Impact of sexuality on cancer


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Impact of sexuality on cancer

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Diala Dajani & AbdulQadir Nashwan

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  • 40-100% of cancer patients experience some form of sexual dysfunction
    Issues do not always resolve after therapy
    Almost all cancer treatments have the potential to alter sexual function (surgery, chemotherapy, radiation, hormones)
    Represents major quality of life (QOL) issue
    With intervention, up to 70% of patients can have improved functioning
    Krychman ML. Sexual rehabilitation medicine in a female oncology setting. Gynecol Oncol. 2006;101:380–384.
  • Azoospermia
  • Summary
    Purpose.—To investigate the sex life of the Moroccan patient affected by cancer and the level
    of communication within medical staff.
    Subjects and methods.—Transversal study with a descriptive aim. Participants were assessed
    prospectively using a questionnaire. A second study conducted in parallel concerned the medical
    and nursing staff.
    Results.—The sample included 97 patients, 84% of whom were women. Mean age was 45 years,
    81% were married. Cancers involving a genital organ represented 58%. Cancer affected sexual
    life of 67% of sexually active persons. The marital status of 20% changed after the diagnosis.
    Twenty-eight practitioners were approached (n = 28). All practitioners believed that patients
    suffer from sexual problems (100%). They also thought that improvement in sexual life would
    improve the overall quality of life for patients (97%). Doctors rarely broached the subject with
    patients. The main identified causes were absence of demand from patients (50%), lack of time
    (42%), difficulties communicating on the subject (42%); lack of intimacy (50%). All practitioners
    thought that patients would prefer to discuss this subject with a person of the same gender
    Conclusion.—Cancer seriously affects the sexuality of patients. Lack of communication is relevant.
    The first stage towards resolution of problems is to ‘‘open the dialogue’’ within the
    medical staff.
    © 2009 Published by Elsevier Masson SAS.
  • Impact of sexuality on cancer

    1. 1. 1. Review primary effect of cancer on sexuality 2. Understand the impact of cancer different therapeutic modalities on sexuality 3. Assess sexual life and needs based on physical, social, psychological background. 4. Design a nursing care plan for sexual dysfunction among patients with cancer. 5. Integrate communication skills with nursing care to provide healthy solutions for sexual dysfunction among cancer patients. 6. Arrange right sexual counseling approaches.
    2. 2. Risk Factors Age < 30 Psychosocial issues Surgery Radiation Medications
    3. 3. Treatment Modalities Chemotherapy Cancer-Associated Drugs Hormonal Therapy Surgery Radiation
    4. 4. Erectile dysfunction Penile/testicular atrophy Decreased libido Ejaculatory dysfunction Gynecomastia Chemotherapy & Hormonal Infertility
    5. 5. Urinary issues Impotence Bowel dysfunction Penile/testicular atrophy Radiation Infertility
    6. 6. Urinary issues Impotence Retrograde ejaculation Disturbed Body Image Surgery Infertility Pain on the site of surgery
    7. 7. Treatment Modalities Chemotherapy Cancer-Associated Drugs Hormonal Therapy Surgery Radiation
    8. 8. Irregular menses Decreased libido Early menopause Vaginal dryness Painful intercourse Chemotherapy & Hormonal Infertility
    9. 9. Pelvic fibrosis Vaginal ulceration Vaginal atrophy/stenosis Decreased lubrication Decreased elasticity Radiation Infertility
    10. 10. Bowel changes Changes in vaginal size/sensitivity Loss of nipple Pain on the site of surgery Disturbed Body Image Surgery Infertility
    11. 11. Drugs Narcotics Others Sedatives Antidepressants Steroids
    12. 12. Impact of cancer on sexuality: How is the Moroccan patient affected? • Cancer affected sexual life of 67% of sexually active persons • The marital status of 20% changed after the diagnosis • The main identified causes were absence of demand from patients (50%) • lack of time (42%) • difficulties communicating on the subject (42%) • lack of intimacy (50%) • All practitioners thought that patients would prefer to discuss this subject with a person of the same gender (100%) Pts n= 97 Phy n= 28
    13. 13. Assessment Approaches  General clues to consider during assessment: Not every nurse can be a sexual counselor , but the solution is to: listen, listen ,and listen actively to the patient and the partner's need. Sexuality is more than the act of intercourse, it includes intimacy, touching and a multitude activities to show affection. Cancer may affect permanently the sexual patterns and fertility, but it cannot alter the fact that one is a sexual being.
    14. 14. Assessment Approaches (cont.) 1. • Personal discomfort. 2. • Fears of embarrassing the patient or the health care provider. 3. • Lack of training or knowledge. 4. • Lack of time. 5. • Concerns about the appropriateness of this type of discussion when dealing with a life threatening condition. 6. • Beliefs that its not a part of the nurse’s job description.
    15. 15. cont.))Assessment approaches  General guide lines for a comprehensive assessment: 1. Nurses must first understand their sexual identity. 2. Nurses must understand what constitutes acceptable sexual patterns and practices. 3. Having a well based knowledge about sexual issues. 4. Asking about sexual patterns early at the assessment is considered important. 5. Understand patient’s medical, psychiatric and psychosocial status.
    16. 16. 6. Cultural, religious beliefs and general intimacy should be incorporated in the discussion. 7. Whenever possible and appropriate the patient’s partner should be included. 8. Medical jargons should be avoided. 9. Information about the disease, must be provided so the anxiety and embarrassment decrease. 10. Questions and responses should acknowledge the subject and related concerns.6. cont.))Assessment Approaches
    17. 17. Sexual Counseling  All patients should receive information about the possible side effects of disease and treatment on sexuality and reproduction : 1. Alteration in physical function and libido. 2. Menopausal symptoms. 3. Problems with erection and ejaculation. 4.Problems about infertility.
    18. 18. Sexual Counseling (cont.) MenWomenCharacteristic Post pubertyOlder than age 30Age Prostate, Orchiectomy, Abdominal pereneal resection, Pelvic exenteration. Gynecologic, Abdominal pereneal resection, Pelvic exenteration. Surgery PelvicPelvicRadiation therapy Antidepressants, Antihistamines, Narcotics, Estrogen, etc… Antidepressants, Antihistamines, Narcotics, Sedatives, etc… Medications Alteration in body image and self esteem, decrease sense of masculinity. Alteration in body image and self esteem, decrease sense of femininity. Psychosocial issues
    19. 19. Sexual Counseling (cont.) "Yes, I feel like people are staring, and it is hard to find clothes, and yes, I get frustrated a lot," ."But ... I had to learn to love my body again." One woman wrote on the National Breast Cancer Foundation Survivor online forum.
    20. 20. Sexual Counseling (cont.)  Research study  Title: Body image in relation to self-esteem in a sample of Spanish women with early-stage breast cancer ( 2005).  Aim: studied to determine the influence that sociodemographic variables, type of surgery, amount of social support, and quality of life had on their body image and self-esteem.  Results and conclusion: married women reported a more positive body image than non-married women, and so did women with a lumpectomy versus those with a mastectomy. The study shown a significant negative correlation between the deterioration of quality of life after surgery and both body image and self-esteem.
    21. 21. Sexual Counseling (cont.)  Evaluation methods 1. ALARM model 2. Auchincloss model ALARM model Activity(sexual)A Libido/desireL Arousal and orgasmA Resolution/ releaseR Medical dataM Auchincloss model Evaluate sexual status: 1.Present sexual function 2.Past experiences 3.Relationships Evaluate medical, psychological and cancer status.
    22. 22. Sexual Counseling (cont.)  After a holistic assessment interventions are important: 1. To maintain optimal sexual function and to promote adaptation for the side effects of sexual dysfunction. 2. Improve quality of life. 3. Remember the individualism. 4. PLISSIT model for intervention.
    23. 23. Sexual Counseling (cont.) PLISSIT model for intervention PermissionP Limited InformationLI Specific SuggestionsSS Intensive TherapyIT
    24. 24. Nursing Management 1. Managing for traditional symptoms are important • Nausea, vomiting, bone marrow depression, thrombocytopenia, neutropenia, etc… 2.Focusing on the symptoms that affect sexual function • Peripheral neuropathies, malnutrition, stomatitis, fatigue, hand-foot syndrome and incontinence. 3.Manage the side effects of treatment as for women • Difficulty reaching climax, Loss of desire for sex, Reduced size of the vagina, Vaginal dryness. 4.manage the side effects of treatment as for men • Erection and ejaculation problems, loss of desire for sex, etc..
    25. 25. Nursing Management (cont.) 5.Stress the importance of communication and openness • Potential alteration in body image and self-esteem, the need for exercise, rest, adequate nutrition, the use of contraception and setting the stage for sexual activity, Kegel exercise. 6.Information on the timing of medication is very important • ??? 7.Appropriate referrals as • Hormonal therapies, medications to manage erectile dysfunction, sperm banking and reconstructive surgeries.
    26. 26.  Ostomy Surgery: Interventions 1. Address issues of Body Image 2. Concerns about odor: A. Tight appliance B. Avoid foods that cause flatulence 3. Appliance cover 4.Ostomy accessories Nursing Management (cont.)
    27. 27.  Don’t forget to tell your patient the important rules : 1.Talk with your health care team 2.Talk with your partner 3.Explore other ways of being intimate 4.Talk with other cancer survivors Nursing Management (cont.)
    28. 28. Fertility Considerations & Procreative Alternatives  Fertility and pregnancy following cancer diagnosis are fraught with a multitude of concerns.  patients must be aware of the pregnancy related issues. 1.Ability to conceive 2.Carry to term 3.Deliver a healthy newborn
    29. 29.  Reproductive counseling (Congenital problems) Congenital abnormalities Mutagenecity Teratogenecity Fertility Considerations & Procreative Alternatives
    30. 30.  Other solution for conception and pregnancy: 1. Semen cryopreservation and sperm recovery 2.Invitro fertilization/ embryo transfer Fertility Considerations & Procreative Alternatives
    31. 31. Pregnancy & Cancer 1. In general most cancers do not adversely affect a pregnancy, nor does pregnancy adversely affect the cancer outcome. 2.Treatment of cancer will affect the pregnancy as abortions, congenital abnormalities, etc.. 3.Data on risk for fetus exposed to chemo is limited and related to trimester (1st is greatest risk)
    32. 32. 1. • Age at treatment (menopausal status) 2. • Type of drug used 3. • Dosage Pregnancy & Cancer
    33. 33. 1. Sexuality and reproductive capacity of the individual with cancer may be affected by a variety of factors, including the biological process of cancer, the effects of treatment, additional health problems and medications, discuss these factors? 2. Although not every nurse is a sexual counselor, how can you provide a comprehensive assessment for patients who are receiving cancer treatment? 3. Managing side effects of cancer and its treatment is integral to the nurse's role. Explain how can you offer suggestions for appropriate managing for signs and symptoms related to sexual dysfunction? 4. Embarrassment is usually presented during assessment and evaluation of the sexual life, as an oncology nurse specialist how can you overcome this problem to avoid false management?
    34. 34. • Yabrok, C.H., Frogge, M.H., & Goodman, M. (2005). Cancer Nursing: Principles and practice (6th Ed). CH 35 (Pages 841 – 869) • Itano, JK & Taoka, KN. (2005). Core Curriculum for Oncology Nursing (4th Ed). Oncology Nursing Society.
    35. 35. AbdulQadir J. Nashwan, RN  Diala Dajani, RN 
    36. 36.  Although increasingly recognized as consequences of cancer or cancer therapy, sexual and reproductive dysfunctions often have been dismissed as normal side effects about which the caregiver can do a little or nothing.  Indeed, these dysfunctions frequently have gone underdiagnosed, underrated, or both because of lack of concern, information, or knowledge on the part of caregiver, or because of fear, lack of knowledge, or embarrassment on the part of patient or family.