2949 - Rates of Sexual Dysfunction and Prevalence of Estrogen Supplementation after Pelvic Radiation for Women with Early-Onset Rectal Cancer

A. Arzola¹, A. L. Kohut-Jackson², T. H. Yao³, S. Kundu³, D. Nebgen³, and E. Holliday⁴; ¹The Universtiy of Texas MD Anderson Cancer Center, Houston, TX, ²Saint Louis University School of Medicine, St. Louis, MO, ³The University of Texas MD Anderson Cancer Center, Houston, TX, ⁴Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Pelvic radiation (RT) for rectal cancer contributes to vaginal dryness, stenosis and dyspareunia. These problems are compounded by hormonal changes experienced by women with early-onset rectal cancer (EORC). Estrogen supplementation may improve vaginal and sexual problems by promoting vaginal epithelial regeneration, but many women are not routinely offered this treatment. We aimed to evaluate patient-reported sexual problems and frequency of estrogen prescription among women treated with pelvic RT for EORC. Materials/

Methods: Patients with EORC, defined as age <50 years at diagnosis, who presented to our Rectal Cancer Clinic from 2012-2022 were enrolled in a prospective patient-reported outcome (PRO) study. For this project, we looked specifically at scores for sexual interest (range 0-100, higher scores = more interest) and dyspareunia (range 0-100, higher scores = more pain) items in the EORTC QLQ-CR29. We recorded whether estrogen was prescribed after pelvic RT (vaginal, oral or both) and when it was prescribed. To evaluate the association with clinical and treatment factors, dyspareunia and sexual interest scores were analyzed with a linear mixed-effects model including age, distance from the anal verge (AV), T-stage, time, type of surgical procedure, estrogen prescription, pelvic floor physical therapy and vaginal dilator use.
Results: Forty women with EORC enrolled in this prospective PRO study. The median [IQR] age at RT was 43 [38-48] years, 34 (85%) were white, 35 (88%) had microsatellite stable tumors, 29 (73%) had T3 tumors and the median [IQR] distance from the AV was 6 [5-8] cm. The majority (N=38, 95%) were treated with 50-50.4Gy in 25-28 fractions with concurrent chemotherapy. Thirty-six women completed the sexual interest and dyspareunia items. At a median [IQR] 24 [14-49] months after pelvic RT, 14 (39%) and 15 (42%) women said they were not at all and a little interested in sex, respectively. Ten (28%), six (17%) and 8 (22%) women said they experienced a little, quite a bit and very much pain with intercourse, respectively. Only 17 women (35%) were prescribed estrogen after pelvic RT. The median [interquartile range IQR] time from RT to estrogen prescription was 17.6 [2.4-27.6] months. Of women prescribed estrogen, 12 (66.7%) were prescribed vaginal, 2 (11.8%) were prescribed oral, 1 (5.9%) was prescribed both oral and vaginal and 2 (11.8%) were prescribed pellets. In linear mixed-effects models for sexual interest and dyspareunia, only distance from the AV was significantly associated with sexual interest (B = -3.03(1.29); P=.029).
Conclusion: Although sexual dysfunction is prevalent after pelvic RT for women with EORC, estrogen was only prescribed for 35% of patients, and the median time to prescribing estrogen was 18 months. Early and proactive referrals post-RT for discussion of estrogen supplementation may improve sexual health outcomes for women with EORC. Further prospective study is warranted.