Providing Care for the Whole Patient: Sexuality and Cancer

TON March 2016 Vol 9 No 2 - Survivorship

Anne Katz, PhD, RN, FAAN, occupies a specialized niche in oncology care—counseling patients with cancer about sexuality. She is a certified Sex Counselor at CancerCare Manitoba and Clinical Nurse Specialist at the Manitoba Prostate Centre in Canada. Dr Katz is the author of 10 books on sexuality and cancer, some of which are self-help books. She also serves as Editor of the Oncology Nursing Forum, the premier research journal of the Oncology Nursing Society (ONS).

The Oncology Nurse-APN/PA spoke with Dr Katz about her chosen career.

What led you to become involved in the field of sexuality and in cancer patients?

Anne Katz (AK): It’s a long and winding story. In short, I had a varied career working in nontraditional areas. For example, working with HIV patients at the beginning of the epidemic. I got a PhD, but still had a burning desire to keep on learning, so in 2000 I took an intensive course in sexuality at the University of Guelph, which was a turning point for me.

I found that I was comfortable talking about sexuality, and I had a private practice in counseling people from the general public about sexuality as well as a faculty appointment in a graduate nursing program. But this was not fulfilling, and I really wanted to do something that would make a difference in people’s lives. My husband said, “You need to find something that makes you happy.”

I did a lit search on sexuality and illness and read some preliminary studies on sexuality and cancer, and suddenly I hit upon an area that inspired me. I wrote a proposal for a program to counsel patients with cancer about sexuality, and the director of psychosocial oncology at the regional cancer center welcomed my proposal. I started seeing cancer patients 1 day a week.

You not only counsel patients and teach, but also have written a number of books. How did that come about?

AK: I like to “work smart” instead of “working hard.” But, of course, I do work hard. I found that information on the topic for oncology care providers was sparse, and decided to write a book. My first attempt was a proposal on “Sexuality and Illness,” with one chapter dealing with cancer. I spoke at a meeting of ONS about the topic and realized that although the issue of the sexual impact of cancer and its treatment was recognized, none or very few oncology care providers were addressing it with patients. I wrote a proposal for a book on cancer and sexuality, and, 2 weeks later, the proposal was accepted. My first book, Breaking the Silence on Cancer and Sexuality (Oncology Nursing Society), was published in 2007. Since then, I have continued to publish books for health professionals and for patients.

What are some of the challenges of your work?

AK: Nurses and oncologists have some discomfort as well as a lack of knowledge about their patients’ sexuality, and consequently they don’t ask about it. At the initial consultations once a patient is diagnosed, they are overloaded with information, and this information may include a mention of sexuality. Nurses and oncologists assume that this has addressed the issue, but at the time of diagnosis and treatment planning, patients are overwhelmed and cannot really take in that much.

Once a patient is treated, changes occur that affect their sex lives. These can include pelvic pain, change in body image and self-esteem, dyspareunia, and erectile dysfunction. But after treatment they are typically not asked about sexuality. If the oncologist or nurse doesn’t bring sexuality up, the patient may be embarrassed or feel that it is not important. “Nobody asked me, so it’s not okay to talk about it.”

This leads to a delay in getting help, maybe even over years, and couples end up living like roommates. Their sexual connectedness is gone. Sex is the 300-lb gorilla in the room. I call it accommodation, adaptation, and silence.

How many sessions does a typical course of treatment take?

AK: I see them as couples for as long as it takes. In Canada, we are blessed with healthcare that is covered for all, so payment is not an issue.

What is the biggest reward of your work?

AK: My biggest reward is to watch couples become open to each other.

I start the discussion and the couple sits around a small table facing me at a 45-degree angle to the table. I’ve seen it happen over and over again, that once the discussion starts, the couple turns their chairs to face each other and they start to talk to each other like they haven’t before. This is a well-known phenomenon in psychotherapy—the third person serves as a catalyst for permission to address “taboo” subjects.

What are some of your suggested interventions?

AK: I have some tricks up my sleeve and evidence-based interventions. One suggestion is to introduce sensate focus—touching and holding each other—so you begin to re-experience your body as a source of pleasure after the pain of cancer treatment. Also this takes erections and sexual intercourse off the table and takes the pressure off the couple. Of course, I am also fully versed in offering and explaining all of the various interventions that we have available.

I have written several self-help books—Woman Cancer Sex and Man Cancer Sex—that I refer patients to. Also I wrote Prostate Cancer and the Man You Love, for partners. These can be purchased at Amazon or Barnes & Noble.

What advice would you give to oncology nurses who want to address these issues?

AK: I encourage them to bring up the subject of sexuality as a consequence of cancer therapy. Just listening to patients can provide much-needed validation and make them feel less isolated. Nurses don’t have to become sex therapists—they can listen and refer the patient for intervention and suggest resources, including my books.

If you won the lottery, would you stop your work?

AK: Every day I learn what it means to be human, vulnerable, scared, and uncertain. Every interaction with patients and their partners humbles me. I am so grateful that I found this work. So to answer your question, no I would not stop.

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Last modified: June 28, 2016