|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 132-133
Lets talk about sex...to our cancer patients
Kunal Dholakia, Gagan Prakash
Department of Uro-Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||9-Sep-2019|
HBB 222, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dholakia K, Prakash G. Lets talk about sex...to our cancer patients. Cancer Res Stat Treat 2019;2:132-3
We congratulate Dr. Talreja and the editorial team of Cancer, Research, Statistics, and Treatment for discussing this important and sensitive yet often ignored aspect of care in cancer patients. The author has been lucid in bringing out the medical, logistical, practical, and philosophical issues relevant to this subject and has peeped into the mindset of both those treating and those being treated for cancer.
Having spent our initial years of training in urology, we were exposed to sexual health management. We want to share our perspective on what has been discussed and suggest possible solutions to the roadblocks in addressing sexual health in cancer patients.
| Identify the Problem|| |
The author has correctly emphasized that cancer patients are now living longer after treatment and quality of life (QOL) issues need attention. Often, sexual health is left out from QOL consideration. In addition, sexual health is different from other domains of QOL as its impact begins even before the treatment gets started and can last for many years after the treatment is over, sometimes lifelong. A consistent theme across the literature has been that oncology professionals do not discuss issues related to sexual health with their patients. The problem seems to be a global one; however, in India, where openness to discuss sexual health is a challenge even in nondisease scenarios, this becomes even more difficult.
| Involve Experts|| |
Oncologists trying to address sexual health and manage it, is an unrealistic, far-fetched thought. A detailed sexual history from a patient or his/her spouse is again not a realistically achievable solution. What is required is an awareness of how the planned or ongoing treatment (surgery/chemotherapy/radiotherapy) can affect sexual health. Knowledge and mindfulness of the oncologist is the critical factor here. Once these are there, it would take just one or two questions to pick patients in whom sexual health is likely to be a concern. It is the “What the mind knows the eyes see” story. Patient or survivor not discussing sexual health is not in our hands and is unlikely to change. Specific approaches such as access to brochures explaining sexual health in follow-up clinics, including questionnaires related to sexual health in surveillance protocols, may help in giving them a lead.
| Assess Appropriately|| |
The author has made a point about the role of training, the discomfort of the oncologist in dealing with sexual issues, and the attitude about the problem being “someone else's job.” We again feel that this is a reality and is unlikely to change. Dealing with sexual health in patients with cancer is a specialized job. It entails detailed history taking; requires experience and use of appropriate questionnaires and tools; consideration of physical, psychological, and social aspects; and above all, requires time. The American Society of Clinical Oncology and the National Comprehensive Cancer Network have published guidelines for sexual health in cancer patients, and the European Organisation for Research and Treatment of Cancer has a questionnaire to assess this.,, This would be too much to ask from a busy oncologist. Instead, referring the patient to someone who can manage this would be a more comfortable option. Identifying patients who need this and counseling them that something can be done about their sexual health issues is the oncologist's responsibility though.
The next step is to make this referral easy for the patient. And this is where priming the hospital administration becomes essential. Diet and nutrition, physiotherapy, pain palliation, and psychiatry are ancillary departments in a cancer hospital, and they all aim to improve patients' QOL. There is a need to add sexual health and fertility clinic to this list.
Sexual problems and their evaluation and management are different for male and female patients with cancer. Given the complex needs of patients and partners after cancer therapy that results in adverse sexual health outcomes, a multidisciplinary team with an integrative approach provides the best care. Such a group could include a sexual health clinician, a urologist, a psychologist, a pelvic floor physiotherapist, and an endocrinologist, who have an interest in and understanding of the impact of specific cancer treatments on sexual function. An integrative approach addressing the emotional and sexual health of the patient and his/her partner must be adopted as a routine part of usual care.
Sexual health of patients with cancer has not been much discussed in Indian literature. We hope that this article will actually “muse” oncologists, caregivers, and policymakers and lead them to incorporate this oft-ignored aspect of cancer care in their routine practice.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Talreja V. Love in the time of cancer. Cancer Res Stat Treat 2018;1:75-7. [Full text]
Ligibel JA, Denlinger CS. New NCCN guidelines for survivorship care. J Natl Compr Canc Netw 2013;11:640-4.
Carter J, Lacchetti C, Andersen BL, Barton DL, Bolte S, Damast S, et al.
Interventions to address sexual problems in people with cancer: American society of clinical oncology clinical practice guideline adaptation of cancer care Ontario guideline. J Clin Oncol 2018;36:492-511.
Nagele E, Den Oudsten B, Greimel E. EORTC Quality of Life Group. How to evaluate sexual health in cancer patients: Development of the EORTC sexual health questionnaire for cancer patients. Transl Androl Urol 2015;4:95-102.