85% of women with breast cancer reported changes to sexual well-being, with most wanting information on these changes
- Correspondence to: Dr Susan Williamson
School of Health, University of Central Lancashire, Brook Building, Preston PR1 2HE, Lancashire, UK;
Implications for practice and research
Women need to be informed about the effect of treatment for breast cancer on sexual well-being.
Routine assessment of sexual well-being prior to, and on completion of, treatment for breast cancer should be conducted.
The training and resource needs of healthcare professionals should be identified to enable them to provide more information on sexual well-being.
Cancer treatment affects sexuality and physical intimacy during and often long after completion of treatment, with many cancer survivors suffering from permanent sexual dysfunction.1 ,2 However, discussions relating to the effect of cancer treatment on sexual function are rarely initiated by healthcare professionals either prior to treatment or during routine follow-up.1–4
An online survey which aimed to evaluate sexual well-being, information needs, experiences of obtaining information and communicating with healthcare professionals about sexual issues was completed by a convenience sample of 1965 members of Breast Cancer Network Australia. The survey combined open and closed questions; descriptive statistics were applied to the quantitative data and thematic analysis to the qualitative data.
The age range of respondents was 18–84 with an average age of 54 years. A total of 45.5% of participants were still receiving treatment and although 85% reported that cancer had affected their sexual well-being and sexual relationships, 65% had not spoken to a healthcare professional about their difficulties. The main reported reasons for this were: they talked to their partner, they were embarrassed, they felt they could cope and they were unaware of any help available. Of the 26% who had discussed sexual well-being with someone, most reported that this was with their partner (76%) and only 48% were satisfied with the discussion. Satisfaction with discussions with healthcare professionals about sexual well-being was low, with breast care nurses scoring highest (59.6%), but 63.4% were satisfied with the information they received through support groups.
Online surveys are becoming more common and the age range of the respondents in this study shows that age is not a barrier to this method. The authors did not state how many participants were invited to complete the survey so the response rate is not clear. The authors acknowledge the limitations of a self-selected convenience sample, but the fact that 1965 women took the time to complete what appears to be a lengthy, detailed survey demonstrates the importance they attach to this issue. The authors are to be commended for acknowledging the multifactorial aetiology involved by not limiting the questions to assessing feelings of sexual attractiveness and sexuality. The results largely confirm findings from other studies which indicate that all patients who have been treated for cancer would welcome the opportunity to have a discussion with a healthcare professional about sexual well-being, but that this rarely happens.1–4
The majority of the respondents reported the negative impact of the well-known side effects of their treatment on their sexual relationships, yet these were not discussed with them prior to treatment. The authors point out the surprisingly low levels of satisfaction with healthcare information contrasted with other studies where respondents report high levels of satisfaction with information received from providers of healthcare and suggest this may reflect the number of healthcare providers this group of women had to approach for information. Unlike other studies, the women in this study wanted written information that they could access, and this may be because searching for information online has become more commonplace in recent years, or because this group of respondents had completed an online survey. Although not reported in the findings, the authors acknowledge in the discussion that groups such as same-sex couples and young women have become marginalised because of difficulties in finding information specific to their needs.
Patients’ inability to find information sources about sexual well-being and healthcare professionals’ reluctance to engage in discussion about sexual problems is not unique to breast cancer and has been reported by other studies.3 ,4 Further research is needed to identify the training and support needs of healthcare professionals to enable them to provide patients with the information they need to manage their sexual well-being after treatment for cancer.