Sexual functioning among young adult cancer patients: A 2‐year longitudinal study

Background Adolescent and young adult patients with cancer (AYAs) identify sexual and reproductive health (SRH) as an important but often neglected aspect of their comprehensive cancer care. The purpose of this study was to explore AYA perceptions and experiences of SRH communication with oncology clinicians. Methods Twenty‐three AYA patients and survivors ages 15‐25 years from a large academic oncology center participated in semistructured qualitative interviews investigating their experiences discussing SRH issues, including specific topics discussed, conversation barriers and facilitators, suggestions for clinicians on how to improve conversations, and education and resource needs. Interviews were audio recorded, transcribed, and coded using a thematic analysis approach. Results Interviews with AYAs revealed two primary themes—a need for oncology clinicians to discuss SRH and critical gaps in current SRH communication practices. AYAs reported a need for improved SRH communication for the purposes of general education, addressing specific SRH issues experienced, and understanding the long‐term impact of cancer and treatment on SRH. The current communication gaps are exacerbated by patient discomfort initiating conversations and the presence of family members. AYAs shared six key recommendations for clinicians on how to improve SRH communication. Conclusions AYAs identify a role for oncology clinicians in discussing SRH as a primary aspect of comprehensive health care during cancer treatment and in survivorship; however, multiple gaps and barriers interfere with such discussions. Future efforts must focus on clinician education and training in SRH as well as education and intervention opportunities for AYAs to optimize the care provided.

Section: Discussionmentioning

confidence: 99%

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients

Frederick

Revette

Michaud

et al. 2019

“…Additional strategies may include utilization of psychosocial assessment tools developed to target SRH issues which research shows increases patient‐clinician communication and decreases risk‐taking behaviors 37 . Notably, a fellow curriculum should include the AYAs’ increased risk for sexual dysfunction during and after cancer treatment as recent research demonstrates problems with sexual function often do not resolve after treatment completion 3,25,27,38,39 . Given the physical and emotional implications of sexual dysfunction, oncology clinicians would benefit from education on sexual health assessment, including strategies for early detection of problems and appropriate referrals for those at risk.…”

Section: Discussionmentioning

confidence: 99%

“…AYA cancer survivors also face increased risk for sexual dysfunction during and after treatment 22‐24 . Upward of 30% of childhood cancer survivors experience sexual problems after treatment, and sexual dysfunction generally does not self‐resolve or improve over time without intervention 25‐27 . Pediatric oncology clinicians often underestimate the relevance of psychosexual issues among AYAs and do not discuss SRH through disease treatment and survivorship 28 …”

Section: Introductionmentioning

confidence: 99%

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

Frederick

Fine

Michaud

et al. 2020

Purpose Pediatric oncology clinicians identify a need for increased sexual and reproductive health (SRH) education with adolescent and young adult (AYA) cancer patients. By surveying pediatric oncology fellowship directors, this study clarifies the state of current fellowship education about SRH for the AYA patient. Methods A survey was sent to all pediatric oncology fellowship program directors (PDs) in the United States consisting of 13 questions pertaining to three primary SRH domains: sexual health, fertility, and safe sex practices. Descriptive statistics and χ2 were used in data analyses. Results Sixty‐three PDs responded to the survey (91% response rate). Of these, 88% reported having formal instruction regarding fertility, 41% reported curriculum regarding contraception and 30% reported some education regarding sexual health. The curriculum “being too full” was identified as a barrier to education on fertility (29%), sexual health (40%), and safe sex practices (38%). Not being a required or expected part of the program was more likely to be endorsed as a barrier for sexual health (26%) and safe sex practices (30%) compared with fertility (8%) (P < 0.005). Lack of experts to teach was a more frequently endorsed barrier to education on sexual health (47%) compared with either fertility (23%) or safe sex practices (25%) (P < 0.005). Conclusions This study identifies important gaps in oncology fellow education about SRH. Future research must explore optimal education strategies that are feasible and acceptable by PDs and fellow learners, and effective in optimizing AYA SRH care.

“…The AYA‐Health Outcomes and Patient Experience (AYA HOPE) cohort study reported the prevalence of sexual problems to be 49% and 43%, within 1 and 2 years after diagnosis, respectively . Likewise Acquati et al found over 50% of study participants reported sexual dysfunction at three measured time points (<4 , 6, and 24 months) from diagnosis.…”

Section: The Impact Of Cancer On Adolescents’ and Young Adults’ Sexuamentioning

confidence: 98%

“…Despite sexuality being integral to psychosocial health and identity formation, the impact of cancer on AYA's sexual function has been largely overlooked, with the aim to cure, treatment and symptom management understandably taking priority . Though research suggests AYA express concern about sexual functioning, few studies examine this in relation to specific diagnoses. The brief overview in Table and review by Stanton et al .…”

Section: The Impact Of Cancer On Adolescents’ and Young Adults’ Sexuamentioning

confidence: 99%

Sexuality and cancer: The experience of adolescents and young adults

Soanes

White

2018

There are many components affecting the experience of sexuality for adolescents and young adults living with and beyond cancer. For patients, the interruption to normal socialization creates gaps in information and experience that potentially hinder development. In clinical practice, conversations relating to sexual consequences of illness or treatment are rare, as are age-appropriate assessment and intervention. In service design, the collaborative approach of oncofertility has yet to be replicated for sexuality. This paper considers how these obstacles can be overcome through local service development to address unmet need and promote sexual well-being for this group of patients.