Sexual health assessment is much less common in women compared to men undergoing cancer brachytherapy

October 24, 2022

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Source/Disclosures

source:

Takayesu J, et al. Abstract 2306. Presented at: American Society of Radiation Oncology Annual Meeting; October 23-26, 2022

Disclosures: The researchers report no relevant financial disclosures.


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Evaluation of sexual function was performed much less often among women who underwent brachytherapy for cervical cancer than among men who received internal radiation therapy for prostate cancer, according to the results of a retrospective analysis.

The findings, presented at the annual meeting of the American Society of Radiation Oncology, show large differences in the percentages of women versus men asked about sexual function both during the consultation and in clinical trials of brachytherapy.

Proportion of brachytherapy recipients asked about sexual function at consultation
Data extracted from Takayesu J, et al. Abstract 2306. Presented at: American Society of Radiation Oncology Annual Meeting; October 23-26, 2022

“There seems to be a large disparity in how we approach sexual dysfunction with our patients, with women being asked about sexual problems much less often than men,” Jamie Takayesu, Ph.D., resident in radiation oncology at the University of Michigan Rogel Cancer Center and lead author of the study, said in a news release. “Just as importantly, we’re seeing this trend nationally in clinical trials.”

Jamie Takayesu

Jamie Takayesu

Background

Prostate cancer and cervical cancer generally respond well to radiation and other therapies, and because patients typically survive 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 of long-term sexual dysfunction, with rates as high as 90% among women and 50% among men, according to the summary.

Takayesu and colleagues hypothesized that there is a discrepancy in clinicians’ assessment of sexual health between women and men receiving brachytherapy for genitourinary cancer. They further hypothesized that this discrepancy would be evident among patients enrolled in clinical trials.

The retrospective analysis included 126 women (mean age, 51 years) with cervical cancer and 75 men (mean age, 69 years) with prostate cancer evaluated for brachytherapy at an academic institution between 2010 and 2021. Researchers examined consultation notes to determine whether patients had were asked about sexual function at baseline with or without assessment using a patient-reported outcome instrument. They also assessed how often sexual health was assessed in prostate cancer brachytherapy (n = 78) and cervical cancer brachytherapy (n = 53) clinical trials listed in the NIH database at Clinicaltrials.gov .

Key findings

The results showed that 89% of men with prostate cancer were asked about sexual function at consultation compared with only 13% of women with cervical cancer (P < 0.001). None of the women underwent a sexual health assessment with a patient-reported instrument; however, 81% of men did (P < 0.001).

Sexual function served as a primary or secondary endpoint in nearly three times as many prostate cancer trials as cervical cancer trials (17% vs. 6%, P = 0.04). Prostate cancer trials also included overall quality of life as an endpoint significantly more often than cervical cancer trials (37% vs 11%, P = 0.01).

Consequences

Many factors likely contribute to the discrepancy in sexual function assessment, such as the variability in treatment options for prostate cancer compared to cervical cancer, according to Takayesu. The lack of FDA-approved treatments to address sexual dysfunction among women — compared to the abundance of pills, implants and other options available to men — can also 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 placement of brachytherapy sources or radiation doses, could preserve women’s sexual function, Takayesu said. For women experiencing sexual dysfunction, pelvic floor therapy is one intervention that can provide relief, she added.

Doctors should feel comfortable starting these discussions with women, according to Takayesu.

“Culturally, there are differences in how we talk about sexual dysfunction that affects men versus women,” she said in the press release. “We see ads on TV for erectile dysfunction, for example, but there’s no equivalent for women.”

References:

  • Sexual side effects of cancer treatment are often not considered in female patients (press release). Available at: astro.org/annualmeetingpress. Published October 21, 2022. Accessed October 21, 2022.
  • Takayesu J, et al. Abstract 2306. Presented at: American Society of Radiation Oncology Annual Meeting; October 23-26, 2022

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