Cancer and Oncology

Category: Family

  • Sexual Activity During Neutropenia and Immunosuppression: What Do You Tell Your Patient?

    JCO Oncology Practice: https://ascopubs.org/doi/10.1200/OP-25-00618

    This topic is not discussed enough in the clinic. Most of us are not sure about the answers. Also the topic is awkward. A Journal of Oncology Practice article (2016) published a survey of cancer survivors. It found that 46% reported sexual health problems related to the diagnosis and treatment of cancer. Additionally, 71% said they had received no care for sexual dysfunction. There is a significant gap in knowledge and resources in this area.

    This is a good article giving simple guidelines.

    The gist of the article is:

    • Sexual health remains important for quality of life during cancer treatment
    • Evidence for strict sexual restrictions in neutropenia is limited
    • Stable monogamous partners: condoms not routinely required if partner healthy
    • Avoid anal sex/fecal exposure, new partners, or sex during severe mucositis
    • Gentle hygiene is sufficient; over-washing may harm mucosa
    • Condoms may be used briefly after chemotherapy to protect partners from drug exposure
    • Counseling should be individualized and evidence-informed, not based on outdated blanket restrictions.

    Table: Sexual Health Guidance During Neutropenia and Immunosuppression

    JCO Oncology Practice: https://ascopubs.org/doi/10.1200/OP-25-00618

    It is important to talk about:

    Fertility and contraception: Use reliable barrier methods or other contraception. Discuss fertility preservation early.

    Emotions: Several patients notice changes in desire, body image, or function (dryness, erectile issues, pain).

    Partner perspective: The healthy partner should be reassured that risk to them is low with basic precautions.

    Intimacy is still possible and often beneficial. It is important to review the person’s situation and give clear and practical guidance for the patient and their partner.

  • Trust and Advocacy: The Doctor-Patient Relationship

    One of the big privileges of being a doctor is that people trust you and tell you things which are very personal to them. They trust you with information which is not shared with others. It is very humbling and also scary at times.

    Some of the most awkward times is when patients tell me things about their family members or close friends. Issues with money, altering a will, trust, so on and so forth.

    The primary idea being to stand up for your patient and advocate for them. I have found that the best person who know the patient is their GP. It gets harder when the patient does not have a long term GP or keeps changing their GP.

    Social workers are a great resource, but harder to find in the real world setting. The majority of social workers have “been-there-done-that” and seen it all, so speak from a standpoint of pure experience. That is hard to get.

    I had an older patient who has been on treatment for a while. The patient comes independently and we have great chats. The patient was accompanied by their child on one of the visits. The child insisted that my patient was getting dementia and was forgetting things. The patient later broke down and told me that money was disappearing from their bank account. The patient is convinced that the child is responsible for it. Such a difficult situation for the family.

    It is really hard to truly heal the situation. Even if the money issues are sorted, the trust is destroyed.

    Everyday is a blessing. Thank God for it.