Patient-Reported Barriers and Facilitators to Seeking and Accessing Support in Gynecologic and Breast Cancer Survivors with Sexual Problems: A Systematic Review of Qualitative and Quantitative Studies

Abstract

Background Greater understanding of patient-reported barriers and facilitators to seeking and accessing sexual health services will help formulate strategies to assist gynecologic and breast cancer patients to overcome obstacles to accessing sexual health support because they typically do not seek sexual education and/or treatment when confronted with sexual concerns. Aim The objectives of this systematic review were to (i) explore the patient-reported barriers to seeking and accessing support for sexual problems in gynecologic and breast cancer survivors, and (ii) identify strategies used to successfully overcome the barriers to accessing sexual health information and/or treatment. Main Outcome Measures The main outcome measures included factors that prevent and/or facilitate gynecologic and breast cancer patients with sexual concerns seeking and accessing sexual health-related services. Methods Systematic searches of major electronic databases (Ovid MEDLINE, PsycINFO, CINAHL, ProQuest, and Chinese database CNKI) from January 2009 to July 2019 were used to identify the barriers and facilitators to seeking sexual education/treatment from the perspective of gynecologic and breast cancer survivors. A narrative synthesis was conducted. Results 20 studies met the inclusion criteria including 12 qualitative, 6 quantitative, and 2 mixed methods studies. 4 interconnected themes were derived from 13 subthemes relating to the barriers/facilitators to seeking and accessing sexual health support. The most common barriers were embarrassment/discomfort in discussing sexual concerns, perceived discomfort of healthcare providers in discussing sexual issues, limitations of the healthcare system to address sexual problems, and the multidimensional nature of sexuality. Help-seeking for sexual health concerns was facilitated by: (i) oncology health professionals initiating and conducting open, honest discussions around sexual concerns with patients; (ii) the availability of information in multiple forms; and (iii) appropriate timing of information provision according to women's preferences. Clinical Implications Oncology health professionals need to develop an open, honest, accepting communication style and be accessible to women with cancer and their partners within healthcare systems. Strengths & Limitations The systematic review was conducted in accordance with guidelines. Variability in the primary aims and outcomes of the included studies precluded a meta-analysis. Conclusions Training programs for providers of oncology care should enhance their knowledge of sexual issues in gynecologic and/or breast cancer, enhance their communication skills with patients, and improve their ability to consult or refer patients to psycho-oncologists or other mental health professionals.

A Pilot Study on the Quality of Sexual Life of Patients Receiving Home Palliative Care in Poland

“…Of these, more than half indicated a lack of help in addressing sexual problems from health care professionals. In addition, older patients are less likely to report sexual problems than younger patients [13,14]. Similar conclusions were formulated by Gleeson and Hazell who found that most healthcare professionals do not routinely assess the sexual well-being of patients receiving palliative care.…”

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“…Standardised instruments (questionnaires) may help to assess the grade of impairment. [136][137][138][139][140] At first recurrence, one out of four patients is younger than 50 years old and premenopausal. Therefore, issues of fertility and contraception must be discussed, and for the latter, only hormone-free contraceptives can be recommended.…”

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“…Patient advocates and studies have strongly emphasized and recognized that there needs to be more support and treatment, such as for those who experience sexual dysfunction, and its long-term consequences on mental well-being. 20 Therefore, collection of patient experience data throughout the breast cancer clinical development program could help inform tolerability of new therapies, with an emphasis on patient-reported symptoms, side-effects, physical function, ability to work, and healthrelated quality of life. Additionally, the breast cancer clinical development program should reflect the racial and ethnic diversity of this patient population.…”