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ASCO Reading Room | Sharon Bober and Matthew Katz on Sexual Health for Lung Cancer and Other Cancer Survivors

When cancer survivors search for sexual health aids online, they’re unlikely to find information from medical professionals or journals, according to research presented at the ASCO Quality Care Symposium.

“Sexual health is often negatively impacted by cancer therapies,” Sharon Bober, PhD, founder and director of the Sexual Health Program and institute psychologist at Harvard Medical School and Dana-Farber Cancer Institute in Boston, and Matthew Katz, MD, of Lowell General Hospital and Radiation Oncology Associates in Massachusetts at the time of the study, and another colleague wrote in the study abstract. “National Comprehensive Cancer Network (NCCN) survivorship guidelines for sexual health broadly recommend sexual aids, without detail about quality or availability.”

The researchers used a consumer-oriented approach to search online for information about non-pharmacological sexual aids related to NCCN recommendations. Just 17% of the links they found were connected to medical or health periodicals, and less than 3% were from an NCCN medical source. The majority were from magazines, newspapers, and blog posts.

“To address gaps between general recommendations and practical application, we identified many highly rated, potentially useful products in NCCN-designated categories that may be valuable for patients as well as clinicians,” the team said.

Bober and Katz elaborated on the study and its findings in the following interview. Katz is now interim chair of Radiation Oncology and residency program director at Tufts Medical Center in Boston.

What are some of the ways cancer therapies impact sexual health, and how common are negative effects among survivors?

Bober and Katz: Sexual health encompasses various aspects of physical, emotional, and social well-being related to sexuality. Changes in sexual health are some of the most common, distressing, and often unaddressed consequences of cancer therapy. Some of these changes may be immediate, and sometimes the impact of treatment on sexual health can be felt months or years after treatment ends.

Treatments including chemotherapy, radiation, surgery, and hormonal therapies all have potential to impact sexual health, and unfortunately, the majority of cancer survivors describe not feeling prepared to manage these changes. Common changes include loss of arousal, pleasure, and desire as well as significant concerns about body image and body integrity, especially in the context of body-altering treatments.

Women may face sudden, treatment-induced menopause or have an increased intensity of genitourinary symptoms of menopause such as vaginal dryness or genital discomfort with or without sexual activity. Men may have problems with erectile function, ejaculation, orgasms, and/or urinary leakage. These issues often feel embarrassing to talk about and not surprisingly these changes can have a stressful impact on relationships. For folks who are single, they often struggle with dating or starting intimate relationships, because there is a real fear of rejection.

Can you tell us more in general about the products you searched for and how you conducted your searches?

Bober and Katz: We used the NCCN guidelines to identify 13 categories of sexual health devices: dilators (anal and vaginal); vaginal health products (gels, hyaluronic acid, moisturizers, oils); lubricants (anal and vaginal); penile devices (extenders, sleeves, and vacuum erection devices); dildos; and vibrators.

We used a consumer-oriented, internet-based approach to conduct an online search for the “best of” in each category. Using the DuckDuckGo search engine to find articles or other publications listing specific items, we identified an initial 807 items, then narrowed it down to 535 that might have clinical benefit. We then searched on seven commercial websites and the manufacturer’s website to look for consumer ratings on each item.

Ultimately, we found 287 items that had at least 50 reviews with an average of four stars or better (out of five).

Can you give a specific example of something you searched for and what you found?

Bober and Katz: Vibratory devices may help improve blood flow and sexual function for anal, penile, and vaginal use. We were able to identify 10 separate types of vaginal vibrators that may have specific benefits for cancer patients, depending on the type of sexual dysfunction they had. Of course, that would require testing, but it may help identify which items may work best for each patient’s needs.

You mentioned publishing a list of potentially useful products you identified. Please tell us more about this.

Bober and Katz: The highly rated consumer sexual health items that we identified may have some clinical benefit for cancer patients, but we don’t know that. Rather than try to focus on specific items and then test them in focus groups or clinical trials, which would take a long time to help patients, we plan to publish the full list of items now. The goal in publishing the list isn’t to recommend [the items], but to give oncologists, sexual health experts, and patients something to start talking about, so the silence about sexual dysfunction doesn’t continue.

Read the study here.

No funding was reported for this study.

Bober reported no conflicts of interest; Katz reported stock/ownership in Bavarian Nordic, CVS Health, Dr. Reddy’s Laboratories, Healthcare Services Group, Moderna, Pfizer, and Siga Technologies.

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