These researchers have dedicated their careers to finding new treatments and cures for people with cancer.
Despite these difficulties, research in this area of cancer care is underfunded—especially studies focused on individuals from sexual and gender minority (SGM) populations. It’s a problem that Daniel Dickstein, MD—a radiation oncology resident at the Icahn School of Medicine at Mount Sinai—is committed to solving. Here, Dr. Dickstein explains how he’s using Conquer Cancer grant funding to rectify the disparities that SGM patients face.
What brought you to the field of cancer research and, specifically, radiation oncology?
DD: On one hand, I’ve had an interest in understanding how the world works at a basic mathematical level. But I’ve also really enjoyed caring for and connecting with people. This brought me to radiation oncology, which requires an understanding of physics and careful treatment planning to target cancer, and an understanding of how to care for individuals and people.
When caring for patients during radiation treatment, you are their advocate; you work with them throughout the process to ensure they get better and can withstand the symptoms of both the cancer and treatments.
How did you come to focus on improving treatment and care for SGM patients?
DD: My previous research projects have largely been influenced by research mentors. However, when I started my residency, I identified an unmet need—the care and treatment of SGM patients with cancer. I was lucky to have Dr. Deborah Marshall—a past Conquer Cancer grant recipient who focuses on improving radiation treatment and sexual health outcomes in female and gender-diverse patients—at my institution to whom I could bring this idea.
Your Conquer Cancer-funded research project focuses on improving sexual health outcomes in SGM patients with prostate cancer after radiotherapy. How did you choose this research focus, and what makes it so important?
DD: I started on the genitourinary cancer service and was seeing a lot of patients with prostate cancer. Radiation treatment for this disease is generally straightforward and effective for patients: Within a 10-year timeframe, patients diagnosed with prostate cancer have a 98-percent survival rate. So, when targeting prostate cancer, we’re generally more concerned about helping patients navigate the side effects of treatment.
Many patients with prostate cancer have choices for treatment, with each treatment having different side effects. Among those side effects is sexual dysfunction. Approximately 95 percent of prostate cancer survivors report experiencing some degree of sexual dysfunction, and 50 percent say this problem moderately to severely impacts their quality of life.
To monitor sexual dysfunction, we use a patient-reported outcome questionnaire called the Sexual Health Inventory for Men (SHIM). Currently, the SHIM only focuses on erectile function. During my time on the genitourinary service, I had a patient—a gay man—ask how radiation treatments can affect patient and survivor experiences with receptive anal intercourse (RAI). I didn’t know how to answer, nor did my colleagues, but I wanted to know how best to respond. I looked up research in this space, but there was quite literally nothing out there regarding how prostate cancer treatments affect RAI and the overall sexual well-being of patients.
As a gay man myself, this problem really resonated with me. For cancer survivors, the topic of sexual pleasure and sexual well-being can often be stigmatized and considered taboo. Additionally, RAI is stigmatized. I really wanted to destigmatize and remove the taboo from both. I wanted to understand how radiation treatments affect patients and survivor experiences with RAI, and work towards finding an answer for my patient.
What have been some of the benefits of receiving mentored support from Dr. Deborah Marshall, who has also received a Conquer Cancer grant for similar research?
DD: Dr. Marshall is an expert on the intersection between radiation oncology and sexual health, and she was part of my Conquer Cancer-funded research from the beginning. It was inspirational to see that she had received a Conquer Cancer grant for research on sexual health and survivorship in women after cancer treatments. It showed me that this area of research is something that others would invest in and that it matters. Before receiving my Conquer Cancer grant, I did face some barriers with receiving support for this research. So, obtaining this award and getting to collaborate with a mentor in this space has been so important and invaluable.
Can you summarize the hypothesis of your Conquer Cancer-funded project, and what some of the outcomes have been so far in your work?
DD: The hypothesis is that sexual health in SGM patients will generally look different than that of cisgender heterosexual men after prostate cancer treatments. For example, SGM patients engage in RAI after treatment and the treatments can often affect pleasure during RAI.
We identified some unique sexual health concerns among SGM patients that are important to account for during prostate cancer treatment. We found that* approximately 70 percent of sexual minority men were sexually active after undergoing treatment for prostate cancer, compared to 40 percent of heterosexual men. We found that of those 70 percent of sexual minority men, approximately 70 percent had engaged in RAI in the past 30 days. When combining all numbers, our results suggest that about one in five sexually active prostate cancer survivors are engaging in RAI and are being affected by treatment-related side effects that have been systematically overlooked in cancer research for so long.
One tangible takeaway here can be that when someone with a diagnosis of prostate cancer comes in to discuss treatment options, we should ask their sexual orientation, gender identity, and sex recorded at birth, followed by sexual behaviors, including RAI. Subsequently, we should discuss the potential impacts of therapies on the ability to engage in and enjoy RAI and talk about alternative options, mitigation strategies, and potential therapies for treatment-related issues with RAI.
What are some of the advances in SGM cancer care that you hope to see over five to 10 years? And how do you think your Conquer Cancer-funded research can contribute to those advances?
DD: The first advance I hope to see is that, from the outset, we ask patients about sexual orientation, gender identity, and sex recorded at birth, among other relevant SGM information. We’re not asking that in most cancer centers, and we need to start really collecting these data to start building a database and answering some basic questions. We also need to start asking patients about sexual behaviors and discuss sex in the context of cancer treatment, as well as pleasure.
I also do anticipate seeing an improved understanding of how radiation treatments contribute to sexual dysfunction, along with more effective ways to mitigate problematic RAI so that SGM patients can have a better quality of life after treatment. I’m working to identify a way to mitigate problematic RAI after radiation treatment, which would help us address and improve patients’ experiences with RAI after prostate cancer treatments.
What is the value of supporting all different types of cancer research, including research into cancer survivorship and sexual health?
DD: I am so appreciative of the Conquer Cancer funding that I received. I think it’s important for advancing survivorship and sexual health for all patients and particularly for SGM populations. There are significant stigma and taboo surrounding sexual health and sexual pleasure, especially within cancer care. Having the support of Conquer Cancer really helps bring attention to this area of cancer research, starting conversations, fostering dialogue, and ultimately reducing the stigma, making it more accepted and taken seriously.
*Source: Nature Reviews: Gastroenterology & Hepatology