Evaluation of Disparity in Physician Assessment of Sexual Dysfunction in Women vs. Men Receiving Brachytherapy for Genitourinary Cancers

Abstract

<h3>Purpose/Objective(s)</h3> Brachytherapy is an integral component of treatment for genitourinary cancers, but comes with long-term risk of sexual dysfunction, with 90% of women and 50% of men experiencing sexual dysfunction after brachytherapy for gynecologic malignancies and prostate cancer, respectively. We hypothesized that women's sexual health was not being assessed in clinic at the same rate as their male counterparts receiving prostate brachytherapy. We similarly hypothesized that our institutional data would be representative of clinical investigators nationally, with lower rates of sexual function assessment in women compared to men enrolled on clinical trials. <h3>Materials/Methods</h3> Patients with cervical or prostate cancer evaluated for brachytherapy between 2010 and 2021 at a single academic institution were included in this retrospective analysis. Consult notes were reviewed to assess if patients were asked about baseline sexual function with or without patient-reported outcomes (PRO). Chi-square test was used to determine statistically significant differences between the two groups (p<0.05). For a more robust national comparison, we also queried the NIH Clinical Trials Database to determine the proportion of clinical trials assessing sexual function as a primary or secondary endpoint after brachytherapy for prostate or cervical cancer. <h3>Results</h3> We analyzed 126 female and 75 male patients who were evaluated for cervical and prostate cancer brachytherapy, respectively. More men than women were asked about sexual function at time of consult, even though the female cohort was younger (Table 1). Rates of assessment of sexual function were similar in men who were and were not offered ADT [45 (88%) vs. 22 (92%); p=0.65]. Prostate cancer brachytherapy trials were also more likely to assess sexual function compared to those in cervical cancer. <h3>Conclusion</h3> We demonstrate a significant difference between men and women in the ascertainment of sexual function both in our clinic and on brachytherapy clinical trials nationwide. We have previously shown that 79% of women believed that sexual function was an important component of their overall health. Even though brachytherapy has a highly deleterious impact on sexual function, women are not being evaluated for this important functional outcome at the same rate as men. Further studies are warranted to fulfill this unmet need and to understand the barriers to assessing and treating sexual dysfunction in women receiving brachytherapy as part of treatment.