Holistic sexual health care in recipients of high dose chemotherapy or
chemo-radiotherapy and bone marrow transplantation for haematological malignancy
presenting with sexual dysfunction
R. Chatterjee (1), H.H. McGarrigle (1), P.D. Kottaridis (2)
Departments of Obstetrics and Gynaecology, UCL, London, UK (1); Department
of Haematology, UCL, London, UK (2)
Introduction: The long term survival of recipients of high dose
chemotherapy (HDC) with or without total body irradiation (TBI) and bone marrow
transplantation (BMT) for haematological and other cancers have improved in the
last decade. Thus sexual morbidity has become apparent affecting 70–80% of
survivors.
Aims of study: To test the hypothesis that holistic sexual health care
implemented by a multidisciplinary team (MDT) of specialists using polytherapy
with sex hormones, counselling and erectogenic drugs can improve the quality of
life of cancer patients.
Design and Methods: We studied 110 patients aged 26–62 (median 41)
years presenting over a l0 year period with features of hypogonadism and sexual
dysfunction, who had HDC and allogeneic with TBI or autologous BMT for a variety
of haematological malignancies. Sexual response was assessed before and at 6 and
12 months of polytherapy by using clinical (IIEF scoring and NIH criteria) and
endocrine parameters. A MDT of specialists (oncologists, reproductive endocrine
and sexual health specialist, counsellors) was involved to offer holistic sexual
health care to the cancer patients. Patients presenting hypogonadism with
diminished libido were treated with Testosterone replacement therapy (TRT) (4
weekly intramuscular injections of testosterone propionate), ED and low libido
were treated sildenafil (50–100 mg twice weekly) and TRT and others had
counselling and support only.
Results: At the onset of study, 49 (44%) patients presented with
diminished libido, 88 (80%) had diminished libido and ED, and 25 (23%) had
ejaculatory and orgasmic problems. All patients with diminished libido were
treated with TRT and only 40 (82%) had correction of libido both clinically and
biochemically. Of the 88 patients with diminished libido and ED who were treated
with TRT and sildenafil, only 50 (57%) had a good response as evident from IIEF
score and NIH criteria. Psychological support and counselling offered to 80/110
(73%) patients and 60/80 (75%) showed good results.
Conclusion: Our data suggest that a holistic approach to cancer care
provided by a multidisciplinary team of specialists using polytherapy may
improve the sexual morbidity of the cancer survivors.
