Sexual dysfunction is prevalent among cancer survivors—and rarely addressed—according to data presented during the 2020 American Society for Radiation Oncology (ASTRO) Annual Meeting.1 A survey of cancer survivors has found that nearly 9 out of 10 respondents reported some change after cancer treatment that negatively impacted their sexual health.
Despite the high frequency of sexual toxicity, however, few survivors were warned about this potential side effect, and even fewer were formally asked about their sexual health after treatment. What’s more, results showed that women who survive cancer may be significantly less likely than men to have their sexual side effects addressed by their provider. Based on these findings, authors of the study recommended that oncology practices integrate questionnaires that assess sexual health into survivorship care for all patients.
“The negative effects on sexual health after cancer treatment are unfortunately very tough, and this is not just for patients treated with radiation,” said lead study author, James M. Taylor, MD, MPH, Chief Resident in the Department of Radiation Oncology at Sidney Kimmel Medical College and Cancer Center at Thomas Jefferson University, Philadelphia. “This includes chemotherapy, hormonal therapy, surgery, and other treatment modalities.”
“Standardized questionnaires [about sexual health] seem to be the preferred way for providers to initiate these very sensitive conversations.”— James M. Taylor, MD, MPH
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“We also demonstrated that standardized questionnaires [about sexual health] seem to be the preferred way for providers to initiate these very sensitive conversations,” he added.
As Dr. Taylor explained, the number of survivors living with treatment-related side effects is increasing as cancer therapy improves. Although cancer treatment can negatively impact survivors’ sexual health, he said, questions remain about the prevalence of sexual toxicity as well as how effectively this side effect is identified and managed by physicians.
Study Design and Patient Population
To better answer these questions, Dr. Taylor and colleagues administered a 25-item survey to cancer survivors to determine the impact of cancer treatment on their sexual function. Designed by a multidisciplinary group of oncologists, the survey evaluated the following items: sexual health and function; the method by which sexual dysfunction was evaluated; and the interventions imparted to patients by their provider. Dr. Taylor and colleagues administered the survey electronically in their clinic and on social media platforms (Facebook and Twitter).
The majority of survivors responded via social media, said Dr. Taylor, who reported that a total of 405 adults completed the anonymous survey. More than 75% of respondents had completed treatment within 5 years, and approximately 80% of respondents were female. The majority of patients were between the ages of 40 and 60.
The two most common cancer diagnoses were breast cancer followed by prostate cancer. The majority of patients received more than one type of therapy, with 78% of patients receiving chemotherapy, 54% receiving radiation therapy, and 48% receiving hormonal therapy.
Sexual Toxicity and Gender Disparity
According to Dr. Taylor, sexual toxicity was “exceedingly common,” with 87% of respondents stating cancer treatment had negatively impacted their sexual health.
Results showed that 70% of cancer survivors reported pain during intercourse, and 57% reported difficulty achieving orgasm. Other common sexual toxicities included erectile dysfunction (77% of men) and vaginal dryness (66% of women). Distortion of body image causing intimacy issues and infertility was reported in 54% and 11% of patients, respectively.
Despite the prevalence of these toxicities, however, only 44% of respondents were preemptively told their sexual health could be affected by treatment. Furthermore, just 28% of respondents had been formally asked about their sexual health by a provider.
Dr. Taylor also noted a gender disparity in responses. Although 53% of male respondents were asked about their sexual health after cancer treatment, just 22% of female respondents had a similar discussion with their provider. This stands in stark contrast to the 86% of respondents who said it was important or essential that oncologists speak to their patients about sexual health and dysfunction and the 51% who stated they would like a questionnaire to initiate a discussion on sexual toxicity.
“We know metrics and questionnaires already exist, so this gives us an actionable intervention we can distribute in the clinic to help mitigate some of these disparities,” Dr. Taylor concluded. “We recommend that oncology practices make questionnaires assessing sexual health mandatory for all patients.”
DISCLOSURE: Dr. Taylor reported no conflicts of interest.
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? 2020 ASTRO Annual Meeting. Abstract 1042.
Karen M. Winkfield, MD, PhD
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