Sexual dysfunction, informed consent and multimodality therapy for rectal cancer

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Abstract

Background: This study assessed the presurgical and preradiation discussion of the risk of posttherapy sexual dysfunction among patients who underwent potentially curative therapy for rectal cancer. The incidence of sexual dysfunction after treatment for rectal cancer was then determined.

Methods: A retrospective review of the medical records of 52 consecutive patients who underwent potentially curative procedures for rectal cancer within 15 cm from the anal verge was performed.

Results: Presurgical discussion of the risk of sexual dysfunction was not documented in the consent in 37 of 52 patients (71%). Among the 5 males who underwent local excision, none reported posttherapy sexual dysfunction. Of the 6 males who were treated by low anterior resection, only 1 had a postoperative complaint of sexual dysfunction. Five of 15 males (33%) treated with abdominoperineal resection (APR) alone reported postprocedure sexual dysfunction, whereas 6 of 8 males (75%) treated with APR and radiation reported dysfunction. Of the entire female cohort, only 1 of the 16 reported sexual dysfunction posttherapy.

Conclusion: A discussion of the risks of posttherapy sexual dysfunction was documented for fewer than one third of the patients. Among males after APR, the use of postoperative radiation showed a trend toward an increase in sexual dysfunction. Surgery and/or radiation therapy did not impact on sexual dysfunction in females.

Section snippets

Patients and methods

We performed a retrospective review of the medical records of 53 consecutive patients from January 1993 through December 1998. All patients underwent potentially curative surgery at Roswell Park Cancer Institute and had biopsy-proven rectal neoplasm within 15 cm from the anal verge. The patient population included 51 patients with adenocarcinoma of the rectum, 1 patient with a sarcoma of the rectum, and 1 patient with a large rectal villous adenoma. The cohort included 37 men and 16 women

Results

The consents included a physician-directed discussion of the procedures to be performed as well as potential risks of therapy. All consents included a discussion of additional perioperative risks including bleeding and infection. Presurgical discussion of possible postsurgical sexual dysfunction was documented in 15 of 53 patients (28%). There were 37 men who underwent surgery, with documentation of preprocedural discussion in 15 (40%). No documentation of preprocedural discussion was found

Comments

Although sexual dysfunction following locoregional therapy for rectal cancer is a commonly encountered problem, our results revealed that a discussion between physician and patient regarding this potential complication frequently did not occur at our own institute. Seventy-two percent of the 53 presurgical consent forms reviewed did not contain any record of discussion of potential sexual morbidity. Although lack of documentation of discussion occurred for 40% of the male patients, the rate of

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