Overview: Cancer Survivorship and Sexual Function

Abstract

I n 1975 Mrs B, a 52-year-old woman receiving her last dose of immune suppressant chemotherapy for leukemia, hesitantly asked me, "What about, you know, relations with my husband?" She had been instructed to avoid potential sources of infection-such as fresh flowers, pets, and crowds-but had received no information about resuming sexual activity. "Let me find out," I responded, and sought out her medical oncologist who likewise had no empirical evidence on which to base his advice: "When she feels well enough." An entire journal issue devoted to sexual function and cancer survivorship is possible because of recent advances in biologic and social sciences, changes in sexual attitudes and behaviors, and demographic changes in cancer survivors. Twenty-five years ago, survival from cancer was typically measured in months, not years; bone-marrow transplant was not an option; radical mastectomy and radical prostatectomy were standard treatments; and the psychosocial focus of cancer care was death and dying. In contrast, we now have better cancer detection, cancer treatments tailored to individual needs and preferences, and improved management of treatment side effects. Newly diagnosed individuals and their families actively participate in treatment decisions and balance the risks of cancer recurrence with treatment side effects. Consequently, some men with early-stage prostate cancer may prefer the wait-and-see approach instead of losing erectile function; others will insist on unilateral or bilateral nerve-sparing surgery. Currently, there are an estimated 8.9 million cancer survivors in the US population, with survivorship being defined as the moment of diagnosis onward (Office of Cancer Survivorship, 2001). Many survivors live long, productive, cancer-free lives, and consider sexual function to be an important aspect of quality of