Sexual health-related care needs among young adult cancer patients and survivors: a systematic literature review

Prevalence and Impact of Sexual Complaints on Depressive Symptoms in Adolescents and Young Adults with Cancer: A Cross-Sectional Sub-Study

Purpose: Adolescents and young adults (AYAs) diagnosed with cancer face unique psychosocial challenges, including sexual complaints. Despite the prevalence of these sexual issues, they are underexplored in AYA oncology care. The aim of this study is firstly to examine the prevalence of sexual complaints among AYAs with cancer across genders, age groups, and types of cancer. Second, we explore the association between sexual complaints and depressive symptoms. Methods: This cross-sectional sub-study included 305 AYAs (aged 15-39 at diagnosis) actively affiliated with the oncology department at Copenhagen University Hospital-Rigshospitalet. Participants completed questionnaires assessing sexual complaints and depressive symptoms. Sexual problems, distress, satisfaction, and willingness to discuss these issues were analyzed alongside demographic, clinical, and treatment data. Univariate and multivariable regression analyses evaluated associations with depressive symptoms. Results: Sexual problems affected 63.9% of AYAs, 49.5% experienced sexual distress, and 58.4% were dissatisfied with their sexual lives. Younger AYAs reported higher sexual satisfaction than older AYAs. Sexual distress, dissatisfaction, and reluctance to discuss sexual issues were associated with increased depressive symptoms in the univariate analysis. In the multivariable model, sexual distress remained independently associated with depressive symptoms, alongside age at diagnosis, civil status, cancer type, and pain. Conclusion: Sexual complaints, particularly distress, are prevalent among AYAs with cancer and are significantly associated with depressive symptoms. Integrating routine discussions about sexual health into oncology care could probably improve mental health outcomes and overall quality of life for this vulnerable group. Future research should focus on targeted interventions to address these interconnected challenges.

A review of the carcinogenic potential of human papillomavirus (HPV) in urological cancers

Direct skin-to-skin contact during intimate sexual contact with a human papillomavirus (HPV)-positive individual is often the cause of HPV infection. In addition, many studies have been written up to date that look at the role of HPV in the growth of other types of tumors. Not all urological cancers are associated with HPV. However, penile cancer (PC) is often caused by HPV, especially high-risk types. HPV-16 has been the most frequent (68.3%), followed by HPV-6 (8.1%) and HPV-18 (6.9%). An increased risk of getting certain types of urinary cancers like prostate, bladder, testicular, and kidney has also been linked to these infections. Additionally, HPV may play a part in continuous inflammation and cancer progression in different organs and tissues. So, making HPV vaccine programs available to more people of the male sex around the world could significantly lower the number of urinary cancers caused by HPV. The critical effects of HPV on different types of urologic cancers (UCs), such as testicular, prostate, penile, and kidney cancer, and the importance of HPV vaccination have been seen in this study.

A randomized controlled trial of an online support group addressing psychosexual distress among women treated for gynecologic cancer

OBJECTIVE

To assess whether a 12-week, professionally facilitated, asynchronous online support group would reduce sexual distress (primary outcome) and improve sexual function, body image, depression symptoms, relationship satisfaction, and social support (secondary outcomes) in women treated for gynecologic cancer.

METHODS

Participants were 398 women recruited from three Canadian provinces and one American cancer center in cohorts of 40. Participants were randomized (50:50 odds) to either the immediate treatment condition (ITC) or the waitlist control condition (WCC). Eligibility included: completed treatment for gynecologic cancer, disease-free for at least 3 months, no more than 5 years post-diagnosis, met criteria for psychosexual distress, willing to discuss sexual concerns, 18 years or older, English speaking, and access to a computer. Participants in the ITC received a 12-week online group along with psychoeducational material each week to stimulate discussion. Two 90-min synchronous sessions were offered in weeks 4 and 8.

RESULTS

Reductions in sexual distress for ITC were not significantly different compared to WCC. Similarly, no treatment effects were observed for body image, depression, relationship satisfaction, or social support. ITC showed statistically significant improvements in sexual functioning compared to WCC, but these gains were not retained at 4-month follow-up.

CONCLUSION

Treatment effects were modest, although in the expected direction. As this study was underpowered, it offers preliminary evidence that an asynchronous, online psychoeducational support group may confer positive benefits for women's sexual functioning. The efficiency, convenience, and accessibility of online interventions has significant potential to close gaps in women's access to evidence-based sexual health care.

Availability of Adolescent and Young Adult-Specific Sexual and Reproductive Health Programs and Resources: A Review of the Websites of National Cancer Institute-Designated Cancer Centers

Adolescent and young adult (AYA) cancer survivors often search online for information about cancer-related sexual and reproductive health concerns. A review of the websites of National Cancer Institute-designated cancer centers (n = 9) and comprehensive cancer centers (n = 58) was conducted to identify the presence of AYA-specific sexual and reproductive health programming and resources. No AYA-specific sexual health programs were found. Oncofertility programs were presented on 56% (n = 5) of cancer centers and 50% (n = 29) of comprehensive cancer center websites. As the population grows, it is imperative that cancer centers provide services to meet AYAs' sexual and reproductive health needs and highlight these services on their websites.

Associations Between Characteristics of Adolescent and Young Adult Cancer Survivors and Their Use of Different Social Media Platforms: An Observational Study of Social Media Accounts

Background: The growing number of adolescent and young adult (AYA) cancer survivors and their unmet needs demand innovative communication and care strategies. This study uses social media data to examine how survivors' demographic and clinical characteristics relate to their social media use. Methods: Data from 300 AYA cancer survivors on six social media sites (YouTube, Instagram, Facebook, TikTok, Reddit, X/formerly Twitter) were collected between August 2022 and March 2023 and analyzed using descriptive statistics and statistical tests (chi-square, Fisher's exact, Welch, Games-Howell post-hoc, logistic regression). Results: Significant differences were observed across platforms for mean current age (p < 0.001) and age at diagnosis (p < 0.001). We also found significant associations between social media type used and current age, age at diagnosis, years since diagnosis, and the timing of social media account creation. AYAs who created their social media account post-diagnosis were less likely to use YouTube (p = 0.003) and more likely to use Facebook (p = 0.009). Treatment completion was associated with increased use of platform X (p = 0.004). Non-White individuals in our sample were less likely to use Facebook (p = 0.008). Significant associations were found between observed sex and platform usage (p < 0.001), with males more likely to use Reddit (p < 0.001) and X (p < 0.001). Conclusions: Significant associations were found between demographic and clinical attributes of AYA cancer survivors and the type of social media they used, suggesting that AYA-specific social media-based interventions should be tailored to subgroup characteristics (e.g., social media type, developmental stage based on age at diagnosis and current age, sex).

Does sexual rehabilitation work for gay and bisexual prostate cancer patients? Acceptability, feasibility, and efficacy results from the Restore-2 randomized controlled trial

PURPOSE

Sexual minority prostate cancer patients have worse health-related quality of life outcomes than heterosexual patients. We conducted the first study to test whether sexual and urinary rehabilitation tailored for sexual minority patients was acceptable, feasible, and efficacious at improving their sexual and urinary function.

METHODS

Restore-2 was a 24-month randomized controlled trial of an online biopsychobehavioral rehabilitation study for sexual minority men treated for prostate cancer experiencing sexual and/or urinary problems. Participants were 401 US sexual minority men treated for prostate cancer and experiencing sexual and/or urinary problems at baseline. Intervention components included phosphodiesterase-5 inhibitors, sexual aids, a pelvic floor exercise regimen and video, a guide to good gay sex following treatment, and coaching. Quality of life assessments were completed at baseline, 3, 6, 12, 18, and 24 months.

RESULTS

We confirmed good acceptability and feasibility, but only minimal improvement was observed over time and no differences were found between treatment and control arms.

CONCLUSIONS

We found no evidence that the intervention improved sexual or urinary outcomes for participants. However, we confirmed excellent acceptability and feasibility for a sexual rehabilitation program tailored to sexual minority participants. In addition, participants reported enduring usage and acceptability of sexual aids (including vacuum pump, anal dilators, and penile constriction rings) as well as masturbation and pelvic floor exercises to accommodate their sexual challenges.

IMPLICATIONS FOR CANCER SURVIVORS

Sexual "accommodation," rather than "rehabilitation," may be a more accurate and realistic goal for this population. Patients should be provided sexual aids to help accommodate their sexual and urinary challenges.

TRIAL REGISTRATION

This study was retrospectively registered with ClinicalTrials.gov, study number: NCT03923582; date: 22/04/2019.

Improving young patient - practitioner communication about sexual health during medical visits

OBJECTIVES

Young people face barriers that lead to gaps in sexual and reproductive health care communications. Issues such as discomfort discussing sexual health lead to inadequate delivery of services resulting in unintended pregnancies and STIs. Closing this communication gap between patients and health care practitioners would improve communication and health outcomes. The objective of this study was to gain feedback from focus groups about: (a) barriers and facilitators to communication surrounding sexual health and (b) the feasibility and acceptability of a question prompt list (QPL) and informational video emphasizing asking questions about sexual health during medical visits as tools young people could use to be more involved during visits.

METHODS

Three focus groups were conducted: two with young adults (n=14) and one with practitioners (n=5) of sexual/reproductive health care services. Practitioners were recruited from healthcare clinics.

RESULTS

Young adults were aged 18-22 years old. Participants identified barriers to communication such as embarrassment over sexual health topics and practitioner assumptions about patients' base of knowledge. A facilitator to communication was patient-friendly language. Focus group participants offered suggestions on how to improve the QPL as well as themes that should be covered in an educational video. Participants viewed the QPL and educational video as useful for encouraging conversations between patient and practitioner.

CONCLUSIONS

Many barriers obstruct communication between young adults and practitioners on topics relating to sexual health. Both the QPL and an educational video could be used to enhance patient-practitioner communication.

Cancer Survivorship Care in the United States at Facilities Accredited by the Commission on Cancer

Importance

Since 2021, American College of Surgeons Commission on Cancer (CoC) accreditation standards require providing a survivorship program for patients with adult-onset cancer treated with curative intent. Since more than 70% of all patients with cancer in the US are treated at CoC-accredited facilities, this presents an opportunity for a landscape analysis of survivorship care availability.

Objective

To determine the prevalence, types, and outcomes of cancer survivorship services at CoC-accredited facilities.

Design, Setting, and Participants

This survey study used an anonymous, online, cross-sectional survey conducted from May 4 to 25, 2023. Participants were CoC-accredited facilities in the US representing diverse CoC program categories, institutional characteristics, geographic regions, and practice types. Department of Veterans Affairs cancer programs were excluded due to data usage restrictions. Data were analyzed from July to October 2023.

Exposure

CoC Survivorship Standard 4.8 was released in October 2019 and programs were expected to adhere to the Standard beginning January 1, 2021.

Main Outcomes and Measures

Questions included self-reported survivorship program characteristics, availability of services aligned to CoC Survivorship Standard 4.8, and perceived program impacts. Response frequencies and proportions were determined in aggregate and by CoC program category.

Results

There were 1400 eligible programs, and 384 programs participated (27.4% response rate). All regions and eligible program categories were represented, and most had analytic caseloads of 500 to 4999 patients in 2021. Most survivorship program personnel included nurses (334 programs [87.0%]) and social workers (278 programs [72.4%]), while physical (180 programs [46.9%]) and occupational (87 programs [22.7%]) therapists were less common. Services most endorsed as available for all survivors were screening for new cancers (330 programs [87.5%]), nutritional counseling (325 programs [85.3%]), and referrals to specialists (320 programs [84.7%]), while treatment summaries (242 programs [64.7%]), and survivorship care plans (173 programs [43.0%]), sexual health (217 programs [57.3%]), and fertility (214 programs [56.9%]) were less common. Survivorship services were usually delivered by cancer treatment teams (243 programs [63.3%]) rather than specialized survivorship clinics (120 programs [31.3%]). For resources needed, additional advanced practice clinicians with dedicated survivorship effort (205 programs [53.4%]) and electronic health record enhancements (185 programs [48.2%]) were most endorsed. Lack of referrals and low patient awareness were endorsed as the primary barriers. A total of 335 programs (87.2%) agreed that Survivorship Standard 4.8 helped advance their programs.

Conclusions and Relevance

These findings of this survey study of CoC-accredited programs establish a benchmark for survivorship care delivery in the US, identify gaps in specific services and opportunities for intervention, contribute to longitudinal reevaluation for tracking progress nationally, and suggest the value of survivorship care standards.

Research progress on sexual functioning and associated factors in childhood cancer survivors: a scoping review

Background

Childhood Cancer Survivors (CCSs) are more likely to report sexual dysfunction than people without cancer history. Sexual functioning encompasses more than just sexual dysfunction. The scarcity of information regarding the status and influencing factors of sexual functioning in CCSs, hampers to devise suitable screening or interventions. This review aims to summarize research progress on sexual functioning and associated factors among CCSs.

Methods

This review protocol is registered in PROSPERO(CRD42023427939) and performed according to PRISMA guidelines. From inception to November 15, 2023, a comprehensive search was conducted in PubMed, EMBASE, CINAHL, Web of Science, SCOPUS, PsycINFO, CNKI Database, Wanfang of Chinese Database, SinoMed Database and Cochrane Library on sexual functioning and childhood cancer survivors. Inclusion criteria were English or Chinese studies focusing on sexual functioning and related factors of cancer survivors, who diagnosed with cancer before 18 years old, and were adult and disease-free when participating in the study. Studies were excluded if the focus was on adult cancer patients or without age information.

Findings

395 records were retrieved, and 22 studies were finally included in this review. Results suggest that CCSs experience a substantial burden of sexual issues, including delayed psychosexual development, low satisfaction, and high prevalence of dysfunction. Underlying factors related to sexual functioning of CCSs were identified, including demographic, cancer treatment-related, psychological, and physiological factors. The historical change in research on sexual functioning was summarized.

Interpretation

Research on sexual functioning among CCSs is limited. The extent to which cancer and related treatments affect sexual functioning remains largely unknown. The relationships between various factors and mechanisms underlying sexual functioning need to be confirmed by more rigorous studies to enable effective interventions to be developed.

Funding

None.

Sexual health and testosterone concentration in male lymphoma survivors: A systematic review

Advancements in lymphoma treatment have increased the number of long-term survivors who may experience late effects such as impaired sexual function and testosterone deficiency. The aim of this review was to determine the prevalence of testosterone deficiency and sexual dysfunction among male lymphoma survivors; and associations between the two. A systematic search identified 20 articles for inclusion. The prevalence of low total testosterone was 0%-50 %, with mean values within reference levels, and for luteinizing hormone above reference levels in 0%-80 %. Four studies included SHBG and free testosterone, with mixed results. Compromised sexual health was found in 23%-61 %. Overall, total testosterone and sexual health were associated. The risk of bias (ROBINS-E and RoB 2) was high/very high, leading to low/very low overall confidence in the bulk of evidence (GRADE). Longitudinal studies evaluating biologically active testosterone and sexual health are needed, to develop evidence based standard procedures for follow-up of sexual health.

Navigating the Cancer Journey: Experiences and Perspectives of Young Adult Patients in Tunisia

Purpose: This study aimed to explore the experiences of young adult cancer patients within the Tunisian context. Methods: A total of 104 patients between the ages of 20 and 40, undergoing treatment for various types and stages of cancer, participated in a questionnaire-based survey. The survey encompassed topics related to the socioeconomic and psychological impacts of cancer, coping mechanisms, relationships, sexuality, and future aspirations. Results: Of the participants, 78 were women (75%) and 26 were men (25%), with an average age of 33 years. Financial difficulties were reported by 60 patients (57.7%). The most common emotional responses to the diagnosis were sadness (54.8%), followed by denial (18.3%) and anger (5.8%). Thirteen patients (12.5%) choose not to receive information about the stage of their disease. In addition, 42 patients (40.4%) experienced a decrease in perceived physical attractiveness, while negative effects on sexuality were observed in 44.2% of cases. The primary concerns reported by patients were the fear of recurrence or progression (48%) and infertility (48%). Furthermore, 43 patients (41.3%) expressed a decrease in self-confidence, notably influenced by financial difficulties (OR: 2.77 [95% CI: 1.12-6.87]), physical alterations (OR: 0.18 [95% CI: 0.07-0.45]), and sexual issues (OR: 0.17 [95% CI: 0.06-0.48]). Notably, 78 patients (75%) continued to make future plans, particularly those under 30 years of age (OR: 0.2 [95% CI: 0.04-0.96]). Moreover, 47.1% of patients expressed an inclination toward immigration to developed countries, primarily due to perceived superior health care systems (61.5%). Conclusions: Young cancer patients face a range of social and psychological challenges, suggesting the necessity for a specialized care approach.

Domains and Categories of Needs in Long-Term Follow-Up of Adult Cancer Survivors: A Scoping Review of Systematic Reviews

The number of long-term cancer survivors increases continually. Understanding their needs is crucial to ensure an adequate follow-up. The aim of our study was to summarize the current literature concerning needs and what influences these needs. A scoping review of systematic reviews was conducted according to the recommendations of the Joanna Briggs Institute. Four electronic databases were searched. Of 414 retrieved papers, 11 met the eligibility criteria. Needs were aggregated into six domains (health-related information, health system, mental, practical, relationship and physical) and 15 categories. The lack of adequate information and the lack of access and/or continuity of supportive care were the most prominent needs. Female gender, younger age, a low level of family and/or social support, and higher educational level were identified as risk factors. Employment and relationship status can affect the needs both in a positive and negative way. The weeks or months after the end of the treatments are particularly critical, and needs can be emphasized during this period. The experience of cancer could also lead to positive changes. The variety of needs affects the quality of life of cancer survivors. Needs assessments should be systematically provided to ensure a better awareness of health professionals and to allow an individual, holistic, and integrated follow-up.

Sexual Functioning and Impact on Quality of Life in Patients with Early-Onset Colorectal Cancer: A Systematic Review

This systematic review investigates the intersection of early-onset colorectal cancer (EOCRC), sexual functioning, and associated quality of life (QoL), aiming to understand the comprehensive impact of EOCRC on these critical dimensions. Through an extensive search across PubMed, Scopus, and Embase up until November 2023, this study synthesized evidence from the literature while adhering to PRISMA guidelines. The studies included EOCRC patients under 50 years, which examined sexual functioning and QoL using validated instruments, and were published in English. After a rigorous screening process, five relevant studies were identified from an initial pool of 2184 articles. This review includes data from five studies involving 2031 EOCRC patients. The key findings revealed a high prevalence of sexual dysfunction, with up to 50% of men experiencing impotence and 58% reporting sexual dysfunction, alongside 36% of women in some studies. Pain was described by 12% to 31% of patients. Anxiety and depression were notably prevalent, affecting up to 69% of participants. EOCRC profoundly impacts sexual functioning and QoL, with a significant prevalence of sexual dysfunction and psychological distress among affected individuals. These findings suggest the need for oncological management strategies that include not only medical treatment but also psychological support and sexual health interventions. This systematic review emphasizes the importance of holistic patient care approaches, advocating for further research and clinical attention to address the complex needs of younger EOCRC patients.

Sexuality, intimacy, and body image among adolescents and young adults with cancer: a qualitative, explorative study

AIM

The aim of this study was threefold: (1) to explore Danish adolescents and young adults' (AYAs) thoughts concerning sexual health particularly focusing on sexuality, intimacy, and body image throughout a cancer trajectory, (2) to investigate how AYAs experience healthcare professionals address of- and respond to sexual health issues, and (3) to identify AYAs' suggestions on how to support conversation about sexual health.

METHODS

A qualitative, single-center study was conducted, including AYAs (18-29 years) diagnosed with cancer recruited at the University Hospital of Copenhagen, Rigshospitalet. Individual semi-structured interviews were conducted from January-February 2023, recorded, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Twelve participants were interviewed, aged 20-29; five were diagnosed with hematological- and seven with oncological cancer. Our analyses yielded three themes: (1) sexuality and body image as part of the identity, (2) excluding relatives in conversations about sexual health, and (3) uncertainty how to discuss sexual health with healthcare professionals. Finally, the AYAs' suggestions to support conversations about sexual health were organized into six thematic categories.

CONCLUSION

In this study, participants experienced altered sexual subsequent impacts on body image and self-esteem during their cancer trajectory. While some adapted to these changes, discussing them with healthcare providers was difficult, especially in the presence of relatives, as the AYAs wanted to shield them from additional concerns. To enhance support, AYAs suggest regular discussions on sexual health and the use of a dialog tool by healthcare professionals.

Sexual Health in Adolescents and Young Adults With Cancer

Sexual health (SH), an integral aspect of overall health and quality of life, can be negatively affected by cancer and cancer treatment. SH is influenced by biological, psychological, social, and cultural factors, and, for adolescents and young adults (AYAs), developmental factors. The AYA population (age 15-39 years) is diverse in terms of psychosexual development, interpersonal relationships, and varying levels of independence, resulting in unique SH needs for this population. AYAs with cancer are particularly vulnerable to unmet SH needs related to contraception and infection prevention, sexual function, body image, and romantic/sexual relationships. Sexual dysfunction during and after cancer treatment is reported by 30%-100% of AYA cancer survivors. Clinical guidelines recommend discussing SH and screening for dysfunction but currently lack specifics regarding psychosexual interventions and strategies for incorporating screening into clinical care. Research and clinical priorities include improved provider-AYA communication regarding SH, standardization of SH measures and screening tools, infrastructure to support the SH needs of AYAs across pediatric and adult clinical environments, and engagement of sexual and gender minority AYAs in research. As the field of SH in cancer evolves, interventions need to be tailored to the developmental needs that are unique to AYAs and address the multidimensional aspects of SH.

Perspectives and Concerns on Late Effects Regarding Sexuality among Adolescents and Young Adults Treated for Testicular Germ Cell Tumor: The PRICELESS-Study-A Qualitative Study

This study aimed to explore perspectives and concerns regarding sexuality among adolescents and young adults (AYAs) possibly experiencing late effects after testicular germ cell tumor (TGCT) treatment. A qualitative study was performed in which semi-structured interviews were held with thirteen AYAs from a center of expertise for TGCT in the Netherlands. Data were analyzed using Braun and Clark's thematic analysis method. Seven interacting and interconnected themes were found: desire to have children, rediscovering sexuality, insecurity about sexual performance, acceptance of physical change, loss of masculinity, burden on relationship, and openness in discussing sexuality. Concerns about the desire to have children seem to play a significant role. In conclusion, TGCT patients face multiple changes (physical, emotional, relational, and sexual), followed by a difficult period of acceptance, after which a new phase of rediscovering sexuality appeared. These findings can help to make healthcare professionals aware of the underlying mechanisms and concerns about sexuality. Furthermore, insights can help to develop sexuality-themed items for a broader monitoring tool to structurally assess the late effects to support discussing sexuality.

Sexual Problems as Late Effects: Awareness and Information Needs Among 1870 Long-term Norwegian Childhood, Adolescent, and Young Adult Cancer Survivors (The NOR-CAYACS Study)

Purpose: Treatment-related sexual problems are common, but understudied, among survivors of Childhood, Adolescent, and Young Adult Cancer Survivors (CAYACS). We investigated awareness of, and information needs regarding, sexual problems as late effects in a nation-wide sample of long-term CAYACS. Methods: Five-year survivors were identified by the Cancer Registry of Norway, diagnosed between 1985 and 2009 with any childhood cancer (0-18 years of age, excluding central nervous system tumors), leukemia, colorectal cancer, breast cancer, non-Hodgkin lymphoma, or malignant melanoma (19-39 years of age). Malignant melanoma survivors treated with local surgery only served as an unmatched reference group. Survivors were mailed a survey, including items on awareness and information needs. Descriptive statistics and logistic regression analyses were used for data analyses. Results: Of 5361 CAYACS invited, 2104 responded (39%), of which 1870 were eligible for inclusion. In all, 62% were aware of sexual problems as late effects (46% aware only, 16% experienced it) and 31% reported information needs. Of all groups, childhood cancer survivors reported the lowest level of awareness (43% aware, 7% experienced it) and the highest information needs (38%). In multivariable models, awareness was associated with higher education, shorter time since treatment, more intense treatments, and experiencing hormonal changes and reduced fertility. Information needs were associated with having experienced sexual problems, female gender, higher treatment intensity, chronic fatigue, and increased depressive symptoms. Conclusions: A substantial proportion of long-term CAYACS report being unaware of, and have information needs regarding sexual problems as late effects decades beyond treatment. Addressing such issues during follow-up care is important.

Sexual quality of life of adolescents and young adult breast cancer survivors

BACKGROUND

With increasing survival rates of adolescents and young adults (AYAs) with breast cancer, health-related quality of life (HRQoL) becomes more important. An important aspect of HRQoL is sexual QoL. This study examined long-term sexual QoL of AYA breast cancer survivors, compared sexual QoL scores with that of other AYA cancer survivors, and identified factors associated with long-term sexual QoL of AYA breast cancer survivors.

MATERIALS AND METHODS

Data of the SURVAYA study were utilized for secondary analyses. Sexual QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). Descriptive statistics were used to describe sexual QoL of AYA cancer survivors. Linear regression models were constructed to examine the effect of cancer type on sexual QoL and to identify factors associated with sexual QoL.

RESULTS

Of the 4010 AYA cancer survivors, 944 had breast cancer. Mean sexual QoL scores of AYA breast cancer survivors ranged from 34.5 to 60.0 for functional domains and from 25.2 to 41.5 for symptom-orientated domains. AYA breast cancer survivors reported significantly lower sexual QoL compared to AYA survivors of other cancer types on all domains. Age, time since diagnosis, relationship status, educational level, chemotherapy, hormonal therapy, breast surgery, body image, and coping were associated with sexual QoL of AYA breast cancer survivors.

CONCLUSIONS

AYA breast cancer survivors experience decreased sexual QoL in the long term (5-20 years) after diagnosis and worse score compared to AYA survivors of other cancer types, indicating a clear need to invest in supportive care interventions for those at risk, to enhance sexual well-being.

Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors

PURPOSE

The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice.

METHODS

A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted.

RESULTS

Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health.

CONCLUSION

Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.

The 'Young Adult Taking Action' programme for young adult cancer survivors: A study protocol for a feasibility study

BACKGROUND

Young adult cancer survivors (YACS) aged 18-39 report age-specific multifactorial challenges with self-care, leisure, work and education requiring multicomponent rehabilitation intervention. Therefore, the 'Young Adult Taking Action' (YATAC) programme was developed.

AIMS/OBJECTIVES

To present a protocol for a feasibility study evaluating the acceptability of the YATAC programme and exploring implementation, mechanisms of impact and outcomes.

MATERIAL AND METHODS

A mixed-method feasibility study with a convergent research design will be conducted. The programme is an age-specific, multicomponent, goal-oriented, and peer-based rehabilitation programme delivered by an interdisciplinary staff consisting of nine components: 1) Goal setting, 2) Everyday life, 3) Physical activity, 4) Psychological issues, 5) Work and study, 6) Sexuality and relationship, 7) Rights and finance, 8) Peer-to-peer support and 9) Individual consultation. Quantitative and qualitative data about acceptability, implementation, mechanisms of impact and outcomes will be collected.

RESULTS

The results will provide essential knowledge about the programme's acceptability, implementation, mechanisms of impact and outcomes.

CONCLUSION AND SIGNIFICANCE

The study will inform adjustment of the programme and will provide knowledge of whether and how to deliver age-specific rehabilitation to YACS.

Point-of-care assessment of sexual concerns among young adult oncology active patients and survivors

PURPOSE

Adolescent and young adult (AYA) oncology populations have unique sexual health concerns that deserve more attention. Our study aimed to describe sexual health and related concerns in young adults (YAs) to move toward integrating sexual health into routine care.

METHODS

A total of 127 YAs (ages 19-39) in active treatment and survivorship from three outpatient oncology clinics provided demographic and clinical information. They completed versions of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) developed specifically for AYAs as part of an ongoing needs assessment study.

RESULTS

Over one quarter (27.6%) of the total sample (Mage = 31.96, SD = 5.33) - 31.9% in active treatment (n = 72) and 21.8% in survivorship (n = 55) - reported at least one sexual health concern (i.e., sexual concern, loss of libido (desire for sex), pain with sex, and unprotected sex). Those undergoing active treatment with sexual concerns had significantly higher distress than those without sexual concerns, whereas this pattern was nonsignificant for those in survivorship. Both genders often endorsed general sexual concerns and loss of libido.

CONCLUSION

The current study adds to the important and burgeoning literature on sexual health concerns of YAs oncology populations. The prevalence of sexual concerns, differences between treatment status and between those with and without sexual concerns highlight the utility and need to embed screening that includes sexual health items at point of care. This can facilitate discussion of these sensitive and multifaceted needs throughout the cancer continuum.

For the LOvE of Reproductive Health Communication: Assessment of the LGBT Oncofertility Education (LOvE) Module

Purpose: The lesbian, gay, bisexual, transgender, and queer (LGBTQ) Oncofertility Education (LOvE) module aims to improve knowledge on providing inclusive and affirming care for LGBTQ adolescents and young adults (AYAs) with cancer. The objective of this study is to evaluate the role of the module in improving reproductive health communication for the care of LGBTQ AYAs with cancer. Methods: A 10-item multiple-choice pre-test and post-test assessed learner knowledge, with total knowledge scores ranging from 0 (no correct responses) to 10 (all correct responses). A post-module survey and open-ended questions assessed relevance of the module, quality, and appropriateness to professional practice. Paired t-tests analyzed changes in knowledge before and after the module. Content analysis was applied to qualitative responses. Results: Thirty-seven learners completed both the pre-test and post-test. Around 8.1% correctly answered all pre-test questions; 59.5% correctly answered all posttest questions. The average pre-test score was 8.3, versus posttest score of 9.5 (p < 0.0001). Eighty-nine percent of learners strongly agreed that LOvE Enriching Communication Skills for Health Professionals in Oncofertility was relevant to their work; 95% strongly agreed that it was easy to understand and navigate. Open-ended responses highlighted how the module helped learners strengthen the provider-patient relationship in the context of oncofertility, create a safe space for patients, and understand the relevance of educational materials about fertility to LGBTQ patients. Conclusions: We found significant improvement in knowledge of reproductive health care for LGBTQ AYAs with cancer after completing the module. Improving provider knowledge may improve confidence in providing inclusive and affirming care for LGBTQ AYAs with cancer, resulting in improved whole-person care.

Point of Care Assessment of Sexual Concerns among AYA Oncology Active Patients and Survivors

Purpose Adolescent and young adults (AYAs) oncology populations have unique sexual health concerns that deserve more attention. The current study aimed to describe the prevalence and characteristics of sexual health and related concerns in AYAs in active treatment and survivorship to move toward integrating sexual health in routine care. Methods A total of 127 AYAs (ages 19-39) in active treatment and survivorship were recruited from three outpatient oncology clinics. In addition to providing demographic and clinical information, they completed an adapted version of the NCCN Distress Thermometer and Problem List (AYA-POST; AYA-SPOST) as part of an ongoing needs assessment study. Results Over one quarter (27.6%) of the total sample ( M age = 31.96, SD  = 5.33) - 31.9% of active treatment, and 21.8% in survivorship - reported at least one sexual health concern (i.e., sexual concern, loss of libido, pain with sex, and unprotected sex). The most frequently endorsed concerns differed between active treatments and survivorship. Both genders often endorsed general sexual concerns and loss of libido. Conclusion The literature on sexual concerns in the AYA population is sparse and inconclusive, especially accounting for gender and other types of concerns. The current study highlights the need for further examination between treatment status, psychosexual concerns, emotional distress, and demographic and clinical factors. Given the prevalence of sexual concerns in AYAs in active treatment and survivorship, providers should consider integrating assessment and discussion of these needs at onset of diagnosis and as part of monitoring.

Do young adults with cancer receive information about treatment-related impact on sex life? Results from a population-based study

BACKGROUND

Sexual dysfunction is common following a cancer diagnosis in young adulthood (18-39 years) and problems related to sex life are ranked among the core concerns in this age group. Yet, few studies have investigated to what extent adults younger than 40, receive information from healthcare providers about the potential impact of cancer and its treatment on their sex life.

METHODS

A population-based cross-sectional survey study was conducted with 1010 young adults 1.5 years after being diagnosed with cancer (response rate 67%). Patients with breast, cervical, ovarian and testicular cancer, lymphoma, and brain tumors were identified in national quality registries. Sociodemographic and clinical factors associated with receiving information were examined using multivariable binary logistic regression.

RESULTS

Men to a higher extent than women reported having received information about potential cancer-related impact on their sex life (68% vs. 54%, p < 0.001). Receipt of information varied across diagnoses; in separate regression models, using lymphoma as reference, both women and men with brain tumors were less likely to receive information (women: OR 0.10, CI = 0.03-0.30; men: OR 0.37, CI = 0.16-0.85). More intensive treatment was associated with higher odds of receiving information in both women (OR 1.89; CI = 1.28-2.79) and men (OR 2.08; CI = 1.09-3.94). None of the sociodemographic factors were associated with receipt of information.

CONCLUSIONS

To improve sexual health communication to young adults with cancer, we recommend diagnosis-specific routines that clarify when in the disease trajectory to discuss these issues with patients and what to address in these conversations.