Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial

Abstract

Background Threatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking. Objective This study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer. Methods This randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer—Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care. Results Although 62% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child’s health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low. Conclusions The Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child’s health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer. Trial Registration ISRCTN Registry 36621459; https://www.isrctn.com/ISRCTN36621459

Greater fertility distress and avoidance relate to poorer decision making about family building after cancer among adolescent and young adult female survivors

“…Decision aids have been shown to be effective in a number of health contexts including with socially disadvantaged populations 39–41 . Focusing on the post‐treatment time period, a 12‐week psycho‐educational intervention for fertility‐related distress and sexual health among childhood cancer survivors (Fex‐Can) reported better cancer‐related fertility knowledge in the intervention group compared to a control group, but there were no differences in reproductive distress 42 . As AYA‐Fs learn new information about the challenges of family building after cancer, it is appropriate to experience negative emotions, and targeting emotion regulation strategies may be an important skill.…”

Efficacy of a web-based psychoeducational intervention, Fex-can sex, for young adult childhood cancer survivors with sexual dysfunction: A randomized controlled trial

“…Participants were categorized based on their level of adherence: high, low (IG participants), or control (CG participants). High activity was defined as fulfilling criteria for both general activity (opened ≥3 modules and spent ≥20 min in the intervention) and at least one criterion for interactive activity (spent ≥3 min in the discussion forum, written ≥1 post, or answered ≥50 % of the quizzes) ( Micaux et al, 2022 ). Low activity users included those who had never logged in.…”

The role of a discussion forum within a web‐based psychoeducational intervention focusing on sex and fertility—What do young adults communicate?

“…Cohort participants rating fertility distress and/or sexual dysfunction at predefined levels were invited to participate in an RCT testing the effects of a web‐based psychoeducational intervention, delivered in two programs: Fex‐Can Fertility and Fex‐Can Sexuality 23 . Efficacy of the Fex‐Can Fertility program have been reported previously, 18 and analysis of the Fex‐Can Sexuality program is currently ongoing. This study concerns a subset of the Fex‐Can RCT participants (i.e., those randomized to receive either of the intervention programs) and investigates interactive participation and content of a moderated discussion forum.…”

“…Based on intervention activity, participants were categorized into high or low activity participants. This categorization has previously been used in a study testing the efficacy of the Fex‐Can Fertility program 18 . Definition of high activity was based on: opening >50% of intervention modules and spending ≥20 min on the website, plus one of the following: (a) spending ≥3 min in the discussion forum, (b) answering ≥50% of the quizzes and reflective questions, and (c) posting ≥1 post in the discussion forum.…”

“…Such interventions are increasingly being utilized to support individuals with cancer 10 and have been found effective in reducing various psychological outcomes 11–13 . Few interventions have targeted fertility and sexuality, some showing positive results in reducing reproductive concerns, 14 and in improving sexual functioning, 15–17 and fertility knowledge 18 . Inclusion of interactive elements and opportunity for peer discussion in web‐based interventions is recommended as it may increase activity and uptake of interventions, 9,19 as well as reduce feelings of loneliness 20 .…”