How Does Treatment Affect the Sexuality of Head and Neck Cancer Patients?

For patients undergoing primary treatment with the combination of radiation/chemotherapy or radiation alone for head and neck cancer, sexuality was significantly impacted in many patients both prior to and during cancer treatment. Researchers found that when patient-reported outcome measures (PROMs) were used to assess sexuality, nearly 37% of study participants reported less sexual interest prior to the onset of treatment. They also noted that sexual interest increased during treatment to 60% when assessed during the 6-week follow-up visit. Baseline sexual interest was noted to return at and past the 12 month follow-up visits. 

The reported reasons for the decrease in sexuality seemed to vary, explained the researchers led by Heleen C. Melissant, MSc, of the Amsterdam Public Health Research Institute, in the study published in Oral Oncology. In the pretreatment population, older age, difficulty with social contact, weight loss, and constipation affected sexuality, whereas during 6- and 24-month follow up visits, female gender and poor social functioning were the main factors affecting sexuality.

“This is an important study insofar as the incidence of sexual dysfunction among people diagnosed with a head and neck cancer has not been adequately studied, nor did we understand how patients and their partners adjust following treatment. The finding that 60% of patients report a detriment to sexual health during treatment should serve as a wake-up call to any oncology professional treating this population,” said Don Dizon, MD, founder of the Oncology Sexual Health First Responders Clinic at Lifespan Cancer Institute and associate professor of medicine at the Alpert Medical School of Brown University.

The mean age of the included study participants was 61 years; 74% of participants were men and 26% were women. Of these patients, 53% underwent radiation, and 47% received chemotherapy/radiation. The most common cancers noted in the study population was of the oropharynx (46%), followed by the larynx (31%), oral cavity (13%), and the hypopharynx (12%). Nearly half of all patients studied were diagnosed with stage IV disease.

Symptoms such as fatigue, nausea and vomiting, sticky saliva, and dry mouth are believed to have contributed to the increase in loss of sexuality during the 6 weeks following treatment. Pain and loss of appetite were also believed to be contributing factors. Some of the other documented concerns reported during the 6- and 24-month follow-up period included factors such as financial concerns, dysphagia, and psychological distress. 

“Sexuality is a very nuanced concept that is experienced differently by men and by women. This study, which used patient-reported outcomes, confirms that sexual health is impacted by treatment for head and neck cancer. Further work is needed to better understand the psychosocial impact of head and neck cancer as it relates to sexual health, for both patients and their partners,” noted Dizon.

Melissant and colleagues reported that within the study findings, there may be benefit in using PROMs to “identify patients who might benefit from supportive care targeting sexuality.”