Sexual Dysfunction Associated With Colorectal Cancer Treatment: An Ignored Condition

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1 Sexual Dysfunction Associated With Colorectal Cancer Treatment: An Ignored Condition O. Lenaine Westney, MD Associate Professor Fellowship Director, Urinary Tract and Pelvic Reconstruction Department of Urology

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5 Colorectal Cancer Survivors

6 Projected New Cancer Diagnoses, 2015

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9 Rectal Cancer Treatment Patterns

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11 Radiation Treatment Planning: 45 Gy

12 Rectal Anatomy High Anterior Resection 15 cm Low Anterior Resection Colorectal or coloanal anastomosis with diverting ileostomy Ultralow Anterior Resection Abdominoperineal Resection Permanent Colostomy

13 Advances in Colorectal Surgery Total mesorectal excision Reduced recurrence Preservation of the neurovascular bundles Introduction of minimally invasive surgery Laparoscopic Robotic assisted

14 TME

15 Sexual Dysfunction in Rectal Surgery Patients Persistent sexual dysfunction after multimodality treatment of rectal cancer occurs in roughly 50-70%, irrespective of gender. Males: ejaculatory and erectile problems APR, surgical complications, radiation therapy, stoma Females: dysparenunia and vaginal lubrication Radiation therapy and stoma Lange MM, Marijnen CA, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, Meershoek-Klein Kranenbarg E, van de Velde CJ; Cooperative clinical investigators of the Dutch. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer Jun;45(9):

16 Factors correlating with sexual interest and function in long-term colorectal cancer survivors What is the general status of sexual interest/function in long-term colorectal cancer survivors? Patients were mailed self-administered standardized surveys: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) Colorectal Cancer (CRC) disease specific module (CR29) Quality of Life in Adult Cancer Survivors (QLACS) N= 771 patients; Mean time from diagnosis questionnaire completion: 10.5 years

17 Disease Characteristics Characteristics Overall Old N=501 Young N=270 N % N % N % Tumor site Colon Rectum/Rectum sigmoid Unknown (multiple or location NOS) Life time any XRT No P Yes Life time any Chemotherapy No <0.001 Yes

18 EORTC QLQ CR29 The EORTC QLQ-CR29 is psychometrically validated in patients at various stages of their treatment for colorectal cancer. The 29 questions include four scales (urinary frequency, stool quality, stool frequency, body image and 19 single items. Responses to sexual interest and function questions were extracted Whistance RN, Conroy T, Chie W, et al.. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer Nov;45(17):

19 EORTC QLQ CR29: Sexual Interest/Function Questions

20 Overall EORTC Score * being scored according to the symptom scale algorithm thus a higher score is better.

21 Mean Domain Score by Permanent Ostomy

22 Mean Domain Score by Radiation Therapy

23 Mean Domain Score by Age at Diagnosis

24 What is the ideal time point for intervention? Prior to any therapy Simultaneous with chemoradiation Early post-operative Erectile Recovery Protocol (Males) Sexual Function Assessment/Rehabilitation Vaginal Reconstruction Differences from standard RRP patients Almost 100% radiated Potentially either a colostomy or diverting ileostomy

25 Conclusions Increasing overall survival in colorectal patients and diagnosis in younger patients has created a more urgent need for urological support and intervention in the management of genitourinary dysfunction Coordination with GI radiation/medical oncologists and colorectal surgeons is required to identify patients desirous of treatment for sexual dysfunction Automatic referral triggered by patient reported ROS in electronic medical record

26 Thank you for your attention