Sexual side effects of cancer treatment are less often discussed among patients

Sexual side effects of cancer treatment are less often discussed among patients

A new study finds that sexual side effects of cancer treatment are far less likely to be discussed in female patients than in male patients, even when the treatment directly affects the sexual organs. Among patients receiving brachytherapy for prostate or cervical cancer at a busy cancer center, 9 in 10 men were asked about their sexual health, compared with 1 in 10 women. The study, which also found lower but similar disparities in clinical trials across the country, will be presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

The results suggest that doctors have the opportunity to better understand their patients' experiences with cancer treatment.

There seems to be a big difference in the way we deal with sexual dysfunction in our patients, with female patients being asked about sexual problems much less often than male patients. Equally important, we are seeing this trend nationally in clinical trials.”

Jamie Takayesu, MD, lead author and radiation oncology resident, University of Michigan Rogel Cancer Center in Ann Arbor, Michigan

Each year, approximately 13,000 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 radiation therapy and other treatments, and an estimated 96% of patients have prostate cancer and 67% of cervical cancer patients survive at least five years after their diagnosis.

Because these patients often face a long life expectancy after treatment, it is important to consider the possibility of long-term side effects, including sexual dysfunction, said Dr. Takayesu. During brachytherapy for prostate or cervical cancer, doctors introduce radioactive sources directly into the tumor, which can lead to poisoning of the organs in the genital area.

About half of women who undergo cervical brachytherapy experience sexual side effects, most commonly vaginal tissue changes and dryness, which can cause pain and discomfort. Between a quarter and half of men who receive prostate brachytherapy experience erectile dysfunction. Side effects may occur during, after or long after treatment.

The study design combined a retrospective analysis of institutional data with an analysis of national clinical trials. For the institutional analysis, researchers reviewed consultation notes in the records of 201 patients treated with brachytherapy for prostate cancer (n=75) or cervical cancer (n=136) between 2010 and 2021.

They found a significant difference between the number of male and female patients asked about sexual health at their initial consultation - 89% of men compared to 13% of women (p<0.001). None of the cervical cancer patients had sexual health assessed using a Patient Reported Outcomes (PRO) tool, compared to 81% of prostate cancer patients.

The research team also examined how often sexual health was assessed in clinical trials nationwide by analyzing trials in the National Institutes of Health Clinical Trials database (clinicaltrials.gov) that included brachytherapy for prostate (n=78) or cervical cancer (n=53 trials). Cancer.

Prostate cancer studies were significantly more likely to include sexual function as a primary or secondary endpoint compared to cervical cancer studies (17% vs. 6%, p = 0.04). They were also more likely to consider overall quality of life as an endpoint (37% vs. 11%, p = 0.01).

This disparity is likely due to several factors, said Dr. Takayesu, including some specific to the diseases under study. For prostate cancer, for example, patients often have multiple treatment options and sexual side effects are a common criterion when choosing between therapies. However, for cervical cancer, there is less variability in the treatment paradigm.

But the doctor's comfort in talking to female patients about sexual dysfunction cannot be ignored, she said. "Culturally, there are differences in the way we talk about sexual dysfunction that affects men and women. For example, on television we see commercials about erectile dysfunction, but there is no equivalent for women."

There are currently no FDA-approved medications specifically for female sexual dysfunction, although several options—medications, implants, and other treatments—are available for male impotence.

"The only tools we typically recommend to women are lubricants and dilators, but even these are not great options," said Dr. Takayesu. Several large studies have confirmed that existing treatments are often ineffective for women. "It's easy for us to prescribe different medications for our male patients, but for our female patients we don't have that first step. I think that creates a barrier to raising these issues," she said.

Until further research is conducted to find effective medical options for female sexual dysfunction, interventions such as pelvic floor therapy may provide patients with some relief, Dr. Takayesu. Survivorship programs and sex therapists can also help patients better understand possible long-term sexual side effects of cancer and treatment.

And specifically for brachytherapy, Dr. Takayesu said sexual function could be preserved through modifications during the treatment planning process, such as different placement of brachytherapy sources or different adjustments to their radiation doses.

Ultimately, the responsibility lies with doctors to ask patients about their sexual health more often, she said. “If we don’t know about problems, we can’t solve them.”

Source:

American Society for Radiation Oncology

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