Survivors of childhood cancer often experience late effects from their treatment, including neurocognitive impairment and impairment in social and psychological functioning. New findings show that these types of impairment can lead to difficulties when trying to initiate sexual and romantic relationships in adulthood.
The findings come from a study published online February 6 in Cancer.
Although the new analysis found that childhood cancer survivors did not differ from control persons in terms of sexual satisfaction and romantic relationships, the intensity of neurotoxic treatment appears to be an indicator of risk for psychosexual impairment.
The authors found that survivors of childhood brain tumors and leukemia, as well as patients who had received treatment with high-dose neurotoxic modalities in childhood, reported the lowest rates of achieving milestones of psychosexual development, although sexual satisfaction did not differ consistently.
In other words, although the patients were less likely to reach certain milestones of psychosexual development, they were not necessarily less satisfied in comparison with others.
Psychosexual development was defined by the authors as reaching certain milestones that included sexual debut, entering committed relationships, and having children.
"When comparing the whole group of survivors to controls, we indeed found only one difference in psychosexual development," said lead author Vicky Lehmann, PhD, postdoctoral research fellow at Nationwide Children's Hospital, Columbus, Ohio. "While this is good news, it bears risk of overlooking certain survivors who might still be struggling."
Another important aspect of this study is that it raises awareness about satisfaction. "While the few available studies on psychosexual development highlighted that survivors seems to lag behind peers, they did not examine what it may mean for survivors," Dr Lehmann told Medscape Medical News. "With our study, we were able to show that although some survivors are less likely to reach certain steps in psychosexual development, they are not necessarily less satisfied ― all underlining the subjective nature of sexuality and romantic relationships."
Neurotoxicity Important in Outcomes
To assess psychosexual development in childhood cancer survivors, Dr Lehmann and colleagues compared 144 young adult survivors with 144 matched control persons.
Both groups completed questionnaires regarding psychosexual development, sexual satisfaction, and satisfaction with their current relationship status. The survivors were aged 20 to 40 years. The amount of time since diagnosis ranged from 5 to 34 years.
The survivors were further divided into those who had received nonneurotoxic treatment (48 survivors), those who had received low-dose neurotoxic treatment (36 survivors), and those who had received high-dose neurotoxic treatment (58 survivors).
Our rationale for why we hypothesized that neurotoxicity could be important for psychosexual outcomes later in life was based on a perspective of development across the life span," said Dr Lehmann.
"Neurotoxic treatments during childhood can impair neurocognitive functioning among survivors, which could make navigating through more complex social interactions difficult for survivors throughout life, including their later ability to engage in romantic relationships," she continued. "This rationale was supported by our data, yet the specific mechanisms remain to be tested. For example, future studies may test whether the neurotoxicity rating predicts actual neurocognitive functioning later in life or examine social skills among long-term survivors more closely."
Aside from having fewer lifetime sex partners, survivors did not differ from control persons in terms of sexual and relationship status satisfaction. But sexual debut differed across groups. The patients who received high-dose neurotoxic treatments were the least likely to have sexual experience (72%), and the group who received nonneurotoxic treatments had the highest rate of sexual experience (98%). Rates were similar (86% and 87%) for the ptaients who received low-dose neurotoxic treatments and control persons.
The authors observed the same pattern for relationship status, with the high-dose group having the lowest rate of having a partner, and the nonneurotoxic group having the highest (51% vs 83%).
There were also differences in the groups when it came to having a family. The low-dose group was the least likely to have children (14% had children), followed by the high-dose group (24%), control persons (34%), and the nonneurotoxic group (40%).
"We urge providers and researchers to comprehensively assess survivors, their lives, and development," said Dr Lehmann. "Survivorship care is typically provided by a multidisciplinary team, and just as it is normal to ask a survivor about physical problems, mood, school/job development, or social life, it should just be as normal to also ask about romantic and sexual aspects.
"We want to emphasize that addressing sexual/romantic issues in survivorship care is not about pathologizing or searching for problems, but there should rather be an open communication where all concerns in any domain could be addressed," she added.
Subtle Differences, but Remain at Risk
Approached for an independent comment, Julie Anna Wolfson, MD, MSHS, assistant professor in the Division of Pediatric Hematology/Oncology, School of Medicine, University of Alabama at Birmingham, noted that the differences between the survivors and control persons were subtle.
"However, survivors who had received high-dose neurotoxic therapy were more less likely to be sexually experienced or be in a relationship, while survivors who had received low-dose neurotoxic therapy and controls were comparable in terms of sexual experience and relationship status," she told Medscape Medical News. "The proportion of survivors having children was highest in the nonneurotoxic groups and controls and lower in the low-dose and high-dose groups.
"In terms of relationship and sexual satisfaction, neither diagnosis nor the degree of neurotoxic therapy administered was associated with satisfaction in multivariable analyses," Dr Wolfson noted.
Although the effects are subtle, it does show that some survivors are at risk for late effects. "I think the take-away message for practicing oncologists, whether they practice in a medical oncology or pediatric oncology arena, is that survivors are at risk of a host of late effects that range from medical to financial to psychosocial," she said.
This study underlines the need for more research in the psychosexual arena to drill down on these problems more, but also the need for practitioners to have this on their radar," Dr Wolfson emphasized. "The study does point out that our traditional categorization of patients by diagnosis is likely oversimplified, and that while further research is necessary, we should also have these problems in mind for a broad group of survivors.
"Sexual dysfunction has been well addressed and highlighted in older cancer survivors, but we need to make sure we ask these questions of the young adult survivors of childhood cancer as well," she added.
The study was funded by the Research Institute at Nationwide Children's Hospital and the Dutch Cancer Society. The authors and Dr Wolfson have disclosed no relevant financial relationships.
Cancer. Published online February 6, 2017. Abstract
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