(012) Gynecologic Oncology Survivorship: Seeking Help for Sexual Distress
Authors: Jang A , Walia A , Othieno A , Chen L , Rowen T 
Published: May 2023

Abstract

Introduction
Addressing sexual side effects is an important component of gynecologic cancer survivorship. In order to provide patient-centered care, it is important to determine which patients have the highest risk of sexual problems following treatment.

Objective
The purpose of this study is to quantify and identify predictors of help-seeking for sexual distress in gynecologic oncology patients undergoing routine surveillance.

Methods
We performed a cross-sectional study of patients who have completed treatment for gynecologic malignancy at a single academic institution. Sexual activity was defined to include masturbation, oral sex, and sexual intercourse. The instrument contained the validated Female Sexual Distress Survey-Revised (FSDS-R), for which a score of 11 or above indicates sexually-related personal distress. We also assessed patient experience and preferences regarding the communication of sexual information with their healthcare team and selected resources. We performed one-sided t-test and logistic regression statistical analyses using STATA version 17.0.

Results
Between May to November 2022, 250 (of 331) eligible patients completed the survey (75% response rate). The median age of respondents was 60-years-old (range 27-85; IQR 19). Thirty-eight percent of patients had ovarian cancer, 42% uterine, and 20% cervical/vaginal/vulvar cancer. The majority (64%) had Stage I disease. The median years from finishing treatment (IQR) was 3.6 (2) years. The sample was diverse, with 44% self-identified as non-white (Asian, Black, Latinx or pacific Islander), while the vast majority (93%) was cis-gender, and 83% were heterosexual. Sixty-seven percent were married or in a relationship. Overall, 133 (53%) reported being sexually active within the past 30 days. FSDS-R scores ranged from 0-52 with a median (IQR) of 5 (15). 38% met criteria for sexually-related personal distress. Age was significantly associated with less sexual distress (OR 0.96; 95% CI: 0.94–0.99; P = 0.01). Uterine cancer was significantly associated with less sexual distress (OR, 0.49; 95% CI: 0.24–0.97; P = 0.04). In contrast, the combined group of cervical/vagina/vulvar cancer patient were also found to have a significantly increased rate of sexual distress (OR, 3.56; 95% CI: 1.56–8.10; P&lt;0.01). Twenty-five percent of patients “somewhat” or “strongly disagreed” that they were adequately informed about sexual side effects of their cancer-directed care while another 42% felt neutral. 86.6% believed that physicians should routinely ask about sexual health, with 75% welcoming this anytime throughout treatment. Over half (53.1%) of respondents reported that healthcare providers “never” or “rarely” asked about sexual difficulties over the past 3 years and 33% of patients had previously discussed their sexual health with their gynecologic oncologist. Most patients (86%) found a sexual health conversation helpful. Patients had varied interest in speaking to a sexual medicine expert (35%) or a psychologist and relationship counselor (22%).

Conclusions
Patients are interested in sexual health with their gynecologic oncologist. An even larger proportion of patients desired to connect with a sexual health specialist, psychologist or relationship counselor, emphasizing the need for a multidisciplinary approach in gynecologic oncology survivorship.

Disclosure
No