By Heather R. Kelly, MSN, RN, BCPA, CPC
Have you ever cared for a young adult with cancer? Looked a patient in the eyes as they realized they may never have biological children? Sat with a young mother fighting for her life while trying to raise small children? Or supported a couple struggling to maintain intimacy while navigating the biggest battle of their lives?
If you have, then you understand that some of the hardest losses associated with cancer and chronic illness have nothing to do with laboratory values, imaging results, or treatment plans. They are the losses that rarely appear in the medical record: fertility, body image, intimacy, identity, confidence, and connection.
As healthcare professionals, we celebrate survivorship and advancements in treatment, and rightly so. Yet too often, we continue to define success solely by survival. We measure remission, response rates, and years gained, while the questions that shape quality of life remain unspoken. What happens when a young woman is thrust into premature menopause because of breast cancer treatment? What happens when a patient living with multiple sclerosis experiences changes in sexual function that strain a relationship? What happens when an individual with heart failure, diabetes, or another chronic condition feels embarrassed to discuss intimacy concerns with their healthcare team?
These conversations frequently fall to the bottom of an already crowded list of priorities.
And yet, they matter.
Sexual health is recognized by the World Health Organization as a fundamental component of overall well-being. Research consistently demonstrates that cancer and its treatment can significantly affect sexual function, fertility, body image, relationships, and emotional health, often long after treatment ends. Many survivors report sexual dysfunction as one of the most distressing and persistent consequences of cancer treatment, with negative effects on quality of life and intimate relationships (Hamilton, 2025).
Unfortunately, despite the prevalence of these concerns, discussions about sexual health often never occur. Oncology providers cite limited time, competing priorities, insufficient training, and discomfort with the topic as barriers to initiating conversations (Kaufman et al., 2024). In today's healthcare environment, where appointments may last only 15 or 30 minutes, clinicians are frequently focused on disease management, treatment decisions, symptom control, and documentation requirements. Important quality-of-life concerns can easily go unaddressed.
This is where case managers can make a meaningful difference.
The CMSA Standards of Practice for Case Management emphasize advocacy, assessment, care coordination, education, and addressing the comprehensive needs of the individuals we serve. Case managers are uniquely positioned to understand not only a patient's clinical condition but also the psychosocial, emotional, family, and quality-of-life concerns that influence overall well-being.
Unlike many healthcare encounters that occur in brief episodes, case managers often build longitudinal relationships with patients and families. We hear the questions that are asked after the physician leaves the room. We notice changes in mood and behavior. We recognize when a patient who once spoke openly about their spouse suddenly avoids discussing relationships. We hear worries about fertility, dating after treatment, physical changes, or fears regarding intimacy.
Often, patients are waiting for permission to have the conversation.
As a nurse, I have found that those of us who spend the most time with patients are often the first to recognize these unspoken concerns. It is the look that lingers a little longer than usual. The hesitation before answering a question. The change in demeanor from one visit to the next. It is in those moments that advocacy begins.
Advocacy does not require us to have all the answers.
Sometimes advocacy means acknowledging that sexual health is an important part of health. It means creating a safe environment where patients understand that their concerns are valid and worthy of discussion. It means asking simple questions such as, "How has treatment affected your relationships or intimacy?" or "Are there any concerns about sexual health or fertility that you would like to discuss?" These small openings can help normalize conversations that many patients desperately want to have but may feel uncomfortable initiating on their own.
The nursing profession has long recognized the importance of holistic care. In a review focused on young adult cancer survivors, Esch (2021) noted that oncology nurses play an integral role in assessing sexual health concerns and helping address the physical and psychosocial challenges that affect sexuality, intimacy, and quality of life. More recently, nursing literature has highlighted that nurses are often ideally positioned to address sexual dysfunction because of their ongoing relationships with patients, but many clinicians report lacking sufficient education or organizational support to do so effectively (Alqaisi et al., 2025).
Case managers can help bridge that gap.
Whether working in acute care, oncology, hospice, rehabilitation, managed care, or community-based settings, case managers are often the professionals’ connecting patients with resources, facilitating referrals, coordinating multidisciplinary care, and advocating for unmet needs. Sexual health concerns may warrant referrals to gynecology, urology, pelvic floor specialists, mental health professionals, fertility specialists, sexual health counselors, or survivorship programs. The simple act of recognizing the need can become the first step toward healing.
Importantly, this conversation extends beyond oncology. Individuals living with chronic conditions such as diabetes, cardiovascular disease, autoimmune disorders, neurologic conditions, and mental health disorders frequently experience effects on sexual function and intimacy. Yet these concerns remain underrecognized throughout healthcare. If our goal is to improve health outcomes and quality of life, then sexual health cannot remain separate from the conversation.
We often speak about patient-centered care. True patient-centered care requires us to address what matters most to patients, not simply what matters most to providers or healthcare systems. For many individuals, relationships, intimacy, identity, and connection are central to their quality of life. Ignoring these concerns does not make them disappear; it simply leaves patients to navigate them alone.
Case managers have always served as advocates for the whole person. Sometimes that means coordinating treatment. Sometimes it means navigating insurance barriers. Sometimes it means supporting caregivers through complex decisions.
And sometimes it means having the courage to ask the question that no one else has asked.
Because while surviving cancer or another chronic illness is worthy of celebration, living well afterward matters too.
References
Alqaisi, O., Al-Ghabeesh, S., Tai, P., Wong, K., Joseph, K., & Yu, E. (2025). A narrative review of the roles of nursing in addressing sexual dysfunction in oncology patients. Current Oncology, 32(8), 457.
Case Management Society of America. (2022). Standards of practice for case management. CMSA.
Esch, M. (2021). Sexual health: A nursing approach to supporting the needs of young adult cancer survivors. Clinical Journal of Oncology Nursing, 25(5), 501–506.
Hamilton, B. K. (2025). SHIFTing to better address sexual health in cancer survivors. Journal of the National Comprehensive Cancer Network, 23(2), 63–65.
Kaufman, R., Agrawal, L., Teplinsky, E., Kiel, L., Abioye, O., & Florez, N. (2024). From diagnosis to survivorship: Addressing the sexuality of women during cancer. The Oncologist, 29(12), 1014–1023.
Looking for an independent case manager?
CMSA’s Find a Case Manager Directory helps individuals, families, healthcare professionals and other referral sources connect with independent case managers who can provide guidance, advocacy and support.
For CMSA members who practice independently, the directory is also a great way to help people find you and the expertise you provide.
Explore the directory: https://bit.ly/44XUVPG
Bio: Heather Kelly, MSN, RN, BCPA, CPC, is a registered nurse with more than 30 years of experience across the healthcare continuum, including oncology, palliative care, hospice, case management, and healthcare administration. She holds a Master of Science in Nursing with a focus on care coordination and is a Board Certified Patient Advocate and Certified Professional Coder. Heather is passionate about patient advocacy, professional mentorship, leadership development, and improving patient-centered outcomes. She is a frequent speaker on cancer survivorship and end-of-life planning and serves on the CMSA Editorial Board.