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.