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

SAN ANTONIO – Although both men and women receiving brachytherapy for prostate or cervical cancer may experience some degree of sexual dysfunction, doctors are far less likely to engage in sexual health discussions with women than men, according to research presented here.

A single-center study found a notable difference in the frequency with which sexual health was discussed with men and women at their initial consultation: 89% of men versus only 13% of women (P.<0.001), reported Jamie Takayesu, MD, of the Rogel Cancer Center at the University of Michigan in Ann Arbor.

Additionally, none of the women with cervical cancer were assessed for sexual health with a PRO tool, compared with 81 percent of men with prostate cancer.

“And this despite the fact that women were on average nearly 20 years younger than their male counterparts,” Takayesu noted during a press conference at the American Society for Radiation Oncology (ASTRO) annual meeting.

The impetus for this work, Takayesu said, was a previous study at her institute that showed 63 percent of women think they should be routinely asked about their sexual health.

“In my clinical experience I felt we weren’t really meeting their needs,” she said. “I’ve had a lot of conversations with men about their erectile function and I wasn’t actually having 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 commonly used in both of these cancers 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 women men will experience sexual dysfunction after treatment.

In addition to determining how many men and women were discussing sexual health with doctors, Takayesu and her colleagues also looked at how often sexual health was assessed in clinical trials nationwide by analyzing studies in the NIH Clinical Trials Database.

The study showed that of 78 studies involving 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 questioned about their sexual health? “There are obviously a lot of confounding factors,” Takayesu said. “Prostate cancer patients, in general, tend to live longer … and have many more types of treatments offered to them. So sexual function becomes a way for them to stratify which treatment is best for them. But it does. I think there are many steps we can take to improve the way we approach sexual health in women. “

He noted, for example, that standardized PROs are being implemented at his institution in the cancer radiotherapy clinic and that educational efforts are underway in both oncology radiology and gynecology, as well as within other specialties, “to try to manage sexual dysfunction. that these women are experiencing. “

“It is also important to examine some of the implicit biases and social constructs that are influencing the discussions of doctors – or any other provider – about female sexual health,” Takayesu said, adding that once female sexual health becomes a more important part. Important of the discussion, radiation oncologists can address how treatments can be modified to reduce sexual toxicity and what kinds of therapies can be added to address female sexual dysfunction.

Commenting on the study, ASTRO Council on Health Equity, Diversity and Inclusion Chair Iris C. Gibbs, MD, of Stanford Medicine in California, said that an important aspect of care “is really about how we see patients. in that lens through which we approach their overall result “.

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

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

Disclosures

Takayesu had no revelations.

Gibbs had no revelations.

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