The training paradox in oncosexuality: a multinational survey on clinician attitudes, barriers, and sexual health communication in geriatric prostate cancer care.

PURPOSE: Sexual dysfunction is common after prostate radiotherapy, yet communication barriers remain unclear. This multinational study assessed radiation oncologists' practices, attitudes, and sexual-health training.

MATERIALS AND

METHODS

The International Geriatric Radiotherapy Group (IGRG) disseminated a 38-item cross-sectional survey to radiation oncologists across 17 countries. The instrument captured demographics, discussion frequencies, perceived barriers, referral patterns, and attitudes toward oncosexuality. Data was analyzed with descriptive statistics, chi-square tests, and multivariable logistic regression. An exploratory sensitivity analysis restricted to respondents reporting regular management of patients receiving radiotherapy with potential impact on sexual health (≥ 1 such patient per month) was performed.

RESULTS

Among 117 radiation oncologists, 87% (102/117) reported some clinical exposure to patients receiving radiotherapy with potential impact on sexual health, and 57% (67/117) reported regular exposure (≥ 1 patient per month). 48% reported that patients rarely initiated discussions, and 8% never addressed the topic. Main barriers were time (39%), competing oncologic priorities (35%), and embarrassment (26%); 60% felt discomfort with older patients. Multivariable analysis revealed a "training paradox": clinicians with formal sexual-health training (56%) had significantly lower odds of initiating discussions at the first visit (OR 0.37, 95% CI 0.15-0.94, p = 0.037) and higher odds of embarrassment with older patients (OR 5.72, 95% CI 2.09-15.65, p = 0.001), independent of age, gender, experience, and practice setting.

CONCLUSION

These findings suggest that awareness-focused sexual-health training alone may be insufficient; behaviourally anchored communication training and formal referral pathways are needed.