Approach to sexuality in the care of cancer patients: barriers and strategies

Vassão, Felipe Vitorino; Barbosa, Luciene Rodrigues; Moraes, Graciana Maria de; Domenico, Edvane Birelo Lopes De

doi:10.1590/1982-0194201800078

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Acta Paulista de Enfermagem

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Sumário

Integrative Review • Acta Paul Enferm. 31 (5) • 2018 • https://doi.org/10.1590/1982-0194201800078 copy

Approach to sexuality in the care of cancer patients: barriers and strategies

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify intervening factors in the approach to sexuality, by patients and professionals, and to describe strategies used in this approach in the care of cancer patients.

Methods:

Integrative literature review, based on systematic steps, databases and/or electronic libraries: LILACS, PUbMed, MEDLINE, IBECS, ScIELO, UpToDate, BDEnf. Searches were carried out between December 2016 and July 2017. Inclusion criteria: studies with cancer patients aged over 18; published in the last ten years (2007-2017); available in full; written in Portuguese, Spanish, and English. Theses, essays, reviews (systematic, narrative, and integrative), opinion articles and editorials were excluded.

Results:

Eighteen articles were included, six of which were related to intervening factors, and 12 articles related to strategies adopted to address sexuality. Most articles showed how difficult it is to address the topic in professional practice, from a communication point of view and also regarding interpersonal relationships between patients and health professionals, reaffirming that the sexual health of patients is often overlooked. Studies that addressed the measures taken to remedy the shortcomings showed different degrees of positivity and that it is necessary to train professionals by means of guidance and counseling strategies. Intervention models can be found in the literature.

Conclusion:

Sexuality is overlooked in the care of cancer patients. Multidisciplinary care in oncology has to acknowledge this situation and implement, in a joint action, educational and psychosocial support activities so this basic human need is met.

Keywords
Sexuality; Sexual health; Health education

Author(s)/ Journal/Year	Method and Level of Evidence (Joanna Briggs Institute)	Intervening Factors
Lindau et al., Psychooncology, 2011⁽⁷7. Lindau ST, Surawska H, Paice J, Baron SR. Communication about sexuality and intimacy in couples affected by lung cancer and their clinical-care providers. Psychooncology. 2011;20(2):179-85.⁾	Descriptive Qualitative LE 4b	Barriers to communication about sexuality: Medical appointments restricted to diseases and communication failure between physicians and patients. Barriers to starting a conversation: diagnosis and treatment are considered as a priority; embarrassment and discomfort to address the topic.
Moore, Higgins and Sharek European Journal of Oncology Nursing, 2013⁽⁸8. Moore A, Higgins A, Sharek D. Barriers and facilitators for oncology nurses discussing sexual issues with men diagnosed with testicular cancer. Eur J Oncol Nurs. 2013;17(4):416-22.⁾	Descriptive Qualitative LE 4b	Lack of knowledge and of reference services, work overload, nurses’ distorted perception of the appropriate moment to address the issue, feeling of discomfort to discuss it, low education level, age, and ethnic differences.
Junqueira et al., Interface, 2013⁽⁹9. Junqueira LC, Vieira EM, Giami A, Santos MA. Análise da comunicação acerca da sexualidade, estabelecida pelas enfermeiras, com pacientes no contexto assistencial do câncer de mama. Interface - Comunic Saude Educ. 2013;17(44):89-101.⁾	Descriptive Qualitative LE 4b	Vision restricted to treatment and its side effects, patients’ silence about the topic, delegation of dialog to professionals, inefficient professional training, and work overload.
Oskay, Can and Basgol, Asian Pac J Cancer Prev, 2014⁽¹⁰10. Oskay U, Can G, Basgol S. Discussing sexuality with cancer patients: oncology nurses attitudes and views. Asian Pac J Cancer Prev. 2014;15(17):7321-6.⁾	Descriptive Quantitative LE 4b	Health service failures: absence of leaflets and manuals about the effects of treatment on sexual life; absence of a routine of assessment and sexual counseling and lack of professional knowledge on the topic.
Ferreira et al., Rev Latino-Am. Enfermagem, 2015⁽¹¹11. Ferreira SM, Gozzo TO, Panobianco MS, Santos MA, Almeida AM. Barreiras na inclusão da sexualidade no cuidado de enfermagem de mulheres com câncer ginecológico e mamário: perspectiva das profissionais. Rev Lat Am Enfermagem. 2015;23(1):82⊠9.⁾	Descriptive Qualitative LE 4b	Difficulty of creating ties as the result of work overload, institutional bureaucracy, inadequate physical space, and different social interpretations of sex.
Cardoso et al., Rev Rene, 2015⁽¹²12. Cardoso DB, Almeida CE, Santana ME, Carvalho DS, Sonobe HM, Sawada NO. Sexualidade de pessoas com estomias intestinais. Rev Rene. 2015;16(4):576-85.⁾	Descriptive Qualitative LE 4b	Uncertainty whether the topic can be discussed during treatment, as a result of the priority given to therapeutic issues.

Author(s)/Journal/Year	Method and Level of Evidence (Joanna Briggs Institute)	Intervention design
Author(s)/Journal/Year	Method and Level of Evidence (Joanna Briggs Institute)	Target population	Intervention procedures	Results
Molton et al., J Psychosom Res, 2008⁽¹³13. Molton IR, Siegel SD, Penedo FJ, Dahn JR, Kinsinger D, Traeger LN, et al. Promoting recovery of sexual functioning after radical prostatectomy with group-based stress management: the role of interpersonal sensitivity. J Psychosom Res. 2008;64(5):527-36.⁾	Randomized clinical study LE 1c	n=101 men who underwent radical prostatectomy	Didactic instructions by means of Cognitive-Behavioral Stress Management (CBSM) and a relaxing technique.	The intervention was effective in the promotion of sexual function recovery of patients.
Boonzaier et al., Journal of Psychosocial Oncology, 2009⁽¹⁴14. Boonzaier A, Schubach K, Troup K, Pollard A, Aranda S, Schofield P Development of a psychoeducational intervention for men with prostate cancer. J Psychosoc Oncol. 2009;27(1):136-53.⁾	Quasi-experimental study LE 2c	n=10 men with prostate cancer	Psychopedagogical and educational manual.	Issues of patients’ interest were discussed in group sessions, and this possibility made the experiment quite satisfactory.
Marcus et al., Psychooncology, 2010⁽¹⁵15. Marcus AC, Garrett KM, Cella D, Wenzel L, Brady MJ, Fairclough D, et al. Can telephone counseling post-treatment improve psychosocial outcomes among early stage breast cancer survivors? Psychooncology. 2010;19(9):923-32.⁾	Randomized clinical trial LE 1c	n=304 women with breast cancer	Telephone consultation, specific printed leaflets, progressive relaxation tapes and guidelines of stress management for ongoing breast cancer.	Telephone consultation: inefficient intervention, especially for women with early stage breast cancer. The meaning of the sickness experience was discussed.
Jun et al., Cancer Nursing, 2011⁽¹⁶16. Jun EY, Kim S, Chang SB, Oh K, Kang HS, Kang SS. The effect of a sexual life reframing program on marital intimacy, body image, and sexual function among breast cancer survivors. Cancer Nurs. 2011; 34 (2):142-9.⁾	Quasi-experimental study LE 2c	n=45 women who survived breast cancer	Educational activity, group discussion, counseling, relaxing, role play, movie and pictures screening about couple sexuality.	The intervention increased sexual satisfaction and improved the acceptance of their body image.
Wiljer et al., J Canc Educ, 2011⁽¹⁷17. Wiljer D, Urowitz S, Barbera L, Chivers ML, Quartey NK, Ferguson SE, et al. A qualitative study of an internet-based support group for women with sexual distress due to gynecologic cancer. J Cancer Educ. 2011;26(3):451-8.⁾	Quasi-experimental study LE 2d	n=27 women	Web-based support group with a 12-week duration (GyneGals) focused on topics related to sexuality.	Benefits of the intervention: emotional well-being, improvement in the quality of life and sexuality; the anonymity nature of the environment favored discussions.
Schover et al., J Natl Compr Canc Netw, 2013⁽¹⁸18. Schover LR, Yuan Y, Fellman BM, Odensky E, Lewis PE, Martinetti P Efficacy trial of an Internet-based intervention for cancer-related female sexual dysfunction. J Natl Compr Canc Netw. 2013;11(11):1389-97.⁾	Randomized clinical trial LE 1c	n=72 women who survived breast or gynecological cancer	Access to Tendrils website, videos, and a therapist manual with general guidance. Techniques of cognitive behavioral sex therapy	The intervention improved sexual function, satisfaction of women with sexual dysfunction and general quality of life in the post-treatment period. There was a decrease in emotional suffering.
Reese et al., Psychooncology, 2014⁽¹⁹19. Barsky Reese J, Porter LS, Regan KR, Keefe FJ, Azad NS, Diaz LA Jr, et al. A randomized pilot trial of a telephone-based couples intervention for physical intimacy and sexual concerns in colorectal cancer. Psychooncology. 2014;23(9):1005-13.⁾	Randomized clinical trial LE 1c	n=23 couples	Telephone consultation.	Improvements in the sexual function for both genders, increased perception of self-effectiveness to enjoy intimacy, and identification of difficulties experienced by a partner who has survived cancer.
Smith and Baron, Clinical Journal of Oncology Nursing, 2015⁽²⁰20. Smith A, Baron RH. A workshop for educating nurses to address sexual health in patients with breast cancer. Clin J Oncol Nurs. 2015;19(3):248-50.⁾	Quasi-experimental study LE 2c	n=29 nurses	Workshop, role playing, a copy of the American Cancer Society booklet - “Sexuality for the woman with cancer” and weekly e-mails.	Training empowered nurses in their jobs as educators and made it easier to talk about sexual health.
Perz et al., BMC Cancer, 2015⁽²¹21. Perz J, Ussher JM; Australian Cancer and Sexuality Study Team. A randomized trial of a minimal intervention for sexual concerns after cancer: a comparison of self-help and professionally delivered modalities. BMC Cancer. 2015;15(1):629.⁾	Randomized clinical trial LE 1c	n=88 people with cancer n=53 partners	Self-help leaflet and telephone or Skype consultation.	Improvement in sexual satisfaction of participants, effective communication and intimacy within the couple, better sexual flexibility and negotiation regarding the intercourse.
Bober et al., J Sex Med, 2015⁽²²22. Bober SL, Recklitis CJ, Bakan J, Garber JE, Patenaude AF. Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: effects of a brief, psychosexual intervention. J Sex Med. 2015;12(1):189-97.⁾	Quasi-experimental study LE 2c	n=37 women	Psycho-educational session, educational materials and telephone consultation.	Increased ability of solving sexual problems and decreased feeling of loneliness.
Jung e Kim, Sexual & Reproductive Healthcare, 2016⁽²³23. Jung D, Kim JH. Effects of a sexual health care nursing record on the attitudes and practice of oncology nurses. Sex Reprod Healthc. 2016;9:21-6.⁾	Randomized clinical trial LE 1c	n=24 nurses	Nursing records focused on sexual health care.	Sexual health care improves nursing practice related to sexuality issues and make care services more efficient.
Jonsdottir et al., European Journal of Oncology Nursing, 2016⁽²⁴24. Jonsdottir JI, Zoëga S, Saevarsdottir T, Sverrisdottir A, Thorsdottir T, Einarsson GV, et al. Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: outcomes from a 2-year educational intervention at a University Hospital. Eur J Oncol Nurs. 2016;21:24⊠30.⁾	Quasi-experimental study LE 2c	n=206 nurses and physicians	Workshops and construction of a website for interventions.	Improved knowledge and communication about sexual health issues.

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[1] Corresponding author Luciene Rodrigues Barbosa E-mail: lucienerodriguesbarbosa@gmail.com