McCabe-White, Linda
(2022)
"This one is a bit of a taboo subject": a mixed methods investigation into the impact of head and neck cancer upon sexuality.
DClinPsy thesis, University of Nottingham.
Abstract
Background: Previous research demonstrates Head and Neck Cancer (HNC) survivors are vulnerable to a negatively impacted sexuality although it is unclear whether changes are attributable to HNC sequelae or other (e.g. maturation) factors. Sexuality is important to wellbeing and unmet sexuality needs following cancer can increase psychological distress. Gaps in knowledge surround the impact of HNC on
sexuality: there is considerably less research in relation to HNC’s impact on sexuality in comparison to other cancers.This is surprising as HNC is the seventh most common cancer and can produce various functional, aesthetic, and psychosocial difficulties. Individual differences in coping/response style account for variability in experiences of living with cancer – there are links between particular coping styles and levels of psychological distress which could be explored in relation to sexuality outcomes. These differences can be targeted through psychological intervention in ways that clinical or demographic characteristics cannot be. Additionally, professionals struggle to discuss sexuality, meaning that the perceived support needs for physical, practical, and psychological support around sexuality are not fully known.
Aims: This study investigated the impact of HNC upon sexuality, whether psychological flexibility and other coping responses were associated with sexuality and quality of life outcomes, and what the perceived support needs were, if any, for support around sexuality.
Method: A mixed method design was used: 60 participants took part in an online survey and 18 participants completed semi-structured interviews. Quantitative data were analysed using descriptive statistics and correlational analyses.Qualitative data were analysed using reflexive thematic analysis with an inductive-deductive design.
Results: Findings support previous literature, showing that for many of the current study’s sample, sexuality is negatively impacted by HNC. This study extended upon
extant research, showing that: for those classified as clinically impaired in relation to sexuality, impairment represented a post-HNC deterioration that was not attributable to other measured variables (e.g., age). The themes developed illustrated a series of events where sexuality is necessarily deprioritised during treatment, sexuality is not discussed by professionals, there is still an impact of altered sexual behaviour which can be understood as due to either psychological or physical barriers, and participants respond by attempting to rebuild/renavigate their sexuality. Significant relationships were not found between response styles and sexuality outcomes. A clear support need was identified for greater physical, practical, and psychological support around sexuality.
Conclusions and Recommendations: The provision of HNC-specific informational resources would benefit patients and assist professionals with discussions of sexuality: the timings of such discussions must be sensitive to the fact that individuals necessarily deprioritise sexuality during active treatment. Consideration should be given to which professional is most appropriate to raise the topic of
sexuality in terms of who is most likely to be involved following physical treatment.Future research could helpfully triangulate the perspectives of the HNC patients with
healthcare professionals to deepen the understanding of the barriers to discussing sexuality for staff, particularly within a population where impacted sexuality is so relevant. Furthermore, to enhance the generalisability of the results obtained from the current sample, research into this study area should be conducted with an explicit focus on increasing ethnic representation within sample participants
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