In your light
I learn how to love.
In your beauty,
how to make poems.
You dance inside my chest
where no-one sees you,
but sometimes I do,
and that sight becomes this art.
Cancer can be devastating in all its forms. There may be much to mourn. Head and neck cancers can be among the most distressing, not only for their obvious ability to alter a person’s appearance but for their capacity to affect a person’s sense of self.
It is rare for oncologists to receive training in the impacts of head and neck cancer and the effect that treatments may have on intimacy and sexual health. Yet we know that patients want to talk about sexual issues with oncologists, and they need practical information about changes in their sex life and reassurance that their issues are not unique.
Sadly, the resumption of intimacy after treatment can be challenging and may lead to a view by clinicians and patients alike that a loss of intimacy falls into the category of treatment-related collateral damage that must be endured, or mentioned only if the patient brings it up first. With a greater incidence of human papillomavirus-associated (HPV) oropharyngeal cancers in the community, more patients are reporting feelings of guilt, resentment, or blame within their intimate relationships.
Overcoming barriers to addressing sexual concerns
To address this need, Professor David Wiesenfeld, VCCC Research and Education Lead, Head and Neck Cancer, and Dr Lachlan McDowell, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre hosted a symposium last month to give clinicians a better understanding of how to address sexual health - to promote wellbeing and reduce isolation for patients.
It provided the opportunity to discuss common HPV-related concerns encountered in the clinic and to learn more about the interventions and referral pathways for treatment-related sexual issues. Professor Jane Hocking, University of Melbourne epidemiologist, and well-known broadcaster and consumer representative Julie McCrossin led a lively panel discussion.
Guidelines and resources available
Dr Maria Ftanou is the head of the Clinical Psychology Department at Peter MacCallum Cancer Centre and says that psychosocial care for patients begins with the treating team. She highlighted the American Society of Clinical Oncology (ASCO) guidelines, which recommend a member of the health care team initiating a discussion with the patient regarding sexual health and dysfunction resulting from the cancer or its treatment. The guideline goes on to say that the issue should be raised with the individual at the time of diagnosis and continue to be reassessed periodically throughout follow-up.
Asking about sexual function and intimacy
Dr Ftanou supports the guidelines and encourages clinicians to 'just ask', at all stages of treatment and follow-up. She shared questions to help initiate these types of conversations. “Relationships, intimacy, and sexuality are integral aspects to one’s quality of life and sexual health is more than sex alone, it is about intimacy, identity, connection, expression and fun,” said Ftanou.
Relationships, intimacy and sexuality are integral aspects to one’s quality of life
Head and Neck Cancer survivor Julie McCrossin spoke passionately in support of more open dialogue between treatment teams and their patients, calling for a greater understanding of the need to normalise the conversation. "We are damaged emotionally, physically or both, and our partners are traumatised too…
“What can we do to make psychological pain relief as much a part of routine care as physical pain relief?"
The Head and Neck Cancer Symposium can be viewed on the Open Learning page on the VCCC website.