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Sexual Function in Childhood Cancer Survivors/Project REACH

When adults have cancer, it’s reasonable to consider how treatment will affect their sex lives. For example, men who have a radical prostatectomy may contend with erectile dysfunction. Women recovering from gynecological cancers may deal with the sexual side effects of surgical menopause.

But what happens when cancer occurs during childhood? How does pediatric cancer and its treatment affect the sex lives of those patients when they grow up?

Researchers from the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School set out to learn more about that question. Their study, published online last month in The Journal of Sexual Medicine, has some interesting results.

Today, we’ll take a closer look at this study and its implications for healthcare providers.

Project REACH

Project REACH (Research Evaluating After Cancer Health) is a cohort study that assesses health outcomes in cancer survivors. Participants complete an annual survey along with some additional surveys as needed.

Two hundred ninety-one Project REACH survivors of childhood cancer were involved with this sexual health study. They ranged in age from 18 to 57 with an average age of 27. Fifty-two percent were women. The most common cancer diagnoses in the group were brain tumors, lymphoma, leukemia, and sarcoma. Treatment types included chemotherapy, radiation, surgery, and transplant procedures.

After analyzing data provided by the participants in three questionnaires, the researchers found the following:

  • 29% of the 291 young adult survivors of childhood cancer surveyed had two or more symptoms of sexual dysfunction.
  • When compared to adults under age 40 in the general population, childhood cancer survivors were three times more likely to have sexual problems.
  • The women in the study population were twice as likely as the men to have sexual dysfunction.
  • Survivors with sexual dysfunction tended to be older than those with normal function. They were also more likely to experience depression and anxiety.
  • Sexual dysfunction was not associated with type of childhood cancer treatment.

Gender

As mentioned above, women in this study were twice as likely as men to have sexual dysfunction. Several hypotheses have been proposed to explain this:

  • Women may feel more stress and anxiety about relationship and sexual difficulties.
  • They may be more vulnerable to some of the physical, emotional, and cognitive late-effects of treatment.
  • They might be at risk for posttraumatic stress symptoms.
  • They may have negative feelings about their body because of treatment.
  • Their treatment might have induced menopause, which can lead to sexual problems.

The authors noted that while none of these hypotheses were supported by their study, their work does emphasize sexual concerns for female childhood cancer survivors.

Age

In this study, the average age of survivors with significant sexual dysfunction was 30. These survivors tended to be older than their counterparts with no sexual problems.

The researchers did not think this was due sexual changes that come with normal aging, however. Instead, they suggested that late-effects of treatment, those that wouldn’t be known when cancer treatment ended in childhood, were a factor. Such effects could interfere with heart, lung, hormonal, and neurological function.

Type of Cancer Treatment

One result that surprised the authors concerned the type of cancer treatment patients received as children. The researchers expected to see types of dysfunction related to types of treatment, as they often are in adults, but instead they found no association.

It’s possible, the authors suggest, that cancer treatment affects children and adults differently. Because children are still growing, treatment might impact their sexual development. Also, treatments that wouldn’t appear to affect sexual health could affect overall organ systems.

Implications for Healthcare Providers

“Our results underscore the stark reality that a significant number of young adult survivors of childhood cancer report the presence of multiple sexual problems and need effective intervention,” the authors wrote.  How can clinicians help?

  • Consider sexual health in broad terms. Remember that the treatment patients received in childhood may have affected their sexual health in ways that might not be obvious. Late-effects may take time to develop.
  • Watch for signs of depression and anxiety, which may be linked to sexual problems.
  • Work through the barriers that may exist when discussing sexual health with this population.
  • If you think your patient has a sexual health issue that is beyond your expertise, ask a colleague for guidance or support.

Of course, we might not know if our patients are survivors of childhood cancer. But if we do, it’s important to keep their sexual health in mind.

Resources

The Journal of Sexual Medicine

Bober, Sharon L., PhD, et al.

“Sexual Function in Childhood Cancer Survivors: A Report from Project REACH”

(Full-text. First published online: May 16, 2013)

http://onlinelibrary.wiley.com/doi/10.1111/jsm.12193/abstract