Christian J. Nelson

Background: Systemic therapy with phosphodiesterase type 5 inhibitors (PDE5is) is the standard of care for erectile dysfunction (ED), but these treatments are not effective in all men, and others may prefer non-systemic treatment options. Aim: The goal of this Delphi consensus initiative was to address unmet needs in the treatment of men with ED and the best use of a US Food and Drug Administration (FDA) cleared topical therapy, MED3000 (Eroxon®), that is available without a prescription. Methods: The iterative Delphi process involved the creation of an initial slate of 38 statements and brief summaries of related evidence (if available), followed by the review from 2 co-chairs and 3 rounds of consensus development by an independent panel. Outcomes: The Delphi process reduced the initial set of 38 statements to 31 for which there was ≥80% support (in some cases after revision of the initial statement and revoting) from the panel in the final round of voting. Results: Statements for which consensus was achieved were consistent with current guidelines in recognizing the need for topical ED therapy. They also provided practical expert advice on the best use of this topical therapy. Statements regarding MED3000 (Eroxon®) for which consensus was not achieved identified important clinical considerations that would benefit from further analysis of existing clinical trial results for MED3000 and collection of new real-world data. Clinical Implications: This initiative identified multiple unmet needs that may be addressed by a well-tolerated and efficacious topical treatment. It also provided a critical assessment from experienced healthcare professionals of the evidence supporting the use of an over-the-counter topical therapy for ED. Strengths and Limitations: The main strength of this Delphi initiative was an expert assessment of unmet needs in ED and the place in therapy for topical medications. The main limitation was that available data for topical treatment leaves some questions unanswered, most notably efficacy in different subpopulations of men with ED. Conclusions: Overall, the statements supported in this Delphi initiative may provide a framework for more detailed recommendations that could be incorporated into treatment guidelines. In addition, the statements for which unanimous support could not be achieved help to identify evidence gaps that are targets for future research.

Background and Objectives: The number of older adults with cancer, those who require complex needs and care, continues to increase. With limited learning opportunities, the healthcare workforce is unprepared to meet this growing need. This study examined the long-term impact of Geriatric Oncology: Cognition and Communication (Geri Onc CC), a multidisciplinary program developed and implemented to address this gap in care. Methods: Multidisciplinary healthcare providers (HCPs) were recruited from across the United States and internationally to participate virtually or in person at a comprehensive cancer center in the Northeast United States. The program included education about geriatric syndromes, unique and complex issues related to older adults with cancer, and tailored communication strategies. Knowledge, attitudes, and self-efficacy were assessed pre- and post-training and at 6- and 12-month follow-ups. Skill utilization and implementation practices were evaluated at 6- and 12-month follow-ups only. Results: 282 HCPs participated. Initial gains in knowledge and self-efficacy were maintained at both 6 and 12 months post-training (p values <.01). More than 70% indicated using all skill categories “somewhat more” or “much more” at both follow-up periods. Most HCPs implemented changes in their clinical practice, teaching, and/or research based on what they learned. Discussion and Implications: Geri Onc CC has demonstrated a sustained, positive impact in many areas, including knowledge and self-efficacy. It also led to greater usage of the skills learned and changes in clinical care, teaching, and research. The program addresses a critical gap in education and training of the workforce caring for older adults with cancer.

Introduction: The World Health Organization estimates that one in eight people around the world is living with a psychiatric disorder. An under-recognized consequence of psychiatric disorders is the detrimental impact they may have on sexuality. Psychotropic medications to treat psychiatric disorders can also have a significant, negative effect on sexual functioning. Objective: This review is a consensus International Consultation on Sexual Medicine (ICSM) report developed to outline and describe these impacts. Methods: The committee members first discussed the structure of the manuscript. Literature searches were conducted for each section, seeking key words related to sexual dysfunction and each specific psychiatric condition and for psychiatric medications and classes of drugs. A modified Delfi approach was used when making decisions on content and recommendations. The content and recommendations were presented at ICSM where experts across the field of sexual medicine provided feedback. These comments were reviewed by the co-chairs of the 24 committees for discussion and feedback. Results: In relation to psychiatric disorders and sexual dysfunction, there are two primary themes evident in the literature, (1) there are significant methodological weaknesses, and (2) the prevalence of sexual dysfunction across all psychiatric disorders is generally high and elevated compared to controls (when available). Additionally, sexual dysfunction associated with psychotropic medications is a frequent treatment-emergent side effect, for antidepressants ranging from 25% to 80% and for antipsychotics ranging from 16% to 60% depending on the underlying mechanism of action of a particular medication. Sexual dysfunction is also associated with many of the co-morbid conditions related to a psychiatric diagnosis. Conclusion: The committee outlined three recommendations which highlight the importance of assessing for sexual dysfunction in those who report psychiatric disorders, evaluating sexual dysfunction across treatment while treating these disorders with psychotropic medication, and recognizing that the causes of sexual dysfunction are often multi-factorial.

Background: Depression in older adults with cancer (OACs) is poorly captured by patient‐reported outcomes (PROs) because traditional criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) may overlook unique symptoms in OACs. By using US Food and Drug Administration Guidance for Industry on PRO development, the authors conceptualized depression in OACs and created the Older Adults with Cancer‐Depression Scale (OAC‐D). This study evaluates the psychometric properties of this novel measure. Methods: Based on a refined conceptual model informed by literature reviews and qualitative work with patients and experts in geriatric oncology, a 35‐item draft PRO was developed. The draft was administered, alongside legacy measures, to OACs aged >70 years and older at a comprehensive cancer center and across the United States. Exploratory graph analysis was used to identify items and factors. Results: The mean ± standard deviation age of the 155 participants was 76 ± 5 years, and 56% were women. Exploratory graph analysis yielded an 18‐item measure with five domains: (1) interest and enjoyment, (2) purpose and meaning, (3) loneliness, (4) social withdrawal, and (5) regret and guilt. Internal consistency (Cronbach alpha, .85–.95) and test‐retest reliability (intraclass correlation coefficient = 0.61–0.80) were strong. Convergent validity was supported by correlations with the Patient Health Questionnaire‐9 ( r = 0.75), the Patient‐Reported Outcomes Measurement Information System anxiety score (r = 0.69), and the Patient‐Reported Outcomes Measurement Information System physical score ( r = −0.39). Known groups analysis demonstrated higher OAC‐D scores for those with a history of depression ( p < .001). Conclusions: The OAC‐D identified five unique domains of depression, only one of which overlapped with DSM criteria. It demonstrated robust psychometric properties, providing a nuanced alternative to DSM‐based measures and addressing the distinctive psychological challenges of cancer and aging.