Effect of Stepped Care on Sexual Interest and Enjoyment in Distressed Patients with Head and Neck Cancer: A Randomized Controlled Trial

Abstract

Introduction: A recent randomized controlled trial (RCT) in patients with head and neck cancer (HNC) with psychological distress showed that a stepped care (SC) program targeting psychological distress compared with care as usual (CAU), is (cost)effective in reducing psychological distress. Aim: The aim of the present study was to investigate whether SC can coalleviate problems with sexual interest and enjoyment. A secondary aim was to investigate whether the presence of an unmet sexual health need and having a psychiatric disorder (depression or anxiety) at baseline moderated any effect of SC on these sexual variables until 1-year follow-up. Methods: HNC survivors (N ¼ 134), randomized to SC or CAU, were assessed regarding their sexual interest and enjoyment before and after the intervention and at 3, 6, 9, and 12 months follow-up. Linear mixed models were used to evaluate differences in the course of sexual interest and enjoyment between SC and CAU. Main Outcome Measure: The "sexuality" symptom subscale, part of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Cancerespecific module. Results: Of all patients, 76.1% had an unmet sexual need at baseline, 24.6% had a psychiatric disorder (anxiety or depression). SC did not reduce problems with sexual interest and enjoyment at any of the follow-up measurements compared with CAU (P ¼ .85). This was neither moderated by an unmet sexual health need at baseline (P ¼ .64) nor by the presence of a psychiatric disorder at baseline (P ¼ .59). Conclusion: A substantial number of patients with HNC have unmet sexual health needs. SC targeting psychological distress does not reduce problems with sexuality in these patients. Interventions specifically targeting sexuality are recommended. LER Schutte, HC Melissant, F Jansen, et al. Effect of Stepped Care on Sexual Interest and Enjoyment in Distressed Patients with Head and Neck Cancer: A Randomized Controlled Trial. Sex Med 2021;9:100304.

Interventions for head and neck cancer survivors: Systematic review

“…Most had a medium to high risk of bias. Among the 13 randomized studies, there were 12 with a medium 13,14,16,18,20 to high 12,15,17,19,[21][22][23] risk of bias, and only one study with a low 24 risk of bias.…”

“…The most common sources of bias were lack of concealment of allocation, heterogeneity of baseline participant characteristics, or unclear/lack of blinding of the participants, assessors, or those delivering the study intervention. Additional reasons for introduction of bias included incomplete information on follow-up of participants, 15 limited information on power calculations, 14,21,22 and lack of target accrual 13 or patient attrition. 19 The 15 non-randomized studies included 12 with a high risk of bias 25,27,29,[32][33][34][35][36][37][38][39][40] and three with a medium risk of bias.…”

The Psychosocial Role of Body Image in the Quality of Life of Head and Neck Cancer Patients. What Does the Future Hold?—A Review of the Literature

“…The general characteristics of the studies included in the review (n = 9) can be found in Table 2. The articles were published from 2018 to 2021 in a variety of scientific journals with different aims and scopes: Indian journal of palliative care [19], Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer [20], Sexual Medicine [21], Psycho-oncology [22], Otolaryngology-head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery [23], Indian journal of palliative care [24], Psycho-oncology [25], Surgery [26], Medicina oral, patología oral y cirugía bucal [27]. All the records were written in English.…”

“…Study 2 [20] included 87 patients, with a mean age of 66 years, divided into a total of 5 groups: oral cavity (n = 17), oropharynx (n = 20), hypopharynx (n = 5), larynx (n = 29) and others (n = 16), from the Department of Otolaryngology-Head and Neck Surgery at Amsterdam UMC, location VUmc. Study 3 [21] consisted of 134 HNC survivors (males = 44/females = 23), with a mean age of 66 years, who were divided into a total of 3 HNC localizations: lip/oral/cavity/oropharynx (n = 29), hypopharynx/larynx (n = 21), other head and neck cancers (n = 17), randomized to investigate differences in the course of sexual interest and sexual pleasure between a care program targeting psychological distress compared to usual care and a control, at the clinic of Amsterdam University Medical Centers (Amsterdam UMC), location VU University medical center. Study 4 [22] is registered at ClinicalTrials.gov (NCT03518671) and was conducted with 10 HNC survivors.…”

“…Using the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Cancer-specific module, Schutte et al [21], found in their study that 76.1% of participants had an unmet sexual need at baseline, and 24.6% had a psychiatric disorder (anxiety or depression).…”