In small survey, oncologists and APPs didn't discuss potential impact of disease, treatment on sexuality.
This article was first published on Sunday, October 27, 2019 in MedPage Today.
By Salynn Boyles, Contributing Writer
NASHVILLE -- Cancer care physicians and providers are not discussing sexual side effects of treatment with their patients, a researcher reported here.
A 19-item survey was distributed to 88 oncology physicians and advanced practice providers (APP), of whom just 13 responded, according to Justin Dubin, MD of the University of Miami Miller School of Medicine.Among the nine oncologists and four APPs who did respond, 30.8% said they often or always discussed sexual health with their patients.
But almost half (46.2%) of responding providers said they rarely or never referred their patients to a specialist trained in sexual health, Dubin and colleagues reported at the Sexual Medicine Society of North America (SMSNA) fall meeting.
Also, more than half (53.8%) reported never receiving training in male erectile dysfunction, while 61.5% said they had never received training in male ejaculatory or orgasmic disorders.
61.5% reported that they had never received training in female sexual disorders related to orgasm or libido.
Sexual side effects are common following treatment for prostate, bladder, colon and other cancers. The study was designed to explore attitudes about providing sexual health information, training in the topic, and barriers to discussing sexual health with their patients with cancer.
"As sexual health experts we are interested in keeping this topic on the agenda," Dubin said. "Unfortunately, the limited data we have shows that sexual health is infrequently discussed by cancer providers. If we are going to improve the sexual health of cancer patients, we really need to start focusing on educating and training these providers."
Co-author Bruce Kava, MD, also of the University of Miami, noted that the low survey response said as much about cancer providers' reluctance to discuss sexual health, as the responses themselves.
"Not only are they not talking to their patients (about sexual health), they didn't want to talk to you about not talking to their patients," he said.
The two barriers to discussing sexual health most often sited by the providers were limited time and lack of training.
Kava said any outreach to oncologists should be simple, direct, and limited to three key points: ask, tell, refer.
"(Oncology providers) have no patience for this stuff. They are very pressed for time." he said. The message should be that the providers should ask their patients about sexual health issues, tell them there are solutions, and refer them to a sexual health specialist, he added.
In a separate SMSNA talk, Carolyn Salter, MD, of Memorial Sloan-Kettering Cancer Center in New York City, said patients and their partners are often unaware of the sexual side effects they may experience related to their cancer treatments.
"Many of the women and their partners were not informed about sexual side effects before treatment, or, if they were informed, they didn't retain to fully understand it," she told MedPage Today.
As a result, many of the women expressed guilt about not being fully informed or exploring other treatment options with their partner, and many were reluctant to discuss treatment-related sexual dysfunction within the relationship, Salter said.
"The issue became the elephant in the room for a lot of couples, and the women were scared to bring it up for fear of making it worse," she said.
Dubin also presented survey results exploring sexual health among adolescent and young adult male cancer patients.
A total of 72 men (ages 18-39) who were scheduled to begin, undergoing, or had recently completed cancer treatments were asked to complete the sexual health surveys International Index of Erectile Function (IIEF-6) and the Masturbation Erection Index (MEI).
A total of 30.6% responded, and 63.3% reported being in a sexual relationship with a partner. Almost half of the men who completed the surveys reported little difficulty achieving or maintaining an erection during intercourse and masturbation, despite their cancer treatment.
"When evaluating the reasons for why subjects did not participate, the 3 most common reasons were patient declining to participate (30.1%), missed appointment due to hospital admission (11.1%), and surveys not provided to patient due to oncologist discomfort with discussing sexual health (11.1%)," the authors reported, reiterating the need for better education among oncologists and AAPs to address sexual health among cancer patients and young adults with cancer.
Dubin and co-authors disclosed no relevant relationships with industry.
“Not only are they not talking to their patients, they didn't want to talk to you about not talking to their patients.”
Bruce Kava, MD, University of Miami
KEY TAKEAWAYS
The two barriers to discussing sexual health most often sited by the providers were limited time and lack of training.
Almost half of providers said they rarely or never referred their patients to a specialist trained in sexual health.
More than half reported never receiving training in male erectile dysfunction, while 61.5% reported that they had never received training in female sexual disorders.