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Tackling depression and intimacy issues in patients with MPNs

Tuesday, July 11, 2017

This is an excerpt of a story that appeared in CURE Magazine. Read the full article here. 

Sexual health challenges are common among many patients with cancer and survivors. However, these issues with intimacy often fly under the radar because health care practitioners are typically concerned with disease control and other emerging symptoms.
As a leukemia nurse practitioner at Weill Cornell Medical College and NewYork-Presbyterian Hospital, Sandra Allen-Bard, BSN, MSN, AOCNP, ANCC, understands these unmet needs, especially among patients diagnosed with myeloproliferative neoplasms (MPNs).
In an interview with CURE, she discussed a recent study she conducted that examined sexuality and depression in patients with MPNs.

Sandra Allen-Bard, MSN, ANCC, AOCNPNurse extraordinaire Sandra Allen-Bard Why did you want to study intimacy in patients with MPNs?

I think it's something that a lot of health care practitioners don't address with patients. Quality of life issues are kind of looked upon like symptoms, there are scores are out there and there are different ways to measure things. Yet, as health care practitioners, we never ask about sexuality or intimacy with the patients unless they bring it up to us. So, I felt that it was a needed topic to make nurses aware of that subject. I just touched upon it a little bit and we just looked at some of the Cornell data prescribing different medications to help that. I think it can be broadened throughout the whole oncology spectrum. At Cornell, our program involves MPNs, so I felt that would be a good place to start. 

What did you find in this data?

There has been only one study in Sweden looking at intimacy and sexuality in patients with MPN that compared them to the regular control population. It's been very underrated. 
Patients with MPNs have a lot of depression. They need transfusions and have body image issues — in the sense of not feeling well. Our clinical data showed that erectile dysfunction is something that is easily treatable, and that men are more apt to talk to us about it than women are with their symptoms. We usually would refer them to urology for erectile dysfunction, although we did have a small population — about 6 to 8 percent — who have been put on drugs such as Viagra or Cialis. With women, we haven't even touched upon what they are going through with vaginal dryness and body issues. 
We prescribe antidepressants a little more; about 25 percent of our patients with the disease have been on antidepressants. We, as practitioners, are a little more comfortable prescribing those than Viagra. The data is interesting.
We also looked at transfusion-dependent patients. They obviously have a lower quality of life and a much less desire to have any intimacy. That was also looked upon with the other clinical trial. 

Age is another factor. Older patients don't want to talk about it. They don't really care too much about that. So, the younger patient population — those in their 40s and 50s — is something we should focus on. 
I always find that patients say they're well to the physician, but when the physician leaves the patient becomes all chatty with me about what's wrong and how they're really feeling. If you ask the right question, you're going to hear the answer you want to hear. So, if it's "How are you doing today?" they're going to say "fine." But if it's "Are you having any night sweats or itching?" then it makes them aware of something possibly related to their disease.
If we can help patients in any way improve their quality of life or intimacy, then I've made a statement.