General Internist Communication about Sexual Function with Cancer Survivors

  • Elyse R. Park
  • Sharon L. Bober
  • Eric G. Campbell
  • Christopher J. Recklitis
  • Jean S. Kutner
  • Lisa Diller
Brief Report

ABSTRACT

BACKGROUND

Sexual dysfunction is an important issue that affects many cancer survivors who are increasingly being cared for by internists.

OBJECTIVE

To examine the attitudes and reported practices of internists regarding survivorship care as it pertains to sexual dysfunction.

DESIGN

Surveys were sent to 406 physicians affiliated with the Department of Internal Medicine at the University of Colorado Denver School of Medicine. Of the 319 eligibles, 227 were returned (71% RR).

MAIN RESULTS

Of the 227 responders, 46% were “somewhat/very” likely to initiate a conversation about sexual dysfunction; 62% “never/rarely” addressed sexual dysfunction. Each additional weekly hour spent in patient care was associated with a 2% increase in the likelihood of sexual dysfunction being addressed or discussions about sexual dysfunction being initiated. Reported inadequate preparation/formal training around survivorship issues was associated with sexual dysfunction being addressed less often (odds ratio [OR] = 0.45). Perception of patient anxiety or fears about health was associated with sexual dysfunction being addressed more often (OR = 2.38). Perceived preparedness to evaluate long-term effects was associated with a greater likelihood of physicians initiating discussions about sexual functioning (OR = 2.49).

CONCLUSIONS

Cancer survivors receive their long-term care from internists. Our results suggest that sexual dysfunction is often not addressed during their follow-up care. Additional training is needed to prepare physicians to negotiate this difficult issue.

KEY WORDS

general internist survivorship sexuality communication 

References

  1. 1.
    Ries LAG, Melbert D, Krapcho M, et al (eds). SEER cancer statistics review, 1975–2005, National Cancer Institute. Bethesda, MD: http://seer.cancer.gov/csr/1975_2005/, based on November 2007 SEER data submission, posted to the SEER web site, 2008. Accessed May 8, 2009.
  2. 2.
    Hewitt M, Greenfield S, Stovall E, eds. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, D.C.: The National Academies Press; 2006.Google Scholar
  3. 3.
    Kornblith AB, Ligibel J. Psychosocial and sexual functioning of survivors of breast cancer. Semin Oncol. 2003;30(6):799–813.CrossRefPubMedGoogle Scholar
  4. 4.
    Siegel T, Moul JW, Spevak M, Alvord WG, Costabile RA. The development of erectile dysfunction in men treated for prostate cancer. J Urol. 2001;165(2):430–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Kornblith AB, Anderson J, Cella DF, et al. Hodgkin disease survivors at increased risk for problems in psychosocial adaptation. Cancer. 1992;70(8):2214–24.CrossRefPubMedGoogle Scholar
  6. 6.
    Monga U, Tan G, Ostermann HJ, Monga TN. Sexuality in head and neck cancer patients. Arch Phys Med Rehabil. 1997;78(3):298–304.CrossRefPubMedGoogle Scholar
  7. 7.
    Schover LR, Jensen SB. Sexuality and Chronic Illness: A Comprehensive Approach. New York, NY, US: Guilford Press;1988.Google Scholar
  8. 8.
    Andersen BL, Woods XA, Copeland LJ. Sexual self-schema and sexual morbidity among gynecologic cancer survivors. J Consult Clin Psychol. 1997;65(2):221–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Bruner DW, Boyd CP. Assessing women’s sexuality after cancer therapy: Checking assumptions with the focus group technique. Cancer Nurs. 1999;22(6):438–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Marwick C. Survey says patients expect little physician help on sex. JAMA. 1999;281(23):2173–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Tsimtsiou Z, Hatzimouratidis K, Nakopoulou E, Kyrana E, Salpigidis G, Hatzichristou D. Predictors of physicians’ involvement in addressing sexual health issues. J Sex Med. 2006;3(4):583–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Sadovsky R. Asking the questions and offering solutions: The ongoing dialogue between the primary care physician and the patient with erectile dysfunction. Rev Urol. 2003;5 Suppl7:S35–48.PubMedGoogle Scholar
  13. 13.
    Gott M, Galena E, Hinchliff S, Elford H. “Opening a can of worms": GP and practice nurse barriers to talking about sexual health in primary care. Fam Pract. 2004;21(5):528–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Holzapfel S. Sexual medicine in family practice Part 1: How to help. Can Fam Physician. 1993;39:608–14.Google Scholar
  15. 15.
    Hartmann U, Burkart M. Erectile dysfunctions in patient-physician communication: Optimized strategies for addressing sexual issues and the benefit of using a patient questionnaire. J Sex Med. 2007;4(1):38–46.CrossRefPubMedGoogle Scholar
  16. 16.
    Humphery S, Nazareth I. GPs’ views on their management of sexual dysfunction. Fam Pract. 2001;18(5):516–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Recklitis CJ, Campbell EG, Kutner JS, Bober SL. Money talks: Non-monetary incentive fails to increase response rates to a physician survey. J Clin Epidemiol. 2009;62(2):224–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Bober SL, Recklitis CJ, Campbell EG, et al. Caring for cancer survivors: A survey of primary care physicians. Cancer. In Press.Google Scholar
  19. 19.
    Penson RT, Gallagher J, Gioiella ME, et al. Sexuality and cancer: Conversation comfort zone. Oncologist. 2000;5(4):336–44.CrossRefPubMedGoogle Scholar
  20. 20.
    Park ER, Bober SL, Norris RL. Sexual health communication during cancer care: Barriers and recommendations. Cancer J. 2009;15(1):74–7.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Elyse R. Park
    • 1
  • Sharon L. Bober
    • 2
  • Eric G. Campbell
    • 1
  • Christopher J. Recklitis
    • 2
  • Jean S. Kutner
    • 3
  • Lisa Diller
    • 2
  1. 1.Institute for Health Policy, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Perini Family Survivors’ Center, Dana-Farber Cancer InstituteHarvard Medical SchoolBostonUSA
  3. 3.University of Colorado Denver School of MedicineDenverUSA

Personalised recommendations