INTERNATIONAL PERSPECTIVES: Holding conversations with cancer patients about sexuality: Perspectives from Canadian and African healthcare professionals

Johanna Maree, Margaret I. Fitch


Cancer treatment can have a significant impact on an individual’s sexuality. However, cancer survivors are reporting that very few healthcare professionals are talking with them about the topic. This work was undertaken to gain an increased understanding about the dialogue between cancer care professionals and cancer patients regarding the topic of sexuality. It was anticipated the effort would allow the identification of barriers that could limit dialogue between patients and healthcare providers, as well as offer insight regarding how to overcome such barriers in busy clinical settings. A Canadian sample of 34 healthcare professionals were interviewed and 27 African nurses engaged in a focus group discussion. A content analysis revealed similarities in terms of personal discomfort with the topic and feeling unprepared to discuss it with patients. There were notable differences between the two samples in terms of the barriers related to culture and tradition. African nurses reported significant cultural barriers, stigma and discrimination influencing conversations about sexuality with cancer patients in contrast to their Canadian counterparts. 

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Andersen, B.L., Woods, X.A., & Copeland, L.J. (1997). Sexual self-schema and sexual morbidity among gynecologic cancer survivors. J Consul Clin Psychol, 65, 221–229. DOI:10.1037/0022-006X.65.2.221

Bedell, S., Manders, D., Kehoe, S. Lea, J. Miller, D., Richardson, D., & Carlson, M. (2017). The opinions and practices of providers towards the sexual issues of cervical cancer patients undergoing treatment. Gynecologic Oncology, 144, 586–591.

Bianchi, A. (2018). Sexuality in end-of-life care: Who should start the discussion? Hospital News, (May), 62.

Bober, S.L., & Varela, V.S. (2012) Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol, 30(30), 3712–9. doi:10.1200/JCO.2012.41.7915

Canadian Association of Nurses in Oncology (2006). Practice Standards and Competencies for the Specialized Oncology Nurse. Available at

Canadian Association of Psychosocial Oncology (2012). Emotional Facts of Life with Cancer. Available at

Candoza, M.R., Garcia, D., Fisher, C.L., Raleigh, M., Kalish, V., & Ledford, C.J.W. (2016). Communication about sexual health with breast cancer survivors: Variation among patient and provider perspectives. Patient Education and Counselling, 99, 1814–1820.

Denzin, N.K., & Lincoln, Y.S, (2000). Handbook of Qualitative Research, 2nd Edition, Thousand Oaks,California: Sage.

Fitch, M.I., Beaudoin, G., & Johnson, B. (2013). Challenges having conversations about sexuality in ambulatory settings: Part I—Patient perspectives. Canadian Oncology Nursing Journal, 23(1), 4–18.

Fitch, M.I., Miller, D., Sharir, S., & McAndrew, A. (2010). Radical cystectomy for bladder cancer: A qualitative study of patient experiences and implications for practice. Canadian Oncology Nursing Journal, 20(4), 177–187.

Fitch, M.I., Page, B.D., & Porter, H.B. (Eds.). (2008). Supportive Care Framework: A foundation for person-centred care. Pembroke, ON: Pappin Communications.

Flynn, K.E., Reese, J.B., Jeffery, D.D., Abernathy, A.P., Lin, L., Shelby, R.A. et al. (2012). Patient experiences with communication about sex during and after treatment for cancer. Psycho-oncology, 21(6), 594-601. doi:10.1002/pon.1947

Harrison, J.D., Young, J.M., Price, M.A., Butow, P.N., & Solomon, M.J. (2009). What are the unmet supportive care needs of people with cancer? A systematic review. Supportive Care in Cancer, 17, 1117–1128.

Hordern, A., (2008), Intimacy and sexuality after cancer: A critical review of the literature. Cancer Nursing, 31(2), E9–17. doi:10.1097/01.NCC.0000305695.12873.d5

Institute of Medicine (IOM) (2007). Cancer Care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press. Institute of Medicine (IOM).

Jackson, S.E., Wardle, J., Steptoe, A., Fisher, A. (2016) Sexuality after a cancer diagnosis: a population based study. Cancer (December 15), 3883–-3891. doi:10.1002/cncr.30263

Katz, A. (2005). Do ask, do tell, Why do so many nurses avoid the topic of sexuality? American Journal of Nursing, 105(7), 66–8.

Katz, A. & Dixon, D. (2016). Sexuality after cancer: A model for male survivors. The Journal of Sexual Medicine, 13(1), 70–78.

Lindau, S.T., Surawska, H., Paice, J., & Baron, S.R. (2011). Communication about sexuality and intimacy in couples affected by lung cancer and their clinical care providers. Psycho-oncology 20(2), 179–85 doi:10.1002/pon.1787

Mercadante, S., Vitrano, V., & Catania, V. (2010). Sexual issues in early and late stage cancer: A review. Supportive Cancer Care, 18, 659–665.

Meyerowitz, B.E., Desmond, K.A., Rowland, J.H., Wyatt, G.E., & Ganz, P.A. (1999). Sexuality following breast cancer. J Sex Marital Ther, 25, 237–250.

Park, E.R., Norris, R.L., & Bober, S.L. (2009). Sexual health communication during cancer care: barriers and recommendations. Cancer J, 15(1), 74–7. doi:10.1097/PPO.0b013e31819587dc

Perz, J., Ussher, J.M., Gilbert, E., and the Australian Cancer and Sexuality Study Team. (2014). Feeling well and talking about sex: Psycho-social predictors of sexual functioning after cancer. BMC Cancer, 14288. Retrieved from

Redelman, M.J. (2008). Is there a place for sexuality in the holistic care of patients in the palliative care phase of life? Am J Hosp Palliat Care, 25, 366–371.

Reese, J.B., Shelby, R.A., & Abernethy, A.P. (2011). Sexual concerns in lung cancer patients: An examination of predictors and moderating effects of age and gender. Supportive Cancer Care, 19, 161–165.

Reese, J.B., Shelby, R.A., Keefe, F.J., Porter, L.S., & Abernethy, A.P. (2010). Sexual concerns in cancer patients: A comparison of GI and breast cancer patients. Supportive Cancer Care, 18, 1179–1189.

Reese., J.B., Beach, M.C., Smith, K.C., Bantug, E.T., Casale, K.F., Porter, L.S. et al. (2017). Effective patient-provider communication about sexual concerns in breast cancer: A qualitative study. Support Care Cancer, 25, 3199-3207. doi:10.1007/s00520-017-3729-1

Reese, J.B., Bober, S., & Daly, M.B. (2017). Talking about Women’s Sexual health after cancer – Why is it so hard to move the needle? Cancer (Dec 15), 4757–4763. doi:10.1002/cncr.31084

Rossen, P., Pedersen, A.F., Zachariae, R., von der Maas, H. (2012). Sexuality and body image in long-term survivors of testicular cancer. European Journal of Cancer, 48, 571–578. doi:10.1016/j.ejca.2011.11.029

Shell, J.A. (2002). Evidenced-based practices for symptom management in adults with cancer: Sexual dysfunction. Oncol Nurs Forum, 29(1), 53–68.

Tierney, D.K. (2008). Sexuality: A quality of life issue for cancer survivors. Seminar Oncol Nurs, 24, 71–79.

Ussher, J.M., Perz, J., & Gilbert, E., and the Australian Cancer and Sexuality Team Cancer (2015). Perceived causes and consequences of sexual changes after cancer for women and men: A mixed method study. BMC Cancer 15, 268. doi:10.1186/s12885-015-1243-8

Varela, V.S., Zhou, E.S., & Bober, S.L. (2013). Management of sexual problems in cancer patients and survivors. Curr Problem Cancer, 37, 319–352.

World Health Organization (WHO). (2002). Defining sexual health. Report of a technical consultation on sexual health, 28–31. Geneva, Switzerland.


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