Psychological interventions for sexual function and satisfaction of women with breast cancer: A systematic review and meta-analysis

Psychological and interpersonal dimensions of sexual function and dysfunction: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)

INTRODUCTION

Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.

OBJECTIVES

This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.

METHODS

A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.

RESULTS

Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.

CONCLUSIONS

This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.

The Renewing Intimacy and SExuality Intervention for Female Cancer Survivors: A Feasibility Study

PURPOSE

This study examined the feasibility and acceptability of a three-session, psychological-based intervention to improve intimacy and sexuality outcomes among women with breast and gynaecologic cancer in Singapore.

METHOD

Patients from outpatient oncology clinics completed screeners for marital and sexual distress. Those who endorsed either marital or sexual distress were invited into the study, and were randomized to receive the intervention immediately or be waitlisted. Intervention feasibility (i.e., reach, adherence) and acceptability (i.e., satisfaction, cultural sensitivity, willingness to pay) and marital, sexual, and body image outcome changes were examined.

RESULTS

1101 patients completed the screener; 24% of patients with breast or gynaecologic cancer reported marital or sexual distress. Forty-six patients who were eligible participated in the study. The majority (88%) of participants who started the intervention completed all 3 sessions. All (100%) participants who completed the intervention reported satisfaction and the majority (97%) reported they would recommend the intervention to a friend. The majority of participants found the intervention to be culturally sensitive (93%) and reported being willing to pay either out of pocket or through their national medical MediSave account (76%). Outcome changes were in expected directions with small effect sizes (0.24-0.42). Several themes emerged from open-ended feedback on what participants found useful and how the intervention can be improved.

CONCLUSIONS

Approximately one quarter of breast or gynaecologic cancer patient who are partnered in Singapore reported marital or sexual distress. Despite the low reach, we found good adherence and high acceptability of the psychological-based intervention. Our findings suggest there is room to improve awareness and delivery of sexuality-related care in an oncology setting.

TRIAL REGISTRATION

Number and date: NCT03420547, April 10, 2018.

Sexual health counseling improves the sexual satisfaction of breast cancer survivors: a randomized controlled trial

PURPOSE

Breast cancer and its treatments can cause sexual problems both physically and psychologically by the changes it brings. This study aimed to investigate the effect of sexual health counseling based on acceptance and commitment therapy (ACT) on the sexual satisfaction of women with chemotherapy-induced menopause (CIM) in breast cancer survivors.

METHODS

Seventy women with CIM were randomly divided into two intervention (N = 34) and control (N = 36) groups. The intervention group attended eight sessions of 90-min sexual health counseling based on ACT. The control group received an educational booklet. The Sexual Satisfaction Scale for Women(SSS-W), the Sexual Quality of Life-Female questionnaire(SQOL-F), and the Menopause Rating Scale(MRS) were used to collect data before, after, and 1 month after the intervention in both groups.

RESULTS

The mean score of sexual satisfaction (F = 45.67, P < 0.001) and sexual quality of life (F = 33.39, P < 0.001) were significantly higher after the intervention and follow-up than before intervention in the intervention group. Also, the mean score of menopausal symptoms was significantly lower after the intervention and follow-up than before intervention in the intervention group (F = 11.80, P < 0.001). However, the mean score of sexual satisfaction (F = 0.02, P = 0.98), sexual quality of life (F = 0.05, P = 0.94), and menopausal symptoms (F = 0.08, P = 0.92) did not show significant differences before, after, and 1 month after the intervention in the control group.

CONCLUSIONS

Therefore, sexual health counseling based on ACT seems to have salutary effect on sexual satisfaction, sexual quality of life, and menopausal symptoms of women with breast cancer who experience CIM.

TRIAL REGISTRATION

This randomized control trial has been approved by Iranian Registry of Clinical Trials, IRCT20230105057055N1 at 2023-01-29.

Post-Treatment Experiences of Reproductive Concerns Among Young Breast Cancer Survivors: A Descriptive Phenomenological Study

PURPOSE

The long-term fertility impact of cancer treatments is a significant concern for young breast cancer survivors. These reproductive concerns often become a persistent source of stress, negatively affecting their quality of life. This study aims to explore the reproductive concerns experienced by young breast cancer survivors post-treatment and the factors influencing their perceptions.

METHODS

This phenomenological study utilized semi-structured interviews to collect data. Eighteen participants were recruited from a tertiary hospital in Mainland China. The interviews were transcribed verbatim and analyzed using Colaizzi's method.

RESULTS

Data analysis revealed five themes and fourteen subthemes: (1) multiple emotional burdens interwoven with concerns about fertility; (2) concerns about risks associated with reproduction; (3) dilemma of childrearing; (4) the significance of reproduction; (5) support needs from family, peers, and professionals.

CONCLUSION

Young breast cancer survivors in China face significant challenges related to reproductive issues. Reproductive health is a crucial aspect of breast cancer survivorship care. Healthcare providers must be attentive to the reproductive concerns of survivors, recognize the importance of multidimensional support for positive adaptation, and offer tailored and ongoing interventions to manage reproductive health in young breast cancer survivors.

Effect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial

OBJECTIVE

The aim of the study was to determine the effect of WhatsApp-based BETTER sex counselling on sexual function and sexual quality of life in breast cancer survivors in a randomized control trial.

METHODS

This is a randomized controlled trial in which a total of 90 breast cancer survivors were recruited using convenience sampling and then randomly assigned to two groups of WhatsApp-based BETTER model counselling and routine care. Data collection tools consisted of a demographic questionnaire, the Sexual Quality of Life-Female (SQOL-F) and the Sexual Function Index (FSFI-BC). Participants in the intervention group were given access to the 6-week program. The program consisted of six consultation and assignment packages covering all six steps of the BETTER model. Data were analyzed using SPSS software version 20. Chi-square test, independent samples t-test and repeated measures analysis of variance were used. The significance level (p-value) was considered to be less than 0.05.

RESULTS

In the control group, the mean score of SQL scale changed from 35.16 ± 10.71 to 35.16 ± 12.97 (P > 0.05) and in the intervention group, it significantly increased from 34.76 ± 10.13 to 68.20 ± 20.48 (P < 0.001). Similarly, the comparison of mean of FSF in the control group showed a none-significant change from 58.13 ± 7.11 to 58.35 ± 6.11 (P > 0.05), and in the intervention group, it significantly improved from 59.49 ± 6.10 to 120.73 ± 25.54 (P < 0.001). The results of rANOVA indicated that there was a significant difference in the mean scores of the SQL and SFS between the two groups from pre- to post-intervention, and then over the 1-month follow-up period in the intervention group (p < 0.001). Considering partial eta squared, the effect of the intervention had the highest interaction effect on both variables of the sexual function index (η2 = 0.73) and sexual quality of life (η2 = 0.41).

CONCLUSIONS

The intervention program was a successful model for improving female sexual quality of life and female sexual function in breast cancer survivors.

TRIAL REGISTRATION

IRCT20210926052601N1, 7-11-2021.

Impact of Cognitive Behavior Therapy on Sexual Dysfunction of Women in Reproductive Age: A Systematic Review

Background

A large number of women suffer from sexual dysfunction. Cognitive behavior therapy (CBT) is a psycho-educational therapy the main purpose of which is to help the individual alter their dysfunctional beliefs and behaviors. We investigated the impact of CBT on reproductive-aged women's sexual function.

Methods

The present study is a systematic review and meta-analysis in which a number of databases (Web of Science, PubMed, Scopus, Cochrane Library, and Embase) were searched from inception to November 2023. Clinical trials examining the impact of CBT on female sexual dysfunction were included. This study evaluated female sexual function and its components, including satisfaction, discomfort, lubrication, arousal, climax, desire, and assertiveness. We used Review Manager version 5.3 for performing the meta-analysis. P values less than 0.05 were considered statistically significant.

Results

Seven articles including a total of 448 women with sexual dysfunction were reviewed. The participants' mean age in the CBT groups was 33.43 ± 6.04 years and that of the control group was 33.24 ± 5.97, which were not significantly different. Our results indicated that CBT is efficient in improving the total score of women's sexual function (SMD = 1.34, 95% CI = (1.02, 1.65), I2 = 86%), sexual satisfaction, lubrication, desire, orgasm, and assertiveness compared with the control group. However, CBT had no positive effect on reducing sexual pain.

Conclusion

Based on the result of the current study, CBT can be suggested as an effective treatment method along with other treatments for women with sexual problems.

Factors associated with sexual dysfunction in patients with colorectal cancer in Iran: a cross-sectional study

Sexual dysfunction is a prevalent issue among individuals diagnosed with colorectal cancer (CRC), significantly impacting their quality of life. However, limited research has explored the factors associated with sexual dysfunction in CRC patients in Iran. This cross-sectional study aimed to identify the demographic factors that may contribute to sexual dysfunction in this population. A cross-sectional study involving CRC patients was conducted from April 1, 2022, to May 1, 2022, in Tabriz, Iran. Ethical approvals were obtained, and convenience sampling was employed at outpatient chemotherapy centers in five Tabriz hospitals. Validated questionnaires, including participants characteristics form, the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males, were utilized. Data were analyzed using IBM SPSS Statistics version 24, employing descriptive statistics and stepwise linear regression to assess association between mentioned factors and sexual function. Among 256 participants, 50.4% were males, 49.6% were females, and 80.5% were married. The predominant age range was 50-60 years. The study findings revealed a high prevalence of sexual dysfunction among both female (Mean ± SD: 10.91 ± 8.67, Min-Max: 3.20-33.00) and male (Mean ± SD: 27.64 ± 16.28, Min-Max: 11-62) CRC patients. Factors such as the presence of a colostomy for FSFI (P < 0.001), type of treatment received for both FSFI and IIEF (P < 0.001), type of housing for both FSFI and IIEF (P < 0.001), occupation for FSFI (P < 0.001), presence of other diseases for FSFI (P = 0.047), and time since the last chemotherapy session for FSFI (P = 0.018), Education for IIEF (P = 0.026), and Age for IIEF (P = 0.002) were identified as significant factors of sexual dysfunction. These demographic factors demonstrated varying effects on sexual function, underscoring the complexity of this issue. The results underscore the significance of addressing sexual health concerns in CRC patients and highlight the necessity for tailored interventions to enhance their overall well-being. Healthcare providers should recognize the influence of demographic factors on sexual function and contemplate integrating sexual health assessments and interventions into the care of CRC patients. Further research is needed to comprehend better the underlying mechanisms and devise effective strategies for managing sexual dysfunction in this population.

Sexual quality of life of adolescents and young adult breast cancer survivors

BACKGROUND

With increasing survival rates of adolescents and young adults (AYAs) with breast cancer, health-related quality of life (HRQoL) becomes more important. An important aspect of HRQoL is sexual QoL. This study examined long-term sexual QoL of AYA breast cancer survivors, compared sexual QoL scores with that of other AYA cancer survivors, and identified factors associated with long-term sexual QoL of AYA breast cancer survivors.

MATERIALS AND METHODS

Data of the SURVAYA study were utilized for secondary analyses. Sexual QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life cancer survivorship core questionnaire (EORTC QLQ-SURV100). Descriptive statistics were used to describe sexual QoL of AYA cancer survivors. Linear regression models were constructed to examine the effect of cancer type on sexual QoL and to identify factors associated with sexual QoL.

RESULTS

Of the 4010 AYA cancer survivors, 944 had breast cancer. Mean sexual QoL scores of AYA breast cancer survivors ranged from 34.5 to 60.0 for functional domains and from 25.2 to 41.5 for symptom-orientated domains. AYA breast cancer survivors reported significantly lower sexual QoL compared to AYA survivors of other cancer types on all domains. Age, time since diagnosis, relationship status, educational level, chemotherapy, hormonal therapy, breast surgery, body image, and coping were associated with sexual QoL of AYA breast cancer survivors.

CONCLUSIONS

AYA breast cancer survivors experience decreased sexual QoL in the long term (5-20 years) after diagnosis and worse score compared to AYA survivors of other cancer types, indicating a clear need to invest in supportive care interventions for those at risk, to enhance sexual well-being.

Psychosocial interventions for ovarian cancer survivors: A systematic review

OBJECTIVES

Ovarian cancer survivorship is complex and is associated with greater symptom burden, fear of reoccurrence, sexual dysfunction, lower quality of life and heightened existential distress in contrast to other cancers. This systematic review aimed to investigate the effectiveness for, and perspective of, psychosocial interventions encompassing psychological, social, and emotional support, tailored to, or involving ovarian cancer survivors at all stages of disease.

METHODS

Adhering to the PRISMA-SR statement guidelines, a systematic search was conducted across PsycINFO, MEDLINE, Embase, Emcare, CINAHL, Scopus, Cochrane Library databases, Google, and Google Scholar. Two reviewers independently undertook a two-stage screening process. The Mixed Methods Appraisal Tool was utilised to assess the methodological quality of included studies. Data were extracted using customised data extraction tools and narratively synthesised.

RESULTS

Thirteen studies were included in this review. Generally positive effects of psychosocial interventions were observed across a range of outcome domains (meaning enhancing, cognitive, social, emotional, and cancer-specific). However, the characteristics of interventions and outcome measures varied across studies. Psychoeducational interventions were identified as the most common psychosocial approach, while Acceptance and Commitment Therapy showed promise in addressing the disease's high symptom burden. Women's perspectives of psychosocial interventions were described as "useful" and promoted positive self-regard.

CONCLUSION

While the evidence base largely support positive effects of psychosocial interventions for ovarian cancer survivors, this finding is constrained by heterogeneity of interventions and modest gains. Future research may explore the standardisation of psychosocial interventions for this demographic, investigating its effects on less explored but prevalent concerns among ovarian cancer survivors such as fear of cancer recurrence and sexual dysfunction.

The effect of cognitive-behavioral therapy and sexual health education on sexual assertiveness of newly married women

BACKGROUND

The present study aimed at investigating the effect of sexual health education and cognitive-behavioral therapy (CBT) on sexual assertiveness (primary outcome) and sexual satisfaction (secondary outcome) of newly married women.

METHOD

This RCT was conducted on 66 newly married women with cases in pre-marriage counseling centers in Tabriz, Iran. Participants were assigned into three groups using block randomization. Eight group sessions of CBT were held for one of the intervention groups (n = 22) and 5-7 sessions of sexual health education for other intervention group (n = 22). The control group (n = 22) received neither education nor counseling during the research. The data were collected using the demographic and obstetric characteristics, Hulbert sexual assertiveness index, and Larson sexual satisfaction questionnaires, and analyzed using ANOVA and ANCOVA tests.

RESULTS

The mean (standard deviation: SD) score of the sexual assertiveness and sexual satisfaction in the CBT group enhanced from 48.77 (13.94) and 73.13 (13.53) before the intervention to 69.37 (7.28) and 86.57 (7.5) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the sexual health education group increased from 48.9(11.39) and 74.95 (8.30) before the intervention to 66. 94 (7.42) and 84.93 (6.34) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the control group changed from 45.04 (15.87) and 69.04 (10.75) before the intervention to 42.74 (14.11) and 66.44 (10.11) after the intervention, respectively. Eight weeks after the intervention, the mean scores of sexual assertiveness and sexual satisfaction in two intervention groups were more than that in the control group (P < 0.001), However, there was no significant difference between the two intervention groups (P > 0.05).

CONCLUSION

The results of this research indicated that CBT and sexual health education are effective in improving women's sexual assertiveness and sexual satisfaction. Considering that sexual health education, does not require complex counseling skills compared to CBT, it can be used as a preferred intervention in promoting sexual assertiveness and satisfaction of newly married women.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT20170506033834N8. Date of registration: 11.09.2021. URL: http://en.irct.ir .

Tailored Psychological Interventions to Manage Body Image: An Opinion Study on Breast Cancer Survivors

OBJECTIVE

Oncological care affects the body strongly, even some years after therapies. Body image, as the mental representation of one's own body, is particularly affected by breast cancer, with a high level of dissatisfaction and negative perception. Literature has shown the effectiveness of various psychological interventions to promote body image in breast cancer survivors, dealing with inner sensations and related emotions and thoughts. The present opinion study presents BI issues and personalized psychological interventions to increase a positive BI in breast cancer survivors.

CONCLUSIONS

Implementing specific and personalized psychological interventions tailored on BI, the characteristics of oncological journey and emotional and cognitive issues is fundamental. Directions for clinical practice are given.

Quality of sexual life and associated factors: a cross-sectional survey of Chinese breast cancer patients

PURPOSE

This study aimed to explore Chinese breast cancer patients' quality of sexual life (QSL) and factors associated with QSL.

METHODS

The questionnaires in this cross-sectional study include the general information questionnaire, cognition and assessment of sexual health questionnaire, Self-acceptance Questionnaire (SAQ), Medical Coping Modes Questionnaire (MCMQ), and Quality of Sexual Life Questionnaire (QSLQ); 201 breast cancer patients were required to complete the questionnaires assessing characteristic information, cognition and assessment of sexual health, QSL, self-acceptance, and coping style. Finally, hierarchical regression was used to analyze the factors associated with QSL in Chinese breast cancer patients.

RESULTS

The mean age (at the time of the survey) of the breast cancer patients was 48.31±9.15. The mean score of the QSLQ (range 28-140) was 75.14±16.57. Hierarchical regression analysis showed that the associated factors of breast cancer patients' QSL included age (at the time of the survey), education level, type of surgery, cognition and assessment of sexual health, self-acceptance, and avoidance and acceptance-resignation coping styles, that independent variables explained 60.4% of the variance.

CONCLUSION

The QSL among Chinese breast cancer patients needs to be improved. Our findings indicated that breast cancer patients with older age, lower education level, or modified radical mastectomy have poor QSL. Breast cancer patients learn correct information about sexual health, enhance self-acceptance, and reduce acceptance-resignation, and avoidance coping could be intervention strategies to improve their QSL.

The correlation between posttraumatic growth and social support in people with breast cancer: A meta-analysis

Posttraumatic growth (PTG) is consistently reported to be associated with social support among people with breast cancer. But so far there is no consensus on the size and direction to which social support are related to PTG in people with breast cancer. Thus, a meta-analysis was performed by us to quantitatively synthesize the previous results. This meta-analysis followed the PRISMA 2020 guidelines. We searched PubMed, PsycINFO, Web of Science, Embase, Chongqing VIP Information Co., Ltd. (VIP), China National Knowledge Infrastructure (CNKI), and WANFANG DATA databases prior to 1 June 2022. A random effects model of Stata software (version 17.0) was employed to compute the pooled association coefficient and examine a series of moderating factors: economic level, publication type, region, year of publication, participants' age, and social support measurement tools. Ultimately, 31 studies including 6,380 breast cancer patients were identified. This meta-analysis offers evidence of a highly positive correlation between PTG and social support among people with breast cancer (r = 0.425). Economic level, region, and social support measurement tools moderated the link between PTG and social support among people with breast cancer. Whether variables such as disease stage, time since diagnosis, and disease treatment moderate the link between PTG and social support among people with breast cancer can be further investigated in the future.