Sexual health and treatment-related sexual dysfunction in sexual and gender minorities with prostate cancer

Prostate cancer treatment has substantial effects on sexual health and function. Sexual function is a vital aspect of human health and a critical component of cancer survivorship, and understanding the potential effects of different treatment modalities on sexual health is crucial. Existing research has extensively described the effects of treatment on male erectile tissues necessary for heterosexual intercourse; however, evidence regarding their effects on sexual health and function in sexual and gender minority populations is minimal. These groups include sexual minority - gay and bisexual - men, and transgender women or trans feminine people in general. Such unique effects in these groups might include altered sexual function in relation to receptive anal and neovaginal intercourse and changes to patients' role-in-sex. Sexual dysfunctions following prostate cancer treatment affecting quality of life in sexual minority men include climacturia, anejaculation, decreased penile length, erectile dysfunction, and problematic receptive anal intercourse, including anodyspareunia and altered pleasurable sensation. Notably, clinical trials investigating sexual outcomes after prostate cancer treatment do not collect sexual orientation and gender identity demographic data or outcomes specific to members of these populations, which perpetuates the uncertainty regarding optimal management. Providing clinicians with a solid evidence base is essential to communicate recommendations and tailor interventions for sexual and gender minority patients with prostate cancer.

Female erectile tissues and sexual dysfunction after pelvic radiotherapy: A scoping review

Sexual function is a vital aspect of human health and is recognized as a critical component of cancer survivorship. Understanding and evaluating the impacts of radiotherapy on female sexual function requires precise knowledge of the organs involved in sexual function and the relationship between radiotherapy exposure and sexual tissue function. Although substantial evidence exists describing the impact of radiotherapy on male erectile tissues and related clinical sexual outcomes, there is very little research in this area in females. The lack of biomedical data in female patients makes it difficult to design studies aimed at optimizing sexual function postradiotherapy for female pelvic malignancies. This scoping review identifies and categorizes current research on the impacts of radiotherapy on normal female erectile tissues, including damage to normal functioning, clinical outcomes of radiation-related female erectile tissue damage, and techniques to spare erectile tissues or therapies to treat such damage. An evaluation of the evidence was performed, and a summary of findings was generated according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. Articles were included in the review that involved normal female erectile tissues and radiotherapy side effects. The results show that little scientific investigation into the impacts of radiotherapy on female erectile tissues has been performed. Collaborative scientific investigations by clinical, basic, and behavioral scientists in oncology and radiotherapy are needed to generate radiobiologic and clinical evidence to advance prospective evaluation, prevention, and mitigation strategies that may improve sexual outcomes in female patients.

Trends in Industry Payments to Medical Oncologists in the United States Since the Inception of the Open Payments Program, 2014 to 2019

Importance

Given the potential for undue influence of industry-physician payments on oncology care, it is important to understand how a national transparency program may be associated with financial interactions between industry and medical oncologists.

Objective

To identify trends in industry payments to medical oncologists from 2014 to 2019 and determine if the implementation of the Open Payments program is associated with changes in the frequency or value of payments or any shift in the nature of industry-oncologist financial interactions.

Design, Setting, and Participants

This retrospective, population-based, observational cohort study analyzed Open Payments reports of industry payments made in 2014 to 2019 to a cohort of licensed medical oncologists practicing in the US in 2014, using data from the National Plan and Provider Enumeration System.

Exposures

Receipt of an industry payment from January 1, 2014, to December 31, 2019.

Main Outcomes and Measures

General industry payments to medical oncologists, including the proportion receiving payments, total annual value and number of payments, and average annual trends over time, by aggregate value and by nature-of-payment category. Trends over time were analyzed using linear regression and generalized estimating equations.

Results

In 2014 to 2019, there were 15 585 medical oncologists who received a total of 2.2 million industry payments with a total value of $509 million. The absolute number of oncologists receiving payments decreased from 10 498 in 2014 to 8918 in 2019 (-15.1%). The annual per-physician payment value decreased among those receiving less than $10 000 in aggregate by -3.2% yearly (95% CI, -4.1% to -2.3%; P < .001), but increased for those receiving more than $10 000. Payments increased for consulting (13.7%; 95% CI, 12.4%-15.0%; P < .001) and for entertainment, meals, travel or lodging, and gifts (0.8%; 95% CI, 0.1%-1.5%; P = .03).

Conclusions and Relevance

The number of medical oncologists accepting industry payments has decreased; however, high-value industry payments have been consolidated in a relatively small number of medical oncologists accepting higher payment values over time. The nature of payments has shifted toward consulting. These findings highlight the limitations of transparency without accountability.

Trends in Industry Payments to Physicians in the United States From 2014 to 2018

This study uses Medicare Open Payments data to characterize trends in the prevalence and value of physicians’ interactions with industry overall and by specialty between January 2014 and December 2018 after implementation of the federal Open Payments transparency program in 2013.

Trends in Financial Relationships Between Industry and Radiation Oncologists Versus Other Physicians in the United States from 2014 to 2018

PURPOSE

The Open Payments transparency program publishes data on industry-physician payments, in part to discourage relationships considered inappropriate including gifts, meals, and speaker's bureau fees. We evaluated trends in physician-level payments to test whether implementation of Open Payments resulted in fewer industry-radiation oncologist (RO) interactions or shifted interactions toward those considered more appropriate compared with medical oncologists (MOs) and other hospital-based physicians (HBPs).

METHODS AND MATERIALS

We performed a retrospective, population-based cohort study of practicing US ROs versus MOs and HBPs in 2014 matched to general (nonresearch) payments between 2014 and 2018. Trends in payments were analyzed and reported by nature of payment. Values of payments to ROs from the top 10 companies were identified.

RESULTS

From 2014 to 2018, 3379 (90.3%) ROs accepted 106,930 payments totaling $40.8 million. The per-physician number and value of payments was lower in radiation oncology than in medical oncology and higher than HBPs. The proportion of ROs accepting payments increased from 61.8% in 2014 to 64.2% in 2018; the proportion of MOs accepting payments decreased from 78.7% to 77.7%; and the proportion of HBPs decreased from 40.8% to 37.5%, respectively. The annual per-physician value and number of payments accepted by ROs and MOs increased. Payments in entertainment, meals, travel and lodging, and gifts increased among ROs and remained stable or decreased among MOs and HBPs. Consulting payments increased across all groups. Top RO payors produced novel cancer therapeutics, hydrogel spacers, radiation treatment machines, and opioids.

CONCLUSIONS

Industry payments to ROs have become more common since OP's inception, while becoming less common for MOs and HBPs. Payments to ROs and MOs have become more frequent and of modestly increasing value compared with other HBPs, for whom the value is decreasing. No large changes in the nature of relationships were seen in ROs. Increased engagement with financial conflicts of interest is needed in radiation oncology.

The Impact of Margins on Outcomes After Wedge Resection for Stage I Non-Small Cell Lung Cancer

BACKGROUND

The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear.

METHODS

Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Women's Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ² values among survival distributions.

RESULTS

Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83-0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival.

CONCLUSIONS

Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy.