Oncology Nursing Forum • Vol. 38, No. 5, September 2011 E351
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groups: indolent (low-grade lymphomas, which grow
slowly) and aggressive (intermediate- and high-grade
lymphomas, which grow quickly). Without intervention,
aggressive NHL can be fatal within months (Johnston,
1999; Sehn & Connors, 2005). Individuals diagnosed
with aggressive NHL undergo extensive treatment for
the disease, including multi-agent chemotherapy regi-
mens (with or without radiation) and, potentially, bone
marrow or stem cell transplantation (Sehn & Connors,
2005). Although advances in NHL treatment have led to
a rise in survival rates (Jemal et al., 2004; Mahadevan &
Fisher, 2011; Sehn & Connors, 2005; Shipp et al., 1993)
by months and even years postdiagnosis, survivors are
at risk for significant adverse effects of their treatment,
such as second cancers and cardiovascular complica-
tions (Andre et al., 2004; Brennan et al., 2005). In this
way, aggressive treatment among NHL survivors may
result in long-term complications that require both med-
ical and psychosocial interventions. One such area that
may be affected is survivors’ sexual well-being (Hewitt,
Greenfield, & Stovall, 2006; Institute of Medicine, 2008;
Monga, 2002; Rowland & Bellizzi, 2008).
Sexual well-being includes factors associated with
sexual experience (Taylor & Davis, 2007), such as partici-
pation in sexual activity, satisfaction with sexual experi-
ences, and sexual function. Sexual well-being has been
identified as a common concern among survivors (Baker,
Denniston, Smith, & West, 2005) and as an area in need
of continued attention in research (Hewitt et al., 2006).
Previous studies have addressed sexual outcomes for
cancer survivors, mainly among individuals diagnosed
with breast, gynecologic, or prostate cancers (Andersen,
on-Hodgkin lymphoma (NHL) ranks
sixth in cancer incidence among women
and seventh among men (American Can-
cer Society, 2011), with rising incidence
rates documented since 1973 (Fisher &
Fisher, 2004). Adult NHLs are divided into two main
Sexual Well-Being Among Survivors
of Non-Hodgkin Lymphoma
Ellen Burke Beckjord, PhD, MPH, Neeraj K. Arora, PhD, Keith Bellizzi, PhD, MPH,
Ann S. Hamilton, PhD, and Julia H. Rowland, PhD
Purpose/Objectives: To describe sexual well-being among
non-Hodgkin lymphoma (NHL) survivors.
Design: Descriptive, correlational, cross-sectional study.
Setting: NHL survivors identified via the Los Angeles County
Cancer Surveillance Program.
Sample: 222 NHL survivors two- to five-years postdiagnosis.
Methods: Data were collected via mailed questionnaire.
Multivariate models were used to examine sexual well-being.
Main Research Variables: Three indices of sexual well-
being were examined in relation to sociodemographic and
medical variables: participation in sexual activity, satisfaction
with sex life, and sexual function.
Findings: Most NHL survivors were participating in sexual
activity; however, more than half were dissatisfied with their
sex life. A substantial minority “usually or always” experienced
problems with sexual function. Associations between study
variables and outcomes differed across indices of sexual well-
being and by gender; older age was associated with decreased
participation, decreased satisfaction, and impaired sexual
function for men as well as with decreased participation for
women. Poorer physical functioning was associated with de-
creased participation for men and women as well as poorer
sexual function for women. Finally, poorer mental functioning
was associated with less satisfaction and poorer sexual func-
tion for men and women; shorter times since diagnosis were
associated with poorer sexual function for women.
Conclusions: Most NHL survivors were sexually active, but
many reported difficulties with satisfaction and function.
Sexual well-being is a multifaceted construct that requires
continued attention throughout survivorship.
Implications for Nursing: Oncology nurses are in an excel-
lent position to ensure that survivors’ sexual concerns are
addressed. Survivorship care plans may help to facilitate
communication about survivors’ sexual well-being.
Anderson, & deProsse, 1989; Beckjord & Campas, 2007;
Can et al., 2008; Carmack Taylor, Basen-Engquist, Shinn,
& Bodurka, 2004; Ganz, Desmond, Belin, Meyerowitz, &
Rowland, 1999; Henson, 2002; Incrocci, 2006; Kao, Jani,