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Matthew AG, McLeod D, Robinson JW, Walker L, Wassersug RJ, Elliott S, Guirguis S, Incze T, Trachtenberg L. Enhancing care: evaluating the impact of True North Sexual Health and Rehabilitation eTraining for healthcare providers working with prostate cancer patients and partners. Sex Med 2024; 12:qfae033. [PMID: 38883808 PMCID: PMC11176973 DOI: 10.1093/sexmed/qfae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/12/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Background Educational programs that enhance healthcare providers' competence in managing the care of patients with sexual dysfunction following prostate cancer treatments are needed to facilitate comprehensive sexual health treatments for patients and their partners. Aim In this study we evaluated the impact of a real-world online sexual health educational intervention called the True North Sexual Health and Rehabilitation eTraining Program. This program is designed to increase healthcare providers' knowledge and self-efficacy in providing sexual healthcare to prostate cancer patients and their partners. Methods Healthcare providers were invited to join a 12-week virtual training program. Participants completed precourse surveys (n = 89), retrospective prepost surveys (n = 58), and a 3-month follow-up survey (subset n = 18) to assess retention of relevant outcomes. Additionally, a course satisfaction survey was administered to participants (n = 57) at the end of the course. Outcomes The main outcomes focused on participants' perceived knowledge and self-efficacy in conducting assessments and providing interventions for various relevant physical, functional, psychological, and relational domains of sexual dysfunction in prostate cancer patients and their partners. Results According to the retrospective analysis of post-then-pre-survey results, graduates perceived that their knowledge of and self-efficacy in providing sexual health counseling improved after completing the course. The 3-month follow-up survey indicated that the course graduate self-efficacy remained high 3 months after the course. Furthermore, the satisfaction survey indicated that a vast majority (98.2%) of participants were satisfied with the educational intervention. Clinical Implications This real-world sexual health educational intervention can increase self-efficacy and knowledge in healthcare providers who are supporting prostate cancer patients dealing with sexual dysfunction. Strengths and Limitations The use of a retrospective post-then-pre-survey helped to mitigate response shift bias while minimizing data gaps. However, it is important to note that this investigation was not a traditional research study and lacked a control group, thus limiting causal attributions. Conclusion The True North Sexual Health and Rehabilitation eTraining program acts as an accessible and effective resource for healthcare providers seeking specialized training in providing sexual healthcare for prostate cancer patients and their partners.
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Affiliation(s)
- Andrew G Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1Z5, Canada
| | - Deborah McLeod
- School of Nursing, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - John W Robinson
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lauren Walker
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Richard J Wassersug
- Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Stacy Elliott
- BC Center for Sexual Medicine, Vancouver Coastal Health Authority, Vancouver, BC V6Z 2K5, Canada
| | - Steven Guirguis
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1Z5, Canada
| | - Taylor Incze
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1Z5, Canada
| | - Lianne Trachtenberg
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 1Z5, Canada
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Reese JB, Bauman JR, Sorice KA, Frederick N, Bober SL. Hematology and Oncology Fellow Education About Sexual and Reproductive Health: A Survey of Program Directors in the United States. JCO Oncol Pract 2024; 20:852-860. [PMID: 38320223 DOI: 10.1200/op.23.00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE Clinical oncology guidelines recommend addressing sexual and reproductive health (SRH) concerns in routine cancer care. However, limited training often hinders clinicians' ability to do so effectively. The objective of this study was to understand the state of current fellowship education on SRH (ie, sexual health, safe sex practices, and fertility) through conducting a national survey of US hematology/oncology fellowship program directors (PDs). METHODS A survey was sent to all PDs of adult hematology/oncology fellowship programs in the United States via online link. PDs who did not complete the survey were sent up to four follow-up emails and a paper mailing. Descriptive statistics and McNemar tests were conducted. RESULTS One hundred-fourteen PDs responded (65%). Fewer programs offered formal instruction on sexual health (49%) and safe sex practices (37%) compared with fertility (75%). Informal training in SRH relied heavily on direct clinical experience (73%-78% of programs), with other methods (eg, case-based approaches, webinars, and journal clubs) being less common. Lack of experts to provide instruction was the most commonly cited barrier to offering training in SRH, endorsed by 74% for sexual health, 68% for safe sex practices, and 54% for fertility; difficulty finding space within the curriculum (50%; 54%; and 43%, respectively) and a lack of training requirements were also commonly endorsed (57%; 60%; and 35%, respectively). Barriers were endorsed more commonly for sexual health topics than fertility. CONCLUSION The results highlight the scarcity of training in SRH, particularly in sexual health, within hematology/oncology fellowship programs. The heavy reliance on informal instruction methods may lead to inconsistent and inadequate education. Efforts to integrate comprehensive training in SRH into fellowship programs are crucial to ensuring that such concerns are included in routine cancer care.
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Affiliation(s)
| | - Jessica R Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Natasha Frederick
- Center for Cancer & Blood Disorders, Connecticut Children's Medical Center, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Paulsen A, Vistad I, Fegran L. Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations. Acta Obstet Gynecol Scand 2024; 103:551-560. [PMID: 38062675 PMCID: PMC10867355 DOI: 10.1111/aogs.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Gynecological cancer and its treatment may cause sexual difficulties in terms of physical and psychosocial health. Considering the essential role that nurses play in cancer care, they are well positioned to be ideal providers for addressing sexual health concerns in the follow-up phase of gynecological cancer. The aim of this study was to gain in-depth knowledge of how gynecological cancer survivors experience sexual health communication in nurse-led follow-up consultations. MATERIAL AND METHODS Using a qualitative hermeneutic approach, we conducted individual semi-structured interviews with 17 women from five different hospitals in Norway between April 4, 2022, and June 2, 2022. The women participated in a large intervention study on cancer follow-up that included sexual health as one of several topics addressed by trained nurses in three consultations in the first year of follow-up. A five-stage Gadamerian-inspired research method was utilized for data collection and analysis. RESULTS We identified three themes: (1) the importance of nurses listening to the women's own perceptions of sexuality, (2) post-treatment sexual challenges influence the women's need to communicate about sexual health, and (3) nursing communication can help women regain their sexual health. CONCLUSIONS Women who have undergone treatment for gynecological cancer find communication with trained nurses regarding sexual health beneficial. We recommend integration of trained nurses in the follow-up team. The nurses should adjust communication according to each gynecological cancer survivor's unique understanding of sexuality and inform women with sexual health concerns at that end of treatment, that sexual health can improve during follow-up.
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Affiliation(s)
- Anita Paulsen
- Department of ResearchSorlandet HospitalKristiansandNorway
- Department of Health and Nursing SciencesUniversity of AgderKristiansandNorway
| | - Ingvild Vistad
- Department of Gynecology and ObstetricsSorlandet HospitalKristiansandNorway
- Institute of Clinical Medicine, University of OsloOsloNorway
| | - Liv Fegran
- Department of Health and Nursing SciencesUniversity of AgderKristiansandNorway
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Arring N, Barton DL, Reese JB. Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors. J Clin Oncol 2023; 41:4927-4936. [PMID: 37535889 PMCID: PMC10617876 DOI: 10.1200/jco.23.00523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice. METHODS A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted. RESULTS Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health. CONCLUSION Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.
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Affiliation(s)
- Noël Arring
- University of Tennessee College of Nursing, Knoxville, TN
| | | | - Jennifer B. Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
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Schubach K, Niyonsenga T, Turner M, Paterson C. Experiences of sexual well-being interventions in males affected by genitourinary cancers and their partners: an integrative systematic review. Support Care Cancer 2023; 31:265. [PMID: 37058163 PMCID: PMC10104925 DOI: 10.1007/s00520-023-07712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Sexual well-being has been identified as an unmet supportive care need among many individuals with genitourinary (GU) cancers. Little is known about the experiences of using sexual well-being interventions among men and their partners. METHODS This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and followed a systematic review protocol. Data extraction and methodological quality appraisal were performed, and a narrative synthesis was conducted. RESULTS A total of 21 publications (reporting on 18 studies) were included: six randomised control trials, seven cross-sectional studies, three qualitative studies, and five mixed methods studies. Sexual well-being interventions comprised medical/pharmacological and psychological support, including counselling and group discussion facilitation. The interventions were delivered using various modes: face-to-face, web-based/online, or telephone. Several themes emerged and included broadly: (1) communication with patient/partner and healthcare professionals, (2) educational and informational needs, and (3) timing and/or delivery of the interventions. CONCLUSION Sexual well-being concerns for men and their partners were evident from diagnosis and into survivorship. Participants benefited from interventions but many articulated difficulties with initiating the topic due to embarrassment and limited access to interventions in cancer services. Noteworthy, all studies were only representative of men diagnosed with prostate cancer, underscoring a significant gap in other GU cancer patient groups where sexual dysfunction is a prominent consequence of treatment. IMPLICATIONS FOR CANCER SURVIVORS This systematic review provides valuable new insights to inform future models of sexual well-being recovery interventions for patients and partners with prostate cancer, but further research is urgently needed in other GU cancer populations.
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Affiliation(s)
- Kathryn Schubach
- Faculty of Health, University of Canberra, Bruce ACT, Australia.
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia.
| | - Theo Niyonsenga
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Rehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
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Benedict C, Shaffer KM, Wirtz MR, Ford JS, Reese JB. Current Considerations in Interventions to Address Sexual Function and Improve Care for Women with Cancer. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zangeneh S, Savabi-Esfahani M, Taleghani F, Sharbafchi MR, Salehi M. Sexual health promotion interventional program for women undergoing breast cancer treatment: Protocol for a mix-methods study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:201. [PMID: 36003244 PMCID: PMC9393915 DOI: 10.4103/jehp.jehp_833_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/26/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women undergoing breast cancer treatment, especially those of reproductive age, experience sexual health challenges. The aim of this study is to design an interventional program for promoting the sexual health of women undergoing breast cancer treatment. MATERIALS AND METHODS This is a mixed qualitative-quantitative exploratory study consisting of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will be selected using purposive sampling method and the data will be collected through semi-structured interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase, the initial version of the program will be designed based on the results of qualitative study and review of literature, the appropriate strategies are prioritized by the members of the panel of experts, and then, the final interventional program is prepared. In the fourth phase, the designed interventional program will be conducted as a quasi-experimental study in two groups of intervention and control and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be selected based on the results of the previous phases and the opinion of the expert panel. CONCLUSIONS The results of this study are expected to contribute to the design of an interventional program based on the needs of women undergoing breast cancer treatment and promote health and meet the sexual health needs of breast cancer patients.
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Affiliation(s)
- Sanaz Zangeneh
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mitra Savabi-Esfahani
- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharbafchi
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Omid Hospital, Iranian Cancer Control Center (MACSA), Isfahan, Iran
| | - Mehrdad Salehi
- Department of psychiatry, Isfahan University of Medical Sciences, Behavioral Sciences Research Center, Isfahan, Iran
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Peleg Nesher S, Luria M, Shachar E, Percik R, Shoshany O, Wolf I. Sexual dysfunction among adolescent and young adult cancer patients: diagnostic and therapeutic approach. Curr Opin Support Palliat Care 2022; 16:83-91. [PMID: 35639574 DOI: 10.1097/spc.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We present a review for healthcare professionals, formulated by a multidisciplinary team, for screening and interventions, describing common sexual impairments encountered by adolescent and young adult cancer patients (AYACP), and suggest a comprehensive evidence-based assessment approach and interventions for treatment of sexual dysfunction (SD). RECENT FINDINGS We discuss the various aspects of SD in AYACP, including causes, challenges and etiologies, and then go on to recommend increased awareness and guidance in healthcare workers, in order to optimize diagnosis and treatment of SD. SUMMARY Although the extent of SD among AYACP is widely recognized, oncological clinicians rarely address SD in their routine practice, lacking a clear approach of interdisciplinary diagnostic and therapeutic interventions. Here, we suggest guiding clinical management to optimize treatment quality.
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Affiliation(s)
- Sharon Peleg Nesher
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv
- Rotem Center - the Israeli Center for Sexual Health
| | - Mijal Luria
- Rotem Center - the Israeli Center for Sexual Health
- Hadassah Mount Scopus University Hospital, Jerusalem
| | - Eliya Shachar
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ruth Percik
- Internal Medicine and Endocrinology Department, Oncology Division, Sheba Medical Center
| | - Ohad Shoshany
- Andrology Service of Urology Department, Rabin Medical Center, Israel
| | - Ido Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
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Ayvat İ, Atli Ozbas A. Experiences and views of nurses about unmet needs of older cancer patients receiving chemotherapy: A qualitative study. Palliat Support Care 2022; 21:1-8. [PMID: 35139980 DOI: 10.1017/s1478951522000098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim is to understand the experiences and views of oncology nurses about the unmet care needs of older cancer patients receiving chemotherapy. Nurses play the key role in evaluating and determining the needs of this special group. METHOD A phenomenological descriptive qualitative study with convenience sampling was used. Participants were referred by the Turkish Oncology Nursing Society. The study participants were 12 nurses aged 34-53 years, with oncology experience between 5 and 27 years. The data were collected using semi-structured face-to-face interviews. Interviews were transcribed verbatim with concurrent analyses and data collection. Thematic content analysis was used to determine common domains. RESULTS The study data were categorized into 3 contexts, 12 themes, and 37 subthemes. The first context, "unmet needs", includes physical care, psychological care, and social care themes. The second context, "barriers to meeting those needs", comprises the theme of patient characteristics, attitude of family, attitude of the nurses/healthcare team, health system, and culture. The last context is "suggestions for meeting needs". Nurses play an important role in identifying and meeting unmet psychosocial needs. SIGNIFICANCE OF RESULTS The study indicated that older cancer patients had problems in identifying, expressing, and making demands for their needs and that their culture contributed to this situation. Nurses serving in the outpatient chemotherapy units should conduct a holistic assessment of older cancer patients, be aware that these patients may not be able to express their needs, be more sensitive toward them, and ensure that the voice of the older patients is heard.
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Affiliation(s)
- İrem Ayvat
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
| | - Azize Atli Ozbas
- Faculty of Nursing, Psychiatric Nursing Department, Hacettepe University, Ankara, Turkey
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Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic. Support Care Cancer 2022; 30:8981-8996. [PMID: 35931832 PMCID: PMC9633476 DOI: 10.1007/s00520-022-07294-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Treatment-induced sexual and intestinal dysfunctions coexist among women after pelvic radiotherapy. We aimed to explore if sexual health and wellbeing may be improved after radiotherapy following nurse-led interventions and if an association exists between improved intestinal health and sexual health. METHODS A population-based cohort of women treated with pelvic radiotherapy underwent interventions at a nurse-led clinic at Sahlgrenska University Hospital, Sweden, from 2011 to 2017. Self-reported questionnaires were used, pre- and post-intervention, to compare self-reported changes in sexual health and wellbeing. A regression model was performed to explore the association between intestinal and wellbeing variables. RESULTS Among the 260 female pelvic cancer survivors included in the study, more women reported increased than decreased satisfaction with overall sexual health post-intervention (26.0% vs. 15.3%, p = 0.035). They also reported significantly reduced superficial genital pain (25.8% vs. 13.1%, p ≤ 0.025), reduced deep genital pain (23.1% vs. 8.0%, p ≤ 0.001), increased QoL (42.7% vs. 22.4%, p < 0.001), and reduced levels of depression (43.1% vs. 28.0%, p = 0.003) or anxiety (45.9% vs. 24.4%, p < 0.001) post-intervention. We found a significant association between reduced urgency to defecate and improved satisfaction with overall sexual health (RR 3.12, CI 1.27-7.68, p = 0.004) and between reduced urgency to defecate with fecal leakage and reduced anxious mode (RR 1.56, CI 1.04-2.33, p = 0.021). CONCLUSION Sexual health and wellbeing can be improved by interventions provided in a nurse-led clinic focusing on physical treatment-induced late effects. Further research to optimize treatment strategies in female pelvic cancer survivors is needed.
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Abstract
Oncosexology is a multidisciplinary field composed of physicians, nurses, psychologists, and other health care professionals focusing on sexual issues in patients with cancer. Although any cancer diagnosis or treatment can be associated with sexual dysfunction, pelvic malignancies (such as prostate, bladder, or colorectal cancer) have the highest rates of sexual dysfunction in men. This includes erectile dysfunction, testosterone deficiency, ejaculatory dysfunction, orgasmic dysfunction, sexual incontinence, and penile shortening. Testicular cancer and hematologic malignancies also have a significant impact on patients' sexual function. Health care providers should address sexual dysfunction with their patients, including any adverse effects of potential treatment options.
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Affiliation(s)
- Carolyn A Salter
- Male Sexual and Reproductive Medicine Program, Department of Urology, Memorial Sloan Kettering Cancer Center, 16 East. 60th Street, Suite 302, New York, NY 10022, USA
| | - John P Mulhall
- Male Sexual and Reproductive Medicine Program, Department of Urology, Memorial Sloan Kettering Cancer Center, 16 East. 60th Street, Suite 302, New York, NY 10022, USA.
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Reese JB, Zimmaro LA, Bober SL, Sorice K, Handorf E, Wittenberg E, El-Jawahri A, Beach MC, Wolff AC, Daly MB, Izquierdo B, Lepore SJ. Mobile Technology-Based (mLearning) Intervention to Enhance Breast Cancer Clinicians' Communication About Sexual Health: A Pilot Trial. J Natl Compr Canc Netw 2021; 19:1133-1140. [PMID: 34388731 PMCID: PMC8840991 DOI: 10.6004/jnccn.2021.7032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/02/2021] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
| | | | - Sharon L. Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute,Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - Kristen Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center,Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center
| | - Elaine Wittenberg
- Department of Communication Studies, California State University, Los Angeles
| | - Areej El-Jawahri
- Department of Hematology/Oncology, Massachusetts General Hospital
| | | | - Antonio C. Wolff
- Women’s Malignancies Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center
| | - Brynna Izquierdo
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University
| | - Stephen J. Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center,Department of Social and Behavioral Sciences, College of Public Health, Temple University
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Cherven B, Sampson A, Bober SL, Bingen K, Frederick N, Freyer DR, Quinn GP. Sexual health among adolescent and young adult cancer survivors: A scoping review from the Children's Oncology Group Adolescent and Young Adult Oncology Discipline Committee. CA Cancer J Clin 2021; 71:250-263. [PMID: 33283888 PMCID: PMC8678924 DOI: 10.3322/caac.21655] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
Sexual function is a vital aspect of quality of life among adolescent and young adult (AYA) (ages 15-39 years) cancer survivors. Sexual function encompasses physical, psychosocial, and developmental factors that contribute to sexual health, all of which may be negatively impacted by cancer and treatment. However, limited information is available to inform the care of AYA cancer survivors in this regard. This scoping review, conducted by the Children's Oncology Group AYA Oncology Discipline Committee, summarizes available literature regarding sexual function among AYA cancer survivors, including relevant psychosexual aspects of romantic relationships and body image. Results suggest that, overall, AYA cancer survivors experience a substantial burden of sexual dysfunction. Both physical and psychosocial sequelae influence survivors' sexual health. Interventions to support sexual health and psychosexual adjustment after cancer treatment are needed. Collaborations between the Children's Oncology Group and adult-focused cooperative groups within the National Cancer Institute's National Clinical Trials Network are warranted to advance prospective assessment of sexual dysfunction and test interventions to improve sexual health among AYA cancer survivors.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta
- Emory University School of Medicine
| | - Amani Sampson
- Department of Ob-Gyn, Grossman School of Medicine, New York University
| | - Sharon L. Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | | | - Natasha Frederick
- Center for Cancer & Blood Disorders, Connecticut Children’s Medical Center, Hartford, CT
- University of Connecticut School of Medicine
| | - David R. Freyer
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles
- USC Norris Comprehensive Cancer Center; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Gwendolyn P. Quinn
- Department of Ob-Gyn, Grossman School of Medicine, New York University
- Perlmutter Cancer Center, New York University
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Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations. Support Care Cancer 2021; 29:5821-5830. [PMID: 33742243 DOI: 10.1007/s00520-021-06157-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the association of physical and psychological symptoms with health care utilization in sexual minority and heterosexual colorectal cancer survivors. METHODS Four hundred eighteen colorectal cancer survivors who were in remission an average of 3 years after their diagnosis were surveyed about their non-emergency health care visits during the preceding 3 months. Survivors reported whether they had experienced any of 21 symptoms common among colorectal cancer survivors in the past week. The relation between having had two or more health care visits in the preceding 3 months and symptoms experienced was assessed using logistic regression, controlling for cancer registry, sexual orientation, sex, age, race/ethnicity, income, and comorbidities. RESULTS Of the survivors, 12% reported no symptoms, while 12% reported six or more symptoms. Sexual minority survivors reported significantly more weight concerns and more health-related and general anxiety as well as worse body image than heterosexual survivors. Frequent worrying about weight and experiencing sore skin around the anal area or stoma were the two symptoms that significantly contributed towards explaining survivors' increased health care utilization. CONCLUSION Weight concerns, which are more common among the heaviest survivors, may prompt survivors to seek help from health care providers, which may lead to more frequent visits. On the other hand, some symptoms, despite their prevalence, had no relationship with the frequency of health care visits, raising questions about whether survivors share these concerns with providers.
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