(106) EXPLORING FEMALE BLADDER CANCER SURVIVORSHIP: PATIENT PERSPECTIVES ON SEXUAL HEALTH CHALLENGES AND RESILIENCE WHEN RECEIVING BLADDER SPARING THERAPIES
Authors: Helman T , Imtiaz N , Nguyen G , Nicaise E , Torlak M , Patil D , Master V , Narayan V , Mehta A , Joshi S 
Published: December 2024

Abstract

Introduction
Over 80 000 patients are diagnosed with bladder cancer (BC) yearly in the United States, approximately 25% of which are women. There are unique quality of life (QoL), reproductive, and sexual health considerations when treating women with both muscle- and non-muscle invasive BC (MIBC and NMIBC). While there has been increased understanding of female sexual dysfunction (FSD) in our cystectomy population, there is very little published on FSD in women receiving bladder sparing treatments.

Objective
To assess the sexual health of female bladder cancer (MIBC and NMIBC) patients receiving bladder sparing therapies through validated survey and patient interview.

Methods
We performed a retrospective analysis of our institutional bladder cancer database to identify female patients &gt;18 years old with diagnosis of NMIBC or MIBC who had not undergone cystectomy from 2012 to present. All identified patients were invited to participate in a quantitative survey and structured qualitative interview. The survey consisted of the female sexual function index (FSFI), sexual health questions from the EORTC NMIBC-C24 (omitting “male only” questions), and additional selected variables including history of menopause, total or partial hysterectomy, and pelvic radiation. Patients answered survey questions by email or phone and recorded interviews were transcribed. Descriptive analysis, Fisher’s exact, and Kruskal-Wallis Test were performed to assess variation in sexual function.

Results
Of the patients within our cohort who met the inclusion criteria (n = 44), 19 were successfully reached by phone with 18 agreeing to participate in the interview. Patient demographics, medical history, and disease characteristics are displayed in Table 1. Of those interviewed, 5/18 (27.7%) were sexually active. The median (min-max) age of sexually active participants was significantly younger 57 (49-65) years compared to those not sexually active, 75 (60-88) years. There were no other significant differences between the two groups. Of the total participants, 77.8% were white and 50% married. Only one patient had not undergone menopause and 77.8% had a history of total or partial hysterectomy. The majority of the patients met criteria for the American Urologic Association (AUA) high risk category, none were low-risk. The median time since diagnosis was 61 (7-145) months with a median of 13.5 (0-57) BCG treatments total. Two patients have MIBC and were treated with trimodal therapy. Of the sexually active, 1/5 (20%) had FSD based on the FSFI, with scores lowest in desire, arousal, and satisfaction. No sexually active patients endorsed fear of contaminating their partner (Table 2). The majority of patients did not feel that the diagnosis or treatment of BC affected their sexual life, Fig. 1 displays representative patient comments.

Conclusions
This is the largest quantitative and qualitative study aiming to understand FSD in BC patients who have not undergone cystectomy. Treatment for BC can be burdensome to patients due to years of treatment regimens and surveillance. It is important to understand the unique perspective of women survivorship to provide supportive intervention and counseling. Although limited by small sample size, it appears that FSD is low in patients receiving bladder sparing treatments.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Ferring Pharmaceuticals Inc and Ciox Health, Cg oncology, Engene pharmaceuticals, Photocure, Blue Earth Diagnostics.