Association between neighborhood socionatural environments and health satisfaction: a longitudinal mediation analysis.

Worldwide, the prevalence of cancer survivors continues to grow, reflecting important advances in both early detection and treatment. In 2018, it was estimated that more than 1.5 million Canadians were living with or beyond cancer, with breast, prostate, and colorectal cancers accounting for nearly half (48.5%) of these cancers. Many of these individuals experience substantial ongoing needs due to their cancer and/or its treatment. Sexual function is one aspect of health that is negatively affected by many cancer treatments. In fact, the prevalence of sexual dysfunction after cancer treatment has been reported to range from 30 to 100%, affecting both males and females. For example, a recent meta-analysis examining females treated for breast cancer reported that nearly three-quarters met the diagnostic criteria for female sexual dysfunction. In males who underwent surgery for prostate cancer, 95% reported substantial erectile dysfunction at 6 months post-treatment, while 93% of males who were treated with multiple therapies for rectal cancer reported a negative impact on erections. For both males and females, common challenges with sexual health after cancer treatment involve disorders of sexual response (e.g., arousal, erectile dysfunction) as well as sexual desire and motivation. Unfortunately, the evidence suggests that, without intervention, these challenges negatively impact quality of life and can last for years or decades after completing cancer treatment. Despite the high prevalence of sexual health concerns after cancer treatment, patients report their concerns in this domain are infrequently discussed or addressed. In fact, only a minority of patients are ever asked about their sexual health concerns, yet report a desire for these conversations with their providers. Men are more likely to be asked than women, with a recent study at a radiation oncology clinic finding that 53% of men reported they were asked about their sexual function compared to only 22% of women. Both oncologists and primary care providers self-report infrequent discussions of sexual health issues with their patients. Barriers to initiating sexual health discussions range from a lack of education and/or confidence around sexual health to a lack of clarity as to which member of the healthcare team is responsible for these conversations. Although the prevalence of sexual dysfunction concerns in cancer survivors is high and often persistent, there is scant literature examining whether and how cancer survivors with sexual dysfunction use healthcare services after cancer treatment and during routine follow-up care. The objective of this study was to examine the association between sexual dysfunction and physician use among adult cancer survivors in Nova Scotia, Canada, after they have completed cancer treatment.