Intimacy, Substance Use, and Communication Needs During Cancer Therapy: A Report From the “Resilience in Adolescents and Young Adults” Study

Abstract

Purpose The prevalence of intimacy and substance use among adolescents and young adults during cancer therapy has not been well described. Methods The “Resilience in Adolescents and Young Adults with Cancer” study was a prospective, multicenter, mixed-methods cohort study. English-speaking patients 14–25 years old with newly diagnosed cancer were invited to complete a comprehensive survey at the time of enrollment (T1) and 3–6 months later (T2). Intimate relationships and health behaviors were assessed with questions adapted from the Guidelines for Adolescent Preventative Services assessment. Descriptive statistics characterized the prevalence of sexual and substance-related behaviors at each time point. Results Of 42 eligible and enrolled participants, 35 (83%) and 25 (59%) completed T1 and T2 surveys, respectively. Their mean age was 17.6 years (standard deviation 2.3), 57% were male, and the most common diagnoses were sarcoma and acute leukemia. Over a third of participants reported dating at each time point; 26% were sexually active at T1, and 32% at T2. Of those endorsing sexual activity, fewer than half reported consistent birth control or condom use and 4 reported their first sexual intercourse during our observation. In addition, 46% (T1) and 44% (T2) reported alcohol use and 23% (T1) and 26% (T2) reported illicit drug use. Despite these activities, fewer than 10% endorsed a worry or need to discuss these behaviors with oncology providers. Conclusions Intimacy and substance use among adolescents and young adults are common during cancer therapy. Clinical and research implications include the identification of optimal communication and patient-centered supports.

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients

“…Clinician education should build upon current discussions of fertility risk and preservation strategies to include safe sex practices during therapy, contraception, and increased risk for sexually transmitted infections . Education interventions must also address AYAs’ elevated risk for sexual dysfunction during and after cancer treatment .…”

Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective

“…Given that the average age of sexual debut is 16 years, it can be assumed that many AYAs have been exposed to sexual behaviors prior to diagnosis. Limited research shows that adolescent survivors of early childhood cancer engage in risky sexual behaviors at rates equivalent to controls and AYAs undergoing cancer treatment engage in sexual activity, including risk‐taking behaviors such as using unreliable methods of contraception or none at all, at rates similar to or higher than their cancer‐free peers . These data support an urgent need for sexual health and contraception education for this vulnerable population.…”

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…Clinicians working with this population need to be aware of this and address the issues in a sensitive and confidential manner. 192,206 Studies have shown increased rates of mental illness and cognitive impairment among adolescent cannabis users compared with adults with similar usage habits. 207 Heavy or regular use of cannabis in adolescents has been associated with impairments in attention, learning, memory, planning, and psychomotor speed.…”