Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline

Abstract

Purpose The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment. Methods ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience. Recommendations It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .

A brief intervention to enhance breast cancer clinicians' communication about sexual health: Feasibility, acceptability, and preliminary outcomes

“…The life‐extending treatments offered to women with breast cancer often impair sexual function and quality of life (QOL) . Clinical cancer guidelines put forth by the National Comprehensive Cancer Network (NCCN) and the American Society for Clinical Oncology (ASCO) recommend that sexual function be addressed in patients with cancer along with other psychological and physical health issues . Yet, cancer clinicians infrequently raise the topic of sexual health with patients, and fewer than half of women with breast cancer receive any sexual health communication .…”

“…Yet, cancer clinicians infrequently raise the topic of sexual health with patients, and fewer than half of women with breast cancer receive any sexual health communication . Thus, for many women with breast cancer suffering from sexual problems is likely unaddressed . Lack of training is a key barrier contributing to breast cancer clinicians' reluctance to raise the topic of sexual health with patients .…”

Sexuality and cancer: The experience of adolescents and young adults

“…The lasting sexual impact in this cohort seems nuanced and different to that reported in adult or AYA cancer. Identified measures of sexual function, interventions to address needs as survivors mature and further research would be welcomed with this growing population …”

“…The inclusion of treatment‐associated sexual difficulties as core a topic in oncology education programs is a further consideration. To support clinicians there are a growing number of web‐based decision‐making tools and clinical management guidance, including new ASCO sexual health and cancer guidance for adults (≥18 years) . This guidance provides details of evidence‐based interventions (pharmaceutical, psychosocial and psychosexual) available to address sexual issues and also underlines the importance of HCP starting the discussion about sexuality with patients.…”

Pediatric hematology and oncology fellow education in sexual and reproductive health: A survey of fellowship program directors in the United States

“…The diverse SRH care needs of AYAs cannot be adequately met unless the provider workforce is sufficiently educated and prepared. Although national guidelines support the need for patient‐clinician communication about SRH across the cancer care continuum, no data are currently available regarding the current state of SRH training during pediatric hematology and oncology fellowship 9,29,30 . As the mandate to address AYA‐centered patient and survivorship care continues to take hold in oncology care, there is a growing need to ensure that clinicians receive appropriate training to address SRH.…”