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Oral squamous cell carcinoma diagnosis affects sexual behavior

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March 13, 2017

Patients with oral squamous cell carcinoma reported significant declines in the frequency of vaginal and oral sex after their diagnosis, regardless of tumor HPV status, according to a study published in Cancer.

Still, nearly 70% of patients reported strengthened relationships with their partners following diagnosis.

Maura L. Gillison

“I designed the study based on 20 years of discussions with patients about the many ways in which a diagnosis of a cancer linked to a sexually transmitted infection can affect their lives,” Maura L. Gillison, MD, PhD, a professor of internal medicine at The Ohio State University Comprehensive Cancer Center, told HemOnc Today. “This study allowed us to measure how common these various experiences are across this patient population. Our hypothesis that patients with HPV–positive cancer have greater relationship stress due to a diagnosis of a cancer caused by a sexually transmitted infection was incorrect. The experience of cancer and its therapy was a great equalizer across all patients treated for oropharyngeal and oral cancer.”

Because strong associations have been observed between sexual behavior, oral HPV infection and risk for oropharyngeal cancer, the researchers explored the effects of diagnosis and treatment of HPV–positive and –negative oropharyngeal and oral cavity squamous cell carcinomas (OSCC) on subsequent relationship stress and sexual behavior.

At diagnosis and at 6-month follow-up, 262 patients with OSCC (81.3% men; 54.6% aged 40-59 years; 54.2% HPV positive) and 81 partners were asked to assess relationship distress, HPV transmission, and concerns about health consequences and sexual behavior.

Relationship distress was infrequently reported. Ninety-two percent of patients said they felt supported by their partner, and 69% of patients said they felt their relationships with their partners had strengthened since cancer diagnosis.

Only 3.6% reported difficulty communicating and 2.1% reported more disagreements. However, both HPV–positive patients (25%) and their partners (14%) reported feelings of guilt or responsibility for the diagnosis of an HPV–caused cancer.

“My entire research team thought the strengthening of relationships was a lovely finding,” Gillison said. “This is consistent with my own observations in clinic. Patients will often share that the cancer diagnosis heightens awareness of what is truly important in their lives. A healthy relationship with a life partner is one of these factors.”

Patients reported significant changes in the frequency of vaginal and oral sexual behaviors from baseline to 6-month follow-up. At baseline, 32% of HPV–positive patients and 29% of HPV–negative patients reported having sexual intercourse at least weekly, and 9.5% of HPV–positive patients and 4.5% of HPV–negative patients said they gave or received oral sex.

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At 6-month follow-up, abstinence from vaginal sex increased from 10% to 34% (P < .01) and abstinence from oral sex increased from 25% to 80% (P < .01). At follow-up, 65% of patients and 72% of partners reported that their sex life had changed; the proportions reporting changes were similar regardless of HPV status.

The study population may not be representative of all patients with OSCC, and only half of eligible partners consented to participate. Long-term follow-up could show additional changes to sexual behavior, the researchers wrote.

“At this point, I hope these data increase awareness of sexual health among care providers,” Gillison said. “In the long run, perhaps the data will stimulate additional research on survivorship issues related to sexual intimacy. Perhaps quality-of-life outcomes should include more measures of the effect of cancer and its treatment on sexual health. This could be particularly important as a measure of quality of life in treatment de-intensification trials.”

Sexual activity remains common among Americans aged 57 to 64 years (73%) and 65 to 74 years (53%), Gypsyamber D’Souza, PhD, and Hilary A. Robbins, MSPH, both of Johns Hopkins Bloomberg School of Public Health, wrote in an accompanying editorial.

“The observed decreases in sexual intimacy [in the study] suggest that there may be a need to incorporate sexual counseling into survivorship care of OSCC,” D’Souza and Robbins wrote. “However, the follow-up visit in this study occurred relatively soon after therapy completion. Longer evaluation of survivors is needed, because some or all of the observed decreases in intimacy may naturally resolve without counseling.” – by Chuck Gormley

For more information:

Maura L. Gillison, MD, PhD, can be reached at the Department of Medicine, The Ohio State University, 420 West 12th Ave.. Room 620, Columbus, OH 43210; email: maura.gillison@osumc.edu.

Disclosure: The Oral Cancer Foundation and The Ohio State University Comprehensive Cancer Center funded the study. Gillison reports personal fees from Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Eli Lilly, GlaxoSmithKline and Merck. One other researcher reports nonfinancial support from Merck and personal fees from Sanofi Pasteur MSD. D’Souza and Robbins report no relevant financial disclosures.