Sexuality & Fertility Issues in Cancer Patients

Sexuality & Fertility Issues in Cancer Patients
bt:Carolyn Vachani, MSN, RN, AOCN

Scope of Sexuality Issues
* 40-100% of cancer patients experience some form of sexual dysfunction
* Issues do not always resolve after therapy
* Almost all cancer treatments have the potential to alter sexual function (surgery, chemotherapy, radiation, hormones)
* Represents major quality of life (QOL) issue
* With intervention, up to 70% of patients can have improved functioning

To Optimize QOL, Nurses Can:
* Learn evidence-based information on how diagnosis/treatment affects sexual function
* Conduct assessments before/during therapy
* Inform patients of possible changes
* Educate clients & partners
* Provide guidance & suggestions for adapting to changes
* Know resources & refer when needed

Survey of Physician/Patient Communications
Nurses’ Beliefs
Johnson’s Behavioral Model
PLISSIT Model for Communication
Sexual Dysfunction in Men
* Chemo/hormonal therapy: Erectile dysfunction, decreased libido, ejaculatory dysfunction, gynecomastia, penile/ testicular atrophy, and infertility
* Radiation/ brachytherapy: Urinary issues, impotence, bowel dysfunction, penile/ testicular atrophy
* Surgery: Urinary issues, impotence, body image, pain, retrograde ejaculation

Sexual Dysfunction in Women
* Chemo/Hormone therapy: Irregular menses, early menopause, hot flashes, insomnia, irritability, depression, vaginal dryness, painful intercourse, infertility, and decreased libido
* Radiation/ brachytherapy: Pelvic fibrosis, vaginal atrophy/stenosis, scarring, decreased lubrication, urinary effects, erythema, edema, ulceration, decreased elasticity, shortening, and increased irritation of vagina
* Surgery: Body image, bowel changes, ROM issues, menopause, pain, changes in vaginal size/sensitivity, loss of nipple

General Nursing Interventions
Ostomy Surgery: Interventions
Interventions for Male Issues
Interventions for Female Issues
Radiation-Induced Vaginal Stenosis
Other Interventions for Women
Resources
* www.eyesontheprize.org (online community for gynecologic cancers)
* Support groups (Gilda’s Club, Wellness Community)
* www.oncolink.org
* www.ustoo.org (prostate cancer website)
* www.fertilehope.org
* www.resolve.org (fertility)
* ACS Sexuality booklets
(available on ACS website)

Pregnancy & Treatment
Risk of Infertility: Radiation
Radiation Risk to Future Pregnancy
Risk of Infertility: Chemo
Azoospermia likely, and are often given with other highly sterilizing agents, adding to the effect
Busulfan (600 mg/M2)
Ifosfamide (42 g/m2)
BCNU (300 mg/m2)
Nitrogen mustard
Actinomycin D
Azoospermia in adulthood if treated before puberty
BCNU (1 g/m2)
CCNU (500 mg/m2)
Prolonged or permanent azoospermia in 90% of men; platinum agents 50%
Chlorambucil (1.4 g/m2)
Cyclophosphamide (19 g/m2)
Procarbazine (4 g/m2)
Melphalan (140 mg/m2)
Cisplatin (500 mg/m2)
Known Effect on Sperm Count
Chemotherapy (dose to cause effect)

Risk for Infertility: Surgery
* Orchiectomy (bilateral)
* Penectomy
* Prostate or bladder surgery damage
* Prostatectomy
* Hysterectomy
* Oopherectomy (bilateral)

Options for fertility preservation in men
* Sperm banking – only after puberty
* Intracytoplasmic sperm injection (ICSI)
* GnRH agonist/antagonists
* Cryopreservation of testicular tissue, then transplant or grow in vivo (+ births in mice)

Options for Fertility Preservation in Women
* Embryo freezing – cycle 12-14 days, 10-25% chance of pregnancy per embryo stored, cost $8-12,000, then cost of storage, thaw & implanting
* Ovarian transposition (oophoropexy) – move ovaries from XRT field, can be laparoscopic, cost ?, been done for 30yrs, 16-90% success rate
* Egg cryopreservation – cycle 12-14 days, 2% chance of live birth per thawed egg, cost ~$8,000, then cost of storage, thaw, fertilizing & implanting

Options for Fertility Preservation in Women
* GnRH agonist/antagonist : theory is to stop proliferation
* Ovarian tissue freezing: 60% follicles lost to freezing, have been 2 live births
* Radical trachelectomy: for cervical cancer, experimental?
Assessing Ovarian Function in Survivors
* FSH & Estradiol
* Anti-Mullerian hormone (AMH)
* Antral follicle count
Financial Assistance
Local Sites for Sperm Banking
* 3 National organizations (by mail)
o www.cryolab.com
o www.reprot.com
o www.xytextissues.com
* Women’s Institute; 815 Locust / Plymouth Meeting
* Penn Fertility 3701 Market
* Fairfax Cryobank 3401 Market (http://www.fairfaxcryobank.com/)
* Drexel Fertility Bala Cynwyd / Center City
* Reproductive Science Institute Jenkintown (http://www.rsiinfertility.com/)
* Women’s Health Group of PA Bryn Mawr

Local Sites for Women
* Women’s Institute: 815 Locust / Plymouth Meeting (http://www.womensinstitute.org/)
* Penn Fertility: 3701 Market (http://www.pennhealth.com/fertility)
* Drexel Fertility: Bala Cynwyd / Center City (http://www.drexelfertility.medem.com)
* Women’s Health Group of PA: Bryn Mawr (http://www.mainlinefertility.com)

References
Sexuality & Fertility Issues in Cancer Patients.ppt