Erectile dysfunction distress common in CRC patients
MedWire News: Erectile dysfunction is common in men who receive treatment for colorectal cancer (CRC), highlights research showing that patients are not given adequate information, support, or treatment for the side effect.
"This paper suggests that clinicians are inadvertently neglecting, misleading, and offending such patients," write Sue Wilson (University of Birmingham, Edgbaston, UK) and co-authors in the BMJ.
The team performed in-depth interviews, lasting an average of 40 minutes, with 28 UK patients who received CRC surgery, chemotherapy, radiotherapy, or stoma. The men were mostly White and married, but varied significantly in age (average 59 years, range 34-80 years) and International Index of Erectile Function score.
The questions focused on the impact of ED on self-perception, relationships, and satisfaction with both information on ED and treatment for the condition.
Twenty-four of the men had ED and this was associated with "profound distress," the researchers report.
However, just 10 of the patients had been given information on the risk for ED, with younger patients most likely to be informed, and older patients most likely to be offended by ageist or dismissive comments.
Nine patients did not seek help for their ED, citing embarrassment or uncertainty who to consult. Ten patients consulted or were offered help by their family physician, and one patient discussed ED with their stoma nurse who referred them for further help.
Patient experiences on asking for ED help varied, with several patients denied treatment on grounds of cost or lack of knowledge. Although eight patients received phosphodiesterase type 5 inhibitors, treatment was free for just one patient, and was ineffective or unacceptable for seven patients.
"This study suggests that clinicians should be aware of three things," Wilson et al write.
"Firstly, there is considerable potential for offending older men by making assumptions about their sexual behavior or motivation; secondly, phosphodiesterase type 5 inhibitors are not a panacea; and thirdly, most men are not going to ask for help with ED."
They add: "Colorectal clinical nurse specialists are well placed to give information, coordinate treatment, and monitor progress, but such an intervention needs to be developed and fully evaluated."
In an accompanying editorial, Larissa Temple (Memorial Sloan-Kettering Cancer Center, New York, USA) notes that the mechanism of ED after CRC treatment is unknown, as is the efficacy and optimal timing of common ED treatments in this population.
She said: "To develop effective interventions it is crucial to understand the potentially unique stressors and confounders associated with CRC."
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By Lynda Williams