This document discusses addressing sexual issues with adolescent and young adult cancer patients and survivors. It is critical to discuss sexuality and fertility early in treatment to allow patients to make informed decisions and feel comfortable asking questions later. Oncology nurses are often the first to identify sexuality concerns and can normalize discussing these issues. Cancer impacts sexuality through changes in body image, relationships, and sexual function. Specific suggestions are provided for how to discuss sexuality using a patient-centered approach tailored for adolescents and young adults.
Adolescents and Young Adults With Cancer Treatment and Transition to An Adult...Methodist HealthcareSA
David J Friedman, MD, Phd
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October, 2010
Informed Consent for the Treatment of Adolescents and Young Adults with CancerMethodist HealthcareSA
Author: Conrad Fernandez, MD., IWK Health Centre, Halifax, NS
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October 2010
Sexual and Intimate Needs of Adolescents and Young Adults with Cancer: A Qual...Methodist HealthcareSA
Sexual and Intimate Needs of Adolescents and Young Adults with Cancer: A Quality of Life Issue
Author: Sage Bolte, PhD, LCSW., Life With Cancer, Fairfax, VA
Presented to the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October 2010
Adolescents and Young Adults With Cancer Treatment and Transition to An Adult...Methodist HealthcareSA
David J Friedman, MD, Phd
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October, 2010
Informed Consent for the Treatment of Adolescents and Young Adults with CancerMethodist HealthcareSA
Author: Conrad Fernandez, MD., IWK Health Centre, Halifax, NS
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October 2010
Sexual and Intimate Needs of Adolescents and Young Adults with Cancer: A Qual...Methodist HealthcareSA
Sexual and Intimate Needs of Adolescents and Young Adults with Cancer: A Quality of Life Issue
Author: Sage Bolte, PhD, LCSW., Life With Cancer, Fairfax, VA
Presented to the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio in October 2010
Following diagnosis and treatment for breast cancer, many women experience changes in their sexuality. In this webinar, Madeleine M. Castellanos, MD, a psychiatrist specializing in sex therapy and sexual medicine, addresses the physical, psychological, and relationship issues that often emerge and explores strategies to find happiness and fulfillment.
Difficult Conversations: Bridging the Communication Gap with Your OncologistMelissa Sakow
Lidia Schapira, MD, Director of the Cancer Survivorship Program at Stanford University, shares her expertise to help you get the most out of your communication with your oncologist. Learn strategies to optimize your meetings with your health care team.
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
This slideshow is a tour of Cancer Awakens - www.cancerawakens.com - showcasing how our site, newsletter and social media channels support the cancer community.
Experts by Experience 2016: A compilation of patient storiesInspire
In cooperation with Stanford Medicine, Inspire presents the special report, "Experts by Experience 2016: A compilation of patient stories," the fourth in an ongoing series.
Facing Forward: When Cancer Changes the Road Aheadbkling
A breast or ovarian cancer diagnosis brings unimaginable changes to a woman's life. Join us for a webinar as Julie Larson, LCSW, helps you reflect upon the psychological impact of this diagnosis. Learn how to develop strategies to face the challenges and emotions of your new normal.
Dr. Aimee Thompson discusses the impact of childhood cancer on the family. To listen the audio recording, please visit: http://www.alexslemonade.org/campaign/symposium-childhood-cancer
Talking to Your Family about Hereditary CancerMelissa Sakow
Karen Hurley, Ph.D., shares strategies for managing the sources of conflict that surround genetic testing within families. Includes whether or not to pursue testing, reaching out to at-risk relatives and the stress that can arise from hereditary disease. Karen Hurley, Ph.D., is a licensed clinical psychologist specializing in hereditary cancer risk.
Presented in collaboration with FORCE.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
Jackie Manthorne's presentation from the CAPO conference covers many issues that cancer survivors face today, based on a survey done by the Canadian Cancer Survivor Network in 2013.
Following diagnosis and treatment for breast cancer, many women experience changes in their sexuality. In this webinar, Madeleine M. Castellanos, MD, a psychiatrist specializing in sex therapy and sexual medicine, addresses the physical, psychological, and relationship issues that often emerge and explores strategies to find happiness and fulfillment.
Difficult Conversations: Bridging the Communication Gap with Your OncologistMelissa Sakow
Lidia Schapira, MD, Director of the Cancer Survivorship Program at Stanford University, shares her expertise to help you get the most out of your communication with your oncologist. Learn strategies to optimize your meetings with your health care team.
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
This slideshow is a tour of Cancer Awakens - www.cancerawakens.com - showcasing how our site, newsletter and social media channels support the cancer community.
Experts by Experience 2016: A compilation of patient storiesInspire
In cooperation with Stanford Medicine, Inspire presents the special report, "Experts by Experience 2016: A compilation of patient stories," the fourth in an ongoing series.
Facing Forward: When Cancer Changes the Road Aheadbkling
A breast or ovarian cancer diagnosis brings unimaginable changes to a woman's life. Join us for a webinar as Julie Larson, LCSW, helps you reflect upon the psychological impact of this diagnosis. Learn how to develop strategies to face the challenges and emotions of your new normal.
Dr. Aimee Thompson discusses the impact of childhood cancer on the family. To listen the audio recording, please visit: http://www.alexslemonade.org/campaign/symposium-childhood-cancer
Talking to Your Family about Hereditary CancerMelissa Sakow
Karen Hurley, Ph.D., shares strategies for managing the sources of conflict that surround genetic testing within families. Includes whether or not to pursue testing, reaching out to at-risk relatives and the stress that can arise from hereditary disease. Karen Hurley, Ph.D., is a licensed clinical psychologist specializing in hereditary cancer risk.
Presented in collaboration with FORCE.
Rosemary Frasso's presentation from the
Penn Urban Doctoral Symposium
May 13, 2011
Co-sponsored with Penn’s Urban Studies program, this symposium celebrates the work of graduating urban-focused doctoral candidates. Graduates present and discuss their dissertation findings. Luncheon attended by the students, their families and their committees follows.
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
Jackie Manthorne's presentation from the CAPO conference covers many issues that cancer survivors face today, based on a survey done by the Canadian Cancer Survivor Network in 2013.
Karen Fasciano, PSY.D., director of the Young Adult Program at Dana-Farber Cancer Institute, discusses the facts around young adults who are diagnosed with lymphoma, how the disease affects their life, and the resources available to young adults who are facing cancer. This presentation was originally given at the Lymphoma Research Foundation's 2013 North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Cancer is one of the most common diseases in the world. Stress is a common experience among cancer patients.
National Comprehensive Cancer Network (2017) defines cancer-related psychological distress as an:
“ unpleasant emotional experience of a Mental, Physical, Social, or Spiritual nature. It can affect the way you think, feel, or act. Distress may make it harder to cope with having cancer, its symptoms, or its treatment. ”
“Condoms are not a family planning Method”: Why efforts to prevent HIV have failed to comprehensively address adolescent sexual and reproductive health
Slides from a presentation given to a group of physicians, discussing the importance of asking patients about their sex lives, as a part of an overall evaluation of general health and well being.
William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS (Founded 1982). Dr. William Allan Kritsonis, Distinguished Alumnus, Central Washington University, College of Education and Professional Studies, Ellensburg, Washington; Invited Guest Lecturer, Oxford Round Table, University of Oxford, United Kingdom; Hall of Honor, Prairie View A&M University/Member of the Texas A&M University System. Professor of Educational Leadership, The University of Texas of the Permian Basin.
Radiotherapy in the Treatment of Sarcomas in Adolescents and Young AdultsMethodist HealthcareSA
Daniel Indelicato, MD, University of Florida, Jacksonville, FL
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference, Methodist Healthcare-San Antonio
Alberto Pappo, MD, St. Jude Children’s Hospital, Memphis TN
Presented at the 2010 Texas Adolescent and Young Adult Oncology Conference hosted by Methodist Healthcare-San Antonio. October 2010.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Thesis Statement for students diagnonsed withADHD.ppt
11c bolte zebrackaya
1. Seminars in Oncology Nursing, Vol 24, No 2 (May), 2008: pp 115-119 115
OBJECTIVES:
SEXUAL ISSUES
To understand the unique impact of
cancer on the psychosexual develop-
ment of adolescents and young adults
and to identify concrete approaches
IN SPECIAL
for broaching the topic of sexuality and
sexual function.
DATA SOURCES:
Review and research articles, clinical
expertise.
CONCLUSION:
POPULATIONS:
It is critical to address sexual health
and fertility issues with young adults
as early as the diagnosis to offer the
ADOLESCENTS AND
patient an opportunity to ask ques-
tions, make true informed decisions,
and feel comfortable coming back and
inquiring about difficulties he/she has
YOUNG ADULTS
later during treatment or afterwards.
IMPLICATIONS FOR NURSING
PRACTICE: SAGE BOLTE AND BRAD ZEBRACK
N
Oncology nurses are often the first
health care professionals to identify URSES and social workers are often the first health care
and address sexuality concerns
in oncology treatment settings. By
professionals to identify and address sexuality concerns
emphasizing the importance of sexu- in inpatient and outpatient oncology settings. Current
ality and intimacy for adolescents and research suggests that patients welcome oncology staff to inquire
young adults throughout the cancer about their sexuality and are willing to discuss sexual concerns.1-3
experience, oncology professionals However, patients rarely initiate this conversation; neither do
can be effective change agents in
advocating for their patients.
health professionals.4,5
Studies suggest that adolescent and young adult (AYA) cancer
KEYWORDS: survivors experience challenges or dissatisfaction around sexual
Adolescent, young adult, cancer, relations and intimacy.6-9 Thus, the oncology team must claim
sexual function, sexuality. responsibility for addressing this important component of health,
life, and quality of life, with every patient – young or old. For
AYA patients and survivors, addressing sexuality and intimacy
concerns is an acknowledgement of the importance of critical de-
velopmental tasks involving identity development, sense of self,
and formation of safe and healthy intimate relationships. The pur-
pose of this article is to review how cancer affects AYA’s attitudes,
behaviors and desires related to sexuality and physical intimacy,
and offers clinical guidelines for addressing sexuality issues with
Sage Bolte, ABD, LCSW, OSW-C: Life this population.
with Cancer, INOVA Cancer Services,
Fairfax, VA. Brad Zebrack, PhD, MSW, MPH:
University of Southern California School of CANCER AND SEXUALITY
Social Work, Los Angeles, CA.
Address correspondence to Brad Zebrack,
S
PhD, MSW, MPH: USC School of Social Work, exuality is one component of an individual’s desire for inti-
669 W. 34th St., Los Angeles, CA 90089-0411;
e-mail: zebrack@usc.edu
macy, and opportunities for intimacy (or lack thereof) can
greatly impact quality of life. Further, having cancer does not
make the desire for healthy sexual function and intimacy disap-
Ó 2008 Elsevier Inc. All rights reserved. pear. Cancer and its treatments impact sexuality and intimacy, re-
0749-2081/08/2402-$30.00/0 gardless of age, race, sexual orientation, gender, or socioeconomic
doi:10.1016/j.soncn.2008.02.004
background.1,4,10-13 Furthermore, sexual dissatisfaction not only
2. 116 S. BOLTE AND B. ZEBRACK
affects the person being treated for disease, but thereby preventing them from participating in
also his or her partner and overall current or fu- normal and age-appropriate activities, including
ture relationships.14 sexual experimentation and developing intimacy.
‘‘Cancer survivors often experience long-term Some AYAs adjust to the changes in their sexual
changes and obstacles, such as impaired immune desire and function without distress. Others experi-
response, vital organ dysfunction, and hormone ence increased distress, depression, or anxiety,
changes resulting in infertility, altered sexual func- which then indirectly influences sexual function.
tion, cognitive changes, ongoing fatigue, depression, When distress is high, sexual desire is low, and there-
anxiety, family distress, and economic challenges, fore sexual response is challenged.25 Young adults
to mention only a few.’’15 p4 Generally speaking, sex- may find themselves confused or embarrassed about
ual function can be influenced by changes in libido, the sexual problems they are experiencing, may not
reproductive capability and potential, lowered or- be aware they are related to cancer treatment,
gasmic intensity, and body image concerns as they and hesitate to raise the issue with health care
relate to weight changes, hair loss, and surgical scar- professionals.
ing. Cancer and its treatment, as well as late or
delayed effects associated with treatment (eg, early
menopause, increased risk of osteoporosis, cogni- IMPLICATIONS FOR ONCOLOGY PRACTICE
tive delays or defects, infertility, and chronic fa-
tigue), can affect developing sexual behaviors,
attitudes, and identity in AYAs.16-20 Altered percep-
tions of body image and self-esteem, changes in rela-
I t is critical to address sexual health and fertility
issues with young adults as early as the diagno-
sis to offer the patient an opportunity to ask ques-
tionships, and other social life challenges can take tions, make true informed decisions, and feel
a significant toll on AYAs, for whom exploring and comfortable coming back and inquiring about dif-
developing sexual and intimate relations is the ficulties he/she has later during treatment or after-
norm.19,21,22 wards. In terms of clinical assessment with regard
to sexuality issues, every cancer treatment center
THE IMPACT OF CANCER ON THE DEVELOPING could be using quality of life screening instru-
ments on admission and completion of treatment.
SENSE OF SELF AND RELATIONS WITH OTHERS Selecting a screening instrument that includes
questions about sexual function, relationships,
I solation and alienation are commonly reported
among AYA patients and survivors as they often
miss out on experiences that their peers are enjoy-
and body image would afford the team an under-
standing of the patient’s needs and concerns. Ask-
ing a simple question during patient assessments
ing, such as dating, leaving home and establishing on sexuality such as ‘‘On a scale of 1 to 5, with 5
independence, going to college, pursuing gainful being highly satisfied and 1 being not satisfied at
employment, getting married, or having chil- all, are you satisfied with your intimate relation-
dren.23 For example, a 14-year-old girl who, be- ships?’’ or ‘‘On a scale of 1 to 5, with 5 being highly
cause of treatment, has not yet begun menses satisfied and 1 being not satisfied at all, how satis-
anxiously waits to finish treatment so she can fied are you about your sexual function?’’ Each
feel like she ‘‘fits in’’ with her girlfriends. A young patient could be offered a sexual health resource
high school freshman, having recently started list on admission or initial diagnosis to normalize
treatment, anxiously awaits the appearance of questions and concerns around sexuality. Along
facial hair after treatment to ‘‘finally not look like with providing a resource list, a member of each
a little boy.’’ The loss of facial hair, pubic hair, team could be prepared and designated as the
and menses may take on very significant meanings ‘‘sexual health expert,’’ insuring every patient has
to AYAs. Furthermore, a young patient’s view of the opportunity to be assessed and provided with
him/her self may be tied up with his or her socially information. Adolescents and their parents can
defined roles or positions (eg, student, father/ be given this information separately or together
mother, employee). When this role or position is by making the assessment part of every new
lost or significantly changed because of cancer, patient orientation.
the resultant loss creates alienation from peers.24 The widely referenced PLISSIT (Permission,
Cancer may deprive AYAs from being understood Limited information, Specific Suggestions, Inten-
by same-age peers who are physically capable, sive therapy) model is an instructive guide for the
3. SEXUAL ISSUES IN SPECIAL POPULATIONS 117
health professional to use in addressing sexuality Always use neutral language, such as ‘‘are you dat-
issues faced by young persons with a disease like ing anyone?’’ instead of ‘‘do you have a boyfriend?’’
cancer.5,26-28 This model is discussed in depth in Obtain a clear understanding of the patient’s defini-
the assessment chapter elsewhere in this issue. tions of sex, as many adolescents and young adults
The model is used here to organize the content do not consider oral sex to be sex. Discussions of
specific to AYAs. safe sex techniques and safety issues should be
part of the pre-treatment as well as post-treatment
Permission education because AYAs may believe if they are
infertile they are excused from safe sex practices.
Health care providers can offer permission for sex- Indeed, male young adult survivors of childhood
ual difficulties to exist and obtain permission from cancer have suggested that they did not use con-
the patient, partner, and parent(s) to initiate sex- doms because they believed they were infertile
ual discussion and legitimize sexual concerns. and thus incapable of getting a partner pregnant.18
Knowing that most patients, and especially AYAs, If the patient is not in a sexual relationship, ad-
will not initiate conversation about sex, sexuality dress the issue of building and maintaining inti-
and intimacy, a health care provider must first de- mate relationships. Offer suggestions as to how
cide whether it is appropriate to address this issue the AYA can maintain friendships. For example,
in the presence of the parent(s) or partner. If un- prompt the AYA to have friends come over when
sure, ask to speak to the patient alone, stating ‘‘I he/she feels up to it. Have friends bring food or
would like to meet privately with her for a few mo- a movie, or go for a walk together. Ask a close friend
ments to go over any questions or concerns she to accompany him/her to a doctor appointment or
may have and verify her understanding of treat- treatment. These simple suggestions may not be
ment procedures and then I will bring you back obvious to the patient during anxiety-provoking
into the room for further discussion.’’ Assent, along periods of treatment. Maintaining friendships and
with parental consent, is critical for adolescents. normal social relationships is a critical component
Assent provides adolescents with the opportunity of healthy psychological and social development
to put forth input in their treatment and to ac- for this age group.
knowledge they have a full understanding of the
impact treatments may have on their sexual func- Limited Information
tion and fertility. The responsibility lies with the
provider to know state laws and rights to privacy Health care providers can offer limited informa-
and sexual health education for underage minors. tion, address myths, and gently re-educate patients
To enable an AYA to discuss issues related to around their sexual health questions with brief ed-
sex, a health care provider might say, ‘‘Often times, ucation and resources. If an AYA states he/she is
after numerous treatments or disease progression, sexually active or interested in becoming sexually
a young person’s thoughts about him/herself and active in the near future, then the health care pro-
relationships, including sexual relationships, may fessional might provide information about how
be affected by treatment or its side effects. Some- cancer and its treatment may affect sexual or inti-
times cancer and its treatments affect relationships, mate relations. An oncology provider can approach
especially when you don’t have enough energy to issues using a general and educational tone saying,
hang out with your friends. How has cancer affected for example, ‘‘many young women experience fa-
your thoughts about your relationships, sexual or tigue and other sexual side effects that impact their
non-sexual, between you, your friends and/or your relationships, such as lowered libido, and may be
partner?’’ The opportunity for addressing concerns concerned about their abilities to engage in any
is provided by generalizing and normalizing com- sexual activity, out of fear of pain or failure to please
mon sexual concerns and offering permission to dis- their partner, decreasing or stopping sexual activ-
cuss sexuality.27 It is also essential to provide ity altogether. Water-based lubricants, the use of
culturally relevant materials and culturally sensitive vaginal dilators, and experimenting with more
interventions that account for religious and socio- touch and caressing can often assist with managing
cultural values. any anxiety or pressure to perform. Would you like
Health care providers should never make as- to talk about what you can do to help you manage
sumptions about sexual history or sexual orienta- your fatigue or anxiety as it relates to sex or your re-
tion when assessing and addressing AYA patients. lationships?’’ Offer the patient a list of resources for
4. 118 S. BOLTE AND B. ZEBRACK
the management of fatigue as it relates to desire and Intensive Therapy
sexual function, such as the American Cancer Soci-
ety’s ‘‘Sexuality, for the Woman with Cancer and Because intercourse or sexual intimacy as they
Her Partner.’’28 Additional resources are found in once enjoyed it may no longer be possible, it also
the article on resources elsewhere in this issue. is important to offer patients opportunities to ex-
Connecting AYAs to peer support groups, websites, press their feelings about this important loss in
and retreat programs specifically created for the their lives. For some young adults, their own or
younger survivor can help decrease feelings of iso- their partner’s concerns, fears, and feelings of
lation and hopelessness, as well as promote their loss or ambivalence accompanied by a lack of inti-
ability to address similar concerns.29,30 macy may create thoughts of being unloved or un-
appreciated. Oncology providers can help young
adults and their partners explore these issues, as
Specific Suggestions well as ways of maintaining sexual and intimate
moments, or else refer them to a trusted network
To help an individual or couple redefine their ‘‘new
of colleagues who can further address sexuality
normal’’ or expectations for intimacy (sexual or
concerns. These professionals may include, but
non-sexual), avoid medical jargon, understand
are not limited to, physical therapists specializing
how sexuality was expressed and pleasure was
in pelvic floor exercises or capable of helping
achieved before cancer, and offer specific sugges-
patients with creative movement/positioning,
tions (for example, advise the use of pillows under
a sex therapist (www.aasect.org), a clinical nurse
joints to help provide cushion and support, or en-
specialist, oncology social worker, gynecologist,
courage taking pain medication 1⁄2 hour to 1 hour be-
urologist, and/or endocrinologist. Some patients
fore intimate engagements (sexual and non-sexual).
may benefit from a referral to a mental health pro-
Discuss redefining sexual intimacy as mutual mas-
fessional for more intense assistance with their
turbation or time spent touching and caressing
sexual health concerns, so it is critical to know
one another. Stay sensitive and aware of the pa-
your own skill level, comfort level, and ability to
tient’s and partner’s definitions of sexuality and inti-
provide further assistance.
macy and the cultural and religious implications
that may influence these.
Young adult cancer survivors may need to get cre- CONCLUSION
ative in their sexual routines. For example, taking
Viagra (Pfizer, Inc, New York, NY) or using a clitoral
sensitizing agent to enhance sexual response may be
beneficial. Vaginal dilators may be needed for the
W ith young adult survivorship on the rise in
those diagnosed with pediatric or adult can-
cers, sexuality is a critical area to be examined.
female adolescent or young adult in premature ovar- Sexuality and intimacy are important components
ian failure or early menopause. AYAs may benefit of a cancer survivor’s quality of life, impacted by
from rehearsing how they might disclose their survi- the diagnosis and consequential treatments. Un-
vorship to someone they are romantically inter- fortunately, many of these treatments and side ef-
ested in. Role-playing their script with a friend fects are not as likely to resolve themselves in the
might assist in lowering their anxiety about dating. short-term, and some may be permanent, requir-
Most of the late effects impacting sexual function ing AYAs to redefine a ‘‘new normal’’ for intimacy
can be managed with creativity, enhancement patterns, sexual behavior, parenting, and how
aids, and medications. Survivors can maintain he/she may define their sexual self. By emphasiz-
hope in remembering that the skin is the largest ing the importance of sexuality and intimacy for
organ, and the brain is the most important organ, AYAs throughout the cancer experience, oncology
so there are endless possibilities to sexual arousal professionals can be effective change agents in ad-
and satisfaction, in spite of cancer treatments. vocating for their patients.
REFERENCES
1. Schover LR. Counseling cancer patients about sexual 2. Cull AM. The assessment of sexual function in cancer
function. Oncology 1999;13:1585-1591. patients. Eur J Cancer 1992;28:1680-1686.
5. SEXUAL ISSUES IN SPECIAL POPULATIONS 119
3. Canada AL, Neese LE, Dawen S, et al. Pilot intervention to 16. Evan E, Zeltzer LK. Psychosocial dimensions of cancer in
enhance sexual rehabilitation for couples after treatment for adolescents and young adults. Cancer 2006;107:1663-1671.
localized prostate carcinoma. Cancer 2005;104:2689-2700. 17. Gotay CC, Muraoka MY. Quality of life in long-term
4. Katz A. Do ask, do tell: why do so many nurses avoid the survivors of adult-onset cancers. J Natl Cancer Inst 1998;
topic of sexuality? Am J Nurs 2005;105:66-68. 90:656-667.
5. Katz A. The sounds of silence: sexuality information for 18. Zebrack BJ, Casillas J, Nohr L, et al. Fertility issues for
cancer patients. J Clin Oncol 2005;23:238-241. young adult survivors of childhood cancer. Psychooncology
6. Fobair P, Stewart SL, Chang S, et al. Body image and sexual 2004;13:689-699.
problems in young women with breast cancer. Psychooncology 19. Evan E, Kaufman M, Cook A, et al. Sexual health and self-
2006;15:579-594. esteem in adolescents and young adults with cancer. Cancer
7. Pendley JS, Dahlquist LM, Dreyer Z. Body image and psy- 2006;107(suppl 7):1672-1679.
chosocial adjustment in adolescent cancer survivors. J Pediatr 20. Hampton T. Cancer treatment’s trade-off: years of added
Psychol 1997;22:29-44. life can have long-term costs. JAMA 2005;294:167-168.
8. Jonker-Pool G, Hoekstra JJ, van Imhoff GW, et al. Male 21. Zebrack B, Oeffinger K, Hou P, et al. Advocacy skills train-
sexuality after cancer treatment–needs for information and ing for young adult cancer survivors: The Young Adult Survivors
support: testicular cancer compared to malignant lymphoma. ´
Conference (YASC) at Camp Mak-a-Dream. Support Care Can-
Pat Educ Counsel 2004;52:143-150. cer 2006;14:779-782.
9. Hannah MT, Gritz ER, Wellisch DK, et al. Changes in mar- 22. Elad P, Yagil Y, Cohen LH, et al. A jeep trip with young
ital and sexual functioning in long-term survivors and their adult cancer survivors: lessons to be learned. Support Care Can-
spouses: testicular cancer versus Hodgkin’s disease. Psychoon- cer 2003;11:201-206.
cology 1992;1:89-103. 23. Roberts CS, Turney ME, Knowles AM. Psychosocial
10. Shell J. Evidence-based practice for symptom management issues of adolescents with cancer. Social Work Health Care
in adults with cancer: sexual dysfunction. Oncol Nurs Forum 1998;27:3-18.
2002;29:53-69. 24. Hughes J, Sharrock W, Martin P. Understanding classical
11. Zabora J. Psychosocial consequences of breast cancer. sociological theory. London: Sage; 2003.
In: Bland KI, Copeland EM, eds. The breast: comprehensive 25. Graziottin A, Basson R. Sexual dysfunctions in women
management of benign and malignant disorders. Philadelphia, with premature menopause. Menopause 2004;11:766-777.
PA: Elsevier; 2004: pp. 1558-1567. 26. Taylor B, Davis S. Using the extended PLISSIT model to
12. Hughes M. Sexuality and the cancer survivor: a silent address sexual healthcare needs. Nurs Standard 2006;21:
coexistence. Cancer Nurs 2000;23:477-482. 35-40.
13. Pelusi J. Sexuality and body image: research on breast 27. McInnes R. Chronic illness and sexuality. Med J Aust
cancer survivors documents altered body image and sexuality. 2003;179:263-266.
Cancer Nurs 2006;29(suppl 2):32-38. 28. Annon JS. Behavioral treatment of sexual problems: brief
14. Svetlik D, Dooley K, Weiner M, et al. Declines in satisfac- therapy New York: Harper & Row; 1976.
tion with physical intimacy predict caregiver perceptions of 29. American Cancer Society. Sexuality, for the woman with
overall relationship loss: a study of elderly caregiving spousal cancer and her partner. Atlanta, GA: American Cancer Society;
dyads. Sex Disabil 2005;23:65-79. 2003.
15. Curtiss C, Haylock P. Improving the care of cancer survi- 30. Roberts C, Piper L, Denny J, et al. A support group inter-
vors: anticipating, assessing for, and managing the effects of vention to facilitate young adults’ adjustment to cancer. Health
cancer and its treatment. Am J Nurs 2006;106:48-52. Soc Work 1997;22:133-141.