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Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma worldwide, has a high prevalence in elderly patients, and presents with a rapidly growing tumor mass involving one or more lymph nodes or extranodal sites.¹ Although the sexuality of patients with hematological malignancies such as DLBCL has not been widely studied, physical and psychosocial changes associated with cancer and cancer treatment are known to affect several aspects of sexuality, including intimacy and communication, sexual interest, sexual function, sexual activity, and sexual satisfaction.² Body image, which involves an individual鈥檚 conscious and unconscious feelings, thoughts, and perceptions about their body, as well as how they are perceived by others, is another important factor affecting both sexuality and health-related quality of life (HRQoL).³

Sexuality in patients with Hodgkin lymphoma has been studied previously, but with a focus on how treatment affected sexuality in younger populations and identification of possible fertility problems.² Research about the effect of hematological malignancies on sexuality in older populations is more limited, with small sample sizes.² In addition, older populations tend to be more affected by comorbidities such as cardiovascular disease, indicating a need for insight into associations between sexuality, body image, comorbidities, and HRQoL in patients treated for DLBCL.2

A cross-sectional study

To address this information gap, Professor Cecilia Olsson, of Karstad University, Karlstad, Sweden, and colleagues conducted a cross-sectional study using the Swedish National Quality Register for Leukemia-Subregistry for Lymphoma.² Patients invited to participate were diagnosed with DLBCL between January 2016 and October 2018, treated with chemotherapy and/or chemoimmunotherapy and/or radiotherapy, and aged 45 years or older. 

• QoL was measured via the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30; ver. 3), which includes symptom, functional, and QoL scales. Scores range from 1 to 100, with higher scores indicating better functioning, higher HRQoL, and a greater symptom load. 
• Sexual adjustment was assessed via the Sexual Adjustment Questionnaire-Swedish version II (SAQ-SII), which measures 4 subscales on a 5-point Likert scale: sexual interest, sexual function, sexual relation, and sexual satisfaction. An additional single item concerning frequency is answered on a 6-point scale. High scores (鈮�4) indicate positive feelings or better functioning, whereas fair scores (=3 and <4) and low scores (<3) indicate decreasing levels of sexual adjustment. 
• Body image was measured via the Body Image Scale (BIS), with total scores ranging from 10 to 40; lower scores indicate positive body image.

Sexuality in patients with DLBCL

Of the 257 patients enrolled in the study, 71% were in a relationship. Mean HRQoL was 69.75, with symptom scores ranging from 5.56 for nausea and vomiting to 37.73 for fatigue. Functional scales ranged from 68.50 for Role to 80.82 for Social Functioning. Participants scored a total of 14.47 on the BIS, indicating relatively unaffected body image. 

• Although SAQ-SII subscale scores for sexual function and sexual satisfaction were fair (3.62 and 3.50 respectively), scores for sexual interest and sexual relation were low (2.63 and 2.72, respectively), yielding a fair overall sexual adjustment score (3.02).One of the SAQ-SII subscales, sexual relation, had a positive and significant impact on HRQoL, meaning that those reporting better sexual relation had a higher HRQoL (standardized regression coefficient=0.178; P=0.029).
• Conversely, body image had a negative and significant association with HRQoL, meaning that participants with a negative body image had a lower HRQoL (standardized regression coefficient =鈥�0.330; P<0.001).
• Presence of comorbidities also was associated with lower HRQoL (standard regression coefficient=鈥�0.268; P<0.001). 

Implications for disease management

鈥淧ositive sexual relationships including intimacy and ability to talk about sex with their partner can improve HRQoL鈥� in patients with DLBCL, stated first author Dr. Olsson in an interview with MPT, adding that 鈥渃omorbidity and negative thoughts about the body can worsen quality of life.鈥� These findings could impact how healthcare providers (HCPs) approach patients with DLBCL by highlighting the importance of addressing sexuality and body image to support their well-being. Furthermore, Dr. Olsson added, 鈥渟exuality and body image need to be recognized in treatment and care guidelines, and health care services need to ensure that HCPs have sufficient competence鈥� to address these issues.

Despite the insights provided by this study, more work is needed to explore additional variables that might establish a more comprehensive understanding of this relationship. 鈥淔eeling satisfied with one's sex life and having positive sexual relationships is something that is often overlooked in cancer treatment and survivorship care, especially in older patients,鈥� stated Dr. Olsson, indicating the need for further study. Through a deeper understanding of sexuality and body image, and the impact these variables have on HRQoL, HCPs can provide support for cancer patients in an area that is often overlooked.

Published: December 30, 2024