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Sexual rehabilitation recommendations for prostate cancer survivors and their partners from a biopsychosocial Prostate Cancer Supportive Care Program

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Abstract

Purpose

This study aimed to highlight the biopsychosocial recommendations provided to prostate cancer survivors and their partners during sexual rehabilitation.

Methods

Retrospective analysis of a prospectively maintained patient database was conducted for visits between 2013 and 2019. The sexual health rehabilitation action plan (SHRAP) is a standardized 29-item list of biopsychosocial recommendations. The frequency of biopsychosocial recommendations provided to patients via their SHRAPs was assessed.

Results

Among 913 patients, across 2671 appointments, nearly 74% of patients underwent radical prostatectomy. Other treatments included combination therapy (surgery, radiation, and/or androgen deprivation therapy (ADT)) (13%), radiation (external beam radiation or brachytherapy) (5%), and active surveillance (2%). Each patient had a median of 2 (SD 2.06) appointments and received a mean of 10.0 (SD 3.9) recommendations at each visit. Educational recommendations (penile rehabilitation, orgasmic guidelines, and climacturia management) were provided in 84% of visits followed by psychosexual recommendations (pleasure-focused, dedicated time, simmering, sexual aids, and sensate focus) in 71% of all appointments. The top recommendations (total n, frequency of recommendation) were penile rehabilitation (2253, 84%), pleasure-focus (1887, 71%), phosphodiesterase inhibitors (1655, 62%), clinical counselor (1603, 60%), vacuum erectile device (1418, 53%) and intracavernosal injections (1383, 52%).

Conclusions

Biopsychosocial programs are evolving to be a key part of prostate cancer survivorship. This study’s insight suggests that prostate cancer survivors require education around their sexual consequences and psychosexual counseling alongside proven biomedical strategies for erectile dysfunction.

Implications for cancer survivors

Cancer survivorship programs should integrate educational and psychosocial strategies alongside biological strategies for prostate cancer survivors and their partners.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Urologic Sciences, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Wallace Yuen, Luke Witherspoon, Julie Wong, Stacy Elliott & Ryan Flannigan

  2. Prostate Cancer Supportive Care Program, Vancouver, BC, Canada

    Eugenia Wu, Sara Sheikholeslami, Jenna Bentley, Christine Zarowski, Monita Sundar, Stacy Elliott & Ryan Flannigan

  3. Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA

    Celestia Higano

  4. Department of Urology, Weill Cornell Medicine, New York, NY, USA

    Ryan Flannigan

Authors
  1. Wallace Yuen
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  2. Luke Witherspoon
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  3. Eugenia Wu
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  4. Julie Wong
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  5. Sara Sheikholeslami
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  6. Jenna Bentley
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  7. Christine Zarowski
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  8. Monita Sundar
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  9. Stacy Elliott
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  10. Celestia Higano
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  11. Ryan Flannigan
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Contributions

Wallace Yuen: conception and design, administrative support, collection and assembly of data, data interpretation, manuscript writing, final approval of the manuscript.

Luke Witherspoon: administrative support, data interpretation, manuscript writing, final approval of the manuscript.

Eugenia Wu: conception and design, administrative support, collection and assembly of data, final approval of the manuscript.

Julie Wong: data collection.

Sara Sheikholeslami: data collection.

Jenna Bentley: conception and design, administrative support, final approval of the manuscript.

Christine Zarowski: conception and design, administrative support, final approval of the manuscript.

Monita Sundar: conception and design, administrative support, final approval of the manuscript.

Stacy Elliott: conception and design, administrative support, final approval of the manuscript.

Celestia Higano: conception and design, administrative support, final approval of the manuscript.

Ryan Flannigan: conception and design, administrative support, manuscript writing, final approval of the manuscript.

Corresponding author

Correspondence to Ryan Flannigan.

Ethics declarations

Ethics approval

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The IRB of the University of British Columbia approved this study.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Conflict of interest

Celestia S. Higano has received research grants from Aptevo, Aragon, Astellas, AstraZeneca, Clovis, Dendreon, eFFECTOR Therapeutics, Emergent, Ferring, Genentech, Hoffman-Laroche, Medivation, and Pfizer; she has also received personal fees from Astellas, Bayer, Blue Earth Diagnostics, Clovis, Dendreon, Ferring, Hinova, Janssen, Merck, Orion, Pfizer, Tolmar, Carrick Therapeutics, Novartis, and Genentech. Ryan Flannigan has received research grants from the Canadian Institute of Health Research, New Frontiers Research Fund, Vancouver Coastal Health Research Institute, and Canadian Urologic Association; he has also received funding from the American Society of Reproductive Medicine, Boston Scientific, Paladin Labs, and Acerus Labs. The other authors have no disclosures or conflicts of interest to report Fig. 3.

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Appendix

Appendix

Fig. 2
figure 2

The abbreviated Sexual Health Rehabilitation Action Plan (SHRAP)

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Fig. 3
figure 3

Frequency of biopsychosocial recommendations provided to patients based on treatment modality. (A) Frequency of specific biomedical recommendations based on treatment modality. (B) Frequency of specific educational recommendations based on treatment modality. (C) Frequency of specific psychosexual recommendations based on treatment modality. (D) Frequency of specific referral recommendations based on treatment modality. ADT = androgen deprivation therapy; Combination = surgery, radiation and/or ADT

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Yuen, W., Witherspoon, L., Wu, E. et al. Sexual rehabilitation recommendations for prostate cancer survivors and their partners from a biopsychosocial Prostate Cancer Supportive Care Program. Support Care Cancer 30, 1853–1861 (2022). https://doi.org/10.1007/s00520-021-06335-1

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  • DOI: https://doi.org/10.1007/s00520-021-06335-1

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