Title: The Underestimated Consequences: How Cancer Treatment Affects Sexual Function and Fertility
Upon receiving a cancer diagnosis, patients and healthcare providers understandably concentrate on the immediate challenge — eliminating or reducing the tumor, halting its spread, and preventing recurrence. However, amidst the urgency of treatment schedules and life-saving measures, discussions surrounding sexual health and fertility are often bypassed or completely ignored. Sadly, these “unseen side effects” can result in enduring emotional and physical impacts, particularly for younger patients who may still be forming intimate connections or considering starting families.
In a recent article published in The Lancet Oncology, Dr. David J. Benjamin, a medical oncologist at the Hoag Family Cancer Institute, illuminates this important — yet frequently overlooked — dimension of cancer treatment.
The Importance of Sexual and Reproductive Health in Cancer Care
Cancer does not confine itself to just cells; it permeates every aspect of a patient’s existence. From personal relationships and family aspirations to self-worth and identity, cancer and its treatments — chemotherapy, radiation, hormonal therapies, and targeted therapies — can significantly affect sexual health and reproductive capabilities.
For young adults, an increasingly represented demographic within breast, colorectal, and genitourinary cancer cases, these issues are not peripheral — they are at the forefront. Sexual difficulties, decreased libido, infertility, and early onset menopause are not unusual outcomes but common, manageable complications that warrant open discussion and proactive intervention.
Yet research consistently indicates that the majority of patients receive insufficient information regarding these possible side effects before commencing treatment. Even though many oncologists acknowledge the significance of these dialogues, numerous barriers such as time limitations, inadequate training, and absence of concrete data are frequently cited as reasons these conversations fail to take place.
Highlighting Key Case Studies: Alectinib and Nirogacestat
Two recent pharmaceutical studies underscore the necessity for a stricter approach to sexual and reproductive health concerns within oncology:
1. Alectinib and Male Hypogonadism:
Alectinib, a targeted medication for non-small cell lung cancer, was shown in a late 2024 retrospective study to induce hypogonadism in a portion of male patients. This condition, characterized by low testosterone levels, may lead to sexual dysfunction, fatigue, and mood shifts. Remarkably, earlier clinical trials involving alectinib did not track this risk, even though participants were as young as 18 years old. For these men, this oversight signifies a missed chance to discuss sperm preservation and hormonal treatments prior to initiating therapy.
2. Nirogacestat and Female Ovarian Dysfunction:
Nirogacestat, an effective treatment for desmoid tumors, revealed a troubling side effect for women: ovarian dysfunction. Clinical trials indicated that a considerable number of participants faced menstrual cycle disruptions, from temporary amenorrhea to premature ovarian failure. While some women recuperated after stopping treatment, others did not — a risk that was not sufficiently communicated or monitored during prior research phases. Given that desmoid tumors are typically not life-threatening and exhibit extended survival rates, the long-term implications for fertility become even more critical.
Closing the Gap: Necessary Changes
Addressing these matters necessitates a comprehensive transformation in how clinical trials, physician education, and patient engagement are conducted:
– Integrate evaluations of sexual and reproductive health in all oncology trials. The FDA already suggests investigating reproductive toxicity when pre-clinical (animal) studies indicate potential issues — yet broader execution and mandatory documentation are essential.
– Emphasize education and training for oncologists. Medical educational programs and ongoing training should incorporate segments on sexual health and fertility preservation.
– Encourage open patient conversations. Healthcare providers should initiate dialogues early on, compassionately presenting options for egg or sperm freezing and discussing shifts in libido, sexual function, and intimacy strategies throughout and after treatment.
– Offer multidisciplinary support. Cancer care teams should encompass reproductive endocrinologists, sexual health advisors, and mental health specialists to provide comprehensive care.
Thriving Beyond Survival
Once cancer has been successfully managed and treatment concludes, patients rightfully seek a future that encompasses more than mere survival — a life they can genuinely reclaim. Intimacy, the opportunity for biological children, and the psychological comfort of having had options all fall under the realm of quality survivorship.
Let us ensure that as medical advancements progress in efficacy, they do not lag behind in compassion. Every facet of the cancer journey is important — including those elements that may not be visible on scans but are deeply felt in the lives patients work to rebuild.
About the Author
Dr. David J. Benjamin is a medical oncologist at Hoag Family Cancer Institute, specializing in genitourinary cancers, including those affecting the prostate, bladder, kidneys, and testicles. A dedicated advocate for patient-centered care, Dr. Benjamin actively leads and participates in clinical research focused on improving both outcomes and the quality of life for individuals navigating cancer.
About Hoag
Hoag is a nonprofit regional health care network