Efficacy Trial of An Internet-Based Intervention for Cancer-Related Female Sexual Dysfunction

Abstract

The recent National Comprehensive Cancer Network Survivorship Guideline recommends systematic evaluation and multidisciplinary treatment of cancer-related sexual dysfunctions. Yet, most oncology professionals fail to routinely assess sexual problems and lack expertise to treat them. An internet-based intervention was designed to educate female patients and their partners about cancer-related sexual problems, to describe medical treatment options and how to find expert care, and to provide self-help strategies. A randomized trial assessed efficacy of the intervention when used as self-help versus the same web access plus three supplemental counseling sessions. Survivors of localized breast or gynecological cancer completed online questionnaires at baseline, post-treatment, and 3- and 6-month follow-up, including the Female Sexual Function Index (FSFI); the Menopausal Sexual Interest Questionnaire (MSIQ), the Brief Symptom Inventory-18 (BSI-18) to assess emotional distress, and the Quality of Life in Adult Cancer Survivors Scale (QLACS). Program evaluation ratings were completed post-treatment. Fifty-eight women completed baseline questionnaires (mean age 53 ± 9). Drop-out rates were 22% during treatment and 34% at 6-month follow-up. Linear mixed models for each outcome across time showed improvement in total scores on the FSFI, MSIQ, and QLACS (P<0.001) and BSI-18 (P=0.001). The counseled group improved significantly more on sexuality measures, but changes in emotional distress and quality of life did not differ between groups. Program content and ease of use were rated positively. Research is needed on how best to integrate this intervention into routine clinical practice, particularly how to improve uptake and adherence.

Self-Reported Sexual Function Measures Administered to Female Cancer Patients: A Systematic Review, 2008–2014

“…The FSFI, originally developed for use in clinical trials of pharmacological treatment for male sexual dysfunction (Goldstein, et al, 2005), permits comparisons through cutoff scores established to distinguish sexual dysfunction in non-cancer populations (Rosen, et al, 2000). Our review also found examples of the FSFI successfully measuring change in sexual function over time (e.g., Carter, Sonoda, Chi, Raviv, & Abu-Rustum, 2008), effectiveness of interventions (e.g., Schover, et al, 2013), and differential impact of cancer treatment approaches (e.g., McGlone, Khan, Flashman, Khan, & Parvaiz, 2012). …”

Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review

“…In all, 63 intervention arms were released sequentially in a predetermined order over time, 16 could be freely navigated, two [51,52] presented modules in sequence but allowed participants free navigation, and one [53] included free navigation once a specific module had been completed.…”

Talking about women's sexual health after cancer: Why is it so hard to move the needle?

“…For example, Schover compared a self-help web-based intervention offering education and guidance on solutions for sexual problems with the same self-help plus three sessions of counseling in a randomized trial in 58 breast and gynecologic cancer survivors and found that although distress and quality of life improved across both conditions, sexual function improved to a greater extent in those with the counseling. 63 In a more recently published trial, Hummel found that intensive internet-based cognitive behavioral therapy was effective at improving sexual function and related outcomes in 169 breast cancer survivors meeting criteria for sexual dysfunction 56 according to the Diagnostic and Statistical Manual of Disorders-IV (DSM-IV). 64 Findings of these trials suggest that recent web-based counseling interventions are highly effective in breast cancer or breast and gynecologic cancer samples 63,65 although they need to be tested in populations of women with cancer-related sexual problems outside of breast and gynecologic cancer.…”

“…63 In a more recently published trial, Hummel found that intensive internet-based cognitive behavioral therapy was effective at improving sexual function and related outcomes in 169 breast cancer survivors meeting criteria for sexual dysfunction 56 according to the Diagnostic and Statistical Manual of Disorders-IV (DSM-IV). 64 Findings of these trials suggest that recent web-based counseling interventions are highly effective in breast cancer or breast and gynecologic cancer samples 63,65 although they need to be tested in populations of women with cancer-related sexual problems outside of breast and gynecologic cancer. Telephone-based behavioral interventions could be helpful for reaching patients across a range of ages and levels of internet use and have gained some preliminary evidence in colorectal and breast cancer samples, 66,67 although larger trials of such interventions are needed.…”