Sexual Dysfunction and Depression in Cancer Patients Receiving Radiotherapy: A Prospective Study

Abstract

Purpose/Objective(s): Quality of life (QoL) is regarded as an important issue in oncology. QoL is composed of many parameters, including sexuality. The term “sexual dysfunction” describes health problems that interfere with sexual intercourse and reproduction, in turn affecting sexuality. Cancer diagnosis and treatments often cause physical and psychological disruptions to sexual health. The main objective of this study was to delineate the rates and clinical course of sexual function (SF) and depression in cancer patients undergoing radical radiotherapy (RT). Materials/Methods: The evaluation included the completion of patients’ self-reported questionnaires. Forty-eight male and 90 female RT-naive patients with breast cancer or pelvic tumors completed the Female Sexual Function Index (FSFI), the International Index of Erectile Function (IIEF) and the Hamilton Depression Scale (HDS) prior to (Phase 1), at the end (Phase 2) and 12 months post-RT (Phase 3). Results: Out of the 174 patients initially assessed, 138 agreed to participate in the study. The majority of patients (93.8% of males and 80% of females) experienced intense sexual dysfunction. At presentation, males reported severe erectile dysfunction (ED) that was significantly associated with age. However, only in sexual desire (SD), was the difference between baseline and Phase 3 significant. Although the incidence of severe ED in all three study phases was impressive, it remained stable over time (severe ED: 79.2% Phase 1 82.2% Phase 3). For all women, an improvement was observed in all parameters of the FSFI over the course of the study. FSFI total scores at Phase 3 were higher compared to Phase 1 and 2 (p<0.05). Females who underwent pelvic RT scored lower than those who underwent breast RT. The differences were significant at all three study phases (p<0.001). As to the primary site, the differences were statistically significant among females with breast cancer (p<0.05). Patients with PS 0 presented higher total FSFI scores at Phase 3 compared to those with PS 1 (p<0.05). Even though depression was not related to SF, 53% of all patients reported some kind of depressive symptoms at baseline (Phase 1). Conclusions: Overall, the current study showed that the majority of patients with cancer treated with RT experienced intense sexual dysfunction. Pelvic RT affected SF to a higher degree than breast RT. We conclude that cancer patients undergoing RT, mainly in the pelvic region, experience an important degree of sexual dysfunction and depression, which the radiation oncologist should not ignore.