Many radiation oncologists tend to discuss the sexual side effects of radiation therapy, specifically brachytherapy, with men more often than with women, according to a two-part study reported at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting.¹ At a high-volume cancer center, 9 of 10 men undergoing brachytherapy for prostate cancer were asked about their sexual health, compared with 1 of 10 women having brachytherapy for cervical cancer.

The survey showed that sexual function was discussed with 89% of men and 13% of women at their initial radiation therapy consultation. Even more striking was the fact that 81% of men with prostate cancer had their sexual health assessed using a patient-reported outcome tool, compared with 0% of women.

This problem is more widespread than perhaps thought, according to the second part of the study. The authors conducted a retrospective analysis of clinical trials of brachytherapy for prostate or cervical cancer included in the National Institutes of Health (NIH) Clinical Trials Database. In this data set, sexual function was much more likely to be included as a primary or secondary endpoint in the prostate cancer trials, and the prostate cancer trials were much more likely to include overall quality of life as an endpoint than the cervical cancer trials.

“We found a big disparity in the way we approach sexual dysfunction with our patients, where female patients are asked about sexual issues much less often than male patients.”

— Jamie Takayesu, MD

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“A prior study at my institution showed that 63% of women thought they should be asked about sexual health. In my clinical experience, I felt we weren’t meeting that need, which was the impetus for the study,” explained lead author Jamie Takayesu, MD, a radiation oncology resident at the University of Michigan Rogel Cancer Center, Ann Arbor. “The first part of the study was a retrospective review at my institution about how many men and women undergoing brachytherapy as part of cancer treatment were being asked about sexual function at consultation. The second part was a review of National Institutes of Health trials to identify how many clinical trials of brachytherapy were studying sexual function and which genders were being studied.”

“We found a big disparity in the way we approach sexual dysfunction with our patients, where female patients are asked about sexual issues much less often than male patients. Equally important is that we see this trend on a national level in clinical trials,” she added.

Background

Each year, about 13,000 to 14,000 new cases of cervical cancer and more than 220,000 new cases of prostate cancer are diagnosed in the United States. Both diseases respond well to treatments, especially if detected early, and the 5-year survival is roughly 67% for cervical cancer and 96% for prostate cancer. Many of these patients are young, and, thus, the potential for long-term side effects, including on sexual function, are important to consider. Brachytherapy involves direct focus of radiation into the tumor, which may cause toxicity to the surrounding organs.

The sexual side effects of radiation for men are well known, with special attention given to impotence, gastrointestinal toxicity, and other genitourinary effects, and most prostate consultations involve a discussion of these potential problems. Dr. Takayesu noted that up to 90% of women with cervical cancer may experience a degree of sexual dysfunction after brachytherapy (most commonly vaginal dryness, leading to pain and discomfort and an inability to have vaginal penetration), and up to 50% of men will experience some erectile dysfunction.

Study Details

The single-center retrospective review included 126 women with cervical cancer and 75 men with prostate cancer who received brachytherapy as part of their treatment plan. The median ages of women and men in these two sets of trials were 51 and 69, respectively, almost a 20-year age gap with women being nearly 20 years younger.

The review of the NHI database included 78 prostate cancer trials and 53 cervical cancer trials. Prostate cancer trials were significantly more likely to include sexual dysfunction as a primary endpoint—17% vs 6% (P = .04)—and more likely to include overall quality of life as an endpoint—37% vs 11%, respectively (P = .01).

Cultural Factors

Some physicians may be less comfortable talking to women about sexuality than to men. Also, male sexuality is often discussed in advertisements, and there are medications and other options to treat erectile dysfunction, but no U.S. Food and Drug Administration–approved medications that help women.

“The only tools we commonly recommend for women are lubricants and dilators, but even these options are not great,” Dr. Takayesu said. “The lack of good treatment options is a barrier to bringing up these issues.”

Next Steps

According to Dr. Takayesu, the next steps at her institution include implementing standard patient-reported outcomes in the clinic along with physician education for oncology, gynecology, and other specialties “to try to address the sexual dysfunction that women are experiencing.”

“We also need to discover whether implicit biases and social constructs impact physicians’ and other health providers’ discussions of female sexual health. Once female sexual health is incorporated as part of the discussion, radiation oncologists can focus on how to reduce sexual toxicity and implement therapies that may help.” 

DISCLOSURE: Dr. Takayesu reported no conflicts of interest.

REFERENCE

1. Takayesu J, Kim H, Evans Jr JR, et al: Evaluation of disparity in physician assessment of sexual dysfunction in women vs. men receiving brachytherapy for genitourinary cancers. 2022 ASTRO Annual Meeting. Abstract 2306. Presented October 23, 2022.