Assessing gynecologic and breast cancer survivors' sexual health care needs

Gynecologic cancer survivor preferences for provider communication regarding sexual health after treatment: a qualitative study

PURPOSE

Survivorship from gynecologic cancers is becoming increasingly prevalent. There are significant sexual side effects that influence quality of life that would be reduced with proper intervention; however, existing literature highlights the lack of understanding of the sexual health needs within this population. Furthermore, multiple studies show that one contributing factor to sexual well-being in survivorship is provider-patient communication. The aim of this study is to explore experiences of sexual distress and survivor experiences of sexual health communication.

METHODS

Adult participants who had been out of active treatment for 3 months were recruited to participate in focus groups. Six focus groups (n = 32) were conducted with survivors of gynecologic cancers via Zoom. Research team members analyzed content using thematic analysis.

RESULTS

Two broad themes were identified: Experiences of provider communication and Preferences for provider communication, with subthemes nested under both. Subthemes from the Experiences theme included absent/lacking communication, negative experiences, emotional reaction to lack of communication, and feeling like sexuality was not valued. Subthemes from the Preferences theme included more conversation and open communication about sexuality, more resources/referrals, and more provider training on sexuality.

CONCLUSION

Survivor experiences of subjective sexual health are often dependent on the type and quality of information they receive from their healthcare team during treatment. Unfortunately, the majority of participants endorsed negative or absent communication related to their sexual health needs, leading to additional distress.

Patient-reported sexual health outcomes of cervical cancer patients treated with definitive chemoradiation and MRI-guided brachytherapy

BACKGROUND

Sexual health is an important survivorship issue in cervical cancer. We assessed patient-reported sexual health outcomes and correlations with oncologist-assessed vaginal toxicity (VT).

METHODS

This was a prospective, cross-sectional study of stage IB-IVA cervical cancer patients treated with definitive chemoradiation, who completed a socio-demographic questionnaire and the following patient-reported-outcomes (PROs): Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Menopause Rating Scale (MRS), Hospital Anxiety and Depression Scale (HADS). VT was assessed using the CTCAE v4.0. Sociodemographic, clinical data, PROs and VT were summarized using descriptive statistics; correlations were evaluated using linear regression analyses.

RESULTS

Between August 2018 and April 2022, 73 patients were analyzed. Median age was 49 (range 25-81), 57.5% had vaginal involvement at diagnosis and 76.9% were partnered. Sexual dysfunction (FSFI score ≤ 26), sexual distress (FSDS-R ≥ 11), severe menopausal symptoms (MRS ≥ 17), anxiety (HAD-Anxiety >7) and depression (HAS-Depression >7) were reported in 86.3%, 54.5%, 36.2%, 46.6% and 24.7%, respectively. Grade 2+ VT was reported in 27.4%. No significant associations were found between PROs and VT. On multivariable analysis, non-partnered status, use of hormone replacement therapy, and International Commission on Radiation Units and Measurements - rectovaginal dose (ICRU-RV) >65Gy were associated with worse sexual health (p < 0.005).

CONCLUSION

Cervical cancer patients self-report high rates of sexual distress, dysfunction and menopause symptoms. Discordance between oncologist-assessed VT and PROs highlights the importance of evaluating the patient's experience. Proactive treatment of menopausal symptoms and attention to radiotherapy doses to the vagina should be considered.

Acceptability and Feasibility of Survivorship Group Medical Visits for Breast Cancer Survivors in a Safety Net Hospital

Providing cost-effective, comprehensive survivorship care remains a significant challenge. Breast cancer survivors (BCS) who have limited income and are from marginalized racial and ethnic groups experience a worse quality of life and report higher distress. Thus, innovative care models are required to address the needs of BCS in low resource settings. Group medical visits (GMV), utilized in chronic disease management, are an excellent model for education and building skills. This single-arm intervention study was conducted at a public hospital in California. GMVs consisted of five 2-h weekly sessions focused on survivorship care planning, side effects of treatment and prevention, emotional health, sexual health, physical activity, and diet. The patient navigators recruited three consecutive GMV groups of six English-speaking BCS (N = 17). A multidisciplinary team delivered GMVs, and a patient navigator facilitated all the sessions. We used attendance rates, pre- and post-surveys, and debriefing interviews to assess the feasibility and acceptability of the intervention. We enrolled 18 BCS. One participant dropped out before the intervention started, 17 BCS consistently attended and actively participated in the GMV, and 76% (13) attended all planned sessions. Participants rated GMVs in the post-survey and shared their support for GMVs in debriefing interviews. The BCS who completed the post-survey reported that GMVs increased their awareness, confidence, and knowledge of survivorship care. GMVs were explicitly designed to address unmet needs for services necessary for survivorship care but not readily available in safety net settings. Our pilot data suggest that patient-navigator-facilitated GMVs are a feasible and acceptable model for integrating survivorship care in public hospitals.

Let's talk about sex! Why should healthcare professionals address sexual distress in breast cancer patients and survivors?

PURPOSE

Sexual distress impacts the quality of life (QoL) of breast cancer patients but is often overlooked in standard care pathways. This study evaluated the prevalence and factors of sexual distress among Dutch breast cancer patients, compared them to the general population, and explored how sexual distress is discussed in clinical settings from the perspectives of patients and healthcare professionals (HCPs).

METHODS

Questionnaires containing the Female Sexual Distress Scale (FSDS) and demographic variables were distributed to women with breast cancer. The effect of breast cancer on sexual distress was assessed with a Mann-Whitney U test. Multivariable linear regression was used to analyze variables associated with FSDS. The Sexuality Attitudes and Beliefs Survey (SABS) was sent to HCPs.

RESULTS

Breast cancer patients reported significantly higher sexual distress compared to a Dutch non-breast cancer cohort, respectively 16.38 (SD 11.81) and 23.35 (SD 11.39). Factors associated with higher sexual distress were psychological comorbidities, the body image scale, and being diagnosed >10 years ago. Sexual distress was not discussed as often as patients needed. Barriers to addressing sexual distress were time constraints, HCPs' confidence in their ability to address sexual distress, and uncertainty about who is responsible for initiation.

CONCLUSIONS

Breast cancer patients showed significantly higher sexual distress compared to the Dutch population. However, it was not frequently addressed in the consultation room. While some barriers have been identified, this study highlights the importance of further exploring obstacles to integrating discussions about sexual distress into routine care to improve QoL of breast cancer patients.

Sexual Health in Women Affected by Gynecologic or Breast Cancer

Sexual health problems are prevalent among women affected by gynecologic or breast cancer. It is important to understand the effects cancer treatment can have on sexual health and to have the tools necessary to identify and treat sexual health problems. This Clinical Expert Series discusses practical methods for routinely screening for sexual dysfunction and reviews sexual health treatment options for women affected by cancer. We review the limitations of the current literature in addressing sexual health problems among sexually and gender minoritized communities. Finally, we discuss appropriate timing of referrals to sexual health experts, physical therapists, and sex therapists. Multiple resources available for both patients and clinicians are included.

A review of functional and surgical outcomes of gynaecological reconstruction in the context of pelvic exenteration

BACKGROUND

Radical surgical excision may be the only curative option for patients with advanced pelvic malignancy, but concerns surrounding the functional outcomes and survivorship of patients undergoing exenterative surgery remain. This is especially important in the context of vulvovaginal resection, where patients are often younger and surgery can have a profoundly negative impact on quality of life, body image and overall wellbeing. Reconstructive procedures are an important means of mitigating these adverse effects but outcomes are poorly described.

AIM

To define the outcomes associated with gynaecological reconstructive procedures following pelvic exenterative surgery and to compare them with the outcomes of those patients who did not undergo reconstruction.

METHODS

An international, multicentre retrospective investigation comparing the outcomes of reconstruction with no reconstruction. The protocol was prospectively registered (NCT05074069).

RESULTS

334 patients were included. 77 patients had a neovagina reconstructed, 139 patients underwent flap reconstruction and 118 were not reconstructed. Patients who underwent reconstruction had a longer operative time and hospital stay with an increased risk of minor perineal complications. Reconstruction did not confer an increased risk of surgical reintervention, and overall complication rates were equivalent. Procedure-specific major morbidity was 5.2 % and 11.5 % for neovaginal and flap reconstruction, respectively. 66 % of patients undergoing neovaginal reconstruction experienced no long term morbidity. 7 % developed neovaginal stenosis and 12 % suffered disease recurrence.

CONCLUSION

Neovaginal reconstruction is safe in carefully selected patients and offers specific advantages over alternative techniques, with few patients requiring reoperation. Primary closure does not increase perineal morbidity.

Fertility-Sparing Treatment in Gestational Choriocarcinoma: Evaluating Oncological and Obstetrical Outcomes in Young Patients

BACKGROUND Gestational choriocarcinoma (GC) is an uncommon neoplasia that occurs in women who may not have completed a procreation plan. The aim of this study was to evaluate oncological and obstetrical outcomes in young patients with GC after fertility-sparing treatment. MATERIAL AND METHODS The eligibility criteria for the study were histopathological diagnosis of GC, age ≤40 years, and treatment with systemic chemotherapy. Patients who underwent upfront hysterectomy were excluded. The response to treatment was assessed according to beta-human chorionic gonadotropin (beta-hCG) serum measurement. Complete response and progression were considered if the beta-hCG dropped to a normal range and increased (or reached a plateau), respectively. The birth rate was calculated as the number of women who gave birth after treatment divided by the total number of patients. RESULTS A total of 18 patients fulfilled the study's eligibility criteria. A complete response and progression to first-line chemotherapy were found in 13 (72.22%) and 5 (27.78%) patients, respectively. Salvage treatment was administered to patients with progression. Overall, 16 (88.88%) patients achieved complete response after treatment and 2 (11.12%) died. GC relapse was diagnosed in 1 patient 62 months after treatment. The birth rate was 22.22%, and a total of 6 children were born. All pregnancies ended in term delivery. No congenital abnormalities were detected in the newborns. CONCLUSIONS GC is a life-threatening form of gestational trophoblastic neoplasia, mainly due to its rapid course and resistance to chemotherapy. Most patients with GC will not be able to bear children after treatment.

Association of sexual attitudes with sexual dysfunction and sexual distress among Chinese breast cancer survivors: a cross-sectional study

PURPOSE

Little is known about sexual dysfunction and sexual distress in Chinese female breast cancer survivors (BCSs), and their associations with physical variables, psychological factors, body image, and sexual attitudes.

METHODS

A cross-sectional study of 341 BCSs was performed with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R). Associations between physical variables, psychological factors, body image, sexual attitudes, sexual dysfunction, and sexual distress were evaluated using logistic regression, adjusted for confounding factors.

RESULTS

We found that 75.37% and 18.48% of BCSs reported sexual dysfunction and sexual distress during the past month, respectively. Attitudes toward sexual behavior such as "sexual activity may impede disease recovery," "sexual activity may cause cancer recurrence or metastasis," and "sexual activity may weaken treatment effects" were significantly associated with an increased likelihood of reporting sexual dysfunction and sexual distress. Body image disruption such as "felt physically less attractive as a result of your disease or treatment" was significantly associated with the experience of sexual distress.

CONCLUSION

Sexual dysfunction and sexual distress are common issues in Chinese BCSs. Sexual misconception likely contributes to sexual dysfunction and sexual distress, and body image has a significantly negative association with sexual distress in BCSs. Interventions targeting sexual attitudes and body image might be important to address BCSs' sexual issues and improve their overall sexual health.

A silence full of words: sociocultural beliefs behind the sexual health of Iranian women undergoing breast cancer treatment, a qualitative study

PURPOSE

Therapeutic interventions lead to impaired sexual health in women undergoing breast cancer treatment. There are some problem such as vaginal dryness, decreased libido, decreased sexual satisfaction, and decreased frequency of sexual intercourse among breast cancer survivors. This study was conducted to discover the sexual experiences of women undergoing breast cancer treatment.

METHODS

A total of 39 semi-structured interviews were held with the women undergoing breast cancer treatment, husbands, and health care providers. Recorded interviews were transcribed and analyzed using qualitative content analysis.

RESULTS

Three categories of cultural and gender taboos, adherence to subjective norms, and hidden values in sexuality were revealed. The cultural and gender taboos category consisted of subcategories of learned sexual shame, fear of judgment, sexual schemas, and gender stereotypes. The adherence to subjective norms category consisted of subcategories of sexual socialization, being labeled as a disabled woman and the priority of being alive to sexuality. The hidden values in sexuality category consist of subcategories of Task-based sexuality, Tamkin, and Sexuality prevents infidelity.

CONCLUSIONS

Socio-cultural beliefs affect the sexual health of women undergoing breast cancer treatment, so paying attention to this issue can improve the quality of sexual health services.

Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study

Treatment for gynecologic cancer is associated with sexual dysfunction, which may present during and/or after treatment. The aim of this study was to investigate the risk of sexual dysfunction among gynecologic cancer survivors compared to cancer-free women in a population-based cohort study. We identified a cohort of 4863 endometrial, ovarian, and cervical cancer survivors diagnosed between 1997 and 2012 in the Utah Cancer Registry. Up to five cancer-free women were matched to cancer survivors (N = 22,693). We used ICD-9 codes to identify sexual dysfunction. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for sexual dysfunction with adjustment for potential confounders. Approximately 6.6% of gynecologic cancer survivors had sexual dysfunction diagnoses 1-5 years after cancer diagnosis. Gynecologic cancer survivors had higher risks of overall sexual dysfunction (HR: 2.51, 95% CI: 2.16, 2.93), dyspareunia (HR: 3.27, 95% CI: 2.63, 4.06), and vaginal dryness (HR: 2.63, 95% CI: 2.21, 3.12) compared to a general population of women, 1-5 years after cancer diagnosis. Sexual dysfunction was associated with advance cancer stage (HRRegional vs. Localized: 1.61, 95% CI: 1.19, 2.31), radiation therapy (HR: 1.73, 95% CI: 1.29, 2.31), and chemotherapy (HR: 1.80, 95% CI: 1.30, 2.50). This large cohort study confirms that there is an increased risk of sexual dysfunction among gynecologic cancer survivors when compared to the general population. Further investigation is needed to address the risk factors for sexual dysfunction and to improve patient-provider communication, diagnosis, documentation, and treatment of sexual dysfunction among gynecologic cancer survivors.

Exploring Brachytherapy Discharge Educational Needs of Gynecological Cancer Patients

Brachytherapy (BT) plays a fundamental role in the treatment of gynecological cancers. Patient education for vaginal self-management and dilator use post-BT involves an interdisciplinary team of healthcare professionals (HCPs) and there is a paucity of post-BT education guidelines. Our objective was to determine the educational needs of gynecological cancer patients surrounding vaginal self-management post-BT and to determine enablers and barriers to the provision of education by HCPs. This cross-sectional study recruited gynecological oncology patients receiving external beam radiotherapy and BT for curative intent. Patients completed a questionnaire to assess their vaginal self-management educational needs, preferred education modality, and desired timing of post-BT education. HCPs were invited to complete a questionnaire to identify enablers and barriers to providing BT education. Twenty patients and 53 HCPs participated. All patients rated each topic as very important/important with information about preventing vaginal stenosis as the most important overall (89%). When asked about topics they addressed during BT education, most HCPs reported that "explaining what vaginal stenosis is and the negative effects of stenosis" was always discussed with patients (N = 37/49, 77%). Barriers to providing post-BT education, including the patients' language and culture, as well as enablers, such as the use of written resources and tools for patients, were identified. Despite a high level of engagement, current education surrounding vaginal self-management post-BT may be inadequate.

Examining Associations Among Sexual Health, Unmet Care Needs, and Distress in Breast and Gynecologic Cancer Survivors

OBJECTIVES

This study evaluated breast and gynecologic cancer patients' sexual function, unmet needs related to sexuality, and distress.

DATA SOURCES

Secondary analyses of a cross-sectional survey study evaluated measures of sexual function (Female Sexual Function Index [FSFI]), unmet needs (Supportive Care Needs Scale), and distress (Patient Health Questionnaire). χ2 test, t tests, and analysis of variances (ANOVAs) tested bivariate relationships. Subgroup comparisons were made based on the Female Sexual Function Index sexual dysfunction diagnostic cut-off score (<26.55; lower scores indicate greater dysfunction). A regression model tested associations between sexual function and unmet needs with distress as the outcome variable.

CONCLUSION

Clinically significant sexual dysfunction was common in this cohort of women. In multivariate modeling, worse sexual function and greater unmet sexuality needs related to greater distress. Future work should explore reasons behind the high levels of sexual dysfunction and unmet needs in female survivors.

IMPLICATIONS FOR NURSING PRACTICE

It is important to routinely screen for sexual health concerns among female cancer survivors at all phases of the cancer trajectory including years posttreatment.

Sexual activity and cancer: A systematic review of prevalence, predictors and information needs among female Arab cancer survivors

INTRODUCTION

The objective of this review is to synthesise and present the best available evidence on the prevalence, predictors and information needs about sexual health among female Arab cancer survivors.

METHODS

The databases searched included MEDLINE, Embase and CINAHL from inception of the database until March 2020. The review was undertaken according to the JBI guidelines. Proportional meta-analysis using a random effects model was used for statistical pooling through JBI SUMARI.

RESULTS

Seven studies involving female Arab cancer survivors were included in the review. The overall prevalence of sexual dysfunction ranged from 16.7 to 67% (pooled estimate 51%, 95% CIs 21.7% to 80.2%). Dyspareunia and erectile dysfunction were the two main types of sexual dysfunction reported after diagnosis, and the overall prevalence ranged from 42.5% to 65% and 38% to 61%, respectively. The prevalence of vaginal dryness was ranged from 19.8% to 54.2%, and dyspareunia ranged from 22.2% to 65%. The lack of sexuality information and communication with health care providers (HCPs) was also reported in the included studies.

CONCLUSION

Cancer and its treatment may result in significant difficulties with sexual activity and sexual functioning among cancer survivor. Communication between the health care professionals and cancer survivors is essential to overcome this problem and improve the quality of life of female Arab cancer survivors.

Non-physician's challenges in sexual and reproductive health care provision for women of reproductive age with cancer: a scoping review of barriers and facilitators

PURPOSE

The American Society of Clinical Oncology Clinical Practice guidelines recommend that non-physicians such as nurses, social workers, and psychologists should be prepared to discuss fertility and sexual concerns with patients. However, literature showed that the utilization rate of sexual and reproductive care for women with cancer remained low. We conducted a scoping review to describe non-physicians' roles, barriers, and facilitators providing sexual and reproductive health (SRH) care to women of reproductive age with cancer.

METHODS

We searched six databases for articles that met the following criteria: (1) English language; (2) original research; (3) non-physician providers; (4) women with cancer under age 50. We categorized barriers and facilitators at the system-, individual-, and clinical encounter-levels from providers' and patients' perspectives.

RESULTS

We included 27 studies from 3451 retrieved articles. The majority of studies have a focus on fertility preservation or sexuality (n = 25). At the system level, the main barriers for non-physicians were lack of SRH care guidelines and collaborating experts. Concerns for patients included socioeconomic and geographic constraints in obtaining care. At the encounter level, providers and patients lacked experience discussing SRH. At the individual level, providers' lack of knowledge in SRH treatment options and interprofessional collaboration and patients' lack of awareness about treatment effects hindered SRH discussions. Facilitators include the availability of SRH programs and specialists, and rapport between providers and patients.

CONCLUSIONS

Supporting non-physicians to provide SRH services to women with cancer requires investment in clinical guidelines, interprofessional collaboration, and training in patient communication.

Opening the Conversation: study protocol for a Phase III trial to evaluate a couple-based intervention to reduce reproductive and sexual distress among young adult breast and gynecologic cancer survivor couples

BACKGROUND

Reproductive and sexual health (RSH) concerns are common and distressing for young adults diagnosed with breast and gynecologic cancer and their partners. This study evaluates the efficacy of a virtual couple-based intervention called Opening the Conversation (OC). The OC intervention is grounded in theory and evidence-based practice and was adapted to improve coping and communication specifically in relation to RSH concerns after cancer.

METHODS

This Phase III trial is conducted in a fully remote setting and enrolls young adult couples (current age 18-44 years) with a history of breast or gynecologic cancer (stage 1-4, diagnosed under age 40) within the past 6 months to 5 years. Eligible dyads are recruited from across the USA. The target sample size is 100 couples. Dyads are randomly assigned to receive either the 5-session OC intervention or a 4-session active control intervention (Side by Side). The primary outcomes are change in reproductive distress and sexual distress. Secondary outcomes include communication about reproductive concerns, communication about sexual concerns, depressive symptoms, sexual function, relationship quality, relationship intimacy, sexual satisfaction, self-efficacy to communicate about sex and intimacy, and quality of life. An exploratory aim examines whether dyadic coping and communication quality mediate intervention effects on survivors' and partners' reproductive distress or sexual distress. Self-report outcome measures are assessed for both groups at baseline (T1), 2 weeks post-treatment (T2), and 3 months post-treatment (T3).

DISCUSSION

Despite the importance of RSH for quality of life for young adult cancer survivors and their partners, evidence-based interventions that help couples navigate RSH concerns are lacking. This randomized controlled trial will determine the efficacy of a novel couple-based intervention to reduce distress related to RSH concerns for younger couples after breast or gynecologic cancer, in comparison to an active control intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04806724. Registered on Mar 19, 2021.

Factors influencing the burden on spousal caregivers of breast cancer survivors

Purpose

To examine the status of spouses’ burdens of caring for breast cancer survivors and explore the relationships between social support, family resilience, breast cancer survivors’ individual resilience, and caregiver burden.

Methods

A cross-sectional study on 315 young and middle-aged breast cancer survivors and their spousal caregivers was conducted at eight comprehensive Southwest China hospitals. The caregivers completed the Chinese Version of the Family Resilience Assessment Scale, the Perceived Social Support Scale, and the Zarit Caregiver Burden Interview, while breast cancer survivors completed the shortened Chinese version of the Connor-Davidson Resilience Scale. Structural equation modeling was used to evaluate the relationships among social support, family resilience, survivors’ individual resilience, and caregiver burden.

Results

Caregiver burden (45.76 ± 14.66) was found to be severe. Social support, family resilience, and individual resilience were significantly negatively associated with caregiver burden (β =  − 0.421, P < 0.001; β =  − 0.208, P < 0.001; and β =  − 0.444, P < 0.001, respectively). Individual resilience not only partially mediated the relationship between family resilience and caregiver burden (b =  − 0.052; 95% confidence interval, − 0.110, − 0.018), but also partially mediated the relationship between support and caregiver burden (b =  − 0.045; 95% confidence interval, − 0.102, − 0.011).

Conclusions

The findings suggest that higher social support, family resilience, and individual resilience tend to ease caregivers’ burden. Healthcare workers should have an in-depth understanding of the care needs of survivors, actively contact social security departments and social organizations to provide financial, technical, and emotional support, and provide family-based care-skills training and psychological counseling to reduce spousal caregivers’ burdens.

Health belief model in predicting treatment intention among healthy and gynecologic cancer women with sexual dysfunction: Structural equation modeling

OBJECTIVE

Few large-scale studies have focused on the effect of gynecologic cancer compared with other biopsychosocial factors on willingness to seek treatment among women with sexual dysfunction. The aim of study was to identify predictors of the intention to treat female sexual dysfunction (FSD) among sociodemographic factors, physiologic factors, psychologic factors, gynecologic cancer, and health belief model (HBM).

MATERIALS AND METHODS

This study was a cross-sectional, hospital-based survey conducted from October 2013 to September 2019. Participants included healthy women and gynecologic cancer survivors who were aged 20 years or older and had been in a monogamous relationship for at least 12 months. They were enrolled in the gynecologic departments in southern Taiwan. Those who met DSM-5 criteria of sexual dysfunction were analyzed with Structural equation modeling. Intention to seek treatment was the primary outcome.

RESULTS

448 of 643 women met DSM-5 sexual dysfunction. The mean age was 42.0 years (range: 21.8-68.1 years). Fifty-eight percent of women reported sexual treatment intention. The model fit was good: χ2 = 367.42, P < .001, χ2/df = 2.83, CFI = 0.933, TLI = 0.921, and RMSEA = 0.066 (95%CI: 0.058-0.074). Perceived severity, perceived benefits, perceived barriers, cue to action, self-efficacy and university education at least significantly predicted treatment intention. There were no significant differences in treatment intention regarding age and gynecologic cancer. Self-efficacy was the strongest predictor, which directly affected treatment intention (P = .001). Perceived severity was the second strongest predictor, mainly affecting treatment intention indirectly (P = .01). Perceived barriers was the third strongest predictor (P = .001), indirectly and negatively affected treatment intention.

CONCLUSIONS

Five out of six HBM factors and university education at least could significantly predict the intention to treat FSD. Gynecologic cancer was not a significant predictor.

Clinician attitude towards sexual counseling in women with gynecologic malignancies: European Network of Young Gynaecological Oncologists (ENYGO) survey

OBJECTIVE

Both the location of primary disease and treatment side effects may have an impact on sexual function in oncogynecological patients. The aim of this study was to examine the prevalence, strategies, difficulties, and ideas for improvement in sexual counseling among specialists managing patients with gynecologic malignancies.

METHODS

This was a cross-sectional survey study performed among healthcare professionals treating patients with gynecologic malignancies. A self-prepared questionnaire included 61 questions concerning general demographic information and different aspects of sexual counseling in the gynecologic oncology practice. Analysis included attitudes, behaviors, management strategies, difficulties, and ideas for possible systemic improvements. Statistical analysis involved descriptive statistics, two-sided chi-square test, and Fisher's exact test.

RESULTS

A total of 150 respondents from 46 countries answered the survey. The majority of survey participants stated that sexual counseling of oncological patients is very important (n=73, 49%) or important (n=46, 31%). One hundred and two (68%) respondents agreed that sexual counseling of gynecologic oncology patients should be routinely provided by the specialist managing the primary disease. However, collecting information concerning sexual function is performed often or always by only 21% of respondents and 19% discuss the topic rarely or never. The most frequently indicated barriers leading to difficulties in sexual counseling include lack of time (74%), lack of specialist knowledge (55%), and patient embarrassment (48%). One hundred and seven (71%) respondents expressed interest in participating in sexual counseling workshops organized by the European Society of Gynaecological Oncology (ESGO)/European Network of Young Gynaecological Oncologists (ENYGO), 74 (49%) would like to access webinars on the topic, and 120 (80%) would be interested in materials in the ESGO online educational resources.

CONCLUSION

One of the proposed solutions to insufficient access to sexual care for women with gynecologic malignancies is providing access to specialist educational programs for both patients and healthcare specialists.

Looking Back to Move Forward: Lessons Learned from a Successful, Sustainable, Replicable Model of Adolescent and Young Adult Program of a Tertiary Cancer Care Center

Background:

The Princess Margaret Cancer Centre (PM) established the adolescent and young adult (AYA) oncology program in 2014 to address the unique needs of AYA by delivering targeted, evidence-based care through a multidisciplinary team.

Methods:

We performed a retrospective analysis of patients who underwent a consultation with the PM AYA program from 2014 to 2020. The association between the health domain concerns reported and age at consultation, cancer diagnoses, and time since diagnosis was analyzed using chi-square test of independence in SPSS.

Results:

In our cohort of 1128 AYA, the median age at assessment was 28.2 years. The most common diagnoses were lymphoma (n = 251, 22.2%), leukemia (n = 207, 18.4%), and breast cancer (n = 162, 14.4%). The most common concerns reported were related to fertility (n = 882, 78.2%) and work/school (n = 472, 41.8%). Fertility concerns were most common in 25–34 age group (443/540, 82.0%) and work-/school-related concerns were highest in 18–24 age group (191/355, 53.8%). Diagnoses significantly affect majority of concerns reported. Fertility concerns were most common in AYA consulted near diagnosis, while body image-, exercise-, and diet-related concerns were more frequently reported, while on active treatments.

Conclusions:

Supporting fertility concerns remains the cornerstone of any successful AYA program. Work-/school-related concerns deserve more elucidation and attention. We identified important patterns in the health-related concerns of AYA, especially as they relate to age, diagnoses, and time since diagnosis. This insight will guide us for improving patient-centered care delivery to AYA.

Female Sexual Dysfunction as Measured by Low Sexual Frequency is Associated with Lower Socioeconomic Status: An Analysis of the National Health and Nutrition Examination Survey (NHANES), 2007-2016

BACKGROUND

Female sexual dysfunction (FSD) is a complex disorder of biopsychosocial etiology, and FSD symptoms affect more than 40% of adult women worldwide.

AIM

In this cross-sectional study, we sought to investigate the association between FSD and socioeconomic status (SES) in a nationally representative female adult population.

METHODS

Economic and sexual data for women aged 20-59 from the 2007-2016 National Health and Nutrition Examination Survey, a United States nationwide representative database, was analyzed. Poverty income ratio (PIR), a ratio of family income to poverty threshold, was used as a measure of SES, and low sexual frequency was used as a measure of FSD. The association between FSD and SES was analyzed using survey-weighted logistic regression after adjusting for relevant social and gynecologic covariates, such as marital status and history of pregnancy, as well as significant medical comorbidities.

OUTCOMES

We found that FSD, as measured by low sexual frequency, was associated with lower SES.

RESULTS

Among the 7,348 women of mean age 38.4 (IQR 29-47) included in the final analysis, 26.3% of participants reported sexual frequency of 0-11 times/year and 73.7% participants reported sexual frequency >11 times/year. Participants of PIR <2 were 92% more likely to report sexual frequency ≤11 times/year than those of PIR ≥2 after adjusting for demographics, social history, gynecologic history and significant medical conditions (OR = 1.92; 95% CI = 1.21-3.05; P < .006).

CLINICAL IMPLICATIONS

The evaluation and treatment of FSD may benefit from a comprehensive approach that takes SES into account.

STRENGTHS & LIMITATIONS

This study is limited by its cross-sectional design, but it is strengthened by a large, nationally representative sample with extensive, standardized data ascertainment.

CONCLUSION

Lower SES and lower sexual frequency are directly correlated among female adults in the United States; future studies should focus on social determinants of health as risk factors for FSD.

Oncology Survivorship and Sexual Wellness for Women

Sexual dysfunction is extremely common in cancer survivors. Cancer survivors are living longer, and survivorship issues like sexual functioning are now a part of routine cancer care. Oncology providers need to be as comfortable assessing and addressing these issues as they would any other aspect relating to cancer care. Providers should know how to perform an evaluation for sexual dysfunction, understand basic treatment options, and have appropriate referrals available to ensure that the patient's needs are met. This review provides an overview of sexual dysfunction pertaining to women who are survivors of cancer and articulates areas needing further research.

The Long-Term Effects of Cancer Treatment on Sexuality and Couple Relationships

Breast cancer and its pharmacological treatment often induce an impairment in women's sexual functioning and couple relationships, as a consequence of physiological changes and psychosocial issues that may arise and persist long after treatment. This study aims to evaluate the sexual functioning, the quality of the couple relationship, and the overall health status of breast cancer survivors. A further objective is to determine the predictive role of specific clinical and sociodemographic variables for sexual functioning and the couple relationship. Sixty-four breast cancer survivors completed the following questionnaires: the Female Sexual Function Index (FSFI), the Dyadic Adjustment Scale (DAS), the Short Form Health Survey-12 (SF-12), and a self-report questionnaire to collect sociodemographic characteristics. Clinical information was retrieved from medical records. Compared to normative data, our sample reported significantly (p < .01) lower mean scores in the FSFI, DAS, and Physical Component (PCS) and Mental Component Summary (MCS) of the SF-12. Multiple regression analyses show a significant effect of age, hormonal therapy, and psychological well-being on sexual functioning and a significant effect of physical and mental well-being on the quality of the couple relationship. Additionally, 75% of patients qualified for sexual dysfunction as measured by the FSFI global scale, and 71.9% declared they were not adequately informed about the side effects of treatments on sexuality. The high prevalence of sexual dysfunction in breast cancer survivors underlines the need for specific attention to this problem, starting from a complete and targeted communication between patients and health providers regarding these side effects.

Mobile Technology-Based (mLearning) Intervention to Enhance Breast Cancer Clinicians' Communication About Sexual Health: A Pilot Trial

BACKGROUND

Most breast cancer clinicians lack training to counsel patients about sexual concerns. The purpose of this study was to assess the feasibility, acceptability, and preliminary effects of a mobile learning (mLearning) intervention (improving Sexual Health and Augmenting Relationships through Education [iSHARE]) aimed at enhancing breast cancer clinicians' knowledge of, beliefs about, and comfort with discussing patients' sexual health concerns.

METHODS

Clinicians listened to a 2-part educational podcast series offering information on breast cancer-related sexual health concerns and effective communication on the topic, which consisted of interviews with expert guests. Intervention feasibility was assessed through rates of enrollment, retention, and intervention completion, with benchmarks of 40%, 70%, and 60%, respectively. Acceptability was assessed through program evaluations, with 75% of clinicians rating the intervention favorably (eg, relevance, satisfaction) signifying acceptability. Clinicians self-reported their knowledge about breast cancer-related sexual health concerns, beliefs (ie, self-efficacy for discussing sexual health concerns), and comfort with discussing sexual concerns measured at preintervention and postintervention. Qualitative analysis examined clinicians' perceptions of lessons learned from the intervention.

RESULTS

A total of 32 breast cancer clinicians enrolled (46% of those invited; 97% of those who responded and screened eligible), 30 (94%) completed both the intervention and study surveys, and 80% rated the intervention favorably, demonstrating feasibility and acceptability. Results showed positive trends for improvement in clinician knowledge, beliefs, and comfort with discussing sexual health concerns. Clinicians reported key lessons learned, including taking a proactive approach to discussing sexual health concerns, normalizing the topic, addressing vaginal health, sending the message that help is available, and assessing sexual health concerns with patients from different backgrounds.

CONCLUSIONS

Breast cancer clinicians were amenable to participating in the iSHARE intervention and found it useful. iSHARE showed promise for improving clinician's knowledge and comfort discussing patients' sexual health concerns. A larger trial is required to demonstrate efficacy. Future studies should also examine whether iSHARE can improve patient-clinician communication and address patients' sexual concerns.

Sexual dysfunction in Thai gynecologic malignancies survivors: A single-institutional cross-sectional observational survey

OBJECTIVE

To examine the prevalence of female sexual dysfunction (FSD) in gynecologic cancer survivors.

METHODS

A cross-sectional observation survey recruited women aged 18-65 years old who were diagnosed with gynecologic cancers and underwent surgery, radiation, chemotherapy, or combined modalities. Data were collected from September 2019 to March 2020 by the Thai version of the female sexual function index questionnaire to define FSD. The survey contained six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

RESULTS

Of the 98 women included in the study, the mean age was 48.7 ± 10.6 years old. Two-third (67.3%) of the participants was premenopausal, had been diagnosed with ovarian cancer, and had early-stage gynecologic cancers. Fifty-eight of 98 (59.2%) participants were sexually active in the past 4 weeks before the survey. Among those, 89.6% had FSD. The median scores in the FSD group were significantly lower than those in the non-FSD group in all six domains, namely, desire, arousal, lubrication, orgasm, satisfaction, and pain (p < 0.05). There was no statistically significant difference observed between participants with and without FSD in terms of age group, cancer-related data, or sexual behavior data, except participants who had good/excellent relationships with their partners, which impacted FSD (p = 0.01).

CONCLUSIONS

This study discovered the high prevalence (89.6%) of hidden issue of "female sexual dysfunction" in Thai gynecologic cancer survivors. The good/excellent relationships with their partners affected the FSD who were sexually active in the past 4 weeks before the survey.

Attitudes and Behavior of Patients with Gynecologic Malignancy Towards Sexual Issues: a Single-institutional Survey

To better understand patients' perspectives and preferences for sexual issues and to provide information to guide medical staff in delivering sexual health care, an anonymous, cross-sectional survey of inpatient gynecologic cancer patients was conducted from April 2017 to March 2018. The questionnaire consisted of three parts: basic information, a history of sexuality discussion, and eight preference questions. A total of 1192 patients were included, and the median age was 43 years. More than half of the patients had a junior high school education or less and low income. Of the patients, 46.2% agreed that, "Doctors should deal with patients' sexual issues," and 56.2% agreed that, "Doctors should raise the topic of sexual issues." While 69.1% of the patients were willing to raise the topic themselves if any sexual problem existed, 35.9% of the patients agreed, "It's not the right time to discuss sex due to my severe disease." Less than 30% of the patients thought that "There's no need to intervene because sex is private" and "I do not feel comfortable discussing sex." A total of 41.1% of the patients were interested in undertaking basic sexual health consultation. Multiple logistic regression analysis demonstrated the following predictive factors for a history of consultation: young age; good education; and agreement with the statements, "Doctors should raise the topic of sexual issues," "If any sexual problem exists, I will raise the topic," and "I have an interest in participating in sex-counseling activities." Patients were willing to discuss sexual issues and were interested in sexual health training. It is important to increase the medical staff awareness of the need to inquire about and address patients' sexual issues.

Clinical use and implications of sexual devices and sexually explicit media

Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.

Benefits of a Multidisciplinary Women's Sexual Health Clinic in the Management of Sexual and Menopausal Symptoms After Pelvic Radiotherapy

OBJECTIVE

The objective of this study was to examine patterns of care and outcomes of female cancer patients treated for sexual and menopausal symptoms following pelvic radiotherapy (PRT) at our institution's multidisciplinary Sexuality, Intimacy, and Menopause (SIMS) Program.

MATERIALS AND METHODS

We performed a retrospective review of 69 female patients who received PRT for gynecologic or gastrointestinal malignancies and were referred for SIMS Program intervention. Indications for referral and treatment patterns were summarized. Preintervention and postintervention, patients were screened at follow-up visits, and symptoms were recorded. Statistics were performed using Stata 13.1.

RESULTS

Cancer types included cervical (53.6%), endometrial (31.9%), anorectal (5.8%), and vulvar/vaginal (8.7%). The median age was 48 years (interquartile range: 38 to 58 y). Patients were educated on vaginal lubricants, moisturizers, and dilator therapy both before and after PRT. Reasons for SIMS referral included persistent menopausal symptoms (50.7%), dyspareunia (40.6%), vaginal dryness (37.7%), decreased libido (17.4%), intimacy concerns (17.4%), and/or physical examination alterations (27.5%). SIMS interventions included vaginal estrogen (77.3%), nonhormonal climacteric interventions (53%), systemic hormone therapy (31.8%), dehydroepiandrosterone (4.6%), testosterone cream (4.6%), and/or psychological pharmacotherapy or counseling (13.6%). With a median follow-up of 36 months (interquartile range: 18 to 58 mo), sexual symptoms improved or were stable in 83.6%, while menopausal symptoms improved or were stable in 80.5%.

CONCLUSIONS

This study highlights the importance of multidisciplinary care in improving the sexual and menopausal symptoms of women after PRT. Future work examining the impact of intervention timing with respect to PRT and measures of patient satisfaction is warranted.

Gender Differences in Sexual Information Needs and Relating Factors in Cancer Patients: A Cross-Sectional Survey

This study aimed to identify the sexual information requirements and related factors according to gender to improve sexual health in cancer patients. In this cross-sectional study, a total of 687 cancer patients from a single cancer center in Korea completed a self-reported questionnaire. Multiple logistic regression analysis was used to compare the sexual information requirements and related factors among cancer patients. The results showed that male cancer patients had higher demands for sexual information than female cancer patients (t = 27.11, p < 0.001). Men appeared to have a greater need than women in the need for sexual information (t = 30.41, p < 0.001) and professional sexual intervention (t = 21.97, p < 0.001). Regarding sexual information needs, income (OR: 0.43, 95% CI: 0.25 to 0.73) was a significant factor in men. In women, age (OR: 0.51, 95% CI: 0.31 to 0.86), alcohol consumption (OR: 1.88, 95% CI: 1.12-3.16), and chemotherapy (OR: 1.87, 95% CI: 1.12-3.12) were significant factors. Significant differences in the overall sexual information needs and related factors were observed between male and female cancer patients. Therefore, a strategy needs to be established to improve the sexual health of cancer patients considering gender differences.

Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study

Introduction

Women’ sexuality becomes complex after breast cancer diagnosis and sexual health is highly neglected in the management of the illness.

Aims

To explore the coping and strategies to overcome sexuality problems and sexual dysfunction among women with breast cancer.

Material and Methods

Using the in-depth and photo-elicitation interview methods, this qualitative study following phenomenological analysis was conducted on fourteen married female respondents with breast cancer and had the positive result for female sexual dysfunction (FSD) screened by Female Sexual Function Index (FSFI-6 items) from Kelantan, Malaysia. The interviews data were audio-recorded, transcribed verbatim and managed in analytic computer software NVivo11 Pro. The transcriptions were analyzed using thematic analysis by referring to the meaning-making theory.

Main Outcome Measures

We identified overlapping themes of coping and strategies among women with breast cancer to overcome sexual problems and sexual dysfunction which correspond with meaning-making theory.

Results

Three themes have emerged. Women with breast cancer that developed sexuality problem and sexual dysfunction strived to accept the illness using religious belief and conform by altering sexual practices. These individuals positively look for a solution by seeking formal healthcare advice, modify their physical appearance, active discussion with the husband and support from other survivors. A few of them passively struggle with the subject by averting the intimacy and receptive toward polygamy.

Conclusion

This study highlighted the various mechanisms that emphasized the pivotal role of religious belief and relationship context as key factors in the coping strategies among women with breast cancer in Malaysia. The finding may not be generalized to other countries.

Che Ya SN, Muhamad R, Zain NM, et al. Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study. Sex Med 2021;9:100336.

Evaluation of the sexual quality of life and sexual function of cervical cancer survivors after cancer treatment: a retrospective trial

OBJECTIVE

The purpose of this study was to explore the factors influencing the sexual quality of life of patients with cervical cancer who underwent radical hysterectomy.

METHODS

This multicenter retrospective cohort study was conducted from June 2013 to June 2018 at nine hospitals in China. In total, 204 women diagnosed with stage IA to stage IIB cervical cancer who underwent radical hysterectomy completed the questionnaire. Sexual function was measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ). All analyses were performed with R version 3.4.3 statistical software packages. A two-sided significance level of 0.05 was used to evaluate the statistical significance.

RESULTS

The mean sexual quality of life score was 37.21 ± 17.28, where a higher PISQ score indicates a better sexual quality of life, and we identified the factors associated with sexual dysfunction. The average follow-up time was 29.0 ± 16.0 months. In addition to radical hysterectomy, 182 (89.2%) patients underwent ovarian suspension, 93 (45.6%) underwent chemotherapy, and 74 (36.3%) underwent concurrent radiotherapy. The univariate analysis confirmed that age represents a protective factor for sexual function (odds ratio (OR) 6.0, 95% confidence interval (CI) 1.1-10.8, p = 0.017). The patients who underwent ovarian suspension were more likely to experience a good sexual quality of life (OR - 7.2, 95% CI [- 14.8, - 0.4], p = 0.035) compared to those who did not undergo ovarian suspension. A significant negative association was observed between radiotherapy and the behavioral-emotive, physical and partner-related domains of the PISQ (behavioral-emotive, OR - 1.5, 95% CI [- 2.6, - 0.4], p = 0.011; physical, OR - 0.9, 95% CI [- 1.5, - 0.3], p = 0.006; partner-related, OR - 0.7, 95% CI [- 1.3, 0.0], p = 0.043). Chemotherapy and radiotherapy were common risk factors for sexual dysfunction, and radiotherapy exerted a stronger effect than chemotherapy.

CONCLUSIONS

This study shows that the sexual function of cervical cancer patients tends to be related to age, radiotherapy, and chemotherapy. However, across these factors, patients with preserved ovaries tend to return to a satisfactory sexual quality of life after recovering from surgery.

Qualitative exploration of sexual life among breast cancer survivors at reproductive age

BACKGROUND

Our understanding of the experiences of women at reproductive age regarding sexual life and issues they may face after starting the treatment of breast cancer is limited. Therefore, this qualitative study aimed to explore sexual life and its related issues among breast cancer survivors at reproductive age in Iran.

METHODS

A qualitative research was conducted. Participants were 21 breast cancer survivors who were under 51 years of age that were chosen using purposeful sampling. In-depth semi-structured interviews were carried out for data collection and the content analysis method was used for data analysis.

RESULTS

The data analysis led to the development of main theme of 'unfulfilled sexual life'. Also, four subthemes were: 'undesirable sexual function', 'context-based beliefs', 'unmet information and supportive needs', and 'emotional crisis'.

CONCLUSIONS

Our research findings inform healthcare providers about the experiences of breast cancer survivors and related changes in their sexual and marriage life at reproductive age. Nurses and other healthcare providers in the multidisciplinary team should proactively identify health-related problems and design appropriate caring strategies to mitigate sexual and marriage issues among breast cancer survivors. Also, the establishment of sexual health counseling units for breast cancer survivors can help this vulnerable group of women with the improvement of their long-term sexual satisfaction.

Development and Application of a Web-based Integrated Support Service Program for Infertile Women

Online-based infertility education provides a health management system to patients using electronic information and technology and no face-to-face interaction with patients and experts. This is a study to develop a web-based integrated support service system to meet the health care and nursing needs of infertile women. To develop a system that is most suitable and practically helpful to infertile women, who are end users of this system, research was conducted. This education system consists of introduction to women's health care, information on women's health, information on organizations for women, community for infertile women, and request for consultation for health management and nursing education of infertile women. This study introduced and applied a user-centered design that maximizes the value of use by first understanding the user's convenience and needs when developing a program.

Development, Implementation, and Patient Perspectives of the Women's Integrative Sexual Health Program: A Program Designed to Address the Sexual Side Effects of Cancer Treatment

Background

Advanced practitioners (APs) are a growing demographic in survivorship care. One goal of survivorship care is to manage consequences of cancer treatments. Sexual dysfunction from prior therapies can impact quality of life. Advanced practitioners are perfectly poised to provide care for sexual problems. This article will describe the development and implementation of the Women’s Integrative Sexual Health (WISH) program by APs within a comprehensive cancer center and describe patient perspectives of care provided.

Methods

Two physician assistants working in gynecologic oncology at the University of Wisconsin Carbone Cancer Center implemented a program to address sexual side effects of cancer treatment. An online survey was sent out to all patients seen in the WISH program since inception.

Results

Between November 2013 and July 2019, 228 patients were seen in the WISH program. A total of 113 women responded (median age: 53 years, range: 31–77; 68% postmenopausal; response rate: 53.8%). Most had breast (57%) or gynecologic (32%) cancers. When asked how helpful the WISH program was, 88% reported that it was at least somewhat helpful. Almost all (95%) reported they would recommend the WISH program to other women.

Conclusion

The WISH program enhances comprehensive survivorship care of female cancer survivors. Women report they benefit from care for sexual issues after cancer treatments. Advanced practitioners working in oncology are uniquely positioned to educate themselves, take leadership roles in the development and implementation of programs, and provide care to women affected by sexual side effects after cancer.

Efficacy of a multimedia intervention in facilitating breast cancer patients' clinical communication about sexual health: Results of a randomized controlled trial

OBJECTIVE

Many women with breast cancer (BC) hesitate to raise sexual concerns clinically. We evaluated a multimedia intervention to facilitate BC patients' communication about sexual/menopausal health, called Starting the Conversation (STC).

METHODS

Female BC patients (N = 144) were randomly assigned to either STC (20-min video, workbook, and resource guide) or control (resource guide only). Audio-recorded dialogue from patients' next oncology clinic encounter was coded for patients' sexual health communication. Self-report surveys assessed patients' beliefs about sexual health communication, self-efficacy for clinical interactions, sexual function/activity, anxiety/depression symptoms, and quality of life at baseline, post-intervention, and 2-month follow-up. T-tests or mixed-effects logistic regression compared study arms.

RESULTS

Women in the STC arm were more likely to raise the topic of sexual health (51%; OR = 2.62 [1.02, 6.69], p = 0.04) and ask a sexual health question (40%; OR = 2.85 [1.27, 6.38], p = 0.01) during their clinic encounter than those in the control arm (30% and 19% for raise and ask, respectively). At follow-up, women in the STC arm showed greater improvements in sexual health communication self-efficacy (p = 0.009) and in anxiety symptoms (p = 0.03), and more women were sexually active at follow-up, compared to the control arm (OR = 1.5, 70% vs. 46%, p = 0.04).

CONCLUSIONS

The STC intervention facilitated women's clinical communication about sexual health and reduced women's anxiety, possibly due to increased confidence in expressing their medical needs. Helpful information gained from clinical discussions could have improved women's willingness or ability to engage in sexual activity. Future studies should identify aspects of the clinical encounter most critical to improving women's sexual outcomes.

The caring experience and supportive care needs of male partners for women with gynaecologic cancer: A qualitative literature review

OBJECTIVE

To systematically review male partners' caring experience and supportive care needs when caring for women with gynaecologic cancer.

METHODS

The PRISMA guidelines were used to conduct this systematic review. We performed a comprehensive literature search in nine databases and qualitative studies published in English or Chinese from inception to January 2020. The included papers were appraised, using the Critical Appraisal Skills Program tool for qualitative research. An inductive thematic analysis method was adopted to synthesise major findings to construct core concepts and themes.

RESULTS

Eight studies were included in this review, and four overarching themes emerged the following: the negative experience of disease, the need for supportive care to cope, adapting to a new life and post-traumatic growth.

CONCLUSIONS

This study shows that male partners had both negative and positive experiences in the caring process, and they could adjust themselves to some extent. Their perceived supportive care needs were often neglected.

RELEVANCE TO CLINICAL PRACTICE

Male partners of women with gynaecologic cancer are an under-recognised group. The couple-oriented or family-oriented supportive care programmes should be implemented to meet the supportive care needs of male partners to enhance their health and well-being.

Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercourse: A multicenter prospective interventional study

OBJECTIVES

Painful sexual intercourse (dyspareunia) is a distressing condition affecting a large proportion of gynecological cancer survivors, yet treatments remain limited and poorly studied. This multicenter prospective interventional study examined the feasibility, acceptability and effects of multimodal pelvic floor physical therapy in gynecological cancer survivors with dyspareunia.

METHODS

Thirty-one endometrial and cervical cancer survivors with dyspareunia participated in 12 weekly 60-min physical therapy sessions combining education, manual therapy, pelvic floor muscle exercises using biofeedback and home exercises, which included the use of a dilator. The adherence rate to home exercises (≥80%), the attendance rate at physical therapy sessions (≥80% of participants attending ≥10 sessions) and the dropout rate (˂15%) served as feasibility and acceptability outcomes and benchmarks. Pain intensity, pain quality, sexual function, pelvic floor dysfunction symptoms and quality of life were measured at baseline and post-treatment. Treatment satisfaction and participants' perceived improvement were also assessed.

RESULTS

The adherence rate was 88% (SD 10), 29/31 (94%) women attended ≥10 treatment sessions, and the dropout rate was 3%. Moreover, women experienced significant improvements in all outcomes after the intervention (p ≤ 0.044). They also reported being highly satisfied with the treatment (9.3/10 (SD 1.2)), and 90% of them were very much or much improved.

CONCLUSIONS

Our findings support the feasibility and acceptability of multimodal pelvic floor physical therapy for gynecological cancer survivors with dyspareunia. The intervention also led to significant improvements in pain, sexual function, pelvic floor dysfunction symptoms and quality of life. A randomized controlled trial is needed to confirm these results.

Sexual functioning and self-esteem in women after mastectomy - a single-centre, non-randomised, cross-sectional study

Aim of the study

The goal of our study was to assess the sexual functioning of patients undergoing mastectomy, five years after surgery, compared to a control group.

Material and methods

A cross-sectional study included 170 patients five years post mastectomy (group A1) and 149 healthy women (group A2) who had never been diagnosed with breast cancer. The study was conducted at the Oncology Centre in Bydgoszcz, at the Amazon Clubs, and at the University of the Third Age by the University of Economy in Bydgoszcz. Standardised questionnaires: the Female Sexual Function Index (FSFI) and Rosenberg’s SES (self-esteem scale) were used.

Results

Our study results show significantly worse sexual functioning in the domains pertaining to desire (p = 0.0015), arousal (p = 0.0052), lubrication (p = 0.0026), ability to reach orgasm (p = 0.0417), sexual satisfaction (p = 0.0142), and the presence of clinically significant sexual dysfunction (p = 0.0028) among patients after amputation of the mammary gland. On the scale of pain relating to sexuality, there were no significant differences between the two groups (p> 0.05). The overall score in the FSFI questionnaire was also lower (p = 0.0066) among women after mastectomy. Highly statistically significant (p < 0.0001) differences in self-esteem were also noted between the two groups, with worse results observed in patients after mastectomy.

Conclusions

Diagnosis of sexual dysfunction in patients treated for breast cancer allows timely implementation of counselling and interventional therapy depending on the causal factors and individual preferences of patients.

Understanding Sexual Help-Seeking for Women With Breast Cancer: What Distinguishes Women Who Seek Help From Those Who Do Not?

BACKGROUND

Sexual problems are extremely common for women after breast cancer (BC).

AIM

To determine, in a sample of BC outpatients, how commonly women sought help for sexual concerns, from a health care provider (HCP), from other individuals, or from alternate sources; and to examine whether help-seeking was associated with women's sexual function/activity, self-efficacy for clinical communication about sexual health, or sociodemographic/medical characteristics.

METHODS

BC patients participating in a sexual/menopausal health communication intervention trial completed web-based baseline self-report surveys. One-way analysis of variances compared effects of the level of sexual help-seeking (none; 1 outlet; 2-3 outlets) on sexual function domains. Chi-square or t-tests compared women seeking help with those not seeking help on other study variables.

MAIN OUTCOME MEASURES

Patient-reported outcome instruments assessed sexual help-seeking (past month), sexual function and activity (PROMIS Sexual Function and Satisfaction Brief Profile Version 2.0), and self-efficacy (confidence) for communicating with their BC clinician about sexual health.

RESULTS

144 women (mean age = 56.0 years; 62% partnered; 67% white; 27% black/African American; 4% Hispanic/Latina; 15% stage IV) participated in this study. 49% of women sought help for sexual concerns, most often from intimate partners, family and/or friends (42%), followed by HCPs (24%), or online/print materials (19%); very few women (n = 4; 3%) sought help only from a HCP. Women seeking help were younger and more likely to be partnered and sexually active than those not seeking help. Sexual function was impaired for all domains but was most impaired for sexual interest. Among sexually active women, those seeking help from 2 to 3 sources reported worse sexual function in certain domains (sexual interest, lubrication, vaginal discomfort, vulvar discomfort-labial, satisfaction). Women seeking help from outlets other than HCPs had significantly lower self-efficacy than those who did not.

CLINICAL IMPLICATIONS

BC patients with access to a partner and who are sexually active but find sex unsatisfying, uncomfortable, or lack interest may be in particular need of sexual help. Further, women may turn to outlets other than HCPs for sexual help partly because they lack the confidence to do so with a HCP. Sexual health information should be made available to women's partners, family, and friends, so they may effectively discuss such issues if needed.

STRENGTHS & LIMITATIONS

Strengths of the study included examination of a range of sexual function domains and a theoretical construct in relation to BC patients' sexual help-seeking and a medically diverse sample. Limitations include a cross-sectional design.

CONCLUSION

Women treated for BC should receive accurate and timely sexual health information. Reese JB, Sorice KA, Pollard W, et al. Understanding Sexual Help-Seeking for Women With Breast Cancer: What Distinguishes Women Who Seek Help From Those Who Do Not? J Sex Med 2020;17:1729-1739.

Patient-Reported Barriers and Facilitators to Seeking and Accessing Support in Gynecologic and Breast Cancer Survivors With Sexual Problems: A Systematic Review of Qualitative and Quantitative Studies

BACKGROUND

Greater understanding of patient-reported barriers and facilitators to seeking and accessing sexual health services will help formulate strategies to assist gynecologic and breast cancer patients to overcome obstacles to accessing sexual health support because they typically do not seek sexual education and/or treatment when confronted with sexual concerns.

AIM

The objectives of this systematic review were to (i) explore the patient-reported barriers to seeking and accessing support for sexual problems in gynecologic and breast cancer survivors, and (ii) identify strategies used to successfully overcome the barriers to accessing sexual health information and/or treatment.

MAIN OUTCOME MEASURES

The main outcome measures included factors that prevent and/or facilitate gynecologic and breast cancer patients with sexual concerns seeking and accessing sexual health-related services.

METHODS

Systematic searches of major electronic databases (Ovid MEDLINE, PsycINFO, CINAHL, ProQuest, and Chinese database CNKI) from January 2009 to July 2019 were used to identify the barriers and facilitators to seeking sexual education/treatment from the perspective of gynecologic and breast cancer survivors. A narrative synthesis was conducted.

RESULTS

20 studies met the inclusion criteria including 12 qualitative, 6 quantitative, and 2 mixed methods studies. 4 interconnected themes were derived from 13 subthemes relating to the barriers/facilitators to seeking and accessing sexual health support. The most common barriers were embarrassment/discomfort in discussing sexual concerns, perceived discomfort of healthcare providers in discussing sexual issues, limitations of the healthcare system to address sexual problems, and the multidimensional nature of sexuality. Help-seeking for sexual health concerns was facilitated by: (i) oncology health professionals initiating and conducting open, honest discussions around sexual concerns with patients; (ii) the availability of information in multiple forms; and (iii) appropriate timing of information provision according to women's preferences.

CLINICAL IMPLICATIONS

Oncology health professionals need to develop an open, honest, accepting communication style and be accessible to women with cancer and their partners within healthcare systems.

STRENGTHS & LIMITATIONS

The systematic review was conducted in accordance with guidelines. Variability in the primary aims and outcomes of the included studies precluded a meta-analysis.

CONCLUSIONS

Training programs for providers of oncology care should enhance their knowledge of sexual issues in gynecologic and/or breast cancer, enhance their communication skills with patients, and improve their ability to consult or refer patients to psycho-oncologists or other mental health professionals. Dai Y, Cook OY, Yeganeh L, et al. Patient-Reported Barriers and Facilitators to Seeking and Accessing Support in Gynecologic and Breast Cancer Survivors With Sexual Problems: A Systematic Review of Qualitative and Quantitative Studies. J Sex Med 2020;17:1326-1358.

Patients' perceived barriers to discussing sexual health with breast cancer healthcare providers

OBJECTIVES

We characterized barriers reported by women with breast cancer (BC) regarding clinical discussions of sexual health, clustered women by their endorsement of these barriers, and compared these groups.

METHODS

BC outpatients (N = 144; M age = 56, 67% White) in a sexual health communication intervention study provided baseline data. Exploratory factor analysis characterized sexual health communication barriers on a standardized measure. Hierarchical cluster analysis detected patient groups with similar response patterns on these factors. ANOVAs, Chi-Square and Fisher's Exact tests compared groups on socio-demographic/medical factors, sexual health communication self-efficacy and outcome expectancies, general clinical self-efficacy, sexual concerns, emotional distress, and discussion about sexual health with an oncology provider.

RESULTS

Two factors emerged: patients' own beliefs about or perceived inability to discuss sexual health (self-centered barriers), and patients' perceptions of providers' reactions to discussing sexual health (provider-centered barriers); self-centered barriers were endorsed more than provider-centered (P < .001). Three clusters emerged: women who endorsed (a) high self-centered and high provider-centered (n = 19; 13%), (b) high self-centered and low provider-centered (n = 95; 66%), and (c) low self-centered and low provider-centered (n = 30; 21%). Women endorsing more barriers reported lower sexual communication self-efficacy, outcome expectancies, and general clinical self-efficacy (P's ≤ .001); no differences in sexual concerns, emotional distress, or discussing sexual health were found.

CONCLUSIONS

Women more strongly endorsed self-centered barriers than provider-centered. When grouped according to these barriers, women differed in their confidence and expectations for sexual health communication, regardless of degree of sexual or emotional distress. Interventions are needed to improve both patients' and providers' skills for discussing sexual health.

The relationship between sexual activity and sexual attitudes among breast cancer survivors in China

Purpose

Less is known about sexual attitudes of breast cancer survivors (BCSs) and its association with sexual activity and sexual dissatisfaction.

Methods

We investigated the proportion of sexual activity and sexual dissatisfaction in a cross‐sectional study among 341 Chinese BCSs aged 30‐75 years old, and we described their association with sexual attitudes, as well as socio‐demographic characteristics, physical health conditions, and mental health problems.

Results

Only 83 (24.3%) individuals reported sexual activity in the past year. More than 50% of BCSs considered that sexual activity had adverse impact on their disease recovery. The sexual attitudes such as “sexual activity may impede disease recovery” (adjusted odds ratio [AOR] = 0.51; 95% confidence interval, 95% CI: 0.30‐0.88), “sexual activity may cause cancer recurrence or metastasizes” (AOR = 0.51; 95% CI: 0.30‐0.87), and “their partner fear contracting cancer by sexuality” (AOR = 0.47; 95% CI: 0.23‐0.98) were significantly associated with decreased likelihood of reporting sexual activity in the past year. Although 201 (58.9%) BCSs reported that breast cancer decreased the frequency of their sexual activity, only 37 (10.9%) had ever discussed sexuality with a doctor to seek advice.

Conclusions

Most Chinese BCSs were sexually inactive. The sexual misconceptions about cancer were great barriers of sexual activity. Professional sexual education and consultation may be regarded as easy and effective intervention measures to correct BCSs' misguided sexual attitudes, and finally improving the overall sexual health for BCSs.

Health care use and remaining needs for support among women with breast cancer in the first 15 months after diagnosis: the role of the GP

BACKGROUND

The number of women with breast cancer in general practice is rising. To address their needs and wishes for a referral, GPs might benefit from more insight into women's health care practices and need for additional support.

OBJECTIVE

To examine the prevalence of health care use and remaining needs among women with breast cancer in the first 15 months after diagnosis.

METHODS

In this multicentre, prospective, observational study women with breast cancer completed a questionnaire at 6 and 15 months post-diagnosis. Medical data were retrieved through chart reviews. The prevalence of types of health care used and remaining needs related to medical, psychosocial, paramedical and supplementary service care (such as home care), was examined with descriptive analyses.

RESULTS

Seven hundred forty-six women completed both questionnaires. At both assessments patients reported that they had most frequent contact with medical and paramedical providers, independent of types of treatment received. Three to fifteen percent of the patients expressed a need for more support. Prominent needs included a wish for more frequent contact with a physiotherapist, a clinical geneticist and a psychologist. Patients also wanted more help for chores around the house, particularly in the early post-treatment phase.

CONCLUSION

A small but relevant percentage of women with breast cancer report having unmet needs. GPs may need to be particularly watchful of their need for more support from specific providers. Future research into the necessity of structural needs assessment among cancer patients in general practice is warranted.

Evaluating a couple-based intervention addressing sexual concerns for breast cancer survivors: study protocol for a randomized controlled trial

Background

Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes.

Methods

This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4).

Discussion

Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation.

Trial registration

ClinicalTrials.gov, NCT03930797. Registered on 24 April 2019.

Factors Influencing Posttraumatic Growth of Gynecologic Oncology Patients Undergoing Chemotherapy

PURPOSE

The purpose of this study was to investigate the factors impacting the posttraumatic growth (PTG) factors during chemotherapy in gynecologic oncology patients. METHOD: The data were collected at six hospitals at a university hospital, general hospital, women's hospital, and 3 oncology hospitals in D metropolitan city. The participants of the study were 135 female patients undergoing chemotherapy for their gynecologic oncology. To identify the factors that influence PTG, we used the questionnaires for the family support, sexual distress, health promoting behavior, and PTG.

RESULTS

There was a significant positive correlation between family support and health promoting behavior and PTG. There was significant negative correlation between sexual distress and PTG. Factors impacting the PTG of gynecologic oncology women undergoing chemotherapy were age, recurrence, family support, sexual distress, and health promoting behavior. These factors accounted for 47.0% of PTG.

CONCLUSION

It is necessary to develop and apply programs that include sexual distress management education, and health promotion with families. PTG programs for gynecologic oncology patients undergoing chemotherapy should be approached considering these results.