Intimacy issues: sexuality, fertility, and relationships

Motivations for cancer history disclosure among young adult cancer survivors

PURPOSE

To gain an in-depth understanding of the motivations for cancer history disclosure and/or non-disclosure among young adult cancer survivors.

METHODS

Using a constructivist grounded theory approach, semi-structured telephone interviews were conducted with breast and testicular cancer survivors diagnosed between the ages of 18 and 39 from across Canada.

FINDINGS

Twenty-eight young adult cancer survivors (16 female; 12 male) participated in this study. Analysis of the interviews revealed two basic motivational systems for disclosure at play: approach-focused motivations geared towards a positive outcome (desire for understanding, acceptance, support and to promote cancer awareness) and avoidance-focused motivations which are geared towards avoiding a negative outcome (fear of discrimination/stigmatization, unwanted attention, pity, loss of privacy, and rejection). Those exhibiting approach-focused motivations were more likely to disclose than those expressing avoidance-focused motivations. Participants also described a series of situational/contextual factors (social/cultural context, relevance, situation/timing, person disclosing, audience/confidant, and time passed since cancer diagnosis) which had the potential to change or influence the disclosure decision despite overarching motivations to disclose or not.

IMPLICATIONS FOR CANCER SURVIVORS

Gaining a better understanding of the cancer history disclosure decision processes of young adult cancer survivors can help them to better adapt and socially reintegrate back into their pre-cancer lives after the completion of treatment. Acknowledging and understanding the disclosure decision process and communication challenges faced by young cancer survivors can also be beneficial to healthcare professionals in the development and provision of better support interventions and informational resources to help improve psychosocial well-being after cancer.

Health-care professionals' perspective on discussing sexual issues in adult patients after haematopoietic cell transplantation

The majority of adult patients have sexual concerns after post-haematopoietic cell transplantation. Even so, health-care professionals (HCP) do not routinely discuss these problems. We, therefore, surveyed all the members of the European Society for Blood and Marrow Transplantation to evaluate the barriers and facilitators to discussing sexual issues. The 73-item web-survey was completed by 166 registered nurses (RNs) and 126 medical doctors (MDs). Sixty-eight percent reported that they seldom discussed sexual issues. Younger MDs (p < 0.001) and those who work in non-western European countries (p = 0.003), RNs with probably less sexual education themselves (p = 0.002), MDs and RNs who have limited knowledge about sexual complications (p < 0.001) and MDs and RNs who feel uncomfortable discussing sexual issues (p < 0.001) are all less likely to discuss these matters. The major perceived barriers were that patients might be embarrassed if sexual issues were discussed in the presence of a relative (60% RNs, 67% MDs) and that professionals prefer patients to raise sexual issues themselves (54% RNs, 44% MDs). The most important perceived facilitator was for the patient to initiate discussion (≥ 90% for RNs and MDs). Overall, haematopoietic cell transplantation survivors may not be receiving the support on sexual issues they probably need.

Adolescent and Young Adult (AYA) Oncology in the United States: A Specialty in Its Late Adolescence

Over the last 30 years, it has become apparent that oncology patients ages 15 to 39 have not reaped the same rewards of improved survival that we have seen in younger and older patients. As a result, in 2006 the Adolescent and Young Adult (AYA) Oncology Progress Review Group convened and examined the factors that impact the care of the 70,000 new cases per year (approximately 7% of all new cases) in the United States and published their findings. The reasons for inferior survival gains are of course multiple and include the settings in which patients are cared for, clinical trial enrollment, insurance coverage, varied treatment of sarcomas, varied treatment of acute lymphoblastic leukemia, the psychosocial impact of cancer and cancer survivorship. A new area of a yet-to-be completely defined subspecialty was born out of this meeting: AYA oncology. As a medical community we realized that these patients do not fit neatly into the pediatric nor adult world and, therefore, require a unique approach which many individuals, oncology centers, advocacy groups, and cooperative trial groups have started to address. This group of dedicated providers and advocates has made strides but there is still much work to be done on the local, national, and international level to make up for shortcomings in the medical system and improve outcomes. We review key components of AYA cancer care in 2015 that all providers should be aware of, how far we have come, where this movement is headed, and the obstacles that continue to stand in the way of better cure rates and quality of life after cure for this unique group of patients. Like an adolescent maturing into adulthood, this movement has learned from the past and is focused on moving into the future to achieve its goals.

Development and psychometric evaluation of a sexual health care knowledge scale for oncology nurses

OBJECTIVE

The purpose of this study was to develop a sexual health care knowledge scale for oncology nurses and to evaluate its psychometric properties using Rasch analysis and the known-groups technique.

BACKGROUND

Although sexual oncology has become a popular topic and sexual health care is now promoted, there has been a lack of instruments supported by psychometric evaluations to measure nurses' knowledge of sexual health issues.

METHODS

The initial 72 items were compiled to form the Sexual Health Care Scale - Knowledge (SHCS-K) for oncology nurses using a literature review and analysis of existing research tools. After a specialist panel verified content validity, the questionnaire was shortened to 58 items. The data were analyzed using a Rasch model to investigate the items with respect to unidimensionality of fit and difficulty and reliability distribution. Discriminant validity was examined using the known-groups technique.

RESULTS

Two items did not fit with the Rasch model. Person and item separation-index ratios were 3.33 and 9.45, respectively, which confirmed that the SHCS-K functioned well. The reliability was good, at 0.99. Significant differences in marital status, levels of education, and participation in SHC training were observed between groups. The final version of the questionnaire consisted of 55 items, with a total score range of 0-55.

CONCLUSIONS

The SHCS-K was found to be a valid and reliable measure for evaluating levels of sexual health care knowledge among this sample of oncology nurses.

Female fertility: a conceptual and dimensional analysis

INTRODUCTION

Female fertility is commonly described as the biological nature of women, yet different meanings emerge when one takes a holistic approach to fertility while considering varying contexts and perspectives. An improved understanding of female fertility will enhance health care professionals' understanding of female fertility and improve communication with women and other health care professionals. This article presents a conceptual and dimensional analysis of female fertility.

METHODS

A search of the literature included the databases CINAHL, PsycINFO, Philosopher's Index, and Web of Science. Concept and dimensional analyses were performed using the Rogers' methodology and the Caron and Bowers' framework to define female fertility and explore the concept. Articles were examined to identify definitions, dimensions, perspectives, antecedents, and consequences of female fertility.

RESULTS

Biological self, psychosexual self, power, and paradox are the attributes of female fertility. The contexts of menarche, menstruation, menopause, infertility, fertility goals, society and culture, and health care were explored. Perspectives included those of women across many different fertility stages as well as perspectives of various clinicians. Necessary antecedents were sexual decision making and influences of culture and society. Consequences were realized fertility, stress, and an understanding of self. A definition of fertility was proposed: Female fertility is a paradoxical phenomenon of power between the biological and psychosexual self.

DISCUSSION

Antecedents, attributes, and consequences derived from the fertility literature can be used by health care providers for patient education and therapeutic interventions. This concept analysis may assist in facilitation of a greater understanding of biological and psychosexual self, as they relate to fertility across the lifespan.

Psychosocial Care of Adolescent and Young Adult Patients With Cancer and Survivors

The delivery of quality care for adolescent and young adult (AYA) patients with cancer and survivors requires an understanding of the unique qualities of this group—the shared norms, attitudes, and beliefs that determine their behavior as well as the unique stresses they face on a day-to-day basis. All AYAs have typical concerns about being comfortable with who they are and who they want to become (identity development, including sexual identity), their bodies (body image), initiating intimate and emotional relationships, separating from parents, and making independent decisions about future goals such as career, higher education, and/or family (autonomy). Yet efforts of AYA patients with cancer and survivors to mature are often confounded by restrictions and limitations placed on them by their disease and treatment. This article promotes understanding of psychosocial challenges faced by AYAs when diagnosed with and treated for cancer. It reviews evidence-based psychosocial support interventions for AYAs with cancer and other life-threatening or chronic diseases, particularly the positive effects of peer support, technology-based interventions, and skill-based interventions. The article concludes with recommendations for clinical care that are intended to promote the ability of AYAs to cope with cancer.

Using a positive self-talk intervention to enhance coping skills in breast cancer survivors: lessons from a community-based group delivery model

PURPOSE

Cancer survivorship is a distinct phase of the cancer continuum, and it can have myriad associated stresses and challenges. The purpose of the present study was to evaluate the effectiveness of a positive self-talk (pst) intervention in enhancing the coping skills and improving the psychological well-being of breast cancer survivors.

METHODS

Participants (n = 38) were recruited from 5 support groups in a small eastern Canadian province. Support groups were randomly assigned to either a control (n = 18) or an intervention (n = 20) condition. Intervention participants were pre-tested, received a 2-hour pst in-person group workshop and a 10-minute "booster" session by telephone, and completed post-test questionnaires 1 month later.

RESULTS

Intervention participants reviewed the workshop favourably. Nearly all participants used the intervention in everyday life, were able to accurately describe how pst works, and found that pst had a considerable impact on their ability to cope with cancer and related sequelae. However, the descriptive findings from the workshop evaluation did not translate into significant differences between the intervention and control groups on the psychometric measures.

CONCLUSIONS

The pst intervention, delivered in a community group model, was positively received and effective in teaching participants about pst and how pst can be used to enhance coping skills for breast cancer patients. However, the intervention did not promote significantly greater levels of change in anxiety, depression, mood disturbance, or coping ability for intervention participants. The unique challenges of community-level psychological intervention are explored.

Development of a Sexual Health Care Scale-Practice (SHCS-P) for Oncology Nursing Care

PURPOSE

The purpose of this study was to develop and validate the Sexual Health Care Scale-Practice (SHCS-P) for oncology nurses to use in nursing care.

METHODS

Apreliminary version of the SHCS-P of 32 items was developed based on the literature and opinion of experts. A panel of eight experts reviewed the preliminary questionnaire for content validity and consolidated the instrument, which was, then, tested with data from 342 oncology nurses in Korea.

RESULTS

Exploratory factor analysis showed that the SHCS-P explained 70.49% of the total variance. The instrument revealed four factors that were named: (1) Practice for sexual function (8 items), (2) Practice for psychological factors (6 items), (3) Practice for social problems and records (4 items), and (4) Practice for reproductive care (3 items). Internal consistency was good, asassessed by the KR 20 value of 0.91. The coefficients for the sub-factors were between 0.81 and 0.93.

CONCLUSION

This scale shows validity and reliability in evaluating the practice of oncology nurses in providing sexual health care and can be used to evaluate the level of practice well as test effects of educational interventions to improve sexual health care competency.

Nurses' knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

BACKGROUND

The experience of living with cancer is associated with a variety of consequences in several central aspects of a patient's quality of life, including intimacy, body image, human relationships, sexuality, and fertility. Despite their importance, incidence, and impact on psychosocial well-being, sexual health care (SHC) is a matter not frequently dealt with by nurses in daily practice.

GOALS OF WORK

The purpose of this study was to gather evidence regarding knowledge, attitudes, and behaviors of oncology nurses toward sexual health issues and to identify salient and latent key factors which influence provision of SHC in the context of cancer.

MATERIALS AND METHODS

A critical review of the literature was conducted over a period of three decades and 18 original research articles were retrieved and analyzed.

RESULTS

A comprehensive data analysis revealed that, although oncology nurses hold relatively liberal attitudes and recognize provision of sexual health care as an important nursing role, they possess limited sexual knowledge and communication skills, while often avoid or fail to effectively respond to patients' sexual concerns. Nine possible influential key factors have been studied: incorrect assumptions toward sexual issues, comfort, sexual knowledge, professional nursing role, patient- and nurse-related issues, work environment-related issues, continuing education activities, and society-related factors. Conflicting findings are reported.

CONCLUSIONS

The findings of the present study propose that there is an evident need of dispelling the myths about sexual health in cancer care. Besides, continuing education activities and availability of education materials could assist nurses to adequately address sexual concerns while caring for patients with cancer.

Alterations of sexual function in women with cancer

OBJECTIVES

To provide an overview of the alterations in sexuality and sexual function that occur in women with cancer.

DATA SOURCES

Research and review articles, books, clinical experience.

CONCLUSIONS

Although initial concerns of women with cancer may not focus on sexuality issues, most women want support in dealing with body changes. Cancer and cancer treatment for women can result in changes in sexuality and sexual function that may or may not improve over time. Sexual assessment can provide the basis for various approaches to intervention.

IMPLICATIONS FOR NURSING PRACTICE

Sexual assessment is an essential part of nursing practice across the trajectory of cancer. With this information, nurses can plan interventions tailored to address these important alterations in the lives of women with cancer.

Parental knowledge of fertility in male childhood cancer survivors

BACKGROUND

In childhood, cancer survivors fertility is a major point of concern. In boys, only semen analysis and impregnation confirm fertility. Since parents constitute a major source of information for children, we investigated recall and assumptions on their child's fertility.

PROCEDURE

One hundred and fifty-nine families with a boy surviving from cancer were asked for recall and expectations on fertility.

RESULTS

Fifty-two percent of parents recalled statements on fertility, in 36% this was not so, 12% did not remember. There were no differences for parental gender and age at diagnosis. In case of intensive treatment parents were better informed. After relapse parents were less informed. Nine percent of the parents expected infertility, 60% was uncertain, 31% expected normal fertility.

CONCLUSIONS

Based on our and literature findings we conclude that only about half of the parents recalls information on fertility. Lack of information, despite written information, is probably caused by limited oral information provision and defective memorization. One-third of the parents assumed a normal fertility in their sons. It is highly recommended to check whether parents are adequately informed on fertility at moments they have coped the problems and emotions at initial diagnosis or at relapse, and if needed repeat the information.

Intimacy and sexuality after cancer: a critical review of the literature

Experiencing a diagnosis of cancer may dramatically alter the way a person feels about themselves, their body, and their significant relationships with others at sexual and intimate levels. The purpose of this article is to provide a critical analysis of the way patient sexuality and intimacy has been constructed throughout cancer and palliative care literature. A critique of 3 well-cited communication frameworks for health professionals: the PLISSIT, ALARM, and BETTER models, will be offered. In summary, a dominant emphasis throughout the literature explores the narrow relationship between cancer treatments and the impact of those treatments on patient sexual function or dysfunction, so that patient sexuality and intimacy are inextricably limited to fertility, contraception, menopausal, erectile functional, or capacity for intercourse. Few studies explore sexual or intimate issues that have arisen in the face of life-threatening illness, particularly when patients are older than 65 years. Despite being well cited during the past 30 years, the PLISSIT and ALARM counseling models are outdated in terms of more reflective, patient-centered, and negotiated forms of communication promoted throughout clinical practice guidelines and patient feedback in qualitative research. The BETTER communication model provides a significant step in assessing and documenting the patient's experience of sexuality after cancer.

Discussions Regarding Sperm Banking With Adolescent and Young Adult Males Who Have Cancer

With improved survival rates among cancer patients, attention to fertility preservation is of paramount importance. An open-ended survey was used to question oncology and reproductive health nurses regarding their interactions with male adolescents and young adults with cancer about sperm banking. Four main areas of interest were identified: (a) key staff need to be identified to initiate discussions about sperm banking, (b) most staff felt unprepared for these discussions, (c) staff education was needed, and (d) provision of educational materials would benefit both staff and patients. The use of sperm banking, as part of the treatment protocol for adolescent and young adult males with cancer, requires the expertise and cooperation of a multidisciplinary team of experts from both oncology and fertility. Because nurses are the primary contacts with patients, nurses' role in promoting the discussion around sperm banking is crucial.

Long-term psychosocial support for families of children who have undergone allogeneic stem cell transplant

Stem cell transplant (SCT) in children has a continuing impact in the lives of the SCT recipients and their families. This realization has led to extended psychosocial support to these families. The aim of this study was to evaluate the extended psychosocial support. How many families accepted the proffered contact with the social worker and what kind of support did the families ask for? The data were collected from the patients' medical charts by the health care social worker. Content analysis was used as the research method. The study reveals a need for continued psychosocial support lasting many years after treatment. The need for support does not lessen with the passage of time, but the nature of the support changes.

Sexuality assessment: 10 strategies for improvement

Although nurses are aware that assessing sexuality, diagnosing sexuality problems, and evaluating outcomes of interventions to address patients' sexuality concerns are part of holistic care, they often do not perform sexuality assessment in practice. Understanding sexuality as patients' perceptions of body image, family roles and functions, relationships, and sexual function can help nurses improve assessment and diagnosis of actual or potential alterations in sexuality. In addition, nurses should increase their knowledge and understanding of sexuality, identify available information and resources, apply practice standards, and develop a skill set to incorporate sexuality questions routinely in clinical assessments. This article provides 10 strategies to help address and validate patients' sexuality experiences and quality-of-life concerns. By promoting sexual health, nurses can help patients regain a sense of normalcy after cancer diagnosis and treatment. Holistic care is provided when nurses acknowledge the importance of sexuality in patients' lives.

Altered sexual health and quality of life in women prior to hematopoietic cell transplantation

The purpose of this cross-sectional descriptive study is to define sexual dysfunction and menopausal symptoms in women following cytotoxic or immunosuppressive medication for the treatment of malignant or life-threatening hematolymphoid diseases. These women were preparing to undergo hematopoietic cell transplantation (HCT) as the next step in their treatment plan. It is assumed that sexual dysfunction and symptoms of premature menopause are more pronounced post-HCT due to the intensity of the preparative regimen on the hypothalamic-pituitary-gonadal axis. This study included 48 pre-menopausal women and 28 spouses/partners. Data were collected using five self-report instruments (demographic and medical, the Female Sexual Function Index, the Menopause-specific Quality of Life, the Psychosocial Adaptation to Illness Scale, and a global quality of life score). The main research variables were female sexual functioning, symptoms of menopause, and quality of life. The findings indicate that 73% of women report decreased libido and 48% report dissatisfaction with their overall sex life. Hot flashes, the most common symptom of menopause are reported by 46% and 27% report the hot flashes moderate to severe in intensity. Vaginal dryness was reported by 35% with 23% reporting the vaginal dryness to be moderate to severe. The mean quality of life (QOL) score in women was 69+/-25 with a range of 2-100 (on a scale of 0-100 with 100 being an excellent QOL). The findings indicate that women treated with standard dose chemotherapy and immunosuppressive therapy for malignant and life-threatening hematolymphoid diseases experience alterations in sexual health and symptoms of premature menopause. The results show that the desire, arousal, and orgasm phase of the sexual response cycle are altered. Additionally, nearly half of the women are experiencing hot flashes, the most common symptom of menopause and over a third report vaginal dryness. There are statistically significant correlations between altered sexual health, menopausal symptoms, and QOL scores.

Constructions of sexuality and intimacy after cancer: Patient and health professional perspectives

With an increasing emphasis on the provision of psychosocial support for patients in cancer and palliative care, an emerging body of literature has highlighted the importance of providing the opportunity for patients to discuss issues of intimacy and sexuality with their health professionals. Very little is known about why health professionals struggle with this level of communication in clinical practice. The aim of this paper is to discuss constructions of intimacy and sexuality in cancer and palliative care from patient and health professional perspectives. A three stage reflexive inquiry was used to systematically and critically analyse data from semi-structured interviews (n=82), a textual analysis of 33 national and international clinical practice guidelines and participant feedback at 15 forums where preliminary research findings were presented to patients and health professionals in cancer and palliative care. The study was conducted across one public teaching hospital in Australia from 2002 to 2005. Data were further analysed drawing upon the work of Giddens on reflexivity, intimacy and sexuality, to reveal that the majority of health professionals embraced a less reflexive, more medicalised approach about patient issues of intimacy and sexuality after cancer. This was in stark contrast to the expectations of patients. Cancer had interrupted their sense of self, including how they experienced changes to intimate and sexual aspects of their lives, irrespective of their age, gender, culture, type of cancer or partnership status. Key findings from this project reveal incongruence between the way patients and health professionals constructed sexuality and intimacy. Structures which govern cancer and palliative care settings perpetrated the disparity and made it difficult for health professionals to regard patients as people with sexual and intimate needs or to express their own vulnerability when communicating about these issues in the clinical practice setting. A degree of reflexivity about personal and professional constructions of sexuality and intimacy was required for health professionals to confidently challenge these dominant forces and engage in the type of communication patients were seeking.

Radiation Therapy in the Treatment of Breast Cancer

OBJECTIVES

To explore the advancements in radiation therapy for patients with breast cancer. To review the side effects associated with radiation therapy to the breast.

DATA SOURCES

Medical and nursing journals and texts.

CONCLUSION

Advances in technology and a shift in the paradigm used to treat breast cancer are leading to newer and accelerated methods of treatment. APBI has gained increased attention and is the subject of numerous clinical trials.

IMPLICATIONS FOR NURSING PRACTICE

Nurses must be aware of the technical aspects associated with new technology and the rationale and implications associated with its use. The focus for nurses working in radiation therapy continues to be patient education and side effect management. Nurses must understand the ramifications such treatment entails so as to provide optimal care.

Effectiveness of sperm banking in adolescents and young adults with cancer

BACKGROUND

Improving success in the treatment of cancer has resulted in an increasing number of survivors. An important quality of life issue among younger survivors is the ability to have a family. Current gonadotoxic treatments for cancer pose a challenge to future fertility. Preservation of fertility after gonadotoxic therapy is an important consideration for these patients. In a regional center, the authors evaluated efficacy and utilization of sperm banking for preservation of male fertility in adolescents and young adults (AYA) with cancer.

METHODS

A retrospective chart review was conducted to obtain data on clinical features, andrology, and fertility from patients (ages < 30 years) who cryopreserved samples of semen from 1995-2005.

RESULTS

Of 821 newly diagnosed male AYA cancer patients, aged 14-30 years, only 146 (17.8%) used sperm cryopreservation technology. Patients who used their cryopreserved semen for attempted conception had a 36.4% success rate with intrauterine insemination (IUI) and a 50.0% clinical pregnancy rate with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

CONCLUSIONS

Sperm cryopreservation by AYA males with cancer is an efficacious method for preserving future fertility. Awareness and employment of assisted reproductive technologies needs to be implemented by an interdisciplinary team of experts caring for these patients and can result in successful paternity in males after treatment for cancer.

Medical and nursing education and training opportunities to improve survivorship care

Improving the quality of care for cancer survivors is contingent on having physicians, nurses, and other professionals with adequate training in survivorship care. Previous literature has documented the deficiencies in existing formal education programs regarding the complex needs of this growing population. Continuing education programs and basic curricula need to incorporate the expanding body of knowledge regarding the physiologic and psychosocial sequelae of survivorship. This article reviews the current status of survivorship education and provides direction for essential content in future education. Topics such as prevention of secondary cancers, long-term complications, rehabilitation services, quality-of-life issues, pain and symptom management, and treatment of recurrent cancer are critical competencies of education that should then become routine care for cancer survivors.

Nurse practice issues regarding sperm banking in adolescent male cancer patients

The impressive increase in the survival rate of childhood cancer patients has produced increased interest in quality of life issues. This research addresses nurse practice issues in determining whether the newly diagnosed adolescent male patient is offered the option of sperm banking before undergoing chemotherapy treatment. Questionnaires were distributed to nurses and nurse practitioners on 3 inpatient and outpatient units who care for adolescent male cancer patients at the time of diagnosis, during chemotherapy, and during follow-up care. Findings indicate that 96.3% of respondents agreed that all male patients undergoing cancer treatment with infertility as a potential side effect should be offered sperm banking. Respondents viewed oncologists and nurse practitioners as appropriate professionals to discuss the option. Lack of knowledge regarding sperm banking could be limiting nurses' willingness to introduce the topic, and education regarding cryopreservation may improve their knowledge and practice.

The politics of heterosexuality--a missing discourse in cancer nursing literature on sexuality: a discussion paper

In this article, a critique of cancer nursing literature on the issue of sexuality is presented, with particular reference to literature on cancers common to women. The paper begins with an account of two competing perspectives on sexuality. The first is a version of sexuality rooted in sexology, underpinned by biomedical science that makes a claim to having identified 'normal' sexuality. The second is a version of sexuality developed within feminist scholarship that tends to reject biological determinism as a basis for understanding sexuality, instead favouring constructionist perspectives, with the socio-political context of sexual relations problematised. The focus of the article then shifts to cancer nursing literature on sexuality that deals primarily with cancers common to women, to appraise the extent to which either of the above perspectives on sexuality is invoked. Within this body of nursing knowledge, I argue that there has largely been an uncritical endorsement of biomedical constructions of sexuality, rooted in orthodox sexology, with a dominant focus on sexual functioning and on sexual rehabilitation for women with cancer. Moreover, in this knowledge base, phallocentric heterosexuality over and above other forms of sexual expression is privileged, and the socio-political context of unequal gender power relations is largely excluded. References to the social sphere as a dimension of nursing care are focused almost exclusively on maintaining normality, and reflect the emphasis on functional restoration. The largely individualistic, uncritical and biocentric emphasis in this literature may serve inadvertently to reinforce and maintain existing gender inequalities in heterosexual relationships. Finally, I consider the difficulties for oncology nurses in dealing with contradictory truth claims or conventional wisdoms about sexuality from the disparate disciplines of which holism is comprised.

Advocacy skills training for young adult cancer survivors: the Young Adult Survivors Conference at Camp Māk-a-Dream

GOALS OF THE WORK

This manuscript reports on the design, implementation, and evaluation of the Young Adult Survivor Conference (YASC)-a 4-day retreat designed to provide an educational and support experience for cancer survivors diagnosed as children, adolescents, and young adults. The goals of the program were to address issues of survivorship, provide cancer education and tools for self-advocacy, and build bridges of support among young adult cancer survivors who may be experiencing similar journeys through life.

THE PROGRAM

YASC was designed to offer advocacy skills specific to participants' needs. Workshops focused on understanding late effects, mentoring and communication, tips for starting peer support programs and networks, and opportunities for offering public testimony and involvement in public policy.

EVALUATION

Program evaluation indicated that participants achieved personal goals and expectations for having fun, meeting other survivors, understanding more about their cancer and potential late effects, and learning about how to tell their story so that it will help others.

CONCLUSIONS

Involvement with peers who have shared a similar experience provided participants an opportunity to address areas of concern such as coping with uncertainty, dependency vs autonomy, social exclusion, body image, intimacy, sexuality and fertility, and career options. Participation in programs such as the YASC offers young survivors opportunities for life experiences that may promote successful achievement of age-appropriate developmental tasks.

Sexuality as an aspect of nursing care for women receiving chemotherapy for breast cancer in an Irish context

In this article, findings are presented from a study that aimed to explore the perceptions and experiences of a sample of nurses in addressing sexuality as an aspect of care for women receiving chemotherapy for breast cancer. A sample of 10 oncology nurses was selected from oncology units at three hospitals in Ireland, and each participant was interviewed in depth. A qualitative strategy was employed to analyse data. Findings indicated that participants tended to construct sexuality in broad terms, and were well aware of the effects of chemotherapy on a person's sexuality. In addition, they considered sexuality education to be a legitimate and important aspect of their role. However, they also revealed that they avoided addressing sexuality with patients, or encountered structural obstacles in doing so. Some participants expressed anger and frustration when discussing barriers to incorporating sexuality into their practice. A strong theme in data was participants' perceptions that they were not adequately prepared in either pre- or post-registration programmes to incorporate sexuality as a dimension of patient care, although post-registration programmes were more likely to furnish them with knowledge about sexuality. Finally, participants' views on sexuality care are considered in the context of Irish culture which until recently was dominated by Catholic Church teachings.

Informational and emotional needs of long-term survivors of breast cancer

AIMS

This paper presents a review of the informational and emotional needs of long-term breast cancer survivors, with particular attention to the different needs of women according to their age and to critiquing healthcare provision to these women.

BACKGROUND

Women with a history of breast cancer are the largest group of cancer survivors. While they may be disease-free, their cancer diagnosis has ongoing physical and psychosocial implications for their lives and well-being.

METHODS

A literature search for the period 1985 to March 2004 was undertaken using the CINAHL, MEDLINE, CANCERLIT, PubMed and CUIDEN databases and the keywords long-term, breast cancer survivors, needs and social support. Hand-searching was also done, and reference lists of papers were examined for relevant studies.

RESULTS

Survivors of breast cancer continue to experience informational and emotional needs during their long-term survivorship, and variation in the amount and type of support required is age-related. However, women's needs are often unmet by oncology teams and they have to find other sources of support, such as self-help groups. Thus, ongoing care is required after completion of medical treatment, and nurses have a significant contribution to make here.

CONCLUSIONS

Nursing research on long-term breast cancer survivorship is limited. Future studies need to investigate the unmet needs of long-term survivors of breast cancer and, specifically, explore the kind of support women would like to receive from oncology teams, and particularly from breast cancer nurses.

Fertility issues for young adult survivors of childhood cancer

BACKGROUND

The effects of cancer and its treatment on reproduction and fertility are well-documented, yet knowledge of the psychosocial and behavioral ramifications of these outcomes for young adult survivors of childhood cancer is limited. As a qualitative exploratory study, this work identifies concerns, attitudes, and behaviors that may be associated with childhood cancer survivors' reproductive capacity.

PROCEDURE

As part of a semi-structured interview assessing the impact of cancer on long-term survivors' quality of life, a convenience sample of 32 childhood cancer survivors between the ages of 19-37 and at least five years beyond diagnosis were asked if they had physical limitations as a result of their cancer or treatment, and if having cancer has affected their ability to have children.

RESULTS

These data are organized around two major themes: (1) survivors' reproductive capacity and (2) their attitudes, experiences and concerns about children and parenting. Fifty-nine percent of survivors reported that they are uncertain about their fertility status, and half recall a parent or health care provider ever mentioning potential reproductive problems associated with their past cancer treatment.

CONCLUSIONS

While some survivors profess to know nothing about their risks for infertility, others possess and recall information that influences their personal relationships, their beliefs about having children, and possibly subsequent decisions and behaviors with regard to having children.