Sexual health after cancer treatment

December 4, 2020
Bob Kronemyer

Freelance writer for Contemporary OB/GYN

The vast majority of cancer survivors reported that they experience sexual side effects after chemotherapy, radiation and other cancer treatments according to the results of a survey presented at the annual meeting of the American Society for Radiation Oncology.

Furthermore, most of the respondents noted that their oncologist had not formally asked them about such side effects.

“A patient and the sexual side effects she was experiencing inspired the development of the study,” said lead author James Taylor, MD, MPH, chief resident in radiation oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia.

Survivorship care is a growing focus in oncology, due to improved outcomes and patients living longer after treatment. “Side effects that impact sexual function or desire are closely associated with quality of life, ranging from erectile dysfunction from prostate cancer treatment to vaginal dryness seen with endocrine therapy for breast cancer,” Taylor told Contemporary OB/GYN.

The 2019 survey was conducted mostly online, through social media platforms Twitter and Facebook, representing patients treated at multiple clinics throughout the United States.

Of the 391 respondents eligible for analysis, 81% were female, and the three most common cancers were breast (67%), prostate (16%) and endometrial (6%).

Treatments included chemotherapy (78%), radiation therapy (54%) and hormone therapy (47%).

Overall, 87% of respondents reported some change after treatment that negatively impacted their sexual health and quality of life. The three most common sexual side effects were painful intercourse (73%), body image distortion (54%) and inability to achieve orgasm (42%).

In addition, fewer than half of respondents (47%) said they were counseled before treatment that their sexual health might be compromised by therapy.

Male cancer survivors were more than twice as likely than female cancer survivors to be asked and counseled about potential treatment sexual toxicity: 53% vs. 22% (P < 0.001).

Significantly more male patients also said they received a formal assessment tool like a survey: 32% vs. 5% of women patients (P = 0.001).

“I was surprised by how common sexual toxicity is among survivors,” Taylor said. “I was also surprised by the gender disparity that we identified.”

A majority of respondents (51%) said they would be more comfortable if a discussion about sexual health was initiated by their provider and guided by a standard questionnaire on possible side effects.

“Patients seem to prefer completing a survey or questions about their sexual health in the clinic, then reviewing the information with their provider, rather than the physician directly asking the patient or the patient driving the discussion,” Taylor said.

A questionnaire given to all patients can reduce patient uneasiness and help bridge the discussion between patient and provider, according to Taylor.

“We need to incorporate counseling on sexual toxicity and side effects of cancer treatment into our clinics,” he said. “There are validated instruments that exist to help identify sexual toxicity in patients and we need to ensure they are being used.”

Taylor believes clinicians have the ability to solve the problem of sexual toxicity and help educate and inform patients on the sexual side effects of treatment.

Taylor and his colleagues are planning a follow-up study of providers and developing a quality improvement project to implement clinically.

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Disclosures

Taylor reports no relevant financial disclosures.