NEW YORK (Reuters Health) – ASCO recently adapted a Cancer Care Ontario (CCO) guideline to create its own recommendations on managing sexual problems that result from cancer diagnosis and/or treatment.
“Although prevalence rates of sexual difficulties associated with cancer and its treatment vary depending on primary diagnosis, treatment modality, methods of assessment, and type of sexual difficulty, estimates are reported to range from 40% to 100%,” according to members of an expert panel who developed the ASCO guidelines.
“This includes disorders of sexual desire and sexual response influenced by the biologic, physiologic, and psychological challenges that cancer and its treatments present,” they add.
Panel members and ASCO staff reviewed the 2016 CCO guideline, determined that the recommendations are “clear, thorough, and based upon the most relevant scientific evidence,” and added statements and modifications to make the guideline relevant to a broader audience.
“The most important issue in the guideline is to bring up the topic of sexual health with the patient,” said Dr. Michael Diefenbach of Northwell Health in Manhasset, New York, a member of the expert panel and a coauthor of the Journal of Clinical Oncology special article on the ASCO guideline, online December 11.
“This does not need to be time intensive,” Dr. Diefenbach told Reuters Health in an email. “There are a host of resources available that address psychosocial and psychosexual issues.”
“In addition to counseling services, there are also a number of medical options available,” he noted. “For women, such options include lubricants, vaginal moisturizers, low-dose vaginal estrogen, and lidocaine, to name a few.”
“For men, phosphodiesterase type 5 inhibitors may be beneficial, in addition to surgery for men who have exhausted all non-surgical options,” Dr. Diefenbach said.
The guideline further states that “both women and men who are experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.”
“I like the idea of having a clear guideline, an algorithm to use as a starting point when faced with sexual issues in our cancer survivors,” said Dr. Bonni Guerin, medical director, Breast Cancer Treatment and Prevention, Carol G. Simon Cancer Center at Overlook Medical Center, Atlantic Health System in Summit, New Jersey.
“They are reasonable, attainable, understandable,” she told Reuters Health by email.
“Practically speaking, implementation is the larger issue,” she observed. “Many of the recommendations are to some extent obvious and fairly straightforward – yet sadly, I would predict they are not part of an oncologist’s general discussion during routine follow-up visits.”
“There is an issue with access to appropriate psychosocial or psychosexual counseling, as not all medical communities have this expertise nearby and, for some, insurance coverage may be an issue,” she added. “Much of what is offered in the guidelines can be accomplished by a member of the healthcare team.”
“There is, I believe, a significant issue that lies within the walls of the exam room,” Dr. Guerin noted. “Doctors do not include sexual health as part of their routine questioning of cancer survivors. We spend quite some time eliciting answers to questions that might signal recurrence, or the more traditional ‘medical’ toxicities to their treatment.”
“Lack of training, lack of comfort in talking about the more intimate parts of our patients’ lives, and frankly time, all are obstacles to an open dialogue about potential sexual problems,” she concluded.
More information on the guideline and additional resources are available at http://bit.ly/2B7duBi.
SOURCE: http://bit.ly/2zkIRKl
J Clin Oncol 2017.
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