Yale Daily News

New research on adolescent and young adult, or AYA, female cancer patients at Yale New Haven Hospital found that many did not receive sexual health counseling during treatment. 

Sarah Abelman MED ’20, a resident at Thomas Jefferson University Hospital, and Julia Cron, assistant professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, co-authored a study that was recently published in the Journal of Pediatric and Adolescent Gynecology. The study analyzed electronic medical records from 2013 to 2018 of female patients, ages 15 to 25, who were undergoing cancer-directed therapy at Yale New Haven Hospital. 

Abelman and Cron found that within this subset of patients, 48.4 percent had documented contraception use during treatment, which suggests that some were sexually active. However, the medical records also reflected that only 33.1 percent received sexual health counseling during this time. The researchers also examined the relationships between these outcomes and various patient characteristics.

“Counseling about reproductive health and contraceptive options was correlated with contraceptive use, so we think that that is a good sign,” Cron said. “If reproductive health and contraceptive counseling is part of the conversation with adolescents and young adults undergoing cancer treatment, it may increase the likelihood that they are going to use contraception.”

As a gynecologist, Cron often sees adolescent patients who were recently diagnosed with cancer to help them with menstrual management. She noticed that many of these patients’ oncology providers often assume that the patient is not sexually active, and therefore, does not need contraception. This was concerning to Cron because an unexpected pregnancy during cancer treatment can cause medical complications and be emotionally taxing for the patient. Abelman and Cron set out to investigate the prevalence of both sexual activity and sexual health counseling among female AYA cancer patients.

The Joint Data Analytics Team at Yale first compiled a list of medical records that fit the inclusion criteria for the study, according to Abelman. She then manually reviewed the records to confirm their eligibility and gathered additional information. The paper states that conversations included in medical records about contraception use or pregnancy prevention during cancer treatment were considered instances of sexual health counseling. Documentation of prescription contraception or condoms use was considered to be evidence of contraception use. 

In addition to the low percentage of documented sexual health counseling, the study also included which patient factors were associated with this counseling or with contraception use. For example, Abelman performed statistical significance tests which found that younger patients, ages 15 to 20, were less likely to have received sexual health counseling, while Latina patients had an increased chance of getting it. 

“​Identifying this gap in care in terms of contraception and contraception counseling means that there is room for us as medical providers to intervene, and improve clinical practice,” Abelman wrote in an email to the News. “To provide ideal care for these patients, steps could make sure these young women all receive counseling about the importance of avoiding pregnancy during their cancer treatment and are offered contraception.” 

Natasha Frederick, Director of the Comprehensive Fertility and Sexual Health Team at Connecticut Children’s Medical Center, is currently developing clinical education curricula to teach oncology providers effective ways to talk to AYA cancer patients about sexual health. 

She explained that oncologists often do not want to initiate these conversations because they are uncomfortable or think the patient will be uncomfortable. The patients themselves are also not usually motivated to bring up their sexual health, especially if their parents are also in the room. Frederick emphasized that since pregnancy during cancer treatment can disrupt care or result in birth defects, it is important to have these conversations. Additionally, the discussion itself must expand beyond pregnancy prevention.

“[Cron and Abelman’s paper] focuses on contraception counseling, which is very important, but it doesn’t get into the larger scope of sexual health, which can go on to include other sub-topics such as relationships, sexual identity, gender identity, body image,” Frederick said. “Sexual health isn’t just any one thing. It’s a term that covers a whole bunch of sub-areas.” 

In order to better understand the scope and prevalence of sexual health counseling for female AYA cancer patients, Cron said she has plans to conduct a similar study in which patients are given survey questionnaires. She recently conducted a pilot study with eight patients, and the data from the study is currently being analyzed.

Cron hopes that this follow-up investigation will address a limitation of the current study, which was a retrospective chart review. It used pre-recorded patient data, which may not always be reliable or accurate, the paper explains. For example, even if a patient received sexual health counseling, it is possible that her oncology provider did not document it. 

“What we’d like to do is hopefully confirm what we found in our retrospective chart review,” Cron said.

According to the American Cancer Society, approximately 30,700 AYAs in the U.S., ages 15 to 29, will be diagnosed with cancer in 2020. 

Emily Ji | emily.ji@yale.edu