229 - Sexual Health and Post-Treatment Symptoms among Female Survivors of Anal Cancer

08:10am - 08:15am ET

Room 254

Presenter(s)

Ann Raldow, MD, MPH - UCLA David Geffen School of Medicine/UCLA Medical Center, Los Angeles, CA

A. Raldow¹, D. Wiley², T. Grogan³, and E. R. Brauer⁴; ¹Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, ²University of California Los Angeles, Los Angeles, CA, ³Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, ⁴UCLA School of Nursing, Los Angeles, CA

Purpose/Objective(s): Data on sexual health outcomes and quality of life in female survivors of anal cancer are limited. This study aimed to characterize sexual dysfunction, treatment-related morbidity, and healthcare utilization patterns, and to identify distinct symptom phenotypes and drivers of QOL in this population.

Materials/Methods: A cross-sectional survey was conducted using a multi-pronged recruitment strategy that included institutional registries, patient advocacy groups, and nonprofit organizations. Eligible participants were female survivors of anal cancer who had completed definitive chemoradiation. Respondents completed a one-time survey capturing sexual function, quality of life, and healthcare access, as well as sociodemographic and clinical characteristics. Age-stratified analyses compared sexual function outcomes between younger (<50 years) and older (=50 years) participants. Latent class analysis identified symptom phenotypes, and classification and regression tree (CART) analysis identified key drivers of QOL.

Results: A total of 308 female survivors participated (mean age 66.1 years; 94.8% White; median 4 years since treatment). In the prior 4 weeks, 73.9% reported no sexual activity, 66.2% no sexual interest, and 57.0% indicated their sex life was “very much” negatively affected by disease or treatment; only 13.8% reported no adverse impact. Among sexually active participants, 64.2% reported moderate-to-severe dyspareunia. Other prevalent symptoms included moderate-severe vaginal dryness (60.5%), vaginal tightness/narrowing (69.2%), stool leakage (70.2%), and frequent anxiety (29.1%). Despite guideline recommendations, only 46.8% reported being offered pelvic physical therapy, yet 73.8% of those counseled attended at least one session. Latent class analysis identified two phenotypes: a high-morbidity class with worse sexual, bowel, urinary, and psychosocial symptoms, and a low-morbidity class with better functioning. Global health rating was the primary driver of QOL, with toileting-related limitations further differentiating those with moderate global health.

Conclusion: Female survivors of anal cancer experience persistent sexual morbidity, including high rates of sexual disinterest, dyspareunia, and other treatment-related dysfunction. The high uptake of pelvic floor therapy among those counseled, coupled with low overall referral rates, highlights a critical gap between guideline-recommended care and current practice patterns. These findings underscore the need for integrated survivorship care models with clear referral pathways for pelvic rehabilitation and other targeted interventions to address the long-term needs of this population.