Internet-based cognitive behavioral therapy for sexual dysfunctions in women treated for breast cancer: design of a multicenter, randomized controlled trial

Abstract

BackgroundSexual dysfunction is a prevalent, long-term complication of breast cancer and its treatment and can be treated effectively with face-to-face sexual counselling. However, relatively few women actually opt for face-to-face sex therapy, with many women indicating that it is too confronting. Internet-based interventions might be a less threatening and more acceptable approach, because of the convenience, accessibility and privacy it provides. Recent studies have demonstrated the efficacy of internet-based programs for improving sexual functioning in the general population. The objective of the current study is to investigate the efficacy of an internet-based cognitive behavioral therapy (CBT) program in alleviating problems with sexuality and intimacy in women who have been treated for breast cancer.Methods/designIn a multicenter, randomized controlled trial we are evaluating the efficacy of an internet-based CBT program in reducing problems with sexuality and intimacy in breast cancer survivors. Secondary outcomes include body image, marital functioning, psychological distress, menopausal symptoms, and health-related quality of life. We will recruit 160 breast cancer survivors (aged 18-65 years) with a formal DSM-IV diagnosis of sexual dysfunction from general and academic hospitals in the Netherlands. Women are randomized to either an intervention or waiting-list control group. Self-report questionnaires are completed by the intervention group at baseline (T0), ten weeks after start of therapy (T1), post-treatment (T2), 3 months post-treatment (T3), and 9 months post-treatment (T4). The control group completes questionnaires at T0, T1 and T2.DiscussionThere is a need for accessible and effective interventions for the treatment of sexual dysfunctions in breast cancer survivors. This study will provide evidence about the efficacy of an internet-based approach to delivering a CBT intervention targeted specifically at these sexual health issues. If proven to be effective, internet-based CBT for problems with sexuality and intimacy will be a welcome addition to the care offered to breast cancer survivors. Hopefully this therapy will lower the barrier to seeking help for these problems, resulting in improved quality of life after breast cancer.Trial registrationThe study is registered at ClinicalTrials.gov (NCT02091765).

A comprehensive review of sexual health concerns after cancer treatment and the biopsychosocial treatment options available to female patients

“…Although additional randomised controlled trials (RCTs) are needed to delineate the specific elements of psychosocial and mind-body interventions that promote particular aspects of sexual function, empirical evidence of their effectiveness continues to accumulate(Brotto, Mehak, & Kit, 2009;Brotto et al, 2010Brotto et al, , 2012Derzko, Elliott, & Lam, 2007;DuHamel et al, 2016;Dyer et al, 2016;Huffman et al, 2016;Hummel et al, 2015). Improvements in parameters of sexual function and QoL have been demonstrated with psychoeducation(Advani, Brewster, Baum, & Schover, 2017;Bober, Recklitis, Bakan, Garber, & Patenaude, 2015;Brotto et al, 2008;DuHamel et al, 2016;Schover et al, 2013), cognitive behavioural therapy (CBT;Brotto et al, 2010Brotto et al, , 2012Duijts et al, 2012;Hummel et al, 2015Hummel et al, , 2017, couples-based interventions, couples counselling(Brotto et al, 2010), targeted psychosexual therapy(Brotto et al, 2010;DuHamel et al, 2016), yoga-based interventions(Brotto et al, 2009) and mindfulness-based interventions(Brotto et al, 2012). Recently, interventions for post-cancer sexual dysfunction have been implemented using online formats, with demonstrated effects on sexual and relational functioning(Classen et al, 2013;Hummel et al, 2015Hummel et al, , 2017Van Lankveld, 2016;Schover et al, 2013).…”

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

“…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.…”

Effects of Therapeutic-Supportive Interventions on Sexual Satisfaction and Function in Women with Breast Cancer: A Systematic Review

“…Prior to the diagnosis and treatment of breast cancer, sexual dysfunction was not reported in 91.5% of pa-tients (6). The prevalence of sexual complications was estimated at 30% -100% using previous treatments and included decreased libido, sexual arousal, and vaginal lubrication, followed by dyspareunia and vaginal dryness (6,(13)(14)(15).…”