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Shaffer KM, Reese JB, Dressler EV, Glazer JV, Cohn W, Showalter SL, Clayton AH, Danhauer SC, Loch M, Kadi M, Smith C, Weaver KE, Lesser GJ, Ritterband LM. Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial. JMIR Res Protoc 2024; 13:e57781. [PMID: 39159450 DOI: 10.2196/57781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/15/2024] [Accepted: 06/14/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. OBJECTIVE Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). METHODS Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. RESULTS This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. CONCLUSIONS By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. TRIAL REGISTRATION ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57781.
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Affiliation(s)
- Kelly M Shaffer
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Emily V Dressler
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Jillian V Glazer
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Wendy Cohn
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Shayna L Showalter
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Anita H Clayton
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Suzanne C Danhauer
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Michelle Loch
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Mai Kadi
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Caleigh Smith
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Kathryn E Weaver
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Glenn J Lesser
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Lee M Ritterband
- University of Virginia School of Medicine, Charlottesville, VA, United States
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Kim M, Gilliland JL, Parnes MF, Bruce C, Stern CS, Allen RJ, Pusic AL, Tadros AB, Nelson JA. BREAST-Q REACT: Qualitative Assessment of the Design, Functionality, and Clinical Utility of a New Score Interpretation Tool. Ann Surg Oncol 2024; 31:4498-4511. [PMID: 38570377 DOI: 10.1245/s10434-024-15185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The BREAST-Q real-time engagement and communication tool (REACT) was developed to aid with BREAST-Q score interpretation and guide patient-centered care. OBJECTIVE The purpose of this qualitative study was to examine the perspectives of patients and providers on the design, functionality, and clinical utility of REACT and refine the REACT based on their recommendations. METHODS We conducted three patient focus groups with women who were at least 6 postoperative months from their postmastectomy breast reconstruction, and two provider focus groups with plastic surgeons, breast surgeons, and advanced practice providers. Focus groups were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS A total of 18 breast reconstruction patients and 14 providers participated in the focus groups. Themes identified by thematic analysis were organized into two categories: (1) design and functionality, and (2) clinical utility. On the design and functionality of REACT, four major themes were identified: visual appeal and usefulness; contextualizing results; ability to normalize patients' experiences, noting participants' concerns; and suggested modifications. On the clinical utility of REACT, three major themes were identified: potential to empower patients to communicate with their providers; increase patient and provider motivation to engage with the BREAST-Q; and effective integration into clinical workflow. CONCLUSION Patients and providers in this qualitative study indicated that with some modifications, REACT has a great potential to elevate the clinical utility of the BREAST-Q by enhancing patient-provider communication that can lead to patient-centered, clinically relevant action recommendations based on longitudinal BREAST-Q scores.
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Affiliation(s)
- Minji Kim
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaime L Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mei-Fan Parnes
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cayla Bruce
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Division of Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Vollrath S, Theis S, Kolokythas A, Janka H, Schleich S, Moreth J, Kiesel L, Stute P. Self-management eHealth solutions for menopause - a systematic scoping review. Climacteric 2024; 27:255-268. [PMID: 38685754 DOI: 10.1080/13697137.2024.2334035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The purpose of this scoping review was to highlight the current scientific evidence on eHealth-based information tools for menopause in terms of quality, requirements and previous intervention outcomes. METHODS We systematically searched electronic databases (Embase, CINAHL, Cochrane Library, Global Health Database [Ovid], Web of Science, ClinicalTrials.gov [NLM], LIVIVO Search Portal [ZB MED] and Google Scholar) from 1974 to March 2022 for relevant records. RESULTS Our search yielded 1773 records, of which 28 met our inclusion criteria. Thirteen of 28 selected studies were cross-sectional with qualitative content analysis of websites about menopause; 9 studies were cohort studies examining the impact of an eHealth intervention; two studies were randomized controlled trials comparing eHealth tools with conventional ones; and four studies were non-systematic literature reviews. CONCLUSION This scoping review highlights the potential of eHealth-based information tools for the management of menopause and shows that most eHealth-based information tools are inadequate in terms of readability and the balanced view on information. Providers of eHealth-based information tools should pay attention to a participatory design, readability, balance of content and the use of multimedia tools for information delivery to improve understanding.
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Affiliation(s)
- Sabrina Vollrath
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Susanne Theis
- Department of Obstetrics and Gynecology, University Medical Center Mainz, Mainz, Germany
| | - Argyrios Kolokythas
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada
| | - Heidrun Janka
- Medical Library, University Library Bern, University of Bern, Switzerland
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | | | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University Hospital, Münster, Germany
| | - Petra Stute
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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Carney LM, Schnur JB, Morgan O, Hyun C, Magin ZE, Martin L, Montgomery GH. Psychosocial interventions to improve sexual functioning in women with cancer: a systematic review of randomized controlled trials. Sex Med Rev 2024; 12:142-153. [PMID: 38185918 PMCID: PMC10986159 DOI: 10.1093/sxmrev/qead052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Many women with cancer struggle with sexual side effects during and after treatment. Although preliminary evidence indicates that psychosocial interventions may be efficacious in improving sexual functioning for women with cancer, no systematic review has summarized the state of the science in this area. OBJECTIVES The primary goal of this review was to narratively synthesize the results of randomized controlled trials (RCTs) testing the efficacy of psychosocial interventions to address sexual dysfunction in women with cancer. A secondary goal was to describe the diversity of the included samples (ie, racial/ethnic and sexual minority). METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted examining RCTs of psychosocial interventions to improve sexual functioning for women with cancer. Articles were identified using MEDLINE, Embase, PsycINFO, and Cochrane CENTRAL. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. RESULTS Seventeen studies were included in the review, 12 of which provided sufficient information to calculate effect sizes. Ten of the 12 studies primarily aimed to improve sexual functioning, all of which demonstrated positive effects on at least 1 outcome of sexual functioning. In the 2 RCTs of psychosocial interventions in which sexual function was a secondary aim, effects were negligible (ds = -0.04 and -0.15). Commonalities among the studies with large effect sizes were that they included education, mindfulness/acceptance, and communication/relationship skills as intervention components. Of note, there was an overall lack of sample diversity across studies, and most studies failed to report the race/ethnicity or sexual orientation of the participants. CONCLUSION Results support interventions targeting sexual functioning outcomes for women with cancer and suggest that multimodal interventions including education, mindfulness/acceptance, and communication/relationship skills may be most effective. Future research should also focus on examining the efficacy and potential adaptations of extant sexual functioning interventions for underrepresented groups.
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Affiliation(s)
- Lauren M Carney
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Julie B Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Orly Morgan
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, FL 33101, United States
| | - Christine Hyun
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Zachary E Magin
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, United States
| | - Lily Martin
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Guy H Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Yen KY, Cheng JY, Li JQ, Toh ZA, He HG. The effectiveness of digital psychosocial interventions on psychological distress, depression, anxiety, and health-related quality of life in patients with gynaecological cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:240. [PMID: 38512538 DOI: 10.1007/s00520-024-08415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Patients with gynaecological cancer often experience psychological issues due to multiple stressors. Psychological disturbances have debilitating effects on patients with gynaecological cancer. In recent decades, digital psychosocial interventions have rapidly advanced and been incorporated into mental health interventions. Digital psychosocial interventions could provide patients with several benefits over traditional in-person interventions, including convenience, anonymity, flexible scheduling, and geographic mobility. The aim of this systematic review was to synthesize the effectiveness of digital psychosocial intervention in reducing psychological distress, depression, and anxiety and improving health-related quality of life in patients with gynaecological cancer. METHODS Three-step extensive search was performed on 22 December 2022 from nine bibliographic databases, trial registries and grey literature. Experimental studies involving patients with gynaecological cancer utilizing digital psychosocial interventions for the improvement of mental health outcomes were included. Meta-analysis was conducted using RevMan 5.4 software. Heterogeneity was analysed by Cochran's Q test and I2. Subgroup analyses were attempted to evaluate relative effect sizes of subgroup features. RESULTS Meta-analysis of nine studies revealed small effect size in reduction of depression post-intervention (d = 0.24, 95% CI - 0.46 to - 0.02) and medium effect size in reduction of psychological distress post-intervention (d = 0.51, 95% CI - 0.81 to - 0.21) and follow-up (d = 0.65, 95% CI - 1.25 to - 0.05) compared to the control group. The effects of digital psychosocial interventions on anxiety and health-related quality of life were not statistically significant. CONCLUSIONS Digital psychosocial interventions probably reduced psychological distress and slightly reduced depression amongst patients with gynaecological cancer compared to the control group, which can be integrated into clinical practice. Additional trials with rigorous methodology and bigger sample sizes are needed to validate findings. TRIAL REGISTRATION PROSPERO (CRD42023389502).
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Affiliation(s)
- Kai Yoong Yen
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Jing Ying Cheng
- Khoo Teck Puat Hospital, Yishun Health, National Healthcare Group, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
| | - Jin-Qiu Li
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- Department of Nursing, Zhuhai Campus, Zunyi Medical University, Zhuhai, Guangdong, China
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- Division of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore.
- National University Health System, Singapore, Singapore.
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Breistig S, Thorkildsen KM, Werner HMJ, Nordgreen T, Sekse RJT. Redefining sexual health after gynaecological cancer: Lived experiences from Gynea, a digital rehabilitation programme. J Clin Nurs 2024; 33:1110-1121. [PMID: 37984464 DOI: 10.1111/jocn.16923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Gynaecological cancer illness and treatment have a significant impact on women's sexual health and concerns regarding sexual health are known to be an unmet need in survivors. The digital support programme Gynea was designed to enhance women's health, including sexual health, after gynaecological cancer treatment. This study aimed to explore how cancer survivors experienced participation in Gynea. METHODOLOGY This is a phenomenological hermeneutic study. Individual, in-depth semi-structured interviews were conducted to explore lived experiences. Twenty women were interviewed after completing the Gynea programme. The transcripts were analysed using Lindseth and Norberg's phenomenological hermeneutic method. FINDINGS Three main themes (with subthemes) emerged from the analysis: (1) A silent existential trauma; (2) Redefining sexual health; (3) Communicating with a partner about sexuality. The women redefined sexual health rather than just being sexual intercourse, being a rediscovery of the body. The women's increased awareness and understanding of their own sexual health empowered their communication about their sexuality with their partners. This was important for regaining sexual health and intimacy in their relationships. CONCLUSION Participation in Gynea helped to strengthen the women's sexual integrity. Knowledge and support empowered them to take care of their sexual needs and communicate these with their partners. IMPLICATIONS FOR PATIENT CARE Healthcare services and nurses need to be aware that sexual health is an existential state of being, in which good sexual health does not necessarily equate to sexual function, but rather to sexual empowerment. Digital support with nurse guidance can support women in caring for their sexual health after cancer illness by thematizing sexual health with a holistic approach and should be part of the medical treatment. PATIENT OR PUBLIC CONTRIBUTION Twenty gynaecological cancer survivors contributed by sharing their experiences from the sexual health module in Gynea.
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Affiliation(s)
- Sigrund Breistig
- Centre of Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
| | - Kari Marie Thorkildsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Henrica Maria Johanna Werner
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW - School for Oncology and Reproduction, University of Maastricht, Maastricht, The Netherlands
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ragnhild Johanne Tveit Sekse
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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Arends SAM, van Rossum CE, Eeltink CM, Robertus JE, Schoonmade LJ, Francke AL, Jongerden IP. Feasibility and effectiveness of communication tools for addressing intimacy and sexuality in patients with cancer: a systematic review. Support Care Cancer 2024; 32:109. [PMID: 38231322 PMCID: PMC10794301 DOI: 10.1007/s00520-024-08308-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024]
Abstract
PURPOSE Patients diagnosed with cancer might experience changes in intimacy and sexuality due to the illness itself, treatment, or psychological and social factors. Healthcare professionals (HCPs) often feel reluctant to discuss these changes. This study aimed to provide an overview of the feasibility and effectiveness of communication tools that support communication regarding changes in intimacy or sexuality among patients with cancer. METHODS This is a systematic review. Databases are PubMed, Embase, CINAHL, PsycInfo, Web of Science and Cochrane Library from inception to June 2023. The Mixed Methods Appraisal Tool was used to assess included studies. Data were summarized in data charting forms. RESULTS In total 35 studies were included, published between 2001 and 2023. Most had a quantitative design and moderate methodological quality. In 11 studies, the PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) was used. Tools were integrated in counselling sessions or training programmes for individual patients, couples, groups of patients, or HCPs. All tools were considered feasible by patients or HCPs. Twenty studies reported significant improvement in sexual functioning, quality of life, quality of care or combined outcomes. CONCLUSION Tools to support communication about changes in intimacy and sexuality among patients with cancer seem feasible and effective. The most commonly used tool, the PLISSIT model, proved to be feasible for HCPs and to have a positive effect on patients' and partners' sexual functioning and quality of life. Giving attention to changes in intimacy and sexuality seems to be important in itself, regardless of the communication tool or approach used.
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Affiliation(s)
- Susanne A M Arends
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands.
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands.
| | - Carlijn E van Rossum
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands
| | - Corien M Eeltink
- Oncology Daycare Center, Dijklander Hospital, Hoorn, the Netherlands
| | - Jantien E Robertus
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands
| | | | - Anneke L Francke
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- NIVEL. Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Van Der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
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Mendes-Santos C, Quinta-Gomes AL, Pereira R, Vasconcelos P, Nobre P, Couto J, Correia de Barros A. A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46734. [PMID: 37368469 DOI: 10.2196/46734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Despite the prevalence of sexual distress and dysfunction in older adults in general and stroke and colorectal cancer survivors in particular, access to specialized care is limited by organizational barriers and stigma, embarrassment, and discrimination. The internet allows reaching services that would otherwise be difficult or impossible to reach, and as smartphones are personal (intimate) technologies, they are a promising vehicle to close this gap. However, research focusing on smartphone-delivered sexual health promotion programs is scarce. OBJECTIVE This study aims to assess the acceptability, feasibility, and preliminary efficacy of Anathema, an 8-week, iOS/Android smartphone-delivered, individually tailored, cognitive-behavioral sexual health promotion program developed to improve relationship and sexual satisfaction, sexual functioning, sexual distress, sexual pleasure, and health-related quality of life (HRQoL) in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. METHODS Two-arm, parallel, open-label, waiting list, feasibility, pilot randomized controlled trials (RCTs) will be conducted involving older adults, stroke survivors, and colorectal cancer survivors. The primary outcomes are the acceptability, usability, and feasibility of Anathema. Sexual function, relationship and sexual satisfaction, sexual pleasure, sexual distress, anxiety, depression, and HRQoL are the secondary outcomes. This study has been reviewed and approved by the ethics committees of Instituto Português de Oncologia do Porto Francisco Gentil, Europacolon Portugal, Faculty of Psychology and Educational Sciences, University of Porto, and Sigmund Freud University (approval numbers: CES218R/021, CES19/023, and 2022/01-05b). RESULTS This project is funded by the European Commission through the Active and Assisted Living (AAL) Programme (reference: AAL-2020-7-133-CP) from April 2021 to December 2023. Recruitment for the pilot RCTs started on January 2023 in Portugal, Austria, and the Netherlands and is currently ongoing. As of May 2023, we randomized 49 participants in the trials. We expect to complete the RCTs in September 2023. The results on the acceptability, feasibility, and preliminary efficacy of Anathema are expected in the second semester of 2023. We expect Anathema to be highly accepted by the populations under study; to prove feasible to scale up to parent RCTs; and to be potentially efficacious in improving sexual functioning, relationship and sexual satisfaction, sexual distress, sexual pleasure, and HRQoL in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. The study results will be published in open-access venues according to COREQ (Consolidated Criteria for Reporting Qualitative Research) and CONSORT EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines. CONCLUSIONS The study results will inform the refinement and scale-up of Anathema. Anathema's wider-scale implementation can potentially promote the sexual health of largely neglected user groups such as older adults, colorectal cancer survivors, and stroke survivors. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46734.
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Affiliation(s)
- Cristina Mendes-Santos
- Fraunhofer Portugal Center for Assistive Information and Communication Solutions, Porto, Portugal
| | | | - Raquel Pereira
- Center for Psychology at the University of Porto, Porto, Portugal
| | | | - Pedro Nobre
- Center for Psychology at the University of Porto, Porto, Portugal
| | - Joana Couto
- Fraunhofer Portugal Center for Assistive Information and Communication Solutions, Porto, Portugal
| | - Ana Correia de Barros
- Fraunhofer Portugal Center for Assistive Information and Communication Solutions, Porto, Portugal
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Vizza R, Capomolla EM, Tosetto L, Corrado G, Bruno V, Chiofalo B, Di Lisa FS, Filomeno L, Pizzuti L, Krasniqi E, Sanguineti G, Villa A, Giannini A, Kayal R, Stranges V, Tomao S, Botti C, Tomao F, Barba M, Vizza E, Ciliberto G, Vici P. Sexual dysfunctions in breast cancer patients: evidence in context. Sex Med Rev 2023:7128131. [PMID: 37076125 DOI: 10.1093/sxmrev/qead006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION In breast cancer patients, endocrine therapy may exert a negative impact on sexual functioning in both genders, with potentially relevant consequences concerning quality of life and treatment adherence. The availability of effective interventions to maintain and/or restore sexual health in breast cancer patients is a key issue to a research agenda. OBJECTIVES To summarize and critically discuss the most updated and qualitatively relevant literature on the therapeutic approach to sexual impairment in breast cancer patients, with a focus on patients treated with endocrine therapy. METHODS We searched PubMed from its inception to February 2022 for observational and intervention trials including participants with sexual dysfunctions. We were particularly interested in studies of breast cancer patients with sexual dysfunctions while undergoing endocrine therapy. We developed a search strategy with the aim of maximizing the number of articles considered for screening and potential inclusion. RESULTS Forty-five studies were selected: 3 observational and 42 intervention studies. Thirty-five studies were exclusively focused on female breast cancer populations. We could not identify studies exclusively focused on or also including male breast cancer patients. Overall, in female patients, the available armamentarium encompasses vaginal lubricants, moisturizers, estrogens, dehydroepiandrosterone, CO2 laser, ospemifene, and counseling. None of these interventions has been demonstrated to completely solve sexual dysfunctions when singularly considered. More favorable outcomes have come from the combination of different therapies. CONCLUSION In female breast cancer, future research is oriented toward the gain of evidence on combined therapies and long-term data on safety issues on the most promising interventions. The lack of evidence on sexual disturbances in male breast cancer patients remains a major concern.
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Affiliation(s)
| | | | - Livia Tosetto
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Giacomo Corrado
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Francesca Sofia Di Lisa
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Lorena Filomeno
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alice Villa
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome 00189, Italy
| | - Ramy Kayal
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | | | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Patrizia Vici
- Phase IV Clinical Studies Unit, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
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10
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Kukafka R, Kim S, Kim SH, Yoo SH, Sung JH, Oh EG, Kim N, Lee J. Digital Health Interventions for Adult Patients With Cancer Evaluated in Randomized Controlled Trials: Scoping Review. J Med Internet Res 2023; 25:e38333. [PMID: 36607712 PMCID: PMC9862347 DOI: 10.2196/38333] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements. OBJECTIVE The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer. METHODS A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions. RESULTS A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9%), followed by those with the self-manage function (67/231, 29%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6%) or patients with advanced or metastatic cancer (22/231, 9.5%). CONCLUSIONS This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research.
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Affiliation(s)
| | - Sanghee Kim
- College of Nursing and Mo-im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Center of Korea: Affiliation of the Joanna Briggs Institution, Yonsei University, Seoul, Republic of Korea
| | - Soo Hyun Kim
- Department of Nursing, Inha University, Inchon, Republic of Korea
| | - Sung-Hee Yoo
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
| | - Ji Hyun Sung
- College of Nursing, Kosin University, Busan, Republic of Korea
| | - Eui Geum Oh
- College of Nursing and Mo-im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Center of Korea: Affiliation of the Joanna Briggs Institution, Yonsei University, Seoul, Republic of Korea
| | - Nawon Kim
- Yonsei Medical Library, Yonsei University, Seoul, Republic of Korea
| | - Jiyeon Lee
- College of Nursing and Mo-im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Center of Korea: Affiliation of the Joanna Briggs Institution, Yonsei University, Seoul, Republic of Korea
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11
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Mejia-Gomez J, Petrovic I, Doherty M, Kennedy E, Wolfman W, Jacobson M, Brezden C, Philippopoulos E, Lukovic J. Sexual dysfunction in female patients with anal cancer treated with curative intent: A systematic review of the literature. Radiother Oncol 2023; 178:109437. [PMID: 36481383 DOI: 10.1016/j.radonc.2022.109437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Patients with anal squamous cell carcinoma (SCC) are treated with sphincter-preserving radiation therapy and concurrent chemotherapy, achieving excellent oncologic outcomes. Patients, however, may experience treatment-related morbidity including sexual dysfunction. The objective of this systematic review was to review the literature on sexual dysfunction in female patients treated for anal cancer and to identify knowledge gaps. MATERIALS AND METHODS This systematic review was registered in PROSPERO prior to initiation. Databases searched included MEDLINE, Embase, PubMed, Cochrane, and Google Scholar. There were no restrictions on the study time period. Studies were limited to English. All study designs were included except review articles, letters to the editor, and case reports with less than ten patients. RESULTS In total, 1801 studies were retrieved and 19 met the inclusion criteria, including: 13 cross-sectional surveys, 3 prospective studies, 1 longitudinal intervention study, 1 retrospective chart review, 1 case control study. Sexual function was assessed using the female sexual functioning index (FSFI), EORTC-QLQ-CR30 and -CR38; response rates were low (<50 % in most studies). Sexual dysfunction was reported by up to 85 % of women; the most common symptoms being dyspareunia (17-65 %), vaginal dryness (22-88 %), and loss of libido (38-95 %). Gastrointestinal issues, such as bowel problems, and body image concerns additionally affected sexual function and quality of life. CONCLUSION Sexual dysfunction is a common issue affecting most female patients treated for anal cancer and there is a paucity of evidence on the management of this important survivorship issue. There is additionally a lack of ethnic, economic, and educational diversity and there are no studies addressing the unique needs of LGBTQ individuals - future studies should make a concerted effort to include a diverse patient population.
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Affiliation(s)
| | - Irina Petrovic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mary Doherty
- Department of Radiation Oncology, University of Toronto and Odette Cancer Centre, Toronto, ON, Canada
| | - Erin Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Wendy Wolfman
- Department of Obstetrics and Gynecology, Division of Menopause and Premature Ovarian Failure, Mt. Sinai Hospital, University of Toronto, Canada
| | - Michelle Jacobson
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Christine Brezden
- Department of Medical Oncology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Jelena Lukovic
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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12
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Silva Ferreira I, Carvalho Fernandes AF, Moura Barbosa Castro RC, Rodrigues Bezerra A, Velasco Yanez RJ. Telenursing in the sexual function of women with breast cancer: A study protocol. Medicine (Baltimore) 2022; 101:e31449. [PMID: 36451379 PMCID: PMC9704939 DOI: 10.1097/md.0000000000031449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Most women with breast cancer have sexual function problems related to cancer diagnosis and treatment. These problems harm the quality of life and relationships. However, most patients do not receive care or guidance regarding sexuality from healthcare providers. This study aimed to test the effect of telenursing counseling on sexual functioning in women undergoing breast cancer treatment. METHODS This randomized clinical trial was conducted at 2 reference hospitals for cancer treatment. One hundred eight women with stage I-IV breast cancer undergoing treatment (surgery, chemotherapy, radiotherapy or hormone therapy) with a partner will be included in this study. The study was authorized by the Ethics Committee of the Federal University of Ceará (Opinion number: 46,13,609) and the Maternity School Assis Chateaubriand (Opinion number: 47,42,687). Patients will be allocated to the following groups: the control group, which will not receive an active intervention, and the intervention group, which will receive 3 telenursing counseling sessions for 6 weeks. The levels of sexual function in these patients before the intervention, soon after the intervention and at 12 weeks were compared and analyzed. All data will be collected and analyzed by the JASP program. RESULTS Differences in levels of sexual function among women allocated to the control and intervention groups in the analyzed periods. CONCLUSION This evidence-based nursing care strategy can be used to improve the sexual function of breast cancer patients and consequently their quality of life and marital relationship.
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13
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Zarski AC, Velten J, Knauer J, Berking M, Ebert DD. Internet- and mobile-based psychological interventions for sexual dysfunctions: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:139. [PMID: 36085306 PMCID: PMC9463146 DOI: 10.1038/s41746-022-00670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Sexual dysfunctions are highly prevalent and undertreated. Internet- and mobile-based psychological interventions (IMIs) could be a promising addition to close this treatment gap, given their accessibility, anonymity, and scalability. This systematic review and meta-analysis investigated the efficacy of IMIs for sexual dysfunctions. A comprehensive literature search was conducted in August 2021 on randomized controlled trials investigating the effects of IMIs on sexual functioning and satisfaction compared to a control condition. Twelve RCTs with 14 comparisons were reviewed with six IMIs targeting female and six IMIs targeting male sexual dysfunctions and n = 952 participants were evaluated in the meta-analysis. IMIs were significantly more effective than control conditions (k = 11 waitlist control group, k = 3 online discussion board) at post-treatment for female sexual functioning (g = 0.59, CI: 0.28–0.90, I2 = 0%) and satisfaction (g = 0.90, CI: 0.02–1.79, I2 = 82%), and male sexual functioning (g = 0.18, CI: 0.02–0.34, I2 = 0%). No significant effect was found for male sexual satisfaction (g = 0.69, CI: −0.13–1.51, I2 = 88%) with substantial heterogeneity in studies. Most studies showed high dropout, with ten studies indicating some concern of risk of bias, and two studies showing high risk of bias. The results suggest that IMIs can be an effective treatment for sexual dysfunctions, although additional high-quality research is needed. Given the limited availability of specialized treatment for sexual dysfunctions and individual preferences for discrete treatment options, IMIs seem to be a valuable addition to routine care, empowering individuals to promote their sexual health on a guided self-help basis.
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Affiliation(s)
- Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. .,Professorship Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany.
| | - Julia Velten
- Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Johannes Knauer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Professorship Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
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14
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Gorman JR, Lyons KS, Harvey SM, Acquati C, Salsman JM, Kashy DA, Drizin JH, Smith E, Flexner LM, Hayes-Lattin B, Reese JB. Opening the Conversation: study protocol for a Phase III trial to evaluate a couple-based intervention to reduce reproductive and sexual distress among young adult breast and gynecologic cancer survivor couples. Trials 2022; 23:730. [PMID: 36056413 PMCID: PMC9438271 DOI: 10.1186/s13063-022-06665-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reproductive and sexual health (RSH) concerns are common and distressing for young adults diagnosed with breast and gynecologic cancer and their partners. This study evaluates the efficacy of a virtual couple-based intervention called Opening the Conversation (OC). The OC intervention is grounded in theory and evidence-based practice and was adapted to improve coping and communication specifically in relation to RSH concerns after cancer. Methods This Phase III trial is conducted in a fully remote setting and enrolls young adult couples (current age 18–44 years) with a history of breast or gynecologic cancer (stage 1–4, diagnosed under age 40) within the past 6 months to 5 years. Eligible dyads are recruited from across the USA. The target sample size is 100 couples. Dyads are randomly assigned to receive either the 5-session OC intervention or a 4-session active control intervention (Side by Side). The primary outcomes are change in reproductive distress and sexual distress. Secondary outcomes include communication about reproductive concerns, communication about sexual concerns, depressive symptoms, sexual function, relationship quality, relationship intimacy, sexual satisfaction, self-efficacy to communicate about sex and intimacy, and quality of life. An exploratory aim examines whether dyadic coping and communication quality mediate intervention effects on survivors’ and partners’ reproductive distress or sexual distress. Self-report outcome measures are assessed for both groups at baseline (T1), 2 weeks post-treatment (T2), and 3 months post-treatment (T3). Discussion Despite the importance of RSH for quality of life for young adult cancer survivors and their partners, evidence-based interventions that help couples navigate RSH concerns are lacking. This randomized controlled trial will determine the efficacy of a novel couple-based intervention to reduce distress related to RSH concerns for younger couples after breast or gynecologic cancer, in comparison to an active control intervention. Trial registration ClinicalTrials.gov NCT04806724. Registered on Mar 19, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06665-3.
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Affiliation(s)
- Jessica R Gorman
- College of Public Health & Human Sciences, School of Social & Behavioral Health Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97330, USA.
| | - Karen S Lyons
- Connell School of Nursing, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - S Marie Harvey
- College of Public Health & Human Sciences, School of Social & Behavioral Health Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97330, USA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77204-4013, USA.,College of Medicine, Department of Clinical Sciences, University of Houston, 4349 Martin Luther King Blvd, Houston, TX, 77004, USA.,Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - John M Salsman
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27157, USA.,Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston Salem, NC, 27157, USA
| | - Deborah A Kashy
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824, USA
| | - Julia H Drizin
- College of Public Health & Human Sciences, School of Social & Behavioral Health Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97330, USA
| | - Ellie Smith
- College of Public Health & Human Sciences, School of Social & Behavioral Health Sciences, Oregon State University, 2250 SW Jefferson Way, Corvallis, OR, 97330, USA
| | - Lisa M Flexner
- Doctor of Physical Therapy Program, Oregon State University- Cascades, 1500 SW Chandler Ave, OR, 97702, Bend, USA
| | - Brandon Hayes-Lattin
- School of Medicine, Oregon Health & Sciences University, 3266 SW Research Dr, Portland, OR, 97239, USA.,OHSU Knight Cancer Institute, 3485 S Bond Ave, Portland, OR, 97239, USA
| | - Jennifer B Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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15
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Zou P, D'Souza D, Luo Y, Sun W, Zhang H, Yang Y. Potential effects of virtual interventions for menopause management: a systematic review. Menopause 2022; 29:1101-1117. [PMID: 35944249 DOI: 10.1097/gme.0000000000002020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Menopausal women are one of the fastest growing demographic groups globally. Virtual interventions have emerged as alternate avenues for menopausal women to manage and cope with their symptoms. OBJECTIVE The purpose of this review is to summarize existing research on the potential effects of virtual interventions for menopause management. EVIDENCE REVIEW This systematic review was written in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were used for literature search and searched from conception to December 2021. Original studies, including randomized controlled trials and quasi-experimental studies, were included if they evaluated a virtual intervention for menopause management and investigated the effects of these interventions on physical and psychosocial outcomes and/or the feasibility of these interventions among menopausal women. Included studies were published in peer-reviewed journals and assessed for quality using the Critical Appraisal Skills Program Checklists. FINDINGS A total of 16 articles were included in this review. Virtual interventions have the potential to improve physical health outcomes including body weight/body mass index/waist circumference, pain, blood pressure, and cholesterol. However, conflicting results were identified for the outcomes of vasomotor and endocrine symptoms, sleep, and sexual functioning. Virtual interventions might also improve psychosocial outcomes, including knowledge and patient-physician communication, although conflicting results were again identified for treatment decision-making ability, quality of life, and anxiety and depression. Virtual interventions were feasible in terms of being usable and cost-effective, and eliciting satisfaction and compliance among menopausal women. CONCLUSIONS AND RELEVANCE Virtual interventions might have the potential to improve the physical and psychosocial health outcomes of menopausal women, although some conflicting findings arose. Future studies should focus on including diverse menopausal women and ethnic minorities, conducting research within low- to middle-income countries and communities, further exploring intervention design to incorporate features that are age and culture sensitive, and conducting full randomized controlled trials to evaluate the effects of the interventions.
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Affiliation(s)
- Ping Zou
- From the School of Nursing, Nipissing University, Toronto, Ontario, Canada
| | - Daniel D'Souza
- Faculty of Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Yan Luo
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Winnie Sun
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People's Hospital Guiyang, China
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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16
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Stafford L, Russell H, Knoetze E, Wilson V, Little R. Sexual functioning after ovarian cancer: are women receiving the information and support they need? Support Care Cancer 2022; 30:4583-4586. [PMID: 35028716 DOI: 10.1007/s00520-021-06733-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Abstract
Ovarian cancer (OC) can significantly impact sexual functioning beyond initial treatment and into survivorship. However, research suggests that the information and advice women want on this topic may not be readily provided by health professionals (HPs). We explored the psychological and sexual wellbeing of a sample of Australian women diagnosed with OC, to inform the development of effective, targeted sexuality resources. This paper presents a subset of our findings. Participants were recruited nationwide via social media, print advertisement and the database of a support organisation, Ovarian Cancer Australia. Self-reported demographic and clinical survey data were collected including perceptions of the availability and adequacy of sexuality support post-OC. Participants (n = 98) were on average 52.8 years old and 5.5 years post-diagnosis. A minority (22%) reported that the impact of OC on their sexuality was discussed by HPs; and 46% were satisfied with that discussion. Approximately half (52%) had wanted to discuss sexuality concerns with a HP during treatment and 43% still felt the need for this discussion. Open-ended responses revealed the need for more information that was detailed and specified what to expect post-diagnosis. Shortcomings of HPs in addressing sexuality were also revealed. This research provides further evidence that sexual health remains inadequately addressed in OC care across the trajectory for the majority of women, and is an area of unmet need.
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Affiliation(s)
- Lesley Stafford
- Women's Mental Health Service, Royal Women's Hospital, Locked Bag 300, Parkville, VIC, 3052, Australia.
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | | | - Elizabeth Knoetze
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Victoria Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Ruth Little
- Women's Mental Health Service, Royal Women's Hospital, Locked Bag 300, Parkville, VIC, 3052, Australia
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17
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Febrina F, Triyoga IF, White M, Marino JL, Peate M. Efficacy of interventions to manage sexual dysfunction in women with cancer: a systematic review. Menopause 2022; 29:609-626. [PMID: 35486951 DOI: 10.1097/gme.0000000000001953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Cancer and its treatment negatively affect female sexual health and function. The prevalence of female sexual dysfunction after cancer is between 33% and 43%. Numerous studies have addressed treatment options for sexual dysfunction in women with cancer, but it still remains a challenge to select the most efficacious option for patients. OBJECTIVE To compile and appraise recent evidence of any interventions for managing sexual dysfunction in female cancer survivors. EVIDENCE REVIEW A literature search of the electronic databases MEDLINE, EMBASE, PsycINFO, and Cochrane Central Register of Controlled Trials (January 2011 to February 2021) was conducted using general search terms of "women", "cancer", "intervention", "sexual dysfunction". We included randomized controlled trials (RCTs) and uncontrolled before-after studies that evaluated the efficacy of intervention for female sexual dysfunction in women with history of cancer. Methodological quality of studies was assessed using Risk of Bias (RoB) 2.0 for RCTs and National Institutes of Health (NIH) assessment tools for uncontrolled before-after studies. FINDINGS Thirty-six studies were included for qualitative synthesis (14 RCTs (n = 1284), 17 uncontrolled trials (n = 589), and 5 cohort studies (n = 497). Only four studies were at low risk of bias. Topical interventions (vaginal gels or creams) were able to alleviate vaginal dryness and dyspareunia, with intravaginal dehydroepiandrosterone (DHEA) (6.5 mg) gel showing evidence of improved sexual function. Evidence for estriol-lactobacilli vaginal tablets was unreliable due to a small-scale study. Psychoeducational therapy (internet-based cognitive behavioral therapy [CBT]) studies typically were at high risk of bias, but all displayed significant improvements of sexual function. Both laser therapy (fractional CO2 and erbium) and multimodal approach studies were at concerning risk of bias, although suggesting beneficial effects on sexual function. CONCLUSIONS AND RELEVANCE The most reliable evidence for improvement was from a study of DHEA vaginal gel, but in general, gels or creams were useful in reducing dyspareunia. Pharmacological, psychoeducational, laser therapy, and multimodal approaches demonstrated potential in managing cancer-related sexual issues, but most were small in size (10-70 participants), with moderate to high risk of bias. Therefore, large-scale, double-blind, RCTs with long-period follow-up, and at low risk of bias are needed to show efficacy for these interventions.
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Affiliation(s)
- Fiorentina Febrina
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
| | - Ichsan Fauzi Triyoga
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
| | - Michelle White
- Monash Medical Centre, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
- Department of Pediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynecology, Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
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Reese JB, Zimmaro LA, McIlhenny S, Sorice K, Porter LS, Zaleta AK, Daly MB, Cribb B, Gorman JR. Coping With Changes to Sex and Intimacy After a Diagnosis of Metastatic Breast Cancer: Results From a Qualitative Investigation With Patients and Partners. Front Psychol 2022; 13:864893. [PMID: 35465532 PMCID: PMC9019080 DOI: 10.3389/fpsyg.2022.864893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Prior research examining sexual and intimacy concerns among metastatic breast cancer (MBC) patients and their intimate partners is limited. In this qualitative study, we explored MBC patients' and partners' experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences. Methods We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software. Results Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: (1) the heavy disease/treatment burden leads to significant, long-term sexual concerns (e.g., loss of interest and vaginal dryness/discomfort) and consequent heightened emotional distress for both patients (e.g., guilt around not being able to engage in intercourse) and partners (e.g., guilt around pressuring the patient to engage in sexual activity despite pain/discomfort); (2) viewing the relationship as having "an expiration date" (due to expected earlier mortality) influences patients' and partners' concerns related to sex/intimacy and complicates coping efforts; and (3) information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences. Conclusion Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients' and partners' perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients' health and quality of life.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lauren A. Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Sarah McIlhenny
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Kristen Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Laura S. Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Alexandra K. Zaleta
- Research and Training Institute, Cancer Support Community, Philadelphia, PA, United States
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Beth Cribb
- Cancer Support Community of Greater Philadelphia, Philadelphia, PA, United States
| | - Jessica R. Gorman
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
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Gorman JR, Lyons KS, Reese JB, Acquati C, Smith E, Drizin JH, Salsman JM, Flexner LM, Hayes-Lattin B, Harvey SM. Adapting a Theory-Informed Intervention to Help Young Adult Couples Cope With Reproductive and Sexual Concerns After Cancer. Front Psychol 2022; 13:813548. [PMID: 35185733 PMCID: PMC8854289 DOI: 10.3389/fpsyg.2022.813548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health (RSH) outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded couple-based intervention to address the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples (22 individuals) with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors (one heterosexual couple and one LGBTQ+ couple, both with cancer history) participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: (1) A highly flexible intervention that can be tailored to couples’ specific RSH concerns; (2) Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; (3) A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and (4) Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship.
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Affiliation(s)
- Jessica R. Gorman
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
- *Correspondence: Jessica R. Gorman,
| | - Karen S. Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX, United States
- Department of Clinical Sciences, College of Medicine, University of Houston, Houston, TX, United States
- Department of Health Disparities Research, The UT MD Anderson Cancer Center, Houston, TX, United States
| | - Ellie Smith
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Julia H. Drizin
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Lisa M. Flexner
- Doctor of Physical Therapy Program, Oregon State University, Bend, OR, United States
| | - Brandon Hayes-Lattin
- School of Medicine, OHSU Knight Cancer Institute, Oregon Health and Sciences University, Portland, OR, United States
| | - S. Marie Harvey
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
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Bamgboje-Ayodele A, Smith A'B, Short CE, Fardell JE, Shaw J, Beatty L, Higgins K, Tutelman PR, Chambers CT, Girgis A. Barriers and facilitators to the availability of efficacious self-directed digital health tools for adults living with cancer and their caregivers: A systematic literature review and author survey study. PATIENT EDUCATION AND COUNSELING 2021; 104:2480-2489. [PMID: 33741232 DOI: 10.1016/j.pec.2021.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to examine barriers and facilitators to the dissemination of efficacious self-directed digital health tools for adults affected by cancer, and quantify funding used to develop and evaluate these digital health tools. METHODS We conducted: (1) a systematic literature review to identify efficacious self-directed digital health tools for adults affected by cancer, published between 2009 and 2019 and (2) an author survey to identify barriers and facilitators to dissemination of those tools, grant funding and the user centredness of their design (UCD) process. RESULTS Of 1314 screened articles, 29 articles describing 26 tools met the inclusion criteria. From 26 surveys sent, 12 were completed, 6 of which described disseminated tools. Whilst researchers' motivation and infrastructure support facilitate tool dissemination, limited funds, lack of infrastructure and limited research timelines are the most common barriers. A median of AUD$250,000 was spent on tools not disseminated to end-users. CONCLUSION Although incorporating UCD processes in the development of digital health tools is important, it is imperative to integrate implementation processes into the planning stages of tool development to ensure dissemination. PRACTICE IMPLICATIONS Researchers, academic institutions, funding agencies and government and non-government organisations all have roles to play to support long-term implementation.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.
| | - Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Camille E Short
- Melbourne School of Psychological Sciences and Melbourne School of Health Sciences (jointly appointed), The University of Melbourne, Australia
| | - Joanna E Fardell
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Lisa Beatty
- Flinders Health & Medical Research Institute, College of Medicine & Public Health, Flinders University, Australia
| | - Kristen Higgins
- Department of Psychology and Neuroscience, Dalhousie University and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Reese JB, Sorice KA, Oppenheimer NM, Smith KC, Bober SL, Bantug ET, Schwartz SC, Porter LS. Why do breast cancer survivors decline a couple-based intimacy enhancement intervention trial? Transl Behav Med 2021; 10:435-440. [PMID: 30544201 DOI: 10.1093/tbm/iby129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recruitment challenges hinder behavioral intervention research in cancer survivors. The purpose was to examine the reasons for declining and intervention preferences of study-eligible breast cancer survivors declining a trial of a four-session couple-based Intimacy Enhancement intervention (refusers) and explore whether refusers differed from participants on key characteristics. Partnered, post-treatment breast cancer survivors reporting sexual concerns who were eligible for but declined participation in the intervention trial were approached to complete a standardized 5-min telephone survey assessing reasons for declining and support preferences. Demographic, clinical, and sexual concerns information were collected during screening. Trial participants and refusers were compared on key variables of age, race, hormone therapy use, time since treatment, level of sexual concerns, and recruitment method using t-tests or chi-square tests. Among the 31 women who declined the trial and completed the survey, the most common reasons for declining were time commitment (74%) and partner noninterest (32%). Most (61%) reported that the telephone format played little to no role in their refusal. Eighty-one percent wanted their partners involved in a program addressing sexual concerns. The two most preferred resources were informational websites (45%) and meeting with a professional (26%). Trial participants and refusers did not differ on any key factors examined. Developing intimacy interventions that are very brief, partner-optional, or that use stepped care may bolster uptake. The methods used to examine study-eligible candidates' needs and preferences could be employed in other health populations, thus having broader implications for research design.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Natalie M Oppenheimer
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, USA
| | - Elissa T Bantug
- Breast Cancer Survivorship Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Sharon C Schwartz
- Section of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Interventions to Improve Sexual Health in Women Living with and Surviving Cancer: Review and Recommendations. Cancers (Basel) 2021; 13:cancers13133153. [PMID: 34202477 PMCID: PMC8268945 DOI: 10.3390/cancers13133153] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/15/2023] Open
Abstract
Sexual health concerns, both physical and psychological, are common and represent an unmet need among women with and surviving cancer. Sexual challenges and conditions negatively impact body image, satisfaction, relationships, well-being, and quality of life, yet are widely reported to be under-recognized and undertreated. To guide clinical care and future research on sexual function in women with cancer, we performed a scoping review of interventions for sexual health concerns, including sexual function, body image, genitourinary symptoms, and hot flashes. Relevant publications between 2005 and 2020 were identified by searching PubMed with a combination of medical subject headings and keywords. Articles were included if they focused on the aforementioned topics, were primary research publications, and included female cancer survivors. Studies focusing on women receiving hormone therapy for breast cancer were also included. A total of 91 investigations conducted in the US and abroad were reviewed. Most commonly, interventions included a component of psychoeducation, although pharmacologic, exercise, and other approaches have been evaluated. Many studies have focused on survivors of breast or gynecologic cancer, among other sampling and methodological limitations. These limitations underscore the need for more work on this vital survivorship issue. Recommendations for future research in this area are also offered.
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Cullen K, Fergus K. Acceptability of an online relational intimacy and sexual enhancement (iRISE) intervention after breast cancer. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:515-532. [PMID: 33797106 DOI: 10.1111/jmft.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to develop and evaluate an online relational intimacy and sexual enhancement (iRISE) intervention for couples experiencing sexual difficulties following breast cancer (BC). The acceptability of iRISE was evaluated using a single-arm, qualitative design, with 14 couples completing satisfaction surveys and posttreatment interviews. The intervention was found to be acceptable, as demonstrated by high satisfaction ratings and qualitative feedback regarding iRISE and its online delivery. Couples spoke about the helpfulness of iRISE and how the intervention improved their sexual relationship. The use of video conferencing (eTherapy) was widely accepted by participants, who highlighted several advantages of this modality. Overall, the results support the acceptability of this online psychosexual intervention for couples affected by BC. The empirical and theoretical basis for the design of iRISE along with findings from a qualitative analysis of couples' experiences of the intervention's helpfulness to them is discussed.
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Affiliation(s)
| | - Karen Fergus
- Department of Psychology, York University, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
PURPOSE OF REVIEW Cancer diagnosis and treatment can have long-lasting psychological and physical consequences that affect both patients and their intimate partners. Improved understanding of extant dyadic interventions in the context of cancer, and how access to these may be enhanced through web-based technologies, introduce new directions for how cancer-related psychological distress for couples may be ameliorated. RECENT FINDINGS Couples are negatively impacted by cancer, both individually, and as a dyad. Bolstering techniques to support effective communication about common cancer-related concerns and support for adjusting to new roles and responsibilities may help to strengthen the couple's relationship so partners are better able to cope with cancer. Although there are various intervention options available for couples dealing with cancer, many pose barriers to participation because of constraints on time and/or distance. However, online interventions have been shown to be effective, both in easing psychological distress and reducing participant burden. SUMMARY Couples dealing with cancer experience psychological distress and must learn to navigate changing roles and responsibilities in the face of the disease. Online interventions offer flexible and innovative platforms and programs that help to address couples' educational needs while strengthening dyadic coping.
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Abstract
PURPOSE OF REVIEW Recent advances in digital healthcare, combined with the increasing appreciation for the need for sexual health programming in cancer, has established a zeitgeist for further development of digital health interventions for sexual health in cancer. Developers of digital health interventions should consider two equally important factors: efficacy of the intervention, and participant engagement. This review describes the status of digital health interventions in sexual health within the oncology setting. RECENT FINDINGS Sexual dysfunction and related psychological distress affecting patients and their partners is recognized as a significant survivorship care need in the oncology setting. Provision of care is challenged by traditional approaches to disease follow-up, and limited healthcare resources. Digital health interventions may offer efficient, accessible, and scalable care pathways. Digital health innovation in cancer survivorship and sexual health indicates trends toward efficacy, yet patient engagement remains a challenge. Implementation of established online patient engagement approaches are recommended. SUMMARY Studies to date may underestimate the potential of digital health interventions in sexual health and cancer due to poor patient engagement. Developers of digital health intervention will benefit from effort in employing engagement strategies and engagement-efficacy analysis.
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Pitcher S, Fakie N, Adams T, Denny L, Moodley J. Sexuality post gynaecological cancer treatment: a qualitative study with South African women. BMJ Open 2020; 10:e038421. [PMID: 32967884 PMCID: PMC7513640 DOI: 10.1136/bmjopen-2020-038421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study investigated women's experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment. DESIGN The study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis. SETTING Data collection took place at a follow-up clinic within the gynaeoncology unit at a public-sector tertiary hospital in Cape Town, South Africa. PARTICIPANTS Purposive sampling was used to recruit participants, and the final sample consisted of 34 women aged 29-70 ([Formula: see text]=52). All women had received a gynaecological cancer diagnosis and had been treated with either surgery, chemotherapy, radiation or a combination of these. On average, the participants were between 12 and 30 months post treatment. RESULTS Women expressed how their sexual functioning post treatment was both nuanced and complex, how heteronormative gender expectations influenced their intimate relationships, and how they experienced a re-embodiment of their sexual subjectivity post treatment. Participants felt that more sexual functioning information from healthcare providers, as well as peer support groups, would assist them in navigating the sexuality changes they experienced. CONCLUSIONS The findings of this study broaden conceptualisations of sexuality post treatment by detailing the ways that it is complex, nuanced, relational and ever shifting. More research is needed about how to incorporate holistic psychosexual support post treatment into the public healthcare system in South Africa.
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Affiliation(s)
- Sorrel Pitcher
- UCT/SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nazia Fakie
- UCT/SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, Western Cape, South Africa
- Radiation Oncology, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Tracey Adams
- UCT/SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, Western Cape, South Africa
- Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Lynette Denny
- UCT/SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, Western Cape, South Africa
- Obstetrics and Gynaecology, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Jennifer Moodley
- UCT/SAMRC Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town, Cape Town, Western Cape, South Africa
- Women's Health Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa
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Figueroa Espinoza KM. ´Tratamientos psicológicos para mejorar la vida sexual en mujeres supervivientes de cáncer ginecológico: revisión sistemática. PSICOONCOLOGIA 2020. [DOI: 10.5209/psic.71361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: explorar qué tratamientos psicológicos pueden ayudar a las mujeres supervivientes de cáncer ginecológico a mejorar su vida sexual y relaciones íntimas. Método: se buscó en bases de datos PubMed, Scopus, PsycInfo y MedLine, investigaciones entre los años 2005 a 2020, enfocados en mujeres supervivientes de cáncer ginecológico e intervenciones dirigidas por un profesional de salud mental sobre la mejoría de la sexualidad y relaciones íntimas de dicha población. Resultados: se obtuvieron 10 artículos (diseño mixto, ensayos controlados aleatorios y estudio de caso) que aplican intervención psicológica enfocada en la mejoría de la sexualidad y relaciones íntimas a mujeres supervivientes de cáncer ginecológico. Conclusiones: La intervención psicoeducativa demostró ser la intervención más utilizada para la mejoría de función sexual y disminución de preocupaciones y malestar sexual en mujeres supervivientes de cáncer ginecológico.
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Ljungman L, Anandavadivelan P, Jahnukainen K, Lampic C, Wettergren L. Study protocol for the Fex-Can Childhood project: An observational study and a randomized controlled trial focusing on sexual dysfunction and fertility-related distress in young adult survivors of childhood cancer. Medicine (Baltimore) 2020; 99:e19919. [PMID: 32664052 PMCID: PMC7360293 DOI: 10.1097/md.0000000000019919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study protocol describes the Fex-Can Childhood project, comprising two studies: The Fex-Can Childhood observational study (OS) and the Fex-Can Childhood randomized controlled trial (RCT). The Fex-Can Childhood OS aims to determine the prevalence and predictors of sexual dysfunction and fertility-related distress in young adult childhood cancer survivors (aged 19-40) compared to an age matched comparison group; the Fex-Can Childhood RCT will evaluate the effect of a web-based psycho-educational intervention (Fex-Can intervention) on sexual dysfunction and fertility-related distress. METHODS The Fex-Can Childhood OS will have a population-based cross-sectional design. All individuals treated for childhood cancer in Sweden at the age of 0 to 17 years (current age 19-40) will be identified through the National Quality Registry for Childhood Cancer. Established self-reported instruments will be used to measure sexual function, fertility-related distress, body image, anxiety and depression, and health-related quality of life. Self-efficacy related to sexual function and fertility, and fertility-related knowledge, will be assessed by study-specific measures. Clinical variables will be collected from the registry. Results will be compared to an age-matched comparison group from the general population.Participants in the Fex-Can Childhood OS who report a high level of sexual dysfunction and/or fertility-related distress will be invited to participate in the RCT. The Fex-Can intervention comprises two programs: The Fex-Can Sex and the Fex-Can Fertility targeting sexual dysfunction and fertility-related distress, respectively. The control condition will be a wait-list. Sexual function and fertility-related distress will be the primary outcomes. The secondary outcomes include body image, anxiety and depression, health-related quality of life and self-efficacy related to sexual function and fertility. Post- and follow-up assessments will be conducted directly after end of intervention (primary end point), at 3 months and 6 months after end of intervention. Additionally, a process-evaluation including study-specific items and a qualitative interview will be conducted. DISCUSSION The Fex-Can Childhood project will advance knowledge in the areas of sexual function and fertility-related distress among young adult survivors of childhood cancer. If the Fex-Can intervention proves to be efficacious, steps will be taken to implement it in the follow-up care provided to this population.
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Affiliation(s)
- Lisa Ljungman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Kirsi Jahnukainen
- Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Schover LR, Strollo S, Stein K, Fallon E, Smith T. Effectiveness trial of an online self-help intervention for sexual problems after cancer. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:576-588. [PMID: 32400321 DOI: 10.1080/0092623x.2020.1762813] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual dysfunction affects over 60% of cancer survivors. Internet interventions have improved sexual function, but with considerable clinician guidance, restricting scalability. This pragmatic trial evaluated an online, self-help intervention. As with many unguided digital interventions, attrition was high. Given low numbers in other groups, this paper focuses on 30% of female patient participants who completed 3-month questionnaires and visited the intervention site (N = 60). Benefits included increased sexually active individuals at follow-up (p < 0.001, Effect size = 0.54), improved sexual function (p < 0.001, Effect size = -0.76, N = 41), and increased use of sexual aids (p = 0.01, Effect size=-0.14, N = 58). The intervention has been revised to improve patient engagement.
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Affiliation(s)
| | - Sara Strollo
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, USA
| | - Kevin Stein
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Elizabeth Fallon
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, USA
| | - Tenbroeck Smith
- Behavioral and Epidemiology Research Group, American Cancer Society, Inc., Atlanta, USA
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Karim H, Choobineh H, Kheradbin N, Ravandi MH, Naserpor A, Safdari R. Mobile health applications for improving the sexual health outcomes among adults with chronic diseases: A systematic review. Digit Health 2020; 6:2055207620906956. [PMID: 32128234 PMCID: PMC7036501 DOI: 10.1177/2055207620906956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Chronic diseases may affect sexual health as an important factor for well-being. Mobile health (m-health) interventions have the potential to improve sexual health in patients with chronic conditions. The aim of this systematic review was to summarise the published evidence on mobile interventions for sexual health in adults with chronic diseases. Methods Five electronic databases were searched for English language peer-reviewed literature from 1 January 2009 to 31 December 2019. Appropriate keywords were identified based on the study's aim. Study selection was based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The full texts of potential studies were reviewed, and final studies were selected. The m-health evidence reporting and assessment (mERA) checklist was used to assess the quality of the selected studies. After data extraction from the studies, data analysis was conducted. Results Nine studies met the inclusion criteria. All interventions were delivered through websites, and a positive effect on sexual problems was reported. Prostate and breast cancer were considered in most studies. Interventions were delivered for therapy, self-help and consultation purposes. Quality assessment of studies revealed an acceptable quality of reporting and methodological criteria in the selected studies. Replicability, security, cost assessment and conceptual adaptability were the criteria that had not been considered in any of the reviewed studies. Conclusions Reviewed studies showed a positive effect of mobile interventions on sexual health outcomes in chronic patients. For more effective interventions, researchers should design web-based interventions based on users' needs and consider the m-health essential criteria provided by mERA. Additionally, mobile interventions can be more effective in combination with smartphone apps.
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Affiliation(s)
- Hesam Karim
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran
| | - Hamid Choobineh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran.,Zeoonosis Research Centre, Tehran University of Medical Sciences, Iran
| | - Niloofar Kheradbin
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran
| | - Mohammad Hosseini Ravandi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran
| | - Ahmad Naserpor
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Iran
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Reese JB, Zimmaro LA, Lepore SJ, Sorice KA, Handorf E, Daly MB, Schover LR, Kashy D, Westbrook K, Porter LS. Evaluating a couple-based intervention addressing sexual concerns for breast cancer survivors: study protocol for a randomized controlled trial. Trials 2020; 21:173. [PMID: 32051002 PMCID: PMC7014745 DOI: 10.1186/s13063-019-3975-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes. Methods This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4). Discussion Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation. Trial registration ClinicalTrials.gov, NCT03930797. Registered on 24 April 2019.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
| | - Lauren A Zimmaro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Stephen J Lepore
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.,Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, Philadelphia, PA, 19122, USA
| | - Kristen A Sorice
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - Leslie R Schover
- Will2Love LLC, 1333 Old Spanish Trail, Suite G, #134, Houston, TX, 77054, USA
| | - Deborah Kashy
- Department of Psychology, Michigan State University, 316 Physics Road, Room 262, East Lansing, MI, 48824, USA
| | - Kelly Westbrook
- Department of Medicine-Oncology, Duke University Medical Center, DUMC 3459, Durham, NC, 27710, USA
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, DUMC 90399, Durham, NC, 27708, USA
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32
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Millman R, Jacox N, Sears C, Robinson JW, Turner J, Walker LM. Patient interest in the Lowdown on Down There: attendance at a vulvovaginal and sexual health workshop post-cancer treatment. Support Care Cancer 2019; 28:3889-3896. [PMID: 31845008 DOI: 10.1007/s00520-019-05162-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/30/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Sexual difficulties and vulvovaginal changes are common for women undergoing, and following, cancer treatments. These changes have significant impacts on quality of life and significant relationships. The current study aimed to (1) evaluate women's interest and attendance in a group-based educational workshop to address changes in vulvovaginal health and sexuality after cancer, and (2) describe participant characteristics and presenting concerns. METHODS Two hundred eighteen women with a history of cancer expressed interest in receiving information about the workshop and completed phone screening. Interested women (n = 156) completed an online questionnaire package examining vulvovaginal health and sexual function prior to attending the workshop. RESULTS Approximately 75% of the women who completed screening attended the workshop. Clinically significant sexual distress was reported by 91% of participants, and 97% of sexually active participants exceeded the threshold for sexual dysfunction (per FSFI). Women within 1-2 years of diagnosis tended to report less sexual distress, less severe vulvovaginal symptoms, and less impact from these symptoms compared to women farther out from diagnosis. While the majority of women reported vaginal dryness and pain during intercourse, only a minority reported engaging in health promotion strategies sufficient to expect symptom improvement. CONCLUSIONS The current study suggests that group-based educational workshops for vulvovaginal and sexual concerns are utilized by patients and should be offered to women well into disease survivorship. Workshops targeting vulvovaginal symptoms and sexual concerns may be a cost-effective method of reducing sexual distress and improving patients' sexual function and quality of life.
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Affiliation(s)
- Roanne Millman
- University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Natalie Jacox
- University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Carly Sears
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - John W Robinson
- University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Jill Turner
- Cross Cancer Institute, Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Lauren M Walker
- University of Calgary, Calgary, AB, Canada. .,Tom Baker Cancer Centre, Calgary, AB, Canada. .,Arnie Charbonneau Research Institute, Calgary, AB, Canada.
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Lleras de Frutos M, Casellas-Grau A, Sumalla EC, de Gracia M, Borràs JM, Ochoa Arnedo C. A systematic and comprehensive review of internet use in cancer patients: Psychological factors. Psychooncology 2019; 29:6-16. [PMID: 31385400 DOI: 10.1002/pon.5194] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Affiliation(s)
- María Lleras de Frutos
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain
| | - Anna Casellas-Grau
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Observatorio de Atención Psicosocial en Cáncer, Insitut Català d'Oncologia, Barcelona, Spain
| | - Enric C Sumalla
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain
| | - Marta de Gracia
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain
| | - Josep M Borràs
- Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain.,Psycho-Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Cristian Ochoa Arnedo
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain.,Psycho-Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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34
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Treanor CJ, Santin O, Prue G, Coleman H, Cardwell CR, O'Halloran P, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev 2019; 6:CD009912. [PMID: 31204791 PMCID: PMC6573123 DOI: 10.1002/14651858.cd009912.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Increasingly, cancer is recognised as a chronic condition with a growing population of informal caregivers providing care for cancer patients. Informal caregiving can negatively affect the health and well-being of caregivers. We need a synthesised account of best evidence to aid decision-making about effective ways to support caregivers for individuals 'living with cancer'. OBJECTIVES To assess the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well-being of informal caregivers of people living with cancer compared with usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, ProQuest, Open SIGLE, Web of Science from inception up to January 2018, trial registries and citation lists of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing psychosocial interventions delivered to adult informal caregivers of adults affected by cancer on a group or individual basis with usual care. Psychosocial interventions included non-pharmacological interventions that involved an interpersonal relationship between caregivers and healthcare professionals. We included interventions delivered also to caregiver-patient dyads. Interventions delivered to caregivers of individuals receiving palliative or inpatient care were excluded. Our primary outcome was caregiver QoL. Secondary outcomes included patient QoL, caregiver and patient depression, anxiety, psychological distress, physical health status and intervention satisfaction and adverse effects. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened studies for eligibility, extracted data and conducted 'Risk of bias' assessments. We synthesised findings using meta-analysis, where possible, and reported remaining results in a narrative synthesis. MAIN RESULTS Nineteen trials (n = 3, 725) were included in the review. All trials were reported in English and were undertaken in high-income countries. Trials targeted caregivers of patients affected by a number of cancers spanning newly diagnosed patients, patients awaiting treatment, patients who were being treated currently and individuals post-treatment. Most trials delivered interventions to caregiver-patient dyads (predominantly spousal dyads) and there was variation in intervention delivery to groups or individual participants. There was much heterogeneity across interventions though the majority were defined as psycho-educational. All trials were rated as being at 'high risk of bias'.Compared to usual care, psychosocial interventions may improve slightly caregiver QoL immediately post intervention (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.04 to 0.53; studies = 2, 265 participants) and may have little to no effect on caregiver QoL at 12 months (SMD 0.14, 95% CI - 0.11 to 0.40; studies = 2, 239 participants) post-intervention (both low-quality evidence).Psychosocial interventions probably have little to no effect on caregiver depression immediately to one-month post-intervention (SMD 0.01, 95% CI -0.14 to 0.15; studies = 9, 702 participants) (moderate-quality evidence). Psychosocial interventions may have little to no effect on caregiver anxiety immediately post-intervention (SMD -0.12, 95 % CI -0.33 to 0.10; studies = 5, 329 participants), depression three-to-six months (SMD 0.03, 95% CI -0.33 to 0.38; studies = 5. 379 participants) post-intervention and patient QoL six to 12 months (SMD -0.05, 95% CI -0.37 to 0.26; studies = 3, 294 participants) post-intervention (all low-quality evidence). There was uncertainty whether psychosocial interventions improve patient QoL immediately (SMD -0.03, 95 %CI -0.50 to 0.44; studies = 2, 292 participants) or caregiver anxiety three-to-six months (SMD-0.25, 95% CI -0.64 to 0.13; studies = 4, 272 participants) post-intervention (both very low-quality evidence). Two studies which could not be pooled in a meta-analysis for caregiver physical health status found little to no effect immediately post-intervention and a small intervention effect 12 months post-intervention. Caregiver or patient satisfaction or cost-effectiveness of interventions were not assessed in any studies. Interventions demonstrated good feasibility and acceptability.Psychosocial interventions probably have little to no effect on patient physical health status immediately post-intervention (SMD 0.17, 95 % CI -0.07 to 0.41; studies = 4, 461 participants) and patient depression three to six months post-intervention (SMD-0.11, 95% CI -0.33 to 0.12; studies = 6, 534 participants) (both moderate-quality evidence).Psychosocial interventions may have little to no effect on caregiver psychological distress immediately to one-month (SMD -0.08, 95% CI -0.42 to 0.26; studies = 3, 134 participants), and seven to 12 months (SMD 0.08, 95% CI -0.42 to 0.58; studies = 2, 62 participants) post-intervention; patient depression immediately (SMD -0.12, 95% CI -0.31 to 0.07; studies = 9, 852 participants); anxiety immediately (SMD -0.13, 95% CI -0.41 to 0.15;studies = 4, 422 participants), and three to six months (SMD -0.22, 95% CI -0.45 to 0.02; studies = 4, 370 participants); psychological distress immediately (SMD -0.02, 95% CI -0.47 to 0.44; studies = 2, 74 participants) and seven to 12 months (SMD -0.27, 95% CI -0.78 to 0.24; studies = 2, 61 participants); and physical health status six to 12 months (SMD 0.06, 95% CI -0.18 to 0.30; studies = 2, 275 participants) post-intervention (all low-quality evidence).Three trials reported adverse effects associated with the interventions, compared with usual care, including higher distress, sexual function-related distress and lower relationship satisfaction levels for caregivers, higher distress levels for patients, and that some content was perceived as insensitive to some participants.Trials not able to be pooled in a meta-analysis did not tend to report effect size and it was difficult to discern intervention effectiveness. Variable intervention effects were reported for patient and caregiver outcomes. AUTHORS' CONCLUSIONS Heterogeneity across studies makes it difficult to draw firm conclusions regarding the effectiveness of psychosocial interventions for this population. There is an immediate need for rigorous trials with process evaluations and clearer, detailed intervention descriptions. Cost-effectiveness studies should be conducted alongside future trials.
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Affiliation(s)
- Charlene J Treanor
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Olinda Santin
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Gillian Prue
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Helen Coleman
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Chris R Cardwell
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
| | - Peter O'Halloran
- Queen's University BelfastSchool of Nursing and Midwifery97 Lisburn RoadBelfastUKBT9 7BL
| | - Michael Donnelly
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences Block B, Royal Victoria Hospital SiteGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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35
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Arthur EK, Wills CE, Menon U. A Systematic Review of Interventions for Sexual Well-Being in Women With Gynecologic, Anal, or Rectal Cancer. Oncol Nurs Forum 2019; 45:469-482. [PMID: 29947348 DOI: 10.1188/18.onf.469-482] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Treatments for cancer in the lower pelvis often cause lasting effects on women's sexual well-being. The purpose of this review is to describe interventions to improve sexual well-being in gynecologic, anal, or rectal cancer survivors. LITERATURE SEARCH This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 checklist and guidelines. A literature search was conducted using PubMed, CINAHL®, PsycINFO, and Cochrane Library. DATA EVALUATION Articles were original intervention research studies of women treated for gynecologic, anal, or rectal cancer and included sexual well-being outcomes. Study characteristics were extracted and compared in a table for analysis and synthesis. SYNTHESIS Of the 16 included studies, 1 focused on genitourinary rehabilitation, 12 focused on psychoeducational interventions, and 3 focused on combination interventions. Most interventions reported at least one positive sexual well-being outcome. Intervention format, delivery, dose, and outcome variables varied widely. IMPLICATIONS FOR RESEARCH Preliminary efficacy and feasibility of interventions are promising, but larger studies designed to discern optimal content, delivery format, dose, and timing are needed.
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36
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Lampic C, Ljungman L, Micaux Obol C, Eriksson LE, Wettergren L. A web-based psycho-educational intervention (Fex-Can) targeting sexual dysfunction and fertility-related distress in young adults with cancer: study protocol of a randomized controlled trial. BMC Cancer 2019; 19:344. [PMID: 30975116 PMCID: PMC6458789 DOI: 10.1186/s12885-019-5518-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background This study protocol describes the clinical trial of the Fex-Can intervention, a web-based self-help program targeting sexual dysfunction and fertility-related distress. The psycho-educational intervention has been developed in collaboration with young patients with cancer and shown to be feasible. The primary objective is to determine whether the Fex-Can intervention, provided in addition to standard care, is superior to standard care in terms of reduction of sexual dysfunction and fertility-related distress directly after end of the 12-week program. The trial also aims to determine whether the intervention has an effect on the secondary outcomes including health-related quality of life, anxiety, depression, body image, fertility knowledge, and self-efficacy related to sexuality and fertility. Methods The trial has an randomized clinical trial (RCT) design with two parallel arms. The active groups receive either the version of the Fex-Can intervention targeting sexual problems or the version targeting fertility-related distress. Control groups receive standard care. Primary outcomes will be sexual function assessed with the Patient-Reported Outcomes Measurement Information System® Sexual Function and Satisfaction measure version 2.0 (SexFS) and fertility-related distress assessed with the Reproductive Concerns After Cancer scale (RCAC). The effect of the intervention will be evaluated directly after end of the program. Primary and secondary outcomes will also be assessed at the short- (12 weeks after end of program) and long-term (20 and 44 months after end of program) follow-up. At least 64 completers will be needed in each arm (total n = 256) to achieve adequate statistical power in the analyses. In order to increase the understanding of how the intervention brings about a possible change, semi-structured interviews will additionally be conducted with a purposeful sample shortly after completion of the intervention. Discussion If the Fex-Can intervention proves to be efficacious the necessary steps will be taken to implement it in routine care for young adults diagnosed with cancer. Healthcare could thereby be provided with an easily accessible, cost-effective intervention to offer to young adults suffering from fertility-related distress or sexual problems. Trial registration ISRCTN36621459. Registered 25 January 2016.
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Affiliation(s)
- C Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - L Ljungman
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - C Micaux Obol
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden
| | - L E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,School of Health Sciences, City, University of London, London, EC1V 0HB, UK.,Department of Infectious Diseases, Karolinska University Hospital, SE-141 86, Huddinge, Sweden
| | - L Wettergren
- Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
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37
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Female Sexual Dysfunction: A Systematic Review of Outcomes Across Various Treatment Modalities. Sex Med Rev 2019; 7:223-250. [DOI: 10.1016/j.sxmr.2017.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 01/23/2023]
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38
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Reese JB, Smith KC, Handorf E, Sorice K, Bober SL, Bantug ET, Schwartz S, Porter LS. A randomized pilot trial of a couple-based intervention addressing sexual concerns for breast cancer survivors. J Psychosoc Oncol 2018; 37:242-263. [PMID: 30580675 DOI: 10.1080/07347332.2018.1510869] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose was to test the feasibility, acceptability, and preliminary efficacy of a 4-session couple-based Intimacy Enhancement (IE) intervention addressing breast cancer survivors' sexual concerns delivered via telephone. Twenty-nine post-treatment breast cancer survivors reporting sexual concerns and their intimate partners were randomized (2:1) to the IE intervention or to an educational control condition, both of which were delivered by trained psychosocial providers. Feasibility and acceptability were measured through recruitment, retention, session completion, and post-intervention program evaluations. Couples completed validated sexual, relationship, and psychosocial outcome measures at pre- and post-intervention. Between-group effect sizes and 95% confidence intervals were calculated using the Hedges g. Data supported intervention feasibility and acceptability. For survivors, the IE intervention had medium to large positive effects on all sexual outcomes and most psychosocial outcomes. Effects were less visible for relationship outcomes and were similar but somewhat smaller for partners. The IE intervention demonstrated feasibility, acceptability, and promise in addressing breast cancer survivors' sexual concerns and enhancing their and their partners' intimate relationships and psychosocial well-being. Implications for Psychosocial Oncology Practice The IE intervention demonstrated feasibility and acceptability, suggesting it could be well-received by breast cancer survivors with sexual concerns and their partners. Effects of the IE intervention on breast cancer survivors' sexual concerns and on their and their partners' intimate relationships and psychosocial well-being could not be attributed to therapist time and attention. Interventions that psychosocial providers can use to address breast cancer survivors' sexual concerns are important to the growing number of breast cancer survivors living for many years after their diagnosis.
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Affiliation(s)
- Jennifer Barsky Reese
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA.,b Department of Social and Behavioral Sciences; Temple University College of Public Health , Philadelphia , Pennsylvania , USA
| | - Katherine Clegg Smith
- c Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,d Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore , Maryland , USA
| | - Elizabeth Handorf
- e Department of Biostatistics and Bioinformatics , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA
| | - Kristen Sorice
- a Cancer Prevention and Control Program , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA
| | - Sharon L Bober
- f Department of Psychosocial Oncology and Palliative Care; Sexual Health Program, Dana-Farber Cancer Institute/Harvard Medical School , Boston , Massachusetts , USA
| | - Elissa T Bantug
- d Johns Hopkins Sidney Kimmel Comprehensive Cancer Center , Baltimore , Maryland , USA
| | - Sharon Schwartz
- g Department of Gynecology , Fox Chase Cancer Center , Philadelphia , Pennsylvania , USA
| | - Laura S Porter
- h Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
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Lubotzky FP, Butow P, Hunt C, Costa DSJ, Laidsaar-Powell R, Carroll S, Thompson SR, Jackson M, Tewari A, Nattress K, Juraskova I. A Psychosexual Rehabilitation Booklet Increases Vaginal Dilator Adherence and Knowledge in Women Undergoing Pelvic Radiation Therapy for Gynaecological or Anorectal Cancer: A Randomised Controlled Trial. Clin Oncol (R Coll Radiol) 2018; 31:124-131. [PMID: 30580905 DOI: 10.1016/j.clon.2018.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
AIMS Women treated with pelvic radiation therapy (PRT) for gynaecological or anorectal cancer report a high number of sexual problems and unmet post-treatment psychosexual information needs. Currently, there is suboptimal adherence to recommended rehabilitation aids, such as vaginal dilators, and a paucity of resources to facilitate post-radiation rehabilitation and reduce distress in this population. This randomised controlled trial aimed to evaluate the effectiveness of a study-developed psychosexual rehabilitation booklet in this setting. MATERIALS AND METHODS Eighty-two women scheduled for PRT to treat gynaecological/anorectal cancer were randomised to receive the intervention booklet (n = 44) or standard information materials (n = 38). Self-report questionnaires administered at pre-treatment baseline and at 3, 6 and 12 months post-treatment assessed adherence with rehabilitation aids, booklet knowledge, anxiety, depression and sexual functioning/satisfaction. RESULTS Dilator adherence and booklet knowledge were significantly higher in the intervention group than in the control group (averaged over time points), with scores significantly increasing over time. Younger age and gynaecological cancer were significant predictors of greater dilator adherence. No significant group differences were found on psychological and sexual measures. CONCLUSIONS The psychosexual rehabilitation booklet was effective in educating women with gynaecological and anorectal cancers about PRT-related psychosexual side-effects and rehabilitation options, as well as promoting uptake of vaginal dilator use. Future research should elucidate the effectiveness of this booklet in women with greater psychological and sexual functioning needs.
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Affiliation(s)
- F P Lubotzky
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - P Butow
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - C Hunt
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - D S J Costa
- Pain Management Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - R Laidsaar-Powell
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - S Carroll
- Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - S R Thompson
- Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - M Jackson
- Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Tewari
- Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia
| | - K Nattress
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - I Juraskova
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia; Centre for Medical Psychology and Evidence-based Medicine (CeMPED), University of Sydney, Sydney, New South Wales, Australia.
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40
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Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, Kuenen MA, Bijker N, Borgstein PJ, Heuff G, Lopes Cardozo AMF, Plaisier PW, Rijna H, van der Meij S, van Dulken EJ, Vrouenraets BC, Broomans E, Aaronson NK. Sexual Functioning and Relationship Satisfaction of Partners of Breast Cancer Survivors Who Receive Internet-Based Sex Therapy. JOURNAL OF SEX & MARITAL THERAPY 2018; 45:91-102. [PMID: 30040589 DOI: 10.1080/0092623x.2018.1488325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/17/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
As part of a larger, randomized controlled trial, we evaluated longitudinally the sexual functioning and relationship satisfaction of 69 partners of breast cancer (BC) survivors who received Internet-based cognitive behavioral therapy (CBT) for sexual dysfunction. The findings suggest that Internet-based CBT positively affects the partners' immediate post-CBT and longer-term overall sexual satisfaction, sexual intimacy, and sexual relationship satisfaction. No sustained changes in other areas of sexual functioning were observed. Our CBT program was focused primarily on the sexual health of the BC survivors. We recommend that future programs include more psychoeducational and behavioral elements targeted at the partners.
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Affiliation(s)
- Susanna B Hummel
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jacques J D M van Lankveld
- b Faculty of Psychology and Educational Sciences , Open University of The Netherlands , Heerlen , The Netherlands
| | - Hester S A Oldenburg
- c Department of Surgical Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Daniela E E Hahn
- d Department of Quality of Life , The Netherlands Cancer Institute , Amsterdam , The Netherlands
- e Family Cancer Clinic , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jacobien M Kieffer
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Miranda A Gerritsma
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Marianne A Kuenen
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Nina Bijker
- f Department of Radiotherapy , Academic Medical Center , Amsterdam , The Netherlands
| | - Paul J Borgstein
- g Department of Surgical Oncology , Onze Lieve Vrouwe Gasthuis, Location East , Amsterdam , The Netherlands
| | - Gijsbert Heuff
- h Department of Surgical Oncology , Spaarne Gasthuis Hoofddorp , Hoofddorp , The Netherlands
| | | | - Peter W Plaisier
- j Department of General Surgery , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - Herman Rijna
- k Department of Surgical Oncology , Spaarne Gasthuis Haarlem , Haarlem , The Netherlands
| | - Suzan van der Meij
- l Department of Surgical Oncology , Flevo Hospital , Almere , The Netherlands
| | - Eric J van Dulken
- m Department of Surgical Oncology , Medical Center Slotervaart , Amsterdam , The Netherlands
| | - Bart C Vrouenraets
- n Department of Surgery , Onze Lieve Vrouwe Gasthuis, Location West , Amsterdam , The Netherlands
| | - Eva Broomans
- o Department of Adult Care , Virenze Institute of Mental Health Care , Utrecht , The Netherlands
- p PsyQ Institute of Mental Health Care , Almere , The Netherlands
| | - Neil K Aaronson
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
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Abstract
More than 60% of people treated for cancer have long-term sexual dysfunction. However, fewer than 25% of those with sexual problems get help from a health professional. Although cancer-related sexual problems usually begin with physiological damage from cancer treatment, a patient's coping skills and the quality of the sexual relationship are crucial in sexual rehabilitation. Barriers to care for people treated for cancer include a lack of discussion with the oncology team. In repeated surveys, fewer than half of patients recall discussing sex or fertility with their care providers, even during informed consent. Practice guidelines on sexuality and cancer were published in 2017 by the American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). Both agree the following: The oncology team should initiate discussions of sexuality and cancer during treatment planning and at follow-up visits. Psychosocial and medical assessment should take place when a concern or problem is identified. Referrals should be offered for multidisciplinary treatment, since sexual problems frequently have both psychosocial and physiological causes.This article describes a system of care that can meet the guidelines while providing sustainable revenue.
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42
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Syrjala KL, Yi JC, Artherholt SB, Romano JM, Crouch ML, Fiscalini AS, Hegel MT, Flowers MED, Martin PJ, Leisenring WM. An online randomized controlled trial, with or without problem-solving treatment, for long-term cancer survivors after hematopoietic cell transplantation. J Cancer Surviv 2018; 12:560-570. [PMID: 29730827 DOI: 10.1007/s11764-018-0693-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/23/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE This randomized controlled trial examines the efficacy of INSPIRE, an INternet-based Survivorship Program with Information and REsources, with or without problem-solving treatment (PST) telehealth calls, for survivors after hematopoietic cell transplantation (HCT). METHODS All adult survivors who met eligibility criteria were approached for consent. Participants completed patient-reported outcomes at baseline and 6 months. Those with baseline impaired scores on one or more of the outcomes were randomized to INSPIRE, INSPIRE + PST, or control with delayed INSPIRE access. Outcomes included Cancer and Treatment Distress, Symptom Checklist-90-R Depression, and Fatigue Symptom Inventory. Planned analyses compared arms for mean change in aggregated impaired outcomes and for proportion of participants improved on each outcome. RESULTS Of 1306 eligible HCT recipients, 755 (58%) participated, and 344 (45%) had one or more impaired scores at baseline. We found no reduction in aggregated outcomes for either intervention (P > 0.3). In analyses of individual outcomes, participants randomized to INSPIRE + PST were more likely to improve in distress than controls (45 vs. 20%, RR 2.3, CI 1.0, 5.1); those randomized to INSPIRE alone were marginally more likely to improve in distress (40 vs. 20%, RR 2.0, CI 0.9, 4.5). CONCLUSIONS The INSPIRE online intervention demonstrated a marginal benefit for distress that improved with the addition of telehealth PST, particularly for those who viewed the website or were age 40 or older. IMPLICATIONS FOR CANCER SURVIVORS Online and telehealth programs such as INSPIRE offer opportunities to enhance HCT survivorship outcomes, particularly for mood, though methods would benefit from strategies to improve efficacy.
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Affiliation(s)
- Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA. .,University of Washington School of Medicine, Seattle, WA, USA.
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA
| | - Samantha B Artherholt
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA
| | - Joan M Romano
- University of Washington School of Medicine, Seattle, WA, USA
| | - Marie-Laure Crouch
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA
| | | | - Mark T Hegel
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-220, Seattle, WA, 98109, USA
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Kang HS, Kim HK, Park SM, Kim JH. Online-based interventions for sexual health among individuals with cancer: a systematic review. BMC Health Serv Res 2018. [PMID: 29514669 PMCID: PMC5842558 DOI: 10.1186/s12913-018-2972-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Online interventions have the advantages of being widely available, accessible, comfortable, cost effective, and they can provide tailored information and support. Despite these benefits, the effects of specifically devised online intervention programs for cancer patients’ sexual problems are somewhat unclear. The aim of this review is to describe online-based interventions and to assess their effects on sexual health among cancer survivors and/or their partners. Methods We investigated the effects of online sexual interventions among individuals with cancer or their partners. Among these, we considered 4 eligible articles. Results Despite the diversity of contents of the interventions, the identified modes of delivery among most of the interventions were as follows: education, interactive methods, cognitive behavior therapy, tailored information, and self-monitoring. Methods of monitoring the interventions, including the utilization of the web site and post-treatment program rating, were reported. All the online intervention programs incorporated a focus on physical, psychological, cognitive, and social aspects of sexual health. Significant effects on patient sexual function and interest and the psychological aspect of sexual problems were reported. Conclusion This study provides evidence that online-based interventions would be effective in improving the psycho-sexual problems of cancer survivors and their partners.
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Affiliation(s)
- Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, 84 heukseok-Ro, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Hyun-Kyung Kim
- Department of Nursing, Korean Christian University, 47 Kkachisan-ro 24 gil, Gangseo-gu, Seoul, 17520, Republic of Korea
| | - Seong Man Park
- School of General Education, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam, 31116, Republic of Korea
| | - Jung-Hee Kim
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, Kuenen MA, Bijker N, Borgstein PJ, Heuff G, Cardozo AMFL, Plaisier PW, Rijna H, van der Meij S, van Dulken EJ, Vrouenraets BC, Broomans E, Aaronson NK. Internet-Based Cognitive Behavioral Therapy Realizes Long-Term Improvement in the Sexual Functioning and Body Image of Breast Cancer Survivors. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:485-496. [PMID: 29297781 DOI: 10.1080/0092623x.2017.1408047] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The study aim was to evaluate the long-term efficacy of Internet-based cognitive behavioral therapy (CBT) for sexual dysfunctions in 84 breast cancer survivors. The positive effects of the intervention on overall sexual functioning, sexual desire, sexual arousal, vaginal lubrication, discomfort during sex, sexual distress, and body image observed immediately posttreatment were maintained at three- and nine-month follow-ups. Although sexual pleasure decreased during follow-up, it did not return to baseline levels. Our findings provide evidence that Internet-based CBT has a sustained, positive effect on sexual functioning and body image of breast cancer survivors with a sexual dysfunction.
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Affiliation(s)
- Susanna B Hummel
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jacques J D M van Lankveld
- b Faculty of Psychology and Educational Sciences , Open University of The Netherlands , Heerlen , The Netherlands
| | - Hester S A Oldenburg
- c Department of Surgical Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Daniela E E Hahn
- d Department of Psychosocial Counseling , The Netherlands Cancer Institute , Amsterdam , The Netherlands
- e Family Cancer Clinic , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Jacobien M Kieffer
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Miranda A Gerritsma
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Marianne A Kuenen
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Nina Bijker
- f Department of Radiotherapy , Academic Medical Center , Amsterdam , The Netherlands
| | - Paul J Borgstein
- g Department of Surgical Oncology , Onze Lieve Vrouwe Gasthuis Location East , Amsterdam , The Netherlands
| | - Gijsbert Heuff
- h Department of Surgical Oncology , Spaarne Gasthuis Hoofddorp , Hoofddorp , The Netherlands
| | | | - Peter W Plaisier
- j Department of General Surgery , Albert Schweitzer Hospital , Dordrecht , The Netherlands
| | - Herman Rijna
- k Department of Surgical Oncology , Spaarne Gasthuis Haarlem , Haarlem , The Netherlands
| | - Suzan van der Meij
- l Department of Surgical Oncology , Flevo Hospital , Almere , The Netherlands
| | - Eric J van Dulken
- m Department of Surgical Oncology , Medical Center Slotervaart , Amsterdam , The Netherlands
| | - Bart C Vrouenraets
- n Department of Surgery , Onze Lieve Vrouwe Gasthuis Location West , Amsterdam , The Netherlands
| | - Eva Broomans
- o Department of Adult Care , Virenze Institute of Mental Health Care , Utrecht , The Netherlands
- p PsyQ Institute of Mental Health Care , Almere , The Netherlands
| | - Neil K Aaronson
- a Division of Psychosocial Research and Epidemiology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
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45
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Carter J, Lacchetti C, Andersen BL, Barton DL, Bolte S, Damast S, Diefenbach MA, DuHamel K, Florendo J, Ganz PA, Goldfarb S, Hallmeyer S, Kushner DM, Rowland JH. Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J Clin Oncol 2018; 36:492-511. [DOI: 10.1200/jco.2017.75.8995] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment. Methods ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience. Recommendations It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Jeanne Carter
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Christina Lacchetti
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Barbara L. Andersen
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Debra L. Barton
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Sage Bolte
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Shari Damast
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Michael A. Diefenbach
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Katherine DuHamel
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Judith Florendo
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Patricia A. Ganz
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Shari Goldfarb
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Sigrun Hallmeyer
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - David M. Kushner
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
| | - Julia H. Rowland
- Jeanne Carter, Katherine DuHamel, and Shari Goldfarb, Memorial Sloan Kettering Cancer Center, New York; Michael A. Diefenbach, Northwell Health, Manhasset, NY; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Sage Bolte, Inova, Fairfax, VA; Barbara L. Andersen, Ohio State University, Columbus, OH; Debra L. Barton, University of Michigan, Ann Arbor, MI; Shari Damast, Yale School of Medicine, New Haven, CT; Judith Florendo, Florendo Physical Therapy, Chicago; Sigrun Hallmeyer,
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Vassão FV, Barbosa LR, Moraes GMD, Domenico EBLD. Abordagem da sexualidade no cuidado ao paciente oncológico: barreiras e estratégias. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Resumo Objetivo: Identificar os fatores intervenientes para a abordagem da sexualidade, pelo paciente e profissional, e descrever as estratégias empenhadas para a abordagem da sexualidade no cuidado ao paciente com câncer. Métodos: Revisão integrativa de literatura, baseada em etapas sistemáticas, nas bases de dados e ou bibliotecas eletrônicas: LILACS, PUbMed, MEDLINE, IBECS, ScIELO, UpToDate, BDEnf. As buscas ocorreram entre dezembro de 2016 a julho de 2017. Criterios de inclusão: estudos com pacientes oncológicos, idade acima de 18 anos; publicados nos últimos dez anos (2007-2017); disponíveis na íntegra; nos idiomas português, espanhol e inglês. Excluídos: teses, dissertações, revisões (sistemática, narrativa e integrativa), artigos de opinião e editoriais. Resultados: Incluídos 18 artigos, seis artigos referentes a fatores intervenientes e 12 artigos referentes a estratégias adotadas para abordagem da sexualidade. A maioria dos artigos evidenciou a dificuldade com a qual o tema é tratado na prática profissional, nas perspectivas da comunicação e das relações interpessoais entre pacientes e profissionais, reiterando a premissa que a saúde sexual do paciente é, normalmente, negligenciada. Os estudos que versavam sobre as intervenções empreendidas para sanarem as lacunas, demonstraram diferentes graus de positividade e demonstraram que é necessária a capacitação dos profissionais com estratégias de orientação e aconselhamento. Há modelos de intervenção disponíveis na literatura. Conclusão: A sexualidade é negligenciada no cuidado ao paciente com câncer. A atenção multidisciplinar em oncologia precisa reconhecer esta realidade e empreender, numa ação conjunta, atividades de educação e apoio psicossocial, para que esta necessidade humana básica seja satisfeita pelos pacientes.
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Reese JB, Bober SL, Daly MB. Talking about women's sexual health after cancer: Why is it so hard to move the needle? Cancer 2017; 123:4757-4763. [PMID: 29116655 PMCID: PMC5716835 DOI: 10.1002/cncr.31084] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 01/06/2023]
Abstract
Despite increasing calls to integrate sexual health into routine cancer care, the majority of women diagnosed with cancer do not receive information about how their cancer treatments will affect their sexual health. With the significant challenges that exist to clinical discussion of sexual health, efforts on multiple fronts are needed to close the gap in the care of women diagnosed with cancer.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center
- Department of Social and Behavioral Sciences, College of Public Health, Temple University
| | - Sharon L. Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center
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Wiklander M, Strandquist J, Obol CM, Eriksson LE, Winterling J, Rodriguez-Wallberg KA, Sjögren Fugl-Meyer K, Ahlgren J, Ljungman P, Lampic C, Wettergren L. Feasibility of a self-help web-based intervention targeting young cancer patients with sexual problems and fertility distress. Support Care Cancer 2017; 25:3675-3682. [PMID: 28721554 PMCID: PMC5658457 DOI: 10.1007/s00520-017-3793-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/12/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study is to evaluate the feasibility of a self-help web-based intervention to alleviate sexual problems and fertility distress in adolescents and young adults with cancer. METHODS Twenty-three persons with cancer (19 women and 4 men, age 18-43, 1-5 years post-diagnosis of lymphoma, breast, gynecologic, central nervous system, or testicular cancer) were recruited to test a 2-month web-based program targeting sexual problems or fertility distress. The programs were organized in modules with educational and behavior change content, including texts, illustrations, exercises, and video vignettes. The program also included a discussion forum and an "ask the expert" forum. In addition, the sexuality program offered two telephone consultations. Feasibility (regarding demand, acceptability, preliminary efficacy, and functionality) was evaluated with the website system data, telephone interviews, continuous online evaluations, and study-specific measures. RESULTS Fifteen participants completed four modules or more. Most of the program features were used and well accepted by these "committed users." The web-based format enabled flexible use by participants with diverse needs. Preliminary efficacy was indicated by self-reported increased knowledge and skill in handling sexual problems and fertility distress. The website was easy to use and functioned well technically. CONCLUSIONS The present study indicated that this web-based intervention was feasible for adolescents and young adults with cancer. The effectiveness of the intervention in decreasing sexual problems and fertility distress will be tested in a population-based randomized controlled trial for adolescents and young adults with cancer. TRIAL REGISTRATION ISRCTN36621459.
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Affiliation(s)
- Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Johanna Strandquist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Claire Micaux Obol
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- School of Health Sciences, City, University of London, London, UK
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Center of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Sjögren Fugl-Meyer
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Ahlgren
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Per Ljungman
- Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
- Department of Allogeneic Stem Cell Transplantations and Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Claudia Lampic
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Lena Wettergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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49
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Bober SL, Recklitis CJ, Michaud AL, Wright AA. Improvement in sexual function after ovarian cancer: Effects of sexual therapy and rehabilitation after treatment for ovarian cancer. Cancer 2017; 124:176-182. [PMID: 28881456 DOI: 10.1002/cncr.30976] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/24/2017] [Accepted: 08/09/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sexual dysfunction is a distressing long-term effect after gynecological cancer and affects the majority of survivors for years after the completion of therapy. Despite its prevalence, treatment-related sexual dysfunction is underrecognized and undertreated for survivors. Thus, the aim of this study was to develop and test a brief psychoeducational intervention for managing sexual dysfunction for women who have undergone treatment for ovarian cancer (OC). METHODS Forty-six OC survivors with documented, treatment-related sexual dysfunction received a single half-day group intervention that included sexual health education and rehabilitation training, relaxation and cognitive behavioral therapy skills to address sexual symptoms, and a single tailored booster telephone call 4 weeks after the group. Assessment measures were completed at the baseline (baseline 1), after an 8-week no-treatment run-in period (baseline 2), and then again 2 and 6 months after the intervention. The Female Sexual Function Index (FSFI) was used to assess sexual functioning, and the Brief Symptom Inventory 18 (BSI-18) was used to capture psychological distress. RESULTS Between baseline 1 and baseline 2, there were no significant changes in the study measures, and this indicated no natural improvement during the run-in period. In contrast, the total FSFI scores improved significantly from baseline 1 to the 2- (n = 45; P < .0005) and 6-month time points (n = 42; P < .05). The BSI-18 scores were also significantly improved at the 2- (P < .005) and 6-month time points (P < .01) in comparison with baseline 1. CONCLUSIONS This brief behavioral intervention led to significant improvements in overall sexual functioning and psychological distress that were maintained at the 6-month follow-up. The results demonstrate the feasibility of this brief, low-intensity behavioral intervention and support the development of a larger randomized controlled trial. Cancer 2018;124:176-82. © 2017 American Cancer Society.
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Affiliation(s)
- Sharon L Bober
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | - Alexi A Wright
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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50
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The implementation of web-based cognitive rehabilitation in adult cancer survivors: examining participant engagement, attrition and treatment fidelity. Support Care Cancer 2017; 26:499-506. [PMID: 28866765 DOI: 10.1007/s00520-017-3855-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Low engagement and high attrition are common challenges in web-based interventions. Typical measures of engagement reported in the literature are not meaningful for describing participant activity within the intervention and can be misleading. This research aimed to develop a more meaningful method of measuring engagement in an online cognitive rehabilitation program whilst monitoring treatment fidelity. METHODS A pilot study and randomised controlled trial (RCT) were conducted. Data from 60 participants were analysed from three intervention groups: pilot cancer group, pilot non-cancer group and RCT cancer group. Groups completed the 4-week eReCog program comprised of four online modules. Engagement scores were calculated based on activities completed in each module. Attrition, interaction with the program facilitator and correlations with outcome measures were analysed. RESULTS Overall engagement in the intervention was high. The non-cancer group participated significantly less than the cancer groups (p = < 0.001), whereby the percentage of activity items completed was 92, 87 and 78% in the pilot cancer, RCT cancer and pilot non-cancer groups, respectively. Attrition was higher in the pilot non-cancer group (24%) compared to the pilot cancer group (8%) and the RCT cancer group (16%). Total engagement was correlated with fewer prospective memory problems on instrumental activities of daily living (p = 0.018). CONCLUSIONS Measuring completed activities in online interventions appears a more meaningful measure of engagement than other conventional methods described in the literature and has the potential to increase treatment fidelity in web-based research.
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