Nurturing Intimacy After Cancer
Article Summary
- Many doctors aren’t trained to address questions of sexual health in cancer patients.
- A new Sylvester Comprehensive Cancer study will evaluate a digital health solution for patients who underwent a bone marrow transplant and have sexual health concerns.
- The app offers education, videos, games and exercises designed to help patients identify what might be contributing to their sexual concerns.
Sex may not be top of mind for someone undergoing treatment for cancer. However, as a powerful dimension of human experience, it is often a concern among patients.
Unfortunately, many clinicians aren’t trained to address questions of sexual health in cancer patients, so patients are often left to struggle through these issues on their own.
A new study will evaluate a digital health solution integrated into survivorship care for patients who underwent a bone marrow transplant and are now experiencing sexual health concerns.
Lara Traeger, Ph.D., from Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, is one of the co-investigators on a five-year R01 study funded by the National Cancer Institute (NCI). In addition to Sylvester, the study will have two other sites: Massachusetts General Hospital and the Fox Chase Cancer Center.
Fostering Open Conversations About Sex After Cancer
A clinical psychologist and associate professor of psychology at the University of Miami, Dr. Traeger is trained in health psychology, which focuses on coping with distress and promoting well-being and healthy behaviors in people who are facing or are at risk for serious illness.
“My patients and I talk about sexual health pretty extensively because it’s not always comfortable for patients to bring it up with their oncology clinicians,” she said. “When I start treatment with patients for anxiety, depression, stress or other coping factors, I usually try to open the door to talking about sexual health concerns because not every clinician is going to do that.”
The inspiration for the study came when lead investigator Areej El-Jawahri, M.D., a bone marrow transplant physician at Mass General, was talking with a patient who’d had a transplant two or three years prior. On the way out the door, the patient asked if it would now be okay to kiss their partner.
“And my colleague’s mouth just dropped to the floor,” Dr. Traeger said. “She felt terrible that she’d never had that conversation with this patient, that it would be fine to kiss and do other things with the patient’s spouse or partner. We realized that people needed help with this issue, to help clinicians better talk about it, to help us better care for patients. And so, we put our oncology and psychology hats on together to figure out what to do.”
A Mobile App for Post-transplant Sexual Concerns
The study is a randomized controlled trial that will test a mobile health application aimed at integrating sexual health into post-transplant patient care. The study focuses on bone marrow transplant recipients, both because patients have pressing concerns about immune function and infection and because sexual dysfunction is a very common complication after transplant.
All patients in the study will have an initial visit with a clinician to discuss any sexual health concerns. Those with contributing biological or medical issues will be referred to treatment.
However, some patients will also be randomly assigned to complete a digital health intervention through a mobile application known as SHIFT (Sexual Health and Intimacy Following Transplant). The SHIFT app offers education, videos, games and exercises designed to help patients identify what might be contributing to their sexual issues or concerns. It will walk users through exercises to start rebuilding intimacy in their relationships and to practice strategies to ease back into sexual activity.
“Patients can work through the intervention at their own pace and in the privacy of their own homes, which can be helpful, given the topic,” Dr. Traeger said.
Regaining a Sense of Connection
Sexual health concerns after cancer might be related to physical, biological issues like not being able to have an erection or vaginal dryness. But often, issues like loss of interest in sex, trouble feeling pleasure or a sense of isolation and lack of intimacy with one’s partner stem from deeper issues related to cancer treatment.
“One of the biggest factors is how cancer treatment changes a patient’s connection with themselves, especially for patients who had blood cancers and went through a bone marrow transplant,” said Dr. Traeger.
A lot of those changes come from how patients feel inside their bodies. Treatments can be disfiguring and they can lead to fatigue and changes in bodily function. However, issues can also arise from changes to the patient’s role in life.
“Maybe you’re used to being the person who takes care of your family or who solves everyone’s problems, and now you’re the one who needs to ask for all this help,” Dr. Traeger said. “It changes your sense of who you are in relation to other people, which can impact your sense of who you are as a person and also a sexually active person.”
Even when a patient knows they have some issues with sexual health, they may not understand why. The SHIFT app is designed to help them tease apart what the contributing factors might be and help them begin to develop a plan for what they need to do to address sexual health concerns.
Since often it’s simply avoidance that prevents transplant patients from addressing sexual health concerns, Dr. Traeger expects that the SHIFT app may help reduce some of the barriers to getting help. Because many cancer survivors are experiencing a lot of health changes, they need access to health care where they don’t constantly have to go to an office. This patient population benefits from having access to care delivered at home.
“We’re really lucky here at the University of Miami that people have good access to survivorship care,” Dr. Traeger said. “That is not true across the country. And so, this is another way to get care out to people who may not have access.”
Tags: bone marrow transplant, cancer research, digital health, Dr. Lara Traeger, sexual health, Sylvester Comprehensive Cancer Center, transplant