Challenges having conversations about sexuality in ambulatory settings: Part II— Health care provider perspectives

Margaret I. Fitch, Gerry Beaudoin, Beverley Johnson


Cancer treatment can have a significant impact on an individual’s quality of life. In particular, body image and sexuality can be compromised. There is increasing evidence that conversations about these specific consequences are not happening often between cancer patients and health care providers, especially in busy ambulatory settings. This study was undertaken to explore the perspectives of cancer care providers regarding the conversations about sexuality that happen following a cancer diagnosis. There was a desire to understand more about the barriers that exist with regards to having this conversation in daily practice.

Thirty-four cancer care professionals (nurses, physicians, social workers and radiation therapists) were interviewed to explore their experiences in having conversations about sexuality. Transcripts were subjected to a standard qualitative content and theme analysis.

Six themes emerged from the analysis. Overall, participants acknowledged treatment can have an impact on a patient’s sexuality. For the most part, any conversations about sexuality topics occurred during informed consent processes before treatment began or when a patient raised a question about a side effect. However, these conversations rarely covered more than the physical side effects and did not focus on the impact of those side effects on emotional and personal relationships or intimacy. Most providers waited for patients to raise any concerns and expressed their own personal discomfort and lack of training in holding these types of conversations. They perceived the conversations as difficult for themselves and for patients.

The findings support the need to clarify role expectations for cancer nurses, as well as other members of the cancer care team, about patient care regarding sexuality, and the provision of education to support the expected role.

Full Text:



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.


Avis, N.E., & Deimling, G.T. (2008). Cancer survivorship and aging.

Cancer, 113(Suppl. 12), 3519–3529.

Barbera, L., Fitch, M.I., Adams, L., Doyle, C., DasGupta, T., & Blake,

J. (2011). “Improving care for women after gynecological cancer:

The development of a sexuality clinic.” Menopause, 18(12), 1327–


Brearley, S.G., Stamataki, Z., Addington-Hall, J., Foster, C., Hodges,

L., Jarrett, N., Richardson, A., … Amir, Z. (2011). The physical

and practical problems experienced by cancer survivors: A

rapid review and synthesis of the literature. European Journal of

Oncology Nursing, 15(3), 204–212.

Braude, H.D., MacDonald, N., & Chasen, M. (2008). Healing and

survivorship: What makes a difference? Current Oncology, 15(4),


Canadian Cancer Society. (2011). Cancer Statistics http://www.


Denzin, N.K., & Lincoln, Y.S. (Eds.). (2000). Handbook of Qualitative

Research (2nd ed.). Thousand Oaks, CA: Sage Publications.

Eton, D., & Lepore, S.J. (2002). Prostate cancer and quality of life: A

review of the literature. Psycho-oncology, 11, 307–326.

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),


Fitch, M.I., Deane, K., & Howell, D. (2003). Living with ovarian cancer:

Women’s perspectives on treatment and treatment decisionmaking.

Canadian Oncology Nursing Journal, 13(1), 8–13.

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.

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,


Hordern, A. (2008). Intimacy and sexuality after cancer: A critical

review of the literature. Cancer Nurs, 31, E9–E17.

Hughes, M.K. (2000). Sexuality and the cancer survivor: A silent

co-existence. Cancer Nursing, 23(6), 477–482.

Institute of Medicine (IOM) (2007). Cancer Care for the Whole

Patient: Meeting psychosocial health needs. Washington, DC:

National Academies Press.

Institute of Medicine (IOM) (2001). Crossing the quality chasm: A

new health system for the 21st century. Washington, DC: National

Academies Press.

International Union Against Cancer (UICC); World Health

Organization (WHO). (2002).;

Jeffry, D. (2001). Overview: Cancer survivorship and sexual function.

J Sex Education Therapy, 26, 170.

Jonker-Pool, G., Van de Wiel, H.B., Hoekstra, H.J., Sleijfer, D.T., Van

Driel, M.F., Van Basten, J.P., & Schrafford Koops, H.S. (2001).

Sexual functioning after treatment for testicular cancer review

and meta-analysis of 36 empirical studies between 1975–2000.

Archives of Sexual Behavior, 30, 55–74.

Katz, A. (2005). The sounds of silence: Sexuality information for

cancer patients. Journal of Clinical Oncology, 23(1), 238–241.

Latini, D.M., Hart, S.L., Coon, D.W., & Knight, S.J. (2009) Sexual

rehabilitation after localized prostate cancer: Current

intervention and future directions. Cancer, 15, 34–40.

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

(In press).

Lockwood-Rayerman, S. (2006). Survivorship issues in ovarian

cancer: A review. Oncology Nursing Forum, 33(3), 553–562.

Mercadante, S., Vitrano, V., & Catania, V. (2010). Sexual issues in

early and late stage cancer: A review. Supportive Cancer Care, 18,


Meyerowitz, B.E., Desmond, K.A., Rowland, J.H., Wyatt, G.E., & Ganz,

P.A. (1999). Sexuality following breast cancer. J Sex Marital Ther,

, 237–250.

National Council on Aging. (1998). Healthy sexuality and vital aging.

Washington, DC: Author.

Penson, R.T., Gallangher, J., Gioiella, M.E., Wallace, M., Borden, K.,

Duska, L.A., Talcott, J.A., … Lynch,T.J. (2000). Sexuality and

cancer: Conversation comfort zone. The Oncologist, 5, 336–344.

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. (2011). Coping with sexual concerns after cancer. Current

Perspective in Oncology, 23, 313–321.

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,

, 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,


Sarna, L. (1993). Correlated of symptom distress in women with

lung cancer. Cancer Prac, 1, 21–28.

Schover, L.R. (1999). Counseling cancer patients about changes in

sexual function. Oncologist, 13(11), 1585–1591.

Shell, J.A. (2002). Evidenced-based practices for symptom

management in adults with cancer: Sexual dysfunction. Oncol

Nurs Forum, 29(1), 53–68.

Stausmire, J.M. (2004). Sexuality at the end of life. Am J Hosp Palliat

Care, 21, 33–38.

Steele, R., & Fitch, M.I. (2008). Why patients with lung cancer do

not want help with some needs. Support Care Cancer, 16(3),


Sun, J., Chapman, J., Gordon, R., Sivaramakrishna, R., Link, M., &

Fish, E. (2002). Survival from primary breast cancer after routine

clinical use of mammography. Breast Journal, 8(4), 199–208.

Syrjala, K.L., Schroeder, T.C., Abrams, J.R., Atkins, T.Z., Brown,

W.S., Sanders, J.E., … Heiman, J.R. (2000). Sexual function

measurement and outcomes in cancer survivors and matched

controls. J Sex Research, 37(3), 213–225.

Tan, G., Waidman, K., & Bostick, R. (2002). Psychosocial issues,

sexuality, and cancer. Sex Disabil, 20(4), 297–318.

Tierney, D.K. (2008). Sexuality: A quality of life issue for cancer

survivors. Seminar Oncol Nurs, 24, 71–79.

World Health Organization (WHO). (2002). Defining sexual health.

Report of a technical consultation on sexual health, 28–31.

Geneva, Switzerland.

Yi, J.C., & Syrjala, K.L. (2009) Sexuality after hematopoietic

stem cell transplantation. Cancer J, 5, 57–64. doi:10.1097/



  • There are currently no refbacks.