A new scoping review from the Children's Oncology Group Adolescent and Young Adult (AYA) Oncology Discipline Committee investigated existing literature about sexual health and functioning for AYA cancer survivors. The researchers found that the evidence available is lacking in many ways.
This review was intended to summarize sexual dysfunction and the relevant psychosexual aspect, which includes romantic relationships and body image in AYA cancer survivors, said Brooke Cherven, PhD, MPH, RN, CPON, Nurse Scientist at the Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Assistant Professor of Pediatrics at Emory University School of Medicine. The conclusion, Cherven told Oncology Times in an interview: "There hasn't been a lot of rigorous research; particularly, there's a lack of longitudinal data that's been collected."
The review article was published online ahead of print in the journal CA: A Cancer Journal for Clinicians (2020; doi.org/10.3322/caac.21655). Previous research reviews regarding sexual function have largely looked at hormonal and physiological factors, Cherven noted. "The influence of psychosocial factors and developmental factors has not received the same amount of attention."
Cherven shared her thoughts about this review and the work she hopes to see in the future to address these literature and care gaps.
1 What were the key research findings?
"There's a significant burden of impaired sexual function among adolescents and young adults after they complete cancer treatment. And there are complex relationships between sexual dysfunction, romantic relationships, and body image in these AYA survivors. These are critical domains that have been identified by survivors as impacting their quality of life.
"We focused on AYA-age survivors of pediatric and AYA cancers, meaning we included survivors who were 15-39 years of age at the time of the study-who had been diagnosed with cancer from birth to 39. Because it was a scoping review, we wanted to look at kind of the state of the science among this broader group of AYA-age survivors.
"In this broad age range, it is important to consider the developmental factors. So if you're thinking about a more adolescent or very early young adult survivor who may not have even been in an intimate relationship or hasn't had any sexual experience, their sexual health needs are different from survivors who are in mid- to late 30s who are partnered and had a strong partner before diagnosis.
"There is a wide range of sexual dysfunction for these groups. And one of the other findings is that there's wide variation in terms of how sexual dysfunction was measured. Some studies used more validated tools to measure sexual dysfunction; other studies looked more at things like sexual satisfaction and other components of sexual functioning.
"So, it's a little difficult to make broad, very strong conclusions on trends other than this is consistently reported as a problem amongst a variety of populations. So depending on cancer diagnosis, treatment, and age, it's coming up as an issue. Sexual dysfunction and sexual health are important to patients' quality of life and it's a problem across the AYA developmental period."
2 Based on this review, were you able to make any more specific conclusions about how these problems differ among cancer survivors of different ages or cancer types?
"[Based on] the way that most of the studies were done, we weren't able to tease out those nuances. But clinically, we can see differences in experiences in survivors who had cancers in their adolescent and young adult years where their psychosexual development was interrupted due to their cancer diagnosis and treatment. We also see that survivors diagnosed in childhood also can experience differences in terms of sexual health needs. And depending on cancer treatment, they may be at risk for some of the hormonal and physiological factors that influence sexual function."
3 What are the next steps and the types of trials you're eager to see done?
"There's a really big need for more prospective studies using validated measures that are developmentally appropriate.
"There is an opportunity to do prospective studies that look at assessing not just sexual function or sexual dysfunction, but some of these other psychosexual factors. For instance, we found that romantic relationships and body image are important aspects of sexual health in this population. So larger studies collecting this information as patients progress from active treatment to completing treatment and into survivorship-this longitudinal data-will be critically important.
"And then we need to test developmentally appropriate interventions that account for these biological and psychosocial factors. A great avenue is collaborations between cooperative research groups, like the Children's Oncology Group and the National Clinical Trials Network, that would allow for design and implementation of this research on a larger scale.
"In tandem, there's also a need for provider-focused interventions that may increase the screening for sexual dysfunction and discussions about sexual health with patients-and referral for treatments amongst survivors who are experiencing issues."