Sexual health is not part of the discussion for women undergoing brachytherapy

SAN ANTONIO — Despite the fact that both men and women who receive brachytherapy for prostate cancer or cervical cancer can experience some degree of sexual dysfunction, doctors are much less likely to engage in discussions about sexual health with women than with men, according to the research presented here.

A single-centre study found a striking difference in how often sexual health was discussed with men and women at their initial consultation – 89% of men compared to only 13% of women (P<0.001), reported Jamie Takayesu, MD, of the Rogel Cancer Center at the University of Michigan in Ann Arbor.

In addition, none of the women who had cervical cancer rated their sexual health with a patient-reported (PRO) instrument, compared with 81% of men with prostate cancer.

“And this was despite the fact that the women were, on average, almost 20 years younger than their men,” Takayesu noted during a press briefing at the American Society of Radiation Oncology (ASTRO) annual meeting.

The impetus for this work, Takayesu said, was a previous study at her institution that showed 63 percent of women felt they should be asked about their sexual health on a routine basis.

“In my own clinical experience, I felt we weren’t really meeting their needs,” she said. “I had a lot of conversations with men about their erectile function, and I really didn’t have the same conversation with women.”

The current study, a retrospective review of patients treated with brachytherapy at the University of Michigan Rogel Cancer Center, included 126 women with cervical cancer and 75 men with prostate cancer. Takayesu pointed out that brachytherapy is used frequently for both types of cancer and that up to 90% of women will experience some degree of sexual dysfunction (most commonly vaginal tissue changes and dryness that can cause pain and discomfort), while about 50 % of men will experience sexual dysfunction after treatment.

In addition to determining how many men and women engage in sexual health discussions with clinicians, Takayesu and her colleagues also examined how often sexual health is assessed in clinical trials across the country by analyzing studies in the NIH Clinical Trials Database.

The study showed that of the 78 studies that included brachytherapy for prostate cancer and 53 for cervical cancer, prostate cancer studies were significantly more likely to include sexual function as a primary or secondary endpoint (17% vs. 6% , P=0.04) and more likely to include overall quality of life as an endpoint (37% vs. 11%, P=0.01).

Why are women less likely to be asked about their sexual health? “There are, of course, many confounding factors,” Takayesu said. “Prostate cancer patients generally tend to live longer … and have many more types of treatments available to them.” So sexual function really becomes a way for them to determine which treatment is best for them. But I do think there are a lot of steps to be taken to improve the way we approach women’s sexual health.”

She noted, for example, that standardized PROs are being implemented at her institution in the radiation oncology clinic, and that educational efforts are being made both in radiation oncology and gynecology, as well as in other specialties, “to try to manage the sexual dysfunction that these women are experiencing experience.”

“It’s also important to address some of the implicit biases and social constructs that influence doctors’ — or providers’ — discussions about women’s sexual health,” Takayesu said, adding that once women’s sexual health becomes a more important part of In the discussion, radiation oncologists can address how treatment can be modified to reduce sexual toxicity, and what kind of therapies can be added to address sexual dysfunction in women.

Commenting on the study, the chair of ASTRO’s Council on Equity, Diversity and Inclusion in Healthcare, Dr. Iris S. Gibbs of Stanford Medicine in California, said that an important aspect of care “is really how we look at patients through that lens that they’re dealing with.” we’re getting closer to their total.”

“And they need bias mitigation,” Gibbs added. “Dr. Takayesu’s study turns this perspective back on us as providers to be more inclusive and recognize the potential for sexual morbidity from our treatment—for all genders.”

  • Mike Bassett is a staff writer focused on oncology and hematology. He is based in Massachusetts.

Disclosures

Takayesu has no disclosures.

Gibbs has no disclosures.

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