Untreated cancer-related sexual health concerns cause significant distress for cancer survivors. To appropriately address the complex sexual health needs of cancer patients, we piloted a specialized, multidisciplinary oncology sexual health clinic within a tertiary cancer center. A quality assurance evaluation was conducted.
During once monthly half-day clinics, a multidisciplinary team of psychologists, advanced practice nurses, and radiation and gynecological oncologists offered specialist integrated care to oncology patients. Patients completed assessment questionnaires prior to each clinic appointment and a follow-up telephone interview approximately 4 months after their initial appointment.
Over the 2-year pilot, 224 patients were referred to the cancer center’s broader sexual health program; 100 patients were triaged to the clinic. A total of 79 new and 58 follow-up appointments were offered. Average wait time for an initial visit was 97 days. Patients’ most frequent concerns included vulvovaginal atrophy, dyspareunia, reduced sexual desire, and erectile dysfunction. Self-reported sexual distress was well above the clinical cutoff at baseline (N = 77, M = 29.78, SD = 12.74). A significant reduction in sexual distress was observed at follow-up (N = 67, M = 21.90, SD = 11.34, t(66) = 7.41, p < 0.001).
Referral rates indicate a high demand for specialized sexual health services within cancer care. Ongoing specialist care is needed to appropriately address the multifaceted sexual concerns of cancer survivors and to adequately manage high distress and symptom comorbidity.
Implications for Cancer Survivors
Results inform a more comprehensive characterization of the presenting concerns of cancer survivors seeking multidisciplinary sexual health care.
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DeSimone M, Spriggs E, Gass JS, Carson SA, Krychman ML, Dizon DS. Sexual dysfunction in female cancer survivors. Am J Clin Oncol. 2014;37:101–6.
Bober SL, Varela VS. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol. 2012;30:3712–9.
Hawkins Y, Ussher J, Gilbert E, Perz J, Sandoval M, Sundquist K. Changes in sexuality and intimacy after the diagnosis and treatment of cancer. Cancer Nurs. 2009;32:271–80.
Varela VS, Zhou ES, Bober SL. Management of sexual problems in cancer patients and survivors. Curr Probl Cancer. 2013;37:319–52.
Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health. 2014;29:632–50.
Robinson PJ, Bell RJ, Christakis MK, Ivezic SR, Davis SR. Aromatase inhibitors are associated with low sexual desire causing distress and fecal incontinence in women: an observational study. J Sex Med. 2017;14:1566–74.
Lindau ST, Gavrilova N, Anderson D. Sexual morbidity in very long term survivors of vaginal and cervical cancer: a comparison to national norms. Gynecol Oncol. 2007;106:413–8.
Schover LR, van der Kaaij M, van Dorst E, Creutzberg C, Huyghe E, Kiserud CE. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl. 2014;12:41–53.
Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology. 2012;21:594–601.
Stead ML, Brown JM, Fallowfield L, Selby P. Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. Br J Cancer. 2003;88:666–71.
Canadian Partnership Against Cancer Experiences of Cancer Patients in Transition Study: Emotional challenges. 2018.
Bober SL, Fine E, Recklitis CJ. Sexual health and rehabilitation after ovarian suppression treatment (SHARE-OS): a clinical intervention for young breast cancer survivors. J Cancer Surviv. 2020;14:26–30.
Barbera L, Fitch M, Adams L, Doyle C, Dasgupta T, Blake J. Improving care for women after gynecological cancer: the development of a sexuality clinic. Menopause. 2011;18:1327–33.
Carter J, Stabile C, Seidel B, Baser RE, Gunn AR, Chi S, et al. Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a Female Sexual Medicine Program. Support Care Cancer. 2015;23:2255–65.
Matthew A, Lutzky-Cohen N, Jamnicky L, Currie K, Gentile A, Santa Mina D, et al. The Prostate Cancer Rehabilitation Clinic: a bio-psychosocial clinic for sexual dysfunction after radical prostatectomy. Curr Oncol. 2018;25:393–402.
Walker LM, Wiebe E, Turner J, Driga A, Andrews-Lepine E, Ayume A, et al. The Oncology and Sexuality, Intimacy, and Survivorship Program Model: an integrated, multi-disciplinary model of sexual health care within oncology. J Cancer Educ. 2019. https://doi.org/10.1007/s13187-019-01641-z.
Alberta Innovates A pRoject Ethics Community Consensus Initiative (ARECCI) Ethics Screening Tool. Available from: http://www.aihealthsolutions.ca/arecci/screening/442204/13c2d9c5edfc00dbbede7630820b1588.
Santos-Iglesias P, Mohamed B, Danko A, Walker LM. Psychometric validation of the female sexual distress scale in male samples. Arch Sex Behav. 2018;47:1733–43.
Derogatis L, Clayton A, Lewis-D'Agostino D, Wunderlich G, Fu Y. Validation of the Female Sexual Distress Scale-Revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5:357–64.
Derogatis LR, Rosen R, Leiblum S, Bennett A, Heiman J. The female sexual distress scale (FSDS): initial validation of a standardized scale for assessment of sexually related personal distress in women. J Sex Marital Ther. 2002;28:317–30.
Carter J, Stabile C, Seidel B, Baser R, Goldfarb S, Goldfrank D, et al. Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors. J Cancer Surviv. 2017;11:274–83.
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–70.
Anderson SR, Tambling RB, Huff SC, Heafner J, Johnson LN, Ketring SA. The development of a reliable change index and cutoff for the revised dyadic adjustment scale. J Marital Fam Ther. 2014;40:525–34.
Busby MD, Christensen C, Crane R, Larson HJ. A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales. J Marital Fam Ther. 1995;21:289–308.
Crane DR, Middleton KC, Bean RA. Establishing criterion scores for the Kansas Marital Satisfaction Scale and the Revised Dyadic Adjustment Scale. Am J Fam Ther. 2000;28:53–60.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–30.
Rosen RC, Cappelleri JC, Gendrano N 3rd. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002;14:226–44.
Millman RD, Jacox N, Sears CS, Robinson JW, Turner JW, Walker LM. Patient interest in the Lowdown on Down There: attendance at a vulvovaginal and sexual health workshop post-cancer treatment. Support Care Cancer. 2019.
Griggs J, Maingi S, Blinder V, Denduluri N, Khorana AA, Norton L, et al. American Society of Clinical Oncology position statement: strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol. 2017;35:2203–8.
Duimering A, Walker LM, Turner J, Andrews-Lepine E, Driga A, Ayume A, Robinson JW, Wiebe E. Quality improvement in sexual health care for oncology patients: a Canadian multidisciplinary clinic experience. Support Care Canc. 2020;28(5):2195–203. https://doi.org/10.1007/s00520-019-05040-4.
L. Walker’s salary is funded by the Arnie Charbonneau Cancer Institute and by the Daniel Family Chair in Psychosocial Oncology. This project was funded in part by the Calgary Foundation and the Alberta Cancer Foundation.
Conflict of interest
The authors declare that they have no conflict of interest.
Application of the Alberta Innovates A pRoject Ethics Community Consensus Initiative (ARECCI) ethics screening tool for quality assurance indicated that research ethics board approval was not required for this quality assurance initiative. All clinical outcomes reported were collected as part of clinical service delivery. All procedures performed in this study were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent for clinical service was obtained from all individual participants who attended the clinical program.
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Walker, L.M., Sears, C.S., Booker, R. et al. Development, implementation, and evaluation of a multidisciplinary oncology sexual health clinic in a Canadian cancer care setting. J Cancer Surviv (2021). https://doi.org/10.1007/s11764-020-00967-8
- Sexual health
- Program development
- Multidisciplinary care
- Cancer survivorship