madman
Super Moderator
INTRODUCTION
Oncosexology is a relatively new term that refers to a multidisciplinary field addressing sexual issues in patients with cancer .1 Physicians, nurses, psychologists, and other health care providers can all be involved in the field of oncosexology. An oncosexologist can be any of these practitioners who focus on the sexual function of patients with cancer. This discipline has developed out of a need to adequately address sexual concerns in oncology patients. Cancer remains a significant health burden in the United States, with almost 2 million new cases and more than 600,000 cancer deaths anticipated. There is a need for specialists to help cancer survivors and their partners navigate changes to sexuality related to the diagnosis and treatment of cancer.
Monitoring for patient cancer-related distress is an American College of Surgeons cancer hospital accreditation standard in the United States.2 Although this focus on distress is warranted, the follow-through for patients who express distress is suboptimal; only approximately one-third of patients referred for distress symptoms actually obtain the desired assistance. There are many barriers to access, including time restraints, patient beliefs, logistical issues, and variability in insurance/financial issues.2 A proposed model to address this gap in care is to identify distress and patient needs, offer support within the oncology team as appropriate, and/or refer out as needed. The oncology team should then help the patient navigate barriers to care and continue to monitor and address patient distress.2
The management of distress in general needs to be improved in oncology patients. Distress related to sexual issues is a particularly sensitive and important aspect of oncology-related distress. Cancer and its treatments can have a direct and indirect impact on sexual function and satisfaction. The absence of sexual experience can be a source of distress. The sexual expression may also be a form of coping with distressing life circumstances and its absence can compound other forms of cancer-related distress.3
Historically, health care providers have not adequately discussed sexual issues with patients with cancer. This is of major concern, given the significant impact of cancer and cancer treatments on sexual functioning. It is estimated that 40% to 100% of patients with cancer experience perturbations in sexual functioning. Patients with pelvic cancers tend to have greater risks with respect to sexual dysfunctions.4 Despite this, many patients with cancer are not counseled on sexual side effects. A study of nearly 500 patients with colorectal cancer (CRC) found that only 16% of patients said that their medical team discussed sexual concerns with them.5 Among patients with prostate cancer (PCA), few reports being counseled on penile length loss, Peyronie disease (PD), and/ or anejaculation after prostate cancer treatment such as radical prostatectomy (RP).6
Self-identified oncosexologists tend to be more engaged and inquisitive regarding a patient’s experience of sexual distress during or after treatment. However, even among these providers, up to 10% may not address sexual issues with patients. A survey of self-reported oncosexology providers who attended a “Cancer, Sexuality and Fertility” meeting demonstrated that only 90% endorsed discussing sexuality with patients. Almost 7% of these practitioners noted they felt uncomfortable discussing sexual concerns with patients, and most had no experience discussing sexuality with adolescent patients.4
Fortunately, research has shown that training practitioners can improve their handling of oncosexology issues. A review of these interventions evaluated 7 studies that aimed to improve the sexual health knowledge of providers and increase their comfort level with these discussions. Interventions included either face-to-face workshops or lectures or online video-based training. Endpoints were assessed anywhere from 3 weeks to 16 months after the interventions and included self-reported questionnaires that ranged from sexual health knowledge and attitudes to frequency discussing the topic and provider comfort level. Many studies showed that with the training of health care providers, there may be a durable improvement in their knowledge and comfort level regarding sexual concerns. This has the end result of an increase in the frequency with which providers discuss sex with patients.7 Increasing these conversations is vital, as it has been shown to improve sexual function in patients with cancer. Of patients with hematologic cancer status-post stem cell transplantation, those who had been counseled on sexual side effects had fewer sexual problems at 3 years after treatment (r 5 0.43, P 5 .02).8
These data demonstrate a clear need to expand the field of oncosexology and better counsel patients with cancer on the sexual impact of their disease and treatments. Sexual functioning should be discussed to assess baseline symptoms and in the context of the impact of various treatment options.3
*This article discusses sexual issues in male patients with cancer, with a specific focus on men with prostate malignancies, as these men are at high risk for sexual dysfunction (Box 1). Readers interested in oncosexology in women are referred to the Mindy Goldman and Mary Kathryn Abel’s article, “Oncology Survivorship and Sexual Wellness for Women,” elsewhere in this issue.
*IMPACT OF CANCER DIAGNOSIS ON SEXUAL FUNCTION
*IMPACT OF MALE SEXUAL DYSFUNCTION ON PARTNERS
*PELVIC MALIGNANCIES
*ERECTILE DYSFUNCTION
*Ejaculatory Dysfunction
*Orgasmic Dysfunction
*Sexual Incontinence
*Peyronie Disease
*Penile Shortening
*TESTICULAR CANCER
-Ejaculatory Dysfunction
-Testosterone Deficiency
-Low Libido
-Erectile Dysfunction
*HEMATOLOGIC MALIGNANCIES
-Testosterone Deficiency
-Erectile Dysfunction and Low Libido
*RECOMMENDATIONS
SUMMARY
In summation, the emerging field of oncosexology focuses on the sexual consequences of cancer and its treatments. As many patients are not being appropriately counseled on sexual consequences, it is imperative that health care practitioners provide adequate information on the sexual dysfunction associated with cancer treatment. Although pelvic cancer, especially genitourinary malignancy, has a higher risk of sexual dysfunction, these changes can occur in all patients with cancer. The etiology is often multifactorial, with psychological and organic components at play. TD from chronic illness, CT, RT, or ADT can contribute to ED, low libido, and ejaculatory and orgasmic dysfunction. Pelvic surgery or RT can remove or damage the ejaculatory apparatus, as well as the cavernous nerves responsible for normal EF. With appropriate treatment and counseling, oncosexologists can help patients to navigate these sexual changes.
Oncosexology is a relatively new term that refers to a multidisciplinary field addressing sexual issues in patients with cancer .1 Physicians, nurses, psychologists, and other health care providers can all be involved in the field of oncosexology. An oncosexologist can be any of these practitioners who focus on the sexual function of patients with cancer. This discipline has developed out of a need to adequately address sexual concerns in oncology patients. Cancer remains a significant health burden in the United States, with almost 2 million new cases and more than 600,000 cancer deaths anticipated. There is a need for specialists to help cancer survivors and their partners navigate changes to sexuality related to the diagnosis and treatment of cancer.
Monitoring for patient cancer-related distress is an American College of Surgeons cancer hospital accreditation standard in the United States.2 Although this focus on distress is warranted, the follow-through for patients who express distress is suboptimal; only approximately one-third of patients referred for distress symptoms actually obtain the desired assistance. There are many barriers to access, including time restraints, patient beliefs, logistical issues, and variability in insurance/financial issues.2 A proposed model to address this gap in care is to identify distress and patient needs, offer support within the oncology team as appropriate, and/or refer out as needed. The oncology team should then help the patient navigate barriers to care and continue to monitor and address patient distress.2
The management of distress in general needs to be improved in oncology patients. Distress related to sexual issues is a particularly sensitive and important aspect of oncology-related distress. Cancer and its treatments can have a direct and indirect impact on sexual function and satisfaction. The absence of sexual experience can be a source of distress. The sexual expression may also be a form of coping with distressing life circumstances and its absence can compound other forms of cancer-related distress.3
Historically, health care providers have not adequately discussed sexual issues with patients with cancer. This is of major concern, given the significant impact of cancer and cancer treatments on sexual functioning. It is estimated that 40% to 100% of patients with cancer experience perturbations in sexual functioning. Patients with pelvic cancers tend to have greater risks with respect to sexual dysfunctions.4 Despite this, many patients with cancer are not counseled on sexual side effects. A study of nearly 500 patients with colorectal cancer (CRC) found that only 16% of patients said that their medical team discussed sexual concerns with them.5 Among patients with prostate cancer (PCA), few reports being counseled on penile length loss, Peyronie disease (PD), and/ or anejaculation after prostate cancer treatment such as radical prostatectomy (RP).6
Self-identified oncosexologists tend to be more engaged and inquisitive regarding a patient’s experience of sexual distress during or after treatment. However, even among these providers, up to 10% may not address sexual issues with patients. A survey of self-reported oncosexology providers who attended a “Cancer, Sexuality and Fertility” meeting demonstrated that only 90% endorsed discussing sexuality with patients. Almost 7% of these practitioners noted they felt uncomfortable discussing sexual concerns with patients, and most had no experience discussing sexuality with adolescent patients.4
Fortunately, research has shown that training practitioners can improve their handling of oncosexology issues. A review of these interventions evaluated 7 studies that aimed to improve the sexual health knowledge of providers and increase their comfort level with these discussions. Interventions included either face-to-face workshops or lectures or online video-based training. Endpoints were assessed anywhere from 3 weeks to 16 months after the interventions and included self-reported questionnaires that ranged from sexual health knowledge and attitudes to frequency discussing the topic and provider comfort level. Many studies showed that with the training of health care providers, there may be a durable improvement in their knowledge and comfort level regarding sexual concerns. This has the end result of an increase in the frequency with which providers discuss sex with patients.7 Increasing these conversations is vital, as it has been shown to improve sexual function in patients with cancer. Of patients with hematologic cancer status-post stem cell transplantation, those who had been counseled on sexual side effects had fewer sexual problems at 3 years after treatment (r 5 0.43, P 5 .02).8
These data demonstrate a clear need to expand the field of oncosexology and better counsel patients with cancer on the sexual impact of their disease and treatments. Sexual functioning should be discussed to assess baseline symptoms and in the context of the impact of various treatment options.3
*This article discusses sexual issues in male patients with cancer, with a specific focus on men with prostate malignancies, as these men are at high risk for sexual dysfunction (Box 1). Readers interested in oncosexology in women are referred to the Mindy Goldman and Mary Kathryn Abel’s article, “Oncology Survivorship and Sexual Wellness for Women,” elsewhere in this issue.
*IMPACT OF CANCER DIAGNOSIS ON SEXUAL FUNCTION
*IMPACT OF MALE SEXUAL DYSFUNCTION ON PARTNERS
*PELVIC MALIGNANCIES
*ERECTILE DYSFUNCTION
*Ejaculatory Dysfunction
*Orgasmic Dysfunction
*Sexual Incontinence
*Peyronie Disease
*Penile Shortening
*TESTICULAR CANCER
-Ejaculatory Dysfunction
-Testosterone Deficiency
-Low Libido
-Erectile Dysfunction
*HEMATOLOGIC MALIGNANCIES
-Testosterone Deficiency
-Erectile Dysfunction and Low Libido
*RECOMMENDATIONS
SUMMARY
In summation, the emerging field of oncosexology focuses on the sexual consequences of cancer and its treatments. As many patients are not being appropriately counseled on sexual consequences, it is imperative that health care practitioners provide adequate information on the sexual dysfunction associated with cancer treatment. Although pelvic cancer, especially genitourinary malignancy, has a higher risk of sexual dysfunction, these changes can occur in all patients with cancer. The etiology is often multifactorial, with psychological and organic components at play. TD from chronic illness, CT, RT, or ADT can contribute to ED, low libido, and ejaculatory and orgasmic dysfunction. Pelvic surgery or RT can remove or damage the ejaculatory apparatus, as well as the cavernous nerves responsible for normal EF. With appropriate treatment and counseling, oncosexologists can help patients to navigate these sexual changes.
