All of Me Iowa – Framework for Sexual Health Care in Oncology

Framework for Sexual Health Care in Oncology – Workgroup Session Four different Groups Group 1 = Normalize & Setting Expectations 1, 2 and 6 Group 2 = Normalize & Setting Expectations 3, 4 and 5 Group 3 = Normalize & Refer as Indicated 1 and 2 Group 4 = Normalize & Refer as Indicated 3, 4, 5 and 6 Work with 2-3 people nearby Choose a scribe to record workgroup feedback Materials for each group: Specified portion of Framework Question sheet (filled out by scribe) End = return materials to conference coordinators Framework for Sexual Health Care in Oncology – Workgroup Session

This guide is written for health care providers who work with people who have cancer, who are being treated for cancer, or who are cancer survivors. Our work grew out of care needs identified by people impacted by cancer and aims to be consistent with the guidance of the National Comprehensive Cancer Network (1). We also discuss the approaches described in the recently published textbook of the European Society of Sexual Medicine (2). The type of cancer, the treatment modality and the physical space where cancer care occurs does not limit the application of this framework – it should be utilized in the manner which best suits the patient’s needs, the oncology care setting, or both. This framework and the associated tools are designed to improve sexual health care at any and every visit where cancer care occurs. The purpose of sexual health care in the oncology setting is to reduce patient uncertainty, confusion, anxiety and distress while improving sexual health outcomes. Reduction of patient apprehension is the responsibility of the cancer care team and essential for effective and efficient communication in the medical setting [3]. Sexual health outcomes after cancer will improve as the focus of cancer care shifts away from rehabilitation toward prevention. This shift is being driven by patient demand and is aided by patient-centered cancer conversations. Treatment decisions that reflect the integration of individual quality of life priorities and pertinent medical information [4] have become the standard of care for prostate cancer, leading to efforts to mitigate surgical morbidity through sexual “pre-habilitation” [5]. However, critical gaps in research and evidence currently exist at the intersection of oncology and sexual medicine as well as other related fields [6]. When treatment-related loss of function after a medical intervention is likely or inevitable, the provider’s responsibility to reduce harm is increased, not reduced. This obligation requires doing everything possible to nurture each patient’s agency over their sexual health and to minimize negative outcomes by offering all ethical treatment choices.

Normalize the Sexual Health Conversation Create a safe and supportive environment Introduce sexual health

Set Expectations Initiate the discussion Discuss the relationship of cancer, cancer treatment and sexual health State clearly that sexual health effects of cancer and cancer treatment side effects are expected  Provide information related to sexual health side effects Appraise if patient has questions, concerns or if more information is required at each visit Document each sexual health conversation to guide future conversations

Refer as Indicated Identify internal & external referral resources Assess team members’ knowledge of referral resources Clearly explain the rationale for each particular referral Utilize the electronic medical record (EMR) to improve the referral process Evaluate and update the referral process on a regular basis Offer existing information in various formats

Framework for Sexual Health Care in Oncology – Workgroup Session Please return materials to conference coordinators Specified portion of Framework Question sheet (filled out by scribe) Framework for Sexual Health Care in Oncology – Workgroup Session

References 1. National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2017, Survivorship, MS-36, accessed 3-21-17. 2. Eds. Yacov, Reisman, Gianotten, Woet. Cancer, Intimacy and Sexuality: A Practical Approach. Springer International Publishing, Switzerland 2017. 3. Kurtz, S., Silverman, J., Benson, J., and Draper, J. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Academic Medicine, 2003 Aug;78(8):802-9. 4. Lindau S.T., Abramshohn E.M., and Matthews, A.C. A manifesto on the preservation of sexual function in women and girls with cancer. American Journal of Obstetrics & Gynecology, 2015;213(2):166-74. 5. Sinta Mina, D. et al. Prehabilitation for men undergoing radical prostatectomy: a multi-centre, pilot randomized controlled trial. BMC Surgery, 2014 Nov 13;14:89. 6. Goldfarb, S.B., et al. A national network to advance the field of cancer and female sexuality. The Journal of Sexual Medicine, 2013 Feb;10(2): 319-25.

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