The Prevalence of Erectile Dysfunction in Post-Treatment Colorectal Cancer Patients and Their Interests in Seeking Treatment: A Cross-Sectional Survey in the West-Midlands

Abstract

INTRODUCTION: Erectile dysfunction (ED) is a recognized complication of colorectal cancer treatment, particularly if surgery is below the recto-sigmoid junction (RSJ), and is an important quality-of-life issue. Previous studies have generated inconsistent prevalence estimates. AIM: We aimed to establish the prevalence of ED in postsurgery colorectal cancer patients and to establish what proportion wished to seek treatment. MAIN OUTCOME MEASURES: Questionnaire: sociodemographics, treatment methods, International Index of Erectile Function (IIEF)-5 questionnaire (validated tool to assess erectile function): score of <21 being used to define ED. METHODS: Cross-sectional survey. INCLUSION CRITERIA: adult male colorectal cancer patients diagnosed in 2000-2007, treated with curative intent in one teaching hospital. STATISTICAL ANALYSIS: logistic regression analysis to determine predictors of ED. RESULTS: The response rate was 46% (229/499). Respondents were aged 28 to 95 years; the majority were white (93.9%), more than half (57.1%) were in a sexual relationship, only a third reported having sex in the past 6 months (33.3%). The vast majority (75.1%; 172/229) of responders had ED as defined by the IIEF-5. ED was significantly associated with increasing age (P < 0.0005), having a malignancy below the RSJ (P = 0.002), having previous radiotherapy (P = 0.007), and having a stoma (P = 0.014). Those with ED were less likely to be in a sexual relationship (P = 0.002) and less likely to have had sex in the last 6 months (P < 0.0005). Only 29% of those with ED were not interested in treatment for their condition. CONCLUSIONS: These data suggest a prevalence rate of ED of 75% in colorectal cancer survivors; this may be functional or psychological in origin. Quality of life may be improved if follow-up clinics for cancer survivors not only concentrated on the detection of recurrence but also offered assessment of erectile function and referral for patients who desire treatment.