Final Results From a Longitudinal Observation Study Evaluating Sexual Health and Facial Appearance and Distress in Human Papillomavirus-Associated Oropharyngeal Cancer Survivors Treated With Chemoradiotherapy.
McDowell L, Gough K, et al. • International journal of radiation oncology, biology, physics • 2025
Most sexual health outcomes impacted by (C)RT return to pretreatment levels by 3, 12, or 24 months, and temporary appearance distress was reported at the end of treatment in HPV-associated oropharyngeal cancer survivors.
Key Findings
Results
Global tests provided moderate-to-strong evidence of differences across time for most EORTC Sexual Health Questionnaire scales/items, with the exception of sexual pain and insecurity with partner.
100 patients with HPVOPC scheduled to receive curative-intent (C)RT were enrolled between October 2020 and November 2021
Sexual health was measured using the 22-item EORTC Sexual Health Questionnaire
Sexual pain and insecurity with partner both had P > .10, indicating no significant change over time
All other scales/items showed moderate-to-strong evidence against the null hypothesis of no differences across time
Linear mixed models were used to estimate mean differences at follow-up assessments compared with before (C)RT
Results
Sexual health outcomes were worst in the last week of treatment and recovered to pretreatment levels at varying timepoints depending on the specific outcome.
Importance of sexual activity and worry about incontinence returned to pretreatment levels by 3 months after (C)RT
Sexual satisfaction, libido, and fatigue affecting sex life returned to pretreatment levels by 12 months after (C)RT
Treatment affecting sex life and confidence in erection returned to pretreatment levels by 24 months after (C)RT
All affected outcomes showed the worst scores in the last week of treatment (week 7)
Assessments were administered before (C)RT, in the last week of treatment, and at 3, 12, and 24 months after (C)RT
Results
Feeling less masculine scores did not return to pretreatment levels by the final 24-month assessment.
On average, feeling less masculine was the only sexual health item that did not recover to baseline by the end of the study period
This finding persisted through the final assessment at 24 months post-treatment
This represents a potentially long-term persistent impact of (C)RT on masculine identity among HPVOPC survivors
Results
Appearance distress was worse in the last week of treatment but improved to pretreatment levels by 3 months after (C)RT.
Appearance-related issues were measured using FACE-Q Appearance and Appearance Distress modules
Appearance distress, but not facial appearance scores, was significantly worse at the end of treatment
Recovery of appearance distress to pretreatment levels occurred by 3 months post-treatment
Facial appearance scores did not show statistically significant worsening at any timepoint
Methods
This study provides longitudinal, multidimensional sexual health data across five timepoints in HPVOPC survivors treated with (C)RT.
The study enrolled 100 patients in a prospective longitudinal observational design
Five assessment timepoints were used: before (C)RT, last week of treatment, and 3, 12, and 24 months post-treatment
Both sexual health and appearance-related outcomes were assessed concurrently
The authors state the data are intended 'to strengthen counseling of patients with HPVOPC'
The study ran from October 2020 to November 2021 for enrollment
What This Means
This research followed 100 patients with HPV-associated throat cancer (oropharyngeal cancer) who were treated with radiation therapy, with or without chemotherapy. Researchers tracked their sexual health and facial appearance concerns before treatment, at the end of treatment, and at 3, 12, and 24 months after treatment. The study found that most aspects of sexual health — including sexual satisfaction, libido, and fatigue affecting sex life — were significantly worse at the end of treatment but gradually recovered. Different outcomes recovered at different rates, with some returning to normal within 3 months and others taking up to 2 years.
One notable finding was that feelings of reduced masculinity did not return to pre-treatment levels even by the 2-year follow-up, suggesting this may be a longer-lasting psychological impact of treatment. Concerns about appearance and distress related to appearance also worsened at the end of treatment but resolved by 3 months post-treatment. Interestingly, objective facial appearance scores did not significantly worsen at any point, suggesting the distress was more psychological than related to actual visible changes.
This research suggests that while cancer treatment causes significant short-term impacts on sexual health and appearance-related wellbeing, most of these effects are temporary and improve over time. The detailed timeline of recovery provided by this study could help doctors better counsel patients about what to expect during and after treatment, and highlights that concerns around masculinity may need longer-term psychological support.
McDowell L, Gough K, Fua T, Coleman A, Drosdowsky A, Rischin D, et al.. (2025). Final Results From a Longitudinal Observation Study Evaluating Sexual Health and Facial Appearance and Distress in Human Papillomavirus-Associated Oropharyngeal Cancer Survivors Treated With Chemoradiotherapy.. International journal of radiation oncology, biology, physics. https://doi.org/10.1016/j.ijrobp.2025.02.004