Sexuality Should Be Addressed With Cancer Patients

TON - September/October 2014 Vol 7 No 5

Cancer and its treatments affect sexuality, but this is not typically discussed with patients. Patients with cancer are often not forthcoming about sexuality, and nurses and other healthcare practitioners may not be comfortable raising the issue.

“A few simple questions [about sexuality] can improve the quality of life of our patients. You need to ask,” said Anne Katz, RN, PhD, clinical nurse specialist at CancerCare Manitoba in Winnipeg, Canada.

Speaking to an audience at the Oncology Nursing Society (ONS) 39th Annual Congress, Katz cited studies showing that younger nurses and those with less experience tended to be more uncomfortable with raising sexuality as an issue, while nurses who work in outpatient settings tend to be more comfortable and identified fewer barriers; nurses knew that their patients wanted to talk about this, but they were reluctant to do so; and 45% of cancer patients had never discussed sexuality with a healthcare provider.1

For nurses, barriers to communication included:

  1. Lack of knowledge and lack of confidence
  2. Avoidance of sexual assessment and intervention
  3. Conservative attitudes
  4. Fear of embarrassing self
  5. Fear of offending patient
  6. Denial of responsibility (the oncologist thinks it is the nurse’s duty, the nurse thinks it is the social worker’s duty, etc)
  7. Institutional issues
  8. Lack of awareness of guidelines even though ONS and American Society of Clinical Oncology (ASCO) state that discussions about sexuality are an important part of patient care.

“Some providers medicalize their interactions with patients by hiding behind their white coats. They may not bring up sexuality because it is not a life-and-death issue, and they may want to avoid this topic,” Katz noted.

The interval between cancer diagnosis and treatment initiation is an opportunity to prepare patients about what to expect in terms of impact on sexuality. During this interval, nurses can assess how patients view their current sex life and how important sexuality is to them. Unfortunately, studies suggest that most of the time the issue is never brought up.

“We can start with anticipatory guidance, because pretreatment is a teachable moment. Keep this in mind. Their sex lives are not going to get better after treatment,” she said.

Several models for assessment of sexual health exist, including the EX-PLISSIT model2 and the adapted version of the “5 A’s” originally designed to help smoking cessation3: Advise, Ask, Assess, Assist, and Arrange.

Katz gave the following advice to the audience: Raise the issue of sexuality by explaining to the patient that you are concerned about quality of life and sexuality. Reassure patients that there are appropriate resources for them, and educate them about the sexual side effects of treatment. Always record your assessment and intervention in the patient’s chart.

Specific sexual challenges for patients with cancer include communication, arousal, and desire (libido), Katz continued.

“Communication lies at the root of all our relationships. Sexuality may not be discussed often by couples, and single survivors may not be open to disclosing a cancer history to people they are dating. Most couples get into a cycle of behavior about sex—what we call ‘sexual scripts.’ Cancer treatment takes away the reliability and the usual ‘sexual script,’ that is—the repetition of their sexual behavior,” she explained.

Couples whose coping styles are more rigid may be unable to be creative and flexible emotionally and intellectually, so they have a hard time creating new ways of being sexual with each other.

“Cancer takes away spontaneity and requires couples to do things differently,” she explained.

If couples do not communicate about sex, the message is that the subject is taboo, she noted. “In some way, sexuality is where death and dying was 20 years ago.”

Desire is a complex phenomenon, especially in today’s society, where most people have very busy lives with little time for desire to surface. When it does, it may be fleeting. Even though desire is partly dependent on hormones, replacing hormones may not induce desire, especially for women, she said.

“If they ever find a pill to increase desire in women, it will be the best-selling drug ever! Problems with desire are related to assumptions about sexual response cycles. For some people, desire won’t happen spontaneously,” Katz told listeners.

Arousal is less complex, especially for men. Arousal is anatomical, physiological, and psychological. Cancer treatments can affect patients’ arousal. The focus of pharmacologic interventions has been the blood vessels and nerves related to arousal.

Katz emphasized the need for open discussions with patients and including sexuality as part of those discussions. This will go a long way toward preparing them for the sexual side effects of treatment and approaches that can help.

References

  1. Katz A. Sexuality and cancer for the frontline nurse. Presented at: Oncology Nursing Society 39th Annual Congress; May 1-4, 2014; Anaheim, CA.
  2. Taylor B, Davis S. Using the extended PLISSIT model to address sexual healthcare needs. Nurs Stand. 2006;21(11):35-40.
  3. Sanchez Varela V, Zhou ES, Bober SL. Management of sexual problems in cancer patients and survivors. Curr Probl Cancer. 2013;37(6):319-352.

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