Sexual Dysfunction Not Well Addressed in Female Cancer Survivors

A study presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting identified sexual dysfunction as a treatment side effect experienced by the majority of cancer survivors that is not currently well addressed.¹

Further, female survivors were significantly less likely to have their sexual dysfunction addressed. Researchers suggested that these collective findings demonstrate the utility of using validated sexual health questionnaires for both male and female cancer survivors to improve physician engagement and facilitate open discussion between patients and providers to improve the quality of life of cancer survivors.

“Sexual dysfunction is an unfortunately common side effect of cancer treatment, and there appears to be a large gender disparity in how physicians discuss sexual health with their patients,” lead author James Taylor, MD, MPH, chief resident in radiation oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, said in a press release.² "Our results show that we are asking men about sexual dysfunction caused by cancer treatment, but we are not asking women as frequently. We should be asking everyone, to determine how we can help."

An IRB-approved questionnaire developed with input from radiation oncologists, medical oncologists, and surgeons was administered from 2017 to 2019 on social media and in clinic using an iPad. The survey was compromised of more than 25 questions and was directed specifically to cancer survivors. However, patients with missing data were excluded from the study analysis.

In total, 405 cancer survivors responded to the survey and 391 (96.5%) were included in the analysis. The majority of respondents were female (n = 313; 81.0%), between the ages of 41 and 50 years old (n = 115; 30.0%), and typically had cancer types such as breast (66.8%) or pelvic tumors including prostate (16.3%), endometrial (6.1%), bladder (3.8%), and rectal (1.8%) cancer. In total, 47.4% of patients received anti-hormone therapy, 78.1% received chemotherapy, and 54.2% received radiation therapy.

Overall, 44% of respondents reported they were preemptively told that sexual health could be affected. Moreover, the majority (n = 337; 87%) of respondents indicated that cancer treatment impacted their sexual function or desire, with 53.8% reporting body image distortion, 73.4% with dyspareunia, and 42.3% unable to achieve orgasm.

Only 27.9% of respondents stated they had been formally asked about their sexual health from a provider. Additionally, male patients were significantly more likely to have been asked than female patients (53% vs. 22%, P < .001). Specifically, standardized sexual health questionnaires were administered to 31.5% of male cancer survivors and only 5.4% of female cancer survivors (P = .001), though 51% of all patients reported that they would be most comfortable with the conversation about sexual health to be initiated by their provider after being given a questionnaire to stimulate that conversation.

"Patients seem to prefer completing a survey or questions about their sexual health in clinic and then reviewing this information with their provider, rather than the physician directly asking the patient or the patient driving the discussion," Taylor explained. "A questionnaire administered to all patients can reduce uncomfortable feelings and make bridging the discussion much easier. We know that validated instruments exist, and it is time to put them into practice."

Of note, response bias may have influenced the high rates of sexual side effects observed in this study. Moving forward, the investigators intend to collect additional responses to validate their findings and include a wider variety of cancer types, combining their results with a companion survey of oncologists that asks similar questions on sexual health discussions from the provider perspective. The researchers also plan to conduct pilot studies that implement existing questionnaires in the clinic to determine where additional tools are needed.

References:

1. Taylor J, Ruggiero M, Maity A, et al. Sexual Health Toxicity in Cancer Survivors: Is There a Gender Disparity in Physician Evaluation and Intervention? Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting. Abstract #: 1042.

2. Sexual health often overlooked in cancer survivorship care, especially for female patients [news release]. Arlington, Virginia. Published October 27, 2020. Accessed November 2, 2020. https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2020/Sexual-health-often-overlooked-in-cancer-survivors