Despite being considered a key component of quality-of-life, sexual health concerns in adolescents and young adults (AYA) patients with cancer (aged 15–39 years old) are often unmet due to barriers from both patients and health care professionals (HCPs). Investigation into policy and practice tools in this scope of practice is also limited.
Aim:
To review the literature on policy and practice tools in AYA oncosexology.
Method:
A scoping review was conducted using four databases: Medline, EMCARE, EMBASE, and PsycINFO, based on the Joanna Briggs Institute Scoping Review methodology. Retrieved articles were extracted into Covidence, followed by two screening rounds. Descriptive and basic content analyses were performed for evidence synthesis.
Results:
Seventy-four articles were included after screening rounds and citation searches. Overall, oncosexology policy and practice tools were categorized into screening tools (11 articles), guidelines (38 articles), training programs (15 articles), service delivery initiatives (5 articles), and the evaluation of their feasibility/challenges to implementation (5 articles). Among these, only ten articles were specifically about the AYA population. They helped identify and resolve sexual health concerns in AYA patients with cancer by providing strategies to overcome communication barriers, treatment options, and information resources for patients, and by advocating for more HCP education on this topic.
Conclusion:
The results warrant the need for more research, implementation and expansion of policy and practice tools for sexual health issues in AYA patients with cancer.
Get full access to this article
View all access options for this article.
References
1.
TierneyDK.Sexuality: A quality-of-life issue for cancer survivors. Semin Oncol Nurs, 2008; 24(2):71–79; doi: 10.1016/j.soncn.2008.02.001
2.
Cororve GingeretM, TeoI, EpnerDE. Managing body image difficulties of adult cancer patients. Cancer, 2014; 120(5):633–641.
3.
ReinmanL, CoonsHL, SopfeJ, et al.Psychosexual care of adolescent and young adult (AYA) cancer survivors. Children (Basel, Switzerland), 2021; 8(11):1058; doi: 10.3390/children8111058
4.
ACOG Committee Opinion No. 747: Gynecologic issues in children and adolescent cancer patients and survivors. Obstet Gynecol, 2018; 132(2):e67–e77; doi: 10.1097/AOG.0000000000002763
5.
SopfeJ, GuptaA, AppiahLC, et al.Sexual dysfunction in adolescent and young adult survivors of childhood cancer: Presentation, risk factors, and evaluation of an underdiagnosed late effect: A narrative review. J Adolesc Young Adult Oncol, 2020; 9(5):549–560; doi: 10.1089/jayao.2020.0025
6.
ServiceVPIC.Optimal Care Pathway for Adolescents and Young Adults with Cancer. Paediatric Integrated Cancer. Service: Melbourne, Australia, 2022.
7.
BoberSL, CarterJ, FalkS. Addressing female sexual function after cancer by internists and primary care providers. J Sex Med, 2013; 10(Suppl 1):112–119; doi: 10.1111/jsm.12027
8.
PerezGK, SalsmanJM, FladeboeK, et al.Taboo topics in adolescent and young adult oncology: Strategies for managing challenging but important conversations central to adolescent and young adult cancer survivorship. Am Soc Clin Oncol Educ Book, 2020; 40(101233985):1–15; doi: 10.1200/EDBK_279787
9.
FrederickNN, CampbellK, KenneyLB, et al.Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective. Pediatr Blood Cancer, 2018; 65(8):e27087-n/a; doi: 10.1002/pbc.27087
10.
AubinS, PerezS. The clinician's toolbox: Assessing the sexual impacts of cancer on adolescents and young adults with cancer (AYAC). Sex Med, 2015; 3(3):198–212; doi: 10.1002/sm2.75
11.
PetersMDJ, GodfreyC, McInerneyP, et al.Chapter 11: Scoping Reviews (2020 version). In: JBI Manual for Evidence Synthesis (Aromataris E, Munn Z. eds.). JBI, 2020. Available from: https://synthesismanual.jbi.global
12.
TounkelI, NalubolaS, SchulzA, et al.Sexual health screening for gynecologic and breast cancer survivors: A review and critical analysis of validated screening tools. Sex Med, 2022; 10(2):100498; doi: 10.1016/j.esxm.2022.100498
13.
DenlingerCS, CarlsonRW, AreM, et al.Survivorship: Sexual dysfunction (female), version 1.2013. J Natl Compr Cancer Netw, 2014; 12(2):184–192.
14.
DowJ, Kennedy SheldonL. Breast cancer survivors and sexuality: A review of the literature concerning sexual functioning, assessment tools, and evidence-based interventions. Clin J Oncol Nurs, 2015; 19(4):456–461; doi: 10.1188/15.CJON.456-461
15.
PoortH, SouzaPM, MalinowskiPK, et al.Taking a “Snapshot”: Evaluation of a conversation aid for identifying psychosocial needs in young adults with cancer. J Adolesc Young Adult Oncol, 2018; 7(5):565–571; doi: 10.1089/jayao.2018.0027
16.
BennettN, IncrocciL, BaldwinD, et al.Cancer, benign gynecology, and sexual function—issues and answers. J Sex Med, 2016; 13(4):519–537; doi: 10.1016/j.jsxm.2016.01.018
17.
DenlingerCS, SanftT, BakerKS, et al.Survivorship, Version 2.2017: Clinical practice guidelines in oncology. J Natl Compr Cancer Netw, 2017; 15(9):1140–1163; doi: 10.6004/jnccn.2017.0146
18.
HuffmanLB, HartenbachEM, CarterJ, et al.Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol, 2016; 140(2):359–368; doi: 10.1016/j.ygyno.2015.11.010
19.
DeSimoneM, SpriggsE, GassJS, et al.Sexual dysfunction in female cancer survivors. Am J Clin Oncol, 2014; 37(1):101–106; doi: 10.1097/COC.0b013e318248d89d
20.
El-ShamiK, OeffingerKC, ErbNL, et al.American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin, 2015; 65(6):427–455; doi: 10.3322/caac.21286
21.
WangJM, HartM, JainP, et al.Relationships, body image, and intimacy: A pilot to increase sexual health conversations between radiation therapists and cancer patients in Ontario. J Med Imaging Radiat Sci, 2022; 53(2):264–272; doi: 10.1016/j.jmir.2022.02.009
22.
JonsdottirJI, ZoëgaS, SaevarsdottirT, et al.Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: Outcomes from a 2-year educational intervention at a University Hospital. Eur J Oncol Nurs, 2015; 21:24–30; doi: 10.1016/j.ejon.2015.12.004
23.
QuinnGP, Bowman CurciM, ReichRR, et al.Impact of a web-based reproductive health training program: ENRICH (Educating Nurses about Reproductive Issues in Cancer Healthcare). Psycho-Oncology, 2019; 28(5):1096–1101; doi: 10.1002/pon.5063
24.
SmithA.A workshop for educating nurses to address sexual health in patients with breast cancer. Clin J Oncol Nurs, 2015; 19(3):248–250; doi: 10.1188/15.CJON.248-250
25.
ReeseJB, LeporeSJ, DalyMB, et al.A brief intervention to enhance breast cancer clinicians' communication about sexual health: Feasibility, acceptability, and preliminary outcomes. Psycho-Oncology, 2019; 28(4):872–879; doi: 10.1002/pon.5036
26.
LeeL.Giving staff confidence to discuss sexual concerns with patients. Cancer Nurs Pract, 2012; 11(2):28–32.
27.
WalkerLM, WiebeE, TurnerJ, et al.The oncology and sexuality, intimacy, and survivorship program model: An integrated, multi-disciplinary model of sexual health care within oncology. J Cancer Educ, 2021; 36(2):377–385; doi: 10.1007/s13187-019-01641-z
28.
GormanJR, LyonsKS, ReeseJB, et al.Adapting a theory-informed intervention to help young adult couples cope with reproductive and sexual concerns after cancer. Front Psychol, 2022; 13(101550902):813548; doi: 10.3389/fpsyg.2022.813548
29.
BerginRJ, GroganSM, BernshawD, et al.Developing an evidence-based, nurse-led psychoeducational intervention with peer support in gynecologic oncology. Cancer Nurs, 2016; 39(2):E19–E30; doi: 10.1097/NCC.0000000000000263
30.
AlthofSE, ParishSJ. Clinical interviewing techniques and sexuality questionnaires for male and female cancer patients. J Sex Med, 2013; 10(Suppl 1):35–42; doi: 10.1111/jsm.12035
31.
BoberSL, KingsbergSA, FaubionSS. Sexual function after cancer: Paying the price of survivorship. Climacteric, 2019; 22(6):558–564; doi: 10.1080/13697137.2019.1606796
32.
UssherJM, HawkeyA, PerzJ.Provision of sexual health support. In: Sexual Health, Fertility, And Relationships In Cancer Care. Oxford University Press: New York, NY, 2020; pp.19–40.
33.
AverytJC, NishimotoPW. Addressing sexual dysfunction in colorectal cancer survivorship care. J Gastrointest Oncol, 2014; 5(5):388–394; doi: 10.3978/j.issn.2078-6891.2014.059
34.
AfiyatiY, KeliatB, RuwaidaI, et al.Improving quality of life on cancer patient by implementation of psychosexual health care. J Ners, 2016; 11(1):7–16; doi: 10.20473/jn.v11i1.1904
35.
WangLY, PierdomenicoA, LefkowitzA, et al.Female sexual health training for oncology providers: New applications. Sex Med, 2015; 3(3):189–197; doi: 10.1002/sm2.66
36.
TracyM, McDivittK, RyanM, et al.Feasibility of a sexual health clinic within cancer care: A pilot study using qualitative methods. Cancer Nurs, 2016; 39(4):E32–E42; doi: 10.1097/NCC.0000000000000295
37.
Mendes-SantosC, NunesF, WeiderpassE, et al.Development and evaluation of the usefulness, usability, and feasibility of iNNOV breast cancer: Mixed methods study. JMIR Cancer, 2022; 8(1):e33550; doi: 10.2196/33550
38.
LisyK, Hulbert-WilliamsN, UssherJM, et al.Lesbian, Gay, Bisexual, and Transgender Issues. In: Sexual Health, Fertility, and Relationships Cancer Care. (Watson M, Kissane DW. eds.) Oxford University Press: Western Sydney University. 2020; doi: 10.1093/med/9780190934033.003.0003
39.
SungSC, JiangHH, ChenRR, et al.Bridging the gap in sexual healthcare in nursing practice: Implementing a sexual healthcare training programme to improve outcomes. J Clin Nurs, 2016; 25(19–20):2989–3000; doi: 10.1111/jocn.13441
40.
BoatmanE. (2020). Developmentally appropriate sexual health conversations with adolescent and young adult oncology patients. [PhD dissertation, Texas Women's University]. Texas Digital Library.
41.
KenneyLB, CohenLE, ShnorhavorianM, et al.Male reproductive health after childhood, adolescent, and young adult cancers: A report from the Children's Oncology Group. J Clin Oncol, 2012; 30(27):3408–3416; doi: 10.1200/JCO.2011.38.6938
42.
MetzgerML, MeachamLR, PattersonB, et al.Female reproductive health after childhood, adolescent, and young adult cancers: Guidelines for the assessment and management of female reproductive complications. J Clin Oncol, 2013; 31(9):1239–1247; doi: 10.1200/JCO.2012.43.5511
43.
LaganaL, FobairP, SpiegelD. Targeting the psychosexual challenges faced by couples with breast cancer: Can couples group psychotherapy help?. J Women's Health Care, 2014; 3(6):205.
44.
CarterJ, LacchettiC, AndersenBL, et al.Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline. J Clin Oncol, 2018; 36(5):492–511; doi: 10.1200/JCO.2017.75.8995
45.
BoberSL, ReeseJB, BarberaL, et al.How to ask and what to do: A guide for clinical inquiry and intervention regarding female sexual health after cancer. Curr Opin Support Palliat Care, 2016; 10(1):44–54. doi: 10.1097/spc.0000000000000186
46.
WhiteID, SanghaA, LucasG, et al.Assessment of sexual difficulties associated with multi-modal treatment for cervical or endometrial cancer: A systematic review of measurement instruments. Gynecol Oncol, 2016; 143(3):664–673; doi: 10.1016/j.ygyno.2016.08.332
47.
EatonAA, BaserRE, SeidelB, et al.Validation of clinical tools for vaginal and vulvar symptom assessment in cancer patients and survivors. J Sex Med, 2017; 14(1):144–151; doi: 10.1016/j.jsxm.2016.11.317
48.
LesterJ, BernhardL, Ryan-WengerN. A self-report instrument that describes urogenital atrophy symptoms in breast cancer survivors. Western J Nurs Res, 2012; 34(1):72–96; doi: 10.1177/0193945910391483
49.
CrowleySA, FoleySM, WittmannD, et al.Sexual health concerns among cancer survivors: Testing a novel information-need measure among breast and prostate cancer patients. J Cancer Educ, 2016; 31(3):588–594; doi: 10.1007/s13187-015-0865-5
50.
DenlingerCS, CarlsonRW, AreM, et al.Survivorship: Sexual dysfunction (male), version 1.2013. J Natl Compr Cancer Netw, 2014; 12(3):356–363.
51.
WinterlingJ, LampicC, WettergrenL. Fex-Talk: A short educational intervention intended to enhance nurses' readiness to discuss fertility and sexuality with cancer patients. J Cancer Educ, 2020; 35(3):538–544; doi: 10.1007/s13187-019-01493-7
52.
FeuzC, TseK, KwanM, et al.Implementing workshops to improve radiation therapists' knowledge and attitudes about sexual health issues in cancer patients. J Med Imaging Radiat Sci, 2019; 50(1):98–105; doi: 10.1016/j.jmir.2018.08.001
53.
ButcherJ, DobsonC, AtkinsonA, et al.Sex and cancer: Opening difficult therapeutic conversations and challenging assumptions using Design Activism-language outside the comfort zone. Sex Relationship Ther, 2016; 31(4):493–509; doi: 10.1080/14681994.2016.1190815
54.
KimJH, ShinJS. Effects of an online problem-based learning program on sexual health care competencies among oncology nurses: A pilot study. J Contin Educ Nurs, 2014; 45(9):393–401; doi: 10.3928/00220124-20140826-02
55.
DuimeringA, WalkerLM, TurnerJ, et al.Quality improvement in sexual health care for oncology patients: A Canadian multidisciplinary clinic experience. Support Care Cancer, 2020; 28(5):2195–2203; doi: 10.1007/s00520-019-05040-4
56.
GormanJR, DrizinJH, SmithE, et al.Patient-centered communication to address young adult breast cancer survivors' reproductive and sexual health concerns. Health Commun, 2021; 36(13):1743–1758; doi: 10.1080/10410236.2020.1794550
57.
StarkSS, NatarajanL, ChingosD, et al.Design of a randomized controlled trial on the efficacy of a reproductive health survivorship care plan in young breast cancer survivors. Contemp Clin Trials, 2019; 77(101242342):27–36; doi: 10.1016/j.cct.2018.12.002
58.
MatzoM, TroupS, HijjaziK, et al.Evaluating a sexual health patient education resource. J Adv Pract Oncol, 2015; 6(3):242–248.
