Supportive Care in Cancer

, Volume 26, Issue 3, pp 887–893 | Cite as

Assessing the utility of a distress screening tool at capturing sexual concerns in a gyne-oncology follow-up clinic

  • Lauren M. WalkerEmail author
  • Majken P. Villiger
  • John W. Robinson
Original Article



Communication and assessment of sexual health within cancer care is poor despite high rates of sexual dysfunction in cancer survivors. Screening for distress programs have been implemented, as a standardized part of cancer care across Canada, with the aim of increasing identification and improving access to support. Alberta Health Services uses a general distress screening form, containing the Canadian Problem Checklist, which includes a list of possible problems, one of which is “intimacy/sexuality.” Theoretically, the discreet nature of the screening for distress form may reduce patient discomfort in disclosing sexual concerns verbally, and therefore help health care providers identify patients requiring intervention. This study aims to determine the adequacy of this distress screening tool in identifying gynecological cancer patients who have an intimacy/sexuality concern.


A chart review was conducted on all follow-up visits in a gyne-oncology clinic over 1 year. Each patient’s chart was reviewed to determine the prevalence of the distress screening form completion, prevalence of the “intimacy/sexuality” item being checked, and documentation of actions taken to address any reported intimacy/sexuality problems.


Seven hundred thirty patient visits were recorded during this period with completed distress screening forms found on 79.0% (n = 577) of charts. Only 6% of the patients indicated an intimacy/sexuality concern on this form. Of those, only one third had documentation that their problem was addressed.


These results call into question the utility of the intimacy/sexuality item on the Canadian Problem Checklist to identify gynecological cancer patients who have sexual concerns. Furthermore, even among those patients who indicated concerns, there is evidence that their problems are rarely addressed. Providers need to directly inquire with patients about their sexual health.


Cancer Oncology Distress screening Gynecologic oncology Sexual distress Sexuality 



Thank you to Dr. Linda Carlson for reviewing and providing helpful feedback on this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Wiggins DL, Wood R, Granai CO, Dizon DS (2007) Sex, intimacy, and the gynecologic oncologists: survey results of the New England Association of Gynecologic Oncologists (NEAGO). J Psychosoc Oncol 25:61–70. CrossRefPubMedGoogle Scholar
  2. 2.
    Dizon DS, Suzin D, McIlvenna S (2014) Sexual health as a survivorship issue for female cancer survivors. Oncologist 19:202–210. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hautamäki K, Miettinen M, Kellokumpu-Lehtinen PL et al (2007) Opening communication with cancer patients about sexuality-related issues. Cancer Nurs 30:399–404. CrossRefPubMedGoogle Scholar
  4. 4.
    Gilbert E, Ussher JM, Perz J (2011) Sexuality after gynecological cancer: a review of the material, intrapsychic, and discursive aspects of treatment on women’s sexual-wellbeing. Maturitas 70:42–57. CrossRefPubMedGoogle Scholar
  5. 5.
    Reis N, Beji NK, Coskun A (2010) Quality of life and sexual functioning in gynecological cancer patients: results from quantitative and qualitative data. Eur J Oncol Nurs 14:137–146. CrossRefPubMedGoogle Scholar
  6. 6.
    Picker NCR (2013) Alberta Health Services Corporate Report: February–August 2013Google Scholar
  7. 7.
    Steele R, Fitch MI (2008) Supportive care needs of women with gynecologic cancer. Cancer Nurs 31:284–291. CrossRefPubMedGoogle Scholar
  8. 8.
    Bourgeois-Law G, Lotocki R (1999) Sexuality and gynecological cancer: a needs assessment. CJHS 8:231Google Scholar
  9. 9.
    Bruner DW, Boyd CP (1999) Assessing women’s sexuality after cancer therapy: checking assumptions with the focus group technique. Cancer Nurs 22:438–447. CrossRefPubMedGoogle Scholar
  10. 10.
    Schover LR, van der Kaaij M, van Dorst E et al (2014) Sexual dysfunction and infertility as late effects of cancer treatment. Eur J Cancer 12:41–53. CrossRefGoogle Scholar
  11. 11.
    Schover LR (1997) Sexuality and fertility after cancer. Wiley, New YorkGoogle Scholar
  12. 12.
    Carr S (2011) Communication about sexuality and cancer. In: Mulhall JP, Incrocci L, Goldstein I, Rosen R (eds) Cancer and sexual health, 1st ed. Humana Press, Totowa, pp 307–316CrossRefGoogle Scholar
  13. 13.
    DeSimone M, Spriggs E, Gass JS et al (2014) Sexual dysfunction in female cancer survivors. Am J Clin Oncol 37:101–106. CrossRefPubMedGoogle Scholar
  14. 14.
    Mitchell AJ (2013) Screening for cancer-related distress: when is implementation successful and when is it unsuccessful? Acta Oncol 52:216–224. CrossRefPubMedGoogle Scholar
  15. 15.
    Carlson LE, Waller A, Mitchell AJ (2012) Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol 30:1160–1177. CrossRefPubMedGoogle Scholar
  16. 16.
    Watson L (2014) Screening for distress: evaluation data updateGoogle Scholar
  17. 17.
    Carlson LE, Waller A, Groff SL et al (2012) Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomized controlled trial of computerized vs personalized triage. Br J Cancer 107:617–625. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Carlson LE, Groff SL, Maciejewski O, Bultz BD (2010) Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol 28:4884–4891. CrossRefPubMedGoogle Scholar
  19. 19.
    Burns M, Costello J, Ryan-Woolley B, Davidson S (2007) Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women’s sexuality. Eur J Cancer Care 16:364–372. CrossRefGoogle Scholar
  20. 20.
    Carlson LE, Angen M, Cullum J et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Watson L, Groff S, Tamagawa R et al (2016) Evaluating the impact of provincial implementation of screening for distress on quality of life, symptom reports, and psychosocial well-being in patients with cancer. JNCCN 14:164–172PubMedGoogle Scholar
  22. 22.
    Tamagawa R, Groff S, Looyis J et al (2016) The effects of a provincial-wide implementation of screening for distress on healthcare professionals’ confidence and understanding of person-centered care in oncology. JNCCN 6:1259–1266Google Scholar
  23. 23.
    Howell D, Keshavarz H, Esplen MJ, et al. (2015) A pan-Canadian practice guideline: screening, assessment and care of psychosocial distress (depression, anxiety) in adults with cancer, Toronto: Canadian Partnership Against Cancer (Cancer Journey Advisory Group) and the Canadian Association of Psychosoci. CAPOGoogle Scholar
  24. 24.
    Bruera E, Kuenhn N, Miller MJ et al (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9PubMedGoogle Scholar
  25. 25.
    Waller A, Garland SN, Bultz BD (2012) Using screening for distress, the sixth vital sign, to advance patient care with assessment and targeted interventions. Support Care Cancer 20:2241–2246. CrossRefPubMedGoogle Scholar
  26. 26.
    College of physicians and surgeons of Ontario (2012) CPSO Policy Statement-Medical RecordsGoogle Scholar
  27. 27.
    Shifren JL, Monz BU, Russo PA et al (2008) Sexual problems and distress in United States women. Obstet Gynecol 112:970–978. CrossRefPubMedGoogle Scholar
  28. 28.
    Carter J, Stabile C, Seidel B et al (2015) Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a female sexual medicine program. Support Care Cancer 23:2255–2265. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Krychman ML, Pereira L, Carter J, Amsterdam A (2006) Sexual oncology: sexual health issues in women with cancer. Oncology 71:18–25. CrossRefPubMedGoogle Scholar
  30. 30.
    Bergmark K, Åvall-Lundqvist E, Dickman PW et al (1999) Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 340:1383–1389. CrossRefPubMedGoogle Scholar
  31. 31.
    Corney RH, Crowther ME, Everett H et al (1993) Psychosexual dysfunction in women with gynecological cancer following radical pelvic surgery. BJOG 100:73–79. CrossRefGoogle Scholar
  32. 32.
    Lindau ST, Schumm LP, Laumann EO et al (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357:762–774. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Levin AO, Carpenter KM, Fowler JM et al (2010) Sexual morbidity associated with poorer psychological adjustment among gynecological cancer survivors. Int J Gynecol Cancer 20:461–470. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Lauren M. Walker
    • 1
    • 2
    Email author
  • Majken P. Villiger
    • 3
  • John W. Robinson
    • 1
    • 2
  1. 1.Division of Psychosocial Oncology, Department of Oncology, Cumming School of MedicineUniversity of CalgaryCalgaryCanada
  2. 2.Psychosocial and Rehabilitation OncologyTom Baker Cancer Centre, Alberta Health ServicesCalgaryCanada
  3. 3.Department of Family Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

Personalised recommendations