From: Management of sexual dysfunction in breast cancer survivors: a systematic review
Systemic therapy interventions | |||||
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Reference | Objective | Participantsa | Intervention description | Intervention frequency | Outcome measures |
Barton (2007) [34] | To test transdermal testosterone for increasing sexual desire | • Sample size = 150 | Two groups: | 8-week intervention: | 1. Sexual desire (CSFQ desire subscale) |
• Mean age 52.3 (SD 7.9) | 1. Vanicream + 2 % testosterone (T), then Vanicream (placebo) | • First product: daily x 4 weeks | 2. Pleasure (CSFQ pleasure subscale) | ||
• Post-menopause status | • Second product: daily x 4 weeks | 3. Sexual function (CSFQ total score) | |||
• History of any cancer (73 % breast cancer) | 2. Vanicream (placebo), then Vanicream + 2 % testosterone cream (T) | 4. Serum testosterone | |||
5. Serum estradiol | |||||
• Decreased sexual desire (Changes of Sexual Functioning Questionnaire, CSFQ) | • Testosterone dose 10.4 mg daily | 6. Serum SHBG | |||
7. Serum AST | |||||
Buijs (2009) [42] | To test venlafaxine versus clonidine on hot flashes | • Sample size = 60 | Two groups: | 18-week intervention: | 1. Sexual function (Sexual Activity Questionnaire) |
• Median age 49-51, range 35-60 | 1. Clonidine (C) then Venlafaxine (V) | • One medication daily x 8 weeks | |||
• History of breast cancer | 2. Venlafaxine, then Clonidine or vice versa | • 2-week washout | |||
• ≥ 14 hot flashes/week | • Second medication daily x 8 weeks | ||||
• V: 75 mg once daily | |||||
• C: 0.05 mg twice daily | |||||
Nunez (2013) [41] | To test bupropion on hot flashes | • Sample size = 55 | Two groups: | 10-week intervention: | 1. Sexual function (Arizona Sexual Experience Scale) |
• Median age 49, range 33-71 | 1. Bupropion (B), then placebo | • One medication daily x 3 days, then twice daily for 25 days | |||
• History of breast cancer | 2. Placebo then bupropion | ||||
• ≥ 7 hot flashes/week | • B: titrated to 300 mg daily | • 1-week washout | |||
• Second medication daily x 3 days, then twice daily for 25 days | |||||
Physical Activity Interventions | |||||
Berglund (1994) [45] | To test physical training, information and coping skills training on physical strength, information need and mood symptoms | • Sample size = 199 | Two groups: | 7-week intervention, 3-months follow up: | 1. Sexual problems frequency |
• All cancers (80 % breast cancer) | 1. Structured rehabilitation run by oncology nurse: | 1. Twice-weekly 2-h sessions for first 4 weeks, then one-weekly 2-h session for 3 weeks | |||
• Within 2 months of completing primary cancer treatment | |||||
Group sessions on physical training, cancer information, coping training | |||||
2. 0 or 1 information session | |||||
2. Controls: Cancer information session with oncologist/ dietitian | |||||
Duijts (2012) [43] | To test cognitive behavioral therapy and physical exercise on menopausal symptoms | • Sample size = 422 | Four groups: | 12-week intervention: | 1. Sexual function (Sexual Activity Questionnaire, habit subscale) |
• Mean age 48.2 (SD 5.6) | 1. Cognitive behavioral therapy (CBT): Group sessions on reducing menopausal symptoms | 1. 6 weekly groups and 12th week refresher | |||
• ≥ 2 menopausal symptoms over prior 2 weeks | |||||
2. Physiotherapist follow up in weeks 4 and 8 | |||||
2. Physical exercise (PE): Home-based, self-directed exercise program to achieve target heart rates, tailored at start by physiotherapist. | |||||
3. CBT/PE | |||||
4. Waitlist control | |||||
Speck (2010) [44] | To test strength training on perceptions of body image | • Sample size = 295 | Two groups: | 1-year intervention: | 1. Self-perception of appearance and sexuality (Body Image Relationships Scale, appearance and sexuality subscale) |
• Mean Age 56.5 (SD 9) | 1. Weight-lifting group instruction at community fitness center on warm-up, core exercises, weight-lifting exercises | 1. First 13 weeks: twice weekly group sessions | |||
• Lymphedema or at risk for lymphedema | |||||
Remaining of year: twice weekly unsupervised exercise; Fitness trainers called participants if they missed sessions. | |||||
2. Waitlist control | |||||
2. Maintain usual exercise level | |||||
Individual-based Counseling and Educational Interventions | |||||
Allen (2002) [55] | To test problem-solving therapy for problems and emotional difficulties | • Sample size = 164 | Two groups: | 16-week intervention: | 1. Sexual health (CARES sexual subscale) |
• Mean age 42.3 (SD 5.4) | 1. Problem-solving therapy: Training sessions and manual on problem solving targeting mid-life breast cancer patients | 1. 6 biweekly training sessions with nurse: 2 in person, 4 on telephone | |||
• Initiating chemotherapy | 2. Marital relationship (CARES marital subscale) | ||||
2. Controls: No therapy | |||||
Anderson (2015) [46] | To test a behavioral intervention on menopausal symptoms | • Sample size = 55 | Two groups: | 12-week intervention: | 1. Sexual function (sexual function subscale, Greene Climacteric Scale) |
• Mean age 49.2 (SD 6.2) | 1. Multi-modal tailored program: | 1. Nurse consultation at weeks 1, 6, 12 | |||
• < 12 months from primary cancer treatment | Goal setting in consultation with nurse, follow up calls and emails, written health education, newsletters and website | ||||
• ≥ 1 menopausal symptom as moderate or severe | |||||
2. Controls: Booklet on breast cancer and early menopause | |||||
Ganz (2000) [48] | To test behavioral and non-estrogen replacement pharmaco-logic interventions on menopausal symptoms | • Sample size = 76 | Two groups: | 4-month intervention: | 1. Menopausal Symptom Scale Score (hot flash, vaginal and urinary subscales of BCPT Symptom Checklist) |
• Mean age 54.5 (SD 5.9) | 1. Intervention: | 1. Months 0, 2 and 4 visits | 2. Sexual health (sexual summary subscale of CARES) | ||
• > 1 menopausal symptom as moderate or severe | Individualized plans of education, counseling, pharmacologic and/or behavioral interventions, psychosocial support, referrals | 2. Months 0 and 4 visits | |||
2. Usual care | |||||
Germino (2013) [56] | To test an uncertainty management intervention in young survivors | • Sample size = 313 | Two groups: | 10-month intervention: | 1. Sexual function (Medical Outcomes Study – Sexual Functioning) |
• Mean age 44 | 1. Uncertainty management strategies: CD on cognitive and behavioral strategies, written guide booklet on long-term treatment effects, breast cancer resource guide, calls by nurse | 1. Weekly 20-min calls x 4 | |||
2. Weekly 20-min calls x 4 | |||||
2. Attention control: Calls by psychology graduate students to talk about cancer experience but no advice offered | |||||
Greer (1992) [59] | To test psychological therapy on quality of life | • Sample size = 174 | Two groups: | 8-week intervention, 4-month follow up: | 1. Sexual relationships (subscale of Psychological Adjustment to Illness Scale) |
• Mean age 51 (SD 13.6) in therapy group; 52 (SD 11.7) in the control group | 1. Psychological therapy: Cognitive behavioral therapy for coping with cancer | 1. Weekly sessions x 8 | |||
• All cancers except central nervous system and non-melanoma skin cancer (52 % breast cancer) | 2. Controls: No therapy | ||||
• Psychological morbidity | |||||
Jun (2011) [49] | To test a sexual life reframing program on marital intimacy, body image, and sexual function | • Sample size = 60 | Two groups: | 6-week intervention: | 1. Marital intimacy (Martial Intimacy Questionnaire) |
• Mean age 45.7 (SD 6.4) in intervention group; 46.2 (SD 6.9) in control group | 1. Sexual reframing program: Group sessions of up to 10 women; Sessions on relaxation, perception of problem, exposure, solving problems, acceptance, reframing | 1. Weekly 2 h sessions x 6 | |||
2. Sexual interest (subscale, CARES) | |||||
3. Sexual dysfunction (subscale, CARES) | |||||
• Married with male partner | |||||
4. Sexual satisfaction (Sexual Satisfaction Scale) | |||||
2. Usual care: Offered intervention for 2 h after final data collection | |||||
Marcus (2010) [57] | To test a telephone counseling program on psychosocial outcomes | • Sample size = 304 | Two groups: | 12-month intervention, 18-month follow up: | 5. Sexual function, (behavioral, evaluative and body image subscales of Sexual Dysfunction Scale) |
• Age < 50: 49 % | 1. Telephone Counseling: Booklet with community breast cancer resources; telephone sessions with counselors; Wellness Kit with 6 thematic booklets, 2 progressive relaxation tapes, stress management guide; cognition- and emotion-focused worksheets | ||||
• Recent primary cancer treatment completion | 1. 45-min telephone sessions: biweekly x 10, then monthly x 6 | ||||
2. Control: Booklet with community breast cancer resources | |||||
Rowland (2009) [51] | To test a psycho-educational group intervention on sexuality and intimacy | • Sample size = 411 | Two groups: | 6-week intervention: | Likert scales: |
• Mean age 57, range 35-86 | 1. Intervention: Group therapy led by social workers on education, communication training, sensate sex therapy | 1. Weekly group sessions x 6 | 1. Satisfaction with variety of sexual activities | ||
• Distress with sexuality or intimacy, body image, and/or communication with partner | |||||
2. Relationship satisfaction | |||||
3. Dyspareunia | |||||
2. Control: Educational pamphlet on cancer survivorship | 4. Pain interferes with pleasure | ||||
5. Improved comfort with sexuality | |||||
Salonen (2009) [58] | To test a telephone-based social support intervention on quality of life | • Sample size = 250 | Two groups: | 1-time intervention, 2-week follow-up: | 1. Sexual functioning (subscale, EORTC QLQ-BR23) |
• Mean age 56-57, range 24-75 | 1. Telephone support by physiotherapist: education about illness, at-home exercises, counseling on stress-related problems, exploring patient demands and exercises | 1. 1-week after breast surgery phone call with therapist (length 3-25 min) | |||
• Newly diagnosed with breast cancer | |||||
2. Control: No telephone support | |||||
Schover (2006) [52] | To test peer counseling on improving sexual function, knowledge about reproductive health, menopausal symptoms and infertility-related distress | • Sample size = 60 | Two groups: | Immediate counseling intervention, 3-month follow up: | 1. Sexual Dysfunction (FSFI) |
• Mean age 49.2, range 30-77 | 1. Intervention: In-person peer counselor sessions reviewing Sisters Peer Intervention in Reproductive Issues after Treatment (SPIRIT) | ||||
1. 60-90 min peer counseling sessions x 3 | |||||
• African American | |||||
2. Control: Waitlist control with SPIRIT and peer counseling at the end of study | |||||
Schover (2011) [53] | To test peer counseling on improving sexual function, knowledge about reproductive health, menopausal symptoms and infertility-related distress | • Sample size = 300 | Two groups: | 6-week intervention, 6-month, 12-month follow up: | 1. Sexual Dysfunction (FSFI) |
• Mean age 54.4 (SD 9.7) for peer group; 54.0 (SD 9.8) for telephone group | 1. Intervention: In-person peer counselor sessions reviewing Sisters Peer Intervention in Reproductive Issues after Treatment (SPIRIT) | ||||
1. 60-90 min peer counseling sessions x 3 | |||||
• African American | |||||
2. 30 min call to counselor encouraged x 1 | |||||
2. Control: Telephone counseling and SPIRIT workbook | |||||
Vos (2004) [60] | To test a group intervention (group psycho-therapy or social support) on psychosocial adjustment | • Sample size = 87 | Three groups: | 12-week intervention, 3-month follow up: | 1. Sexual function (subscale, EORTC QLQ-BR32) |
• Mean age 49.2, range 29-68 | 1. Psychotherapy: Group therapy with cognitive behavior components | 1. Weekly 2.5 h sessions x 12; post-treatment 1 and 2 month 2.5 h sessions | |||
• Newly diagnosed with breast cancer | |||||
2. Social support: Group therapy with peer support | |||||
2. Weekly 2.5 h sessions x 12; post-treatment 1 and 2 month 2.5 h sessions | |||||
3. Waitlist control | |||||
1 & 2 Group interventions discussed fear of recurrence, coping, body image, sexuality, intimacy, social support. | |||||
Couples-based Counseling and Educational Interventions | |||||
Baucom (2009) [47] | To test couple-based relationship enhancement on relational distress | • Sample size = 14 | Two groups: | 12-week intervention, 12-month follow up: | 1. Marriage quality (Quality of Marriage Index) |
• Median age 50, range 30-80 | 1. Relationship enhancement intervention: Cognitive behavioral therapy on cancer-related topics | ||||
• Married with male partner | 1. Biweekly 75 min sessions with therapist x 6 | 2. Sexual function (Derogatis Inventory of Sexual Functioning) | |||
2. Controls: Community resources list | |||||
Christensen (1983) [61] | To test a structured couples treatment program on psychosocial discomfort | • Sample size = 20 | Two groups: | 6-week intervention: | 1. Sexual satisfaction (Sexual Satisfaction Scale) |
• Mean age 39.7 | 1. Therapy sessions on communication and problem solving | 1. Weekly sessions x 4 | |||
• Married with male partner | |||||
• Recent mastectomy | 2. Controls: No therapy | ||||
Kalaitzi (2007) [50] | To test combined couples and sexual therapies on sexual and body image problems | • Sample size = 40 | Two groups: | 12-week intervention: | 1. Sexual desire frequency |
• Mean age 51.8 for intervention group, 53.3 for control group | 1. Intervention: Therapy sessions - 1st in hospital; communication training, sensate focus, body imagery, therapist separation | 1. Biweekly sessions x 6 | 2. Intercourse frequency | ||
3. Masturbation frequency | |||||
• Married and sexually active with male partner | 4. Orgasm frequency | ||||
5. Initiative for sex | |||||
• Recent simple mastectomy | 2. Control: no therapy | 6. Satisfaction with relationship | |||
Schover (2013) [54] | To test an Internet-based intervention, with and without sexual counseling, on sexual function and satisfaction | • Sample size = 72 | Two groups: | 12-week intervention, 6-month follow up: | 1. Sexual function (FSFI) |
• Mean age 53 (SD 9) | 1. Intervention: In-person counseling to review website and behavioral homework (both partners) | 1. Counseling sessions x 3 | 2. Sexual satisfaction (Menopausal Sexual Interest Questionnaire) | ||
• History of breast (80 %) or gynecologic cancer | |||||
• Sexually active | 2. Self-help controls | ||||
• Sexual dysfunction (FSFI score < 26.5) | Both groups: Website on sexual and fertility consequences of cancer, genital anatomy, management of vaginal dryness, communication, dating, treatments for loss of desire, resuming sex comfortably. | ||||
• In a partnered relationship | |||||
Scott (2004) [96] | To test a couples-based intervention on adjustment to cancer | • Sample size = 94 | Three groups: | 6-month intervention, 12-month follow up: | 1. Sexual self schema (Sexual Self Schema Scale) |
• Mean age 51 (SD 9.8) | 1. Couple coping training: Booklet, in-person couples counseling on coping and support | ||||
• Newly diagnosed breast (61 %) or gynecologic cancer | 1. 2-h counseling sessions at baseline, 1-week, 5-weeks, 6 months; telephone calls at 1 and 3 months | 2. Sexual desire (subscale, Brief Index of Sexual Function) | |||
• In a partnered relationship | 2. Medical information education: Booklet on cancer and brief telephone calls | 3. Sexual arousal (subscale, Brief Index of Sexual Function) | |||
2. Telephone calls (<15 min) at baseline, 1- and 2-week post-surgery, 6 and 9 months | |||||
3. Patient coping training: Booklet and in-person counseling, telephone calls on coping and support | |||||
3. 2-h counseling sessions at baseline, post-surgery, 1-week, 6 months; telephone calls at 1 and 3 months |