The sexual health of female rectal and anal cancer survivors: results of a pilot randomized psycho-educational intervention trial

Abstract

Background Sexual dysfunction is a frequently reported consequence of rectal/anal cancer treatment for female patients. Purpose The purpose of this study was to conduct a small randomized controlled trial to assess the efficacy of a telephone-based, four-session Cancer Survivorship Intervention-Sexual Health (CSI-SH). Methods Participants (N = 70) were stratified by chemotherapy, stoma, and menopause statuses before randomization to CSI-SH or assessment only (AO). Participants were assessed at baseline, 4 months (follow-up 1), and 8 months (follow-up 2). Results The intervention had medium effect sizes from baseline to follow-up 1, which decreased by follow-up 2. Effect sizes were larger among the 41 sexually active women. Unadjusted means at the follow-ups were not significantly different between the treatment arms. Adjusting for baseline scores, demographics, and medical variables, the intervention arm had significantly better emotional functioning at follow-ups 1 and 2 and less cancer-specific stress at follow-up 1 compared to the AO arm. Conclusion The data supported the hypothesized effects on improved sexual and psychological functioning and quality of life in CSI-SH female rectal/anal cancer survivors compared to the AO condition. Condensed Abstract This pilot study (N = 70) of CSI-SH supported the impact of this intervention on sexual and psychological functioning and quality of life on rectal and anal cancer survivors compared with an AO condition. However, intervention effects were stronger at follow-up 1 as compared to follow-up 2 and were stronger for sexually active women. Implications for Cancer Survivors Women may benefit from a brief, four-session, sexual health intervention after treatment from rectal and anal cancer.

Sexual quality of life, body image distress, and psychosocial outcomes in colorectal cancer: a longitudinal study

“…Other researchers have similarly found that women with colorectal cancer reported worse sexual QOL [40] and greater psychological distress [7] compared to men, and that associations between sexual QOL and psychological distress were strongly linked for women [12]. Large well-designed research studies on sexual QOL in women with colorectal cancer could help clarify these associations, yet such studies are challenging to conduct because of low recruitment and inadequate survey completion [15, 18, 41]. Therefore, well-funded multi-site studies are needed.…”

“…A simple brief validated sexual concerns screener [43, 44], could be used to identify patients with sexual or body image concerns and lead to timely treatments. Recent work offers guidance to clinicians to assess and refer patients who report sexual and body image concerns once identified [44, 45], and a few small intervention studies offer promising findings for interventions addressing sexual outcomes in samples of patients with colorectal cancer [18, 41]. Interventions are particularly needed to help ensure that the sexual concerns of women treated for cancer are addressed given that compared to men with cancer, women are significantly less likely to have sexual concerns discussed in their care [46].…”

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

“…Female rectal and anal cancer survivors have been found to experience substantial sexual difficulties related to vaginal strictures ostomy interference with sexual activity, soiling of personal and bed clothing, bowel and bladder incontinence, pain, and psychological distress (Sun et al, 2016;Sunesen et al, 2015), with prevalence rates of sexual concerns in the range of 19%-62% (DuHamel et al, 2016). Post-mastectomy and lumpectomy, women are faced with scarring, pain, and lost sensation in breast and/or nipple tissue (Falk & Dizon, 2013;Farthmann et al, 2016;Sekse et al, 2010).…”

“…In fact, clinical recommendations often suggest waiting until 4-6 weeks post RT to begin a dilation protocol (Bakker et al, 2014;Miles & Johnson, 2014). Owing to the close proximity of the vagina to the anus, it is not uncommon for anal cancer patients to experience vaginal stenosis after pelvic RT (DuHamel et al, 2016;Son, Law, Oh, & Apte, 2015) and also colo-rectal surgery (DuHamel et al, 2016;Hendren et al, 2005), therefore vaginal dilation may be appropriate; however, further evaluation of vaginal dilation outside of gyneoncology is needed. Owing to the close proximity of the vagina to the anus, it is not uncommon for anal cancer patients to experience vaginal stenosis after pelvic RT (DuHamel et al, 2016;Son, Law, Oh, & Apte, 2015) and also colo-rectal surgery (DuHamel et al, 2016;Hendren et al, 2005), therefore vaginal dilation may be appropriate; however, further evaluation of vaginal dilation outside of gyneoncology is needed.…”

“…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).…”