Abstract
Background/Aims Sexual health problems represent one of the most frequently experienced and longest-lasting effects of breast cancer treatment, but research suggests that providers rarely discuss sexual health with their patients. Existing research examining barriers to addressing the sexual health concerns of cancer patients has focused on discrete characteristics of the provider-patient interaction without considering the broader context in which these interactions occur. Drawing on focus group discussions with breast cancer survivors, we explore how foundational cultural and structural characteristics of the healthcare system may be preventing breast cancer survivors from addressing their sexual health concerns.
Methods Five focus groups were conducted with breast cancer survivors receiving support services at a breast cancer advocacy and resource organization in Northern California. Each group focused on a different aspect of treatment including: 1) diagnosis; 2) surgery and reconstruction; 3) chemotherapy; 4) radiation; and 5) survivorship. An interview guide for each topic area was used to elicit participants’ thoughts, opinions and experiences of breast cancer treatment. Analysis utilized inductive techniques incorporating elements of Grounded Theory to identify salient themes that emerged in the discussions.
Results An average of eight women participated in each focus group, and women were allowed to participate in more than one group, for a total of 21 participants. Participants’ discussions illustrated three core ways in which cultural and structural characteristics of the healthcare system prevented them from addressing their sexual health concerns, including: 1) the structure of cancer care led to participants being disconnected from the healthcare system at the time when sexual side effects most commonly emerged; 2) when their sexual side effects did emerge, the highly specialized structure of the biomedical system made it difficult for patients to identify the appropriate provider to address their complex sexual health concerns; and 3) when patients did discuss sexual health with their providers, their providers approached sexuality as primarily physical, while participants were experiencing biopsychosocial sexual concerns.
Conclusions These results suggest that addressing breast cancer survivors’ sexual health needs will require a comprehensive approach that includes educating physicians, coordinating existing resources, and developing new sources of information and support during the survivorship period.
