Are Your Patients With Cancer Experiencing Sexual Dysfunction? Just Ask!

Sexual dysfunction is one of the most prevalent side effects of cancer and cancer treatment, and it is one that patients find deeply unsettling. Nearly 85% of patients with cancer say that cancer negatively impacted their sexual health. However, just a fraction of patients report that their healthcare team initiated a discussion about the topic.

A widespread issue

Sexual dysfunction impacts patients with all types of cancer, yet it is often only patients with cancer that directly affect sexual or reproductive organs who are asked about this issue.

Disorders that affect sex and intimacy are often multifactorial. There are many circumstances that may impact sexual desire and intimacy, such as:
• Side effects from chemotherapy and high-dose radiation
• Physical discomfort after surgery or radiation
• Damage to nerve fibers in sexual organs
• Fatigue
• Nausea
• Decreased libido from hormone therapy
• Erectile dysfunction after surgery

Psychological factors play a significant role, as the anxiety of treatment and/or distress about body image can reduce sexual desire.

An ongoing concern

These problems can persist for years after treatment. In fact, studies show 50% of men and 80% of women who have had a stem cell transplant experience sexual dysfunction, with 20-49% of men and 40-71% of women reporting being sexual inactive between >1 to five years after transplant. Despite these statistics, the majority of patients still receive no education or support to assist them in addressing these side effects after transplant.

To help address these challenges, a group of researchers conducted a pilot
randomized trial to utilize a multimodal mobile app to help patients with blood
cancers who were facing distress from sexual dysfunction in the months after
their stem cell transplant.

Betty K. Hamilton, MD, of Cleveland Clinic Cancer Institute, who was not part
of the research group, penned an editorial in JNCCN about this important topic and its impact on cancer survivors. She commended the team for finding novel ways to tackle this often unacknowledged side effect.

“As more patients are living longer with cancer, there is greater need to address quality of life issues such as sexual health,” says Dr. Hamilton. “Some providers may be reluctant to bring it up due to their own lack of comfort, but this research highlights the importance of addressing sexual health, even in a complex patient population, and demonstrates that it is very feasible to do.”

Pilot study

In the study, patients were randomly assigned to either have access to a digital app called SHIFT or "enhanced usual care" consisting of a session with a hematopoietic cell transplant clinician and educational materials. The app is a visual tool that walks patients through specific biological, interpersonal, social and psychological concerns. Using gamification and intimacy exercises, it offers techniques that patients and their partners can try out or communicate about in the privacy of their home.

The researchers found that this type of intervention showed positive outcomes, including increased interest in sex, more satisfaction/pleasure from sexual experiences, lower levels of anxiety related to sex and improved quality of life.

Initiating conversations

Dr. Hamilton emphasizes the importance of normalizing sexual health support. “Don’t be afraid to bring it up, just as you would any other symptom. Survivorship issues are often best addressed when they’re addressed up front. It’s never too early to discuss the topic, even if you’re just briefly educating patients that treatment may affect their libido and that there are resources to help.”

For physicians who are new to the topic, it may take a bit of time to become accustomed to having these discussions. “Just like any difficult conversations we have, it takes practice, and it's not going to be perfect every time,” says Dr. Hamilton. “The key takeaway is that patients want their healthcare providers to address the issue.”