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L. Incrocci
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MTE 16 - Living with Cancer and Sexuality (Ticketed Session) (ID 68)
- Event: WCLC 2015
- Type: Meet the Expert (Ticketed Session)
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 07:00 - 08:00, 111
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MTE16.01 - Living with Cancer and Sexuality (ID 2001)
07:00 - 08:00 | Author(s): L. Incrocci
- Abstract
- Presentation
Abstract:
With the improvement of treatment efficacy, quality of life and sexual functioning after cancer treatment have become very important. Sexual well-being may be altered by both the diagnosis and the treatment of cancer. This in turn can have a deleterious impact on quality of life. Sexual dysfunction in cancer patients may result from biological, psychological and social factors (1). Biological factors such as anatomic alterations (rectum or penile amputation), physiological changes (hormonal status) and secondary effect of medical intervention may preclude normal sexual functioning even when sex desire is intact. Side effects of chemotherapy such as nausea, vomiting, fatigue, hair loss can result in adverse effects on sexuality together with disfiguring surgery (mastectomy, colostomy). Negative emotional states such as anxiety, depression, anger may also disrupt sexual activity (1). Disturbances of body image can contribute to the development of sexual dysfunction as well. Radiotherapy and radical prostatectomy are the most effective treatments for prostate cancer. Erectile dysfunction is reported in 6-80% after external-beam radiotherapy and 2-61% after brachytherapy. Erectile dysfunction after surgery is reported in 40-70% after nerve-sparing techniques and 100% in non-nerve-sparing techniques, and it occurs immediately after surgery. Ejaculation problems and libido decrease occur in up to 80%. Vascular, neurogenic and psychogenic factors are all important etiologic factors (1-3). Similar data are reported after treatment of bladder and colorectal cancer in males. Testicular cancer affects young men in their fertile and sexually active life. Retrograde ejaculation, erectile dysfunction, loss of libido, decreased orgasm and body image impairment are often reported after treatment (1,4). Surgery and radiotherapy for gynaecological cancer can alter vaginal sensation and may cause stenosis leading to painful penetration (1,3,5). These treatments lead to ovarian suppression, with vaginal discharge, dryness, dyspareunia and a loss of sexual interest. Only 50% of the females is still sexually active after cancer treatment (1). There is often fear of pain and of urine or faeces incontinence during sexual activity. Similar complaints are reported after treatment of colo-rectal and anal cancer in women. There is no data on the effects of treatment for lung cancer on sexual functioning. Though it is to be expected that these patients, both males and females, can report sexual dysfunction as a result of chemotherapy, social and psychological factors (distress, depression). For several reasons sexual counseling has not become a routine part of oncology care in most hospitals (6). There is a time constraint: in busy oncology clinics, where the outpatient visit is focused on addressing prognosis and treatment, physicians do not have time to assess quality of life. Another barrier is the discomfort physicians, and patients, have to discuss sexuality. The great majority of oncology professionals are scared to address sexuality and the great majority of sexological professionals are scared by cancer (7). Sexual counseling should be routinely provided in an oncology clinic having a health care professional (physician, or oncology nurse specialist) to evaluate and discuss quality of life matters, including sexual dysfunction, and possible treatments. In most cases patients do not require extensive medical or psychological treatments, but they need information about the impact of cancer treatment on sexuality (6). Patients, and partners, are often uninformed about the anatomy of sexual organs, therefore they have to be counseled on the effects that treatment has on the sexual organs. Several questionnaires are available to evaluate sexual functioning in both males and females (1). Recently a specific questionnaire on sexual functioning after treatment of cancer has been developed in the USA, but has not been validated yet in other countries (8). The 3rd International Consultation on Sexual Medicine appointed for the first time in 2009 a Committee on chronic illness (including cancer) and sexual medicine. The recommendations of that committee are very useful in helping to develop research programs in oncology and sexual medicine (9). Sexual dysfunction is often unrecognized, underestimated and untreated. Cancer affects quantity and quality of life. The challenge for physicians and other health care professionals is to address both components with compassion (7). References 1. Sadovsky R, Basson R, Krychman M, et al. Cancer and sexual problems. J Sex Med 2010;7:349-373. 2. Incrocci L, Slob AK, Levendag PC. Sexual (dys)function following radiotherapy for prostate cancer: a review. Int J Radiat Oncol Biol Phys 2002;52:681-693. 3. Incrocci L, Jensen PT. Pelvic radiotherapy and sexual function in men and women. J Sex Med 2013;10 Suppl 1:53-64. 4. Wortel RC, Ghidey WA, Incrocci L. Orchiectomy and radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function. J Sex Med 2015;12:210-218. 5. Jensen PT, Groenvold M, Klee MC, et al. Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys 2003;56:937-949. 6. Schover LR. Counseling cancer patients about changes in sexual function. Oncology 1999;11:1585-1591. 7. Incrocci L. Talking about sex to oncologists and cancer to sexologists. J Sex Med 2011;12:3251-3253. 8. Flynn KE, Lin L, Cyranowski JM, et al. Development of the NIH PROMIS® Sexual Function and Satisfaction measures in patients with cancer. J Sex Med 2013;10 Suppl 1:43-52. 9. Montorsi F, Adaikan G, Becher E, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2010;7:3572-3588.
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