Your Cancer Patient’s Sexual Well-Being Really Matters

BARCELONA — Oncologists struggle to discuss fertility and sexual health with patients, and the tools available to qualitatively and quantitatively assess these aspects are limited. This was highlighted during a session titled, “Oncofertility: What Every Health Professional Involved in Cancer Care Should Know,” held here at the 2024 annual meeting of the European Society for Medical Oncology (ESMO).

The session provided an opportunity to review current knowledge and the work still needed for assessing and treating sexual health issues in cancer patients.

“Sexual health, a broad concept that goes beyond efforts to preserve fertility, is crucial for cancer patients but is not yet adequately assessed,” said Cristiane Bergerot, PhD, a psycho-oncologist working with Oncoclínicas&Co and Medica Scientia Innovation Research, São Paulo, Brazil.

Gender-Based Assessment

Experts highlighted the risk for gonadal toxicity from a variety of conventional and innovative cancer therapies.

Classic cytotoxic chemotherapy, for example, significantly affects gonadal function. In men, it can lead to a temporary decrease in sperm quality, temporary or permanent azoospermia, and sometimes endocrine disorders. In women, it induces acute amenorrhea, temporary or permanent reduction in ovarian reserve, and temporary amenorrhea. In severe cases, it leads to early ovarian failure.

Gonadal toxicity depends on both the stage of the disease — generally greater in advanced stages — and the type of treatment or therapeutic regimen in place. Today, numerous guidelines, including those published by ESMO, are available for assessment.

“The new therapies represent a real challenge in terms of counseling on fertility preservation and gonadal toxicity,” said Isabelle Demeestere, MD, PhD, director of the Research Laboratory on Human Reproduction at Université libre de Bruxelles, Brussels, Belgium, during the session. She drew attention to the scarcity of data on the subject and the current lack of recommendations or guidelines.

“Today, survival is a crucial component of cancer care, and several domains must be considered,” added Matteo Lambertini, MD, PhD, associate professor of oncology at the University of Genova and the IRCCS Ospedale Policlinico San Martino in Genoa, Italy. He emphasized that if various aspects of life after cancer, including fertility, are not properly addressed, patients might not choose to adhere to their therapies, with significant negative health consequences.

ESMO guidelines recommend that fertility counseling in reproductive-age cancer patients always be conducted at the earliest stages following diagnosis. For women, techniques to preserve fertility are available, but it is essential to also consider other aspects of reproductive health, from pregnancy to breastfeeding. Lambertini also noted that assessing young female patients must include exploring issues such as contraception, sexual dysfunction, and vasomotor symptoms related to the disease and treatments.

Fertility Is Not Everything

There is a high incidence of problems related to sexual health in cancer patients that varies by cancer type. For colorectal tumors, it stands at 70%-80%, for breast cancer it varies from 50% to 90%, and it is also quite high in head and neck cancers, reaching 50%-60%.

Additionally, the data available today highlight a significant gap between patient needs in terms of sexual health and the support they receive to address them.

“These data underline the importance of including sexual health assessments in the patient care pathway,” said Bergerot, adding that sexual intercourse is not the only component of a person’s sexual well-being. Aspects such as intimacy, sensuality, body image, arousal, and desire should not be overlooked, nor should sexual health after a cancer diagnosis be considered differently for men and women.

How should these aspects be appropriately assessed?

Questionnaires from the European Organisation for Research and Treatment of Cancer (EORTC) represent an important, albeit imperfect, tool for assessing health-related quality of life (HRQoL) in cancer patients.

An ongoing study managed by EORTC, designed with the goal of developing a guideline document for HRQoL assessment in research on rare solid tumors, found that EORTC questionnaires contain few questions related to sexual health and are not sufficient to explore the issue appropriately. The analysis showed that, among the questionnaires specific to cancer types, those for anal and bladder cancer contain the most questions related to sexual health.

However, some questionnaires, such as those for lung or brain cancer, do not evaluate these aspects at all. And when they do, the questions focus on sexual function, body image, and little else.

“Many aspects are not addressed, and consequently, they do not emerge during the patient’s assessment,” said Bergerot, who proposed a list of new items to be included in the EORTC questionnaires. She further explained to Univadis Italy, a Medscape Network platform, that expanding the range of questions on sexual health would allow for a more complete picture and better address any doubts or problems the patients have.

“The psycho-oncologist plays a crucial role in improving the sexual health of patients. But to be truly helpful, they must be able to engage with them. For this to happen, it is essential that the oncologist conducts an accurate assessment of the disorders related to the sexual sphere,” said Bergerot. As explained by the speakers, doctors often only deal with the clinical part of sexual health, as they have resources and strategies they can propose to the patient to improve the situation. “On other aspects of sexuality, they might feel uncomfortable, not having clear and certain answers. But it is still necessary to start the discussion on the topic,” Bergerot said.

Demeestere and Bergerot declared no conflicts of interest in relation to what was presented during the sesssion. Lambertini disclosed that he has received fees for consultations and presentations from various pharmaceutical companies, none of which are directly related to the topic under discussion. 

Cristina Ferrario is a molecular biologist and former researcher in molecular oncology at three institutes in Milan. She has a master’s degree in communication and health from the University of Milan, Milan, Italy, and a master’s degree in cancer genetics from the University of Pavia, Pavia, Italy. She has worked as a science journalist for more than 20 years.

This story was translated from Univadis Italy using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.