The effects of head and neck cancer on relationship intimacy in adults: a systematic review of the literature

Objectives
This systematic literature review aimed to explore the effects of head and neck cancer (HNC) on relationship intimacy in adults and identify the current support available to patients with HNC and their partners in relation to relationship intimacy.

Methods
Seven databases (CINAHL, Pubmed, Scopus, Web of Science, SocINDEX, PsycARTICLES, Psychology, and Behavioural Science Collection) were searched using grouped terms “head and neck cancer and intimacy” and “head and neck cancer and support.” Studies written in English to assess adult patients with HNC and its effects on relationship intimacy and studies assessing the use of intimacy-specific support tools/methods were included. The review protocol was registered in June 2022 with PROSPERO ID: CRD42022329614.

Results
Thirty publications were included within the review. Six topics emerged: relationships, communication, sexual interest, barriers, couples-based communication intervention strategies, and assessment tools. While there were positive dyadic changes observed, many patients reported negative experiences relating to changes in relationship roles, sexual issues, and poor communication with partners and health care professionals that affected intimacy. There were 5 interventions identified; of those, the results varied, with some improvements noted in psychological well-being but not necessarily sexual interest and enjoyment.

Conclusions
HNC profoundly affects relationship intimacy. However, both patients and health care professionals find it challenging to discuss these issues, often leaving it an unmet need. Appropriate training and development for health care professionals that facilitate communication between clinician and patient are necessary to support conversations on intimacy needs.

Implications for Nursing Practice
There exists a need for patients to receive support in relation to intimacy following diagnosis and treatment, and the evidence suggests that this may be more effective post-treatment and from health care professionals who are appropriately trained. Couples’ communication interventions may prove useful, but further research is required on the efficacy of combining both psychological and sexual support together.