Lasting sexual effects of treatment in young-adult cancer survivors11 May 2015
Childhood cancers and their treatment often have long-lasting effects on patient's sexuality and sexual function, results of a small survey suggested.
Survey design with interviews of young-adult cancer survivors
To inform issues pertinent to clinical practice and research, investigators conducted semistructured interviews with young-adult survivors of childhood cancers. Interviews occurred at least 12 months after completion of cancer therapy, and each participant acknowledged two or more problems related to sexual function.
The transcript of each interview was reviewed independently by two investigators, who exhibited greater than 90% concordance in their assessments. To assist in their assessments, the investigators used a validated computer program developed for analysis of unstructured data.
The 22 patients had a mean age of 22.6 and a mean age at cancer diagnosis of 13. Diagnoses comprised leukemias, lymphomas, sarcomas, germ-cell tumors, and neuroblastoma.
The assessments yielded five themes related to the patients' issues and concerns:
- Physical and psychological problems: erectile dysfunction, vaginal dryness, and fatigue (among others); stress and anxiety predominated among psychological issues
- Long-term impact of physical change: negative body image, impetus for unwanted discussion of cancer history
- Discomfort disclosing cancer history: uncertainty about how and when to bring up the issue; fear of being treated differently or pitied
- Concern about future fertility: an issue for young men and women alike
- Inadequate clinical discussions: providers primarily interested in "whether I got my period and grew some boobs; they never talked about sex at all"
Results of the study show poor professional guidance on sexual issues
The 22 teenagers and young adults included in the survey described a variety of physical and psychological problems. They expressed concern about long-term physical changes brought about by the disease and treatment, future fertility, and sexual dysfunction and intimacy.
At the same time, many of the survey participants, who ranged in age from 18 to 32, felt that their healthcare providers did not adequately address sexual issues. The survivors also had difficulty discussing their cancer history with peers and others, considering it a potential barrier to friendship and intimacy.
“They want discussions of sexual health but they will not initiate the conversation”
"Young adult survivors of childhood cancer need guidance on how to communicate cancer history with their peers and partners," Natasha N. Frederick, MD, of Dana-Farber Cancer Institute and Boston Children's Cancer and Blood Disorders Center, said here at the American Society of Pediatric Hematology/Oncology meeting.
"They want discussions of sexual health and function, including fertility and contraception, with their oncology providers but they will not initiate the conversation," Frederick said.
Clinicians and researchers need to "identify barriers to sexual health communication between pediatric oncology providers and young-adult survivors of childhood cancers. Longitudinal studies are needed to assess the evolution of sexual function in young-adult survivors of childhood cancers over time," the group wrote.
Source: MedPage Today