Demographics and Methodology
Eight cancer care providers and thirteen married couples were qualitatively interviewed. ?The interviews took place at two cancer centers in the same urban area, one serving primarily African American patients and the other, Caucasian patients. ?The providers included all members of a cancer care team (e.g. oncologist, nurse, surgeon, psychologist) who may or may not have had a relationship with the chosen patients, while the couples ranged in age from 43 to 79. Additionally, there were equal numbers of male and female patients, patients older and younger than age 65, and individuals in varying stages of cancer.
Interviews were designed to last between 20 and 30 minutes and were conducted separately for each individual. ?The interviews included questions in three domains: 1) the effects of lung cancer on physical and emotional aspects of their relationship (e.g. how was your emotional relationship before your diagnosis and has it changed since?); 2) the ways in which those aspects affect the experience of living with cancer (e.g. does a strong relationship affect cancer outcomes?); and 3) communication about these aspects as part of their cancer care (e.g. have you talked to your healthcare provider about your relationship?). ?Questions about barriers to communication as well as the effect age may have on these domains were also asked.
Interviews were allowed to continue until the researchers felt they were not hearing anything new or unique from the interviewees.
What Did They Find?
On a positive note, both cancer care providers and couples affected by lung cancer perceived sexuality and relationship issues as important. ?Furthermore, providers understood the varied and complex ways in which such a diagnosis could affect these areas. ?Despite this fact, and the belief from couples that it is the provider?s job to raise the issue, conversations about sexuality and relationships rarely occurred. ?Part of this may be due to understandable reasons such as competing interests (e.g. complications from treatment), a lack of time, a belief that it is another provider?s job, and a lack of expertise in the area; on the other hand, providers simply citing that the patient did not seem concerned does not feel as valid because it reflects the fact that sexuality, despite being recognized as important, is not a part of the cancer care conversation. ?Finally, providers felt that these areas were even less important to discuss with older clients.
Couples of all ages reported both positive and negative effects of lung cancer on their relationship and sexuality. ?Some positive reported effects included increased non-coital physical closeness, relationship solidarity, and partner appreciation. ?Negative effects were largely the result of cancer and/or its treatment and ranged from physical ailments such as pain and fatigue to psychosocial ones including anxiety and low sex drive. ?It is important to note that despite all of these changes, most couples did not report having talked about these issues with their partner.
Strengths & Weaknesses
The authors should be commended for the way in which the interviews were conducted: different interviewers were used for doctors, patients, and partners to help decrease bias and make the situation as comfortable as possible for all involved. ?Furthermore, the provider interviews were completed first so that the researchers could ?enhance and enrich? the questions they then asked of the couples. ?Finally, because this is a qualitative study, it allowed researchers to receive more nuanced responses and delve into these topics in a way that is not possible when one is simply rating physical and emotional relationship traits.
That being said however, the study has some limitations. ?Being small and qualitative in nature, it lacks the rigor of larger, quantitative studies that include extensive statistical analysis and allow more generalizable conclusions to be drawn. ?It also is not generalizable beyond married, heterosexual couples. ?Furthermore, the authors had clinicians themselves recruit participants, introducing a large bit of bias. ?No information is given about refusal to participate and there is no way to tell if the physicians played favorites or even adhered to regularly asking patients. ?It is likely that the clinicians only asked those they assumed would say yes or perceived to be good candidates, even if the clinicians did not do so on purpose. ?Finally, the authors do not use the same definitions of words like intimacy between the two groups. ?For example, intimacy was only defined for couples while sexuality was left undefined. ?Though their goal here was to not limit the meaning of these words, it seems a disservice to the study to allow for confusion around the terms.
Conclusions
Despite near universal agreement that sexuality and relationships are vital parts of one?s quality of life, few conversations about these issues are occurring as part of the cancer care regimen. ?Particularly troubling is the belief expressed by the providers regardless of their occupation (e.g. oncologist, social worker, etc) that this discussion is ?someone else?s? job. ?While there is not a lot of literature on this topic?and although this study is far from perfect?it adds a number of layers to the connection between sex and cancer. ?First, it shows that older couples struggling with cancer are as interested as younger individuals in talking about their physical and emotional relationship. ?Secondly, it shows that the relationship between cancer and sexuality is actually bidirectional (e.g. the quality of one?s physical relationship affects their experience with cancer just as one?s cancer affects their physical relationship). ?Finally, it gives a stepping stone for future research on how such conversations can begin to be incorporated into routine cancer care. ?All of these factors show that not only is there much more work that needs to be done, but also that these are salient issues and there is a willingness and room to change.
Citation
Lindau, S. T., Surawska, H., Paice, J., & Baron, S. R. (2011). Communication about sexuality and intimacy in couples affected by lung cancer and their clinical-care providers. Psycho-Oncology, 20: 179?185. doi: 10.1002/pon.1787
Source: http://thecsph.org/sexual-studies-sex-and-lung-cancer-whats-the-connection
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