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Unsurprisingly, , looking at a digital platform to engage young women with breast cancer in self-management of symptoms, identified that the two most utilized domains were sexual and mental health. The authors conclude that these needs suggest that both are being suboptimally addressed in the clinic, but I would suggest that patients -- young women in particular -- may simply prefer the privacy of home or anonymity of digital health to engage in questions and management of their mental health and sexual health side effects.

In the research, 30 women under the age of 45 were enrolled in an interactive, web-based intervention to both educate and self-manage common symptoms across the spectrum of breast cancer care and treatment. Ten women were enrolled from each of three cohorts -- early breast cancer (EBC), metastatic breast cancer (MBC), and breast cancer survivors (BCS). Patients were then prompted to complete self-assessments weekly for 12 weeks (EBC or MBC) or every 4 weeks (BCS) and, pending responses, could trigger up to 37 resources focused on patient-reported outcomes.

Overall, 61% of the assessments were completed, with the lowest completion rate amongst the MBC participants (52%). Based both on the lower completion rate and post-participations semi-structured qualitative surveys, it appears that the frequency of self-assessments for MBC patients may be delivered at a different time interval for optimal utilization.

Over 85% of participants triggered resources for sexual health (90%), stress and mindfulness (87%), fatigue (87%), and anxiety (87%), with vaginal dryness, sleep problems, emotional health in survivorship, mental health services, depression, and sadness also triggering greater than 80% for study participants, nearly all falling into the broader categories of sexual or mental health.

Rather than interpret this work as a call for increased mental and sexual health imbedded within our clinic, or increased training for clinicians around mental and sexual health services, I feel it is an opportunity to see a call to action for a vital role of telehealth in the young breast cancer population. Increasingly, young women with breast cancer are empowered to partner in shared decision-making with their clinicians and engaging in deep discussions about their mental health or emotional distress may otherwise erode that relationship.

Additionally, as young women with breast cancer often have engaged, supportive extended networks of family and friends that participate in clinic visits as part of their vital support network, it is understandable that detailed dialogue about sexual health may not be best in that context. However, having available telehealth services with skilled providers who partner with but are not central to the patient's primary treatment team may be the optimal care delivery mechanism for young women with breast cancer to seek best mental or sexual health.

I would hypothesize that Sella et al's work is generalizable for any person with any cancer diagnosis to seek best care for sexual or mental health needs.

The Young, Empowered, and Strong Web-based intervention proves a valuable digital health tool for engaging patients around mental and sexual health. This work proposes a clear path forward to trial solutions to these sensitive but universal topics in our new telehealth world.

Stephanie L. Graff, MD, FACP, is director of breast oncology at Lifespan Cancer Institute and assistant professor of medicine at Brown University in Providence, Rhode Island, and medical advisor for the Dr. Susan Love Foundation for Breast Cancer Research.

Read the study here and an interview about it here.