ReviewSexual Function in Women with Colorectal/Anal Cancer
Introduction
The U.S. population of cancer survivors is expected to grow to 20 million by 2026.1 Despite early screening/detection and cancer prevention strategies, colorectal cancer is a common malignancy among both men and women.2 Anal cancer is less common; however, the number of newly diagnosed anal cancer cases has been rising every year.3 The incidence and mortality rates of colorectal cancer are higher in men than in women, and rates of anal cancer are slightly higher in women.3 In 2018, there will be an estimated 47,530 newly diagnosed cases of colon cancer, 17,100 new cases of rectal cancer, and 5,620 new cases of anal cancer among women.4
Treatment for colorectal/anal cancers varies by disease site and severity. Standard treatment typically includes a combination of surgery, chemotherapy, and/or radiation therapy. Management of colorectal cancer relies primarily on surgical resection of the bowel with the adjacent draining lymph nodes. The use of neoadjuvant or adjuvant chemotherapy (with or without radiation) to treat colorectal cancer depends on tumor location and disease stage. Treatment for colorectal/anal cancer may require a temporary or permanent stoma (an artificial opening on the abdomen through which the bowel or bladder diverts). The stoma opening allows for the attachment of a changeable bag through which feces can be eliminated.5 For anal cancer, primary radical radiotherapy and concomitant chemotherapy improve survival while also preserving the anal sphincter.6 The 5-year survival rates for colorectal/anal cancer have improved in recent years with screening advancements, an increase in the removal of colonic polyps (precursors to cancer), novel surgical techniques and therapies (adjuvant therapy), better preoperative staging, and targeted therapies.7 The use of adjuvant chemotherapy for colon cancer and neoadjuvant chemoradiation for rectal cancer also has improved survival rates.8
Female survivors of colorectal/anal cancer are typically older adults, with an average age of 72 years for colon, 63 years for rectal, and early 60s for anal cancer.1 Common issues of aging, such as comorbid illnesses and vulvovaginal tissue quality, can be exacerbated by cancer therapy.7 As these women live longer, understanding the long-term side effects of treatment are a priority.
Common physical side effects of treatment include autonomic nerve injury, bowel function issues (eg, incontinence, increased stool frequency, flatulence), buttock pain, and vulvovaginal health issues (eg, dryness, fibrosis, adhesions, shortening),9, 10, 11 all of which can adversely impact quality of life (QOL). Colorectal/anal cancer can have adverse and persistent effects on sexual function and psychological well-being. It should be noted that urologic issues, such as erectile dysfunction, are common among male cancer survivors and can result in significant difficulties in survivorship12; however, in this review, we explore the limited recent literature on the sexual health of women diagnosed and treated for colorectal/anal cancer, and also offer insights from our recent cohort of women who sought treatment to address vulvovaginal sexual health concerns.
Section snippets
Literature Review
We searched PubMed for peer-reviewed, English-language articles published between 2008 and 2018 using the following search terms: “colorectal cancer,” or “rectal cancer,” or “anal cancer” and “female,” and “sexual function,” or “sexual dysfunction.” Because most of the studies that we identified were not exclusively female-focused, we included studies that had both men and women. The criteria for inclusion consisted of peer-reviewed articles (cross-sectional, longitudinal, interventional, or
Overview of the Literature
Of 65 initially identified studies, 23 met our inclusion criteria (Table 1).13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 Of these 23 studies, 10 included women only13, 14, 15, 16, 17, 18, 23, 25, 30, 34 and 13 included both men and women.19, 20, 21, 22, 24, 26, 27, 28, 29, 31, 32, 33, 35 There were 15 cross-sectional survey studies,13, 14, 15, 17, 19, 20, 21, 24, 25, 26, 30, 31, 32, 33, 34 2 psychoeducational interventions,23, 27 5 longitudinal
Future directions of research and clinical care
Studies that have examined the sexual function of women with colorectal/anal cancer have identified sexual dysfunction as a prevalent issue after cancer treatment. Although the rates of sexual dysfunction vary by study design and treatment modality, the research supports including the management of sexual function in patients with colorectal/anal cancer as part of standard care. Furthermore, sexual function concerns should be reassessed throughout treatment and into survivorship.
Future research
Conclusions
Our review of the existing literature shows that more research is needed to explore the sexual health concerns of women treated for colorectal/anal cancer regarding long-term follow-up, pretreatment assessments, and interventions. Future trials including more women and younger patients are needed. Addressing the sexual health concerns of women with cancer is imperative for maximizing QOL into long-term survivorship. During the shared decision making process, healthcare providers should prepare
Statement of authorship
Category 1 Conception and Design Jocelyn Canty; Cara Stabile; Jeanne Carter
Acquisition of Data
Jocelyn Canty; Lisania Milli; Barbara Seidel; Deborah Goldfrank; Jeanne Carter
Analysis and Interpretation of Data
Jocelyn Canty; Cara Stabile; Lisania Milli; Barbara Seidel; Jeanne Carter
- (a)
Drafting the Article
Jocelyn Canty; Cara Stabile; Jeanne Carter
- (b)
Revising It for Intellectual Content
Jocelyn Canty; Cara Stabile; Lisania Milli; Barbara Seidel; Deborah Goldfrank; Jeanne Carter
- (a)
Final Approval of the Completed Article
Acknowledgments
The authors thank Sally Saban and George Monemvasitis for their careful review and valuable feedback.
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Sexual Function and Quality of Life Among Turkish Oncology Patients Receiving Chemotherapy
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2023, Radiotherapy and OncologyCitation Excerpt :The use of patient reported outcomes (PROs) could increase awareness and facilitate conversation regarding these important, yet sensitive issues and help survivorship planning and guide interventions. The use of PROs has been gaining increasing attention as endpoints in randomized trials as well as in routine clinical visits as a way to capture the patient’s perspective in regards to toxicity[67–69]. It is important to strive beyond a goal of superior clinical outcomes and evaluate the experiences of patients while respecting and recognizing diversity and priorities of patients.
High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study
2020, European Journal of Oncology NursingCitation Excerpt :Problems with intimacy, high levels of worrying, pain, or fatigue (Rohrl et al., 2016), or sequelae after surgery (Bruheim et al., 2010a,b) might explain some of these findings. Sexual difficulties might impact negatively on the patients in how they view themselves and interact with others (Canty et al., 2019). The present study conveys the importance of attention and knowledge on symptoms in order to offer good health care and prioritizing the care.
Stability of Symptom Clusters in Patients With Gastrointestinal Cancers Receiving Chemotherapy
2019, Journal of Pain and Symptom ManagementCitation Excerpt :In addition, at T2 and T3, this symptom had the highest distress ratings. Given the growing evidence on sexual dysfunction in patients with GI cancers,32–35 clinicians need to assess for this symptom and initiate appropriate referrals. While across the three symptom dimensions and the three assessments, five distinct symptom clusters were identified, three of them (i.e., psychological, CTX-related, and weight change) were relatively stable across symptom dimensions and across time.
Executive Summary of the Lower Anogenital Tract Cancer Evidence Review Conference
2023, Obstetrics and Gynecology
Conflicts of interest: None to report.
Funding: Funded in part through National Institutes of Health/National Cancer Institute Memorial Sloan Kettering Cancer Center Support Grant P30 CA008748.