Sexual function among cancer patients

Sexual function is a major element of quality of life for cancer patients, but cancer treatment can disrupt androgen production and impact sexual health. Presenting at the 2019 American Society for Reproductive Medicine Scientific Congress & Expo, researchers from the University of Pennsylvania explored circulating androgen levels before and after cancer therapy, as well as sexual function.

The prospective cohort study included women aged 15 to 39 with a cancer diagnosis and controls. Participants completed sexual health questionnaires and tests of serum androgens (free testosterone, dehydroepiandrosterone sulfate [DHEAS]) and ovarian reserve (follicle-stimulating hormone [FSH], anti-Müllerian hormone [AMH], antral follicle count [AFC]). Women with cancer were split into two groups: a) women with a new cancer diagnosis, assessed pretreatment and every 3 months post-treatment to examine short-term effects (N = 117) and b) cancer survivors ≥ 1 years from the end of therapy with no evidence of disease to examine long-term effects (N = 120). Similar-aged controls (N = 100) and late reproductive-aged controls (N=63) were used for comparisons through linear regression models adjusted for age and BMI.

The authors found that in adjusted models, women with a new cancer diagnosis (median age 27) had significantly lower testosterone and DHEAS levels than similar-aged controls. This was true even before the start of therapy (median testosterone 0.35 ng/mL vs 0.49 ng/mL, P < 0.01 DHEAS 0.79 µg/mL, P < 0.01). There was no difference in AMH levels pretreatment. Following cancer therapy, testosterone levels were further suppressed, and the authors recorded a median within-person decrease of 62% (P < 0.01) at 2 months and 39% (P < 0.01 at 6 months after treatment end. By 12 months after treatment, testosterone levels among cancer patients exhibited some recovery, at a rate of 6% per month (P < 0.01).

Reported sexual dysfunction before and after treatment was prevalent regardless of testosterone or DHEAS levels. Of the sexually active participants in the study, 41% reported decreased libido at their pretreatment visit and 42% reported 6 months post-treatment. In long-term survivors, women (median age 24) remote from therapy (median 8.2 years) had significantly lower testosterone and DHEAS levels compared to similar-aged controls (P = 0.01 and P < 0.01, respectively). However, these levels were higher than late-reproductive-aged controls (median age 47), (P = 0.02 for testosterone, P < 0.01 for DHEAS). Sexual dysfunction did not differ from controls (20% in survivors, 16% in similar-aged controls, 17% in late reproductive-aged controls, P = 0.83), and symptom prevalence was not associated with androgen levels.

The authors believe that even prior to chemotherapy, women with a new cancer diagnosis have  lower androgen levels than controls. This could be due to preexisting suppression of the hypothalamic pituitary ovarian axis. Following therapy, androgen levels drop even further, and while there is some recovery, long-term levels remain lower than in controls. More research focused on sexual function and quality of life in cancer survivors could be beneficial for counseling these women.