Preserving sexual function in rectal cancer treatment options

ESCP 2020 – Virtually Vilnius: ‘Preserving sexual function in rectal cancer treatment options’ preview: an interview with Anne Thyø

Preservation of quality of life and functional outcomes – including sexual function – has recently gained more attention in rectal cancer treatment and the number of studies about sexual dysfunction is increasing.

Recorded risk of sexual dysfunction after rectal cancer treatment ranges widely depending on definition, assessment, and outcome. Records from the Dutch TME trial reported female sexual dysfunction rates of about 60% and even higher in males.

While surgery is the cornerstone treating rectal cancer, many patients are also treated with neo-adjuvant radiotherapy.

Direct nerve-damage during surgery has always been considered to be the main cause of sexual dysfunction. The risk is reduced with a correctly performed TME procedure, however surgery also causes pelvic scarring and fibrosis.

Radiotherapy reduces the risk of local recurrence. However, the side-effect profile is well known and sexual function is at stake when treated with radiotherapy due to vascular/tissue damage and neuro-toxicity.

Also, open procedure has been compared to laparoscopy. Laparoscopy may improve recovery, but when compared to open surgery, it does not seem to be safer regarding sexual function.

In Aarhus, Dr Thyø’s team have recently investigated a large national Danish cohort of patients diagnosed with colorectal cancer between 2001-2014. This has resulted in the largest investigated cohort about sexual function. Patients were sent PROMs regarding late side effects such as bowel dysfunction, urinary dysfunction, sexual dysfunction, pain, and quality of life.

Rectal resection was compared to colonic resection and local excision. There were no significant differences regarding sexual function between patients after colon resection and local excision. But when compared to rectal cancer patients, rectal resection was highly associated to worse sexual function. In both male and female patients, the most significant treatment related factors associated with sexual dysfunction was permanent stoma and radiotherapy treatment.

They also investigated the impact of permanent stoma in colon cancer patients finding a strong correlation to sexual dysfunction in both male and female patients.

Sexual dysfunction is due to both physical and psychological factors. Most studies focus on the physical aspects of sexual dysfunction such as erectile dysfunction, ejaculatory dysfunction, vaginal dryness, dyspareunia, and inability to have an orgasm. There is also a major psychological impact of a cancer diagnosis. Cancer is associated with stress and depression, which is well known to deteriorate sexual function.

Among females they found that lack of sexual desire is very common and is the one aspect that impacts the most on the patient’s quality of life. Also, among females, there is very high risk of becoming sexually inactive after diagnosis.

In breast cancer patients there is also a high risk of sexual dysfunction, which is not caused by pelvic nerve damage, but merely to loss of sexual self-image and altered body image. Many stoma patients probably share these issues. Moreover, psychological distress and fear of recurrence are concerns that all cancer patients share.

Lastly, many rectal cancer patients suffer from co-existing side effects, which also potentially threatens sexual health.

So, despite a correctly performed TME procedure and no use of stoma or radiotherapy, some patients will still experience sexual problems.

In the individual patient, it is difficult to quantify the specific treatment impact on sexual function since sexual dysfunction is multifactorial and sexuality and the perception of sexual quality of life is highly individual from one patient to another.

Key points

With today’s treatment options, it seems unavoidable that some patients will develop sexual dysfunction. However, with screening we will diagnose more patients with early tumours accessible for local excision, hence less use of radiotherapy, surgical resection and stoma.

The risk of sexual dysfunction and treatment options must be discussed with all patients prior to treatment. For some, sexuality may not be important anymore, but all patients should be recognized and informed about potential side effects. We need to find those who consider sexuality an important aspect of quality of life in order to offer professional counselling and early intervention during and after treatment.

 Dr Thyø will deliver a session on this topic during Virtually Vilnius – Monday 21 September at 14:30-14:40 CET.

 

Anne Thyo
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