Sexual Health Toxicity In Cancer Survivors: Is There A Gender Disparity In Physician Evaluation And Intervention?

As cancer survivorship increases, mitigating and managing treatment related toxicities is an essential component of multidisciplinary oncologic care. It is known that sexual dysfunction in cancer survivors is a common and distressing consequence of treatment. We sought to determine the prevalence of sexual dysfunction, to characterize physician identification and management of this toxicity, and to find solutions for intervention. An IRB approved questionnaire, developed with input from radiation oncologists, medical oncologists and surgeons was administered from 2017-2019, on social media and in clinic using an iPad. The survey consisted of more than 25 questions and was targeted specifically to cancer survivors. Patients with missing data were excluded from the analysis. Descriptive analyses were done with frequency counts and percentages. Differences in response by gender were assessed using Chi-Square tests for categorical variables and ANOVA for Likert responses with a p < 0.05 being significant. 405 cancer survivors responded to the survey; 391 (96.5%) patients were included. Most were female (n = 313, 81.0%), between 41-50 years old (n = 115, 30.0) and had cancer types such as breast (66.8%), or pelvic tumors including prostate (16.3%), endometrial (6.1%), bladder (3.8%) and rectal (1.8%) cancer. Overall, 47.4% of patients received anti- hormone therapy, 78.1% received chemotherapy and 54.2% received radiation therapy. Forty-four percent of respondents were preemptively told that sexual health could be affected. Most (n = 337, 87%) of respondents stated cancer treatment impacted their sexual function or desire with 53.8% reporting body image distortion, 73.4% with dyspareunia, and 42.3% unable to achieve orgasm. Only 27.9% of respondents stated they had been formally asked about their sexual health from a provider. Male patients were significantly more likely to have been asked than female patients (53% vs. 22%, p<0.001). Standardized sexual health questionnaires were administered to 31.5% of male cancer survivors and only 5.4% of female cancer survivors (p = 0.001) but 51% of all patients state that they would be most comfortable with the conversation about sexual health to be initiated by their provider after being given a questionnaire to drive that conversation. We identified sexual dysfunction as a treatment side effect experienced by the majority of our cancer survivors that is not well addressed. Female survivors were significantly less likely to have their sexual dysfunction addressed. As discomfort surrounding sexual health is present, we demonstrate the utility of using validated sexual health questionnaires for both male and female cancer survivors to improve physician engagement, and facilitate open discussion between patients and providers to improve the quality of life of our patients.