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Sexual Health in Young Adult Patients after Chimeric Antigen Receptor T-Cell Therapy

Year: 2024

Type: article

Abstract: Chimeric antigen receptor T-cell therapy (CAR T) shows promise for treating relapsed/refractory hematologic malignancies. Despite known immune mediated toxicities, studies on late effects and survivorship concerns are limited. Sexual health is crucial for health-related quality of life (HRQOL), particularly for young adults (YAs) aged 18-39 years. No prior studies have evaluated sexual health in YAs post-CAR T. We conducted a mixed methods study to examine sexual health and HRQOL and explore sexual health communication with healthcare providers (HCPs) in YAs post-CAR T. This cross-sectional study recruited YAs aged 18-39 years treated with CAR T to complete a survey and semi-structured interview. The survey included PROMIS short form measures assessing sexual health and HRQOL and study-specific items on patient-provider sexual health communication. PROMIS scores were calculated as T-scores with a normative M=50, SD=10, and minimally important difference (MID)=5. The interview explored the impact of cancer and CAR T on sexual health and HRQOL, sexual health communication with HCPs, and support systems during and post-treatment. Preliminary analysis included descriptive statistics for quantitative data compared to evidence-based thresholds and thematic analysis of qualitative data. In total, 13 YAs completed the survey and 10 completed an interview. Median age was 35 years (range: 21-39), 61.5% identified as male, 92.3% identified as heterosexual, and median time since CAR T was 30 months (Table 1). Survey results are summarized in Table 2. Average interest in sexual activity was low for females (M=35.1, SD=10.0) but not males (M=48.7, SD=10.3). Other average scores were within normal ranges. Several differences in average scores by gender exceeded the MID; females reported less interest in sexual activity, worse fatigue, more impaired social function, and worse emotional impact. Most YAs had not discussed (46.2%) or did not recall discussing (38.5%) sexual health with an HCP pre-CAR T. Most (76.9%) had not discussed sexual health with an HCP post-CAR T. Qualitative findings revealed three major themes: 1) YAs perceive a lack of HCP awareness of YA sexual health priorities, 2) Lack of communication and information about potential sexual health concerns post-CAR T, and 3) Parental caregiving is a barrier to YAs discussing sexual health with HCPs. This was the first study to explore sexual health in YAs treated with CAR T. Findings highlight a need for improved patient-provider sexual health communication and more publicly available educational resources. As the population of CAR T recipients grows, research on patient reported outcomes and late effects is warranted to improve survivorship outcomes.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2023.12.467