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McDowell L, Gough K, White I, Corry J, Rischin D. Sexual Health, sexuality and sexual intimacy in patients with head and neck cancer - A narrative review. Oral Oncol 2024; 157:106975. [PMID: 39083855 DOI: 10.1016/j.oraloncology.2024.106975] [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] [Received: 03/05/2024] [Revised: 06/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
Sexuality and sexual intimacy are important aspects of cancer survivorship. In head and neck cancer (HNC), concerns around sexual health, sexuality and sexual intimacy are infrequently raised or addressed in standard HNC consultations, either before embarking on treatment or during survivorship. The changing demographic of HNC patients, largely due to the increasing proportion of patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPVOPSCC), has driven renewed interest in some specific survivorship issues, including sexual behaviours and lifestyles, which may account for both the primary mode of HPV transmission and the younger and less comorbid population affected by this disease. While HNC survivors may have many complex needs in the short and longer term, some patients may prioritise preserving sexual function above other more HNC-specific issues, such as swallowing and xerostomia. Beyond HPVOPSCC, there is evidence to suggest that impairment of sexual health is a pervasive survivorship issue across all HNC cancer types, and this narrative review article highlights publications reporting quantitative assessments of sexual health outcomes in HNC patients. There are also limited studies evaluating whether current sexual health models of care are adequate for HNC patients or whether new or adapted models are needed. Future research will also need to define the impact of our treatments on the sexuality and sexual intimacy concerns of specific HNC cohorts with more granularity to enhance pre- and post-treatment counselling.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - June Corry
- Genesis Care St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Shaffer KM, Reese JB, Dressler EV, Glazer JV, Cohn W, Showalter SL, Clayton AH, Danhauer SC, Loch M, Kadi M, Smith C, Weaver KE, Lesser GJ, Ritterband LM. Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial. JMIR Res Protoc 2024; 13:e57781. [PMID: 39159450 DOI: 10.2196/57781] [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] [Received: 02/26/2024] [Revised: 05/15/2024] [Accepted: 06/14/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. OBJECTIVE Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). METHODS Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. RESULTS This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. CONCLUSIONS By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. TRIAL REGISTRATION ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57781.
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Affiliation(s)
- Kelly M Shaffer
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Emily V Dressler
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jillian V Glazer
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Wendy Cohn
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Shayna L Showalter
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Anita H Clayton
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Suzanne C Danhauer
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Michelle Loch
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Mai Kadi
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Caleigh Smith
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kathryn E Weaver
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Glenn J Lesser
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Lee M Ritterband
- University of Virginia School of Medicine, Charlottesville, VA, United States
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Carter J, Pugh SL, Arring N, Littell RD, Page SJ, Rowland Jr. KM, Goodman JR, Razaq W, Siddique S, Borges M, Kachnic LA, Barton DL. NRG-CC004 ancillary data study-exploring the effect of bupropion on sexual desire in female cancer survivors with and without vulvovaginal symptoms. J Sex Med 2024; 21:709-715. [PMID: 38856026 PMCID: PMC11294673 DOI: 10.1093/jsxmed/qdae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/12/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Female cancer survivors often experience estrogen-deprivation symptoms, which may lead to decreases in sexual desire, vulvovaginal health (lubrication, dryness, discomfort), and sexual satisfaction. Interventions are needed to address these concerns. AIM The objective of this secondary analysis was to determine if women with higher (better) scores on the Female Sexual Function Index (FSFI) lubrication and pain subscales reported higher desire scores based on treatment with bupropion vs placebo. METHODS Participants were part of NRG Oncology's NRG-CC004 (NCT03180294), a randomized placebo-controlled clinical trial evaluating bupropion (150 vs 300 mg) to improve sexual desire in survivors of breast or gynecologic cancer. All participants with baseline data from the FSFI lubrication, pain, and desire subscales with 5- and/or 9-week data were analyzed. The FSFI subscale scores were correlated using Spearman correlation coefficients. Logistic regression was used to determine associations between FSFI desire and other FSFI subscales while accounting for treatment arm and other covariates. OUTCOMES The primary outcome of NRG Oncology's NRG-CC004 (NCT03180294) randomized phase II dose-finding trial was change from baseline to 9 weeks on the FSFI desire subscale score. Similar to the parent study, the primary outcome for this ancillary data study was the FSFI desire subscale score at 5 and 9 weeks. RESULTS Overall, 230 participants completed the FSFI at baseline and 189 at 9 weeks. The strongest correlations were between lubrication and pain at baseline (all participants, rho = 0.77; bupropion arms, rho = 0.82), week 5 (all participants, rho = 0.71; bupropion arms, rho = 0.68), and week 9 (all participants, rho = 0.75; bupropion arms, rho = 0.78), and the weakest correlations were between desire and pain. In patients in the treatment arms there were no interactions between lubrication or pain.The impact of various covariates on the FSFI score for desire at 9 weeks demonstrated that participants of non-White race (odds ratio [OR], 0.42; 95% CI, 0.21-0.81; P = .010), with a high lubrication score (OR, 0.36; 95% CI, 0.21-0.61; P = .0002), with a high pain score (less pain) (OR, 0.50; 95% CI, 0.29-0.87; P = .014), or with prior pelvic surgery (OR, 0.38; 95% CI, 0.23-0.63; P = .0002) had lower odds of having low desire. CLINICAL IMPLICATIONS Acute estrogen-deprivation symptoms should be addressed prior to sexual desire intervention. STRENGTHS AND LIMITATIONS This secondary analysis was not powered to examine all variables. CONCLUSION Lubrication and pain were predictors of low desire. Therefore, vulvovaginal atrophy and associated genitourinary symptoms of menopause such as vaginal dryness and dyspareunia should be addressed prior to or in parallel with interventions for sexual desire.
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Affiliation(s)
- Jeanne Carter
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA 19103, United States
| | - Noel Arring
- University of Tennessee, Knoxville, TN 37966, United States
| | | | - Seth J Page
- Cancer Center of Kansas, Wichita, KS 67460, United States
| | | | - Judie R Goodman
- Trinity Health St. Joseph Mercy Oakland, Pontiac, MI 48341, United States
| | - Wajeeha Razaq
- University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
| | | | - Monica Borges
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA 19103, United States
| | - Lisa A Kachnic
- Columbia University Medical Center, New York, NY 10032, United States
| | - Debra L Barton
- University of Tennessee College of Nursing, Knoxville, TN 37996, United States
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Li Y, Zheng M, Na L, Wang M. Association between bladder cancer treatment and female sexual function. Sex Med Rev 2024:qeae051. [PMID: 39059372 DOI: 10.1093/sxmrev/qeae051] [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: 01/10/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Bladder cancer ranks 17th in prevalence of cancer types among women, and the trend is rising. The increased risk of female sexual dysfunction (FSD) after radical cystectomy (RC) underscores the need for greater focus on preserving and mitigating FSD. OBJECTIVES To place greater emphasis on the importance of female sexual function (FSF) in the treatment of bladder cancer and stimulate additional research to discover more effective solutions for enhancing the overall quality of life. METHODS This review used a narrative approach. Previous reviews on FSF after RC have provided limited and 1-sided solutions due to the lack of research. What makes this review unique is its innovative approach: it includes all available measures curing FSD as well as comparative analyses based on experimental data, thus making the findings more comprehensive. A detailed perspective of treatments for female bladder cancer is provided, including nerve- and organ-sparing RC, robot-assisted RC, and radiotherapy. We also analyze the impact of treatments for female bladder cancer on postoperative FSD. Additionally, solutions for addressing or alleviating postoperative FSD are summarized, such as urinary diversion, vaginal reconstruction, and drug and nondrug treatment. RESULTS Research has suggested that robot-assisted nerve- and organ-sparing RC is promising. Moreover, orthotopic neobladder among urinary diversions without a stoma helps to maintain a positive female body image. If part of the anterior vaginal wall must be removed during RC, vaginal reconstruction can restore the dimensions with synthetic grafts and biologic scaffolds. Additionally, postoperative measures, such as vaginal laser and hormone therapy, and use of vaginal dilators and lubricants have a significant role in reducing distress caused by FSD to provide maximum relief. CONCLUSIONS To support FSF after RC, various interventions are needed, and urologists must focus on patient recovery while minimizing treatment impact on FSF as much as possible.
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Affiliation(s)
- Yakui Li
- China Medical University, Shenyang, China
| | - Ming Zheng
- Department of Urology, Liao Yang Liao Hua Hospital
| | - Lei Na
- Department of Urology, Shengjing Hospital of China Medical University
| | - Mingli Wang
- Department of Surgery, Shengjing Hospital of China Medical University
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Demedis J, Reedy J, Miller K, Hu J, Klosky JL, Dorsey Holliman B, Peterson PN, Chow EJ, Studts C. Testing effectiveness and implementation of a standardized approach to sexual dysfunction screening among adolescent and young adult-aged survivors of childhood cancer: A type I hybrid, mixed methods trial protocol. PLoS One 2024; 19:e0305677. [PMID: 39038011 PMCID: PMC11262696 DOI: 10.1371/journal.pone.0305677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Approximately 20-50% of adolescent and young adult-aged childhood cancer survivors (AYA-CCS) experience sexual dysfunction (SD), although this healthcare need is widely underrecognized. Previous research from both AYA-CCS patients and their providers report that SD needs are unaddressed despite patient desires for SD discussions to be incorporated as part of their care. Patients and providers agree that standardized use of a patient-reported outcome measure may facilitate SD discussions; an SD screening approach was developed with patient and provider input. This study will measure the effectiveness of a standardized SD screening intervention and assess implementation outcomes and multilevel barriers and facilitators to guide future research. METHODS This multi-site, mixed methods, type 1 effectiveness-implementation hybrid trial will be evaluated using a pre-post design (NCT05524610). The trial will enroll 86 AYA-CCS (ages 15-39) from two cancer centers in the United States. The SD intervention consists of core fundamental functions with a "menu" of intervention options to allow for flexibility in delivery and tailoring in variable contexts. Effectiveness of the intervention on facilitating SD communication will be measured through patient surveys and clinical data; multivariable logistic regression will be used for the binary outcome of self-reported SD screening, controlling for patient-level predictors. Implementation outcomes will be assessed using mixed methods (electronic health record abstraction, patient and provider surveys, and provider interviews. Quantitative and qualitative findings will be merged using a joint display to understand factors affecting intervention success. IMPLICATIONS Identification and treatment of SD in AYA-CCS is an important and challenging quality of life concern. The type 1 hybrid design will facilitate rapid translation from research to practice by testing the effects of the intervention while simultaneously identifying multilevel barriers and facilitators to real-world implementation. This approach will inform future testing and dissemination of the SD screening intervention.
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Affiliation(s)
- Jenna Demedis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
- Center for Cancer and Blood Disorders at Children’s Hospital Colorado, Aurora, CO, United States of America
| | - Julia Reedy
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kristen Miller
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Junxiao Hu
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - James L. Klosky
- Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Brooke Dorsey Holliman
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Pamela N. Peterson
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- Denver Health Medical Center, Denver, Colorado, United States of America
| | - Eric J. Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Washington, DC, United States of America
| | - Christina Studts
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States of America
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, United States of America
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Liberacka-Dwojak M, Wiłkość-Dębczyńska M, Perkowski R. Breaking the silence: the role of sexual communication on quality of life in women with cervical cancer. Support Care Cancer 2024; 32:503. [PMID: 38985342 PMCID: PMC11236959 DOI: 10.1007/s00520-024-08713-x] [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] [Received: 03/06/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Cervical cancer (CC) and its treatments impact various dimensions of quality of life (QoL), including physical, psychological, and sexual functioning. Sexual health, a crucial QoL aspect, is often compromised, highlighting the necessity for open sexual communication. MATERIALS AND METHODS This study involved 60 women diagnosed with stage IIb-IIIa CC. The 36-Item Short Form Survey (SF-36) was used to measure physical and psychological components of QoL, the Female Sexual Function Index-6 (FSFI-6) to assess its sexual component, and the Sexual Communication Self-Efficacy Scale (SCSES) to diagnose communication confidence. Self-administered questions gauged patient-provider sexual communication. The results include quotes from participants, providing additional insight. RESULTS Sexual communication self-efficacy and patient-provider communication correlated significantly with QoL components. Only 23.33% discussed sexual issues with their doctors. Participants' experiences highlighted the impact of cancer on sexuality and the need for tailored support. DISCUSSION Post-diagnosis psychosexual changes emphasize the importance of communication in renegotiating sexual identity and needs. Effective communication is associated with improved QoL, highlighting the role of healthcare professionals in addressing psychosexual issues. Integrating PLISSIT and BETTER models provides a comprehensive approach to sexual communication in the cancer context. CONCLUSION The study demonstrates the importance of sexual communication self-efficacy in QoL of CC patients and highlights the need for healthcare professionals to include sexual communication education in cancer care.
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Affiliation(s)
| | | | - Radosław Perkowski
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Gorman JR, Corey SL, Ginavan I, Garcia J. "Just for pregnant women, not for you": a qualitative evaluation of the sexual and reproductive healthcare experiences of transgender and gender diverse cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01633-z. [PMID: 38980652 DOI: 10.1007/s11764-024-01633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges. METHODS We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health. RESULTS Themes describing challenges were as follows: (1) Cancer treatment's impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns. CONCLUSIONS TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors' support networks and implementing system-level changes in cancer care settings.
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Affiliation(s)
- Jessica R Gorman
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA.
| | - Stephanie L Corey
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Isabelle Ginavan
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Jonathan Garcia
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
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Sanders JJ, Temin S, Ghoshal A, Alesi ER, Ali ZV, Chauhan C, Cleary JF, Epstein AS, Firn JI, Jones JA, Litzow MR, Lundquist D, Mardones MA, Nipp RD, Rabow MW, Rosa WE, Zimmermann C, Ferrell BR. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol 2024; 42:2336-2357. [PMID: 38748941 DOI: 10.1200/jco.24.00542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. METHODS ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 52 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Arun Ghoshal
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Erin R Alesi
- Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
| | | | | | - James F Cleary
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | | | | | - Michael W Rabow
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Donz R, Russia B, Barbaret C, Braybrook D, Perceau-Chambard E, Reverdy T, Economos G. What contributes to promote sexual health in cancer palliative care? A realist review. Sex Med Rev 2024; 12:334-345. [PMID: 38508856 DOI: 10.1093/sxmrev/qeae008] [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] [Received: 07/29/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored. OBJECTIVES In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care. METHODS A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations. RESULTS Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo. CONCLUSIONS The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.
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Affiliation(s)
- Roxane Donz
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
| | - Bruno Russia
- Hospitalisation à domicile, Centre Léon Bérard, Lyon 69008, France
| | - Cécile Barbaret
- Service de soins palliatifs, CHU de Grenoble, La Tronche 38700, France
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London SE5 9PJ, United-Kingdom
| | - Elise Perceau-Chambard
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Thibaut Reverdy
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
- Oncology Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Guillaume Economos
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
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Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, Banerjee S, Bowen R, Buckley L, Burbos N, Coleridge S, Edmondson R, El-Bahrawy M, Fotopoulou C, Frost J, Ganesan R, George A, Hanna L, Kaur B, Manchanda R, Maxwell H, Michael A, Miles T, Newton C, Nicum S, Ratnavelu N, Ryan N, Sundar S, Vroobel K, Walther A, Wong J, Morrison J. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024. Eur J Obstet Gynecol Reprod Biol 2024; 300:69-123. [PMID: 39002401 DOI: 10.1016/j.ejogrb.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Adrian Andreou
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London NHS Trust, 60 Whitfield Street, London W1T 4E, UK
| | | | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Beverley Counselling & Psychotherapy, 114 Holme Church Lane, Beverley, East Yorkshire HU17 0PY, UK
| | - Nikos Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital Colney Lane, Norwich NR4 7UY, UK
| | | | - Richard Edmondson
- Saint Mary's Hospital, Manchester and University of Manchester, M13 9WL, UK
| | - Mona El-Bahrawy
- Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | - Jonathan Frost
- Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Bath BA1 3NG, UK; University of Exeter, Exeter, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | | | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Baljeet Kaur
- North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London and Barts Health NHS Trust, UK
| | - Hillary Maxwell
- Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX and University of Surrey, School of Biosciences, GU2 7WG, UK
| | - Tracey Miles
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Claire Newton
- Gynaecology Oncology Department, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Shibani Nicum
- Department of Oncology, University College London Cancer Institute, London, UK
| | | | - Neil Ryan
- The Centre for Reproductive Health, Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh BioQuarter City, Edinburgh EH16 4UU, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham and Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, UK
| | - Katherine Vroobel
- Department of Cellular Pathology, Royal Marsden Foundation NHS Trust, London SW3 6JJ, UK
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Jason Wong
- Department of Histopathology, East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - Jo Morrison
- University of Exeter, Exeter, UK; Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
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11
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Demedis J, Reedy J, Miller K, Hu J, Klosky JL, Holliman BD, Peterson PN, Chow EJ, Studts C. Testing effectiveness and implementation of a standardized approach to sexual dysfunction screening among adolescent and young adult-aged survivors of childhood cancer: A type I hybrid, mixed methods trial protocol: Effectiveness of sexual dysfunction screening among AYA cancer survivors: a study protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.05.24308510. [PMID: 38883789 PMCID: PMC11178009 DOI: 10.1101/2024.06.05.24308510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Approximately 20-50% of adolescent and young adult-aged childhood cancer survivors (AYA-CCS) experience sexual dysfunction (SD), although this healthcare need is widely underrecognized. Previous research from both AYA-CCS patients and their providers report that SD needs are unaddressed despite patient desires for SD discussions to be incorporated as part of their care. Patients and providers agree that standardized use of a patient-reported outcome measure may facilitate SD discussions; an SD screening approach was developed with patient and provider input. This study will measure the effectiveness of a standardized SD screening intervention and assess implementation outcomes and multilevel barriers and facilitators to guide future research. Methods This multi-site, mixed methods, type 1 effectiveness-implementation hybrid trial will be evaluated using a pre-post design (NCT05524610). The trial will enroll 86 AYA-CCS (ages 15-39) from two cancer centers in the United States. The SD intervention consists of core fundamental functions with a "menu" of intervention options to allow for flexibility in delivery and tailoring in variable contexts. Effectiveness of the intervention on facilitating SD communication will be measured through patient surveys and clinical data; multivariable logistic regression will be used for the binary outcome of self-reported SD screening, controlling for patient-level predictors. Implementation outcomes will be assessed using mixed methods (electronic health record abstraction, patient and provider surveys, and provider interviews. Quantitative and qualitative findings will be merged using a joint display to understand factors affecting intervention success. Implications Identification and treatment of SD in AYA-CCS is an important and challenging quality of life concern. The type 1 hybrid design will facilitate rapid translation from research to practice by testing the effects of the intervention while simultaneously identifying multilevel barriers and facilitators to real-world implementation. This approach will inform future testing and dissemination of the SD screening intervention.
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Affiliation(s)
- Jenna Demedis
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, CO, USA
| | - Julia Reedy
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristen Miller
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Junxiao Hu
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Brooke Dorsey Holliman
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Colorado, USA
| | - Pamela N Peterson
- Department of Internal Medicine, University of Colorado School of Medicine, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Washington, USA
| | - Christina Studts
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA
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12
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Reese JB, Bober SL, Sorice KA, Handorf E, Chu CS, Middleton D, McIlhenny S, El-Jawahri A. Starting the Conversation: randomized pilot trial of an intervention to promote effective clinical communication about sexual health for gynecologic cancer survivors. J Cancer Surviv 2024; 18:800-809. [PMID: 36604391 PMCID: PMC10323044 DOI: 10.1007/s11764-022-01327-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Gynecologic cancer survivors often hesitate to raise sexual health concerns with their clinicians. We pilot tested Starting the Conversation (STC), a theory-guided intervention aimed at facilitating survivors' clinical communication about sexual health. METHODS Survivors (N = 32) were randomized 2:1 to STC (23-min video and accompanying workbook grounded in social cognitive theory that provides information and skills training for communicating with providers about sexual concerns, and resource guide) or control (resource guide only). Feasibility was assessed through enrollment, retention, and intervention completion rates (benchmarks: 60%, 80%, 70%); acceptability was assessed through post-intervention program evaluations (benchmark: 75%). Preliminary effects were assessed for sexual health communication (self-reported after next clinic encounter), self-efficacy for clinical communication about sexual health (post-intervention and 2-month follow-up), and sexual activity and anxiety/depressive symptoms (2-month follow-up). RESULTS All feasibility/acceptability benchmarks were surpassed; 76% enrolled, 97% retained, ≥ 95% used intervention materials, and 100% endorsed STC as acceptable. Positive STC effects were seen for increases in self-efficacy (Cohen's d's = 0.45 at post-intervention; 0.55 at follow-up). In STC, 35% and 45% of women raised or asked about sexual health concerns during the post-intervention clinic visit, respectively, versus 0 and 27% in the control arm. Other measures showed little change. CONCLUSIONS Data support the STC intervention as feasible and acceptable, with promising effects for gynecologic cancer survivors' communication about sexual health concerns. Because sexual health communication is relevant across the treatment trajectory, we included both on-treatment and post-treatment survivors. While this may be a limitation, it could also enhance sample generalizability. A larger trial is needed to determine efficacy. IMPLICATIONS FOR CANCER SURVIVORS Communication about sexual health is important yet lacking for cancer survivors. Patient-focused interventions may help address concerns and improve survivors' health outcomes.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Christina S Chu
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Danny Middleton
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Sarah McIlhenny
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Areej El-Jawahri
- Department of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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13
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Vitorino CN, Omodei MS, de Souza RC, Nahas GP, de Araujo Brito Buttros D, Carvalho-Pessoa E, Vespoli HDL, Nahas EAP. Assessment of sexual function in postmenopausal breast cancer survivors. Sex Med 2024; 12:qfae035. [PMID: 38948072 PMCID: PMC11212005 DOI: 10.1093/sexmed/qfae035] [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: 02/17/2024] [Revised: 04/27/2024] [Indexed: 07/02/2024] Open
Abstract
Background Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors. Aim The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC. Methods This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70 years of age, with amenorrhea for ≥12 months and sexually active. They were compared with 178 women without BC, matched (±2 years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's t test, chi-square test, and logistic regression (odds ratio [OR]). Outcomes Evaluation of sexual function in postmenopausal women treated for BC. Results Postmenopausal BC survivors showed poorer sexual function in the desire domain (P = .002). No significant differences were observed between groups in the other FSFI domains and total score (P > .05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) (P = .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; P = .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; P = .002). Clinical Implications Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction. Strength and Limitations The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners. Conclusion Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.
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Affiliation(s)
- Caroline Nakano Vitorino
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Michelle Sako Omodei
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Rafaela Caroline de Souza
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Georgia Petri Nahas
- Department of Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Daniel de Araujo Brito Buttros
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Eduardo Carvalho-Pessoa
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
- Department of Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Heloisa De Luca Vespoli
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
- Department of Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
| | - Eliana Aguiar Petri Nahas
- Graduate Program in Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
- Department of Obstetrics and Gynecology, Medical School, São Paulo State University, Botucatu, São Paulo 18618-970, Brazil
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14
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Sun K, Thao Dinh N, Lewin J, Grzeskowiak L, Mariano C, Bailey E, Lazarakis S, Hussainy SY. A Scoping Review of Oncosexology Policy and Practice Tools Focused on Adolescents and Young Adults. J Adolesc Young Adult Oncol 2024; 13:389-443. [PMID: 38563827 DOI: 10.1089/jayao.2023.0145] [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: 04/04/2024] Open
Abstract
Background: Despite being considered a key component of quality-of-life, sexual health concerns in adolescents and young adults (AYA) patients with cancer (aged 15-39 years old) are often unmet due to barriers from both patients and health care professionals (HCPs). Investigation into policy and practice tools in this scope of practice is also limited. Aim: To review the literature on policy and practice tools in AYA oncosexology. Method: A scoping review was conducted using four databases: Medline, EMCARE, EMBASE, and PsycINFO, based on the Joanna Briggs Institute Scoping Review methodology. Retrieved articles were extracted into Covidence, followed by two screening rounds. Descriptive and basic content analyses were performed for evidence synthesis. Results: Seventy-four articles were included after screening rounds and citation searches. Overall, oncosexology policy and practice tools were categorized into screening tools (11 articles), guidelines (38 articles), training programs (15 articles), service delivery initiatives (5 articles), and the evaluation of their feasibility/challenges to implementation (5 articles). Among these, only ten articles were specifically about the AYA population. They helped identify and resolve sexual health concerns in AYA patients with cancer by providing strategies to overcome communication barriers, treatment options, and information resources for patients, and by advocating for more HCP education on this topic. Conclusion: The results warrant the need for more research, implementation and expansion of policy and practice tools for sexual health issues in AYA patients with cancer.
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Affiliation(s)
- Kexin Sun
- The University of Melbourne, Melbourne, Australia
| | - Nhu Thao Dinh
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Jeremy Lewin
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Australia
- ONTrac at Peter Mac, Victorian Adolescent & Young Adult Cancer Service, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Luke Grzeskowiak
- Flinders University and South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chiara Mariano
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Eliza Bailey
- Radiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Australia
| | - Safeera Y Hussainy
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Parkville, Australia
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15
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Lazarus JE, Gupta K. Recurrent UTI in Women-Risk Factors and Management. Infect Dis Clin North Am 2024; 38:325-341. [PMID: 38599896 DOI: 10.1016/j.idc.2024.03.010] [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: 04/12/2024]
Abstract
Urinary tract infections (UTIs) are common in women; more than 50% of women will be diagnosed with a UTI in her lifetime. Many of these women will go on to develop recurrent UTI. Nevertheless, evidence-based prevention of recurrent UTI is under-utilized. Here, the authors provide detailed practical advice on UTI prevention with a thorough review of the evidence. Non-antibiotic prevention measures discussed include increased fluid intake, vaginal estrogen therapy, methenamine, and cranberry. Antibiotic prophyalxis for carefully selected patients is also discussed.
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Affiliation(s)
- Jacob E Lazarus
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, GRJ 512C, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kalpana Gupta
- Harvard Medical School, Boston, MA, USA; Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, Executive Suite, West Roxbury, MA 02132, USA; Boston University School of Medicine, Boston, MA, USA.
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16
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Reese JB, Bauman JR, Sorice KA, Frederick N, Bober SL. Hematology and Oncology Fellow Education About Sexual and Reproductive Health: A Survey of Program Directors in the United States. JCO Oncol Pract 2024; 20:852-860. [PMID: 38320223 DOI: 10.1200/op.23.00499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE Clinical oncology guidelines recommend addressing sexual and reproductive health (SRH) concerns in routine cancer care. However, limited training often hinders clinicians' ability to do so effectively. The objective of this study was to understand the state of current fellowship education on SRH (ie, sexual health, safe sex practices, and fertility) through conducting a national survey of US hematology/oncology fellowship program directors (PDs). METHODS A survey was sent to all PDs of adult hematology/oncology fellowship programs in the United States via online link. PDs who did not complete the survey were sent up to four follow-up emails and a paper mailing. Descriptive statistics and McNemar tests were conducted. RESULTS One hundred-fourteen PDs responded (65%). Fewer programs offered formal instruction on sexual health (49%) and safe sex practices (37%) compared with fertility (75%). Informal training in SRH relied heavily on direct clinical experience (73%-78% of programs), with other methods (eg, case-based approaches, webinars, and journal clubs) being less common. Lack of experts to provide instruction was the most commonly cited barrier to offering training in SRH, endorsed by 74% for sexual health, 68% for safe sex practices, and 54% for fertility; difficulty finding space within the curriculum (50%; 54%; and 43%, respectively) and a lack of training requirements were also commonly endorsed (57%; 60%; and 35%, respectively). Barriers were endorsed more commonly for sexual health topics than fertility. CONCLUSION The results highlight the scarcity of training in SRH, particularly in sexual health, within hematology/oncology fellowship programs. The heavy reliance on informal instruction methods may lead to inconsistent and inadequate education. Efforts to integrate comprehensive training in SRH into fellowship programs are crucial to ensuring that such concerns are included in routine cancer care.
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Affiliation(s)
| | - Jessica R Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Natasha Frederick
- Center for Cancer & Blood Disorders, Connecticut Children's Medical Center, Hartford, CT
- University of Connecticut School of Medicine, Farmington, CT
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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17
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Laguna JC, Tagliamento M, Lambertini M, Hiznay J, Mezquita L. Tackling Non-Small Cell Lung Cancer in Young Adults: From Risk Factors and Genetic Susceptibility to Lung Cancer Profile and Outcomes. Am Soc Clin Oncol Educ Book 2024; 44:e432488. [PMID: 38788188 DOI: 10.1200/edbk_432488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Lung cancer has traditionally been associated with advanced age; however, its increasing incidence among young adults raises concerning questions regarding its etiology and unique considerations for this population. In contrast to the older population, the onset of lung cancer at younger age may be attributed to a complex interplay of incompletely understood individual susceptibility and prevalent environmental risk factors beyond tobacco smoke exposure, such as radon gas and air pollution, which are widespread globally. Consequently, this leads to distinct clinical and molecular profiles, requiring a tailored approach. Furthermore, a diagnosis of cancer represents a threatening event during the prime years of a young person's life, prompting concern about career development, social aspects, fertility aspirations, and physical independence. This poses significant additional challenges for health care professionals in a field that remains underexplored. This comprehensive review recognizes lung cancer in young adults as a distinct entity, exploring its clinical and molecular characteristics, diverse predisposing factors, and priorities in terms of quality of life, with the aim of providing practical support to oncologists and enhancing our understanding of this under-researched population.
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Affiliation(s)
- Juan Carlos Laguna
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Laura Mezquita
- Medical Oncology Department, Hospital Clinic of Barcelona, Barcelona, Spain
- Laboratory of Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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18
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Goldberg C, Greenberg MR, Noveihed A, Agrawal L, Omene C, Toppmeyer D, George MA. Ovarian Suppression: Early Menopause, Late Effects. Curr Oncol Rep 2024; 26:427-438. [PMID: 38305992 DOI: 10.1007/s11912-023-01491-5] [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] [Accepted: 12/11/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE OF REVIEW Pre-menopausal women diagnosed with hormone receptor (HR) breast cancer are candidates for prolonged hypoestrogenism to improve cancer outcomes. However, the disease benefit eclipses the toxicities associated with ovarian function suppression (OFS), which are often under-reported. RECENT FINDINGS Increased risk of mortality from cardiovascular disease, bone disorders, and metabolic disorders is well reported in women with no history of cancer, after surgical oophorectomy or premature ovarian failure. Vasomotor symptoms, urogenital atrophy, weight gain, sexual dysfunction, cognitive decline, and sleep disturbances contribute to the increased non-compliance associated with OFS, especially in younger women. Balancing the toxicities of prolonged OFS with its benefits should be critically analyzed by providers when making recommendations for their patients. Supportive care to manage multi-system toxicities and to counteract the long-term impact on all-cause mortality should be emphasized by every cancer program. Future studies with OFS should incorporate patient outcomes and strategies for symptom management in addition to focusing on improving disease outcomes.
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Affiliation(s)
- Chaya Goldberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | | | - Coral Omene
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Deborah Toppmeyer
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Mridula A George
- Rutgers Cancer Institute of New Jersey, Rutgers, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
- The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA.
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19
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Kim M, Carter J, Tadros AB, Abuhdra N, Nelson JA, Stern CS. A guide for addressing sexual health in breast cancer patients. J Surg Oncol 2024; 129:1034-1040. [PMID: 38385690 DOI: 10.1002/jso.27602] [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] [Received: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Sexual health concerns are common in breast cancer surgery but often overlooked. Yet, breast cancer patients want more sexual health information from their providers. We aimed to share ways for providers to address sexual health concerns with their breast cancer patients at different stages of the treatment process. METHODS Experts in breast cancer treatments, surgeries, and sexual health at Memorial Sloan Kettering Cancer Center assembled to review the literature and to develop the recommendations. RESULTS Providers should provide sexual health information for their breast cancer patients throughout the continuum of care. Conversations should be initiated by the providers and can be brief and informative. Whenever appropriate, patients should be referred to Sexual Medicine experts and/or psychosocial support. There are various recommendations and tools that can be utilized at diagnosis, endocrine and chemotherapy, and breast surgery to identify patients with sexual health concerns and to improve their sexual functioning. CONCLUSION In this paper, we sought to provide providers with some insights, suggestions, and tools to address sexual health concerns. We encourage healthcare providers to initiate the conversation throughout the continuum of care beginning as early as diagnosis and refer patients to additional services if available.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeanne Carter
- Gynecology Service, Department of Psychiatry, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nour Abuhdra
- Breast Oncology, Department of MedicineMemorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Ospina-Serrano AV, Maximiano C, Cantos B, Torrente M, Mendez M, Sanchez JC, Calvo V, Collazo-Lorduy A, Blanco M, Nuñez B, Triana I, Parejo C, Martinez P, Duma N, Provencio-Pulla M. Sexual dysfunction in patients with cancer, a challenge in oncology practice: results of the CLARIFY project. Clin Transl Oncol 2024; 26:1147-1156. [PMID: 37917247 DOI: 10.1007/s12094-023-03332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Sexual dysfunction (SD) associated with oncological treatment is a common and understudied disorder. Our aim was to characterize SD in a cohort of Spanish patients. METHODS Analytic observational study in patients included in the CLARIFY H2020 project at the Hospital Universitario Puerta de Hierro. Clinical variables and validated measures of sexual function were collected from October 2020 to May 2022. Frequency and quality of sexual activity were assessed. Descriptive, trend associations, and logistic regression analyses were performed. RESULTS A total of 383 patients were included: breast cancer 68.14% (261), lung cancer 26.37% (101), and lymphoma 5.50% (21). Mean age was 56.5 years (range 33-88). 19.58% (75) were men and 80.42% (308) were women. 69% and 31% of men and women, respectively, reported being sexually active. The absolute frequency of overall sexual dissatisfaction was 76% in women and 24% in men. Women with breast cancer were most likely to have severe sexual dysfunction. Those with early disease had resolved complaints after 5 years. In multinomial logistic regression, significant associations were found in women with metastatic breast cancer and severe disorders of arousal (p 0.000), lubrication (p 0.002), orgasm (p 0.000), as well as dissatisfaction with sexual performance (p 0.000) and global sexual dissatisfaction (p 0.000). Women with lung cancer have severe arousal dysfunction (p 0.016) and global sexual dissatisfaction (p 0.044). CONCLUSIONS Our population has a high prevalence of SD, which supports the need to increase awareness of this disorder among the medical oncology team and the importance of including sexual health assessment in oncological patient follow-up.
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Affiliation(s)
- Aylen Vanessa Ospina-Serrano
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España.
| | - Constanza Maximiano
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Blanca Cantos
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Maria Torrente
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Miriam Mendez
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Juan Cristobal Sanchez
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Virginia Calvo
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Ana Collazo-Lorduy
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Mariola Blanco
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Beatriz Nuñez
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Ivan Triana
- Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Consuelo Parejo
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Paula Martinez
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
| | - Narjust Duma
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Mariano Provencio-Pulla
- Instituto Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro-Majadahonda, C/Manuel de Falla, 1, 28222, Madrid, Majadahonda, España
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21
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Hanai A, Ishikawa T, Kawauchi S, Iida Y, Kawakami E. Generative artificial intelligence and non-pharmacological bias: an experimental study on cancer patient sexual health communications. BMJ Health Care Inform 2024; 31:e100924. [PMID: 38575326 PMCID: PMC11002430 DOI: 10.1136/bmjhci-2023-100924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/09/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives The objective of this study was to explore the feature of generative artificial intelligence (AI) in asking sexual health among cancer survivors, which are often challenging for patients to discuss.Methods We employed the Generative Pre-trained Transformer-3.5 (GPT) as the generative AI platform and used DocsBot for citation retrieval (June 2023). A structured prompt was devised to generate 100 questions from the AI, based on epidemiological survey data regarding sexual difficulties among cancer survivors. These questions were submitted to Bot1 (standard GPT) and Bot2 (sourced from two clinical guidelines).Results No censorship of sexual expressions or medical terms occurred. Despite the lack of reflection on guideline recommendations, 'consultation' was significantly more prevalent in both bots' responses compared with pharmacological interventions, with ORs of 47.3 (p<0.001) in Bot1 and 97.2 (p<0.001) in Bot2.Discussion Generative AI can serve to provide health information on sensitive topics such as sexual health, despite the potential for policy-restricted content. Responses were biased towards non-pharmacological interventions, which is probably due to a GPT model designed with the 's prohibition policy on replying to medical topics. This shift warrants attention as it could potentially trigger patients' expectations for non-pharmacological interventions.
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Affiliation(s)
- Akiko Hanai
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuo Ishikawa
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Extended Intelligence for Medicine, The Ishii-Ishibashi Laboratory, Keio University School of Medicine, Tokyo, Japan
- Collective Intelligence Research Laboratory, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Shoichiro Kawauchi
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
| | - Yuta Iida
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
| | - Eiryo Kawakami
- Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, Yokohama, Japan
- Department of Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
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22
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Robison K, Kulkarni A, Dizon DS. Sexual Health in Women Affected by Gynecologic or Breast Cancer. Obstet Gynecol 2024; 143:499-514. [PMID: 38207333 DOI: 10.1097/aog.0000000000005506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/29/2023] [Indexed: 01/13/2024]
Abstract
Sexual health problems are prevalent among women affected by gynecologic or breast cancer. It is important to understand the effects cancer treatment can have on sexual health and to have the tools necessary to identify and treat sexual health problems. This Clinical Expert Series discusses practical methods for routinely screening for sexual dysfunction and reviews sexual health treatment options for women affected by cancer. We review the limitations of the current literature in addressing sexual health problems among sexually and gender minoritized communities. Finally, we discuss appropriate timing of referrals to sexual health experts, physical therapists, and sex therapists. Multiple resources available for both patients and clinicians are included.
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Affiliation(s)
- Katina Robison
- Tufts Medical Center, Boston, Massachusetts; Columbia University, New York, New York; and the Lifespan Cancer Institute and Legorreta Cancer Center, Brown University, Providence, Rhode Island
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23
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Demedis J, Reedy J, Chow EJ, Dorsey Holliman B, Peterson PN, Studts CR. Provider perspectives and recommendations on standardized sexual function screening intervention in adolescent/young adult oncology patients. Pediatr Blood Cancer 2024; 71:e30872. [PMID: 38233999 DOI: 10.1002/pbc.30872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Sexual function (SF) concerns are common among adolescent and young adult (AYA) cancer survivors, are underrecognized and undertreated. This study sought AYA oncology provider input on the implementation of an SF screening tool to address this unmet need. PROCEDURE Semi-structured interviews were completed with oncology providers (n = 25) who care for AYAs at a single institution. Interviews sought to understand barriers to addressing SF, elicit perspectives on use of an established screening tool, and obtain recommendations for SF screening intervention development and implementation. Interviews were developed using the Consolidated Framework for Implementation Research (CFIR); thematic analysis-guided interpretation. RESULTS AYA oncology providers were in favor of using an SF screening tool, but confirmed previously identified barriers and implementation considerations within multiple CFIR domains, including concerns about privacy, patient comfort, provider buy-in, provider knowledge, resource needs, and workflow/capacity constraints. They identified numerous strategies to address barriers through screening intervention design and implementation approaches. For example, provider buy-in could be optimized through education, availability of clinical resources, creation of a dedicated sexual healthcare team, provider engagement in intervention development, and leadership involvement. CONCLUSIONS Development and implementation of an effective SF screening intervention is necessary to improve diagnosis and treatment of sexual dysfunction, with the ultimate goal of improving sexual health-related quality of life in AYA cancer survivors. AYA oncology providers identified numerous intervention and implementation design strategies for the development and implementation of an SF screening intervention, which must be integrated with patient recommendations.
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Affiliation(s)
- Jenna Demedis
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julia Reedy
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Washington, USA
| | - Brooke Dorsey Holliman
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pamela N Peterson
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Christina R Studts
- Adult & Child Center for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Cancer and Blood Disorders at Children's Hospital Colorado, Aurora, Colorado, USA
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24
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Hickey M, Basu P, Sassarini J, Stegmann ME, Weiderpass E, Nakawala Chilowa K, Yip CH, Partridge AH, Brennan DJ. Managing menopause after cancer. Lancet 2024; 403:984-996. [PMID: 38458217 DOI: 10.1016/s0140-6736(23)02802-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2023] [Accepted: 12/11/2023] [Indexed: 03/10/2024]
Abstract
Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Partha Basu
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Jenifer Sassarini
- Department of Obstetrics and Gynaecology, School of Gynaecology, University of Glasgow, Glasgow, UK
| | - Mariken E Stegmann
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donal J Brennan
- Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland; Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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25
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Smith M, Kurup S, Devaraja K, Shanawaz S, Reynolds L, Ross J, Bezjak A, Gupta AA, Kassam A. Adapting an Adolescent and Young Adult Program Housed in a Quaternary Cancer Centre to a Regional Cancer Centre: Creating Equitable Access to Developmentally Tailored Support. Curr Oncol 2024; 31:1266-1277. [PMID: 38534928 PMCID: PMC10969112 DOI: 10.3390/curroncol31030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/15/2024] [Accepted: 02/23/2024] [Indexed: 05/26/2024] Open
Abstract
Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality.
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Affiliation(s)
- Marlie Smith
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
- Adolescent and Young Adult Program, Department of Supportive Care, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Simone Kurup
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
| | - Kaviya Devaraja
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
| | - Shaayini Shanawaz
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
| | - Lorrie Reynolds
- Central Regional Cancer Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada;
| | - Jill Ross
- Childhood Cancer Care, Pediatric Oncology Group of Ontario, Toronto, ON M5G 1V2, Canada;
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Abha A. Gupta
- Adolescent and Young Adult Program, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C4, Canada; (M.S.); (K.D.); (S.S.); (A.A.G.)
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Alisha Kassam
- Department of Pediatrics, Southlake Regional Health Centre, Newmarket, ON L3Y 2P9, Canada;
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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26
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Claes M, Tuts L, Robijns J, Mulders K, Van De Werf E, Bulens P, Mebis J. Cancer therapy-related vaginal toxicity: its prevalence and assessment methods-a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01553-y. [PMID: 38383907 DOI: 10.1007/s11764-024-01553-y] [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: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE In 2020, almost 9 million women were diagnosed with cancer worldwide. Despite advancements in cancer treatment strategies, patients still suffer from acute and long-term side effects. This systematic review aims to evaluate the most frequently reported adverse effects in the genitourinary system and compare them across cancer types, treatment modalities, and evaluation methods. METHODS Pubmed Central, SCOPUS, and Cochrane Library were searched following the PRISMA guidelines to identify all prospective and retrospective observational cohort studies and randomized controlled trials assessing vaginal side effects of adult female cancer patients. The study quality was evaluated using The Newcastle-Ottawa Scale or the Risk of Bias 2 tool, as appropriate. RESULTS The most prevalent population was breast cancer patients, followed by gynaecological cancer patients. Overall, the focus was on vaginal dryness, while vaginal stenosis was the primary outcome in gynaecological cancer patients. Significant discrepancies were found in the frequency and severity of the reported adverse events. Most studies in this review evaluated side effects using patient-reported outcome measures (PROMs). CONCLUSIONS Genitourinary syndrome of menopause following cancer treatment is most frequently documented in breast and gynaecological cancer patients, often focussing on vaginal dryness and vaginal stenosis based on PROMs. This review provides a complete overview of the literature, but more high-quality clinical trials are necessary to draw firm conclusions on acute and chronic vaginal toxicity following cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS This review could help improve the current preventive and curative management options for genitourinary complications, thereby increasing the patient's QoL and sexual functioning.
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Affiliation(s)
- Marithé Claes
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
- LCRC, Hasselt, Belgium.
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium.
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium.
| | - L Tuts
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - J Robijns
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - K Mulders
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - E Van De Werf
- LCRC, Hasselt, Belgium
- Dept. Radiation Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Radiation Oncology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
- Dept. Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
| | - P Bulens
- LCRC, Hasselt, Belgium
- Dept. Radiation Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Radiation Oncology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
- Dept. Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
| | - J Mebis
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
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27
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Cherven BO, Demedis J, Frederick NN. Sexual Health in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:717-724. [PMID: 37856773 DOI: 10.1200/jco.23.01390] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/21/2023] Open
Abstract
Sexual health (SH), an integral aspect of overall health and quality of life, can be negatively affected by cancer and cancer treatment. SH is influenced by biological, psychological, social, and cultural factors, and, for adolescents and young adults (AYAs), developmental factors. The AYA population (age 15-39 years) is diverse in terms of psychosexual development, interpersonal relationships, and varying levels of independence, resulting in unique SH needs for this population. AYAs with cancer are particularly vulnerable to unmet SH needs related to contraception and infection prevention, sexual function, body image, and romantic/sexual relationships. Sexual dysfunction during and after cancer treatment is reported by 30%-100% of AYA cancer survivors. Clinical guidelines recommend discussing SH and screening for dysfunction but currently lack specifics regarding psychosexual interventions and strategies for incorporating screening into clinical care. Research and clinical priorities include improved provider-AYA communication regarding SH, standardization of SH measures and screening tools, infrastructure to support the SH needs of AYAs across pediatric and adult clinical environments, and engagement of sexual and gender minority AYAs in research. As the field of SH in cancer evolves, interventions need to be tailored to the developmental needs that are unique to AYAs and address the multidimensional aspects of SH.
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Affiliation(s)
- Brooke O Cherven
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Jenna Demedis
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
- Division of Hematology/Oncology/BMT, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Natasha N Frederick
- Center for Cancer & Blood Disorders, Connecticut Children's, Hartford, CT
- Division of Hematology and Oncology, Department of Pediatrics, University of Connecticut School of Medicine, Mansfield, CT
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28
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Nahshon C, Segev Y, Schmidt M, Lavie O. Attitude of BRCA1/2 mutation carriers towards surgical risk reduction for breast, ovarian and uterine cancer: still much to be done. Int J Gynecol Cancer 2024; 34:260-266. [PMID: 37918957 DOI: 10.1136/ijgc-2023-004801] [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: 11/04/2023] Open
Abstract
OBJECTIVE To study and quantify the attitude of BRCA1/2 mutation carriers towards surgical risk reduction procedures. METHODS This cross-sectional national study was conducted by distribution of an anonymous questionnaire on social media platforms and to BRCA1/2 carriers' medical clinic. RESULTS 530 BRCA1/2 mutation carriers answered the survey. Risk reduction bilateral salpingo-oophorectomy was discussed with 447/489 (91%) of patients and performed in 260/489 (53%). Hormonal replacement therapy was discussed in 280/474 (59%) of patients. Addition of hysterectomy to risk reduction bilateral salpingo-oophorectomy was discussed in 129/481 (27%) of patients and performed in 44/443(10%). Age over 35 years at time of mutation detection was found to be significant in raising risk reduction bilateral salpingo-oophorectomy and hysterectomy performance rates. Risk reduction mastectomy was discussed in 390/471 (83%) of patients and performed in 156/471 (33%). In a multivariate analysis, BRCA1 mutation carriers (OR=1.66 (95% CI 1.07 to 2.57), p=0.024) and a personal cancer history leading to the mutation detection (OR=4.75 (95% CI 1.82 to 12.4), p=0.001) were found to be significant in increasing the likelihood of opting for risk reduction mastectomy. Additionally, highest risk reduction mastectomy performance rates were observed in the group of patients with a first-degree family history of breast cancer under the age of 50 years (OR=1.58 (95% CI 1.07 to 2.32), p=0.01). CONCLUSIONS This study highlights the high performance rates of risk reduction bilateral salpingo-oophorectomy, while hysterectomy was added in 10%, and that despite high awareness and acceptance rates for risk reduction mastectomy, only 33% had the procedure. The data presented provides insights for the clinician counseling BRCA1/2 mutation carriers, with regards to adherence to recommendations, understanding their concerns towards treatment and management alternatives; and finally, to construct a personalized management medical plan.
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Affiliation(s)
- Chen Nahshon
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yakir Segev
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Meirav Schmidt
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Lee-Miller C, Montgomery KE, Evered J, Phelps K, Norslien K, Parkes A, Kwekkeboom K. A Midwest Stakeholder Evaluation of an Adolescent and Young Adult Cancer Survivor Needs Assessment Survey. J Adolesc Young Adult Oncol 2024; 13:123-131. [PMID: 37581596 DOI: 10.1089/jayao.2023.0062] [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: Over 87,000 adolescents and young adults (AYAs) are diagnosed with cancer in the United States each year. Improvement in outcomes in the AYA population has lagged that of both younger and older patients. This decrement may be attributable to several factors, including insufficient supportive care services. Our team modified the Needs Assessment & Service Bridge (NA-SB) tool, utilizing an iterative approach with patient and clinician stakeholders to meet the needs of the AYA population at a large Midwestern Cancer Center. Methods: We recruited a 10-member AYA Advisory Board (AB) from our Cancer Center patients, and met five times over 9 months to discuss supportive care and the NA-SB. We recruited a multidisciplinary group of oncology clinicians to assess content validity and conducted interviews with nine clinician stakeholders to discuss implementation. Results: The AB generated a 59-item-modified NA-SB, retaining most of the original NA-SB items and adding several more. Five items with concerns for relevance and/or clarity were revised to create the final 58-item-modified NA-SB. Priorities for implementation were identified by AB and clinician stakeholders. Conclusions: The modified NA-SB thoroughly reflects supportive care needs of our Midwestern AYA cancer survivors. When implemented, the tool may facilitate patient-care team communication and provide data to prioritize development of new supportive care resources. AYA cancer survivors have unique supportive care needs that are insufficiently addressed by current care models; using the modified NA-SB may help address those needs, leading to improved AYA outcomes.
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Affiliation(s)
- Cathy Lee-Miller
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Jane Evered
- Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kat Phelps
- University of Wisconsin-Madison School of Nursing, Madison, Wisconsin, USA
| | | | - Amanda Parkes
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Franzoi MA, Aupomerol M, Havas J, Soldato D, Lambertini M, Massarotti C, Hang H, Pistilli B, Fasse L, Tredan O, Gillanders E, Joly F, Cottu P, Mouret-Reynier MA, Tarpin C, Arnaud A, Everhard S, Martin AL, Di Meglio A, Vaz-Luis I. Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes. ESMO Open 2024; 9:102236. [PMID: 38350335 PMCID: PMC10937197 DOI: 10.1016/j.esmoop.2024.102236] [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] [Received: 08/07/2023] [Revised: 11/28/2023] [Accepted: 01/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes. METHODS Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics. RESULTS Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified. CONCLUSIONS Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.
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Affiliation(s)
- M A Franzoi
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif.
| | - M Aupomerol
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - J Havas
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - D Soldato
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Gynecology Department, Policlinico San Martino, University of Genova, Genova; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - C Massarotti
- Physiopatology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Health (DiNOGMI department), School of Medicine, University of Genova, Genova, Italy
| | - H Hang
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - B Pistilli
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Fasse
- Interdisciplinary and Patient Pathway Department, Institut Gustave Roussy, Villejuif
| | | | - E Gillanders
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - F Joly
- Centre François Baclesse, Caen
| | | | | | - C Tarpin
- Institut Paoli Calmettes, Marseille
| | | | | | | | - A Di Meglio
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - I Vaz-Luis
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
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Alves M, Durães D, Fonseca I. Addressing Sexual Health in Oncology Patients. ACTA MEDICA PORT 2024; 37:65-66. [PMID: 38183229 DOI: 10.20344/amp.20671] [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] [Received: 09/09/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Margarida Alves
- Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar de Setúbal. Setúbal. Portugal
| | - Diana Durães
- Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar de Setúbal. Setúbal. Portugal
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Stal J, Yi SY, Cohen-Cutler S, Gallagher P, Barzi A, Freyer DR, Kaslander JN, Anto-Ocrah M, Lenz HJ, Miller KA. Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers. Cancer Causes Control 2024; 35:111-120. [PMID: 37597065 PMCID: PMC10764568 DOI: 10.1007/s10552-023-01772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To examine the prevalence of female sexual dysfunction (FSD), male erectile dysfunction (ED), and the prevalence and correlates of sexual health discussions between early-onset CRC survivors and their health care providers. METHODS An online, cross-sectional survey was administered in partnership with a national CRC advocacy organization. Respondents (n = 234; diagnosed < 50 years, 6-36 months from diagnosis/relapse) were colon (36.8%) and rectal (63.3%) cancer survivors (62.5% male). The Female Sexual Function Index (FSFI-6) was used to measure FSD, and the International Index of Erectile Function (IIEF-5) was used to measure ED. Survivors reported whether a doctor communicated with them about sexual issues during/after treatment. RESULTS Among females (n = 87), 81.6% had FSD (mean FSFI-6 score = 14.3 [SD±6.1]). Among males (n = 145), 94.5% had ED (mean IIEF-5 score = 13.6 [SD±3.4]). Overall, 59.4% of males and 45.4% of females reported a sexual health discussion. Among the total sample, older age of diagnosis and relapse were significantly associated with reporting a discussion, while female sex was negatively associated with reporting a sexual health discussion. Among males, older age at diagnosis and relapse, and among females, older age of diagnosis, were significantly associated with reporting a sexual health discussion. CONCLUSION The prevalence of FSD and ED were high (8 in 10 females reporting FSD, almost all males reporting ED), while reported rates of sexual health discussion were suboptimal (half reported discussion). Interventions to increase CRC provider awareness of patients at risk for not being counseled are needed to optimize long-term health outcomes.
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Affiliation(s)
- Julia Stal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA.
| | - Serena Y Yi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA
| | - Sally Cohen-Cutler
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Afsaneh Barzi
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - David R Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jonathan N Kaslander
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA
| | - Martina Anto-Ocrah
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heinz-Josef Lenz
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Morrison J, Baldwin P, Hanna L, Andreou A, Buckley L, Durrant L, Edey K, Faruqi A, Fotopoulou C, Ganesan R, Hillaby K, Taylor A. British Gynaecological Cancer Society (BGCS) vulval cancer guidelines: An update on recommendations for practice 2023. Eur J Obstet Gynecol Reprod Biol 2024; 292:210-238. [PMID: 38043220 DOI: 10.1016/j.ejogrb.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
| | - Peter Baldwin
- Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Adrian Andreou
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Department of Gynae-Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, East Yorkshire HU16 5JQ, UK; Perci Health Ltd, 1 Vincent Square, London SW1P 2PN, UK. https://www.percihealth.com/
| | - Lisa Durrant
- Radiotherapy Department, Beacon Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK
| | - Katharine Edey
- Centre for Women's Health Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
| | - Asma Faruqi
- Department of Cellular Pathology, The Royal London Hospital, Barts Health NHS Trust, London E1 2ES, UK
| | - Christina Fotopoulou
- Department of Cellular Pathology, The Royal London Hospital, Barts Health NHS Trust, London E1 2ES, UK; Gynaecologic Oncology, Imperial College London Faculty of Medicine, London SW7 2DD, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | - Kathryn Hillaby
- Department Gynaecological Oncology, Cheltenham General Hospital, Gloucestershire, Hospitals NHS Foundation Trust, GL53 7AN, UK
| | - Alexandra Taylor
- The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
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Jahan N, Cathcart-Rake E, Vierkant RA, Larson N, Loprinzi C, O'Sullivan CC, Faubion S, Kuhle C, Vencill JA, Couch F, Olson JE, Ruddy KJ. Sexual Dysfunction in Patients With Metastatic Breast Cancer. Clin Breast Cancer 2024; 24:72-78.e4. [PMID: 37867114 DOI: 10.1016/j.clbc.2023.09.018] [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] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Sexual well-being is a key determinant of quality of life. Sexual dysfunction in patients with metastatic breast cancer (MBC) is understudied. PATIENTS AND METHODS Patients were eligible for this study if they participated in the Mayo Clinic Breast Disease Registry (MCBDR), had a diagnosis of de novo MBC, and responded to a question about sexual dysfunction at the baseline MCBDR survey. Participants reported their sexual dysfunction on a scale of 0 (no dysfunction) to 10 (severe dysfunction) at baseline and then annually for 4 years. Participants answered additional sexual symptom questions in years 2 and 4. Associations between patient attributes and the presence and severity of sexual dysfunction, changes in sexual dysfunction from baseline to subsequent surveys, and associations between specific sexual symptoms and severity of sexual dysfunction were assessed. RESULTS One hundred three patients with de novo MBC answered the sexual dysfunction question at baseline. The prevalence of any sexual dysfunction (score of 1-10) was 56.3% at baseline (n = 103), 57.1 % at year 1 (n = 77), 80.4% at year 2 (n = 46), 65.8% at year 3 (n = 38), and 85% at year 4 (n = 20). Vaginal dryness was reported by approximately 49% and 39% of patients in years 2 and 4 respectively. Vaginal dryness was associated with higher severity of sexual dysfunction. CONCLUSIONS Self-reported sexual dysfunction is frequent in women with de novo MBC. Vaginal dryness is a frequently reported treatable symptom associated with higher severity of sexual dysfunction. Clinicians should assess patients with MBC for sexual dysfunction and discuss potential treatment strategies.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology and Oncology, University Alabama at Birmingham, Birmingham, AL
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nicole Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Carol Kuhle
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Kyei KA, Daniels J, Broni R, Anim-Sampong S, Kitson-Mills D, Amoabeng KA, Odey Tackie JN, Obeng-Mensah T, Anoa Scott PA, Owusu AB. The sexuality of women with cervical cancer undergoing definitive radiotherapy in Ghana. Radiography (Lond) 2024; 30:332-339. [PMID: 38128249 DOI: 10.1016/j.radi.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The purpose of this study was to assess the sexuality of cervical cancer patients undergoing radiotherapy at a major cancer treatment center in Ghana. This is an area of interest as globally; cervical cancer kills approximately 342,000 people per annum with an estimated number of 604,000 new cases in 2020. Acknowledging the World Health Organization's definition of sexual health as a state of physical, mental and social well-being in relation to sexuality, this paper sheds light on how these dimensions affect the quality of life of cervical cancer patients. METHODS This was a longitudinal study, which assessed the impact of radiotherapy on the sexuality of both premenopausal and postmenopausal cervical cancer patients presenting for primary treatment with chemoradiation from April to July, 2021 at a major cancer treatment centre in Ghana. The Female Sexual Function Index and Body Image Scale questionnaires were respectively used to evaluate the sexual functions scores among the cervical cancer patients, and to assess the impact of the treatment on their body image. MATLAB software was used for data analysis. RESULTS Most of the cervical cancer patients sampled were postmenopausal (57 %). About 79 % premenopausal and 96 % postmenopausal cervical cancer patients were sexually inactive during radiotherapy (day 15). Also, 48 % premenopausal and 24 % postmenopausal patients were very dissatisfied with their bodies at the onset of treatment. The frequency of orgasm in cervical cancer patients declined after treatment causing a deterioration in their sexual function. The patients' sexuality was influenced by age and menopausal status. The decreased sexual desire of the patients resulted in emotional distancing from their partners, which invariably induced changes in their partners' level of sexual interest. This study established significant differences between premenopausal and postmenopausal cervical cancer patients who were generally very dissatisfied with their sexual relationships with their partners on day 1 (p = 0.02) and on day 15 (p = 0.00) of treatment. CONCLUSION The majority of patients who presented for treatment for cervical cancer in this study were postmenopausal. Their interest in sexual activity was more influenced by their menopausal status than their antineoplastic treatment. This study indicates that cervical cancer patients are more likely to develop sexual health problems which could substantially worsen over the course of their treatment and beyond. IMPLICATION FOR PRACTICE The study will contribute within the oncology team by assisting personnel in putting in place measures that will guide the treatment of cervical cancer patients and improve quality of care.
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Affiliation(s)
- K A Kyei
- Dept. of Radiography, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana; National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - J Daniels
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana.
| | - R Broni
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - S Anim-Sampong
- Dept. of Radiography, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana
| | - D Kitson-Mills
- Dept. of Radiography, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana; National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - K A Amoabeng
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - J N Odey Tackie
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - T Obeng-Mensah
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - P A Anoa Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O. Box KB 369, Korle-Bu, Accra, Ghana
| | - A-B Owusu
- University of Ghana Medical Centre, Legon, Ghana
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Anderson JN, Paladino AJ, Blue R, Dangerfield DT, Eggly S, Martin MY, Schwartzberg LS, Vidal GA, Graetz I. Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer. J Cancer Surviv 2023:10.1007/s11764-023-01511-0. [PMID: 38114711 PMCID: PMC11216545 DOI: 10.1007/s11764-023-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer. METHODS We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis. RESULTS Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust. CONCLUSIONS Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence. IMPLICATIONS FOR CANCER SURVIVORS Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.
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Affiliation(s)
- Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA.
| | - Andrew J Paladino
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38103, USA
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA
| | - Derek T Dangerfield
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW #308, Washington, D.C, 20037, USA
| | - Susan Eggly
- Department of Oncology, School of Medicine, Wayne State University, 87 E. Canfield, Detroit, MI, 48201, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN, 38163, USA
| | | | - Gregory A Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN, 38138, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Ospina Serrano AV. Overview of sexual dysfunction in patients with cancer. Clin Transl Oncol 2023; 25:3369-3377. [PMID: 37633856 DOI: 10.1007/s12094-023-03311-5] [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] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
Among survivor's patients with cancer, sexual dysfunction (SD) is a common treatment-related disturbance that significantly affects their quality of life. The disorder can be a short-term effect, but frequently it can be permanent and patients often do not receive adequate support to overcome the problem. The characteristics of SD may differ depending on the type of neoplasm and oncological treatment. The most common long-term effects are those related to treatment-induced menopause, ablative oncologic surgery, and altered gonadal function. Breast, prostate, and gynecologic cancers are the tumors most commonly associated with disturbances in sexual health, although there is evidence of SD in patients with other types of neoplasms. It is necessary for the healthcare team caring for oncological patients to be aware of the characteristics of sexual dysfunction in this population. This will make it possible to offer patients a comprehensive and personalized approach to improve their quality of life.
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Affiliation(s)
- Aylen Vanessa Ospina Serrano
- Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla 1, 28222, Madrid, Spain.
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Cid M, Gal J, Schiappa R, Azuar AS, Merello M, Delpech Y, Gosset M. Information and oncosexological management in breast cancer patients. Eur J Obstet Gynecol Reprod Biol 2023; 291:252-258. [PMID: 37944213 DOI: 10.1016/j.ejogrb.2023.10.030] [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] [Received: 09/18/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Breast cancer treatment is a particularly high-risk situation for the deterioration of sexual health, leading to an alteration in body image and physical deteriorations such as vaginal trophicity. The aim of this study was to evaluate the information received by patients concerning this alteration of their sexual health in relation to their treatment, and to identify their expectations and needs in terms of oncosexual management. STUDY DESIGN A bicentric qualitative retrospective study was conducted, involving women aged 18 to 80, treated for breast cancer by total or partial mastectomy after 2014 and having had a follow-up consultation between July and December 2019. Data were collected using medical files and a de-identified questionnaire sent by post or e-mail after obtaining consent. The main outcome measures were the proportion of patients who received informations about oncosexology and those who felt impact on their sexual health. RESULTS Of the 274 patients included in the study, 60% said they had received no information about the sexological side effects of their disease or treatment. Of these, 62.5% dared not talk about it during consultation. Patients were keen to receive oncosexological advice or treatment from a specialized nurse or doctor. In 76.1% of cases, patients declared that they had been sexually active in the year prior to their cancer diagnosis, compared with 54.94% after treatment. They reported a loss of femininity in 24% of cases, and 40.5% had no sexual desire. CONCLUSION Women treated for breast cancer report a lasting alteration in their body image and sexual activity. Information on the impact of the disease and its treatment on sexual health is inadequate, even though patients are keen to receive specialized care with professional sexology consultations. The impact of breast cancer on sexual health should systematically explained to the patients, especially as treatment options exist and can be offered.
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Affiliation(s)
- Marie Cid
- Department of Breast and Gynaecological Surgery, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06100 Nice, France
| | - Jocelyn Gal
- Department of Epidemiology, Biostatistics and Health Data, Centre Antoine-Lacassagne, Université Côte d'Azur, 33 avenue de Valombrose, 06100 Nice, France
| | - Renaud Schiappa
- Department of Epidemiology, Biostatistics and Health Data, Centre Antoine-Lacassagne, Université Côte d'Azur, 33 avenue de Valombrose, 06100 Nice, France
| | - Anne-Sophie Azuar
- Department of Gynecology and Obstetrics, Grasse Hospital Center, Chemin de Clavary, 06130 Grasse, France
| | - Marion Merello
- Department of Gynecology and Obstetrics, Grasse Hospital Center, Chemin de Clavary, 06130 Grasse, France
| | - Yann Delpech
- Department of Breast and Gynaecological Surgery, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06100 Nice, France
| | - Marie Gosset
- Department of Breast and Gynaecological Surgery, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06100 Nice, France.
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Arring N, Barton DL, Reese JB. Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors. J Clin Oncol 2023; 41:4927-4936. [PMID: 37535889 PMCID: PMC10617876 DOI: 10.1200/jco.23.00523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice. METHODS A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted. RESULTS Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health. CONCLUSION Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.
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Affiliation(s)
- Noël Arring
- University of Tennessee College of Nursing, Knoxville, TN
| | | | - Jennifer B. Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
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Smith KL, Tsai HL, Lim D, Wang C, Nunes R, Wilkinson MJ, Sheng JY, Couzi R, Fetting J, Riley C, Wolff AC, Santa-Maria CA, Papathakis K, Collins-Chase L, Hilton C, Thorner E, Montanari A, Ikejiani D, Snyder C, Stearns V. Feasibility of Symptom Monitoring During the First Year of Endocrine Therapy for Early Breast Cancer Using Patient-Reported Outcomes Collected via Smartphone App. JCO Oncol Pract 2023; 19:981-989. [PMID: 37733984 DOI: 10.1200/op.23.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/07/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
PURPOSE Treatment-associated symptoms drive early discontinuation of adjuvant endocrine therapy (ET) for breast cancer. We hypothesized that symptom monitoring with electronic patient-reported outcomes (ePROs) during adjuvant ET will enhance symptom detection, symptom management, and persistence. METHODS Eligible patients were initiating ET for stage 0-III breast cancer. Participants completed ePRO surveys via smartphone at baseline and 1, 3, 6, and 12 months. Measures included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Fatigue, and Vaginal Discomfort; plus Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events items assessing joint pain, hot flashes, vaginal dryness, concentration problems, and memory problems. Scores surpassing prespecified thresholds triggered alerts, and recommended symptom management pathways were provided to clinicians. The primary objective was to evaluate feasibility, assessed by survey completion rates, with targets of >65% for the baseline survey and ≥1 follow-up survey during the first 6 months. Secondary objectives included 12-month ET discontinuation rate (target: ≤15%), describing symptoms and evaluating pathway implementation. RESULTS Among 250 participants, 73.2% completed the baseline survey and 69.6% completed ≥1 follow-up survey during the first 6 months. Thirty-one percent of participants had ≥1 symptom alert at baseline and 74% had ≥1 symptom alert during follow-up. The proportions of participants for whom pathway-concordant symptom management was documented at each time point ranged from 12.8% to 36.6%. Twenty-eight participants (11.2%) discontinued ET by 12 months. CONCLUSION Symptom monitoring with ePROs during adjuvant ET is feasible. Despite infrequent documentation of pathway-concordant symptom management after symptom alerts, ePROs were associated with favorable short-term ET persistence.
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Affiliation(s)
- Karen Lisa Smith
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
- AstraZeneca, Gaithersburg, MD
| | - Hua-Ling Tsai
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - David Lim
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Division of Statistics Collaborative Inc, WCG, Washington, DC
| | - Chenguang Wang
- Division of Biostatistics and Bioinformatics, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Regeneron Pharmaceuticals, Tarrytown, NY
| | - Raquel Nunes
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
- AstraZeneca, Gaithersburg, MD
| | - Mary J Wilkinson
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer Y Sheng
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rima Couzi
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Fetting
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol Riley
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Antonio C Wolff
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cesar A Santa-Maria
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katie Papathakis
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Christie Hilton
- Division of Hematology and Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Elissa Thorner
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Montanari
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Claire Snyder
- Johns Hopkins Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vered Stearns
- Sidney Kimmel Comprehensive Cancer Center, Women's Malignancies Disease Group, Johns Hopkins University School of Medicine, Baltimore, MD
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Quarello P, Toss A, Berchialla P, Mascarin M, Lambertini M, Canesi M, Maria Milano G, Incorvaia L, Luigi Banna G, Peccatori F, Ferrari A. Healthcare Professional Communication on Sexual Health: A Report from the Italian Working Group on Adolescents and Young Adults with Cancer. Oncologist 2023; 28:e884-e890. [PMID: 37348061 PMCID: PMC10546817 DOI: 10.1093/oncolo/oyad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Sexual function is an important concern for adolescent and young adult (AYA) with cancer. The aim of this study was to explore the attitude of Italian health care professionals who deal with AYA patients with cancer toward sexual health communication. MATERIALS AND METHODS A 11-question survey was developed by the AIOM (Associazione Italiana di Oncologia Medica) and AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) AYA workgroup and sent to AIOM and AIEOP members. RESULTS The sample comprised 360 respondents, 54.2% AIEOP and 45.8% AIOM members. Eighty percent were physicians, 14.5% nurses, 4.7% psychologists, and 0.8% other professionals. Medical oncologists are more used to investigate about AYA sexual health than pediatric oncologists (58.2% vs. 46.2%), even if pediatrics more frequently refer patients to specific and shared protocol (40% vs. 26.1%). Both AIOM and AIEOP participants mostly talk about sexual health only on request or occasionally (78.8% and 79%, respectively). Clinician-reported barriers to communication identified in this study are lack of preparation and embarrassment for both the categories, plus the presence/interference of parents for pediatrics and lack of time for medical oncologists. Overall, less than 5% of clinicians in our survey received specific training on potential sexual health issues in AYA patients with cancer and only 2% felt adequately prepared to speak about it. CONCLUSION Sexual health is a key component of comprehensive care for AYA with cancer during treatments. This study highlighted the need of Italian providers for specific training and guidelines on sex-related health issues encountered by AYA patients.
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Affiliation(s)
- Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Maurizio Mascarin
- AYA Oncology and Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy
| | - Matteo Lambertini
- Departament of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marta Canesi
- Department of Pediatrics, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Maria Milano
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children Hospital, Roma, Italy
| | - Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences Section of Medical Oncology University of Palermo, Palermo, Italy
| | | | - Fedro Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milano, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Rojas K, Spring LM, O'Riordan L, Weiss A. Endocrine Therapy for Surgeons: Practical Pearls for Managing Menopausal, Bone Loss and Sexual Adverse Effects. Ann Surg Oncol 2023; 30:5951-5961. [PMID: 37495843 DOI: 10.1245/s10434-023-13907-4] [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] [Received: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
Breast cancer patients are living longer than ever before and as such the population of breast cancer survivors continues to grow. Approximately 80% of breast cancers are hormone receptor-positive (HR+) and most patients will receive neoadjuvant or adjuvant estrogen blockade, referred to as endocrine therapy. Although endocrine therapy reduces HR+ breast cancer recurrence by 30-50%, significant adverse effects pose a threat to treatment adherence. These adverse effects include vasomotor symptoms, colloquially referred to as hot flashes, bone loss, joint arthralgias, genitourinary syndrome of menopause (GSM), previously referred to as vaginal atrophy, and low libido. This review will present the evidence-based treatments available for each of these adverse effects, including clear treatment algorithms for GSM, which is often experienced by patients but overlooked by providers. The most important takeaway is to ask open-ended questions, encourage reporting of these symptoms, and refer patients to specialty providers as needed. Surgeons may be the first to encounter these symptoms, therefore it is critical to remain informed of the treatment options.
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Affiliation(s)
- Kristin Rojas
- Dewitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, MUSIC™ Sexual Health After Cancer Program, Miami, FL, USA
| | - Laura M Spring
- Harvard Medical School, Boston, MA, USA
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anna Weiss
- Division of Surgical Oncology, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
- Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
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Li Y, Liu M, Sun Y, Guo D, Li M. Sexual health problems of patients with cancer: A bibliometrics study and visualization analysis via CiteSpace. Heliyon 2023; 9:e20856. [PMID: 37876432 PMCID: PMC10590793 DOI: 10.1016/j.heliyon.2023.e20856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
Purpose This study aimed to conduct a bibliometric analysis of the data acquired and clarified the current research status of sexual health problems in patients with cancer, to provide a comprehensive visual perspective suitable as a reference for subsequent research. Methods We searched the Web of Science Core Collection (WoSCC) up to April 30, 2023 to identify studies associated with sexual health problems in patients with cancer. CiteSpace was used to create visualization networks for countries, institutions, authors, and journals. Results A total of 3183 publications related to sexual health problems in patients with cancer were collected from the WoSCC. In terms of volume, the USA (1259 papers) was the leading country, the Memorial Sloan Kettering Cancer Center (119 papers) was the leading institution, and Carter (39 papers) was the author with the most publications. The top-cited references and keywords were related to quality of life. The top five clusters of reference cocitation were 'brachytherapy', 'prostate cancer', 'radical prostatectomy', 'hypogonadism', and 'breast cancer'. Meanwhile, the top five clusters of keyword cocitation were 'breast cancer', 'prostate cancer', 'rectal cancer', 'testicular cancer', and 'sexual function'. The analysis of the top 25 references and keywords with the strongest citation bursts of published papers on sexual health problems in patients with cancer to reveal the research hotspots and trends. Conclusions Research on sexual health among patients with cancer is constantly developing. The current research focuses on the impact of different treatment options for sexual health and quality of life of patients with breast, rectal, and genitourinary neoplasms. Exploring the long-term changing regularities of sexual function among cancer survivors and formulating sexual health interventions toward patient-reported outcomes and needs are key research directions.
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Affiliation(s)
- Ying Li
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, 300060, China
| | - Mingyue Liu
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, 300060, China
| | - Yanxia Sun
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, 300060, China
| | - Dandan Guo
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, 300060, China
| | - Min Li
- Department of Gynecological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Centre for Cancer, Tianjin, 300060, China
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Silva A, Galica J, Woo K, Luctkar-Flude M. Using simulation to enhance primary care sexual health services for breast cancer survivors: a feasibility study. Support Care Cancer 2023; 31:576. [PMID: 37713111 DOI: 10.1007/s00520-023-08037-2] [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] [Received: 05/10/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To evaluate the impact of a virtual simulation game (VSG) to improve primary care sexual health services for breast cancer survivors. METHODS We developed a VSG to help primary care providers (PCPs) address sexual health disturbances among breast cancer survivors. We used a pretest-posttest design with a series of validated tools to assess the feasibility and perceived impact of the VGS, including an open-ended question about participants' perceptions. Quantitative data was analyzed using descriptive and inferential statistics and qualitative data through an inductive content analysis approach. RESULTS Of the 60 participants, the majority were nurse practitioner students (n = 26; 43.3%), female (n = 48; 80%), and worked full-time (n = 35; 58.3%). Participants perceived the VSG as feasible and potentially effective. The intervention elicited an improvement in PCPs' perception of knowledge between pretest and posttest surveys (z = - 1.998, p = 0.046). Professional background and previous exposure to sexual health training were predictors of knowledge perception. Participants described the intervention as an engaging educational strategy where they felt safe to make mistakes and learn from that. CONCLUSIONS VSGs can be a potentially effective educational approach for PCPs. Our findings indicate that despite being an engaging interactive strategy, VSG interventions should be tailored for each professional group. IMPLICATIONS FOR CANCER SURVIVORS This intervention has potential to improve the knowledge and practice of PCPs related to breast cancer follow-up care to support comprehensive care for survivors, resulting in a better quality of life and patient outcomes.
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Affiliation(s)
- Amina Silva
- School of Nursing, Queen's University, Kingston, ON, Canada.
- Nursing Department, Brock University, St. Catherines, Canada.
| | | | - Kevin Woo
- School of Nursing, Queen's University, Kingston, ON, Canada
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Frederick NN, Lehmann V, Ahler A, Carpenter K, Cherven B, Klosky JL, Nahata L, Quinn GP. Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know. Pediatr Blood Cancer 2023; 70 Suppl 5:e30611. [PMID: 37548483 DOI: 10.1002/pbc.30611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 08/08/2023]
Abstract
Sexual health may be disrupted in adolescents and young adults (AYAs) both during and after cancer treatment, irrespective of whether they are diagnosed in childhood, adolescence, or young adulthood. Unfortunately, oncology providers often underestimate the relevance of psychosexual issues for AYAs and underprioritize sexual health throughout treatment and survivorship. The purpose of this narrative review is to provide information on (a) the etiology of psychosexual dysfunction in childhood, adolescent, and young adult cancer patients and young adult survivors of childhood cancer; (b) strategies for communicating and evaluating potential sexual health issues of AYA patients/survivors; and (c) guidance for the practicing pediatric oncologist on how to address sexual health concerns with patients.
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Affiliation(s)
- Natasha N Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), Department of Sexual Medicine, University of Basel, Basel, Switzerland
| | - Kristen Carpenter
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio
| | - Brooke Cherven
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
| | - James L Klosky
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Atlanta, Georgia
| | - Leena Nahata
- Department of Pediatrics, Endocrinology and Center for Biobehavioral Health, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Gwendolyn P Quinn
- Departments of OB-GYN, Population Health, Center for Medical Ethics, School of Medicine, New York University, New York, New York
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Johannessen MS, Miaskowski C, Kleven AG, Ritchie CS, Paul SM, Grov EK, Hareide M, Gaudernack H, Utne I. Age-related differences in the occurrence, severity, and distress of symptoms in older patients at the initiation of chemotherapy. BMC Geriatr 2023; 23:481. [PMID: 37558973 PMCID: PMC10413597 DOI: 10.1186/s12877-023-04198-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Evaluate for differences in occurrence, severity, and distress ratings for 32 symptoms between younger older adults (YOA, < 70 years) and older adults (OA, ≥ 70 years) at initiation of chemotherapy. METHODS Patients (n = 125) were recruited prior to the initiation of chemotherapy and completed the Memorial Symptom Assessment Scale. Differences in occurrence, severity, and distress ratings were evaluated using Independent sample t-tests and Chi-square or Fisher's exact tests. RESULTS On average, the older patients reported ten concurrent symptoms that equates with a moderate symptom burden. Symptoms with the highest occurrence rates were not always the most severe and/or the most distressing. Few age-related differences were found in patients' symptom experiences. When age-related differences were identified, OA reported lower occurrence, severity, and distress ratings. Nine of the ten symptoms with highest occurrence rates were common for both age groups. For severity and distress, only half of the symptoms were common. In terms of severity and distress, all of the top ten ranked symptoms were in the moderate to severe range. CONCLUSIONS Both YOA and OA reported a moderate symptom burden and severity and distress scores in the moderate to severe range. The symptoms with the highest occurrence rates were not always the most severe/or the most distressing. Our findings suggest that different dimensions of the symptom experience (i.e., occurrence, severity, and distress) warrant evaluation in older oncology patients.
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Affiliation(s)
- Marlen Sunde Johannessen
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | | | - Anne Grethe Kleven
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Ellen Karine Grov
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Martine Hareide
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Henrik Gaudernack
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway
| | - Inger Utne
- Department of Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Pilestredet 32, 0166, Oslo, Norway.
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Cucinella L, Tiranini L, Cassani C, Martella S, Nappi RE. Genitourinary Syndrome of Menopause in Breast Cancer Survivors: Current Perspectives on the Role of Laser Therapy. Int J Womens Health 2023; 15:1261-1282. [PMID: 37576184 PMCID: PMC10422970 DOI: 10.2147/ijwh.s414509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Genitourinary syndrome of menopause (GSM) is a frequent consequence of iatrogenic menopause or anti-estrogenic adjuvant therapies in breast cancer survivors (BCSs). GSM may profoundly affect sexual health and quality of life, and a multidimensional unique model of care is needed to address the burden of this chronic heterogeneous condition. Severe symptoms may be insufficiently managed with non-hormonal traditional treatments, such as moisturizers and lubricants, recommended as the first-line approach by current guidelines, because concerns exist around the use of vaginal estrogens, particularly in women on aromatase inhibitors (AIs). Vaginal laser therapy has emerged as a promising alternative in women with GSM who are not suitable or do not respond to hormonal management, or are not willing to use pharmacological strategies. We aim to systematically review current evidence about vaginal laser efficacy and safety in BCSs and to highlight gaps in the literature. We analyzed results from 20 studies, including over 700 BCSs treated with either CO2 or erbium laser, with quite heterogeneous primary outcomes and duration of follow up (4 weeks-24 months). Although evidence for laser efficacy in BCSs comes mostly from single-arm prospective studies, with only one randomized double-blind sham-controlled trial for CO2 laser and one randomized comparative trial of erbium laser and hyaluronic acid, available data are reassuring in the short term and indicate effectiveness of both CO2 and erbium lasers on the most common GSM symptoms. However, further studies are mandatory to establish long-term efficacy and safety in menopausal women, including BCSs.
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Affiliation(s)
- Laura Cucinella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, IRCCS San Matteo Foundation, Pavia, Italy
| | - Silvia Martella
- Unit of Preventive Gynecology, IRCCS European Institute of Oncology, Milan, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Bramati P, Dai J, Urbauer DL, Bruera E. Attitudes of Palliative Care Specialists Toward Assessing Sexual Dysfunction in Patients With Cancer. J Pain Symptom Manage 2023; 66:e185-e188. [PMID: 37146890 DOI: 10.1016/j.jpainsymman.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/07/2023]
Abstract
CONTEXT The sexual health of patients is frequently neglected. OBJECTIVES To evaluate the attitudes and beliefs of palliative care providers toward discussing the presence of sexual dysfunction (SD) in patients with cancer METHODS: In this pilot study, an anonymous survey was conducted among palliative care professionals about their attitudes toward discussing SD RESULTS: Forty-nine (89%) palliative care providers completed the survey. Thirty-four (69%) responded that they rarely or never discussed sexuality with their patients and most believed it is the oncologist's responsibility. The top reasons for not discussing SD were that the patient did not raise the issue, lack of time and the presence of a third party. The majority acknowledged the need of more training and that printed materials would be helpful. CONCLUSION Palliative care providers infrequently address the presence of SD among patients with cancer. Additional training and routine screening for SD might help addressing this problem.
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Affiliation(s)
- Patricia Bramati
- Department of Palliative Care, Rehabilitation and Integrative Medicine (P.B., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Jianliang Dai
- Department of Biostatistics (J.D., D.L.U.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana L Urbauer
- Department of Biostatistics (J.D., D.L.U.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine (P.B., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Lustberg MB, Kuderer NM, Desai A, Bergerot C, Lyman GH. Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship. Nat Rev Clin Oncol 2023; 20:527-542. [PMID: 37231127 PMCID: PMC10211308 DOI: 10.1038/s41571-023-00776-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.
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Affiliation(s)
- Maryam B Lustberg
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Aakash Desai
- Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cristiane Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Brazil
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
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Frederick NN, Lehmann V, Ahler A, Carpenter K, Cherven B, Klosky JL, Nahata L, Quinn GP. Psychosexual functioning in cancer survivorship: What the pediatric oncologist needs to know. Pediatr Blood Cancer 2023; 70:e28437. [PMID: 34873822 PMCID: PMC9167888 DOI: 10.1002/pbc.28437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
Sexual health may be disrupted in adolescents and young adults (AYAs) both during and after cancer treatment, irrespective of whether they are diagnosed in childhood, adolescence, or young adulthood. Unfortunately, oncology providers often underestimate the relevance of psychosexual issues for AYAs and underprioritize sexual health throughout treatment and survivorship. The purpose of this narrative review is to provide information on (a) the etiology of psychosexual dysfunction in childhood, adolescent, and young adult cancer patients and young adult survivors of childhood cancer; (b) strategies for communicating and evaluating potential sexual health issues of AYA patients/survivors; and (c) guidance for the practicing pediatric oncologist on how to address sexual health concerns with patients.
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Affiliation(s)
- Natasha N. Frederick
- Department of Pediatrics and the Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center, University of Connecticut School of Medicine
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), Department of Sexual Medicine, University of Basel
| | - Kristen Carpenter
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH
| | - Brooke Cherven
- Department of Pediatrics, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - James L. Klosky
- Department of Pediatrics, Emory University School of Medicine & Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Leena Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Endocrinology and Center for Biobehavioral Health, Nationwide Children’s Hospital
| | - Gwendolyn P. Quinn
- Departments of OB-GYN, Population Health, Center for Medical Ethics, School of Medicine, New York University
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