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Journal of Cancer Survivorship

, Volume 13, Issue 6, pp 932–942 | Cite as

Talking about sexual health during survivorship: understanding what shapes breast cancer survivors’ willingness to communicate with providers

  • Mollie Rose CanzonaEmail author
  • Carla L. Fisher
  • Kevin B. Wright
  • Christy J. W. Ledford
Article
  • 47 Downloads

Abstract

Purpose

Breast cancer survivor (BCS)–provider communication about sexual health (SH) is often absent or inadequate. Patients report wanting providers to broach the topic, but providers cite barriers to initiating discussions. While the health care community works to address barriers, it is unrealistic to rely solely on provider initiation of SH conversations. This research investigates willingness to communicate about sexual health (WTCSH) to better understand what may interfere with survivors’ ability to self-advocate and receive care for these concerns.

Methods

(N = 305) BCSs completed online surveys. Hierarchical multiple regression determined the relationship between Sexual Quality of Life—Female (SQOL—F), which measures psychological and social dimensions of SH and WTCSH. Interviews were then conducted with forty BCSs. The constant comparative method was used to thematically analyze the transcripts.

Results

The mean SQOL score was 53.4 out of 100. No statistically significant differences in SQOL or WTCSH were found by age or survivorship length. The positive relationship between WTCSH and SQOL was significant, F (6,266) = 4.92, p < .000, adj. R2 = .080). Five themes illustrated factors that shape WTCSH: (1) comfort discussing SH; (2) perception of demographic similarity/discordance; (3) patient-centered communication; (4) belief that SH is (un)treatable, and (5) ability to access timely/coordinated care.

Conclusions

Findings establish the significance of SH concerns and provide an in-depth understanding of intrapersonal, interpersonal, and organizational issues informing WTCSH.

Implications for Cancer Survivors

Age and gender dynamics, perceptions of provider SQOL messaging, and futility influence survivor openness. Addressing these areas may encourage disclosure among women who would otherwise continue to suffer in silence.

Keywords

Breast cancer Survivorship Patient-provider communication Sexual health Oncology 

Notes

Acknowledgments

The authors would like to thank the women who participated in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclaimer

Views expressed within this publication do not represent those of the authors and do not reflect the official position of the Uniformed Services University of the Health Sciences, or the US Government, the Department of Defense at large.

References

  1. 1.
    Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L. Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat. 1996;38:183–99.CrossRefGoogle Scholar
  2. 2.
    Ligibel JA, Denlinger CS. New NCCN Guidelines® for survivorship care. J Natl Compr Canc Netw. 2013;11(5S):640–4.CrossRefGoogle Scholar
  3. 3.
    Frechette D, Paquet L, Verma S, et al. The impact of endocrine therapy on sexual dysfunction in postmenopausal women with early stage breast cancer: encouraging results from a prospective study. Breast Cancer Res Treat. 2013;141:111–7.CrossRefGoogle Scholar
  4. 4.
    World Health Organization. Sexual health. 2008. Retrieved from http://www.who.int/reproductive-health/gender/sexualhealth.html.
  5. 5.
    Tuinman MA, Hoekstra HJ, Viine DJ, et al. Sexual function, depressive symptoms and marital status in nonseminoma testicular cancer patients: a longitudinal study. Psycho-oncology. 2010;19:238–47.CrossRefGoogle Scholar
  6. 6.
    Rezaei M, Elyasi F, Janbabai G, Moosazadeh M, Hamzehgardeshi Z. Factors influencing body image in women with breast cancer: a comprehensive literature review. Iran Red Crescent Med J. 2016;18:e39465.CrossRefGoogle Scholar
  7. 7.
    Hawkins Y, Ussher J, Gilbert E, Perz J, Sandoval M, Sundquist K. Changes in sexuality and intimacy after the diagnosis and treatment of cancer: the experience of partners in a sexual relationship with a person with cancer. Cancer Nurs. 2009;32:271–80.CrossRefGoogle Scholar
  8. 8.
    Oktay JS, Walter CA. Breast cancer in the life course: women’s experiences. New York: Springer; 1991.Google Scholar
  9. 9.
    Wenzel L, Dogan-Ates A, Habbal R, et al. Defining and measuring reproductive concerns of female cancer survivors. J Natl Cancer Inst Monogr. 2005;94.Google Scholar
  10. 10.
    Avis NE, Crawford SL, Green R. Vasomotor symptoms across the menopause transition. Obstet Gynecol Clin. 2018;45:629–40.CrossRefGoogle Scholar
  11. 11.
    Kirby JS, Baucom DH, Peterman MA. An investigation of unmet intimacy needs in marital relationships. J Marital Fam Ther. 2005;31:313–25.CrossRefGoogle Scholar
  12. 12.
    Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A Study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762–74.CrossRefGoogle Scholar
  13. 13.
    Halley MC, May SG, Rendle KAS, Frosch DL, Kurian AW. Beyond barriers: fundamental ‘disconnects’ underlying the treatment of breast cancer patients’ sexual health. Cult Health Sex. 2014;16:1169–80.CrossRefGoogle Scholar
  14. 14.
    Ganz PA. Quality of life across the continuum of breast cancer care. Breast J. 2000;6(5):324–30.CrossRefGoogle Scholar
  15. 15.
    Reese JB, Sorice K, Beach MC, et al. Patient-provider communication about sexual concerns in cancer: a systematic review. J Cancer Surviv. 2017;11:175–88.CrossRefGoogle Scholar
  16. 16.
    Kantsiper M, McDonald EL, Geller G, Shockney L, Snyder C, Wolff AC. Transitioning to breast cancer survivorship: perspectives of patients, cancer specialists, and primary care providers. J Gen Intern Med. 2009;24(Suppl 2):S459–66.CrossRefGoogle Scholar
  17. 17.
    Canzona MR, Ledford CJW, Fisher CL, Garcia D, Raleigh M, Kalish VB. Clinician barriers to initiating sexual health conversations with breast cancer survivors: the influence of assumptions and situational constraints. Fam Syst Health. 2018;36:20–8.CrossRefGoogle Scholar
  18. 18.
    Hordern AJ, Street AF. Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs. Med J Aust. 2007;186(5):224–7.CrossRefGoogle Scholar
  19. 19.
    Hordern AJ, Street AF. Constructions of sexuality and intimacy after cancer: patient and health professional perspectives. Soc Sci Med. 2007;64:1704–18.CrossRefGoogle Scholar
  20. 20.
    Hill EK, Sandbo S, Abramsohn E, et al. Assessing gynecologic and breast cancer survivors’ sexual health care needs. Cancer. 2011;117:2643–51.CrossRefGoogle Scholar
  21. 21.
    Reese JB, Shelby RA, Keefe FJ, Porter LS, Abernethy AP. Sexual concerns in cancer patients: a comparison of GI and breast cancer patients. Support Care Cancer. 2010;18:1179–89.CrossRefGoogle Scholar
  22. 22.
    Reese JB, Keefe FJ, Somers TJ, Abernethy AP. Coping with sexual concerns after cancer: the use of flexible coping. Support Care Cancer. 2010;18:785–800.CrossRefGoogle Scholar
  23. 23.
    Reese JB, Bober SL, Daly MB. Talking about women’s sexual health after cancer: why is it so hard to move the needle? Cancer. 2017;123:4757–63.CrossRefGoogle Scholar
  24. 24.
    Wright KB, Frey L, Sopory P. Willingness to communicate about health as an underlying trait of patient self-advocacy: the development of the willingness to communicate about health (WTCH) measure. Commun Stud. 2007;58:35–51.CrossRefGoogle Scholar
  25. 25.
    Hagan TL, Cohen SM, Rosenzweig MQ, Zorn K, Stone CA, Donovan HS. The female self-advocacy in cancer survivorship scale: a validation study. J Adv Nurs. 2018;74(4):976–87.CrossRefGoogle Scholar
  26. 26.
    Smith RA, Hernandez R, Catona D. Investigating initial disclosures and reactions to unexpected, positive HPV diagnosis. West J Commun. 2014;78:426–40.CrossRefGoogle Scholar
  27. 27.
    Berger CR, Calabrese RJ. Some explorations in initial interaction and beyond: toward a developmental theory of interpersonal communication. Hum Commun Res. 1975;1:99–112.CrossRefGoogle Scholar
  28. 28.
    Jeffreys MD, Leibowitz RQ, Finley E, Arar N. Trauma disclosure to health care professionals by veterans: clinical implications. Mil Med. 2010;175:719–24.CrossRefGoogle Scholar
  29. 29.
    Wright KB, Frey LR. Communication and care in an acute cancer center: the effects of patients’ willingness to communicate about health, health-care environment perceptions, and health status on information seeking, participation in care practices, and satisfaction. Health Commun. 2008;23:369–79.CrossRefGoogle Scholar
  30. 30.
    Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 3rd ed. Thousand Oaks: Sage; 2009.Google Scholar
  31. 31.
    Bland JM, Altman DG. Cronbach’s alpha. BMJ. 1997;314(7080):572.  https://doi.org/10.1136/bmj.314.7080.572.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine Pub. Co; 1967.Google Scholar
  33. 33.
    Owen WF. Interpretive themes in relational communication. Q J Speech. 1984;70:274–87.CrossRefGoogle Scholar
  34. 34.
    American Cancer Society. Breast Cancer Facts & Figures. Atlanta: American Cancer Society; 2013.Google Scholar
  35. 35.
    Symonds T, Boolell M, Quirk F. Development of a questionnaire on sexual quality of life in women. J Sex Marital Ther. 2005;31:385–97.CrossRefGoogle Scholar
  36. 36.
    Flynn KE, Reese JB, Jeffery DD, et al. Patient experiences with communication about sex during and after treatment for cancer. Psycho-Oncology. 2012;21:594–601.CrossRefGoogle Scholar
  37. 37.
    Cline RJ. Everyday interpersonal communication and health. In: Thompson TL, Dorsey AM, Miller KI, Parrott R, editors. Handbook of health communication. Mahwah: Lawrence Erlbaum Associates, Inc.; 2003. p. 285–313.Google Scholar
  38. 38.
    Butler L, Banfield V, Sveinson T, et al. Conceptualizing sexual health in cancer care. West J Nurs Res. 1998;20:683–99 discussion 700–705.CrossRefGoogle Scholar
  39. 39.
    Canzona MR, Garcia D, Fisher CL, Raleigh M, Kalish V, Ledford CJW. Communication about sexual health with breast cancer survivors: variation among patient and provider perspectives. Patient Educ Couns. 2016;99:1814–20.CrossRefGoogle Scholar
  40. 40.
    Gross K, Schindler C, Grize L, Späth A, Schwind B, Zemp E. Patient–physician concordance and discordance in gynecology: do physicians identify patients’ reasons for visit and do patients understand physicians’ actions? Patient Educ Couns. 2013;92:45–52.CrossRefGoogle Scholar
  41. 41.
    Jerant A, Bertakis KD, Fenton JJ, Tancredi DJ, Franks P. Patient-provider sex and race/ethnicity concordance: a national study of healthcare and outcomes. Med Care. 2011;49:1012–102.CrossRefGoogle Scholar
  42. 42.
    Malhotra J, Rotter D, Tsui J, Llanos AAM, Balasubramanian BA, Demissie K. Impact of patient-provider race, ethnicity, and gender concordance on cancer screening: Findings from medical expenditure panel survey. Cancer Epidemiol Biomarkers Prev. 2017;26(12):1804–11.  https://doi.org/10.1158/1055-9965.EPI-17-0660.CrossRefPubMedGoogle Scholar
  43. 43.
    Gilbert E, Perz J, Ussher JM. Talking about sex with health professionals: the experience of people with cancer and their partners. Eur J Cancer Care (Engl). 2016;25:280–93.  https://doi.org/10.1111/ecc.12216.CrossRefGoogle Scholar
  44. 44.
    Marwick C. Survey says patients expect little physician help on sex. JAMA. 1999;281:2173–4.CrossRefGoogle Scholar
  45. 45.
    Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. J Sex Med. 2011;8:549.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of CommunicationWake Forest UniversityWinston-SalemUSA
  2. 2.Department of Social Sciences & Health PolicyWake Forest School of MedicineWinston-SalemUSA
  3. 3.Comprehensive Cancer Center of WFUWinston-SalemUSA
  4. 4.Department of Advertising, UF Health Cancer Center, UF Health Center for Arts in MedicineUniversity of FloridaGainesvilleUSA
  5. 5.Department of CommunicationGeorge Mason UniversityFairfaxUSA
  6. 6.Department of Family MedicineUniformed Services University of the Health SciencesBethesdaUSA

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