# Virtual versus in-person sexual rehabilitation for prostate cancer survivors: a retrospective cohort study comparing the Prostate Cancer Rehabilitation Clinic (PCRC) and the True North Sexual Health and Rehabilitation eClinic (SHAReClinic)

## TL;DR

This study compares virtual and in-person sexual rehabilitation for prostate cancer survivors and finds similar outcomes, suggesting virtual care is a viable option.

## Contribution

The study provides evidence that virtual sexual rehabilitation is as effective as in-person care for prostate cancer survivors.

## Key findings

- No significant differences were found in sexual function and distress outcomes between the virtual and in-person clinics.
- Partnered in-person participants reported higher intimacy compared to virtual participants.
- Pro-erectile medication use was similar in both groups, indicating comparable adherence and sexual activity.

## Abstract

Sexual dysfunction is a common and distressing consequence of prostate cancer (PCa) treatment, yet few healthcare institutions offer comprehensive, systematic care, limiting equitable access. Virtual models may improve accessibility and efficiency without sacrificing effectiveness.

To assess whether outcomes in the virtual Sexual Health and Rehabilitation eClinic (SHAReClinic) were comparable to those in the in-person Prostate Cancer Rehabilitation Clinic (PCRC) in improving sexual health outcomes for PCa survivors.

A retrospective cohort chart review was conducted on PCa patients enrolled in either the PCRC or SHAReClinic between September 2017 and August 2018, with data collected 12 months post-treatment. Clinic assignment was based on standard care pathways. Sexual health outcomes were measured using the Sexual Health Inventory for Men (SHIM), Sexual Distress Scale (SDS), Male Sexual Health Questionnaire (MSIS), and Expanded Prostate Cancer Index Composite (EPIC-26). Pro-erectile medication usage was also analyzed.

Primary outcomes were SHIM and SDS scores. Secondary outcomes included MSIS, EPIC-26 scores, and pro-erectile medication use as an indicator for adherence and ongoing sexual activity.

Among 98 PCa patients (55 PCRC, 43 SHAReClinic), no significant differences were found in SHIM and SDS scores. While partnered PCRC participants reported significantly higher intimacy on the MSIS compared to partnered SHAReClinic participants (P = .042), no significant differences were found on the EPIC-26 sexual health domain. Pro-erectile medication use was similar in both groups. Multivariable analyses showed comparable outcomes in sexual function, distress, and health-related quality of life, except for intimacy.

SHAReClinic yields comparable outcomes to PCRC and provides an effective, resource-efficient alternative to in-person sexual rehabilitation for PCa patients, particularly in settings with limited accessibility or resources.

This study provides a comprehensive assessment of sexual health outcomes; however, the small sample size limits generalizability. In addition, there was a significant imbalance in treatment modality, with radiation patients represented only in the SHAReClinic cohort. Further research in larger, more diverse populations with longer follow-up is needed to confirm these findings and better understand intimacy differences.

SHAReClinic demonstrates outcomes comparable to PCRC in managing sexual dysfunction in PCa patients, offering a viable and accessible option for sexual rehabilitation.