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Needs in cancer patients - how to communicate them?
Communication regarding sexual needs in cancer patients is important, but unfortunately often overlooked. There is a false belief that, given the many challenges that cancer brings to a patient, sexuality is one of the last things that should be taken into account. This is absolutely not true - sexual needs are physiological needs and, just like any other, they require satisfaction. Of course, in the course of oncological disease, the possibilities of satisfying sexual needs may (but do not have to) be slightly modified, but this does not mean that the patient's sexual life ceases to be a source of fulfillment and satisfaction [1] . The treatment team has an important role in the process of caring for the well-being of an oncology patient. First of all, it is good practice to create a safe and trusted environment for the patient. The patient should feel comfortable and safe because this is what creates space to open conversations about sexual needs. It is important for the doctor to create an atmosphere of trust so that the patient knows that he is welcome to express his concerns and ask questions about sexuality. It is also good practice for the doctor to initiate a conversation about sexual needs. During such a conversation, it is worth assuring the patient that it is natural to have questions or concerns about the impact of the disease and oncological treatment on the sexual sphere. Open questions will certainly be helpful in such a conversation, as they will allow the patient to express his concerns or describe new experiences [2] . Proactivity is also important - listening carefully to the patient. This creates space to express your emotions, concerns and questions. At this point, it is worth paying attention to how important it is to listen carefully and show interest and understanding. The next step is to provide the patient with the necessary information about possible side effects of treatment, changes in sexual function, and available strategies and resources that can help deal with these challenges. In providing comprehensive care, the cooperation of the entire treatment team is crucial - many different fields of medicine may influence the sexual needs of oncology patients. Patient care can be provided not only by doctors and nurses, but also by psychologists and sexologists and psychotherapists. It is important to provide the patient with comprehensive care to be aware of problems arising during treatment, because this allows the patient to be referred to the appropriate specialist if necessary [3] . Your own work also plays an invaluable role - it is worth encouraging the patient to seek support - your doctor can inform you about available resources and support groups for cancer patients. Self-help groups can be valuable support in dealing with challenges in meeting sexual needs. Support can be received either through individual therapy, through group therapy sessions, or through use from extensive resources conveniently available electronically. Monika Kaszuba [1] Cichosz M., Wieczorek A. (2016), Sexual problems of cancer patients. Roczniki Psychology, 19(2), pp. 167-187 [2] Bębenek M., Czuba B., Pilewska-Kozak A., Wojtyna E. (2015). The impact of cancer on the sexual sphere. Przegląd Menopauzalny, 14(4), pp. 273-278 [3] Sobolewski M., (2018). Sexuality of patients with cancer of the reproductive organs - recommendations of the European Society of Oncology (ESMO) and other scientific societies. Ginekologia Polska, 89(2), pp. 103-107
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The impact of cancer on sexuality
Cancer can have a very diverse impact on a person's sexuality. It depends on many factors, including the type and stage of the disease, the type of treatment used and the individual characteristics of the patient and psychological support - both from specialists and the patient's relatives. Cancer may affect physical and hormonal changes in the body, decreased energy, chronic fatigue, changes in appearance, stress, emotional changes or self-esteem, body image and interpersonal relationships. All the areas indicated above may have a greater or lesser impact on sexuality. Some types of cancer and treatments can lead to physical changes that may affect sexual function. They can, but they don't have to - remember that each case is different, so generalizations are subject to a large margin of error. However, to use specific examples, surgery to remove genital organs may have a significant impact on experiences related to sexuality. Other treatments - such as radiotherapy (especially in the genital area) or chemotherapy - may be equally important and may result in pain, vaginal dryness or erection problems. The desire and appetite for physical intimacy and sex may also decrease [1] . Some types of cancer and their treatment may affect hormone levels. Examples of treatments that influence hormonal changes include removal of the ovaries, surgical treatment of breast cancer or targeted hormonal therapy. This type of treatment may affect both the level of desire and sexual function [2] . Cancer and its treatment usually lead to decreased energy and increased fatigue. It is often accompanied by changes in appearance, such as weight loss, hair loss, or scars after surgery. It is worth remembering that sexuality has various dimensions and may also include building a sense of security and attractiveness. Sex is not prohibited for cancer patients - unless it is a cancer related to the reproductive organs. Undoubtedly, it may be difficult for loved ones to realize that a person suffering from cancer often feels unattractive and defective. The change in self-perception affects the feeling of increasing stress and deepening depression of mood. This is a difficult moment both for the sick person and for their loved ones. A person suffering from oncology has every right to closeness - it is worth talking about their needs and concerns [3] . It may be helpful to formulate messages as direct as possible - e.g. "you can touch me", "don't be afraid to touch me, it doesn't hurt me", "it's important to me, I want you to keep touching me", or "I want you to as little as possible has changed between us. I have to go to the doctor, I have to take medications, but let everything else be as it used to be, I need your touch as much as before (or even more than before).” Cancer may affect self-esteem, body image, interpersonal relationships, and perception of one's sexuality. Some patients may feel a sense of loss, fear of rejection, shame, difficulty communicating with a partner or difficulties in finding their way in a new reality after the diagnosis. It is important that patients talk to their doctors about all problems related to sexuality - there are various strategies, therapies and treatment methods that may be helpful in dealing with the new challenges presented by the disease. Many patients also use the help of psychologists, sexologists or patient support groups [4] . Problems related to sexuality affect the quality of life and should not be treated marginally. Sexual health is important, and when problems arise, it is worth contacting specialists and asking for help. Monika Kaszuba [1] Dębska G., Samochowiec J. (2017). Sexual problems in the course of cancer. Psychiatria Polska, 51(6), pp. 1127-1138 [2] Lemańska A., Skrzypulec-Pinta V., Łuszczak M, et al. (2013). Sexual function in women after breast cancer treatment. “Medycyna Ogólna i Nauki o Zdrowiu”, 19(4), pp. 395-400 [3] Kowalski P., Filipiak M., Krajewski P. (2016) . Reproduction and sexuality of oncology patients. Nursing Polish, 2(60), pp. 175-178 [4] Sobolewski M., (2018). Sexuality of patients with cancer of the reproductive organs - recommendations of the European Society of Oncology (ESMO) and other scientific societies. Ginekologia Polska, 89(2), pp. 103-107
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