Dr. Kristin Rojas will present her findings from the center’s Sexual Health after Cancer Program.
By Lisette Hilton
Kristin Rojas, M.D., FACS, assistant professor of surgical oncology at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, will speak at the annual meeting of the American Society of Clinical Oncology (ASCO), to be held in Chicago, during a session focused on common sexual health concerns in breast cancer patients taking lifesaving endocrine therapy.
Her goal at the June 2-6 meeting of ASCO, an organization representing more than 45,000 oncology professionals, is to educate clinicians about sexual health — an underreported and largely untreated patient concern. Dr. Rojas, a breast surgeon and board-certified gynecologist, created Sylvester’s Menopause Urogenital Sexual Health and Intimacy Clinic (MUSIC) program because she saw the need to treat sexual health issues that often arise from cancer treatment.
Dr. Rojas will present during the session entitled “A Juggling Act: Managing the Toxicity of Estrogen Deprivation for Patients with Breast Cancer,” June 5 at 8 a.m. CDT. “I'm thrilled we have been asked to share our experience on the national stage to increase awareness about these important quality-of-life concerns affecting more than 80% of female cancer survivors,” Dr. Rojas said.
A woman’s quality of life isn’t the only reason to address her sexual health concerns, according to Dr. Rojas. Treating these issues safely can make it more likely that patients will adhere to endocrine therapy, which could improve cancer outcomes.
“By appropriately preparing patients for side effects ahead of time and giving them safe tools to address the symptoms if they arise, we can help patients get their lives back after cancer,” Dr. Rojas attested.
Dr. Rojas will reveal data from a study of female cancer patients in the Sexual Health after Cancer Program, offered through MUSIC, from 2020 to 2021. Among the findings from a diverse study group of 104 women, patients reported a range of symptoms including not only vaginal dryness but also painful sex, low desire and hot flashes. More than one in four reported problems with orgasm, and almost half of the patients had signs of vaginal stenosis, or vaginal narrowing and shortening — a finding that is not well-known in breast cancer patients on estrogen suppression.
Safe Options for Practice
Dr. Rojas shared that her ASCO presentation will offer “easy to implement, step-by-step” plans that oncologists can use to safely treat many of these patients, including the following recommendations for safe care.
Hot flashes: These are caused by the brain misinterpreting the core body temperature when estrogen levels drop, resulting in widespread vasodilation, which can present as sweating, palpitations and panic attacks. Treatments include exercise, acupuncture, venlafaxine and oxybutynin.
Genitourinary syndrome of menopause (GSM): Low estrogen results in GSM symptoms including vaginal dryness, loss of elasticity, vaginal burning or pain, recurrent bladder infections and more. Treatments include eliminating irritants, regular moisturizing with non-hormonal or hyaluronic acid moisturizers and preservative-free silicone-based lubricants. Water-based lubricants without irritants can be used for patients using non-silicone-compatible condoms.
Painful sex: GSM and pelvic floor muscle spasms cause painful sex. Providers can treat patients by addressing GSM and adding pelvic floor relaxation exercises, which may include dilators.
Breast cancer patients on endocrine therapy should avoid some products and devices marketed to treat sexual concerns, according to Dr. Rojas.
“These include vaginal lasers, which are not FDA-approved to be used in the vagina and can result in burns, scarring and chronic pain. These should not be recommended to women with a history of cancer,” she warned.
Patients also often have concerns about infertility risk and bone health. Dr. Rojas mentions that family planning and bone density monitoring should be added to treatment plans.
The Need to Know
Breast cancer patients have reported that they want to know about how cancer therapies, like endocrine therapy, will affect their sexual health, and they want to have sexual health discussions with their providers early and often throughout treatment, explained Dr. Rojas.
“There has been so much demand for Sylvester’s MUSIC program that we’ve expanded it. It has become a blueprint for other such programs around the country,” she stated. “ASCO is giving me the opportunity to educate colleagues about this need and how to address it. As a result, I hope more women get access to safe and effective therapies that will help improve their quality of life and could improve cancer outcomes.”
With improved targeted therapies in breast cancer, Dr. Rojas said oncology professionals will change the conversation from, "Will you live after cancer?" to “How will you live after cancer?”