Patient-provider communication about sexual concerns in cancer: a systematic review

Abstract

Purpose Cancer survivors’ needs around sexual concerns are often unmet. The primary objective of this systematic review was to examine the prevalence of and factors associated with patient-provider communication about sexual concerns in cancer. Methods Using PRISMA guidelines, we searched PubMed/MEDLINE, PsychInfo, and CINAHL databases for peer-reviewed quantitative research papers (2000–2015) in cancer samples. Search terms across three linked categories were used (sexuality; communication; cancer). The National Comprehensive Cancer Network (NCCN) Sexual Function Guidelines were used as a framework to categorize communication reported in each study. Results Twenty-nine studies from 10 countries (29% in USA) were included. Studies assessed patients only (21), providers only (4), and both (4). Communication measures differed across studies and many lacked validity data. When reported by patients or providers, the average prevalence of discussing potential treatment effects on sexual function was 50% (60% for men; 28% for women) and 88%, respectively. As reported by patients or providers, respectively, assessing patients’ sexual concerns (10% and 21%), and offering treatments (22% and 17%) were measured in fewer studies and were reported less frequently. Both patients and providers (28% and 32%, respectively) reported a low prevalence of other non-specific communication. Greater prevalence of communication was associated with male patient gender and more years of provider experience. Conclusions Sexual issues go unaddressed for many cancer survivors, particularly women. Both patient and provider interventions are needed. Implications for Cancer Survivors Enhancing patient-provider communication about sexual concerns through evidence-based interventions could improve patient sexual function and quality of life.

Sexual Health as Part of Gynecologic Cancer Care: What Do Patients Want?

“…Providers should look beyond age when identifying patients who would most benefit from a discussion about sexual health and consider both sexual activity and partner status. Things I can do to help maintain my sexuality and intimacy 12 (14) 17 (20) Written resources regarding sexuality and intimacy 3 (4) 10 (12) Community resources regarding sexuality and intimacy 2 (2) 4 (5) Other 6 (7) 2 (2) I have never discussed any topics surrounding sexuality or intimacy with my health care team 32 (39) N/A *Percentages do not total 100% because multiple answers were allowed and not all patients provided an answer; the denominator is total patients (83).…”

“…13,14 Additional factors include patient reluctance to ask for help when it is desired, feeling that it is the provider's responsibility to initiate sexual health discussions, and deferral to the provider to choose the topics that are important. 13,14 There is a critical need to better understand the experiences, needs, and preferences of women with gynecologic cancers regarding sexuality and sexual health care. In this study, the current provision of sexual health care is examined, along with patient factors that may be influencing provider decisions to discuss sexuality.…”

Talking about women's sexual health after cancer: Why is it so hard to move the needle?

“…37–43 Yet despite these calls to action, the majority of women experiencing treatment-related sexual dysfunction suffer without help. 44 Although oncology clinicians generally acknowledge the importance of addressing sexual health for women who have been treated for cancer 45,46 and patients say they want their physicians to ask about these concerns, 47,48 communication about sexual health is not part of routine care for most cancer patients and survivors. 44,49 Results of a recent systematic review published in Journal of Cancer Survivorship demonstrate that across different studies and a range of cancer sites, fewer than one third of women with cancer reported receiving information about potential sexual side effects of treatments, compared to twice as many men with cancer who had reported receiving such information.…”

“…44,49 Results of a recent systematic review published in Journal of Cancer Survivorship demonstrate that across different studies and a range of cancer sites, fewer than one third of women with cancer reported receiving information about potential sexual side effects of treatments, compared to twice as many men with cancer who had reported receiving such information. 44 …”

“…For instance, experienced clinicians could deliver clinical approaches which stand out as the most promising for addressing sexual distress and avoidance in women with cancer, including those that use mindfulness-based techniques. These can be delivered in an individual context (e.g., Brotto’s brief mindfulness-based interventions for female sexual dysfunction), 44,69–71 or in a couple-based context, through partnered sensual touching exercises (i.e., Masters and Johnson-style sensate focus exercises). 41–43,51 Experienced sex therapists are also well-versed in educating clients about how to use personal products such as vibrators which can not only enhance physical pleasure, but also promote physical rehabilitation.…”