scholarly journals Sexual Health as Part of Gynecologic Cancer Care: What Do Patients Want?

2018 ◽  
Vol 28 (9) ◽  
pp. 1737-1742 ◽  
Author(s):  
Casey M. Hay ◽  
Heidi S. Donovan ◽  
Erin G. Hartnett ◽  
Jeanne Carter ◽  
Mary C. Roberge ◽  
...  
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Sexual Activity ◽  
Cancer Patients ◽  
Cancer Care ◽  
Gynecologic Cancer ◽  
Relationship Status ◽  
Cancer Type ◽  
Sexual Health Care

ObjectiveSexual health is important to quality of life; however, the sexual health of gynecologic cancer patients is infrequently and inadequately addressed. We sought to understand patient experiences and preferences for sexual health care to help inform strategies for improvement.Methods/MaterialsAn anonymous, cross-sectional survey of outpatient gynecologic cancer patients at a large academic medical center was performed as part of a larger study examining patient and caregiver needs. The survey explored patient-provider discussions about sexuality across 3 domains (experiences, preferences, barriers) and 4 phases of cancer care (diagnosis, treatment, treatment completion, follow-up). Age, relationship status, sexual activity, and cancer type were recorded.ResultsMean age was 63 years. Most patients had ovarian cancer (38%) or endometrial cancer (32%). Thirty-seven percent received treatment within the last month, 55% were in a relationship, and 35% were sexuality active. Thirty-four percent reported sexuality as somewhat or very important, whereas 27% felt that it was somewhat or very important to discuss. Importance of sexuality was associated with age, relationship status, and sexual activity but not cancer type. Fifty-seven percent reported never discussing sexuality. Age was associated with sexuality discussions, whereas relationship status, sexual activity, and cancer type were not. The most common barrier to discussion was patient discomfort. Follow-up was identified as the best time for discussion. Sexuality was most often discussed with a physician or advanced practice provider and usually brought up by the provider.ConclusionsDemographic predictors of importance of sexuality to the patient are age, relationship status, and sexual activity. Providers primarily use age as a proxy for importance of sexuality; however, relationship status and sexual activity may represent additional ways to screen for patients interested in discussing sexual health. Patient discomfort with discussing sexuality is the primary barrier to sexual health discussions, and awareness of this is key to developing effective approaches to providing sexual health care.

Screening for Depression in Cancer Care

2009 ◽  
Author(s):  
Linda E. Carlson ◽  
Sheena K. Clifford
Keyword(s):  
Head And Neck ◽  
Cancer Patients ◽  
Cancer Care ◽  
Gynecologic Cancer ◽  
Large Body ◽  
The Elderly ◽  
Depression Symptoms ◽  
Cancer Type ◽  
Lung Cancer Patients ◽  
The Past

There is an increasing awareness of the importance of screening for depression and distress in oncology settings. Researchers have devised quick and simple methods for assessing symptoms in a wide range of patients that are acceptable to both patients and providers, and introduced computerized systems that make it possible to quickly screen a large number of patients efficiently. A large body of data concerning implementation of screening in cancer care seems to suggest that screening can serve to stimulate discussions of psychosocial and mental health issues between patients and oncology staff, but whether screening affects patient outcomes is still unclear. As with many other medical populations, people suffering with cancer are susceptible to clinical depression. More so than many other illnesses, cancer is associated with a poor prognosis and is in many ways synonymous with fear. References to the ‘‘Big C’’ and hushed tones prevailed in the past when a diagnosis of cancer was discussed, and remnants of these attitudes are still prevalent in many communities and countries worldwide. Hence, beyond the burden of the tumor and the associated treatment, the psychological toll of cancer is significant. Two thorough reviews of the prevalence of depression in cancer have been published in the past few years, and in addition to several other general reviews, summaries are available with reference to specific types of cancer (prostate, pancreatic, advanced disease) and specific patient groups (children and the elderly). Taking methodologic issues into consideration, the point prevalence of major depressive disorder and depression symptoms comorbid with cancer is most commonly cited between 10% and 25%.2 This rate varies considerably depending on how depression is measured (standard clinical interview, questionnaire), how it is conceptualized, the criteria used to define depression, the types of patients assessed (cancer type, demographics, inpatients versus outpatients), and the point during the cancer treatment trajectory when assessment occurs. Massie summarized 88 papers investigating depression prevalence in cancer patients: the highest rates of depression were found in head and neck, pancreatic, breast, and lung cancer patients (up to 50% of all patients), with lower rates generally reported in colon cancer, gynecologic cancer, and lymphomas (rates from 8% to 25%). The cancers with higher rates of depression generally have less positive prognoses (pancreatic, lung) or involve disfiguring treatments (head and neck, breast), perhaps explaining these discrepancies.

An assessment of clinical and economic outcomes of U.S. veteran lung cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19122-e19122 ◽  
Author(s):  
Elyse Fritschel ◽  
Li Wang ◽  
Lu Li ◽  
J Zhang ◽  
Onur Baser
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Health Care Costs ◽  
The United States ◽  
Economic Outcomes ◽  
Cancer Type ◽  
Lung Cancer Patients ◽  
Care Costs

e19122 Background: More people die from lung cancer in the United States than any other cancer type, and despite improvements in survival for other cancer types, 5-year lung cancer survival has remained low (Centers for Disease Control and Prevention. Lung Cancer. Available at www.cdc.gov/cancer/lung. Accessed February 04 , 2013; Youlden DR, Cramb SM, Baade PD. The international epidemiology of lung cancer: geographical distribution and secular trends. J Thorac Oncol. 2008; 8(3): 819-31.). This study aimed to describe the outcomes of lung cancer patients in the U.S. Department of Veterans Affairs (VA) population. Methods: A retrospective study of patients diagnosed with lung cancer during the study period of October 1, 2005 to September 30, 2010 was conducted using the Veterans Health Administration datasets. Lung cancer patients were identified using International Classification of Disease 9th Revision Clinical Modification (ICD-9-CM) diagnosis code 162.xx. Descriptive statistics were calculated as means ± standard deviation (SD) and percentages. Comorbidities were measured for the 1-year baseline period before the disease identification date. Health care costs and utilization were measured for the 1-year follow-up period after the identification date. Results: In patients identified with lung cancer (n=73,150), common comorbidities included hypertension (n=21,377, 29.22%), chronic airway obstruction (n=14,305, 19.56%), abnormal findings on radiological and other lung field examination (n=12,437, 17.00%), and diabetes (n=11,569, 15.82%). Nearly half of all lung cancer patients had follow-up inpatient visits (46.47%), which translated to an average inpatient cost of $21,420 annually per patient. Nearly every patient studied had at least one follow-up outpatient visit (99.11%), and the average cost per patient totaled $12,986 annually ($12,110 for outpatient office and $411 for outpatient ER service costs). Conclusions: Inpatient and outpatient visits result in considerable health care costs for veteran lung cancer patients. Comorbid conditions are also relatively frequent in this population. Further research could elucidate economic outcomes for lung cancer patients by comorbidity severity.

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

Prognostic utility of differential contrast-enhancement patterns on late gadolinium enhancement cardiac MRI (LGE-CMR) in patients with cancer-associated cardiac masses

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Chan ◽  
W Dinsfriend ◽  
J Kim ◽  
R Steingart ◽  
J.W Weinsaft
Keyword(s):  
Contrast Enhancement ◽  
Cancer Patients ◽  
Cancer Type ◽  
Tissue Properties ◽  
All Cause Mortality ◽  
Prognostic Utility ◽  
Cardiac Masses ◽  
Embolic Risk ◽  
Lge Cmr

Abstract Background LGE-CMR tissue characterization is widely used to identify cardiac masses (CMASS) in cancer patients – including neoplasm (NEO) and thrombus (THR). Prognostic utility of their differential LGE patterns is unknown. Purpose To determine incremental prognostic utility of LGE patterns in CMASS Methods The population comprised of cancer patients with CMASS on LGE-CMR, for which etiology was classified based on presence (NEO) or absence (THR) of enhancement, and controls matched for cancer type/stage. LGE-CMR tissue properties of NEO was classified based on extent of contrast enhancement – diffusely enhancing (DE), mixed (ME), and predominantly avascular (PA). Clinical follow up was performed for embolic events within 6 months of CMR and all-cause mortality. Results 330 cancer patients (55% M; 55±16yo) with an array of cancer diagnoses (19% sarcoma, 17% GI, 13% GU) were studied. Among CMASS+ pts (n=190), 66% had NEO and 34% had THR on LGE. All THR were non-enhancing. Among NEO, LGE pattern was variable (46% DE, 41% ME, 13% PA); ME lesions were larger than other groups (Fig. 1A). Quantitative tissue properties were consistent with qualitative groups, as evidenced by stepwise variation in signal intensity and CNR. Cumulative embolic events were 3-fold higher in CMASS+ than controls (All: 20% vs. 7%, p=0.001; PE: 13% vs. 5%, p=0.02; CVA/systemic embolism: 10% vs. 3%, p=0.01). Median time to event was 1.3 months [IQR 0.1–2.3] from CMR. Aggregate events were similar between NEO and THR, reflecting similar rates of PE and CVA (p=NS). Among CMASS pts with embolic events, 56% were on anticoagulation at time of event (59% NEO, 50% THR, p=0.61). Regarding CMASS morphology, emboli were 3-fold higher among intracavitary (IC) or highly mobile (HM) CMASS (IC: 25% vs 7%, p<0.001; HM: 38% vs 12%, p=0.001). Regarding location, right sided CMASS were associated with a 3–5 fold increase in PE (IC: 19% vs 6%; HM: 35% vs 7%, both p<0.001) and similar CVA events among left sided CMASS (IC: 17% vs. 6%, p=0.02; HM: 33% vs 6%, p=0.05). Embolic events were similar when partitioned based on quantitative LGE patterns between patients with and without embolic events. As for all-cause mortality, NEO on CMR conferred increased mortality than THR (HR 3.06 [CI=1.84–5.1], p<0.001) and matched controls (HR 2.08 [CI=1.42–3.04], p<0.001) during a median follow-up of 9.4 months [IQR 3.6–23.2]. Among NEO subgroups (Fig. 1B), survival was lower in patients with heterogeneous LGE patterns vs matched controls: the lowest survival in ME (p=0.002) suggests increased vascularity and tumor hypoxia/necrosis associated with aggressive tumors and hence larger lesions. Conclusions Among cancer patients, CMR-evidenced CMASS confers high short-term embolic risk, which are equivalently common between NEO and THR. Intra-cavitary location and increased mobility augment embolic risk irrespective of CMASS tissue properties whereas differential LGE patterns on CMR strongly impact prognosis. Funding Acknowledgement Type of funding source: None

‘Most young men think you have to be naked in front of the GP’: a qualitative study of male university students’ views on barriers to sexual health

Sexual Health ◽  
2016 ◽  
Vol 13 (2) ◽  
pp. 124 ◽  
Author(s):  
Cameron Ewert ◽  
Archibald Collyer ◽  
Meredith Temple-Smith
Keyword(s):  
Health Care ◽  
General Practice ◽  
Sexual Health ◽  
University Students ◽  
Health Information ◽  
Young Men ◽  
Sexual Health Education ◽  
Sexual Health Care ◽  
Sexual Health Information ◽  
Male University Students

Background In Australia, 15- to 29-year-olds account for 75% of all sexually transmissible infection (STI) diagnoses. STI rates among young men are rising, with most diagnosed in general practice. Young men less frequently attend general practice than young women, and rarely present with sexual health issues, making it difficult for general practitioners (GPs) to offer opportunistic STI education and screening. Little is known of the barriers preventing male university students accessing general practice for sexual health care, or what would facilitate this. Methods: Semi-structured interviews were conducted with young men aged 18–24 years attending university between 2012 and 2014. Interviews were recorded, transcribed and analysed using content and thematic analysis. Results: Twenty-eight interviews of 26–50 min duration found self-imposed views of masculinity, privacy and embarrassment as key barriers to accessing GPs for sexual health care. This was compounded by poor STI knowledge and not knowing when or where to go for care. Participants, except if they were international students, acknowledged school as an important source of sexual health education. The need for sexual health education at university was identified. While the Internet was a popular source, there were mixed views on the benefits of social media and text messaging for sexual health promotion. Conclusions: Current expectations of young male university students to seek sexual health care or acquire sexual health information from medical care may be misplaced. Universities have an excellent opportunity to provide young men with appropriate sexual health information and could offer novel strategies to help young men look after their sexual health.

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