SAN ANTONIO — There is a huge gender disparity between women and men who undergo brachytherapy as to whether they are asked about their sexual function, US researchers have shown.
Brachytherapy, which involves implanting beads of radioactive material, is an “important treatment for genitourinary cancers,” but it carries a long-term risk of sexual dysfunction, noted lead author Jamie Takayesu, MD, a radiation oncology resident at the University of Michigan Rogel Cancer Center in Ann Arbor, Michigan.
Up to 90% of women with gynecologic malignancies and 50% of men with prostate cancer report sexual problems after such treatment.
However, when her team examined the records of over 200 patients who underwent brachytherapy for cervical or prostate cancer at their institution, they found that women were seldom asked about their sexual health.
Whereas most men (89%) were asked about their sexual health before treatment, only 13% of women were asked (P < .001).
Also, none of the women with cervical cancer were assessed with regard to their sexual function using a patient-reported outcome (PRO), compared with 81% of men with prostate cancer.
“And this was despite the fact that women were, on average, almost 20 years younger than their male counterparts,” Takayesu said. (The meadian age of women with cervical cancer was 51 years, vs 69 years for men with prostate cancer.)
The team also accessed a National Institutes of Health clinical trials database and found that 17% of clinical trials for prostate cancer included sexual function as a primary or secondary endpoint, compared with only 6% of trials for cervical cancer (P = .040).
The study was presented here at the American Society for Radiation Oncology (ASTRO) 2022 Annual Meeting on October 23.
“This is an eye-opening study for radiation oncologists,” commented David Byun, MD, a radiation oncologist at NYU Langone’s Perlmutter Cancer Center, New York City, who was not involved in the study.
“While a small, retrospective study, the stark disparity in sexual health assessment between men and women is indeed illuminating,” he said.
“The potential long-term quality-of-life side effects, including their impact on sexual health, must be adequately discussed during consultation so patients are fully informed,” Byun added.
The finding should be shocking “except that it’s not, sadly,” commented Fumiko Chino, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center, New York City.
However, by highlighting a known problem, it “brings it to the forefront and makes us realize we should start addressing it,” she told Medscape Medical News.
Sexual health is “the capacity for having meaningful relationship with others, and these things can be seriously damaged from radiation,” Chino said. “Radiation is an incredibly powerful tool that can save lives, but we should be using it smarter to cause less long-term, lasting damage.”
This is an “important survivorship issue,” she said, but “it’s just being neglected,” especially for women. The “huge pharmaceutical boom” that came with the “little blue pill made us realize that sexual health is important for men, but that realization has not really happened for women.”
That may be because “there’s more complexity” around female sexual health, “or it may be because we’re trying to simplify men’s sexual health” down to whether the man can “get an erection,” which she suggested was “not sufficient, really.”
There are “good treatments” for female sexual dysfunction, but because women are not being asked about their sexual function, these are not being prescribed, she said.
Speaking at a press briefing held during the meeting, Takayesu said: “I think this is something that most clinicians already know, that women are significantly less likely to be asked about their sexual health prior to receiving brachytherapy for cancer.
“There are, of course, a lot of confounding factors,” she added, including the fact that men with prostate cancer, in general, tend to live longer than women with cervical cancer.
Also, patients with prostate cancer “have many more types of treatments that are offered to them, and so sexual function does become a way for them to stratify which treatment is best for them.
“But I do think there are still a lot of steps to be made in improving how we approach sexual health and women,” she said, including implementing standardized PROs and providing guidance to colleagues.
“I’ve also been discussing with other specialties and other colleagues in occupational therapy, physical therapy, and sexual health clinics to try to manage the sexual disruption that these women are experiencing.”
Only after that has been implemented and some of the “implicit biases and social constructs” regarding sexual health have been tackled, she said, can we “really turn to how” radiotherapy can be altered to “decrease sexual toxicity,” and only then can therapies be evaluated so as to “address female sexual dysfunction.”
Commenting at the press briefing, Iris C. Gibs, MD, professor of radiation oncology, Stanford Cancer Center, Stanford, California, said this study turns the “lens through which we approach better overall outcomes…back on us as providers.”
These findings oblige clinicians to be “more inclusive and to recognize the potential for this sort of sexual morbidity from our treatments from all genders.”
No funding for the study has been described. The authors have disclosed no relevant financial relationships.
American Society for Radiation Oncology (ASTRO) Annual Meeting 2022: Abstract 2306. Presented October 23, 2022.
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