Erectile Dysfunction Common in Childhood Cancer Survivors

Fran Lowry

October 15, 2018

Erectile dysfunction (ED) was reported by 29% of male survivors of childhood cancer in the first large study that set out to investigate this issue.

The study involved 1021 male survivors who had been treated for cancer while they were children at St. Jude Children's Research Hospital, Memphis, Tennessee. From this group, scores from questionnaires that assessed sexual health were available for 956 men. Of these patients, 29% (n = 277 participants) reported having ED.

The study was published as a research letter October 4 in JAMA Oncology.

"The prevalence of erectile dysfunction was higher than what has previously been reported," senior author James L. Klosky, PhD, told Medscape Medical News. He was at St. Jude Children's Research Hospital when he led the study but has since moved. He is now a professor at Emory University School of Medicine and is director of psychology at the Aflac Cancer and Blood Disorders Center, Atlanta, Georgia.

"Yet, this is the first very large study which has considered erectile dysfunction among males with a history of childhood cancer. At 29%, ED among survivors was even higher than what is typically reported in the general population," Klosky said.

Interventions Can Help

Risk factors that were associated with ED included low testosterone level, low lean muscle mass, and poor body image or body dissatisfaction.

Most of the variables that were associated with ED in the study are modifiable, and there are established pharmacologic, behavioral, and psychological interventions that should help, Klosky said.

"If a survivor with ED has low testosterone, for example, exogenous testosterone may be an option, whereas if it's low lean muscle mass, working out may be beneficial. If a patient has ED and body image dissatisfaction, psychological intervention is indicated. The key issues to remember include proactively assessing survivors for ED and referring to appropriate specialists," he commented.

ED in male childhood cancer survivors might be a result of the treatment they received for their cancer, Klosky noted.

Hypogonadism could be an underlying factor driving ED in survivors, but other late effects of therapy and their treatment should also be considered.

"There are so many other established consequences of therapy that have been traditionally prioritized in the patient encounter, it's important not to forget sexual functioning," he said.

Erectile Dysfunction in CCSs Unappreciated

ED as a possible adverse effect in childhood cancer survivors has not received much press or been reported in the literature.

"But the fact that ED is being reported by 29% of our sample, essentially that's 3 out of 10 men. This strongly suggests that assessment of sexual functioning be included as part of the clinical interview," Klosky said.

The research also showed that Hispanic and African American men who survived childhood cancer had a greater risk for subsequent ED.

"The clinical translation of this finding suggests that if you have a survivor of childhood cancer who identifies as African American or Hispanic, you need to ask about this," Klosky said.

"There is uptick in reported ED among black and Hispanic survivors. Regardless of race, it's important to initiate this line of questioning with patients, because ED is such a sensitive topic. Sometimes patients are embarrassed to bring it up themselves," he said.

Study Details

In the current study, the median age of the study participants was 31.3 years (range, 18.8 - 61.5 years). Patients were regarded as having ED if they had a score of less than 25 on the validated, 6-item version of the International Index of Erectile Function.

Men with low testosterone levels, defined as morning serum concentrations less than 250 ng/dL, were almost twice as likely to report ED as men with normal levels (relative risk, 1.70; 95% confidence interval, 1.20 - 2.41).

Younger age at the time of the study was also an independent risk factor for ED.

"This finding may be a reflection of the differential age distributions across tumor types. Protocols to treat patients with brain tumors were introduced at St. Judes in the mid 1980s, and this association is likely driven by the robust representation of young survivors treated for brain tumors in our study, which is a population at risk for hypogonadism," Klotsky noted.

The results are hypothesis generating and need validation in an independent cohort, he added.

Nevertheless, "clinicians should be aware that appropriate management of ED in survivors of childhood cancer could translate to significant benefits in health-related quality of life," Klosky said.

The study was supported by American Lebanese Syrian Associated Charities and the National Cancer Institute. Dr Klosky reported no relevant financial relationships.

JAMA Oncol. Published Online October 4, 2018. Abstract

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