Study Sheds Light on Sexual Health Issues After Cervical Cancer Treatment

By Leah Lawrence - Last Updated: September 27, 2024

Patients and providers may not be on the same page when it comes to sexual health issues, according to a recent study of patient-reported sexual health outcomes among patients with cervical cancer.

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“Cervical cancer patients self-report high rates of sexual distress, sexual dysfunction, and severe menopausal symptoms,” reported researchers led by Elizabeth Chuk, MD, of the University of Toronto, in Gynecologic Oncology. “The discrepancy between oncologist-assessed toxicity and patient-reported outcome measurements (PROMs) underscores the importance of evaluating the patient’s experience and not relying on oncologist’s assessments alone.”

Dr. Chuk and colleagues conducted a prospective, cross-sectional study of 73 patients with stage IB-IVA cervical cancer. Patients had been treated with chemoradiation and MRI-guided brachytherapy. They completed a sociodemographic questionnaire and several patient-reported outcomes scales.

The median age of included patients was 49 years. The majority (76.9%) of patients were partnered, and about one-fifth (21.5%) identified as being part of the 2SLGBTQIA+ (Two Spirit, Lesbian, Gay, Bisexual, Transgender, Queer and/or Questioning, Intersex, Asexual) community. More than half of patients had vaginal involvement at diagnosis.

After treatment, 86.6% of patients used a vaginal dilator and 16.4% were using oral or local hormone therapy.

Most patients (86.3%) reported sexual dysfunction, and more than half reported sexual distress. About one-third (36.2%) of patients reported severe menopausal symptoms, and of these patients, most were younger than age 50. Patients also reported experiencing anxiety (46.6%) and depression (24.7%).

Physician-assessed vaginal toxicities of grade 2 or worse occurred in about one-quarter (27.4%) of patients. No significant associations between patient-reported outcomes and grade 2 or worse vaginal toxicity were identified.

“Given the complexity of sexual health and the discrepancies between what patients experience and clinicians report, it is important to collect PROMs,” the researchers wrote. “Furthermore, selection of the most appropriate PROM to use is prudent. While various validated PROMs are available to assess sexual dysfunction and sexual distress, it is imperative to measure and interpret both for a holistic assessment of sexual health.”

Multivariable analysis identified several factors associated with significantly worse sexual health including non-partnered status, use of hormone replacement therapy, and International Commission on Radiation Units and Measurements – rectovaginal dose (ICRU-RV) of >65 Gy. The researchers noted that the link between sexual health and hormone replacement therapy, “could potentially stem from the likelihood that symptomatic patients were more inclined to seek intervention.” Age and use of vaginal dilator were not associated with poor sexual health.

Additionally, ICRU-RV >65 Gy was also associated with an increase in sexual distress (P=.02) and menopausal symptoms (P=.002).

“Clinical identification of vaginal toxicity should prompt physicians to discuss sexual health with attention to both sexual dysfunction and sexual distress, while assessing the downstream impact on sexual functionality and quality of life,” the researchers wrote. “Earlier and more aggressive hormonal treatment of menopausal symptoms in younger patients as well as careful consideration to radiotherapy doses to the vagina could significantly improve patients’ sexual health.”

Reference

Patient-reported sexual health outcomes of cervical cancer patients treated with definitive chemoradiation and MRI-guided brachytherapy

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