Sexual Dysfunction Among Adolescent and Young Adult Men Diagnosed with Cancer.

Purpose: Adolescent and young adult (AYA) cancer patients frequently demonstrate sexual dysfunction; however, there is a lack of data quantifying the severity and frequency. Methods: Males aged 18-39 years, diagnosed with cancer of any kind and who were scheduled to begin, were actively receiving, or had completed cancer treatment within 6 months, were offered validated surveys during their oncology appointment. These surveys included the International Index of Erectile Function (IIEF-6), Masturbation Erection Index (MEI), 36-Item Short Form Survey, and 5-point Likert scales to assess their desire and ability to engage in sex and masturbation. Results: Forty subjects completed the IIEF survey with a mean score of 17.7 ± 11, erectile dysfunction (ED) prevalence accordingly was 58%. Thirty-eight subjects completed the MEI with a mean score of 25.3 ± 5.3, ED prevalence was again 58%. Age and IIEF scores demonstrated a statistically significant (p < 0.05, n = 38) Pearson's correlation coefficient of 0.40, patients younger than 30 years had an ED prevalence of 72% (mean IIEF 13), whereas patients aged 30 years and older had an ED prevalence of 45% (mean IIEF 22). All treatment modalities had ED rates >30%: chemotherapy demonstrated the highest prevalence at 64% (mean IIEF 17), whereas radiation therapy had the lowest prevalence at 33% (mean IIEF 23). Conclusion: This study demonstrates that the prevalence of sexual dysfunction among male AYA patients undergoing treatment for cancer is high. AYA oncologists should discuss potential sexual health concerns when treating this population. The exact cause of ED (non-organic vs. organic) within this group should be explored further.

Evaluation of a Comprehensive, Adaptable, Life- Affirming, Longitudinal (CALL) palliative care project.

BACKGROUND: Many persons with life-threatening illnesses require services before they begin receiving hospice or hospital-based palliative care. Although health care professionals focus on diagnosis, treatment, and comfort care, patients and families view the illness as it impacts their whole life. OBJECTIVE: Evaluating a Comprehensive, Adaptable, Life-Affirming, Longitudinal (CALL) intervention to patients with life-threatening cancer, cardiac illness, respiratory conditions or dementia. The CALL Care interventions are consistent with the 2004 Clinical Practice Guidelines for Quality Palliative Care. DESIGN: Prospective observational study. SETTING AND SUBJECTS: Eleven sites (1 primary care, 8 acute care, and 2 long term care) located around the United States. Two hundred ninety-five patients and families enrolled in the study; many were enrolled for over 12 months. MEASUREMENTS: Patient self-reported Modified City of Hope Questionnaire addressing physical, psychosocial, emotional, and spiritual status and health care experiences; completed at enrollment and every three months. Family members completed Modified City of Hope Bereaved Family Questionnaire, with contents similar to the patient questionnaire. Sites compiled health care and community services utilization data regularly. RESULTS: Participants reported improved pain and symptom management. Fewer than one third were hospitalized (29%), and 7% had a critical care admission while enrolled. In addition, participants had high use of hospice (48% of those who died), and were likely to die at home (38% of those who died). CONCLUSIONS: CALL Care is an effective interdisciplinary intervention approach to individualize care for people living with life-threatening illness.

A "CALL" for community-focused palliative care.

Providing interdisciplinary coordinated health and social services has a profound positive impact on patients and families facing life-threatening illness. CALL Care is a demonstration project designed to provide this type of care and bridge gaps in the existing palliative care system. The program seeks to provide care that is comprehensive, adaptable, life-affirming, and longitudinal. Hallmarks of the approach include identification and offer of assistance to those facing terminal illness as close to diagnosis as possible, periodic comprehensive assessments of the patient and family situation, coordination of health and social care services made possible by an active interdisciplinary team process with a single care coordinator, and links to community resources. This article describes the CALL Care experience, presents several case studies illustrative of the interventions and their impact, and provides recommendations for those seeking to make a similar commitment to integrated palliative care services.

Palliative care: rapid redesign to support systemwide quality improvement.

Large-scale change techniques and rapid redesign methodologies were used to improve the quality of care delivered to patients at the end of life in a large, multihospital healthcare delivery system. By bringing key stakeholders from across the system together at a symposium to formulate the vision and critical criteria for palliative care programs, as well as to develop a flexible set of design tools, each region in the system could respond to the unique needs of its own community. Hospice length of stay for the system improved by 100% in the year after the systemwide symposium.