The Role of Nurse Navigators in Assessing and Managing Cancer-Related Sexual Problems

November 2018 Vol 9, NO 11
Leslie R. Schover, PhD
Regina Franco, MSN, ANP-C
Prisma Health, Greenville, SC
Jennifer Fox, MSN, AOCNP-C
Mark A. O'Rourke, MD
Stephanie M. Hoopes, BSN, RN, OCN, ONN-CG
Prisma Health Upstate Center for Integrative Oncology and Survivorship
Greenville, SC
Clancy Crawford, BS

Background: Recently, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) published practice guidelines advocating that all cancer patients be asked about sexual concerns during treatment planning and follow-up. Those with identified problems should be assessed and referred for multidisciplinary treatment.1,2

Objectives: To describe a practical workflow in an outpatient survivorship clinic where trained nurse navigators (NNs) and advanced practice registered nurses (APRNs) assess cancer-related sexual concerns and problems.

Methods: Research suggests that 60% of men and women have long-term sexual dysfunction related to cancer treatment, but less than 25% seek professional help.3 This abstract describes a comprehensive system to manage reproductive issues in outpatient oncology settings using online self-help and training programs, with a central role for NNs. The workflow begins with (1) one question from a frontline clinician to identify a concern, followed by (2) prescription of an online self-help resource, (3) an assessment visit with a trained NN and/or advanced practitioner that includes a structured interview, exam, and brief counseling, and (4) referral as needed for specialized care (gynecology, urology, oncofertility, mental health, pelvic physical therapy). An NN could identify problems initially and/or be trained to conduct the assessment interview. An APRN or physician can conduct an exam and prescribe medication. Will2Love’s online self-help programs for men and women were created and tested with 3 National Cancer Institute grants.4-6 Each explains sexual side effects of most types of cancer and their treatments and educates survivors on sexual anatomy and response, such as avoiding unintended pregnancy and sexually transmitted infections during and after cancer, enhancing relationships and sexual communication, cognitive-behavioral exercises to prevent or overcome specific sexual problems, and guidance on choosing medical treatment options. Patient video stories are included. The online training system for professionals includes skills in discussing sexuality, outlines for assessment interviews, treatment algorithms for specific sexual problems combining the self-help resources and medical options for reproductive healthcare, and a detailed clinician’s manual on using the self-help programs for brief counseling or sex therapy.

Results: The Center for Integrative Oncology and Survivorship at Greenville Health System was first to implement this model. An APRN- and NN-staffed Sexual Health Evaluation (SHE) clinic for female survivors includes interview and exam templates, assessment workflows, treatment algorithms for common problems, and a list of outside referral resources (ie, pelvic physical therapy and sexual counseling). The APRN and NN collaborate to perform the assessment. Patients receive samples of vaginal lubricants, moisturizers, a small vibrator, and a free subscription to the online self-help program. A monthly call between Will2Love and SHE clinic staff, consisting of case reviews, education, and further refinement of algorithms and clinic flow, furthers program development and quality control.

Conclusions: With online patient and professional education resources, NNs can effectively assist and educate survivors about reproductive health, meeting new ASCO and NCCN guidelines. In hospitals with fewer resources or advanced practitioners, NNs can use the self-help programs and clinician’s manual to identify problems, conduct initial assessments, and make appropriate referrals for treatment.


  1. Denlinger CS, Sanft T, Baker KS, et al. Survivorship, version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2017;15:1140-1163.
  2. Carter J, Lacchetti C, Andersen BL, et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J Clin Oncol. 2018;36:492-511.
  3. Schover LR, van der Kaaij M, van Dorst E, et al. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl. 2014;12:41-53.
  4. Schover LR, Canada AL, Yuan Y, et al. A randomized trial of internet-based versus traditional sexual counseling for couples after localized prostate cancer treatment. Cancer. 2012;118:500-509.
  5. Huyghe E, Martinetti P, Sui D, Schover LR. Banking on Fatherhood: pilot studies of a computerized educational tool on sperm banking before cancer treatment. Psychooncology. 2009;18:1011-1014.
  6. Schover LR, Yuan Y, Fellman BM, et al. Efficacy trial of an Internet-based intervention for cancer-related female sexual dysfunction. J Natl Compr Cancer Netw. 2013;11:1389-1397.
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