George Dowswell, PhD
Men with colorectal cancer (CRC) are not routinely informed about the potential for erectile dysfunction (ED) or how the condition can best be managed, according to the results of a small, UK-based qualitative interview study. In fact, men with CRC are given short shrift compared to men with prostate cancer, for whom care pathways have been developed “to ensure that information about ED is incorporated into routine care and that treatment is offered,” the researchers said.
George Dowswell, PhD, with the University of Birmingham in England, and colleagues interviewed 28 men in the West Midlands who had been treated for CRC over a recent 10-year period. Most had undergone surgery and chemotherapy. Participants were chosen from a wide variety of backgrounds and treatment strategies in order to provide “a broad range of views and experiences of erectile dysfunction and to include minority views.”
CRC affects more than 38,000 people each year in the United Kingdom, and about half of patients survive for more than 5 years after treatment. The disease is more common in men than in women, and recent survey results indicate that 75% of men develop ED after treatment.
There is little published research characterizing the experiences of men with CRC who develop ED or their preferences about information, services, and treatment. And much of what is thought to be true is derived from prostate cancer studies and may not be true for patients with CRC.
Results of the present survey showed that while most men experienced ED as a result of their treatment, many of them maintained that they had not been “warned specifically” about the possibility of ED. They were rarely provided with adequate, effective, and affordable care for ED. Ageism was evident among health professionals, who tended to offer more information and help to younger men and sometimes told older patients that ED would not be a concern given their age.
Survey responses also “reflect the popular belief” among both clinicians and patients that phosphodiesterase type 5 (PDE5) inhibitors are effective in all patients. However, these agents are often ineffective, and patients have insufficient access to alternate treatments, the study authors said.
Future research should closely examine how information on ED is currently disseminated in order to determine what effect the various methods have on men’s understanding of the condition, they added. It would also be helpful to interview patients’ partners, who may provide “different and richer” accounts of ED.
Dowswell G, Ismail T, Greenfield S, Clifford S, Hancock B, Wilson S. Men’s experience of erectile dysfunction after treatment for colorectal cancer: qualitative interview study [published online ahead of print October 18, 2011]. BMJ. 2011;343:d5824. doi: 10.1136/bmj.d5824.