Women less likely than men to be asked about sexual health after cancer treatment
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Most cancer survivors reported experiencing some degree of sexual dysfunction after treatment, yet women were less likely than men to report being asked about sexual health by their health care provider, according to study results.
“As cancer therapy improves, the number of survivors living with treatment-related side effects is increasing,” James Taylor, MD, MPH, chief resident in the department of radiation oncology at Sidney Kimmel Cancer Center of Thomas Jefferson University, said during a press conference at the virtual ASTRO Annual Meeting. “We know that cancer treatment can negatively impact cancer survivors’ sexual health, but questions remain, including how common is sexual toxicity among cancer survivors, how do physicians ask survivors about sexual side effects, and how do physicians manage and treat sexual side effects when they are identified in clinic?”
To gain a better understanding of how sexual dysfunction affects cancer survivors, Taylor and colleagues developed a survey about experiences with sexual adverse effects after cancer treatment and distributed it to 405 adults via social media and in clinic.
“It is important to note that most respondents were recruited from social media, which means they represent patients treated at multiple clinics across different areas of the U.S. where practice patterns may differ,” Taylor said.
Of the 391 respondents (81% women; 30% aged 41 to 50 years) who met inclusion criteria, 67% were breast cancer survivors, 16% were prostate cancer survivors and 6% were endometrial cancer survivors. Most were treated with chemotherapy (78%), followed by radiation therapy (54%) and hormone therapy (47%).
Results showed 87% of respondents reported some type of sexual dysfunction and reduced quality of life after treatment, including loss of sexual interest (80%), challenges with arousal (75%), painful intercourse (70%) and difficulty achieving orgasm (57%).
“Unfortunately, fewer than half of respondents [44%] reported that they were preemptively warned that their sexual health could be affected by treatment,” Taylor said.
Moreover, women were less likely than men to have sexual dysfunction addressed by their health care provider (22% vs. 53%; P < .001) and less likely to receive a formal assessment tool on sexual health (5% vs. 32%; P = .001).
More than half (51%) of respondents reported being comfortable with their physician initiating the discussion about sexual health, guided by a standard questionnaire on potential adverse events.
“Our survey showed that sexual toxicity is exceedingly common, a gender disparity exists in the evaluation of sexual dysfunction among cancer survivors, and most cancer survivors would like for their physician to provide a standard questionnaire to initiate or guide the discussion on sexual health,” Taylor said. “This is all very important. The metrics in questionnaires already exist, so this gives us an actionable intervention that we can distribute in clinic to help mitigate some of these disparities.”
Perspective
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Deborah C. Marshall, MD, MAS
This abstract reveals a significant gender disparity in how patients are educated about sexual side effects of cancer treatment, how often such side effects are discussed with providers and in what manner they are discussed. The findings are consistent with the well-known disparity in evidence-based treatments for men with cancer relative to women. Yet, the abstract points to an easily disseminated, concrete step toward reducing this disparity: asking all female patients, as part of standard practice, to complete a standardized patient-reported outcomes measure (for example, the PROMIS SexFS or EORTC SHQ-22) and then discussing the results during appointments.
Although this is an initial study, and more work needs to be done to understand why the conversations are so rare, the results have the potential to improve patient-centered care and, more importantly, to make discussion of sexual side effects with female cancer survivors as routine and mainstream as discussion of other well-known side effects like insomnia, musculoskeletal pain and neuropathy.
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Geraldine M. Jacobson, MD, MPH, MBA, FACR, FASTRO
This study addresses the self-reported impact of cancer treatments on sexual function among cancer survivors, via a survey available on social media and in clinic using an iPad. Although this survey represents a limited sample of patients, there was asymmetry between female survivors’ experiences and concerns regarding sexual toxicity and the initiation of this topic by their providers.
The impact of cancer treatment on desire, sexual function and body image has been well-documented. But, as this report demonstrates, there has not been a systematic approach to providing this information to patients prior to treatment or addressing post-treatment sexual toxicity. The researchers recommended the use of a validated sexual health questionnaire for both male and female cancer survivors to facilitate discussions with providers to address these quality-of-life issues.
As medical outcomes for cancer improve, there is an increasing population of survivors who aspire to optimal quality of life after treatment. As physicians and health care providers, we have an opportunity to address the unmet need of minimizing the impact of cancer treatment on sexual health for both women and men.
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Taylor J, et al. Abstract 1042. Presented at: American Society for Radiation Oncology Annual Meeting (virtual); Oct. 25-28, 2020.
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