Abstract
Introduction
Sexuality is an important aspect of life involving physical, psychological, interpersonal, and behavioral aspects. The aim of this review was to examine the literature regarding sexuality in advanced cancer patients, after taking into consideration the principal changes produced by the disease and its treatment.
Methods
This review considered references through a search of PubMed by use of the search terms “advanced cancer,” “palliative care,” in combination with “sexuality” and/or “intimacy.”
Results
Surgery, chemotherapy, hormonal therapy, radiotherapy, and drugs commonly given for the symptomatic treatment have relevant consequences on sexuality, also in the advanced stage of disease. Sexual dysfunction is a multifaceted issue and different causes may concomitantly have a role, including the psychological and clinical status. The existing clinical studies have shown important cultural barriers on sexuality. Sexuality is not considered a medical concern compared with the priority of treating cancer or symptoms. Although this issue is very private, unaddressed sexuality changes can be among the most negative influences on the social well being of a cancer patient. It is increasingly acknowledged that issues surrounding sexuality are an important factor in quality of life for patients with cancer and that sexuality is a legitimate area of concern in oncology and palliative care. Few studies have assessed sexuality in the advanced stage of disease. Nevertheless, advanced cancer patients are willing to talk about their sex lives and the impact of the disease on their sexual function.
Conclusions
To provide this component of care, professionals need to have good communication skills, an open and non-judgmental approach, and knowledge of the potential ramifications of disease and treatment of sexuality problems.
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References
World Health Organization. Sexual Health. http://www.who.int/reproductive-health/gender/sexual_health.htlm
Hughes M (2000) Sexuality and the cancer survivor. Cancer Nurs 23:477–482
Shell JA (2008) Sexual issues in the palliative care population. Semin Oncol Nurs 24:131–134
Ganz P, Rowland J, Desmond K, Meyerowitz B, Wyant G (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16:501–514
Hordern A (2008) Intimacy and sexuality after cancer. A critical review of the literature. Cancer Nurs 31:E9–E17
Caffo O, Fellin G, Bolner A, Coccarelli F, Divan C, Frisinghelli M, Mussari S, Ziglio F, Malossini G, Tomio L, Galligioni E (2006) Prospective evaluation of quality of life after interstitial brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 66:31–37
Hordern A (2000) Intimacy and sexuality for the woman with breast cancer. Cancer Nurs 23:230–236
Hordern A, Street A (2007) Issues of intimacy and sexuality in the face of cancer. Cancer Nurs 30:E11–E18
Katz A (2005) The sounds of silence: sexuality information for cancer patients. J Clin Oncol 23:238–241
Yurek D, Farrar W, Andersen BL (2000) Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. J Consult Clin Psychol 68:697–709
Bolte S, Zebrack B (2008) Sexual issues in special population: adolescent and young adults. Semin Oncol Nurs 24:115–119
McKee A, Schover L (2001) Sexuality rehabilitation. Cancer 92:1008–1012
Tierney KD (2008) Sexuality: a quality of life issue for cancer survivors. Semin Oncol Nurs 24:71–79
DeFrank J, Bahn Metha C, Stein CK, Baker F (2007) Body image dissatisfaction in cancer survivors. Oncol Nurs Forum 34:E36–E41
Kagan S, Holland N, Chalian A (2008) Sexual issues in special population: geriatric oncology-sexuality and older adults. Semin Oncol Nurs 24:120–126
Lunden-Nielsen B, Muller K, Adamsen L (2005) Malignant wounds in women with breast cancer: feminine and sexual perspective. J Clin Nurs 14:56–64
Bodurka DC, Sun CC (2006) Sexual function after gynecologic cancer. Obstet Gynecol Clin North Am 33:621–630
Bodurka DC, Pieterse SCC, QD MCP, ter Kuile MM, Lowik M, van Eijkeren MA, Trimbos JB, Kenter GG (2006) An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. Int J Gynecol Cancer 16:1119–1129
Waxman E (1993) Sexual dysfunction following treatment for prostate cancer: nursing assessment and interventions. Oncol Nurs Forum 20:1567–1571
Symon Z, Daignault S, Symon R, Dunn RL, Sanda MG, Sandler HM (2006) Measuring patients' expectations regarding health-related quality-of-life outcomes associated with prostate cancer surgery or radiotherapy. Urology 68:1224–1229
Fisher SE, Daniels IR (2006) Quality of life and sexual function following surgery for rectal cancer. Colorectal Dis 8(Suppl 3):40–42
Shell JA (2002) Evidence-based practice for symptom management in adults with cancer: sexual dysfunction. Oncol Nurs Forum 29:53–69
Metcalf M, Fishman S (1985) Factors affecting the sexuality of patients with head and neck cancer. Oncol Nurs Forum 12:21–25
Yi JC, Syrjala KL (2009) Sexuality after hematopoietic stem cell transplantation. Cancer J 5:57–64
Claessens JJ, Beerendonk CC, Schattenberg AV (2006) Quality of life, reproduction and sexuality after stem cell transplantation with partially T-cell-depleted grafts and after conditioning with a regimen including total body irradiation. Bone Marrow Transplant 37:831–836
Ganz P, Greendale G (2007) Female sexual desire—beyond testosterone. J Natl Cancer Inst 99:659–661
Wilke DR, Parker C, Andonowski A, Tsuji D, Catton C, Gospodarowicz M, Warde P (2006) Testosterone and erectile function recovery after radiotherapy and long-term androgen deprivation with luteinizing hormone-releasing hormone agonists. BJU Int 97:963–968
Barton DL, Wender DB, Sloan JA, Dalton RJ, Balcueva EP, Atherton PJ, Bernath AM Jr, DeKrey WL, Larson T, Bearden JD 3rd, Carpenter PC, Loprinzi CL (2007) Randomized controlled trial to evaluate transdermal testosterone in female cancer survivors with decreased libido; North Central Cancer Treatment Group protocol N02C3. J Natl Cancer Inst 99:672–679
Donovan KA, Taliaferro LA, Alvarez EM, Jacobsen PB, Roetzheim RG, Wenham RM (2007) Sexual health in women treated for cervical cancer: characteristics and correlates. Gynecol Oncol 104:428–434
Saewong S, Choobun T (2005) Effects of radiotherapy on sexual activity in women with cervical cancer. J Med Assoc Thai 88(Suppl 2):S11–S15
Pietrzak L, Bujko K, Nowacki MP, Kepka L, Oledzki J, Rutkowski A, Szmeja J, Kladny J, Dymecki D, Wieczorek A, Pawlak M, Lesniak T, Kowalska T, Richter P, Polish Colorectal Study Group (2007) Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol 84:217–225
Namiki S, Satoh T, Baba S, Ishiyama H, Hayakawa K, Saito S, Arai Y (2006) Quality of life after brachytherapy or radical prostatectomy for localized prostate cancer: a prospective longitudinal study. Urology 68:1230–1236
Rajagopal A, Bruera ED (2003) Improvement in sexual function after reduction of chronic high-dose opioid medication in a cancer survivor. Pain Med 4:379–383
Rajagopal A, Vassilopoulou-Sellin R, Palmer JL, Kaur G, Bruera E (2004) Symptomatic hypogonadism in male survivors of cancer with chronic exposure to opioids. Cancer 100:851–858
Stausmire JM (2004) Sexuality at the end of life. Am J Hosp Palliat Care 21:33–38
Redelman MJ (2008) Is there a place for sexuality in the holistic care of patients in the palliative care phase of life? Am J Hosp Palliat Med 25:366–371
Lamieux L, Kaiser S, Pereira J, Meadows LM (2004) Sexuality in palliative care: patient perspectives. Palliat Med 18:630–637
Ananth H, Jones L, King M, Tookman A (2003) The impact of cancer on sexual function: a controlled study. Palliat Med 17:202–205
Rowland J (1994) In sickness and in health: the impact of illness on couples’ relationships. J Marital Fam Ther 20:327–332
Hordern A, Currow D (2003) A patient-centered approach to sexuality in the face of life-limiting illness. Med J Aust 179:S8–S11
Hordern A, Strett A (2007) Constructions of sexuality and intimacy after cancer: patient and health professional perspectives. Soc Sci Med 64:1704–1718
Hordern A, Street A (2007) Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs. Med J Aust 186:224–227
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Mercadante, S., Vitrano, V. & Catania, V. Sexual issues in early and late stage cancer: a review. Support Care Cancer 18, 659–665 (2010). https://doi.org/10.1007/s00520-010-0814-0
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DOI: https://doi.org/10.1007/s00520-010-0814-0