Changes in sexuality and intimacy after cancer were examined using open-ended questionnaire responses with 156 informal carers who were partners of a person with cancer. Interviews were conducted with 20 participants to examine changes in depth. Seventy-six percent of partners of a person with "nonreproductive" cancer types and 84% of partners caring for a person with cancer involving "reproductive" sites reported an impact on their sexual relationship. Cessation or decreased frequency of sex and intimacy was reported by 59% of the women and 79% of the men. Renegotiation of sexuality and intimacy after cancer was reported by only 19% of the women and 14% of the men. Reasons for changes to sexuality after cancer were the impact of cancer treatments, exhaustion due to caring, and repositioning of the person with cancer as a patient, not a sexual partner. Changes to sexuality were associated with reports of self-blame, rejection, sadness, anger, and lack of sexual fulfillment. Positive consequences of changes included accepting the changed sexual relationship and having increased closeness and intimacy. These findings reinforce the need to acknowledge the sexual needs of partners as well as people with cancer, by healthcare professionals working in cancer and palliative care.

Recognition that informal cancer carers experience unmet needs and psychological distress has led to the development of a range of psycho-social interventions.The efficacy of such interventions is examined through a systematic review of the research literature, following National Health and Medical Research Council and Cochrane Collaboration guidelines. Of 13 level II randomised controlled trials (RCTs), only eight showed significant differences across groups, with moderate effect size. This included improvement in caregiver experience or appraisal of caregiving following psycho-education (two studies); improved sexual satisfaction, dyadic coping, relationship quality and communication, or reduced psychological distress, following couple counselling (4); reduced distress following family grief therapy (1); and reduction in distress in bereavement following home palliative care (1). Level III and IV studies were also reviewed, reporting positive effects of psycho-education (5), problem solving (3), an arts intervention (1) and a support group (1). However, methodological concerns limit the generalisability of findings of level III and IV studies. It is concluded that interventions should target those most in need of support; recognise specific needs of carers across cancer type and stage, gender and relationship context; be theory based; and evaluations should utilise RCT designs with outcome measures appropriate to the specific aims of the intervention, rather than global measures of distress.

There is a growing body of research showing that cancer impacts upon the sexuality of informal carers in a couple relationship with a person with cancer. However, this research is primarily focused on partners of a person with gynaecological or breast cancer, within a framework where the physiological effects of cancer on sexual performance are the focus. We conducted semi-structured interviews with 20 informal carers in a couple relationship with a person with cancer, across a range of cancer types. The aim was to explore accounts of changes to sexuality and intimacy post-cancer, in the context of discursive constructions of sexuality and the caring role. Our findings show that partners' sexual experiences were shaped by absence of desire in the person with cancer; the stress and exhaustion associated with caring tasks; the repositioning of the person with cancer as childlike or as an asexual 'sick patient'; and the belief that there were expectations about 'acceptable' sexual conduct in the context of cancer caring. Carers accepted the diminishment of their sexual relationship, but expressed feelings of disappointment, anger and sadness about this loss. It is concluded that it is vital that support services are developed, so that couples may develop new sexual strategies, and cope more effectively with potential disruptions to their sexual and intimate relationship.