Results from a new study found that radiation oncologists tend to discuss sexual side effects in women undergoing treatment for cervical cancer far less frequently than they discuss sexual side effects in men undergoing treatment for prostate cancer. These findings were presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting 2022 by the study's lead investigator Jamie Takayesu, MD, Radiation Oncology Resident, University of Michigan Rogel Cancer Center, Ann Arbor.
Cervical cancer and prostate cancer are often treated with brachytherapy, in which a sealed radiation source is implanted in the body. This treatment can negatively affect surrounding tissues in the genital area. Approximately 25% to 50% of men who receive prostate cancer brachytherapy will experience erectile dysfunction and approximately 50% of women who receive cervical brachytherapy will experience sexual side effects such as changes to vaginal tissue and dryness, which can cause pain during intercourse.
Dr Takayesu explained that she wanted to conduct this research because an earlier study found that approximately one-half of the women in her institution who were undergoing brachytherapy wanted to be asked about their sexual function and receive information about potential side effects.
“In my clinical experience, I felt we weren’t meeting that need, which was the impetus for the study,” she explained. “We found 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. Equally important is that we see this trend on a national level in clinical trials.”
The study combined a retrospective analysis of institutional data with an analysis of national clinical trials.
The single-center retrospective research included 136 women with cervical cancer and 75 men with prostate cancer who received brachytherapy as part of their treatment plan. Results showed that radiation oncologists discussed sexual function and side effects with 89% of men versus only 13% of women during initial consults. Following brachytherapy, 81% of men had their sexual health assessed by a patient-reported outcome (PRO) measure, whereas 0% of women had their sexual health assessed using this measure.
Dr Takayesu noted that these findings were particularly striking since the women were almost 2 decades younger than the men (median age, 51 and 69 years, respectively).
The analysis of clinical trials involving brachytherapy for prostate or cervical cancer was based on the National Institutes of Health Clinical Trials Database (https://clinicaltrials.gov). Results showed that prostate cancer trials were significantly more likely to include sexual dysfunction as a primary end point (17% vs 6%, respectively; P = .04) and were also more likely to include overall quality of life as an end point (37% vs 11%, respectively; P = .01).
Dr Takayesu said it is possible that male physicians are more comfortable talking about sexuality to other men than to women, although she did not account for sex of the radiologists in her study. She also noted that erectile dysfunction is frequently discussed in the media and there are medications and other options are available to treat this condition, whereas there are no FDA-approved medications for female sexual dysfunction.
“The only tools we commonly recommend for women [with sexual dysfunction] are lubricants and dilators, but even these are not great options,” she said. “I think the lack of good treatment options is another barrier to bringing up these issues.”
Dr Takayesu said that her institution is planning to include standardized PROs for patients being treated for all types of cancer “to try to address the sexual dysfunction that women are experiencing.”
Formal discussant Iris C. Gibbs, MD, FAAWR, FACR, FASTRO, Professor, Radiation Oncology, Stanford Cancer Center, CA, and Chair, ASTRO Council on Health Equity, Diversity, and Inclusion, called this abstract “pioneering and innovative.”
“An important aspect of patient care is the lens through which we approach our patients. We need to mitigate bias. Dr Takayesu’s study turns the lens on us to be more inclusive and recognize the sexual morbidity associated with our treatments for all genders,” Dr Gibbs said.
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