Internet-Based Intervention Improves Cancer-Related Sexual Dysfunction in Women
An Internet-based intervention may significantly improve both sexual function and satisfaction in women with sexual dysfunction years after treatment for breast or gynecologic cancer, according to a randomized trial reported in the November issue of the Journal of the National Comprehensive Cancer Network. Leslie R. Schover, PhD, of The University of Texas MD Anderson Cancer Center, and colleagues also found that the intervention may reduce emotional distress and improve the overall quality of life in these women after treatment.
The investigators created a website called Tendrils: Sexual Renewal for Women After Cancer, which included text, graphics, animations, and multicultural photographs and clipart. It was intended to educate both female patients and their partners about common sexual problems (such as vaginal dryness, pain, and decreased sexual desire); describe treatment options; and offer self-help strategies.
Study Details
Women between 1 and 7 years after diagnosis of localized breast or gynecologic cancer and no longer on active treatment (other than hormone therapy) were eligible for the study. These patients were in a sexual relationship for at least 6 months, scored as sexually dysfunctional on the Female Sexual Function Index, and had a partner willing to do behavioral homework.
A total of 58 patients (with a mean age of 53 years) completed baseline online questionnaires, including the Female Sexual Function Index, the Menopausal Sexual Interest Questionnaire, the Brief Symptom Inventory-18, and the Quality of Life in Adult Cancer Survivors scale. The questionnaires assessed background and medical history. Subscales of the Female Sexual Function Index measured sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. Subscales of the Menopausal Sexual Interest Questionnaire measured desire, responsiveness, and satisfaction. The Brief Symptom Inventory-18 assessed emotional distress, and the Quality of Life in Adult Cancer Survivors scale measured global quality of life.
The Internet-based intervention used solely on a self-help basis was compared with access to the same website supplemented with three in-person sessions on sexual counseling. For 12 weeks, all of the women used the website. The women could navigate to sections focusing on topics such as fertility consequences of cancer, sex after menopause, managing vaginal dryness and pain, treatment options for loss of sexual desire or problems reaching orgasm, ways to improve body image, and communication with sexual partners and health-care professionals. After this period, half of the patients then went on to receive supplemental in-person counseling.
Of the 36 women assigned to the self-help group, 31 completed the baseline questionnaire, 24 completed the questionnaire posttreatment, 21 completed the 3-month follow-up questionnaire, and 22 completed the 6-month follow-up questionnaire. Of the 36 women assigned to the counseling group, 27 completed the baseline questionnaire, 22 completed the counseling sessions, 18 completed the questionnaire posttreatment, 16 completed the 3-month follow-up questionnaire, and 16 completed the 6-month follow-up questionnaire.
Improvements Seen in Sexual Measures, Emotional Distress, and Quality of Life
The investigators found that improvements in sexual outcomes were seen in both treatment groups. Based on the scores on the Female Sexual Function Index and the Menopausal Sexual Interest Questionnaire, gains in sexual outcomes were significant from baseline to posttreatment in both groups. The benefits remained significant at the 6-month follow-up, although most women did not achieve the criteria for “normal sexual function” on either measurement tool.
For women in the counseling group, the treatment effects noted on the Menopausal Sexual Interest Questionnaire were highly significant (P < .001). On the other hand, for women in the self-help group, the treatment effects were not statistically significant (P = .082; with a between-group difference of P = .011). However, the investigators noted that at 6-month follow-up, the benefits regressed for the counseled women but improved slightly over time for women in the self-help group. A reason cited for this difference was the fact that women in the self-help group were more likely to continue using the intervention website during the 6 months after the treatment period than those in the counseling group.
In addition to the benefits in sexual outcomes, the investigators found that the intervention also reduced emotional distress and improved the overall quality of life after treatment, particularly in the self-help group. Distress improved significantly over time on the Brief Symptom Inventory-18 score (effect, ?2.96; P = .001) and the total Quality of Life in Adult Cancer Survivors scale score (effect, ?13.73; P < .001). Posttreatment, however, changes were significant only within the self-help group; and, at 6-month follow-up, these gains were maintained.
In closing, Dr. Schover and colleagues stated, “Future research should focus on how best to integrate this Internet-based intervention into routine clinical practice.”
This study was funded by a grant from the National Cancer Institute and supported in part by The University of Texas MD Anderson Cancer Center.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
