The need for reproductive and sexual health discussions with adolescent and young adult cancer patients

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…146 AYA women with cancer have unique contraception needs, and the options are dependent on the type of cancer, its treatment, and treatmentrelated complications. 147 The NCCN Guidelines recommend discussion about the use of contraception before starting therapy. 147 Long-acting reversible contraception (LARC) with intrauterine devices (IUDs) or implantable contraceptives are more effective than short-term contraceptive methods, which include the use of estrogen and progestin with various delivery systems.…”

“…147 The NCCN Guidelines recommend discussion about the use of contraception before starting therapy. 147 Long-acting reversible contraception (LARC) with intrauterine devices (IUDs) or implantable contraceptives are more effective than short-term contraceptive methods, which include the use of estrogen and progestin with various delivery systems. 148 LARC has been shown to be superior to short-acting contraceptives in AYA women.…”

“…208 AYA patients are also vulnerable to sexual and reproductive health complications that should be addressed before, during, and after completion of treatment. 147 Traditional risk-taking behaviors of AYA individuals coupled with a compromised immune system can put AYA patients with cancer and survivors at a greater risk of sexually transmitted infections. See the section on "Contraception During and After Treatment for Cancer" (page 84) for more discussion of appropriate contraception choices for patients with cancer and survivors.…”

Adolescent and Young Adult Cancer: Principles of Care

“…Common fears among ayas with cancer include fear that the body will never return to its original appearance, fear of not being recognized by others, and fear of being mistaken for an individual of the opposite sex 21 . Those fears can result in loss of sex appeal or even a distorted body image, making it difficult for ayas with cancer to reach important relationship milestones such as dating and marriage 22 . It is important to create opportunities for ayas to have open and frank discussions about their emerging sexual identity and practices, including use of contraception, unintended pregnancies, and sexually transmitted infections 22 .…”

“…Changes in physical health because of cancer treatment-including weight changes, hair loss, scarring, infertility, and amputation-not only make ayas with cancer feel different from their peers, but also represent frightening changes that can have an adverse effect on self-esteem and relationships with others 21,22 . Recent research suggests that young women who have limb-sparing surgeries might be most at risk for difficulties with sexual functioning and self-worth and thus should be targeted for intervention 23 .…”