Addressing patient sexuality issues in cancer and palliative care

A guide to the fundamental aspects of prostate cancer and the nurse's role

Prostate cancer remains a significant health concern, particularly among older men. This article provides an in-depth examination of prostate cancer, focusing on the critical role of nurses in managing this condition. It covers the pathophysiology, diagnosis and treatment options for prostate cancer, emphasising the importance of patient education, psychosocial support and holistic care. Through a detailed exploration of evidence-based practices, this article aims to enhance nurses' understanding of the subject and their ability to deliver comprehensive care to patients with prostate cancer, ultimately improving patient outcomes and quality of life.

[Sexual health in cancer care: A cross-section of patients and professionals from a patient association]

Sexual health is a central aspect of the well-being and quality of life of cancer patients. Through two separate surveys, one conducted among patients and the other among professionals, we assessed the needs and practices relating to sexual health in cancer care. The results showed that the importance attached to taking intimate and sexual life into account was fairly high, but that 44% of patients had discussed the subject with a professional, and the majority had done so on their own initiative. The types of support requested were a dedicated consultation (38%) and exchanges with other people with cancer (21%). More than half of the professionals did not discuss sexual health with their patients. The needs identified were specific training, time to exchange and share experiences with other professionals, and resources (documentation, reference websites). Professional training and appropriate tools seem necessary to meet patients' expectations.

The relationship between stress, social support, and quality of life among spouses of patients at the end-of-life stage in Thailand: A correlational study

Background

Non-communicable diseases have become a leading global health challenge, with mortality rates steadily rising. Insufficient patient care can worsen chronic illness, often placing significant caregiving responsibilities on the patient's spouse. In some cases, spouses may need to leave their jobs to provide full-time care, especially during the end-of-life stage. Spousal caregivers often face emotionally distressing circumstances while caring for their loved ones, which can lead to elevated stress levels. However, research indicates that adequate social support can improve caregivers' quality of life, reducing some of the burdens associated with end-of-life care.

Objectives

This study aimed to assess and analyze the relationships between stress, social support, and quality of life experienced by spousal caregivers in Thailand, guided by Lazarus and Folkman's (1984) Stress and Coping Theory.

Methods

A correlational descriptive study design was used. The study was conducted with 84 spouses of patients in the end-of-life stage at a university hospital between October 2021 and March 2022. Data were collected using a questionnaire covering stress, social support, and quality of life and analyzed using Pearson's Product Moment and Spearman Rank Correlation Coefficients.

Results

The majority of spouses were women aged between 31 and 83 years (Mean = 61.24, SD = 10.42). The mean stress level was 6.40 (SD = 1.62), the mean social support was 55.07 (SD = 9.06), and the mean quality of life was 94.69 (SD = 10.04). There was no significant correlation between social support and stress (r = -0.098, p = 0.373). However, stress was negatively correlated with quality of life (r = -0.299, p = 0.006), and social support was positively related to quality of life (r = 0.219, p = 0.045).

Conclusion

Spousal caregivers of patients at the end-of-life stage experienced varying levels of stress, social support, and quality of life. While no significant relationship was found between social support and stress, stress negatively impacted quality of life, while higher social support was associated with improved quality of life. Healthcare providers, especially nurses, should assess and address the stress, social support, and overall well-being of spousal caregivers to enhance their quality of life.

Quality of Nursing Care: Addressing Sexuality as Part of Prostate Cancer Management, an Umbrella Review

BACKGROUND

Sexuality is a fundamental aspect of health and wellbeing. The management of prostate cancer can result in erectile dysfunction and body feminisation, resulting in loss of masculinity and alterations of body image. Prostate cancer patients identify sexuality as an unmet need and report little or no communication with their healthcare providers on the topic.

AIM

This umbrella review aims to determine the barriers that may preclude nurses from discussing sexuality with prostate cancer patients.

DESIGN

An umbrella review of systematic review studies was undertaken using the PRISMA guidelines.

METHOD

Five databases were comprehensively searched, CINAHL, MEDLINE, PsycINFO, Cochrane and Prospero, from October 1, 2013 to December 1, 2023, using the defined criteria. A total of 11 systematic reviews were included in this review consisting of 10 with quantitative and 1 with quantitative/mixed methods approach.

RESULTS

This study identified common themes, which were categorised into four groups: (a) lack of training and education, (b) age and years of clinical experience of nurses, (c) personal values and attitudes and (d) organisational factors. These factors contribute to why nurses feel unprepared and admit to not having adequate knowledge or expertise to have this discussion.

CONCLUSION

The findings of this study illustrate that nurses require specialised communication skills to manage sensitive discussion with patients. Education is crucial to facilitate and empower nurses to discuss sexuality with their patients. Developing a pathway to specialist referrals will encourage nurses to address this with their patients.

NO PATIENT OR PUBLIC CONTRIBUTION

For the preparation of this paper, no direct involvement of patients or public has been deemed applicable to this work. This is an umbrella review paper.

Addressing sexual health in oncology: perspectives and challenges for better care at a national level

Introduction

The emotional impacts of oncological treatments can negatively affect sexual health and intimate relationships. Advances in cancer management have extended patient survival, underscoring the importance of addressing sexual health post-diagnosis.

Objectives

To explore physicians' practices regarding the approach to sexual health during oncological consultations; identifying barriers to addressing sexuality and assessing the need for sexual health training.

Methods

An observational, cross-sectional study that assessed the management of sexual health by physicians involved in oncological treatment, using an anonymous questionnaire distributed via SurveyMonkey.

Results

Of 133 physicians surveyed, 31.6% never or rarely address sexual health. Only 10.5% feel frequently prepared on this topic, while 24.8% almost never have the appropriate tools to address it. 97.7% of oncologists and 92.9% of otolaryngologists (ENTs) recognize the need for sexual health training. Sexual health was more frequently discussed among patients diagnosed with prostate, cervical and breast cancer, and less so among those with ENT, bladder and colorectal tumours. The approach was more frequent among patients treated with curative intent (77.4%) than those with palliative intent (5%). The main barriers identified were lack of training (46%), lack of time (39.8%) and patient discomfort (34.6%).

Conclusion

The majority of professionals dealing with oncological patients do not address their sexual health, with the lack of training, lack of time and patient discomfort being the main barriers identified. However, 92% indicate a need for sexual health training, which could contribute to early intervention, strategy establishment and timely referral to specialists in the field.

Sexual health-a topic for cancer patients receiving oncological treatment with palliative intent

OBJECTIVES

Sexuality is an important dimension of health-related quality of life (HRQOL) in cancer patients. Studies evidence that most patients report impairments of their sexual health related to their disease or its treatment. The Quality of Life Group of the European Organization for the Research and Treatment of Cancer (EORTC) developed a patient reported outcome measure assessing multidimensional aspects of sexual health. The validation study for this instrument revealed heterogenous results for patients in palliative oncological treatment. The aim of this secondary analyses is to examine differences in patient related sexual health outcomes between palliative patients with good performance status (GPS) and those with poor performance status (PPS).

METHODS

In this observational cohort study, self-reported sexual health issue scores were compared between the two groups of patients in palliative oncological treatment with GPS vs PPS status.

RESULTS

Patients with GPS experienced significantly more sexual satisfaction than patients with PPS (p = 0.015). They reported significantly more treatment effects on their sexual activity (p = 0.005) and suffer more from decreased libido (p = 0.008). Patients with PPS reported significantly more fatigue (p = 0.03) and regarded preservation of sexual activity of higher importance than did patients with GPS (p = 0.049).

CONCLUSIONS

Our study demonstrates the importance of sexuality for patients in palliative oncological treatment, especially for those with limited performance status. Considering the patients´ perspective, sexual health reaches beyond physical functioning. Patients in a palliative phase of disease report high levels of psychosexual problems while sexual performance deteriorates. Sexuality is an important aspect of HRQOL for these patients, needs to be addressed by health care providers and sensitively integrated into palliative care plans.

What contributes to promote sexual health in cancer palliative care? A realist review

INTRODUCTION

Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored.

OBJECTIVES

In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care.

METHODS

A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations.

RESULTS

Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo.

CONCLUSIONS

The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.