A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors.

BACKGROUND: Sexual difficulties and vaginal pain are common following treatment for breast cancer. AIM: The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. METHODS: Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. OUTCOMES: Assessments were repeated at posttreatment and 6 months after the completion of the group. RESULTS: There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. CONCLUSION: Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. STRENGTHS AND LIMITATIONS: We used a randomized methodology. Future studies should seek to diversify participants. CLINICAL IMPLICATIONS: These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.

Implementation of individually tailored treatment plans in a group-based intervention for women with mixed vulvo-vaginal and sexual health concerns following cancer treatment: A feasibility study.

PURPOSE: This study evaluated a professionally-led, group-based vulvo-vaginal and sexual health (VSH) workshop for women diagnosed with cancer. The study goals were to: (1) implement and assess a novel group intervention for diverse VSH concerns; (2) explore post-workshop changes in symptom bother, motivation to use VSH treatments, and frequency of VSH treatment use; (3) examine post-workshop changes in sexual well-being. METHODS: A group-based educational workshop to address a variety of VSH concerns was developed and implemented. During the workshop, participants created an individualized treatment plan by selecting from various VSH treatment options presented. Treatment plan follow-ups were administered online at one-, two-, and three-months post-workshop. At baseline and three-month follow-up, participants completed online questionnaires to assess self-reported vulvo-vaginal symptoms, sexual function, sexual distress, and use of VSH strategies. RESULTS: 195 participants (age 20-81) attended workshops over a 2.5-year period. Individualized treatment plans were effectively completed by most participants (92%). Preliminary results show decreases in bother severity associated with VSH concerns post-workshop, stabilizing after 2 months. At three-month follow-up, participants reported increased use of VSH treatment strategies. Sexual satisfaction, sexual distress, and emotional impact of vulvovaginal symptoms also improved. CONCLUSIONS: Workshop attendance was associated with increased uptake of VSH treatment strategies and improvements in several parameters of sexual well-being. Findings indicate that individualized treatment plans can be implemented effectively in a group setting and that a one-time, group-based educational workshop can meaningfully impact VSH-related behavior change, reduce vulvo-vaginal symptom bother and promote sexual well-being in patients with diverse VSH concerns.

Feasibility and Acceptability of a Group-Based Mindfulness Intervention for Sexual Interest/Arousal Disorder Following Breast Cancer Treatment.

This study aimed to assess feasibility and preliminary efficacy of an 8-week Mindfulness-Based Cognitive Therapy (MBCT) group program to treat Sexual Interest/Arousal Disorder (SIAD) in women following breast cancer (BrCa) treatment. Thirty women participated, of whom 67% (n = 20) attended at least 6 of 8 group sessions. Feedback indicated the program was relevant and valuable; minor modifications were suggested to further address survivorship concerns. Results of pre-post questionnaires demonstrated significant improvements in sexual distress and sexual interest/desire, with large effect sizes. Results support the feasibility and preliminary efficacy of an 8-week MBCT program among women following breast cancer treatment.

Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial.

BACKGROUND: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients' needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO-the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. METHODS: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. RESULTS: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. CONCLUSION: This pilot trial was successful, with minor modifications needed prior to a large trial.

Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids.

BACKGROUND: Prostate cancer (PCa) treatments commonly lead to erectile difficulties. While the mainstay treatment is erectile aids (EAs) to promote erectile recovery, some men never use these treatments and those whose do use EAs often abandon them in the long-term. AIM: The goal of this study was to examine PCa patients' experiences with EAs, to elucidate relationships between experiences with EAs on psychological and sexual well-being, and to explore benefits and drawbacks to EA use. METHODS: A self-report survey including validated questionnaires was administered to examine PCa patients' use and perceptions of helpfulness of EAs, and to characterize associations between use, perceived helpfulness, and psychological and sexual well-being. The survey was followed by an open-ended prompt to explore participants' experiences with EAs. OUTCOMES: We surveyed 260 North American men, up to 25 years after receiving treatment for PCa. Three groups of patients were observed, including those who used EAs and perceived them to be helpful, those who used EAs and perceived them to be unhelpful, as well as a smaller group of patients who never used EAs. RESULTS: Around 80% of the sample were using or had used EAs. Despite the high frequency of use, not all men found EAs helpful. Men who used EAs and found them unhelpful reported poorer psychological and sexual well-being compared to men who didn't use aids or who used EAs but found them helpful. Results indicated both benefits and drawbacks to the use of EAs. Benefits related largely to the efficacy of the aid in promoting erections. A wide range of drawbacks were also reported. CLINICAL IMPLICATIONS: Given the negative sexual and psychological impacts associated with using EAs and finding them unhelpful, we suggest that researchers and health care providers should take care to proactively address potential challenges that are common with EA use, and also to consider the risks of failed attempts with EAs. STRENGTHS & LIMITATIONS: By using both scaled and open-ended questions, a more nuanced picture of the relative benefits and limitations of EA use within the PCa population is presented. As responses were not mandatory, a subset of participants provided comments about the use of EAs. Additionally, the sample was quite homogenous, with mostly white, American and well-educated participants, so it therefore lacks generalizability to other populations. CONCLUSION: This paper illustrates several challenges to EA use, while providing insight into reasons for abandonment of use of EAs. Walker LM, Sears CS, Santos-Iglesias P, et al. Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids. J Sex Med 2021;18:1775-1787.

Perspectives of health care providers referring patients to a newly implemented sexual health program in a Canadian cancer center.

PURPOSE: Screening and discussion about sexual health concerns within cancer care are frequently impeded by lack of access to sexual health resources and lack of fluency with sexual health topics. To address this, a multi-disciplinary sexual health program was developed and piloted in a Canadian tertiary cancer center. The aim of this study was to assess referring health care providers' perspectives on the newly implemented oncology sexual health program. METHODS: A brief online survey was administered system-wide to cancer care providers to query their perceptions of the pilot multidisciplinary sexual health program, the Oncology and Sexuality, Intimacy and Survivorship (OASIS) program. RESULTS: According to survey results, the OASIS program was perceived by health care providers as valuable, helpful for patients, and important for addressing gaps in clinical care. Additional comments indicated an ongoing need for increased access to information about the program and referral procedures. CONCLUSION: Survey results highlight the need for consistent program dissemination efforts to equip health care providers with accessible patient education materials and easily implemented referral procedures. Importantly, providers indicated that they were more likely to raise the topic of sexuality with patients because they had somewhere to refer patients who had sexual concerns. Overall, findings inform efforts to implement sexual health programming within cancer care institutions.

A study protocol for a multicenter randomized pilot trial of a dyadic, tailored, web-based, psychosocial, and physical activity self-management program (TEMPO) for men with prostate cancer and their caregivers.

BACKGROUND: Prostate cancer predisposes patients and caregivers to a wide range of complex physical and psychosocial challenges, and interventions must incorporate a wide range of self-management strategies to help patients and their caregivers effectively cope with cancer challenges. To palliate this need, our team recently developed and evaluated the initial acceptability of a dyadic, Tailored, wEb-based, psychosocial, and physical activity self-Management PrOgram (TEMPO). TEMPO is a 10-week, interactive, web-based intervention consisting of five modules designed to help dyads manage their physical and psychosocial needs. It aims to teach dyads new self-management strategies and encourages them to increase their physical activity (PA) levels, mainly through walking and strength-based exercises. Initial acceptability evaluation of TEMPO revealed high user satisfaction, in addition to having a number of potential benefits for participants. After integrating suggested changes to TEMPO, the proposed pilot study aims to further test the acceptability and feasibility of TEMPO. METHODS: This study is a multicenter, stratified, parallel, two-group, pilot randomized control trial (RCT), where patient-caregiver dyads are randomized (stratified by anxiety level) to receive (a) TEMPO or (b) usual care. Participants (n goal = 40) are recruited across Canada at participating cancer centers and through self-referral (e.g., online recruitment). Patient inclusion criteria are (a) having received prostate cancer treatment within the past 2 years or scheduled to receive treatment, (b) identified a primary caregiver willing to participate in the study, and (c) has access to the Internet. Eligible caregivers are those identified by the patient as his primary source of support. Dyads complete a baseline questionnaire (T1) and another one 3 months later (T2) assessing various aspects of physical and emotional functioning (e.g., the Medical Outcomes Study (MOS) 12-item Short Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale (PSS)), self-management behaviors (e.g., the Health Education Impact Questionnaire (heiQ)), physical activity (the International Physical Activity Questionnaires (IPAQ) and the Multidimensional Self-efficacy for Exercise Scale (MSES)), and dyadic coping (the Dyadic Coping Inventory (DCI)). Dyads that used TEMPO are also asked to participate in a semi-structured exit interview exploring their overall experience with the program. DISCUSSION: This feasibility analysis will begin to develop the knowledge base on TEMPO's value for men with prostate cancer and their caregivers to inform a larger trial. TRIAL REGISTRATION: NCT04304196.

Development, implementation, and evaluation of a multidisciplinary oncology sexual health clinic in a Canadian cancer care setting.

PURPOSE: Untreated cancer-related sexual health concerns cause significant distress for cancer survivors. To appropriately address the complex sexual health needs of cancer patients, we piloted a specialized, multidisciplinary oncology sexual health clinic within a tertiary cancer center. A quality assurance evaluation was conducted. METHODS: During once monthly half-day clinics, a multidisciplinary team of psychologists, advanced practice nurses, and radiation and gynecological oncologists offered specialist integrated care to oncology patients. Patients completed assessment questionnaires prior to each clinic appointment and a follow-up telephone interview approximately 4 months after their initial appointment. RESULTS: Over the 2-year pilot, 224 patients were referred to the cancer center's broader sexual health program; 100 patients were triaged to the clinic. A total of 79 new and 58 follow-up appointments were offered. Average wait time for an initial visit was 97 days. Patients' most frequent concerns included vulvovaginal atrophy, dyspareunia, reduced sexual desire, and erectile dysfunction. Self-reported sexual distress was well above the clinical cutoff at baseline (N = 77, M = 29.78, SD = 12.74). A significant reduction in sexual distress was observed at follow-up (N = 67, M = 21.90, SD = 11.34, t(66) = 7.41, p < 0.001). CONCLUSIONS: Referral rates indicate a high demand for specialized sexual health services within cancer care. Ongoing specialist care is needed to appropriately address the multifaceted sexual concerns of cancer survivors and to adequately manage high distress and symptom comorbidity. IMPLICATIONS FOR CANCER SURVIVORS: Results inform a more comprehensive characterization of the presenting concerns of cancer survivors seeking multidisciplinary sexual health care.

Patient interest in the Lowdown on Down There: attendance at a vulvovaginal and sexual health workshop post-cancer treatment.

PURPOSE: Sexual difficulties and vulvovaginal changes are common for women undergoing, and following, cancer treatments. These changes have significant impacts on quality of life and significant relationships. The current study aimed to (1) evaluate women's interest and attendance in a group-based educational workshop to address changes in vulvovaginal health and sexuality after cancer, and (2) describe participant characteristics and presenting concerns. METHODS: Two hundred eighteen women with a history of cancer expressed interest in receiving information about the workshop and completed phone screening. Interested women (n = 156) completed an online questionnaire package examining vulvovaginal health and sexual function prior to attending the workshop. RESULTS: Approximately 75% of the women who completed screening attended the workshop. Clinically significant sexual distress was reported by 91% of participants, and 97% of sexually active participants exceeded the threshold for sexual dysfunction (per FSFI). Women within 1-2 years of diagnosis tended to report less sexual distress, less severe vulvovaginal symptoms, and less impact from these symptoms compared to women farther out from diagnosis. While the majority of women reported vaginal dryness and pain during intercourse, only a minority reported engaging in health promotion strategies sufficient to expect symptom improvement. CONCLUSIONS: The current study suggests that group-based educational workshops for vulvovaginal and sexual concerns are utilized by patients and should be offered to women well into disease survivorship. Workshops targeting vulvovaginal symptoms and sexual concerns may be a cost-effective method of reducing sexual distress and improving patients' sexual function and quality of life.

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

The repercussions of cancer diagnosis and treatment profoundly impact the sexual wellbeing of women prior to, during, and following cancer treatment. Sexual health concerns are often under-addressed within clinical and research settings, and information tends to be limited to women with breast or gynecological cancers. In this narrative literature review, the authors critically evaluate research published between 1990 and 2016, pertaining to sexual health concerns of women diagnosed with cancer, of any type or stage, and to the psychosocial and biomedical interventions that currently exist for the treatment of sexual health-related side-effects (e.g. vaginal dryness, dyspareunia and vulvo-vaginal atrophy). The findings of 109 published articles are discussed and summarised according to four central themes: how cancer affects female sexual wellbeing; physical impacts of cancer diagnosis and treatment; emotional impacts of cancer diagnosis and treatment; and interventions for sexual dysfunction. Suggestions to enhance research and clinical practice in relation to the sexual health concerns of women following cancer treatments are also presented. Concerns pertaining to women's sexual health are diverse, multiple, and pervade all types and stages of cancer. Several evidence-based psychosocial and biomedical interventions exist to help women manage physical and psychosocial ramifications of cancer diagnosis and treatment.