Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study

Abstract

Background: Colorectal cancer (CRC) is accompanied by specific treatment-related physical (ostomy, incontinence) and psychosexual (body image, depression) consequences on sexual health.Aim: An assessment of sexual health of CRC patients 2 years after diagnosis. Methods:We selected all CRC patients of a French nationwide longitudinal study. Data sources included patient questionnaires, medical questionnaires and medico-administrative databases.Outcomes: We evaluated sexual health using the Relationship and Sexuality Scale and assessed self-reported rates of discussion about sexuality with health care providers.Results: Across the 487 patients, 258 were men and 229 were women, with 77% diagnosed with colon cancer and 23% with rectal cancer. Overall, 54% of patients reported a decrease in sexual desire, 61% a decrease in frequency of intercourse, and 48% a decrease in the possibility to reach an orgasm. Patients still experiencing fecal incontinence 2 years after diagnosis have all sexual desire, intercourse, orgasm and satisfaction RSS items decreased.Rectal cancer patients had significantly more frequent desire and orgasm troubles than colon cancer patients (p=.003; p=.014, respectively). Regarding the discussion about sexuality, only 20% of men and 11% of women; 11% of colon cancer and 33% of rectal cancer patient recalled having discussed sexuality with the medical team. Factors independently increasing the chance to have discussed sexuality with the medical team were being younger (OR=2.77 [1.31; 5.84], p=.007), having an ostomy (OR=2. 93 [1.27; 6.73], p=.011) and radiotherapy (OR=2. 78 [1.23; 6.27], p=.014).Clinical Implications: These results highlight the need for developing interventions to improve information delivery at cancer announcement and for managing sexual troubles during survivorship in CRC patients, particularly those experiencing fecal incontinence. Strengths & Limitations:Strengths are the sample size, the national representativeness using the data of a large-scale nation-wide survey, the possibility to compare colon and rectal cancers. Limits are the assessment of sexuality 2 years after diagnosis, using only selfreported measures. Conclusion:This study highlights the lack of discussion about sexuality with the oncology team and the need for specific sexual rehabilitation interventions, especially for patients with rectal cancer and fecal incontinence. Developing these aspects may help CRC patients improve their sexual prognosis.

Colorectal Cancer in the Young: Epidemiology, Prevention, Management

“…A cross-sectional study in France of patients with CRC ages 20 to 84 found that only 20% of men and 11% of women-11% with colon cancer, and 33% with rectal cancer-discussed sexuality with their cancer team, although younger patients (, age 55) received more information than their older counterparts. 109 Studies have shown that patients with CRC have higher rates of sexual dysfunction than the general population and are less sexually active after surgery. Female patients may face vaginal reconstruction, dryness, or pain during intercourse, and male patients may experience erectile dysfunction.…”

Can the provision of sexual healthcare for oncology patients be improved? A literature review of educational interventions for healthcare professionals

“…All treatment modalities, surgery, chemotherapy or radiotherapy cause specific sexual problems and can, therefore, impair sexual health. These problems might arise at the beginning of treatment; it is likely they will continue during long-term follow-up and survival [ 4 , 10 , 13 – 16 ]. Hence, the probability is that all healthcare professionals working with cancer patients will encounter patients who experience sexual problems as a result of their disease or treatment.…”

Psychological and sexual distress in rectal cancer patients and partners

“…Thus, the present work emphasizes the need to offer interventions to address sexual problems, especially at the beginning stages of treatment. Couples may benefit from psychoeducational or intimacy‐enhancing programs 10,34,35 that equip them with the resources to cope with the long‐term consequences of surgery on their well‐being and sexual health.…”