A cancer diagnosis is undeniably stressful and takes a toll on emotional well-being, including sexual health. Changes in sexual health is a challenge of cancer that no one is talking about.Sex, sexuality, and intimacy are just as important for people with cancer as they are for people who do not have cancer.¹ Today, it is also more relevant than ever as more cancer survivors are diagnosed at a younger age.

However, patients may feel uncomfortable bringing up the topic, afraid of using the wrong terms, or their cultural beliefs prevent them from bringing up the topic. Talking about sexual health or intimacy issues with patients who have cancer can be even more challenging with competing priorities to discuss. Additionally, oncology providers and their staff may be uncomfortable discussing the topic, and worry about not being able to answer questions from patients.

Cigna Healthcare^℠ has assembled a list of resources that oncology providers and their staff can use to support the expressed sexual health needs of patients with cancer and deliver an exceptional patient experience.

The following evidence-based, curated listing of resources can better equip oncology providers to be prepared to address and screen for sexual health side effects caused by cancer or cancer treatment, have a conversation with their patients, and also provide them with supportive resources.

Resources for physicians

• American Society of Clinical Oncology
  • Exploring sexual health in premenopausal patients with hormone positive early breast cancer: Comparison between LHRH and oophorectomy
  • Sexual health outcomes in sexual minority vs. heterosexual men after prostate radiotherapy.
• Leukemia and Lymphoma Society: Randomized Trial of a Sexual Dysfunction Intervention for Hematopoietic Stem Cell c, Transplant Survivors

Resources to share with patients

• The National Cancer Institute: How Cancer Affects Your Self-Image and Sexuality provides tips on how to cope with body changes and changes in the patient’s sex life. Also offers information about Sexual Health Issues in Women and Men with Cancer.
• Livestrong provides information about Female and Male Sexual Health After Cancer.
• American Cancer Society: Fertility and Sexual Side Effects in People with Cancer provides an overview of how cancer and cancer treatment may affect females and males, intimacy and fertility, including the effect on children and youth fertility.
• Centers for Disease Control: Acknowledges common concerns and challenges while providing information on how to get help.
• The Leukemia and Lymphoma Society provides ways for patients to communicate with their partner, how to build intimacy, tips on managing sexual side effects, and questions to ask members of their health care team. It includes referrals to pelvic floor therapists, oncology social workers and certified sex therapist.
• American College of Obstetrics and Gynecology addresses concerns about sexual health after cancer, including addressing cancer-induced menopause and treating symptoms.
• The Dana Farber Cancer Institute discusses sexual health during cancer treatment, as well as tips for maintaining intimacy during and after cancer. 
• Memorial Sloan Kettering provides information on sex and cancer treatment, having sex during cancer treatment, preventing pregnancy, fertility planning, and preventing infection.

Case management programs and support

Additionally, we are providing specialized training for our oncology case managers to better equip them to have culturally tailored discussions with patients about the effect of cancer on sexual health and intimacy. Specifically, case managers:

• Provide education and resources on the effect of cancer on sexual health and intimacy, including referrals to complementary therapies (e.g., pelvic floor physical therapists, and relationship and sex therapists).
• Assist customers in developing a list of questions to ask their providers:
  • Male treatment plans including erectile and ejaculatory dysfunction medications, hormone replacement for low testosterone, fertility preservation, and rehabilitationafter surgery.
  • Female comprehensive care, which includes intimacy support services, information about lubricants and moisturizers, pain therapytreatments, and referrals to physical therapistsfor pelvic exercises.
  • Provide access to counseling to discuss relationships, body image, intimacy, sexuality, and coping with infertility-related distress,leveraging our network of designated American Psychosocial Oncology Society (APOS) behavioral providers.

Our oncology-specific Evernorth^® Behavioral Health (Evernorth) provider network is powered by our collaborative relationship with APOS, an organization dedicated to researching and treating the psychosocial aspects of cancer. More than 250,000 Evernorth providers now have the opportunity to obtain our oncology specialty designation through APOS’s new Oncology Virtual Academy. Providers who complete the on-demand, 30-hour course will receive an oncology specialty designation within the Evernorth network. This designation for behavioral health providers improves our ability to connect cancer patients to specialists who have the expertise and experience to help them achieve whole person health and wellness.

Visit the Case Management & Health Engagement Programs page on the Cigna for Health Care Professionals portal (CignaforHCP.com) to learn more about available programs and how we can work with you and your patients to add valuable support for your care coordination efforts. By working together, we can you help attain better outcomes for your patients with Cigna Healthcare coverage.

^1. American Cancer Society. How cancer and cancer treatment can affect sexuality. Updated February 1, 2020. Accessed April 20, 2021