Psychosexual Care of Adolescent and Young Adult (AYA) Cancer Survivors

Within the cancer survivor community, adolescent and young adult (AYA) cancer survivors – ages 15 to 39 years – have unique challenges related to their psychosocial and sexual health. They face many developmental life experiences that can be disrupted or delayed by cancer and its treatment, impacting their psychosexual wellbeing.

Providers across all disciplines involved in the care of AYA cancer survivors must fully understand these nuanced effects and the interacting variables to offer comprehensive assessments and interventions in pediatric oncology and survivorship clinics.

Access to psychosexual care during and up to many years after cancer treatment is a critical need for AYA survivors:

• Up to 60% experience adverse physical and emotional outcomes including depression and anxiety
  • Twice as likely to complete suicide compared to healthy AYA peers
  • Highest risk for death by suicide among all other groups
• Must re-establish their developmental course after treatment (education, career, independence, post-treatment fertility, romantic/sexual relationships, reproductive decisions)

Biopsychosocial and Hammond frameworks for AYA cancer survivors

The biopsychosocial and Hammond’s contextual frameworks can be used to guide optimal care approaches for AYA cancer survivors.

The biopsychosocial model

• Considers biological, interpersonal, sociocultural, and psychological factors influencing health and illness
• Emphasizes how these factors and an individual’s sexual health relate to one another
• Helps clinicians understand the range of outcomes that AYA cancer survivors can experience

Hammond’s framework

• Helps explain physical and emotional factors globally
  • considers social and cultural factors
• Includes a discussion of personal values, impact of diagnosis and treatment

Researchers from the Center for Cancer and Blood Disorders at Children’s Hospital Colorado, including Robert Casey, PhD, and Jenna Demedis, MD, conducted a narrative review of the literature using biopsychosocial and contextual models to describe the following challenges:

• Sexual functioning and fertility
• Sexuality
• Relationships
• Body image

They included recommendations for clinicians based on a review of relevant literature. Refer to the full published manuscript for all citations and references related to the recommendations.

Recommendations for sexual functioning, fertility, sexuality, relationships and body image of AYA cancer survivors

Sexual health and fertility concerns

• Use a biopsychosocial/contextual framework to assess AYA cancer survivors to understand the intersection of biology, sexuality, body image, relationships, and sociocultural beliefs with sexual functioning to develop personalized interventions.
• Work in interprofessional teams to perform sexual health and biopsychosocial assessments during and after cancer treatment for early intervention and reduced risk of adverse effects of cancer on psychosexual wellbeing
• Acknowledge, normalize, and address any distress AYA cancer survivors may experience about fertility.
• Ask early direct questions about gender identity and sexual/romantic relationships and goals for parenthood and family. Revisit as the AYA survivor develops.

Body image, sexuality and relationships

• Speak with AYA survivors regarding concerns about disclosing cancer history to partners, discuss sexual health and function and information needs for relationships during and after treatment.
• Address interconnectedness of body image, self-esteem, sexuality, and sexual health and their impact on AYA survivors’ psychosocial and relationship well-being during treatment and survivorship.

Assessment and communication in the healthcare setting

• Make it a priority to address the difference between sexual health and fertility issues during patient assessments, especially when it comes to self-report data, using dimensional, developmentally appropriate measures.
• Provide accurate information about sexual health; interprofessional care teams should be involved in education and discussions – without parents or caregivers present.

Psychosocial support and intervention

• Web-based technology is not a proven approach for this population
• Brief in-person interventions offer promise
  • Participants in two-person counseling sessions with a psychologist reported benefits to knowledge, perception of body image and anxiety about relationships

Conclusion: key recommendations to promote psychosocial health among AYA cancer survivors

To best support this diverse and unique group of cancer survivors, clinicians must expand their biomedical perspective and consider variables impacting psychological and physical health. This includes:

• Using biopsychosocial and contextual frameworks
• Speaking directly with survivors about gender identity, sexual/romantic relationships, sexual health and functioning, and family planning.
• Addressing psychological considerations to ensure a comprehensive psychosexual assessment.
• Establishing a trusting relationship with AYA survivors to promote honest and open communication and wellbeing.