Une approche biopsychosociale au rétablissement sexuel après le traitement du cancer de la prostate : suggestions pour la pratique infirmière en oncologie

Lauren M Walker, Andrea M Beck, Amy J Hampton, John W Robinson

Abstract


Au cours des dix dernières années, de nombreuses nouvelles études ont fait surface sur l’impact, sur les relations intimes, du dysfonctionnement érectile (DE) induit par le traitement du cancer de la prostate (CP). Malgré les importants progrès dans le traitement du DE—grâce aux inhibiteurs de phosphodiestérase, aux pompes à vide pour pénis et aux injections intracaverneuses—les patients et leurs partenaires continuent d’avoir des difficultés à maintenir une vie sexuelle gratifiante. Seuls la moitié des patients atteints d’un CP sont disposés à tenter un traitement contre le DE, et moins de la moitié des patients qui constatent des résultats positifs à la suite d’un tel traitement continuent de l’utiliser à long terme. 

Bien qu’il existe des stratégies efficaces qui s’enseignent aux patients pour surmonter les obstacles associés à l’application des traitements contre le DE, la plupart des patients, s’ils sont laissés à eux-mêmes, se découragent et abandonnent rapidement. Les infirmières jouent un rôle important dans l’éducation et le counselling aux patients, tant en ce qui concerne leur préparation avant le traitement du CP qu’à l’étape du suivi. 

Elles sont donc bien placées pour promouvoir le rétablissement sexuel des patients atteints de CP et pour ainsi accroître le taux de réussite parmi les patients et leurs partenaires en matière de sexualité. Les infirmières sont formées pour dispenser des soins biopsychosociaux holistiques, une approche qui complète les traitements biomédicaux contre le DE et qui répond à un besoin bien réel. 

Dans un premier temps, nous offrons aux infirmières des suggestions qui visent à renforcer leur capacité de discuter, d’évaluer et d’intervenir dans le domaine des difficultés d’ordre sexuel. S’ensuivent des recommandations précises—basées sur la documentation scientifique sur le CP—visant à aider les infirmières à soutenir les patients qui reçoivent un traitement contre le DE. Nous offrons en outre des conseils sur des méthodes d’éducation des patients qui favorisent le développement d’attentes réalistes face aux traitements. Non seulement ces suggestions devraient-elles aider à améliorer l’adhésion aux traitements contre le DE, mais encore elles devraient aider les patients à réfléchir de façon plus globale au processus de rétablissement sexuel et à élaborer des objectifs de rétablissement au-delà de la simple restauration du fonctionnement érectile. La souplesse dans les pratiques sexuelles semble être importante pour la renégociation fructueuse du fonctionnement sexuel. Par conséquent, on devrait suggérer aux patients des stratégies sexuelles sans pénétration—qui ne requièrent donc pas d’érections—dans le cadre de la pratique clinique de routine. Outre les stratégies visant à surmonter les obstacles particuliers comme la perte de libido et de moral liée à l’échec du traitement, il convient d’offrir des recommandations concernant la communication de couple, la persistance dans le processus thérapeutique et le travail de deuil par rapport à la perte de fonctionnement sexuel.

Mots clés : cancer de la prostate, dysfonctionnement érectile, adaptation sexuelle, counselling, éducation du patient


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References


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