Fertility and sexuality in early-onset colorectal cancer patients: a monocentric survey

Background

Evidence concerning the impact of chemotherapy on sexual health and fertility in early-onset colorectal cancer (EO-CRC) patients is scarce.

Patients and methods

We aimed to assess through an anonymous online survey the effect of chemotherapy on sexual quality of life and fertility preservation management in patients with stage II-IV EO-CRC treated at our center. Sexual health was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22) questionnaire. Fertility issues were assessed through a structured survey form.

Results

From 2010 to 2022, 139 out of 6444 patients were diagnosed with EO-CRC at our center. A total of 84 patients (60.4%) completed the survey, while 55 (39.6%) did not participate; 50 (59.5%) were women and 42 (50%) had stage II-III disease. Only 11.9% (8/67) of patients reported having discussed sexual issues with their oncologist, while 45% (18/40) received specific counseling about fertility preservation, with no statistically significant differences between sexes. Libido decrease and sexual pain were reported more often by women compared with men in each setting; the difference was statistically significant (P < 0.05). A statistically significant correlation between age ≥45 years and persistent amenorrhea after adjuvant chemotherapy was reported (P < 0.05). Three women and three men underwent ovarian tissue or sperm cryopreservation, respectively.

Conclusions

Clinicians tend to discuss fertility issues more often than sexual health with patients, regardless of sex. Women seem to experience more libido decrease and sexual pain compared with men, and their risk of persistent amenorrhea increases with age. Both fertility and sexuality counseling should be improved in EO-CRC management.