Quality improvement in sexual health care for oncology patients: a Canadian multidisciplinary clinic experience

Purpose With the goal of improving the quality of sexual health care provision at our tertiary cancer centre, we developed, implemented, and assessed a multidisciplinary sexuality in an oncology program, to identify patient needs and apply interventions that could be effective in a broader oncology care context. Methods The establishment of our institution's first oncology-focused sexual health program is described within a quality improvement framework. A complementary retrospective chart review was performed to evaluate clinicodemographic data, including responses to validated sexual health questionnaires, from a 2-year clinical pilot. Results A sexual health program was introduced for cancer patients identified by health care providers or self-referred, receiving 130 referrals and conducting 64 consultation and 75 follow-up visits within a 2-year pilot period. Patients attending the program were 75% female, of mean age 52 years, and had most often breast (33%) or hematologic (30%) malignancies. Most (84%) had completed curative-intent treatment, with no evidence of disease, with 34% on ongoing endocrine therapy. The most frequent reasons for referral were sexual pain (38%), decreased libido (35%), and vaginal dryness (35% of females). All female patients demonstrated sexual dysfunction on the Female Sexual Function Index, and 80% of male patients demonstrated moderate to severe erectile dysfunction on the Sexual Health Inventory for Men. Patients waited a median of 63 days (SD 107, range 3-516) from referral to consultation, suggesting that demand for multidisciplinary sexual health care overwhelmed existing resources. Conclusions We have demonstrated unmet sexual health needs across a diverse oncology patient population and have presented a framework for addressing these issues, highlighting the challenges encountered and proposing improvements. Insights emerging from a quality improvement perspective included the role of group-based sexual health support to improve accessibility and the need for staff education to encourage proactive intervention before referral for specialized care is needed.