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Kuiper ST, Zweers D, Suelmann BBM, Meijer RP, Vervoort SCJM. Perspectives and Concerns on Late Effects Regarding Sexuality among Adolescents and Young Adults Treated for Testicular Germ Cell Tumor: The PRICELESS-Study-A Qualitative Study. Cancers (Basel) 2024; 16:715. [PMID: 38398106 PMCID: PMC10886665 DOI: 10.3390/cancers16040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to explore perspectives and concerns regarding sexuality among adolescents and young adults (AYAs) possibly experiencing late effects after testicular germ cell tumor (TGCT) treatment. A qualitative study was performed in which semi-structured interviews were held with thirteen AYAs from a center of expertise for TGCT in the Netherlands. Data were analyzed using Braun and Clark's thematic analysis method. Seven interacting and interconnected themes were found: desire to have children, rediscovering sexuality, insecurity about sexual performance, acceptance of physical change, loss of masculinity, burden on relationship, and openness in discussing sexuality. Concerns about the desire to have children seem to play a significant role. In conclusion, TGCT patients face multiple changes (physical, emotional, relational, and sexual), followed by a difficult period of acceptance, after which a new phase of rediscovering sexuality appeared. These findings can help to make healthcare professionals aware of the underlying mechanisms and concerns about sexuality. Furthermore, insights can help to develop sexuality-themed items for a broader monitoring tool to structurally assess the late effects to support discussing sexuality.
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Affiliation(s)
- Stefan T. Kuiper
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Daniëlle Zweers
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Britt B. M. Suelmann
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Richard P. Meijer
- Oncological Urology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sigrid C. J. M. Vervoort
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
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2
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Holme IK, Hollund HA, Vandraas K, Kiserud CE, Reinertsen KV, Loge JH, Lie HC. Sexual Problems as Late Effects: Awareness and Information Needs Among 1870 Long-term Norwegian Childhood, Adolescent, and Young Adult Cancer Survivors (The NOR-CAYACS Study). J Adolesc Young Adult Oncol 2024; 13:203-212. [PMID: 37579257 DOI: 10.1089/jayao.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Purpose: Treatment-related sexual problems are common, but understudied, among survivors of Childhood, Adolescent, and Young Adult Cancer Survivors (CAYACS). We investigated awareness of, and information needs regarding, sexual problems as late effects in a nation-wide sample of long-term CAYACS. Methods: Five-year survivors were identified by the Cancer Registry of Norway, diagnosed between 1985 and 2009 with any childhood cancer (0-18 years of age, excluding central nervous system tumors), leukemia, colorectal cancer, breast cancer, non-Hodgkin lymphoma, or malignant melanoma (19-39 years of age). Malignant melanoma survivors treated with local surgery only served as an unmatched reference group. Survivors were mailed a survey, including items on awareness and information needs. Descriptive statistics and logistic regression analyses were used for data analyses. Results: Of 5361 CAYACS invited, 2104 responded (39%), of which 1870 were eligible for inclusion. In all, 62% were aware of sexual problems as late effects (46% aware only, 16% experienced it) and 31% reported information needs. Of all groups, childhood cancer survivors reported the lowest level of awareness (43% aware, 7% experienced it) and the highest information needs (38%). In multivariable models, awareness was associated with higher education, shorter time since treatment, more intense treatments, and experiencing hormonal changes and reduced fertility. Information needs were associated with having experienced sexual problems, female gender, higher treatment intensity, chronic fatigue, and increased depressive symptoms. Conclusions: A substantial proportion of long-term CAYACS report being unaware of, and have information needs regarding sexual problems as late effects decades beyond treatment. Addressing such issues during follow-up care is important.
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Affiliation(s)
- Ida K Holme
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrikke A Hollund
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kathrine Vandraas
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Kristin V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Cathrine Lie
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
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3
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Hoyt MA, Wang AWT, Ceja RC, Cheavens JS, Daneshvar MA, Feldman DR, Funt SA, Nelson CJ. Goal-Focused Emotion-Regulation Therapy (GET) in Young Adult Testicular Cancer Survivors: A Randomized Pilot Study. Ann Behav Med 2023; 57:777-786. [PMID: 37078969 PMCID: PMC10441857 DOI: 10.1093/abm/kaad010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Young adult testicular cancer survivors experience adverse impacts after treatment. We developed Goal-focused Emotion-regulation Therapy (GET) to improve distress symptoms, emotion regulation, and goal navigation skills. PURPOSE This pilot study examined GET versus an active control intervention in young adult survivors of testicular cancer. METHODS Seventy-five eligible survivors treated with chemotherapy were randomized to receive GET or Individual Supportive Listening (ISL). Study acceptability, engagement, and tolerability were examined, and intervention fidelity and therapeutic alliance were compared between arms. Preliminary efficacy was evaluated by effect sizes for between-group changes in primary (anxiety and depressive symptoms) and secondary (career confusion, goal navigation, and emotion regulation) outcomes from baseline to immediately and 3-month post-intervention. RESULTS Among the 38 men randomized to GET, 81.1% completed all study sessions compared with 82.4% of the 37 men assigned to ISL. Fidelity to the intervention was 87% in GET. Therapeutic alliance wassignificantly higher among those receiving GET versus ISL. Participants exhibited a medium group-by-time effect size with greater reductions in depressive (d = 0.45) and anxiety (d = 0.29) symptoms for those in GET versus ISL, with a similar pattern at 3 months for depressive (d = 0.46) and anxiety (d = 0.46) symptoms. CONCLUSIONS GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adults. Observed effect sizes preliminarily suggest meaningful change, though should be interpreted with caution in small samples. GET may be a developmentally-matched behavioral approach to improve psychosocial function in this cancer group. CLINICAL TRIAL INFORMATION Clinicaltrials.gov, NCT04150848. Registered on October 28, 2019.
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Affiliation(s)
- Michael A Hoyt
- Department of Population Health & Disease Prevention, University of California, Irvine, Irvine, CA, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, USA
| | | | - Raymond Carrillo Ceja
- Department of Population Health & Disease Prevention, University of California, Irvine, Irvine, CA, USA
| | | | | | - Darren R Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Samuel A Funt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Science, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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4
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Crist N, Egert MC, Bernie HL. Sexual dysfunction in male childhood cancer survivors and adolescent and young adult survivors of hematologic malignancies. Sex Med Rev 2023; 11:106-113. [PMID: 36744841 DOI: 10.1093/sxmrev/qeac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 02/07/2023]
Abstract
Sexual Health is an important aspect of overall health and quality of life (QoL) among adolescent and young adult (AYA) as well as childhood cancer survivors (CCS). Sexual health encompasses psychosocial, physical, developmental, emotional and relationship factors that impact sexual function. Cancer and its associated treatments are associated with negative effects on sexual health, body image, relationships, as well as overall physical and mental health. Data shows that CCS are known to experience diminished QoL compared to their peers. However, limited information is available to guide the assessment and treatment of sexual dysfunction in AYA and CCS. Further, exploration into specific cancer types, treatment methods and their resultant effects on sexual function within these populations is far more limited. We conducted an extensive review of the literature that focused on sexual dysfunction in male survivors of hematologic malignancies (HM). Our review identified an increased incidence of sexual dysfunction within male AYA and CCS of HM, and the negative impact this has on overall QoL. Our results show the degree to which survivors of HM experience increased sexual dysfunction, and the therapies and pathophysiologic mechanisms that may contribute to the development of sexual dysfunction within this population. These findings highlight the lack of research on this topic and need for further exploration into AYA and CCS sexual health to improve patient care and close the knowledge gaps to better assess and treat sexual dysfunction in this patient population.
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Affiliation(s)
- Nikos Crist
- Department of Urology, Indiana University School of Medicine, Indianapolis, IA, United States
| | - Melissa C Egert
- Department of Urology, Indiana University School of Medicine, Indianapolis, IA, United States
| | - Helen L Bernie
- Department of Urology, Indiana University School of Medicine, Indianapolis, IA, United States
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Abiuso AMB, Varela ML, Raices T, Irusta G, Lazzati JM, Besio Moreno M, Cavallotti A, Belgorosky A, Pignataro OP, Berensztein E, Mondillo C. Histidine decarboxylase inhibitors: a novel therapeutic option for the treatment of leydigioma. J Endocrinol 2022; 255:103-116. [PMID: 36069766 DOI: 10.1530/joe-21-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
Recent reports indicate an increase in Leydig cell tumor (LCT) incidence. Radical orchiectomy is the standard therapy in children and adults, although it entails physical and psychosocial side effects. Testis-sparing surgery can be a consideration for benign LCT of 2.5 cm or less in size. Malignant LCTs respond poorly to conventional chemotherapy, so new treatment modalities are needed. In this study, we observed increased histidine decarboxylase expression and pro-angiogenic potential in LCT surgically resected from pediatric patients (fetal to pubertal) vs control samples from patients without endocrine or metabolic disorders which were collected at necropsy. We, therefore, evaluated for the first time the antitumor efficacy of two histidine decarboxylase inhibitors (α-methyl-dl-histidine dihydrochloride (α-MHD) and epigallocatechin gallate (EGCG)), alone and combined with carboplatin, in two preclinical models of LCT. MA-10 and R2C Leydig tumor cells, representing two different LCT subtypes, were used to generate syngeneic and xenograft mouse LCT models, respectively. In the syngeneic model, monotherapy with α-MHD effectively reduced tumor growth and angiogenesis. In the xenografts, which showed co-expression of histidine decarboxylase and CYP19, the combination of EGCG plus carboplatin was the most effective therapy, leading to LCT growth arrest and undetectable levels of plasmatic estradiol. Testicular and body weights remained unaltered. On the basis of this study, histidine decarboxylase may emerge as a novel pharmacological target for LCT treatment.
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Affiliation(s)
- Adriana María Belén Abiuso
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - María Luisa Varela
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Trinidad Raices
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Griselda Irusta
- Laboratory of Ovarian Physiology and Tumor Biology, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Juan Manuel Lazzati
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Marcos Besio Moreno
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Alina Cavallotti
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Alicia Belgorosky
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Omar Pedro Pignataro
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
- Department of Biological Chemistry, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Esperanza Berensztein
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Carolina Mondillo
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
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Petrella AR, Sabiston CM, O’Rourke RH, Santa Mina D, Hamilton RJ, Matthew AG. Process Evaluation of a Sport-Based Supportive Care Intervention for Testicular Cancer Survivors: A Mixed Methods Study. Cancers (Basel) 2022; 14:cancers14112800. [PMID: 35681779 PMCID: PMC9179291 DOI: 10.3390/cancers14112800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Testicular cancer survivors report unmet supportive care needs that are associated with poorer physical and mental health, yet engagement in traditional supportive care is low. The Ball’s in Your Court intervention was designed to engage testicular cancer survivors in supportive care by leveraging a community-based sport and exercise model. Age-appropriate, gender-sensitized, and disease specific elements were reflected in the intervention design, setting, content, and delivery. The intervention included five weekly health promotion sessions among a group of testicular cancer survivors. The purpose of this study was to explore the intervention’s (i) feasibility and acceptability, (ii) effects on testicular cancer survivors’ perceived health, and (iii) gain feedback for intervention refinement. A total of 10 testicular cancer survivors participated in the pilot and completed questionnaires on demographics, cancer history, perceived health, and physical activity behavior at baseline (pre-intervention) and perceived health and satisfaction with intervention components (post-intervention). Open-ended feedback surveys were collected after each weekly session and researcher field notes were recorded by three members of the study team. One month following the intervention, a focus group was conducted with intervention participants. All participants were satisfied with the intervention. Content analysis of the qualitative data supported intervention acceptability. Visual analysis conducted at the individual level indicated that perceived health either remained stable or improved from pre- to post-intervention. The Ball’s in Your Court intervention provides a feasible and acceptable approach for the delivery of supportive care aimed at improving testicular cancer survivors’ health and wellness. Recommendations for intervention refinement were provided and require future examination.
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Affiliation(s)
- Anika R. Petrella
- Cancer Division, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Catherine M. Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (R.H.O.); (D.S.M.)
- Correspondence:
| | - Roxy H. O’Rourke
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (R.H.O.); (D.S.M.)
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON M5S 2W6, Canada; (R.H.O.); (D.S.M.)
| | - Robert J. Hamilton
- The Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (R.J.H.); (A.G.M.)
| | - Andrew G. Matthew
- The Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (R.J.H.); (A.G.M.)
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7
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Lehmann V, Laan ETM, den Oudsten BL. Sexual health-related care needs among young adult cancer patients and survivors: a systematic literature review. J Cancer Surviv 2021; 16:913-924. [PMID: 34669141 PMCID: PMC9300501 DOI: 10.1007/s11764-021-01084-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 01/05/2023]
Abstract
Purpose Young adult cancer patients and survivors have age-specific care needs, but care needs related to sexual health are poorly understood. A systematic literature review was conducted to examine sexual health-related care needs among patients/survivors diagnosed with cancer during young adulthood (age: 18–39 years). The prevalence and types needs were assessed along with associated patient factors. Methods Four major databases were screened to identify relevant studies, which were also assessed for risk of bias; all following PRISMA guidelines. Results Identified studies (N = 35) often assessed sexual health-related care needs by whether participants experienced a generic need for support from providers. The prevalence of such needs ranged between 8 and 61.7% and was higher in female survivors and those with more health impairments. The type of diagnosis could also play a role in these varying prevalence rates, but was not systematically tested in included studies. Types of sexual health-related care needs were clustered into practical/emotional support needs (e.g., coping with physical side effects), information needs (e.g., more details), and communication needs (e.g., providers should initiate conversations, validate concerns, be empathetic/open). Needs should be addressed in-person and/or online. Conclusions The extent of needs related to sexual health varies among young adult patients and survivors, but types of needs center around improving provision of support and information by providers. Implications for Cancer Survivors Sexual health should routinely be addressed alongside other potential effects of cancer treatment to allow for constructive conversations between patients and providers. Referrals to (online) resources or specialists should be tailored to individual preferences. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01084-w.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Ellen T M Laan
- Department of Sexology and Psychosomatic Gynecology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders, Tilburg University, Tilburg, Netherlands
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8
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Tsatsou I, Konstantinidis T, Kalemikerakis I, Adamakidou T, Vlachou E, Govina O. Unmet Supportive Care Needs of Patients with Hematological Malignancies: A Systematic Review. Asia Pac J Oncol Nurs 2020; 8:5-17. [PMID: 33426184 PMCID: PMC7785074 DOI: 10.4103/apjon.apjon_41_20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022] Open
Abstract
Hematological malignancies require intensive and long-term treatment, which brings a significant burden on patients, leading to unmet supportive care needs. The purpose of this review was to investigate the unmet supportive care needs of patients with hematological malignancies during and after active treatment as well as the factors that affect them. A systematic bibliographic search was carried out in the PubMed database for English articles published between 2009 and 2020 according to the Preferred Reporting Items for Systematic Reviews guidelines and under the terms: "unmet needs", "supportive care", "hematological malignancy" and "hematological cancer." Twenty studies were evaluated and reviewed. Hierarchical frequently reported unmet supportive care needs were informational, emotional, physical, daily living/practical (accessibility, transportation, and financial problems), and family life/relational needs. In particular, patients with multiple myeloma most frequently reported unmet needs at the informational, physical, emotional, and daily living/practical domain. Patients with myelodysplastic syndromes reported physical, emotional, practical, and relational needs. Patients with leukemia and lymphoma rated their needs as informational, physical, psychological, daily living, and sexual. Sexual and spiritual unmet needs were reported at a low level. Predictive indicators for increased unmet supportive care needs were the type of the hematological malignancy, younger age, marital status, female gender, monthly income, coexistence of anxiety and depression, and altered quality of life. To conclude with, the literature reports a significant number of unmet supportive care needs in patients with hematological malignancies, whose frequency and intensity were influenced by a variety of factors. However, the large heterogeneity of studies (design, sample, and needs assessment tools) makes the generalization of the results difficult.
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Affiliation(s)
- Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General Hospital, Heraklion, Greece
| | | | | | | | - Eugenia Vlachou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Ourania Govina
- Department of Nursing, University of West Attica, Athens, Greece
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9
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Okada K, Fujita K, Fukuhara S, Kiuchi H, Uemura M, Imamura R, Nonomura N. Erectile Dysfunction in Germ Cell Tumor Survivors. World J Mens Health 2020; 39:533-540. [PMID: 32777864 PMCID: PMC8255390 DOI: 10.5534/wjmh.200042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose Germ cell tumors (GCTs) are the most common malignant neoplasms in adolescents and young adults, and most patients with these tumors can be completely cured. Therefore, maintaining quality of life (QOL) is important. Erectile dysfunction (ED) is one factor that reduces the QOL of GCT survivors. We aimed to clarify the relationship between ED and age, follow-up period, serum levels of hormones, and treatment methods for GCT survivors. Materials and Methods We evaluated ED using the Sexual Health Inventory for Men questionnaire (SHIM) and measured serum levels of hormones in survivors after GCT treatment. The relationships between the SHIM score responses and age, serum levels of hormones, follow-up period, and treatment methods were assessed using a logistic analysis. Results Fifty-two GCT survivors were enrolled and 46 survivors completed the SHIM. The median age, follow-up period, and SHIM score were 38 years, 35 months, and 18, respectively. Regarding the SHIM scores, 85% had scores <22 and 46% had scores <17. The percentage of SHIM scores <17 was 69% in patients with under 2 years of follow-up. It significantly improved to 33% in patients with over 2 years of follow-up. The multivariate analysis identified the follow-up period as an independent factor for SHIM scores <17. Age, serum levels of hormone, and treatment method were not significant factors for SHIM scores <17. Conclusions Improvement of SHIM score can be expected after GCT treatment regardless of age, serum levels of hormone, and treatment method.
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Affiliation(s)
- Koichi Okada
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Hoyt MA, Wang AWT, Ryan SJ, Breen EC, Cheavens JS, Nelson CJ. Goal-Focused Emotion-Regulation Therapy (GET) for young adult survivors of testicular cancer: a pilot randomized controlled trial of a biobehavioral intervention protocol. Trials 2020; 21:325. [PMID: 32290859 PMCID: PMC7157999 DOI: 10.1186/s13063-020-04242-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background Testicular cancer diagnosis and treatment, especially given its threat to sexuality and reproductive health, can be distressing in the formative period of young adulthood and the majority of young survivors experience impairing, distressing, and modifiable adverse outcomes that can persist long after medical treatment. These include psychological distress, impairment in pursuit of life goals, persistent physical side effects, elevated risk of secondary malignancies and chronic illness, and biobehavioral burden (e.g., enhanced inflammation, dysregulated diurnal stress hormones). However, few targeted interventions exist to assist young survivors in renegotiating life goals and regulating cancer-related emotions, and none focus on reducing the burden of morbidity via biobehavioral mechanisms. This paper describes the methodology of a randomized controlled biobehavioral trial designed to investigate the feasibility and preliminary impact of a novel intervention, Goal-focused Emotion-Regulation Therapy (GET), aimed at improving distress symptoms, emotion regulation, goal navigation skills, and stress-sensitive biomarkers in young adult testicular cancer patients. Methods Participants will be randomized to receive six sessions of GET or Individual Supportive Therapy (ISP) delivered over 8 weeks. In addition to indicators of intervention feasibility, we will measure primary (depressive and anxiety symptoms) and secondary (emotion regulation and goal navigation skills, career confusion) psychological outcomes prior to (T0), immediately after (T1), and 12 weeks after (T2) intervention. Additionally, identified biomarkers will be measured at baseline and at T2. Discussion GET may have the potential to improve self-regulation across biobehavioral domains, improve overall cancer adjustment, and address the need for targeted supportive care interventions for young adult cancer survivors. Trial registration Clinicaltrials.gov, NCT04150848. Registered on 28 October 2019.
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Affiliation(s)
- Michael A Hoyt
- Department of Population Health and Disease Prevention and the Chao Family Comprehensive Cancer Center, University of California, Irvine, 653 E Peltason Drive, Irvine, CA, 95697-3957, USA.
| | | | - Sean J Ryan
- Department of Psychology, Graduate Center, City University of New York, New York, NY, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Discussing sexuality in cancer care: towards personalized information for cancer patients and survivors. Support Care Cancer 2020; 28:4227-4233. [PMID: 31900615 DOI: 10.1007/s00520-019-05257-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The needs of cancer patients and survivors regarding discussing sexuality are frequently unmet, with many not receiving adequate information. To optimize information about sexuality and cancer, patients' perspective is needed. The goals of this study were to investigate what kind of information Dutch cancer patients need, their ideas on how to improve communication, and to identify patients who are more in need of information regarding sexuality. METHODS The Dutch Federation of Cancer Patient Organizations developed and conducted a nationwide 28-item online survey. The survey was distributed among cancer patients and survivors. RESULTS In total, 2657 (ex) cancer patients participated, with a median age of 61 years, and half were male (45.2%). Of the respondents, 65% were in need of information about sexuality. Patients ≤ 61 years (p < 0.001), patients with a self-reported negative effect of cancer on sexuality (p < 0.001) and patients who were diagnosed less than 2 years ago (p < 0.04) reported a higher need for information. Regardless of type of cancer, patients were most in need of practical tips and practical information regarding sexuality. To enhance communication about sexuality, 64% of the respondents suggested that it would be of help if care providers give information as standard care. CONCLUSIONS (Ex) cancer patient prefer to receive standard information about sexuality by their care providers. According to patients' preferences, information must include practical tips. Age, self-reported negative effect on sexuality status and time from diagnoses influenced the need for information.
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Mütsch J, Friedrich M, Leuteritz K, Sender A, Geue K, Hilbert A, Stöbel-Richter Y. Sexuality and cancer in adolescents and young adults - a comparison between reproductive cancer patients and patients with non-reproductive cancer. BMC Cancer 2019; 19:828. [PMID: 31438895 PMCID: PMC6704507 DOI: 10.1186/s12885-019-6009-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 08/02/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Sexuality is an important aspect of quality of life for adolescent and young adults that remains understudied in cancer patients. Most current knowledge about how cancer and cancer treatments can affect patients' sexuality pertains to reproductive cancer patients (breast, gynecological, male reproductive organs), whereas only little is known about how the disease affects the sex lives of patients with other types of cancer. This study examined sexual satisfaction and sexual supportive care needs among adolescent and young adult cancer patients, with a particular focus on how the type of cancer a person has is associated with these issues differently. METHODS Five hundred seventy-seven (n = 424 females, 73.5%) patients between 18 and 39 years of age at diagnosis and representing all major tumor entities completed the standardized questionnaire. The analysis addressed the following topics: sexual satisfaction (Life Satisfaction Questionnaire), sexual supportive care needs (Supportive Care Needs Survey), and changes in sexuality (Questions on Life Satisfaction Modules). These topics were tested by mean differences between reproductive and non-reproductive cancer, equivalence testing and regression analyses. RESULTS About one third of the patients reported being dissatisfied with their sexuality and having supportive care needs in this area. Changes in sexuality were significantly more common in women with reproductive cancers than in those who had other types of cancer (t = - 2.693, p = .007), while both groups had equivalence in scores for sexual satisfaction and sexual supportive care needs. Reproductive cancers are not more associated with deterioration of sexual satisfaction (R2 = .002, p = .243), changes in sexuality (R2 = .006, p = .070) or increased sexual supportive care needs than non-reproductive cancers (R2 = .004, p = .131). CONCLUSIONS The results indicate that about a third of adolescents and young adults with both reproductive but also with non-reproductive cancer experience sexual dissatisfaction in similar measure. An equal percentage of these patients also express a desire to receive supportive care in this area. Consequently, health care professionals should address issues of sexuality and cancer as a matter of routine when caring for young adults even when patients have a non-reproductive cancer.
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Affiliation(s)
- Julian Mütsch
- Department of Mental Health, Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Michael Friedrich
- Department of Mental Health, Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Katja Leuteritz
- Department of Mental Health, Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Annekathrin Sender
- Department of Mental Health, Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Kristina Geue
- Department of Mental Health, Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Anja Hilbert
- Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany
| | - Yve Stöbel-Richter
- Faculty of Managerial and Cultural Studies, University of Applied Sciences Zittau / Goerlitz, P. O. Box 30 06 48, 02811 Goerlitz, Germany
- Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine, University of Leipzig, Philipp-Rosenthal-Str. 27, 04103 Leipzig, Germany
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13
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Fidler MM, Frobisher C, Hawkins MM, Nathan PC. Challenges and opportunities in the care of survivors of adolescent and young adult cancers. Pediatr Blood Cancer 2019; 66:e27668. [PMID: 30815985 DOI: 10.1002/pbc.27668] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 02/06/2023]
Abstract
Adolescents and young adults (AYA) with cancer are an understudied group. Much of what is known about long-term outcomes after AYA cancer has been derived from cohorts of childhood cancer survivors, which seldom include patients at the older end of the AYA age spectrum. In general, AYA cancer survivors have a lower risk for premature mortality, subsequent primary neoplasms and chronic health conditions than childhood cancer survivors. However, AYA cancer survivors are vulnerable to psychosocial challenges, concerns about fertility and relationships and financial toxicity. No single model is optimal for the care of these survivors, but it is generally agreed that all survivors require a survivor care plan that promotes their adherence to evidence-based surveillance guidelines. There is a need to create survivor cohorts that include the full range of AYA ages and diagnoses to be able to address the many pressing questions that remain unanswered in this vulnerable population.
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Affiliation(s)
- Miranda M Fidler
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Paul C Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Heiniger LE, Smith AB, Olver I, Grimison P, Klein B, Wootten A, Abbott JAM, Price MA, McJannett M, Tran B, Stockler MR, Gurney H, Butow PN. e-TC: Development and pilot testing of a web-based intervention to reduce anxiety and depression in survivors of testicular cancer. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28544085 DOI: 10.1111/ecc.12698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 01/27/2023]
Abstract
e-TC is an online intervention designed to address common psychosocial concerns of testicular cancer survivors. It aims to reduce anxiety, depression and fear of cancer recurrence by providing evidence-based information and psychological intervention. This paper details the development and pilot testing of e-TC. During pilot testing, 25 men (with varying psychological profiles) who had completed treatment for testicular cancer, 6 months to 5 years ago (which had not recurred), used e-TC over a 10-week period and provided quantitative and qualitative feedback on the feasibility and acceptability of the programme. Six men also completed a qualitative interview to provide detailed feedback on their experiences using e-TC. Fourteen men (56%) completed at least 80% of the programme. Participants reported a high level of satisfaction with the programme. Men's limited time was a barrier to programme use and completion, and participants suggested that men with a more recent diagnosis and a higher level of distress may be more likely to engage with the programme. e-TC appears to be a feasible and acceptable online intervention for survivors of testicular cancer. Findings from this study are currently being used to refine e-TC and guide the design of a larger efficacy study.
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Affiliation(s)
- L E Heiniger
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - A B Smith
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Centre for Oncology Education and Research Translation (CONCERT), The Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW, Australia
| | - I Olver
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Cancer Council Australia, Sydney, NSW, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - P Grimison
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - B Klein
- Centre for Biopsychosocial and eHealth Research and Innovation, Federation University, Ballarat, Vic., Australia.,National Institute for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - A Wootten
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Epworth Prostate Centre, Epworth, Vic., Australia
| | - J-A M Abbott
- Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, Vic., Australia
| | - M A Price
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - M McJannett
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - B Tran
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - M R Stockler
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Concord Hospital, Concord, NSW, Australia.,NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - H Gurney
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia.,Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - P N Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.,The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia.,Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
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15
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Kim IR, Kim SH, Ok ON, Kim SH, Lee S, Choi E, Kim SJ, Yoon DH, Lee MH. Sexual problems in male vs. female non-Hodgkin lymphoma survivors: prevalence, correlates, and associations with health-related quality of life. Ann Hematol 2017; 96:739-747. [DOI: 10.1007/s00277-017-2940-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/31/2017] [Indexed: 01/17/2023]
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16
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Changes in Sexuality, Body Image and Health Related Quality of Life in Patients Treated for Hematologic Malignancies: A Longitudinal Study. SEXUALITY AND DISABILITY 2016; 34:367-388. [PMID: 27881887 PMCID: PMC5102943 DOI: 10.1007/s11195-016-9459-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Longitudinal studies exploring sexuality, body image and health-related quality of life (HRQoL) are lacking in patients treated with chemo- or chemoimmuno-therapy for hematologic malignancies. The aim was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until 6 months after treatment. Twenty patients above 45 years (median age 62) treated for DLBCL, CLL or AML participated. Data were collected at baseline, 1- and 6-months after treatment by means of three instruments: SAQ-S, BIS and EORTC QLQ-C30. The results showed that patients' sexuality was negatively affected 1 month after treatment, but after 6 months the patient reported scores had returned almost entirely to baseline scores. Body image was slight negatively affected after 1 month and after 6 months, 50 % reported that body image was not affected at all. Regarding HRQoL, patients reported gradually improved scores during the study period. Regression analysis showed that changes in sexuality and body image seemed to influence changes in HRQoL. This study has shown changes in sexuality, body image and HRQoL over time in patients above age 45 treated for hematologic malignancies. One month after treatment all three areas becomes negatively affected, and thereafter the patients' scores recovered to a great extent regarding these issues within 6 months. Sexuality and body image seem to be important aspects of HRQoL for these patients and need to be integrated in the cancer rehabilitation during and after treatment.
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17
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Perz J, Ussher JM. A randomized trial of a minimal intervention for sexual concerns after cancer: a comparison of self-help and professionally delivered modalities. BMC Cancer 2015; 15:629. [PMID: 26353787 PMCID: PMC4564976 DOI: 10.1186/s12885-015-1638-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 09/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information and discussion of sexual changes with a health professional is a high priority for many cancer patients in order to assist with sexual changes and ensure that sexual intimacy does not cease post-cancer. The PLISSIT model is widely recommended as a framework for providing sexual information and support, allowing for the discussion of sexual changes at various levels of increasing intensity. The aim of the present study is to evaluate the early stages of the PLISSIT model by examining the relative efficacy of written information provision about cancer related sexual changes, and information provision accompanied by a single session of counselling, for people with cancer and their partners, across a range of cancer types. METHOD Eighty-eight people with cancer and 53 partners across a range of sexual and non-sexual cancers, took part in a randomised trial which adopted mixed method analysis to examine changes in psychological wellbeing, quality of life, relationship satisfaction and communication, and sexual functioning, following written information provision about cancer related sexual changes (self-help condition; SH), or written information accompanied by a single session of counselling (health professional condition; HP). RESULTS Ratings of the usefulness and efficacy of the SH and HP interventions, collected through analysis of Likert scales, open ended survey items and interviews, indicated that both conditions were found to be useful and efficacious by the majority of participants, serving to increase awareness of sexuality, improve couple communication about sex, and help in the management of sexual changes, through the exploration of non-coital sexual practices. In contrast, the quantitative analysis of standardized instruments found no significant improvements in psychological wellbeing, quality of life, relationship satisfaction and communication, or sexual functioning. There were significant reductions in self-silencing in the HP condition, and a trend towards increases in sexual satisfaction across both conditions. CONCLUSION These results offer support for the early stages of the PLISSIT model, in terms of normalization and increased awareness of sexual changes after cancer, increased couple communication about sexual changes, and legitimation of exploration of a range of non-coital sexual practices and intimacy. However, more complex and intensive interventions are needed to address sexual functioning and psychological wellbeing. The findings provide support for the proposition that providing permission to discuss sexuality should be the core feature underpinning all stages of interventions designed to provide sexuality information and support for people with cancer and their partners, and also demonstrate the potential importance of limited information and specific suggestions. TRIAL REGISTRATION This study was registered in the Australian New Zealand Clinical Trials Registry. ( ACTRN12615000399594 ) on 29 April 2015.
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Affiliation(s)
- Janette Perz
- Centre for Health Research - School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia.
| | - Jane M Ussher
- Centre for Health Research - School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia.
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18
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Aubin S, Perez S. The Clinician's Toolbox: Assessing the Sexual Impacts of Cancer on Adolescents and Young Adults with Cancer (AYAC). Sex Med 2015; 3:198-212. [PMID: 26468383 PMCID: PMC4599557 DOI: 10.1002/sm2.75] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Adolescents and young adults aged 15-39 years who have been diagnosed with cancer (AYAC) have unique medical and psychosocial needs. Following their cancer treatments, AYAC must learn to manage the sometimes irreversible general side effects of cancer treatments including side effects that impact their sexuality. These side effects include but are not limited to: infertility, altered body/physical appearance, and sexual dysfunction. Such effects may hinder AYAC efforts to date and experiment sexually, limiting sexual maturation and confidence, as well as the formation or maintenance of meaningful couple and sexual relationships. It is clear that we need to tailor our clinical approaches to ensure that we assess the unique needs and concerns faced by AYAC. AIMS Based on consistent study findings substantiating the distinctive needs of AYAC, the main objective of this article is to present the core clinical components involved in assessing sexuality among AYAC. METHODS The clinical recommendations are based on the authors and experts' clinical experiences coupled with a thorough examination of the literature related to AYAC sexuality. MAIN OUTCOME MEASURES This article first describes the three components (clinical interview, review of chart notes, and self-report questionnaires) of a sexuality assessment and the seven core domains that highlight target areas of focus. RESULTS A detailed outline of each of the core domains of assessment (socio-demographics; medical history; fertility and sexually transmitted infection; sexual functioning; sexual coping style; body and self-image; and sexual history and dating/couple experience) is presented. A "toolbox" table containing useful resources for clinicians (e.g., questionnaires and red flags) and direct resources for AYAC patients are included. CONCLUSION Cancer can have a significant impact on numerous domains of AYAC sexuality. The assessment of and attention to the impact of sexuality on AYAC is crucial in order to provide effective and comprehensive quality patient cancer care.
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Affiliation(s)
- Sylvie Aubin
- Lady Davis Institute, Jewish General HospitalMontreal, QC, Canada
- Department of Psychology, McGill UniversityMontreal, QC, Canada
- Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Jewish General HospitalMontreal, QC, Canada
| | - Samara Perez
- Lady Davis Institute, Jewish General HospitalMontreal, QC, Canada
- Department of Psychology, McGill UniversityMontreal, QC, Canada
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Ussher JM, Perz J, Gilbert E. Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study. BMC Cancer 2015; 15:268. [PMID: 25885443 PMCID: PMC4407322 DOI: 10.1186/s12885-015-1243-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/23/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes. METHOD This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview. RESULTS Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer. CONCLUSION The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.
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Affiliation(s)
- Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Emilee Gilbert
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
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Geue K, Schmidt R, Sender A, Sauter S, Friedrich M. Sexuality and romantic relationships in young adult cancer survivors: satisfaction and supportive care needs. Psychooncology 2015; 24:1368-76. [DOI: 10.1002/pon.3805] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Kristina Geue
- University of Leipzig; Department of Medical Psychology and Medical Sociology; Philipp-Rosenthal-Str. 55 04103 Leipzig Germany
| | - Ricarda Schmidt
- Leipzig University Medical Center; Integrated Research and Treatment Center Adiposity Diseases, Medical Psychology and Medical Sociology; Philipp-Rosenthal-Str. 27 04103 Leipzig Germany
| | - Annekathrin Sender
- University of Leipzig; Department of Medical Psychology and Medical Sociology; Philipp-Rosenthal-Str. 55 04103 Leipzig Germany
| | - Siegfried Sauter
- Rehabilitation Clinic for Children with their Families, Youngsters and Young Adults; Oberkatzensteig 11 78141 Schönwald im Schwarzwald Germany
| | - Michael Friedrich
- University of Leipzig; Department of Medical Psychology and Medical Sociology; Philipp-Rosenthal-Str. 55 04103 Leipzig Germany
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Stamataki Z, Brunton L, Lorigan P, Green AC, Newton-Bishop J, Molassiotis A. Assessing the impact of diagnosis and the related supportive care needs in patients with cutaneous melanoma. Support Care Cancer 2015; 23:779-89. [PMID: 25189151 DOI: 10.1007/s00520-014-2414-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/18/2014] [Indexed: 01/21/2023]
Abstract
PURPOSE Despite the large number of people affected by melanoma, little is known about the specific needs of melanoma patients. Understanding the effects of melanoma diagnosis and the specific supportive care needs of this group of patients is a necessary step towards provision of effective psychosocial care. METHODS Semi-structured interviews were carried out with 15 patients with malignant melanoma of the skin. The sample size, which was purposive, included 8 females and 7 males from 27 to 78 years old. Data were analysed using the NVIVO 8 software and principles of thematic analysis. RESULTS Four major areas were identified: (a) Emotional effects due to body image, fear of the sun and uncertainty for the future; (b) Effects on Relationships, with some patients in need of more support than others from family and work colleagues; (c) Functional effects due to on-going symptoms such as pain and lymphedema; and (d) Health System and Information Needs, around the clarity, quality and timing of the information received from the health care professionals. CONCLUSIONS The findings suggest that we often fail to pick up melanoma patients' health and psychosocial needs and fail to refer them appropriately, rather than the services not being available. Interventions should focus on patient and carer education about melanoma and sun protection, psychosocial support and effective information giving. Patient-reported outcome measures should routinely be collected to identify issues of specific concerns to the patients and directing them to the right services based on their individual needs.
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Affiliation(s)
- Zoe Stamataki
- Christie NHS Foundation Trust, Block C, Withington Hall Cotton Lane, Manchester, M20 4UX, UK,
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Sporn NJ, Smith KB, Pirl WF, Lennes IT, Hyland KA, Park ER. Sexual health communication between cancer survivors and providers: how frequently does it occur and which providers are preferred? Psychooncology 2014; 24:1167-73. [PMID: 25534170 DOI: 10.1002/pon.3736] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/22/2014] [Accepted: 11/18/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sexual health concerns in cancer survivors are often unaddressed by providers. Study objectives were to assess cancer survivors' reported rates of communication with oncology providers about sexual health, preference for such communication with their oncology or primary care providers (PCPs), and factors associated with these communication rates and preferences. METHODS Sixty-six patients attending a cancer survivorship clinic were asked how often their oncologist addressed and initiated discussion about sexual functioning and whether they wanted their oncologist or PCP to ask about their sexual health. We also assessed whether various sociodemographic characteristics and levels of depression, anxiety, and sexual satisfaction were associated with survivors' sexual health communication rates and preferences. RESULTS 41% of patients wanted their oncologist to ask about sexual health and 58% of patients wanted their PCP to ask about sexual health. Over 90% of patients reported that their oncologist infrequently addressed sexual health concerns and that their oncologist was unlikely to initiate such discussions. Education level influenced whether patients wanted their oncologist to ask about sexual health. Age, education level, and insurance type influenced whether patients wanted their PCP to ask about sexual health. Levels of depression, anxiety, and sexual satisfaction were not associated with communication rates or preferences. CONCLUSIONS Patients attending a survivorship clinic reported infrequent communication about sexual health with their oncology providers, despite wanting their providers to ask about sexual health concerns.
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Affiliation(s)
- Nora J Sporn
- University of Kansas, Department of Psychology, Lawrence, KS, USA
| | - Kelly B Smith
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - William F Pirl
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Inga T Lennes
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Kelly A Hyland
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Cancer Center, Boston, MA, USA.,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
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Gilbert E, Perz J, Ussher JM. Talking about sex with health professionals: the experience of people with cancer and their partners. Eur J Cancer Care (Engl) 2014; 25:280-93. [PMID: 25040442 DOI: 10.1111/ecc.12216] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 12/31/2022]
Abstract
Changes to sexuality can be one of the most difficult aspects of life following cancer. This study examines the experience of discussing sexuality post cancer with health care professionals (HCPs), from the perspective of women and men with cancer (PWC), and their partners (PPWC), across a range of cancer types. A total of 657 PWC (535 women, 122 men) and 148 PPWC (87 women, 61 men) completed a survey containing closed and open-ended items, analysed by analysis of variance and thematic analysis. Discussions about sexuality with a HCP were more likely to be reported by men (68%) compared to women PWC (43%), and by women (47%) compared to men PPWC (28%), as well as by those with a sexual or reproductive cancer. Men PWC and women PPWC were most likely to want to discuss sexuality with a HCP, with men PWC and PPWC reporting highest levels of satisfaction with such discussions. Open-ended responses revealed dissatisfaction with the unwillingness of HCPs to discuss sexuality, unhappiness with the nature of such discussion, and positive accounts of discussions about sexuality with HCPs. These findings lend support to the notion that people with cancer and their partners may have unmet sexual information and support needs.
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Affiliation(s)
- E Gilbert
- Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia
| | - J Perz
- Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia
| | - J M Ussher
- Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia
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Rood JAJ, Eeltink CM, van Zuuren FJ, Verdonck-de Leeuw IM, Huijgens PC. Perceived need for information of patients with haematological malignancies: a literature review. J Clin Nurs 2014; 24:353-69. [DOI: 10.1111/jocn.12630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Janneke AJ Rood
- Department of Haematology (pk 2 br 018); VU University Medical Center; Amsterdam The Netherlands
- Department of Internal Medicine; Medical Center; Alkmaar
| | - Corien M Eeltink
- Department of Haematology (pk 2 br 018); VU University Medical Center; Amsterdam The Netherlands
| | - Florence J van Zuuren
- Department of Clinical Psychology; University of Amsterdam; Amsterdam The Netherlands
| | | | - Peter C Huijgens
- Department of Haematology (pk 2 br 018); VU University Medical Center; Amsterdam The Netherlands
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Factors associated with haematological cancer survivors experiencing a high level of unmet need across multiple items of supportive care: a cross-sectional survey study. Support Care Cancer 2014; 22:2899-909. [PMID: 24828759 DOI: 10.1007/s00520-014-2264-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/22/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE This study aimed to identify subgroups of haematological cancer survivors who report a "high/very high" level of unmet need on multiple (≥7) items of supportive care. METHODS Haematological cancer survivors, aged 18 to 80 years at recruitment were selected from four Australian state-based cancer registries. Eligible survivors were sent a survey containing the Survivor Unmet Needs Survey (SUNS). Logistic regression analysis was used to identify characteristics associated with haematological cancer survivors reporting a "high/very high" level of unmet need on ≥7 items of the SUNS. RESULTS Of the 696 survivors included in this study, 175 (n = 25 %) reported a "high/very high" level of unmet need on seven or more items of the SUNS. Survivors who: had relocated due to their cancer (OR: 2.04; 95 % CI: 1.18, 3.52), had difficulty paying bills (OR: 2.42; 95 % CI: 1.34, 4.38), had used up their savings as a result of cancer (OR: 1.90; 95 % CI: 1.06, 3.40), and were classified as having above normal symptoms of depression (OR: 3.65; 95 % CI: 2.17, 6.15) and stress (OR: 5.94; 95 % CI: 3.22, 10.95) on the Depression Anxiety and Stress Scale-21 (DASS-21) had statistically significantly higher odds of reporting seven or more "high/very high" unmet needs. CONCLUSIONS Additional and intensive supportive care may be needed for this subgroup of haematological cancer survivors experiencing multiple "high/very high" unmet needs. Assistance with accessing relevant financial support and highly accessible services that provide emotional and information support, such as online and telephone peer support programs may prove beneficial in addressing the needs of this subgroup of haematological cancer survivors. It is suggested that future, methodologically rigorous intervention studies assess such strategies.
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Perz J, Ussher JM, Gilbert E. Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer. BMC Cancer 2014; 14:228. [PMID: 24673768 PMCID: PMC3986691 DOI: 10.1186/1471-2407-14-228] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Changes to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study. METHOD Six hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships. RESULTS Men and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer. CONCLUSION These results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.
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Affiliation(s)
- Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
| | - Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
| | - Emilee Gilbert
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
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Olsson C, Athlin E, Sandin-Bojö AK, Larsson M. Sexuality is not a priority when disease and treatment side effects are severe: conceptions of patients with malignant blood diseases. J Clin Nurs 2013; 22:3503-12. [PMID: 24003940 DOI: 10.1111/jocn.12333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe how patients with malignant blood diseases conceive the influence of chemo- or chemoimmunotherapy on sexuality, and their need of support related to this issue. BACKGROUND Sexuality is often negatively affected in cancer patients with sex-specific diagnoses. For patients with malignant blood diseases, the research is limited with regard to the effect on sexuality. Knowledge about their need for support related to sexuality is also needed as nurses are found to often avoid this area of their responsibility. DESIGN Qualitative design. METHODS Twelve patients treated for malignant blood diseases were interviewed twice. Phenomenography was used for the analysis. RESULTS The analyses revealed an outcome space consisting of two main categories: 'Sexuality is overshadowed by the cancer experience' and 'No need of support but timely information might be helpful', both comprehensively related to three interrelated description categories 'Affected strength', 'Affected sexual desire' and 'Affected body image', which describe conceptions of how sexuality was affected. CONCLUSION Patients experienced negative effects on sexual function and sexual relationship during and after treatment period due to affected strength, sexual desire and negatively body image. However, when disease and side effects were experienced as severe, thoughts and interest of sexuality were overshadowed, and the need or wish for support related to this issue was very low. It is important to note that some patients expressed that pre- or post-treatment information might have been helpful. RELEVANCE TO CLINICAL PRACTICE It is acknowledged in the cancer care of today that cancer follow-up should address psychosocial support in which sexuality is an important area. Therefore, it is imperative that cancer care is organised in a patient centred way, with adequate time for nurses to provide continuity in the nurse-patient relation and supportive care also during cancer rehabilitation.
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Affiliation(s)
- Cecilia Olsson
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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Smith A‘B, King M, Butow P, Luckett T, Grimison P, Toner GC, Stockler M, Hovey E, Stubbs J, Hruby G, Gurney H, Turner S, Alam M, Cox K, Olver I. The prevalence and correlates of supportive care needs in testicular cancer survivors: a cross-sectional study. Psychooncology 2013; 22:2557-64. [DOI: 10.1002/pon.3323] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Allan ‘Ben’ Smith
- Psycho-Oncology Co-operative Research Group (PoCoG); University of Sydney; Sydney Australia
| | - Madeleine King
- Psycho-Oncology Co-operative Research Group (PoCoG); University of Sydney; Sydney Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group; Sydney Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group (PoCoG); University of Sydney; Sydney Australia
| | - Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT), South Western Sydney Clinical School; The University of New South Wales; Sydney Australia
| | - Peter Grimison
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group; Sydney Australia
- Sydney Cancer Centre; Sydney Australia
| | - Guy C. Toner
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group; Sydney Australia
- Peter MacCallum Cancer Centre and University of Melbourne; Melbourne Australia
| | - Martin Stockler
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group; Sydney Australia
- Sydney Cancer Centre; Sydney Australia
| | - Elizabeth Hovey
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group; Sydney Australia
- Prince of Wales Hospital; Sydney Australia
| | - John Stubbs
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group; Sydney Australia
- Cancer Voices Australia; Sydney Australia
| | | | - Howard Gurney
- Crown Princess Mary Cancer Centre, Westmead Hospital; Sydney Australia
| | - Sandra Turner
- Crown Princess Mary Cancer Centre, Westmead Hospital; Sydney Australia
| | | | - Keith Cox
- Sydney Cancer Centre; Sydney Australia
| | - Ian Olver
- Cancer Council Australia; Sydney Australia
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Gilbert E, Ussher JM, Perz J, Wong WKT, Hobbs K, Mason C. Men's experiences of sexuality after cancer: a material discursive intra-psychic approach. CULTURE, HEALTH & SEXUALITY 2013; 15:881-895. [PMID: 23656602 DOI: 10.1080/13691058.2013.789129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Men can experience significant changes to their sexuality following the onset of cancer. However, research on men's sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on men's sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, men's intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of 'normal' masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Men's relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.
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Affiliation(s)
- Emilee Gilbert
- a Centre for Health Research , University of Western Sydney , Sydney , Australia
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Hall A, Lynagh M, Bryant J, Sanson-Fisher R. Supportive care needs of hematological cancer survivors: a critical review of the literature. Crit Rev Oncol Hematol 2013; 88:102-16. [PMID: 23582686 DOI: 10.1016/j.critrevonc.2013.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 02/05/2013] [Accepted: 03/14/2013] [Indexed: 01/10/2023] Open
Abstract
The purpose of this review was to determine the perceived supportive care needs of hematological cancer survivors, and the patient characteristics associated with higher levels of need. Medline, PsychInfo, CINAHL, EMBASE and PsycEXTRA, were searched for eligible articles published between 1979 and 2011. Ten full-text articles were identified. Extensive variation among study populations, methodologies and needs assessment measures used, made it difficult to synthesize results. Consequently, we could not confidently determine the most prevalent perceived needs of hematological cancer survivors. However, the limited data loosely suggests that concerns surrounding cancer recurrence and survival may be predominant needs experienced by hematological cancer survivors. Younger survivors were also identified by several studies as reporting higher levels of several areas of need. Future research is needed to assess the supportive care needs of large heterogeneous, population-based samples of hematological cancer survivors, utilizing valid, reliable and standardized measures of supportive care needs.
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Affiliation(s)
- Alix Hall
- Priority Research Centre for Health Behaviour, Faculty of Health, The University of Newcastle & Hunter Medical Research Institute, Callaghan, NSW, Australia.
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34
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Hautamäki-Lamminen K, Lipiäinen L, Beaver K, Lehto J, Kellokumpu-Lehtinen PL. Identifying cancer patients with greater need for information about sexual issues. Eur J Oncol Nurs 2013; 17:9-15. [DOI: 10.1016/j.ejon.2012.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/30/2012] [Accepted: 03/17/2012] [Indexed: 10/28/2022]
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McGrath PD. The Impact on Sexuality After Diagnosis and Treatment for a Hematologic Malignancy: Findings From Australia. Oncol Nurs Forum 2012; 39:595-600. [DOI: 10.1188/12.onf.595-600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cleary V, McCarthy G, Hegarty J. Development of an Educational Intervention Focused on Sexuality for Women with Gynecological Cancer. J Psychosoc Oncol 2012; 30:535-55. [DOI: 10.1080/07347332.2012.703767] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Bender JL, Wiljer D, To MJ, Bedard PL, Chung P, Jewett MAS, Matthew A, Moore M, Warde P, Gospodarowicz M. Testicular cancer survivors' supportive care needs and use of online support: a cross-sectional survey. Support Care Cancer 2012; 20:2737-46. [PMID: 22382589 DOI: 10.1007/s00520-012-1395-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 01/25/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Jacqueline L Bender
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, Toronto General Hospital, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada
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Paul CL, Carey ML, Hall AE, Lynagh MC, Sanson-Fisher RW, Henskens FA. Improving access to information and support for patients with less common cancers: hematologic cancer patients' views about Web-based approaches. J Med Internet Res 2011; 13:e112. [PMID: 22189354 PMCID: PMC3278098 DOI: 10.2196/jmir.1894] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 09/08/2011] [Accepted: 09/25/2011] [Indexed: 11/18/2022] Open
Abstract
Background Meeting the psychosocial needs of vulnerable groups such as cancer survivors remains an ongoing challenge. This is particularly so for those who have less access to the usual forms of medical specialist and in-person support networks. Internet-based approaches offer an opportunity to better meet patients’ information and support needs by overcoming the barrier of geographic isolation. Objective The aim of the study was to assess the reported level of access to the Internet, preferred sources of information, and preferred sources of support among survivors of hematologic cancers. Method A population-based, Australian state cancer registry invited eligible survivors to complete a survey about psychosocial needs, including items measuring Internet access and patterns of use. Of the 732 eligible survivors invited to participate, 268 (36.6%) completed and returned the pen-and-paper-based survey. Results The majority of participants (186/254, 73.2%) reported a high level of access to the Internet, with higher Internet access associated with a higher level of education, larger household, younger age, and being married or employed. A total of 62.2% (156/251) of survivors indicated they were likely to use the Internet for accessing information, with the percentage much lower (69/251, 28%) for accessing support via the Internet. Likelihood of using the Internet for support was associated with feeling anxious and being employed. Conclusions While the Internet appears to offer promise in increasing equitable access to information and support for cancer survivors for both metropolitan and regional areas, it is viewed less favorably for support and by particular subgroups (eg, older people and those without a university degree) within the survivor population. Promoting greater understanding of this mode of support may be required to achieve its potential. Information and support options other than Web-based approaches may continue to be needed by vulnerable groups of cancer survivors.
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Affiliation(s)
- Christine Louise Paul
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
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Beckjord EB, Arora NK, Bellizzi K, Hamilton AS, Rowland JH. Sexual Well-Being Among Survivors of Non-Hodgkin Lymphoma. Oncol Nurs Forum 2011; 38:E351-9. [DOI: 10.1188/11.onf.e351-e359] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zebrack BJ. Psychological, social, and behavioral issues for young adults with cancer. Cancer 2011; 117:2289-94. [DOI: 10.1002/cncr.26056] [Citation(s) in RCA: 315] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, Porter LS, Dombeck CB, Weinfurt KP. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology 2011; 21:594-601. [PMID: 21394821 DOI: 10.1002/pon.1947] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/29/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We studied patients' experiences with oncology providers regarding communication about sexual issues during and after treatment for cancer. METHODS During development of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) Sexual Function measure, we collected focus group and survey data on communication with oncology professionals about sexual problems. We conducted 16 focus groups with patients and survivors (n = 109) and analyzed the discussions for major themes, including experiences discussing sex during oncology visits. During testing of the PROMIS Sexual Function measure, we assessed experiences discussing sexual problems with oncology professionals (n = 819) and measured bivariate associations between asking for information from clinicians and sexual function and satisfaction with sex life. RESULTS Most patients and survivors (74%) thought that discussions with oncology professionals about sexual problems were important, but whether they had ever received information about sexual function from a provider varied by cancer type (23% lung, 29% breast, 39% colorectal, and 79% prostate). Those who had asked an oncology professional about sexual problems had significantly greater interest in sexual activity as well as more sexual dysfunction. CONCLUSIONS Sexual problems are a widespread concern among patients and survivors, but there is much variation in experiences of communication about sexual issues, and many patients do not receive the information they need from their oncology providers. There are large differences in sexual function between patients who do and do not ask providers about sexual problems. Sexual health has yet to be fully integrated into oncology care, even for cancers involving sex organs.
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Affiliation(s)
- Kathryn E Flynn
- Duke Clinical Research Institute, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27715, USA.
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Arden-Close E, Eiser C, Pacey A. Sexual functioning in male survivors of lymphoma: a systematic review (CME). J Sex Med 2011; 8:1833-41. [PMID: 21324087 DOI: 10.1111/j.1743-6109.2011.02209.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The lymphomas (Hodgkin's lymphoma [HL] and non-Hodgkin's lymphoma [NHL]) are among the most common cancers affecting men under 45 years. Survival rates are now excellent, but treatment is associated with a number of side effects including sexual dysfunction with potential implications for compromised quality of life (QoL). AIMS To address the (i) prevalence of sexual dysfunction among lymphoma survivors relative to the general population, survivors of other cancers, and in survivors of HL and NHL; and (ii) relationships between sexual functioning and disease and treatment, demographic, and psychological variables. METHODS Inclusion criteria were quantitative studies that focused on adult male survivors of lymphoma and included a comparison group and presented results separately for HL and NHL. Standardized systematic searches were used. Information about design, sample size, age, time since diagnosis, type of treatment, comparison group, measures, and findings were extracted from eligible studies. RESULTS Ten articles met the inclusion criteria, of which, nine included patients with HL only, and one included patients with HL or NHL. Sexual function was compromised relative to the general population, better than testicular cancer survivors, and worse than leukemia survivors. Depression was consistently associated with sexual dysfunction. There was evidence that chemotherapy, relapse, reduced testosterone levels, older age at survey, and worse physical QoL were associated with worse sexual function. CONCLUSIONS Conclusions are limited by methodological issues including lack of utilization of standardized measures of sexual function and longitudinal research. Even so, there is evidence of sexual dysfunction among lymphoma survivors. Clinicians need to be sensitive to these issues. Future longitudinal work is necessary to determine the likelihood of recovery.
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Affiliation(s)
- Emily Arden-Close
- University of Sheffield-Department of Psychology, Sheffield, UK University of Sheffield-School of Medicine and Biomedical Sciences, Academic Unit of Reproductive and Developmental Medicine, Sheffield, UK
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Carpentier MY, Fortenberry JD. Romantic and sexual relationships, body image, and fertility in adolescent and young adult testicular cancer survivors: a review of the literature. J Adolesc Health 2010; 47:115-25. [PMID: 20638003 PMCID: PMC2907366 DOI: 10.1016/j.jadohealth.2010.04.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/17/2010] [Accepted: 04/15/2010] [Indexed: 11/16/2022]
Abstract
This review presents a summary of existing knowledge regarding the effect of testicular cancer along four broad domains, including romantic and sexual relationships, body image, and fertility. A total of 37 studies were reviewed. Of note, most research consists of older adult testicular cancer survivors, with very little research attention afforded to adolescent and young adult survivorship. Relationship status (i.e., partnered versus unpartnered) appears to play an important role as it relates to adjustment outcomes in testicular cancer survivors. In addition, sexual function (and thereby fertility) and body image are also frequently compromised. Implications regarding a lack of developmentally focused research on adolescent and young adult testicular cancer survivorship are discussed, along with recommendations for new research.
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Affiliation(s)
- Melissa Y Carpentier
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Tuinman MA, Hoekstra HJ, Vidrine DJ, Gritz ER, Sleijfer DT, Fleer J, Hoekstra-Weebers JEHM. Sexual function, depressive symptoms and marital status in nonseminoma testicular cancer patients: a longitudinal study. Psychooncology 2010; 19:238-47. [PMID: 19319832 DOI: 10.1002/pon.1560] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
GOAL To longitudinally investigate sexual functioning in testicular cancer patients during the first year, and examine the effect of relationship status (with a partner or single) and depressive symptoms on sexual functioning. PATIENTS AND METHODS 93 testicular cancer patients (39% single) treated in two large referral centers for testicular cancer filled in the International Index of Erectile Function (IIEF) and CES-D after orchiectomy (T1) and 3 (T2) and 12 (T3) months later. RESULTS Orgasmic functioning, overall satisfaction and total sexual functioning decreased between T1 and T2 and increased to an above T1 level at T3. Levels of erectile functioning and intercourse satisfaction were higher at T3 than at T1 and T2. Desire remained stable. Type of treatment did not affect sexual functioning. Singles reported worse sexual functioning at all measurement times than committed patients, and comparable desire. One year after surgery, singles also reported worse sexual functioning on three domains when compared with norms. Depressive symptoms were highest and significantly but weakly related to one domain of sexual functioning at T1, to three domains at T2, and to none at T3. Early depressive symptoms had small to moderate predictive power on sexual functioning at T2, but not at T3. CONCLUSION Sexual functioning, but not desire, fluctuates during the first year after testicular cancer. Type of treatment and depressive symptoms were no risk factors for sexual dysfunction in the longer term. Singles reported more sexual problems than patients in a relationship and norms, they may need more information and guidance concerning their sexuality.
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Affiliation(s)
- Marrit A Tuinman
- Department of Surgical Oncology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Errihani H, Elghissassi I, Mellas N, Belbaraka R, Messmoudi M, Kaikani W. Impact du cancer sur la sexualité : qu’en est-il du patient marocain ? SEXOLOGIES 2010. [DOI: 10.1016/j.sexol.2009.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Errihani H, Elghissassi I, Mellas N, Belbaraka R, Messmoudi M, Kaikani W. Impact of cancer on sexuality: How is the Moroccan patient affected? SEXOLOGIES 2010. [DOI: 10.1016/j.sexol.2009.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sadovsky R, Basson R, Krychman M, Morales AM, Schover L, Wang R, Incrocci L. Cancer and Sexual Problems. J Sex Med 2010; 7:349-73. [DOI: 10.1111/j.1743-6109.2009.01620.x] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kiserud CE, Schover LR, Dahl AA, Fosså A, Bjøro T, Loge JH, Holte H, Yuan Y, Fosså SD. Do male lymphoma survivors have impaired sexual function? J Clin Oncol 2009; 27:6019-26. [PMID: 19858388 DOI: 10.1200/jco.2009.23.2280] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Sexual function in male lymphoma survivors was examined and compared with that of age-matched controls. PATIENTS AND METHODS This cross-sectional study included serum gonadal hormone levels (testosterone, sex hormone-binding globulin, luteinizing hormone [LH], and follicle-stimulating hormone) and responses to questionnaires assessing sexual function (Brief Sexual Function Inventory [BSFI]), socioeconomic factors, quality of life, emotional distress, and fatigue. The lymphoma group included 246 men < or = 50 years old at diagnosis who were diagnosed from 1980 to 2002 and treated at the Norwegian Radium Hospital. For each lymphoma survivor, two age-matched controls (n = 492) were drawn from a normative sample with BSFI scores. RESULTS The lymphoma survivors had a mean age at survey of 47.4 years, the mean duration of follow-up was 14.8 years, and 79% lived in committed relationships. All BSFI domain scores decreased significantly with age. Lymphoma survivors having low testosterone and/or elevated LH had lower BSFI scores than survivors with normal gonadal hormones. Multivariate analyses showed that increasing age, more emotional distress, poor physical health, and low testosterone and/or elevated LH were significantly associated with reduced sexual function within the lymphoma group. Lymphoma survivors had significantly lower BSFI domain scores than did controls on erection, ejaculation, and sexual satisfaction. CONCLUSION Lymphoma survivors had significantly poorer sexual function than normative controls. It is unclear whether the abnormal hormone levels directly cause the reduced sexual function within the lymphoma group or if a mediating factor is involved, such as aging, emotional distress, or perceived health status.
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Affiliation(s)
- Cecilie E Kiserud
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
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Harrison JD, Young JM, Price MA, Butow PN, Solomon MJ. What are the unmet supportive care needs of people with cancer? A systematic review. Support Care Cancer 2009; 17:1117-28. [PMID: 19319577 DOI: 10.1007/s00520-009-0615-5] [Citation(s) in RCA: 606] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 02/02/2009] [Indexed: 11/25/2022]
Affiliation(s)
- James D Harrison
- Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service & School of Public Health, Royal Prince Alfred Hospital, University of Sydney, PO Box M157, Missenden Road, NSW 2050, Sydney, Australia.
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Abstract
OBJECTIVES To understand the unique impact of cancer on the psychosexual development of adolescents and young adults and to identify concrete approaches for broaching the topic of sexuality and sexual function. DATA SOURCES Review and research articles, clinical expertise. CONCLUSION It is critical to address sexual health and fertility issues with young adults as early as the diagnosis to offer the patient an opportunity to ask questions, make true informed decisions, and feel comfortable coming back and inquiring about difficulties he/she has later during treatment or afterwards. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses are often the first health care professionals to identify and address sexuality concerns in oncology treatment settings. By emphasizing the importance of sexuality and intimacy for adolescents and young adults throughout the cancer experience, oncology professionals can be effective change agents in advocating for their patients.
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