Exploring how attachment insecurities mediate the link between sexual and partnership satisfaction in adolescents and young adults with cancer
DOI:
https://doi.org/10.2340/1651-226X.2025.42110Keywords:
Sexual health, attachment-related anxiety, attachment-related avoidance, AYA cancer survivors, oncology, supportive careAbstract
Background and purpose: Comprehensive data on factors affecting partnership satisfaction among adolescents and young adult (AYA) cancer survivors are limited. Our study examines partnership satisfaction, sexual satisfaction, and attachment insecurities, exploring how attachment-related anxiety and avoidance influence the relationship between sexual and partnership satisfaction across major tumor entities in this population.
Patients and methods: We utilized data from two measurement time points (t1 and t6) of the AYA-LE study, a prospective longitudinal investigation examining the temporal course and associated factors of life satisfaction and psychological distress among AYA cancer survivors. We examined the mediating effect of attachment insecurities (ECR-RD) on the relationship between sexual satisfaction (FLZ-Sex) and partnership satisfaction (PFB), while controlling for sociodemographic and clinical characteristics, in a sample of N = 275 participants.
Results: Higher sexual satisfaction was correlated with lower attachment-related anxiety (r = -0.51, p < 0.001) and lower attachment-related avoidance (r = -0.49, p < 0.001). Both lower attachment-related anxiety and attachment-related avoidance were correlated with higher partnership satisfaction (r = -0.64, p < 0.001 and r = -0.72, p < 0.001, respectively). Sexual satisfaction partially predicted partnership satisfaction of AYA cancer survivors through attachment-related anxiety and attachment-related avoidance while the mediating effect accounted for 75% of the total effect.
Interpretation: The associations between sexual satisfaction, partnership satisfaction, and attachment highlight the need to address emotional and relational aspects in supportive care for AYA cancer survivors. There is a clear need for more targeted studies on attachment patterns, sexual satisfaction, and partnership satisfaction in this specific population to further refine and validate these approaches.
Downloads
References
Reinman L, Coons HL, Sopfe J, Casey R. Psychosexual care of adolescent and young adult (AYA) cancer survivors. Children (Basel). 2021;8(11):1074. DOI: https://doi.org/10.3390/children8111058
https://doi.org/10.3390/children8111074 DOI: https://doi.org/10.3390/children8111074
National Cancer Institute. Adolescents and young adults with cancer [Internet]. 2024 [cited 2024 Dec 5]. Available from: https://www.cancer.gov/types/aya
Levin NJ, Zebrack B, Cole SW. Psychosocial issues for adolescent and young adult cancer patients in a global context: A forward-looking approach. Pediatr Blood Cancer. 2019;66(8):e27789.
https://doi.org/10.1002/pbc.27789 DOI: https://doi.org/10.1002/pbc.27789
Cherven B, Sampson A, Bober SL, Bingen K, Frederick N, Freyer DR, et al. Sexual health among adolescent and young adult cancer survivors: a scoping review from the Children’s Oncology Group Adolescent and Young Adult Oncology Discipline Committee. CA Cancer J Clin. 2021;71(3):250–63.
https://doi.org/10.3322/caac.21655 DOI: https://doi.org/10.3322/caac.21655
Bowlby J. The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976. Br J Psychiatry. 1977;130:201–10.
https://doi.org/10.1192/bjp.130.3.201 DOI: https://doi.org/10.1192/bjp.130.3.201
Cassidy J, Shaver PR, editors. Handbook of attachment: Theory, research, and clinical applications. New York: The Guilford Press; 2016, 1068 p.
Heresi Milad E, Rivera Ottenberger D, Huepe Artigas D. Associations among attachment, sexuality, and marital satisfaction in adult Chilean couples: a linear hierarchical models analysis. J Sex Marital Ther. 2014;40(4):259–74. DOI: https://doi.org/10.1080/0092623X.2012.756840
https://doi.org/10.1080/0092623X.2012.751076 DOI: https://doi.org/10.1080/0092623X.2012.751076
Khoury CB, Findlay BM. What makes for good sex? The associations among attachment style, inhibited communication and sexual satisfaction. J Relatsh Res. 2014;5:e7.
https://doi.org/10.1017/jrr.2014.7 DOI: https://doi.org/10.1017/jrr.2014.7
Little KC, McNulty JK, Russell VM. Sex buffers intimates against the negative implications of attachment insecurity. Pers Soc Psychol Bull. 2010;36(4):484–98.
https://doi.org/10.1177/0146167209352494 DOI: https://doi.org/10.1177/0146167209352494
Ramos K, Leo K, Porter LS, Romano JM, Baucom BRW, Langer SL. Attachment in couples coping with cancer: Associations with observed communication and long-term health. Int J Environ Res Public Health. 2023;20(7):5249.
https://doi.org/10.3390/ijerph20075249 DOI: https://doi.org/10.3390/ijerph20075249
Lehmann V, Keim MC, Ferrante AC, Olshefski RS, Gerhardt CA. Psychosexual development and satisfaction with timing of developmental milestones among adult survivors of childhood cancer. Psychooncology. 2018;27(8):1944–9. DOI: https://doi.org/10.1002/pon.4746
https://doi.org/10.1002/pon.4728 DOI: https://doi.org/10.1002/pon.4728
do Rosário Ramos Nunes Bacalhau M, Pedras S, Da Graça Pereira Alves M. Attachment style and body image as mediators between marital adjustment and sexual satisfaction in women with cervical cancer. Support Care Cancer. 2020;28(12):5813–9.
https://doi.org/10.1007/s00520-020-05423-y DOI: https://doi.org/10.1007/s00520-020-05423-y
Bober SL, Varela VS. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol. 2012;30(30):3712–9.
https://doi.org/10.1200/JCO.2012.41.7915 DOI: https://doi.org/10.1200/JCO.2012.41.7915
Olsson M, Steineck G, Enskär K, Wilderäng U, Jarfelt M. Sexual function in adolescent and young adult cancer survivors – a population-based study. J Cancer Surviv. 2018;12(4):450–9.
https://doi.org/10.1007/s11764-018-0684-x DOI: https://doi.org/10.1007/s11764-018-0684-x
Kiecolt-Glaser JK. Marriage, divorce, and the immune system. Am Psychol. 2018;73(9):1098–108.
https://doi.org/10.1037/amp0000388 DOI: https://doi.org/10.1037/amp0000388
Warner EL, Nam GE, Zhang Y, McFadden M, Wright J, Spraker-Perlman H, et al. Health behaviors, quality of life, and psychosocial health among survivors of adolescent and young adult cancers. J Cancer Surviv. 2016;10(2):280–90. DOI: https://doi.org/10.1007/s11764-015-0474-7
https://doi.org/10.1007/s11764-015-0484-5 DOI: https://doi.org/10.1007/s11764-015-0484-5
Obertson EG, Sansom-Daly UM, Wakefield CE, Ellis SJ, McGill BC, Doolan EL, et al. Sexual and romantic relationships: Experiences of adolescent and young adult cancer survivors. J Adolesc Young Adult Oncol. 2016;5(3):286–91.
https://doi.org/10.1089/jayao.2015.0061 DOI: https://doi.org/10.1089/jayao.2015.0061
Stinson JN, Jibb LA, Greenberg M, Barrera M, Luca S, White ME, et al. A qualitative study of the impact of cancer on romantic relationships, sexual relationships, and fertility: perspectives of Canadian adolescents and parents during and after treatment. J Adolesc Young Adult Oncol. 2015;4(2):84–90.
https://doi.org/10.1089/jayao.2014.0036 DOI: https://doi.org/10.1089/jayao.2014.0036
Leuteritz K, Friedrich M, Nowe E, Sender A, Stöbel-Richter Y, Geue K. Life situation and psychosocial care of adolescent and young adult (AYA) cancer patients – study protocol of a 12-month prospective longitudinal study. BMC Cancer. 2017;17(1):82.
https://doi.org/10.1186/s12885-017-3077-z DOI: https://doi.org/10.1186/s12885-017-3077-z
Geue K, Mehnert-Theuerkauf A, Stroske I, Brock H, Friedrich M, Leuteritz K. Psychosocial Long-term effects of young adult cancer survivors: Study protocol of the longitudinal AYA-LE long-term effects study. Front Psychol. 2021;12:688142.
https://doi.org/10.3389/fpsyg.2021.688142 DOI: https://doi.org/10.3389/fpsyg.2021.688142
Leuteritz K, Friedrich M, Nowe E, Sender A, Taubenheim S, Stoebel-Richter Y, et al. Recruiting young adult cancer patients: Experiences and sample characteristics from a 12-month longitudinal study. Eur J Oncol Nurs. 2018;36:26–31. DOI: https://doi.org/10.1016/j.ejon.2018.05.001
https://doi.org/10.1016/j.ejon.2018.07.003 DOI: https://doi.org/10.1016/j.ejon.2018.07.003
Henrich G, Herschbach P. Questions on life satisfaction (FLZM) – a short questionnaire for assessing subjective quality of life. Eur J Psychol Assess. 2000;16(3):150–9.
https://doi.org/10.1027//1015-5759.16.3.150 DOI: https://doi.org/10.1027//1015-5759.16.3.150
Schumacher J, Laubach W, Brähler E. Wie zufrieden sind wir mit unserem Leben? Soziodemographische und psychologische Prädiktoren der allgemeinen und bereichsspezifischen Lebenszufriedenheit. Zeitschrift für Medizinische Psychologie. 1995;4:17–26.
Hahlweg K. Konstruktion und Validierung des Partnerschaftsfragebogens PFB. Z Klin Psychol. 1979;8:17–40.
https://doi.org/10.1027//0044-3409.08.1.17
Ehrenthal JC, Zimmermann J, Brenk-Franz K, Dinger U, Schauenburg H, Brähler E, et al. Evaluation of a short version of the experiences in close relationships-revised questionnaire (ECR-RD8): results from a representative German sample. BMC Psychol. 2021;9(1):140.
https://doi.org/10.1186/s40359-021-00637-z DOI: https://doi.org/10.1186/s40359-021-00637-z
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82. DOI: https://doi.org/10.1037//0022-3514.51.6.1173
https://doi.org/10.1037/0022-3514.51.6.1173 DOI: https://doi.org/10.1037/0022-3514.51.6.1173
IBM Corp. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp; 2019
Hayes AF. The PROCESS macro for SPSS, version 4.2. [Internet]. 2022. Available from: https://www.processmacro.org.
Hinz A, Stöbel-Richter Y, Brähler E. Der Partnerschaftsfragebogen (PFB): Normierung und soziodemographische Einflussgrößen auf die Partnerschaftsqualität [The “Partnerschaftsfragebogen” (marital quality questionnaire): Psychometric norms and sociodemographic influences on partnership quality]. Diagnostica. 2001;47(3):132–41.
https://doi.org/10.1026//0012-1924.47.3.132 DOI: https://doi.org/10.1026//0012-1924.47.3.132
Kay JS, Juth V, Silver RC, Sender LS. Support and conflict in relationships and psychological health in adolescents and young adults with cancer. J Health Psychol. 2019;24(4):502–17.
https://doi.org/10.1177/1359105316676629 DOI: https://doi.org/10.1177/1359105316676629
Graugaard C, Sperling CD, Hølge-Hazelton B, Boisen KA, Petersen GS. Sexual and romantic challenges among young Danes diagnosed with cancer: results from a cross-sectional nationwide questionnaire study. Psychooncology. 2018;27(6):1608–14. DOI: https://doi.org/10.1002/pon.4700
https://doi.org/10.1002/pon.4686 DOI: https://doi.org/10.1002/pon.4686
Acquati C, Miller-Sonet E, Zhang A, Ionescu E. Social wellbeing in cancer survivorship: A cross-sectional analysis of self-reported relationship closeness and ambivalence from a community sample. Curr Oncol. 2023;30(2):1720–32. DOI: https://doi.org/10.3390/curroncol30020133
https://doi.org/10.3390/curroncol30020132 DOI: https://doi.org/10.3390/curroncol30020132
Janssen SHM, van der Graaf WTA, van der Meer DJ, Manten-Horst E, Husson O. Adolescent and young adult (AYA) cancer survivorship practices: An overview. Cancers (Basel). 2021;13(19):4856. DOI: https://doi.org/10.3390/cancers13194847
https://doi.org/10.3390/cancers13194856 DOI: https://doi.org/10.3390/cancers13194856
Borstelmann NA, Rosenberg SM, Ruddy KJ, Tamimi RM, Gelber S, Schapira L, et al. Partner support and anxiety in young women with breast cancer. Psychooncology. 2015;24(12):1679–85. DOI: https://doi.org/10.1002/pon.3780
https://doi.org/10.1002/pon.3773 DOI: https://doi.org/10.1002/pon.3773
Carpentier MY, Fortenberry JD, Ott MA, Brames MJ, Einhorn LH. Perceptions of masculinity and self-image in adolescent and young adult testicular cancer survivors: implications for romantic and sexual relationships. Psychooncology. 2011;20(7):738–45. DOI: https://doi.org/10.1002/pon.1772
https://doi.org/10.1002/pon.1780 DOI: https://doi.org/10.1002/pon.1780
Lewis PE, Sheng M, Rhodes MM, Jackson KE, Schover LR. Psychosocial concerns of young African American breast cancer survivors. J Psychosoc Oncol. 2012;30(2):168–84. DOI: https://doi.org/10.1080/07347332.2011.651259
https://doi.org/10.1080/07347332.2011.651261 DOI: https://doi.org/10.1080/07347332.2011.651261
Robinson L, Miedema B, Easley J. Young adult cancer survivors and the challenges of intimacy. J Psychosoc Oncol. 2014;32(4):447–62.
https://doi.org/10.1080/07347332.2014.917138 DOI: https://doi.org/10.1080/07347332.2014.917138
Thompson AL, Long KA, Marsland AL. Impact of childhood cancer on emerging adult survivors’ romantic relationships: a qualitative account. J Sex Med. 2013;10(Suppl 1):65–73. DOI: https://doi.org/10.1111/j.1743-6109.2012.02950.x
https://doi.org/10.1111/jsm.12058 DOI: https://doi.org/10.1111/jsm.12058
Nahata L, Morgan TL, Lipak KG, Olshefski RS, Gerhardt CA, Lehmann V. Romantic relationships and physical intimacy among survivors of childhood cancer. J Adolesc Young Adult Oncol. 2020;9(3):359–66.
https://doi.org/10.1089/jayao.2019.0114 DOI: https://doi.org/10.1089/jayao.2019.0114
Ehrenthal JC, Dinger U, Lamla A, Funken B, Schauenburg H. Evaluation der deutschsprachigen Version des Bindungsfragebogens “Experiences in Close Relationships--Revised” (ECR-RD). Psychother Psychosom Med Psychol. 2009;59(6):215–23. DOI: https://doi.org/10.1055/s-2008-1067425
https://doi.org/10.1055/s-0028-1103294 DOI: https://doi.org/10.1055/s-0028-1103294
Link C, Qi S, Thompson S, DeIure A, McKillop S, Watson L. Understanding the symptoms and concerns of adolescents and young adults with cancer in Alberta: A comparative cohort study using patient-reported outcomes. J Adolesc Young Adult Oncol. 2023;12(2):199–206. DOI: https://doi.org/10.1089/jayao.2021.0213
https://doi.org/10.1089/jayao.2022.0079 DOI: https://doi.org/10.1089/jayao.2022.0079
Józefacka NM, Szpakiewicz E, Lech D, Guzowski K, Kania G. What matters in a relationship-age, sexual satisfaction, relationship length, and interpersonal closeness as predictors of relationship satisfaction in young adults. Int J Environ Res Public Health. 2023;20(5):4213. DOI: https://doi.org/10.3390/ijerph20054103
https://doi.org/10.3390/ijerph20054213 DOI: https://doi.org/10.3390/ijerph20054213
Stefanou C, McCabe MP. Adult attachment and sexual functioning: a review of past research. J Sex Med. 2012;9(10):2499–507.
https://doi.org/10.1111/j.1743-6109.2012.02843.x DOI: https://doi.org/10.1111/j.1743-6109.2012.02843.x
Barnett M, McDonnell G, DeRosa A, Schuler T, Philip E, Peterson L, et al. Psychosocial outcomes and interventions among cancer survivors diagnosed during adolescence and young adulthood (AYA): a systematic review. J Cancer Surviv. 2016;10(5):814–31.
https://doi.org/10.1007/s11764-016-0527-6 DOI: https://doi.org/10.1007/s11764-016-0527-6
George C, Main M, Kaplan N. Adult Attachment Interview (AAI) [database record]. APA PsycTests. 1985. Available from: https://doi.org/10.1037/t02879-000. DOI: https://doi.org/10.1037/t02879-000
Mikulincer M, Shaver PR. Attachment in adulthood: structure, dynamics, and change. 2018th ed. New York: The Guilford Press; 2018.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Svenja Heyne, Hannah Brock, Diana Richter, Annekathrin Sender, Jenny Rosendahl, Michael Friedrich, Kristina Geue, Anja Mehnert-Theuerkauf
This work is licensed under a Creative Commons Attribution 4.0 International License.
