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Sex and the Cancer Patient: Still a Problem with Targeted Agents

TOP - December 2010, Vol 3, No 8 published on November 30, 2010
Cristi Radford, MS, CGC

MILAN—Sexual issues related to cancer and its treatment are substantial—and do not seem to be resolving with the use of new molecular targeted agents instead of endocrine therapy and chemotherapy. This conclusion can be drawn from two studies presented by investigators from Argentina and France.

Argentine investigators questioned 29 female and 21 male cancer patients on issues of sexuality. Half were married and all had good performance status. Most of the women had gynecologic cancers (48% of the total population). Gastrointestinal cancers were seen in 30% overall and urologic cancers in 12%; the remainder were respiratory, head and neck, and skin cancers.

“We found the three phases of human sexual response to be affected, all reaching statistical significance. Most impact was seen in females,” said Bonicatto Silvia, MD, of the Hospital San Roque de Gonnet in Buenos Aires. “When the descriptors of ‘a little’ versus ‘not at all’ were compared, the most affected areas were arousal and orgasm.”

Although 84% of all patients reported “some” sexual arousal before treatment, this fell to 53% after treatment. Conversely, before treatment 16% reported “no arousal,” and this rose to 47% after treatment, Silvia reported.

For orgasm, “some” orgasmic function was reported by 84% before treatment, declining to 53% after treatment, whereas “no” orgasms were reported by 16% and 47%, respectively. Desire was somewhat less affected, with 86% reporting desire at baseline and 69% posttreatment. Pre and posttreatment means are shown in the Table.

Women were particularly affected by a lack of lubrication. Before treatment, 64% reported lubrication or “vaginal wetness during sex,” but this dropped to 36% after treatment. For men, erectile dysfunction was less affected, with 52% reporting sexual function before treatment and 43% after treatment.

Not surprisingly, sexual activity declined. Before their cancer treatments, 100% of men and 82% of women reported some degree of sexual activity. After treatment, 82% of men were still sexual but only 39% of women were.

Targeted agents affect sex life too
Also at the meeting, French researchers reported on one of the few studies to investigate the impact of newer cancer treatments on sexual functioning, finding significantly decreased levels of sexual function and satisfaction in patients taking targeted therapies.

Yohann Loriot, MD, and Thomas Bessede, MD, from the Institut Gustave Roussy in Villejuif, France, surveyed 51 patients (40 men, 11 women), median age 58, who had been treated with a targeted therapy for more than 3 months. The drugs involved were sunitinib, sorafenib, temsirolimus, everolimus, bevacizumab, erlotinib, and cetuximab.

Men completed the International Index of Erectile Function (IIEF) questionnaire and women completed the Female Sexual Function Index (FSFI) questionnaire.

The median overall IIEF score for men was 40, which was just 53% of the maximum score (range, 5-75). Specifically, the mean scores (out of the maximum) were 14/30 for erectile function, 6/15 for intercourse satisfaction, 6/10 for orgasmic function, 6/10 for sexual desire, and 5/10 for overall satisfaction.

Women scored even lower. Median FSFI was 8.4, which was just 24% of the maximum (range, 2-29.6). Mean scores were 2.2/6 for desire, 1.86/6 for arousal, 1.5/6 for lubrication, 1.7/6 for orgasm, 2.6/6 for satisfaction, and 2/6 for pain.

“The sex lives of the patients in our study had reduced quality and intensity,” Loriot said. “We also found that more than half the patients expressed a wish for a satisfying sexual life, but many found it difficult to initiate a discussion on the topic with their doctors.”

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Last modified: April 27, 2020