The Scientific Network on Female Sexual Health and Cancer

LETTER FROM THE CHAIR

Dear Friends and Colleagues,

First and foremost, I am delighted to send warm greetings as we approach the holiday season and winter solstice. I hope the holidays will allow you time to celebrate, rest and recharge. I want to also acknowledge that this is the last letter I will be writing in my current role as Chair of the Scientific Network. It has truly been an honor to lead our Network over the past two years. I certainly had no idea what it would mean to help steer a modest-sized academic society through the challenges of an on-going pandemic, but I can tell you that I have learned a lot during my tenure as Chair. I have learned that organizations, like people, can become more flexible and creative in a crisis. I have learned that not everything that we think is essential is indeed mission critical, and I have come to appreciate that community is everything, including at the organizational level. In truth, I am incredibly relieved and proud that the Network found a way to develop and deliver opportunities to keep educating, learning, and networking about female sexual health and cancer despite the many challenges we have faced since the world went into lockdown almost three years ago.

On that note, it is with great pleasure that I can report we just had a tremendously successful in-person Scientific Conference in November at Yale University – the first such gathering for our Network since 2019. It was literally a sell-out event. Co-chaired brilliantly by Dr. Shari Damast (Yale University) and Dr. Kristen Carpenter (The Ohio State University), we had the opportunity to spend two unparalleled days hearing about leading-edge research, patient experiences, and novel clinical initiatives taking place across the country. I left New Haven with a bevy of new energy and ideas that was fueled by participating in such an intimate gathering with fellow scientists and clinicians all engaged in a shared mission. Our participant feedback made it clear that all participants (actually 100%!) were pleased with the plentiful opportunity to connect with others. It was simply a gem of a meeting.

Looking ahead, the Network is busy planning for opportunities to learn and connect both in-person and online in 2023. The Network is heading to the ISSWSH Annual Meeting in March where we will be having a breakfast, delivering a symposium, and continuing to develop meaningful connections between our organizations. Most importantly, I want to invite each of you to stay engaged with the incredibly dynamic group of people who make up our Network! We are excited to be offering upcoming webinar opportunities to do just that, planned for the spring and fall. Stay tuned for details. And of course, you can expect informative Network newsletters coming to your inbox this summer and winter.

Lastly, I also want to offer an enormous and heartfelt “Thank You!” to my dedicated, thoughtful and deeply kind colleagues who comprise the Network Leadership and Board of Directors, as well as the superb administrative staff from Status Plus. The Network is a small but mighty organization and working with each of you has made my role as Chair a pleasure. I feel very lucky indeed. Finally, I want to note that it is a privilege to pass the baton to Dr. Jennifer Reese (Fox Chase Cancer Center), who will be taking over as Chair this January. I honestly cannot think of a more capable, creative, and enthusiastic person to take the reins and the Network will be in great hands under her leadership!

Sending my best wishes for a Happy, Healthy, and Joyful 2023!

Sharon Bober

NETWORK RECOGNITION, CELEBRATIONS, AND CONGRATULATIONS

Congratulations to Pebble Kranz, Allison Quick, and Kelly Shaffer on being elected to a second term on the Scientific Network Board of Directors!

The Network recognizes the following board members who are rotating off the Board at the end of 2022 for their service and dedication to the Scientific Network:

Emily Abramsohn, MPH

Kristen Carpenter, PhD

Stacy Tessler Lindau, MD, MAPP

Sharon Bober, PhD, will conclude her term as Chair at the end of 2022. Thank you, Dr. Bober, for your dedication and countless hours contributed to managing the Network! Dr. Bober will remain on the board for the coming two years as Immediate Past Chair.

HIGHLIGHTS FROM THE 8TH CONFERENCE OF THE SCIENTIFIC NETWORK ON FEMALE SEXUAL HEALTH AND CANCER

The 8th Conference of The Scientific Network on Female Sexual Health and Cancer took place November 17th and 18th at Yale University in New Haven, Connecticut. This charming setting was a perfect backdrop for a jam-packed program, and with 87 attendees registered, every seat was spoken for! The Newsletter Committee had the opportunity to mingle with attendees and gather their thoughts on what made this event impactful and important. Check out some of the multidisciplinary perspectives below.

Janeane N. Anderson, PhD, MPH, with the University of Tennessee Health Science Center in Memphis, TN:
I was a first-time attendee of the 8th Conference of the Scientific Network on Female Sexual Health and Cancer on the beautiful campus of Yale University. The robust conference program addressed multidisciplinary interests. I was impressed by the depth and breadth of scholarship in keynote addresses as well as paper and poster presentations. Dr. Narjust Florez reinforced the importance of cultural and epistemic humility when engaging with patients from diverse ethnoracial, cultural, regional, or other backgrounds. Racialized, minoritized patients have heightened exposure to intersectional stigma and systems of oppression (e.g., racism, sexism, heterosexism, classism) that create multilevel barriers to quality care. Dr. Florez’s presentation was a timely, needed reminder that clinicians and researchers must engage in ongoing, critical self-reflection and interrogation of our beliefs, biases, and privileges to meet the changing needs of diverse patient populations.

As a social scientist and communication scholar, I gleaned new insights into communication processes and conceptual models from Dr. Hoda Badr’s presentations. I appreciated Dr. Badr’s charge to clinicians and researchers to consider the ways in which couples’ communication patterns may influence health and quality of life outcomes as well as the limitations of current research given limited study participation from diverse communities (e.g., folks of color, sexual and gender minorities).

Without a doubt, I was most affected by Ms. Jennifer Strauss’s presentation: “A Previvor’s Experience.” Her raw and authentic account of her experience with cancer and transition into a patient advocate was a direct cue to action for me to rededicate myself to more intentional community-engaged work. I appreciated Ms. Strauss’s description of the multilevel factors that influence treatment adherence and her repeated acknowledgment of her personal privilege. Her willingness to highlight the ways in which her survivorship experience was greatly influenced by personal and social factors that are often unavailable to other women with cancer was an important reminder for all in the room about the ways in which social determinants of health determine health—and life—outcomes. I am still chewing on Ms. Strauss’s discussion of the importance of helping patients understand their sexual selves prior to a cancer diagnosis. I literally added this cue to action to my “Things to Think About for the Next Study” list.

To me, one of the greatest values of the conference was the opportunity to network with sexual medicine clinicians from across the country. As a junior faculty member, I was eager to attend the conference to meet practicing clinicians and/or researchers to assess the feasibility of future research collaborations. I am heartened by the possibilities that may come from new relationships I made at the conference.

Dr. Narjust Florez presenting on Health Equity, Global Health, Cancer & Sexuality

Patient advocate Jennifer Strauss (left) with Johann D’Addario, MHS, PA-C (right), of Smilow Cancer Hospital at Yale New Haven Health

Colleagues Lauren Broschak, MSW, LCSW, OSW-C, Survivorship Program Manager, and Rebecca DiPatri, BSN, RN, OCN, Oncology Nurse Navigator; both with the Inova Schar Cancer Institute, Life with Cancer, in Fairfax, VA:

Lauren: I really enjoyed my experience at the conference. I was worried that as someone who does not consider themselves to be a scientist that this conference wouldn't be for me, and I couldn't have been more wrong! Not only did I gain a ton of knowledge that I can bring back to my clinical practice, but I also felt I found my community. This conference was so inclusive, and I felt like I fit in perfectly. If anyone is unsure if they should come, I would encourage them to try it! This is something I am hoping to do every year.

Rebecca: I had a wonderful time at the conference and have brought back so much food for thought. My key takeaways from the conference included: 1) exploring the who and how of routine follow-up on sexual health and the benefits of hormone replacement for blood cancer patients after stem cell transplant; 2) opportunities to perform QI studies and sexual health research within my institution; 3) development of sexual health education/programming to support caregivers; and 4) attention to supporting sexual health needs (including reviewing of current programs) of those with metastatic disease. And this is only a bit of what I have taken away!

UPCOMING NETWORK OPPORTUNITIES

Educational webinar opportunities from the Network are upcoming this Spring 2023 and Fall 2023! Do you have information or expertise you’d like to share, or information that you’d like to hear from others? Proposals and ideas should be sent to Pebble@RochesterCenterForSexualWellness.com by January 15, 2023.

MEMBER SPOTLIGHT

At our recent conference, Network Chair Dr. Sharon Bober (left) had the honor of bestowing this year’s Stacy Tessler Lindau Trainee Research Award to Lydia L. Chevalier, PhD (right), who presented on Sexual Function and Body Image in Cancer Survivors: A Project REACH Study. Network Newsletter Committee member Dr. Christina Wilson was able to catch up with Dr. Chevalier after her presentation to learn a little more about her and her work.

Christina Wilson (CW): Can you please tell us a little bit about yourself and your background?
Lydia Chevalier (LC): I am a licensed clinical psychologist with training in behavioral medicine and health psychology across the lifespan. I completed my PhD at Boston University, my residency at the University of Washington, and am currently completing a fellowship in cancer survivorship at Dana-Farber Cancer Institute and Harvard Medical School. I was first introduced to sexual medicine on residency when I was working with patients with spinal cord injuries and amputations. I was then able to complete a clinical rotation on fellowship with Dr. Sharon Bober in the Dana-Farber Sexual Health clinic. Working with Dr. Bober and seeing patients through this clinic has inspired me to dedicate my career to assessment and treatment of sexual health after cancer.

CW: Where do you work and what is the focus of your research and/or clinical practice?
LC: I am currently completing a fellowship in the Perini Survivors’ Center at Dana-Farber Cancer Institute. Through this fellowship I provide brief assessment and treatment for pediatric cancer survivors as well as conduct research on the most effective ways to screen for psychosocial late effects (e.g., anxiety, insomnia) in this population. I also treat patients through the Dana-Farber Sexual Health Program and have begun conducting research on the assessment of sexual health in young adult cancer survivors (YACS). For example, we recently published an article demonstrating that YACS feel comfortable completing questionnaires on sexual health and indeed feel that it is important for providers to assess these concerns. We are currently writing a paper describing sexual health concerns in this population as well as conducting qualitative interviews with YACS about what sexual health concerns they feel are important to assess.

CW: How long have you been a member of the Network?
LC: I have only been a member of the Network since August 2022 and am so happy to have found such a wonderful community!

CW: What do you find meaningful and/or how have you benefited from Network membership?
LC: This was my first Scientific Network meeting, and I loved hearing from experts in sexual health across so many disciplines. The genuine and enthusiastic collaboration and support across multiple specialties was inspiring, and I think critical, to making progress in this area. I have already communicated with several members I hope to collaborate with and look forward to other meetings and educational events.

CW: What is an interesting fact about you, or what is your favorite hobby?
LC: I absolutely love plants. My partner and I drove 46 plants across the country with us when I moved for residency and (successfully) moved 94 back a year later. We now have well over 100 house plants - but I’m too scared to do an official count.

RESEARCH SPOTLIGHT

In October 2022, the Journal of the National Cancer Institute (JNCI) published findings from a Danish research team led by Cold and colleagues in a paper entitled Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study. In this large, population-based observational study, 8,461 postmenopausal women ages 35-95 years old (median age 61 yo) with early-stage, non-metastatic ER+ breast cancer who were not using any hormone therapy (75%, N=6,371) or who were prescribed vaginal estrogen therapy (VET; 25%, N=1,957) or systemic hormone therapy (MHT; 2%, N=133) after their cancer diagnosis were included in study analyses.

After a median follow-up of 9.8 years, authors found VET users did not have increased risk of cancer recurrence compared to non-users (HR=1.08, 95% CI 0.89-1.32). However, in subgroup analyses, VET users who were taking an aromatase inhibitor (AI) had elevated risk of cancer recurrence compared to non-users (HR=1.39, 95% CI = 1.04-1.85). VET users, including the subgroup of those taking an AI, did not have any increased risk of cancer-related mortality compared to non-users. The authors state this is the first study to report a possible increased risk of breast cancer recurrence in patients on AIs who used a vaginal estrogen. Interpretation of these findings should take into consideration important methodologic limitations including the non-randomized study design and lack of information on route, dose, and frequency of VET use.

Professional Perspectives
The researchers' conclusions of this study have been making waves since publication. Here to offer their own practical perspectives and interpretations of study findings are two of the Scientific Network’s very own experts in the field:

• Dr. Sharon Bober (Dana Farber Cancer Institute): This Danish study looked at longitudinal data from a cohort of postmenopausal women, 1997-2004, examining either vaginal estrogen therapy (VET) or systemic therapy. They evaluated mortality and risk of recurrence associated with use of VET and in subgroup analysis found that there was an increased risk of recurrence, but not mortality, in women who used VET with adjuvant AIs. However, the issue is that the dose or delivery system of vaginal estrogen is not addressed. The Vagifem (estradiol vaginal tablet) dose was 25 mcg until 2010. After 2010, doses went from 25 mcg to 10 mcg. We currently also have other low dose options like Imvexxy, which is a 4-mcg estradiol tablet. Because this data was from 1997-2004, I think it is likely that the dose of vaginal estrogen women were getting between 1997-2004 was significantly more than we give women now. Moreover, how VET is delivered was also not addressed, and dosing again can vary significantly depending on how topical estrogen is being delivered. I think it is important not to jump to conclusions about vaginal estrogen being contraindicated for women on AIs based on this study alone.


• Dr. Stacy Tessler Lindau (UChicago Medicine): This study from Denmark is an important addition to the limited knowledge base available to effectively counsel post-menopausal women with ER+ breast cancer about treatment options for the very common and distressing problems of vaginal dryness, dyspareunia, and loss of capacity for sexual activity that result from anti-estrogen therapies. As the authors point out, a prospective randomized controlled trial would be the gold standard study and is needed given the high prevalence of (distressing and costly) genitourinary symptoms and loss of sexual activity among women with ER+ breast cancer.
  
  This retrospective (1997-2004), observational study uses a large, unique, and high-quality data source. The focus is post-menopausal Danish women with early-stage ER+ breast cancer who did not receive chemotherapy (so findings may not be pertinent to people with early-stage cancer diagnosed pre-menopause, those with later stage cancer or those who did receive chemotherapy). As the authors acknowledge, the findings may be affected by factors for which the study could not account and so translation of the findings should take this limitation into account. Furthermore, among the group using vaginal estrogen, multiple modalities of vaginal estrogen therapy were documented. In supplementary material, the authors identify Estring (estradiol vaginal ring), Ovestin (estriol cream) and Vagifem (estradiol tablet) as among the vaginal estrogen therapies that women in this study may have used. However, it is important to consider that the analysis does not differentiate between these – in other words, we do not know whether mode (e.g., ring, cream, tablet) or estrogen type (e.g., estradiol, estriol) or dose might have conferred different levels of risk (or even protection) against recurrence. Of note, estriol cream is not FDA-approved for use in the US. The observed association likely reflects, at least in part, the dominant modality used in this population during the study period, but this information is not disclosed in the paper. In addition, the study does not fully account for estrogen use pre-diagnosis, but another study reports that rates of estrogen use in the general Danish population at that time were nearly 40% among menopausal women. Only women with documented HRT or VET use in the two years before a breast cancer diagnosis were excluded (Figure 1 indicates 1249 excluded for use of VET or MHT before BC, but the methods indicate that only use in the prior two years was examined). Rates of estrogen use in the Danish population are well characterized and may have been higher than a comparable, contemporaneous (1997-2004) U.S. population. Practically speaking, current practice guidelines in the U.S. already recommend non-hormonal vaginal modalities as first line treatment of vaginal symptoms in ER+ breast cancer patients. This study corroborates those recommendations. It is also important to note that while there is a higher rate of diagnosed recurrence, there is not a higher rate of mortality in the subgroup of ER+ breast cancer patients on AI therapy. This finding could be driven by a higher rate of detection of recurrence in the AI subgroup (e.g., closer vigilance). A more accurate conclusion for this study would be: “For early-stage, post-menopausal, BC patients receiving adjuvant AIs, vaginal estrogen therapy should be used with caution.” This conclusion is consistent with current practice.
 

Additional Perspectives

• Network member Dr. Shari Goldfarb (Memorial Sloan Kettering), with colleagues, in a letter to the editor at JNCI: RE: Systemic or vaginal hormone therapy after early breast cancer: a Danish observational cohort study
• Dr. Elizabeth Cathcart-Rake & Dr. Kathryn Ruddy (Mayo Clinic), in an accompanying JNCI editorial, Vaginal Estrogen Therapy for the Genitourinary Symptoms of Menopause: Caution or Reassurance?
 

NEW AND NOTEWORTHY

Network member Elizabeth K. Arthur and Network Chair Elect Jennifer Barsky Reese, with colleagues, published Profiles of Women’s Adjustment After Cancer Based on Sexual and Psychosocial Wellbeing: Results of a Cluster Analysis in the journal BMC Cancer.

Network Board Members Stacy T. Lindau and Emily M. Abramsohn, and colleagues, published Unwanted Sexual Activity Among United States Women Early in the COVID-19 Pandemic in the American Journal of Obstetrics and Gynecology, and a poster addressing a cancer-specific analysis of their research data was presented at the Network’s 8th Conference in November.

Network members Jessica Pettigrew, Helen L. Coons, and colleagues, published No One-Size-Fits-All: Sexual Health Education Preferences in Patients with Breast Cancer in the journal Breast Oncology.

Network Secretary Carol L. Kuhle, Network member Jennifer Vencill, and colleagues published Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship in the Journal of Clinical Medicine.

Network Board Member Marloe Esch was featured in an article for ONS Voice, a publication of the Oncology Nursing Society, addressing Sexual Considerations for Patients with Cancer.

UPCOMING MEETINGS OF INTEREST

Medical Student Forum on Female Sexual Medicine - Virtual, January 22, 2023

SGO 2023 Winter Meeting - Whistler, BC, Canada, Feb 2-4, 2023

ISSWSH Annual Meeting - St Louis, MO, March 2-5, 2023

SGO 2023 Annual Meeting - Tampa, FL, March 25-28, 2023

Sexual Medicine Society of North America Annual Scientific Program at AUA - Chicago, IL, April 26, 2023

SSTAR Annual Meeting - Tampa FL/Virtual, May 4-7, 2023

ESMO Breast Cancer Annual Congress - Berlin, Germany, May 11-13, 2023

ASCO Annual Meeting - Chicago IL/Virtual, June 3-6, 2023

AASECT Annual Meeting - San Francisco, CA, June 7-11, 2023

Transforming Women’s Health - Chicago, IL/Virtual, June 8-10, 2023

MASCC Annual Meeting - Nara, Japan, June 22-24, 2023

A SPECIAL THANK YOU

The Scientific Network would like to acknowledge and thank our sponsors, whose support made the 8th Conference of the Scientific Network possible!

Gold Institutional Sponsors

With support from Yale Cancer Center and the Smilow Cancer Hospital at Yale-New Haven

Silver Institutional Sponsors

With support from the Departments of Obstetrics & Gynecology and Psychiatry, the Lindau Lab, and the Comprehensive Cancer Center

Bronze Institutional Sponsor

Institutional Supporters

University of Rochester

Institutional Supporters

Carol Kuhle

Mayo Clinic

Bronze Corporate Sponsors

Corporate Supporters

Palatin

Soul Source

Sprout Pharmaceuticals, Inc.

DONATE TO THE NETWORK!

As you partake in the joys of gift-giving this holiday season, please consider donating to the Scientific Network. Dr. Stacy Lindau offers these thoughts for your end-of-year annual giving consideration: “I give to the Scientific Network on Female Sexual Health and Cancer because it is the only organization in the world solely dedicated to ensuring that women with cancer can continue to live a sexual life. I give because this Network connects today’s world-class clinicians, scientists, advocates, and innovators in the field to the people who will carry this work forward with excellence. I give to the Scientific Network because it’s the place I go for soulmates in the pursuit of caring for whole women affected by cancer. I made my gift today.”

WELCOME NEW MEMBERS

Amy Siston, PhD, CST, Chicago, IL (Department of Psychiatry and Behavioral Sciences, University of Chicago)
Irania Santaliz Moreno, St. Louis, MO (Washington University)
Cristina Pozo Kaderman, PhD, Boston, MA (Brigham and Women’s Dana-Farber Cancer Institute, Brigham and Women’s Hospital)
Lydia Chevalier, PhD, Boston, MA (Dana-Farber Cancer Institute)
Jennifer Bires, MSW, LICW, OSW-C, Fairfax, VA (Inova Shar Cancer Institute)
Satish Sanjana, Philadelphia, PA (University of Miami Medical School, Sonalkar Lab)
Emily Gehron, DNP, CRNP, AOCNP, RNFA, Lancaster, PA (Penn Medicine Lancaster General Health, Medical Oncology)
Elisabeth Costigan, NP, Boston, MA (MGH Radiation Oncology)
Elizabeth Murphy, Psy.D., Maywood, IL (Loyola University Medical Center)
Kristina Slunecka, NP-C, Fort Collins, CO (UCHealth Cancer Center)

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