Male survivors of childhood cancer and perceptions of sexual dysfunction risk: A report from the Childhood Cancer Survivor Study

BACKGROUND: Sexual dysfunction (SD) is an underrecognized late effect of childhood cancer. This study sought to comprehensively examine factors influencing the perceived risk of SD among male survivors of childhood cancer. METHODS: Adult male survivors (N = 1581) from the Childhood Cancer Survivor Study who were aged a median of 8 years (range, 0-20 years) at cancer diagnosis and 38 years (range, 22-60 years) at survey reported their perceptions of relative risk for SD compared to peers. Multivariable logistic regression evaluated sociodemographic, treatment, and health factors associated with perceptions of risk. RESULTS: Overall, 29% of survivors (450 of 1581) perceived themselves at increased risk for SD. Among survivors exposed to treatments known to be associated with SD risk, increased risk was perceived by only 33%-42% of males, which varied by the specific exposure. Treatment-related risk factors (vs. no exposure) associated with increased perception included gonadotoxic chemotherapy (odds ratio [OR], 1.6; 95% CI, 1.2-2.1), genitourinary/pelvic/spinal surgery (OR, 2.6; 95% CI, 1.4-4.7), and pelvic/testicular radiation (OR, 1.9; 95% CI, 1.4-2.5). Poor mental health-related quality of life (OR, 2.0; 95% CI, 1.4-2.7) and less-than-excellent general health were associated with increased perception of SD risk. Men who perceived heightened SD risk reported oncologists (26.4%) and primary care providers (25.3%) as top sources of information about risk. CONCLUSIONS: Many male survivors do not perceive heightened risks for SD, despite a history of treatment-related risk factors. Because SD risk is multifactorial, oncology and survivorship providers should prioritize individualized education and counseling to improve survivors' understanding of their risk on the basis of their treatment history and current health.