software version 17 was used to analyze and interpret the data information .Both descriptive and inferential analysis was done and presented as means, medians and percentages .the prevalence of SD was calculated by counting number of participants with SD then divided by sample size and converted into percentage by multiplying with 100. This prevalence was also stratified by gender. Classifications of SD identified was reported in percentages and stratified by gender. To determine independent associated factors of SD logistic regression was employed whereby variables with a p value of \u0026lt;\u0026thinsp;0.25 in the bivariate logistic regression were adopted for multivariate analysis to cater for co-founding factors, and variables with a p value of \u0026lt;\u0026thinsp;0.05 were considered statistically significant independent risk factors for SD at the multivariate analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eA total of 214 patients were interviewed with 3 who withdrew from the study. Over half (127, 59.35%) were male, while majority (105, 49.09%) were above 50 years of age. The median age was 50 IQR45; 58, whereas over two thirds (181, 84.58%) were married (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical classifications of participants at MRRH.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClassifications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127(59.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87(40.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003eMedian\u0026thinsp;=\u0026thinsp;50 IQR: 45;58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;50years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105(49.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41-50yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61(28.50)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31-40yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(18.22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21-30yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(4.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnglican\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96(44.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86(40.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(9.35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(5.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(13.55)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHiv\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(12.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(3.74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151(70.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMarital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181(84.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(7.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeparated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(4.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(2.80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(1.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCancers ICD-11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReproductive cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94(43.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGIT Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85(39.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHematological cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(7.94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSarcomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(8.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCancer Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96(44.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61(28.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot staged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(23.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(3.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eTypes of cancers documented\u003c/h2\u003e \u003cp\u003eReproductive organ cancers (94, 43.93%) majorly prostate cancer (46, 21.96%). Gastro intestinal cancers (85 39.72%) majorly esophageal cancer (27, 12.62%) were the most diagnosed neoplasms (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eClasses of chemotherapy agents used\u003c/h2\u003e \u003cp\u003eOut of 8 (eight) classes of chemotherapeutic drugs nearly half of the participant were on taxanes (101, 47.2%), followed by platinum analogues being used by (72, 33.64%) of participants with the least used regimen being plant alkaloids (7, 3.27%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of sexual dysfunction among adult cancer patients\u003c/h2\u003e \u003cp\u003eThe prevalence of sexual dysfunction among adult cancer patients at MRRHCU was 42.52%, with 21(24.14%) of female having sexual dysfunction while 68 (54.23%) of male having sexual dysfunction (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClassifications of sexual dysfunctions among cancer patients\u003c/h2\u003e \u003cp\u003eThe most affected sexual domain in men was overall sexual dissatisfaction (33.86%), while female reported low sex desire (18.39%) as the most presenting sexual dysfunction (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of classification of sexual dysfunction identified among participants at MRRHCU\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall sex dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.86%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eErectile dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.28%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased orgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercourse dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduced sexual desire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.98%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow sex desire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.39%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased sexual arousal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.24%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.09%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePainful penetration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.79%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased orgasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.49%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReduced lubrication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.05%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong male participants with SD, 19 (27.94%) had three sexual domains affected followed by 15 (22.06%) of participants who had four sexual domains affected (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong female participants with SD majority (8, 38.1%) of participants had four affected sexual domains, (4, and 19.05%) of participants exhibited three classes of sexual dysfunctions (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with sexual dysfunctions\u003c/h2\u003e \u003cp\u003eAt bivariate logistic regression analysis, five variables including female gender (cOR 3.75 [2.05\u0026ndash;6.82 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.000), hormonal therapy (cOR 3.13 [1.41-7.00 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.005), on anthracyclines (cOR 5.92 [1.71\u0026ndash;20.50 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.005), having gastro-intestinal cancers (cOR 2.75 [1.49\u0026ndash;5.05 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.001), age bracket of 31\u0026ndash;40 years (cOR 1.56 [0.73\u0026ndash;3.34 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.000) were significantly associated with sexual dysfunction. These five variables were adapted to the multivariate logistic regression. At multivariate logistic regression only three variables: female gender (aOR 3.99 [1.93\u0026ndash;8.25 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.001), using anthracyclines (aOR 4.26 [1.02\u0026ndash;17.76 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.047), and having gastro-intestinal cancers (aOR 3.46 [1.34\u0026ndash;8.93 at 95%CI]; p value\u0026thinsp;=\u0026thinsp;0.010) (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic analysis of factors associated with sexual dysfunctions among adult cancers patients at MRRH.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003ePresence of SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e95%\u003c/p\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP\u003c/p\u003e \u003cp\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.85\u0026ndash;57.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e31\u0026ndash;40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.73\u0026ndash;3.34\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.62\u0026ndash;2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2.05\u0026ndash;6.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e3.99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e1.93\u0026ndash;8.25\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTaxanes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38\u0026ndash;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlatinum analogues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.88\u0026ndash;2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlkylating agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.66\u0026ndash;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHormonal therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eref\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1.41-7.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnthracyclines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.91\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1.71\u0026ndash;20.50\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e4.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e1.02\u0026ndash;17.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGIT cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGIT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e57\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e1.49\u0026ndash;5.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e3.46\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e1.34\u0026ndash;8.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.87\u0026ndash;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.21\u0026ndash;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.10\u0026ndash;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of sexual dysfunctions among adult cancer patients at MRRHCU was 42.52% (95% CI: 35\u0026ndash;49%) with prevalence among male and female patients at 54.33% and 24.14 respectively. This shows there exists a burden of sexual dysfunctions among adult cancer patients at MRRHCU. This study findings are similar to 39.02% reported by a study done in United States of America by (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Reasons could be due to the use of similar tools which are the FSFI and IIEF tools and an almost equal sample size. The findings of this study however is higher compared with a study done in Germany that documented a prevalence of 31.8% with men reporting a higher proportion 40.5% than women 23.7% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This is because the German study had a higher sample size compared to ours. The current prevalence 42.06% is lower compared to the findings of studies in Kenya 85% and Denmark that gave an overall higher prevalence of 60% (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This difference may have resulted from the different methods where a body images scale and multidimensional social support scale were used in addition to use of FSFI and IIEF tools, also difference in inclusion criteria where these studies included participants with advanced cancers which were excluded in our study. African cultures that consider sexuality talk a taboo hinders Africans especially women from reporting and discussing their sexual functions with health care workers.\u003c/p\u003e \u003cp\u003eOur study revealed that among male adult patients the highly affected sexual domains was overall sex dissatisfaction findings are similar to a study done in Sweden with others affected being erectile dysfunction, orgasmic dysfunction that had comparable results with studies done in Germany by (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). All these sexual dysfunctions in men have nearly a similar pathophysiology and therefore these could be attributed to the use of chemotherapeutic agents that interfere with erection mechanism and psychological distress that these patients undergo which could interfere with their sexual life and also presence of reproductive cancers.\u003c/p\u003e \u003cp\u003eWhile assessing the classifications of female sexual dysfunctions the most affected domain that we noted was decreased sexual desire that is similar to a study in Guinea (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Decreased sexual arousal and vaginal pain, these affected sex domains are similar to numerous studies like those conducted in Sweden, Canada and Australia (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This could be attributed to psychological distress that patients go through and most importantly dyspareunia can be due to cytotoxic chemotherapy that alters the reproductive systems morphology as well as hormonal therapy that is used in women with gynecological cancer that alters their sex hormone status.\u003c/p\u003e \u003cp\u003eSome of the factors associated with sexual dysfunction among cancer patients on chemotherapy from at logistic regression were female gender, GIT cancer, chemotherapy agents anthracyclines were statistically significant at (p\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAlthough from the observation the overall prevalence is high, gender plays a role in sexual dysfunctions, as from our study findings females are 3.99 times likely to develop sexual dysfunction than men, this findings are similar to a study in China and another related study in Netherlands that found being a female is a risk factor for developing sexual dysfunction (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Surgical procedure such as hysterectomy interferes with cervix and vaginal innervation, atherosclerosis in women affects pudendal arterial bed decreasing blood flow to clitoris and vagina. Estrogen regulation decreases its vasoprotective and vasodilation effects on the vagina (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGastro intestinal cancer patients were 3.46 times likely to developing sexual dysfunction as opposed to those who don\u0026rsquo;t have GIT cancer. This finding is similar to a study in France that reported GIT cancers to be a significant risk factors for developing SD among cancer patients (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Lower tumor location that compress genital nerves such as pudendal nerve and presence of stoma in some colorectal cancer patients that cause anxiety and distress have been fronted as reasons for sexual dysfunction (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe chemotherapy agents that were independently associated with sexual dysfunction among cancer patients are the anthracyclines, whereby patients on anthracyclines were 4.26 times likely to develop sexual dysfunctions than those who did not receive anthracyclines therapy. This findings is similar to a study done in Netherlands that reported anthracyclines to be associated with development of sexual dysfunctions (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Anthracyclines have systemic effects, vaginal and rectal mucosal toxicities that reduces sexual desire and sexual arousal (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The carditoxicity symptoms of anthracyclines can be exacerbated during sexual intercourse resulting in one or more sexual dysfunction.\u003c/p\u003e \u003cp\u003eThe strength of the study included a relatively high number of participants, Use of validated sexual dysfunction tools to assess sexual functions.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eBreast and prostate being the prevalent cancers cannot be generalized to other cancers. The study was limited by the cross-sectional study design where we relied on patient\u0026rsquo;s self-reported dysfunction that could have potential recall bias. These could be improved by doing a prospective study that has SD baseline assessed before initiation of chemotherapy. The study was also done in a single Centre.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur findings suggest that nearly half of the adult cancer patients on chemotherapy at the Mbarara Regional Referral Hospital Cancer Centre develop sexual dysfunctions. The most affected sexual domain in men was overall sexual satisfaction and erectile dysfunctions while the female reported decreased sexual desire as the most presenting type of sexual dysfunction. Being female, having gastro intestinal cancer and chemotherapy agents anthracyclines were independent risk factors of sexual dysfunction. Routine screening of sexual functions in cancer patients. Sexual rehabilitation as well as establishment of sexual rehabilitation clinic. Enhanced heath care workers pharmacovigilance on cancer clinics. Research on sexual dysfunction and its relation to quality of life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADT \u0026nbsp; : Androgen deprivation therapy;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eED: Erectile dysfunction;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFSFI: Female sexual function index;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGIT: Gastro intestinal;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGVHD: Graft-versus-host disease; IIEF: International index of erectile function;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMRRH: Mbarara regional referral hospital;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD: Sexual dysfunction;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSF: Sexual function;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMRRRHCU: Mbarara regional referral hospital cancer unit\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data that support the conclusion of the study as well as the manuscript are incorporated in this manuscript any required data will be availed if and when requested.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in accordance with the Helsinki Declaration.\u0026nbsp;Approval was sought from the pharmacy department. Research approval from Mbarara University faculty research ethic committee was obtained before commencing the study. Ethical approval was sort from MUST research and ethics committee Institutional review board (IRB) Approval number (MUST-2023-876). Request and approval from relevant authorities at Mbarara regional referral hospital to carry out the study at the facility was obtained. Full consent was obtained from the participants prior to the study on a voluntary basis and with a right of withdrawal any anytime during the study. For data confidentiality unique patient identifiers instead of patients name were used and the data was only accessible to the principle researcher and research assistants only. With softcopies being password protected and hard copies kept under lock and in key in a secured cupboard.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors do hereby extend their sincere appreciation the all the study participants and the healthcare workers at MRRHCU. We are also thankful to the study participant for their cooperation throughout the data collection period. We would also like to acknowledge Mbarara Regional Referral Hospital for enabling us to carry out this study in their facility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs there was not external funding for the study, the research was fully funded by the researchers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors made significant contributions to the work reported in this study, from proposal conception, study design, reviewing and revising literatures data collection, analysis and results interpretation. All the authors also gave their final approval for the version to be published as well as an agreement on the journal to which the manuscript has been submitted. They agreed to be accountable for every details of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agreed to the submission of this manuscript for publication in addition to the consent to publish which was included in the informed consent form and attained ethical and participant approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sharing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset is available for sharing upon reasonable request to the corresponding author\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. 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Gynecol Oncol. 2004;93(2):561\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"anorgasmia, dyspareunia, erectile dysfunction, anthracyclines, and chemotherapy","lastPublishedDoi":"10.21203/rs.3.rs-4342382/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4342382/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Sexual dysfunction is one of the social challenges that devastate many people among them cancer patients, but which is considered non-medical and often disregarded. Chemotherapeutics used among cancer patients are potential risk factors for development of SD and such understanding of these risk factors can lead to numerous interventions to bypass their effects on sexual life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe goal of this study was to determine the prevalence, classifications and factors associated with sexual dysfunctions among cancer patients on chemotherapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study was conducted among 214 cancer patients at the Mbarara Regional Referral Hospital in south western Uganda for a period of 3 months from August to October 2023. A systematic sampling technique was employed in the study; a questionnaire was used to collect patient data. Standardized female sexual function index and international index of erectile function tools were used to classify types of sexual dysfunctions among women and men respectively. Sexual dysfunction associated factors were analyzed by logistic regression using stata version 17.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Two hundred and fourteen participants were enrolled 127 males and 87 females with a median age of 50 years; overall 90 (42.06%) of the patients, 68 (54.33 %) of males and 21 (24.14%) of females) experienced at least one domain of sexual dysfunction. At presentation majority of men 43 (33.86%) reported overall sexual dissatisfaction, while majority of the female 15 (18.39%) patients reported decreased sexual desire others being reduced arousal and vaginal pain. The multivariate logistic regression identified the independent risk factors for sexual dysfunctions: female gender (aOR 3.99, 95% CI 1.93-8.25; p value =0.001), Gastro intestinal cancers (aOR 3.46, 95% CI 1.34-8.93; p value =0.010) and anthracyclines (aOR 4.26, 95% CI 1.02, 17.76; p value=0.047) were statistically significant independent risk factors of sexual dysfunctions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eOur findings suggest that there is a high prevalence of sexual dysfunctions among cancer patients at the Mbarara Regional Referral Hospital. In male patients, the overall sexual dissatisfaction is the most prevalent while decreased sexual desire is prevalent in female. Routine screening of sexual functions should be encouraged among all patients receiving chemotherapies. Female patients, those diagnosed with gastro-intestinal cancers, and those on regimens containing anthracyclines should be more closely monitored for sexual dysfunction.\u003c/p\u003e","manuscriptTitle":"Prevalence, Classifications and Factors Associated With Sexual Dysfunction among Adult Cancer Patients on Chemotherapy at Uganda Cancer Institute, Mbarara","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 16:44:14","doi":"10.21203/rs.3.rs-4342382/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-30T16:44:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-30T08:05:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-30T08:05:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2024-04-29T10:47:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e310cba-1949-4d08-99aa-53222dff1239","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-07T16:08:46+00:00","versionOfRecord":{"articleIdentity":"rs-4342382","link":"https://doi.org/10.1186/s12885-024-12987-z","journal":{"identity":"bmc-cancer","isVorOnly":false,"title":"BMC Cancer"},"publishedOn":"2024-09-30 15:58:02","publishedOnDateReadable":"September 30th, 2024"},"versionCreatedAt":"2024-05-07 16:44:14","video":"","vorDoi":"10.1186/s12885-024-12987-z","vorDoiUrl":"https://doi.org/10.1186/s12885-024-12987-z","workflowStages":[]},"version":"v1","identity":"rs-4342382","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4342382","identity":"rs-4342382","version":["v1"]},"buildId":"re_ckhLnmML6MCF96OHNJ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}