Sexual health assessment far less common for women vs. men undergoing cancer brachytherapy
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Assessment of sexual function occurred far less often among women undergoing brachytherapy for cervical cancer than men who received the internal radiotherapy for prostate cancer, according to results of a retrospective analysis.
The findings, presented at American Society for Radiation Oncology Annual Meeting, showed stark differences in the percentages of women vs. men asked about sexual function both at the time of consult and on brachytherapy clinical trials.
“There seems to be a big disparity in the way we approach sexual dysfunction with our patients, where female patients are asked about sexual issues much less often than male patients are,” Jamie Takayesu, MD, radiation oncology resident physician at University of Michigan Rogel Cancer Center and lead author of the study, said in a press release. “Equally importantly, we see this trend on a national level in clinical trials.”
Background
Prostate and cervical cancer generally respond well to radiation and other therapies, and because patients typically survive for many years after treatment, sexual adverse events are an important consideration, Takayesu said in the press release. Brachytherapy, a key component of treatment for these cancers, carries a high risk for long-term sexual dysfunction, with rates as high as 90% among women and 50% among men, according to the abstract.
Takayesu and colleagues hypothesized that a disparity existed in clinician assessment of sexual health between women vs. men receiving brachytherapy for genitourinary cancers. They further hypothesized that this disparity would be evident among patients enrolled on clinical trials.
The retrospective analysis included 126 women (median age, 51 years) with cervical cancer and 75 men (median age, 69 years) with prostate cancer evaluated for brachytherapy at an academic institution between 2010 and 2021. Researchers checked consult notes to determine whether patients had been asked about sexual function at baseline with or without assessment using a patient-reported outcomes tool. They also assessed how frequently sexual health assessment occurred in clinical trials of prostate cancer brachytherapy (n = 78) and cervical cancer brachytherapy (n = 53) listed in the NIH’s clinicaltrials.gov database.
Key findings
Results showed 89% of men with prostate cancer had been asked about sexual function at consult compared with only 13% of women with cervical cancer (P < .001). None of the women underwent sexual health assessment with a patient-reported outcomes tool; however, 81% of the men did (P < .001).
Sexual function served as a primary or secondary endpoint in nearly three times as many prostate cancer trials compared with cervical cancer trials (17% vs. 6%, P = .04). Prostate cancer trials also included overall quality of life as an endpoint significantly more often than cervical cancer trials (37% vs. 11%, P = .01).
Implications
Many factors likely contribute to the disparity in assessment of sexual function, such as the variability in treatment options for prostate cancer compared with cervical cancer, according to Takayesu. The lack of FDA-approved treatments to address sexual dysfunction among women — compared with the plethora of pills, implants and other options available to men — also may be a barrier to discussing the topic.
“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,” she said in the press release.
Modifications during treatment planning, such as to the placement of brachytherapy sources or to radiation doses, could preserve women’s sexual function, Takayesu said. For women who experience sexual dysfunction, pelvic floor therapy is one intervention that may provide relief, she added.
Physicians must become comfortable initiating these discussions with women, according to Takayesu.
“Culturally, there are differences in how we talk about sexual dysfunction that affects men vs. women,” she said in the press release. “We see ads on television about erectile dysfunction, for example, but there’s no equivalent to these for women.”
References:
- Sexual side effects of cancer treatment often unaddressed with female patients (press release). Available at: astro.org/annualmeetingpress. Published Oct. 21, 2022. Accessed Oct. 21, 2022.
- Takayesu J, et al. Abstract 2306. Presented at: American Society for Radiation Oncology Annual Meeting; Oct. 23-26, 2022; San Antonio.
Perspective
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David J. Byun, MD
This is an eye-opening study for radiation oncologists. Although a small retrospective study, the stark disparity in sexual health assessment between men and women is indeed illuminating.
We must contextualize the authors’ findings on how well many patients do in terms of disease control after treatment. The potential long-term quality-of-life side effects, including their impact on sexual health, must be adequately discussed during consultation, so patients are fully informed.
We also must be cognizant of such disparities’ impact on our patients in the LGBTQ+ community.
Simply put, clinicians should never make assumptions about what is essential for our patients based on their gender, socioeconomic background and beyond.
Educate and communicate. Ask your patients what is important to them so you can best serve them.
Perspective
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Krisha J. Howell, MD
The authors successfully quantify a not-surprising deficit in assessing initial sexual function prior to radiation treatment for women with cervical cancer. They demonstrated this both among trial and nontrial patients relative to similar practices for men with prostate cancer.
Years of robust prostate cancer data reinforce collection of pretreatment and patient-reported outcomes of patients during and after therapies. Over time, this information has transformed into actionable treatment modifications for cancer care and management of adverse events. Similar, broad treatment options do not necessarily exist or are not as apparently integrated into management for our female patients. However, to expand similar knowledge and treatment options for female patients, initial steps include the recognition of this deficit and the expansion of data collection.
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Takayesu J, et al. Abstract 2306. Presented at: American Society for Radiation Oncology Annual Meeting; Oct. 23-26, 2022; San Antonio.
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