(192) Meta-Analysis of Sexual Dysfunction Among Survivors of Head and Neck Cancer

Abstract Introduction Sexual dysfunction is a significant yet underrecognized consequence among survivors of head and neck cancer. Treatments such as surgery, chemotherapy, and radiotherapy lead to profound physical and psychological sequelae that affect sexual health, intimacy, and quality of life. Despite its prevalence, sexual health is rarely discussed in oncology settings, leaving many survivors unsupported in this domain. A comprehensive synthesis of evidence is needed to determine the extent and nature of sexual dysfunction in this patient population. Objective This systematic review and meta-analysis aimed to evaluate the pooled prevalence of sexual dysfunction among survivors of head and neck cancer, identify the most frequently reported domains of dysfunction, and examine the extent to which sexual health is addressed in clinical care. Methods Electronic databases (PubMed, Embase, Scopus, IndMed, Google Scholar, and medRxiv) were systematically searched for studies published between 1994 and 2024 that assessed sexual dysfunction as an outcome following head and neck cancer treatment. Eligible studies included clinical trials, cross-sectional, and retrospective studies. Data extraction was conducted independently by three reviewers. Meta-analyses were performed using random-effects models, with heterogeneity assessed using the I2 statistic. Subgroup analyses evaluated specific dysfunction domains including desire, intercourse difficulties, orgasmic function, satisfaction, and overall impact on sexuality. The review protocol was prospectively registered in PROSPERO (CRD42024593437). Results Nineteen studies comprising 2,739 participants were included. The pooled prevalence of negative impacts on sexuality was 51% (95% CI: 38%–64%). Difficulties with sexual desire were reported by 36% (95% CI: 31%–41%), while 50% (95% CI: 36%–64%) experienced intercourse-related problems. Only 24% (95% CI: 5%–67%) of participants reported sexual satisfaction one year post-treatment. Importantly, 86% (95% CI: 69%–94%) of patients stated that sexual health was not discussed in routine care. Commonly identified barriers included stigma, lack of provider training, and perceived role limitations of oncology professionals. Studies using standardized tools, such as the EORTC quality-of-life head and neck cancer module, consistently demonstrated significant impacts of treatment on sexual health. Conclusions Sexual dysfunction is a prevalent, multifaceted, and underaddressed concern for head and neck cancer survivors. More than half of patients report long-term negative impacts on sexuality, with significant difficulties in desire, intercourse, and satisfaction. Clinical neglect of sexual health-reported by nearly nine in ten patients-represents a critical gap in survivorship care. Integrating sexual health assessments, open communication, and evidence-based interventions such as counseling and rehabilitation into routine oncology practice is essential. These findings underscore the urgent need for standardized tools and structured clinical pathways to address intimacy and sexual well-being, ultimately enhancing quality of life in this vulnerable population. Disclosure No