Unmet needs in sexual health in bladder cancer patients: a systematic review of the evidence

Effectiveness of the Continuous Care Model on Quality of Life, Sexual Satisfaction and Function in Bladder Cancer Patients Undergoing Tumor Resection Surgery: A Randomized Control Trial

BACKGROUND

Bladder cancer is a global health concern, and while surgery is vital, it often diminishes patient quality of life, notably sexual function. Existing self-care education is insufficient, necessitating a more holistic approach. The Continuous Care Model (CCM), which emphasizes patient empowerment, shows promise. This study investigates a CCM intervention that includes sexual health education to improve quality of life (QoL) and sexual satisfaction in bladder cancer patients.

METHODS

This randomized controlled trial enrolled 54 bladder cancer patients undergoing tumor resection surgery in Tehran, Iran (April-September 2024). Participants were randomly assigned to either a CCM intervention group (n = 26) and a control group (n = 28). QoL was assessed using the EORTC QLQ-C30; sexual function and satisfaction were measured using the Larson Sexual Satisfaction Questionnaire, IIEF, and FSFI at baseline and at 1 and 3 months postintervention.

RESULTS

The CCM group demonstrated significantly improved overall QoL (P < .001) and several subscales (physical, emotional, cognitive, fatigue) compared to controls. Sexual satisfaction also improved significantly in the CCM group (P < .001). Sexual function enhanced particularly for males (enhanced orgasm and sexual desire, P = .049, P = .020, respectively). No significant changes in female sexual function were observed, although past medical history (P = .019) and partner's job (P = .017) were significantly associated with female sexual function.

CONCLUSIONS

The CCM intervention effectively enhanced QoL, sexual satisfaction, and sexual function particularly in males. Further research is needed to address the unique challenges impacting female patients' sexual function postbladder cancer surgery.

"I was in a very deep, dark place... I wasn't prepared for that": A qualitative assessment of the emotional well-being needs of patients undergoing cystectomy

INTRODUCTION

Studies have shown that cystectomy has a large psychological burden on patients with bladder cancer. However, there has been little work characterizing areas of improvement. This project aimed to understand cystectomy patients' experiences and to identify patient-centered methods to improve perioperative support.

METHODS

Five focus groups, divided by diversion type and gender, (4 virtual, 1 in person) of patients with bladder cancer (n = 17) who underwent cystectomy were conducted. Conversations were transcribed and qualitatively analyzed using the Sort and Sift, Think and Shift© method. Transcripts were coded in NVivo and themes were summarized in higher-level analysis.

RESULTS

Patients described feelings of depression, anger, and anxiety in response to their cancer diagnosis, need for cystectomy, and living with urinary diversion. Patients experienced daily mental hardship while adapting. They experienced distress from diversion visibility in public and private encounters. Many expressed a dichotomy of feeling grateful for the treatment while also feeling bitter about the impact on their daily life. Patients reported that while their care team provided support for tangible needs, they did not provide information for nor discuss mental and sexual health needs during this time. Patients reported that if their provider had initiated discussions and offered referrals, they would have accepted support. Patients also emphasized the benefit of social and peer support networks for emotional support.

CONCLUSIONS

Groups identified the psychological difficulties of bladder cancer diagnosis and cystectomy. Potential avenues for improvement included incorporating support resources into the care plan and perioperative discussion regarding the emotional impact of surgery.

Implementation of a sexual health clinic in an oncology setting: patient and provider perspectives

BACKGROUND

Sexual dysfunction is prevalent among cancer survivors, significantly impacting patient and partner quality of life. Despite this, sexual health clinics (SHCs) remain rare in cancer centres across Canada. An innovative clinic was developed at Princess Margaret Cancer Centre in Toronto, Canada to address this significant gap in survivorship care. This study examines factors affecting the provision of sexual healthcare and the implementation of a sexual health clinic within a large urban centre.

METHODS

The Quality Implementation Framework was used to explicate patient and provider experience and identify barriers and facilitators to integrating sexual healthcare into routine cancer care workflows. Healthcare providers and patients representing selected cancer types (prostate, cervical, ovarian, testicular, bladder, kidney, and head and neck cancer) participated in semi-structured interviews. Interviews were transcribed and analyzed using the Framework qualitative analysis protocol.

RESULTS

The analysis identified three organizing domains and ten themes that describe the unique aspects of the sexual healthcare experience and critical factors for sexual health implementation. Both patients and providers described a lack of sexual health support in the oncology setting and emphasized the need for comprehensive and personalized care. Limitations of current care provision included mutual silence between patients and providers due to discomfort in discussing sexual issues, insufficient provider confidence in delivering optimal sexual healthcare, and constraints related to space and time. Key Factors for implementing a sexual health clinic in oncology emphasized the importance of having a dedicated clinic, flexibility in service delivery, proactive patient engagement, and ongoing staff education.

CONCLUSIONS

Findings highlight significant challenges in addressing sexual health in an oncology setting, underscoring the need for specialized sexual health clinics that are integrated with, but distinct from, routine oncology care. This study further emphasizes the need for incorporating sexual healthcare in survivorship programs as well as the necessity of conducting thorough implementation research, involving multiple stakeholders, prior to launching new programs.

Radical cystectomy in the female patient: The pelvic floor, sexual function, and patient/provider education

Radical cystectomy in women results in numerous deleterious anatomic impacts to the pelvic floor that can result in sexual dysfunction, pelvic organ prolapse, and other disorders of pelvic floor function. A comprehensive understanding of this relationship and the quality-of-life impacts of radical cystectomy in women is important. This narrative review provides an overview of female pelvic floor disorders in the setting of radical cystectomy, with focus on present understanding of related anatomy, incidence, and prevention strategies, as well as the importance of both provider and patient education.

The effect of psychosocial interventions for sexual health in patients with pelvic cancer: a systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer.

METHODS

Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers.

RESULTS

Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01).

DISCUSSION

There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.

Identifying the supportive care needs of people affected by non-muscle invasive bladder cancer: An integrative systematic review

PURPOSE

To understand supportive care needs among people with non-muscle invasive bladder cancer (NMIBC).

METHODS

An integrative systematic review was reported using the Preformed Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Seven electronic databases were searched for relevant studies, including all quantitative, qualitative, and mixed methods studies, irrespective of research design. The review process was managed by Covidence systematic review software. Two reviewer authors independently performed data extraction using eligibility criteria. Quality appraisal was conducted, and a narrative synthesis was performed.

RESULTS

A total of 1129 articles were screened, of which 21 studies met the inclusion criteria. The findings revealed that the frequency of supportive care needs reported by NMIBC participants included psychological/emotional (16/21:76%), physical (16/21:76%), practical (8/21:38%), interpersonal/intimacy (7/21:33%), family-related (7/21:33%), health system/information (5/21:23%), social (4/21:19%), patient-clinician communication (3/21:14%), spiritual (1/21:5%) and daily needs (1/21:5%).

CONCLUSION

People affected by NMIBC experience anxiety, depression, uncertainty, and fear of recurrence. The physical symptoms reported included urinary issues, pain, sleeping disorders and fatigue. These supportive care needs persist throughout the participants' treatment trajectory and can impact their quality of life.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying supportive care needs within the NMIBC population will help inform future interventions to provide patient-centred care to promote optimal well-being and self-efficacy for people diagnosed with NMIBC.

Prospective evaluation of sexual health following radical cystectomy due to bladder cancer

Background

There is a lack of data concerning sexual health following open radical cystectomy (RC), especially in elderly patients and women.

Aim

To describe sexual health and its impact on general health as well as survival in patients undergoing standard open RC for the treatment of bladder cancer (BC). Due to limited data, subgroup analysis for elderly patients and women was performed.

Methods

A prospective noninterventional clinical study was performed evaluating sexual health in RC with any kind of urinary diversion due to BC with a follow-up of 12 months after RC. The study was approved by the local ethics review board (A 2021-0175) and was registered at the German Clinical Trial Register (DRKS00026255). Assessment of sexual health was done with the following validated questionnaires: EORTC QLQ-C30 (for quality of life; European Organisation for Research and Treatment of Cancer), EORTC SH22 (for sexual health), and IIEF-5 (5-item International Index of Erectile Function).

Outcomes

The standard measurements of EORTC QLQ-C30, EORTC SH22, and IIEF-5 as well as overall survival.

Results

Thirty-two patients participated in the study with a mean age of 71.5 years (SD, 9.7): 25 (78.1%) were male and 7 (21.9%) were female. Overall there is a heterogenic picture for sexual health in the study population, but sexual satisfaction is significantly higher prior to surgery while the importance of a sex life stays high and stable. Interestingly, the general health score is significantly correlated to sexual satisfaction (Pearson's correlation; r = 0.522, P = .002) preoperatively but not following surgery: r = 0.103 (P = .665) after 3 months, r = 0.478 (P = .052) after 6 months, r = 0.276 (P = .302) after 9 months, and r = 0.337 (P = .202) after 12 months. The importance of a sex life is still essential for the patients, especially when recovering from RC; nearly the same can be reported for elderly patients. Unfortunately, the data for women are too limited to report robust results.

Clinical Implications

Evaluation, advice, and monitoring of sexual health must be integrated into clinical practice, particularly in women.

Strengths and Limitations

At least to our knowledge, this is the first systematic prospective evaluation of sexual health in patients with BC receiving RC. Due to the small sample size, there is a risk of selection bias.

Conclusion

Sexual health is important for patients with BC receiving RC, and it is an essential part of quality of life, especially in elderly patients.

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.

Preservation of Erectile and Ejaculatory Functions After Tetramodal Bladder-Sparing Therapy Incorporating Consolidative Partial Cystectomy Against Muscle Invasive Bladder Cancer

OBJECTIVE

To cross-sectionally assess erectile and ejaculatory functions after tetramodal bladder-sparing therapy consisting of transurethral resection, chemoradiotherapy, and consolidative partial cystectomy in patients with muscle invasive bladder cancer.

MATERIALS AND METHODS

Among 72 enrolled male patients who underwent tetramodal bladder-sparing therapy from 2006 to 2019, 42 who visited the outpatient clinic from February to October 2020 received questionnaires. Erectile function, ejaculatory function, and quality of life were assessed using the International Index of Erectile Function short form, the Male Sexual Health Questionnaire Ejaculatory Dysfunction short form, and the Functional Assessment of Cancer Therapy.

RESULTS

Among the 42 patients, 9 were excluded because of incomplete responses and 33 were eligible for analyses. The median (range) age at survey and the time from treatment completion to responding to the questionnaires was 70 (50-87) years and 4.2 (0.4-14.0) years, respectively. The median International Index of Erectile Function short form-5 score was 11 (5-25), and 3 (9.1%) and 9 (27.3%) patients had no and mild erectile dysfunction, respectively. The Male Sexual Health Questionnaire Ejaculatory Dysfunction short form results showed that 23 (69.7%) patients responded that they could ejaculate. Patients with higher Male Sexual Health Questionnaire Ejaculatory Dysfunction short form scores had better erectile function and quality of life than those with lower Male Sexual Health Questionnaire Ejaculatory Dysfunction short form scores.

CONCLUSION

Preservation of erectile and ejaculatory functions was demonstrated in muscle invasive bladder cancer patients treated with tetramodal bladder-sparing therapy. In addition to lower urinary tract function, preservation of male sexual function, especially ejaculatory function, in bladder-sparing therapy can be an advantage over radical cystectomy.

Experiences of sexual well-being interventions in males affected by genitourinary cancers and their partners: an integrative systematic review

PURPOSE

Sexual well-being has been identified as an unmet supportive care need among many individuals with genitourinary (GU) cancers. Little is known about the experiences of using sexual well-being interventions among men and their partners.

METHODS

This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and followed a systematic review protocol. Data extraction and methodological quality appraisal were performed, and a narrative synthesis was conducted.

RESULTS

A total of 21 publications (reporting on 18 studies) were included: six randomised control trials, seven cross-sectional studies, three qualitative studies, and five mixed methods studies. Sexual well-being interventions comprised medical/pharmacological and psychological support, including counselling and group discussion facilitation. The interventions were delivered using various modes: face-to-face, web-based/online, or telephone. Several themes emerged and included broadly: (1) communication with patient/partner and healthcare professionals, (2) educational and informational needs, and (3) timing and/or delivery of the interventions.

CONCLUSION

Sexual well-being concerns for men and their partners were evident from diagnosis and into survivorship. Participants benefited from interventions but many articulated difficulties with initiating the topic due to embarrassment and limited access to interventions in cancer services. Noteworthy, all studies were only representative of men diagnosed with prostate cancer, underscoring a significant gap in other GU cancer patient groups where sexual dysfunction is a prominent consequence of treatment.

IMPLICATIONS FOR CANCER SURVIVORS

This systematic review provides valuable new insights to inform future models of sexual well-being recovery interventions for patients and partners with prostate cancer, but further research is urgently needed in other GU cancer populations.

The Anatomy of a Hybrid In-Person and Virtual Sexual Health Clinic in Oncology

Sexual health is compromised by the diagnosis and treatment of virtually all cancer types. Despite the prevalence and negative impact of sexual dysfunction, sexual health clinics are the exception in cancer centers. Consequently, there is a need for effective, efficient, and inclusive sexual health programming in oncology. This paper describes the development of the innovative Sexual Health Clinic (SHC) utilizing a hybrid model of integrated in-person and virtual care. The SHC evolved from a fusion of the in-person and virtual prostate cancer clinics at Princess Margaret. This hybrid care model was adapted to include six additional cancer sites (cervical, ovarian, testicular, bladder, kidney, and head and neck). The SHC is theoretically founded in a biopsychosocial framework and emphasizes interdisciplinary intervention teams, participation by the partner, and a medical, psychological, and interpersonal approach. Virtual visits are tailored to patients based on biological sex, cancer type, and treatment type. Highly trained sexual health counselors facilitate the virtual clinic and provide an additional layer of personalization and a "human touch". The in-person visits complement virtual care by providing comprehensive sexual health assessment and sexual medicine prescription. The SHC is an innovative care model which has the potential to close the gap in sexual healthcare. The SHC is designed as a transferable, stand-alone clinic which can be shared with cancer centers.

Women's experience of sexuality after radical cystectomy - a qualitative study

PURPOSE

The aim of this study was to explore how women experienced sexuality after radical cystectomy due to bladder cancer.

METHODS

We performed an interview study with qualitative design with content analysis. Inclusion criteria were age below 75 years. In total 10 women, with a median age of 64 years at surgery, were interviewed at median 24 months post radical cystectomy.

RESULTS

The 10 women described sexual life as affected after surgery but they all tried to find ways to overcome the new situation together with their partner. The overall theme was 'A balance between emotional and physical closeness' emerged from 30 codes that were condensed into five subcategories and two categories: 'A sensual relationship' and 'A sexual relationship'. The first category constituted the subcategories 'Feeling of intimacy' and 'The importance of the relationship'. The category 'A sexual relationship' was revealed from the subcategories 'Reluctance to engage in sexual activity' and 'Partner inability to engage in sexual activity', and 'Acting for sexual rehabilitation'.

CONCLUSIONS

The uncertainty that the women felt about their anatomical changes after radical cystectomy created a sexual anxiety and reluctance to resume intercourse. Even though the surgery had a major impact on their sexual life, the women tried to be sexually active. However, the meaning of sexual life was not just having sexual activity but also included closeness, affirmation, affection, and feeling attractive. Sexual counseling at an appropriate timepoint is essential to assure a balance between emotional and physical closeness, i.e. to regain sexual health.

Female sexual function in bladder cancer: A review of the evidence

Background

Bladder cancer (BC) treatments are known to be invasive; nevertheless, research into the long-term effects is limited and in the context of sexual function often male focussed. Female sexual dysfunction (FSD) has been reported in up to 75% of female patients. This systematic scoping review examines the literature on sexual consequences of BC in female patients.

Objective

This study aimed to systematically evaluate the evidence on female sexual function in BC to identify areas of unmet need and research priorities.

Evidence Acquisition

We performed a critical review of PubMed, PsychMed, CINAHL, MEDLINE and the Cochrane Library in March 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews statement following Levac et al. methodology. Identified reports were reviewed according to the Critical Appraisal Skills Programme (CASP) criteria. 45 publications were included.

Evidence Synthesis

There was an inconsistent use of patient-reported outcome measures (PROMs), with commonly used PROMs having a narrow symptom focus. However, common symptoms emerged: loss of desire, orgasmic disorders, vaginal dryness, dyspareunia, difficult intromission, reduced clitoral sensation, psychological concerns related to diagnosis, fear of contamination and body image. Sexual activity was reduced in most groups, despite women expressing a motivation to retain sexual function. The degree of symptom distress associated with FSD is underreported. Evidence emerged regarding a gap for women in clinician counselling and follow-up.

Conclusions

The patient's perspective of FSD in BC patients is poorly understood and under-addressed in clinical practice. There have been very few qualitative studies of FSD in BC. Any intervention designed to address the problem must start with greater understanding of both the patients' and clinicians' perspective.

Lay Summary

We examined the evidence on sexual consequences of BC in women. It is apparent that despite common themes of sexual dysfunction emerging, the problem is poorly understood and addressed in clinical practice.

Development of a specific supportive care needs scale for radical cystectomy patients and its reliability and validity test

OBJECTIVE

To develop a specific supportive care needs scale for patients who have undergone radical cystectomy, and to assess its reliability and validity.

METHODS

The clinical test version of the scale was developed based on literature review, qualitative interviews, Delphi method, and a pretest. The reliability and validity of the scale were assessed in a cohort of 603 patients who had undergone radical cystectomy at 5 Grade A hospitals in Chongqing, China.

RESULTS

The final scale included 26 items across the following 7 dimensions: health information needs, social needs, family support needs, physiological needs, sexual needs, daily activities needs, and psychological needs. The content validity index was 0.991 and the content validity indices of each item ranged from 0.889 to 1.00. Seven factors were extracted by exploratory factor analysis and the cumulative contribution of variance accounted for 70.762%. Confirmatory factor analysis revealed a good fit of the model (X²/df = 1.595, GFI = 0.904, IFI = 0.943, TLI = 0.932, CFI = 0.942, RMSEA = 0.044, and RMR = 0.026). The Cronbach's ɑ coefficient and retest reliability were 0.807 and 0.810, respectively.

CONCLUSION

The specific supportive care needs scale for radical cystectomy patients developed in this study showed the good reliability and validity. The tool can be invaluable for comprehensive assessment of the specific supportive care needs of these patients.

Radical cystectomy and women's sexual health - can we do better?

PURPOSE OF REVIEW

Female sexual function after radical cystectomy is a crucial, but historically overlooked component of bladder cancer survivorship. This review focuses on recent studies, which have investigated pelvic health and sexual function after radical cystectomy. We discuss modifiable factors, which may contribute to decreased sexual function after radical cystectomy and techniques, which may lead to improved outcomes.

RECENT FINDINGS

Sexual function is important to women and there is a significant desire (and unmet need) for more perioperative counseling and discussion regarding sexual function changes and quality of life impacts. Sexual function may be altered due to a combination of hormonal changes from ovarian removal, anatomic changes from vaginal alteration, and sensation changes due to damage to the neurovascular bundle. Techniques to preserve these structures have been developed.

SUMMARY

Sexual function is an important component of survivorship and increasing attention is being focused on this area. Long term studies with objective measures are needed for to compare various techniques and ensure oncologic safety. Ovarian preservation, anterior vaginal wall preservation, and vaginal estrogen replacement should be carefully considered for most patients.

Mental Health in Urologic Oncology

This article is a systematic review of mental health in urologic oncology patients with prostate cancer (PCa), bladder cancer (BC), renal cell carcinoma (RCC), testicular cancer (TC), or penile cancer (PeCa). For all pathologies, a focus on increasing quality of life post-treatment demonstrated a positive impact in reducing Mental Health Illness (MHI) prevalence. Cancer specific mental health care may be given to patients to reduce suicide risk in BC patients and sexual identify and masculinity counseling may improve mental health for TC or PeCa patients. In order to better accommodate patient’s mental health needs when undergoing GU cancer treatment, we recommend incorporation of mental health metrics such as questionnaires to assess early treatment of MHI, a greater emphasis on psychosocial support with the patient’s loved ones, peers, and healthcare team, alongside advising healthy habits such as exercise which has been shown to drastically reduce MHI incidence across all pathologies. We hope that these measures conducted by urologists and oncologists, alongside possible coordination with psychiatrists and psychologists for psychotherapy, psychopharmacology, and neuro-stimulation treatment modems may be helpful in the long term to reduce MHI incidence in urology oncology patients. Given the higher incidence of MHI in oncology patients and in the patient population after the Covid-19 pandemic, MHI awareness in the sphere of urologic oncologic treatment continues to be crucial when creating a collaborative treatment platform for patients.

Perceived Unmet Needs in Patients and Caregivers Living With Advanced Bladder Cancer: An Infodemiology Study Using Data From Social Media in the United States (Preprint)

Background

Locally advanced or metastatic bladder cancer (BC), which is generally termed advanced BC (aBC), has a very poor prognosis, and in addition to its physical symptoms, it is associated with emotional and social challenges. However, few studies have assessed the unmet needs and burden of aBC from patient and caregiver perspectives. Infodemiology, that is, epidemiology based on internet health-related content, can help obtain more insights on patients’ and caregivers’ experiences with aBC.

Objective

The study aimed to identify the main discussion themes and the unmet needs of patients with aBC and their caregivers through a mixed methods analysis of social media posts.

Methods

Social media posts were collected between January 2015 and April 2021 from US geolocalized sites using specific keywords for aBC. Automatic natural language processing (regular expressions and machine learning) methods were used to filter out irrelevant content and identify verbatim posts from patients and caregivers. The verbatim posts were analyzed to identify main discussion themes using biterm topic modeling. Difficulties or unmet needs were further explored using qualitative research methods by 2 independent annotators until saturation of concepts.

Results

A total of 688 posts from 262 patients and 1214 posts from 679 caregivers discussing aBC were identified. Analysis of 340 randomly selected patient posts and 423 randomly selected caregiver posts uncovered 33 unique unmet need categories among patients and 36 among caregivers. The main unmet patient needs were related to challenges regarding adverse events (AEs; 28/95, 29%) and the psychological impact of aBC (20/95, 21%). Other patient unmet needs identified were prognosis or diagnosis errors (9/95, 9%) and the need for better management of aBC symptoms (9/95, 9%). The main unmet caregiver needs were related to the psychological impacts of aBC (46/177, 26.0%), the need for support groups and to share experiences between peers (28/177, 15.8%), and the fear and management of patient AEs (22/177, 12.4%).

Conclusions

The combination of manual and automatic methods allowed the extraction and analysis of several hundreds of social media posts from patients with aBC and their caregivers. The results highlighted the emotional burden of cancer for both patients and caregivers. Additional studies on patients with aBC and their caregivers are required to quantitatively explore the impact of this disease on quality of life.

Indications for fertility preservation not included in the 2017 Japan Society of Clinical Oncology Guideline for Fertility Preservation in Pediatric, Adolescent, and Young Adult Patients treated with gonadal toxicity, including benign diseases

In recent years, local governments in Japan have established a public financial support system for fertility preservation in pediatric, adolescent, and young adult cancer patients. Fertility preservation has become popular for patients with cancers included in the gonadal toxicity risk classification of the 2017 edition of the Guideline for Fertility Preservation in Children, Adolescents and Young Adult Cancer Patients from the Japan Society of Clinical Oncology. However, patients with cancer and non-cancer diseases that are not included in the Guideline's gonadal toxicity risk classification also often receive treatment that may affect fertility, but they are often denied the opportunity of fertility preservation because no public financial support is available for diseases not listed in the Guideline. The national research project proposes including these diseases in the indications and treatment for fertility preservation. Therefore, we cooperated with the Japan Society for Fertility Preservation and the Ministry of Health, Labour and Welfare research group to solicit opinions from experts in each therapeutic area and reviewed the literature and overseas guidelines. This paper summarizes the findings of the project. We believe that it will be an important source of information for clinicians treating patients who need fertility preservation but note that the appropriateness of fertility preservation for the disorders listed in this report needs to be continuously reviewed as medical care advances.

Erectile dysfunction in nonmuscle-invasive bladder cancer patients before and after transurethral resection (TUR) of bladder tumor in China

The aim of this study was to investigate the incidence of erectile dysfunction (ED) in nonmuscle-invasive bladder cancer (NMIBC) patients before and after transurethral resection (TUR) in China. Clinical data from 165 male patients with NMIBC who received adjuvant intravesical chemotherapy after TUR in Neijiang First People's Hospital (Neijiang, China) between January 2010 and June 2019 were retrospectively reviewed. The sexual function of these patients was evaluated before and 1.5 years after initial TUR by the International Index of Erectile Function-5 (IIEF-5). An age-specific subanalysis was performed among the patients: <45 years old (Group 1, n = 19) and ≥45 years old (Group 2, n = 146). Before and 1.5 years after TUR, the incidence rates of ED in Group 1 were 15.8% and 52.6%, and those in Group 2 were 54.1% and 61.0%, respectively. The difference between groups was statistically significant at the preoperative stage (15.8% vs 54.1%, P = 0.002) but not at the postoperative stage (52.6% vs 61.0%, P = 0.562). Compared with the preoperative stage, the incidence of ED at the postoperative stage was increased significantly in Group 1 (15.8% vs 52.6%, P = 0.017) but not in Group 2 (54.1% vs 61.0%, P = 0.345). In conclusion, the incidence of ED increased in male NMIBC patients under the age of 45 years after TUR in China. These patients should be offered professional counseling during the follow-up period.

The effect of sexual self-schemas and sexual embarrassment of nursing students on the attitudes and beliefs of students related to sexual health

AIM

Sexual health needs are one of the holistic care needs. Nurses need to help individuals identify and meet these needs. However, sometimes their perception of sexuality can affect their attitudes towards care. The aim of this study determine the effect of sexual self-schema and sexual embarrassment on attitudes and beliefs related to sexual health in nursing students.

BACKGROUND

The sexual self-schema, which emphasizes the cognitive aspect of sexuality, is defined as cognitive generalizations that a person does for her/his own sexuality. Sexual self-schemas are known to affect individuals' feelings, beliefs and attitudes towards sexuality. Those with a positive sexual self-schema experience less embarrassment and more positive attitudes towards sexuality. Those with a negative sexual self-schema experience more sexual embarrassment. Those who experience sexual embarrassment have an avoidance of sexual interaction and talking about sexual issues. Nurses and student nurses have embarrassed to talk about sexuality with their patients. It is thought that sexual attitudes and beliefs are effective on this situation.

DESIGN

This study was conducted in a cross-sectional descriptive type. Structural equality model was established to test the hypotheses of the research. In the model, the direct effects of the sexual self-schema and the sexual embarrassment on sexual attitudes and beliefs were examined. In addition, the mediating effect of sexual embarrassment between sexual schemas and sexual attitudes and beliefs is also included in the model.

METHODS

The study population was the students who attended to and conducted clinical practice at the second, third and fourth study year at a Faculty of Health Sciences. For data collection, the Introductory Information Form which questioned socio-demographic characteristics of individuals, Sexual Self-Schema Scale (SSS), Sexual Embarrassment Scale (SES), and Sexual Attitudes and Beliefs Survey for Sexual Health (SABS) were used. The data were collected online with voluntary participation.

RESULTS

Students' average scale scores were: SSS: 121.57 ± 21.23, SES: 12.16 ± 5.74 and SABS: 35.62 ± 7.53. It was also found that sexual self-schemas and sexual embarrassment effected sexual attitudes and beliefs.

CONCLUSION

It could be recommended that these results be tested with different studies, that the course content on sexual issues be reviewed be addressed in a broader context.

Incorporating the Principles of Sex Therapy into Urologic Care

Urologic conditions and their treatments can have a significant impact on patients' sexual functioning and sexual health. Although urologists address sexual dysfunction within their scope of practice, sexual health conversations occur rarely and focus narrowly on physiologic sexual function. The sex therapy perspective considers biologic, psychological, relationship, and cultural aspects of sexuality. We propose that urologists benefit from taking this perspective when performing sexual health assessment. Urologists are not required to provide sex therapy but can optimize their patient's sexual well-being by taking a holistic perspective on sex and offering informational resources and referral to colleagues with complementary sexual health expertise.

The development of the Cystectomy-Pathway Assessment Tool (C-PAT): a concise tool to assess the quality of care in the cystectomy pathway

OBJECTIVES

To develop and test the psychometric properties of a concise, patient-reported questionnaire, designed to assess key aspects of the radical cystectomy (RC) patient pathway that are important to both patients and clinicians.

PATIENTS AND METHODS

Draft items were developed by a consultation with a 13-member expert clinical panel, and the in-depth qualitative analysis of 14 semi-structured interviews with patients who had received RC within the previous 18 months. A further nine cognitive interviews with patients refined the items and ensured they were easy to complete. Pilot testing in 122 patients recruited from five hospitals in England tested the properties of validity and reliability of the resulting 17-item questionnaire.

RESULTS

Patients and clinicians identified the following aspects as important for the delivery of quality patient care. These included timely referral and initial test results; an explanation of risk/benefits of treatment; access to a cancer nurse specialist; training and support in stoma management; timely surgery, surgical complications, and timely follow-up. Pilot testing showed missing data was low (≤3% for all items), and between 73% and 89% of the responses to items were the most positive about their care (indicating ceiling effects). Five items were identified using factor analysis as being statistically related (Cronbach's α 0.76, intraclass correlation coefficient test-retest reliability of 0.95) and formed the scored part of the tool 'care and support', scored 0-16. There was insufficient evidence at this stage to show the tool was capable of measuring differences between cancer centres.

CONCLUSION

We have developed a questionnaire that captures aspects of quality of care within the RC patient pathway. The results support the validity and reliability of the 17-item Cystectomy-Pathway Assessment Tool (C-PAT). We envisage the tool can be the basis for audit of the patient reported assessment of the quality of care for individual cancer centres.

Designing a Pragmatic Intervention to Help Improve the Bladder Cancer Patient Experience

Bladder cancer (BC) is the 10th most common malignancy worldwide and the patient experience is found to be worse than that for patients diagnosed with other cancer types. We aimed to develop a wellbeing intervention to help improve the bladder cancer patient experience by ameliorating their health-related Quality of Life (HRQoL). We followed the 3 phases of the modified Medical Research Council (MRC) Framework for development of complex interventions. Following a systematic review of the literature on mental, sexual, and physical wellbeing, we conducted discussion groups with patients and healthcare professionals on these 3 themes. A consultation phase was then conducted with all relevant stakeholders to co-design a wellbeing intervention as part of a feasibility study. A pragmatic wellbeing feasibility trial was designed based on the hypothesis that a wellbeing program will increase patient awareness and attendance to services available to them and will better support their needs to improve HRQoL. The primary feasibility endpoints are patient attendance to the services offered and changes in HRQoL. The principle of patient centered care has strengthened the commitment to provide a holistic approach to support BC patients. In this study, we developed a wellbeing intervention in collaboration with patients and healthcare professionals to meet an unmet need in terms of the BC patient experience.