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PurposeThe objectives were to assess changes in sexual QOL and body image distress over time and to examine longitudinal associations between sexual QOL and body image variables with psychosocial outcomes in a sample of colorectal cancer patients.MethodsParticipants (N = 141) completed a mail-based survey assessing sexual QOL [sexual distress (ISS), treatment impact on sexual function (SFQ), sexual function (FSFI; IIEF)], body image distress (BIS), and psychosocial outcomes [relationship quality (DAS-4), depressive symptoms (CESD-SF), and health-related QOL (HRQOL; FACT-C)]; 88 patients completed 6-month follow-up surveys (62%). Gender and cancer subgroups (male vs. female; rectal vs. colon cancer) were compared and longitudinal models examined associations between sexual QOL and body image variables with psychosocial outcomes over time and by subgroup.ResultsImpairments in sexual QOL and body image distress were common. Women and patients with rectal cancer reported worse body image distress compared to men (p = .005) and those with colon cancer (p = .03), respectively; compared to patients with colon cancer, those with rectal cancer reported worse treatment impact (p < .001) and marginally worse sexual function and HRQOL (p’s = .05). At 6-month follow-up, body image distress decreased (p = .02), while sexual QOL was stable (e.g., 58% classified as dysfunctional at both time points, p = .13). For most sexual and body image predictors, worse impairment was associated with worse psychosocial outcomes over time. Several significant gender and cancer subgroup effects were found.ConclusionsSexual QOL and body image are compromised after colorectal cancer and tend to remain impaired if unaddressed. Sexual concerns should be addressed early to limit broader-reaching psychosocial effects.

Purpose Cancer survivors’ needs around sexual concerns are often unmet. The primary objective of this systematic review was to examine the prevalence of and factors associated with patient-provider communication about sexual concerns in cancer. Methods Using PRISMA guidelines, we searched PubMed/MEDLINE, PsychInfo, and CINAHL databases for peer-reviewed quantitative research papers (2000–2015) in cancer samples. Search terms across three linked categories were used (sexuality, communication, and cancer). The National Comprehensive Cancer Network (NCCN) Sexual Function Guidelines were used as a framework to categorize communication reported in each study. Results Twenty-nine studies from 10 countries (29 % in USA) were included. Studies assessed patients only (21), providers only (4), and both (4). Communication measures differed across studies and many lacked validity data. When reported by patients or providers, the average prevalence of discussing potential treatment effects on sexual function was 50 (60 % for men and 28 % for women) and 88 %, respectively. As reported by patients or providers, respectively, assessing patients’ sexual concerns (10 and 21 %) and offering treatments (22 and 17 %) were measured in fewer studies and were reported less frequently. Both patients and providers (28 and 32 %, respectively) reported a low prevalence of other non-specific communication. Greater prevalence of communication was associated with male patient gender and more years of provider experience. Conclusions Sexual issues go unaddressed for many cancer survivors, particularly women. Both patient and provider interventions are needed. Implications for Cancer Survivors Enhancing patient-provider communication about sexual concerns through evidence-based interventions could improve patient sexual function and quality of life.

Background Sexual wellbeing is a critical yet often overlooked aspect of overall wellbeing for women across cancer diagnoses. Objective We identified profiles of women cancer survivors by sexual and psychosocial outcomes and compared groups for differences in relevant outcomes and individual characteristics. Methods Partnered women treated for cancer ( n  = 226; M age = 51.1 (12.6); 54% breast cancer; 86% White) completed a cross-sectional survey assessing sexual and psychosocial wellbeing. K-means cluster analysis modeled subgroups (clusters) with similar response patterns on measures of sexual wellbeing (sexual function, distress, sexual communication, and self-efficacy for communication), psychosocial wellbeing (quality of life (QOL), anxiety and depressive symptoms), and time since treatment. ANOVAs with Tukey post-hoc analyses and chi-square analyses tested cluster mean differences. Results Three distinct clusters of women differed by levels of adjustment in sexual and psychosocial wellbeing: higher-adjustment (32.7%), intermediate (37.6%), and lower-adjustment (29.6%). Significant differences among the clusters were found for all outcomes, with largest effect sizes for sexual distress (η 2 p  = 0.66), sexual communication (η 2 p  = 0.51), sexual satisfaction (η 2 p  = 0.44), and anxiety and self-efficacy for communication (η 2 p  = 0.32). The intermediate adjustment group was characterized by lower adjustment on measures of sexual and relationship function, and better adjustment on measures of QOL and mood. Conclusions Findings suggest that for women cancer survivors, measures of sexual and psychosocial wellbeing can model distinct profiles to inform targeted interventions to meet women’s needs. Evidence-based targeted interventions could lead to better sexual function, and ultimately to better QOL and overall wellbeing. Implications for practice A stepped intervention approach to sexual health care for women with cancer, where content and format depend on degree of sexual and psychosocial adjustment after cancer, may be most appropriate. Interdisciplinary teams may address sexual, emotional, and relationship functioning.

Background Brief self-assessment of sexual problems in a clinical context has the potential to improve care for patients through the ability to track trends in sexual problems over time and facilitate patient–provider communication about this important topic. However, instruments designed for research are typically too long to be practical in clinical practice. Objective To develop and validate a single-item self-report clinical screener that would capture common sexual problems and concerns for men and women. Design We created three candidate screener items, refined them through cognitive interviews, and administered them to a large sample. We compared the prevalence of responses to each item and explored the discrepancies between items. We evaluated the construct validity of the items by comparing them to scores on the Patient-Reported Outcomes Measurement Information System® Sexual Function and Satisfaction (PROMIS® SexFS) measure. Participants Local patients participated in two rounds of cognitive interviews (n = 7 and n = 11). A probability-based random sample of U.S. adults comprised the item-testing sample (n = 3517). Main Measures The items were as follows: 1) a yes/no item on any sexual problems or concerns (“general screener”), 2) a yes/no item on problems experienced for 3 months or more during the past 12 months, with a list of examples (“long list screener”), and 3) an item identical to the long list screener except that examples appeared individually as response options and respondents could check all that applied (“checklist screener”). Key Results All of the screeners tested showed evidence for basic validity and had minimal missing data. Percentages of women and men endorsing the screeners were 10 % and 15 % (general); 20 % and 17 % (long list); and 38 % and 30 % (checklist), respectively. Participants who endorsed the screeners had lower function compared to those who did not endorse them. Conclusions We recommend the checklist screener for its specificity and ability to identify specific problems associated with decreased sexual function.

Women with breast or gynecological cancer and their intimate partners often face sexual problems in their relationships. Accessing care for sexual health problems is challenging for several reasons (eg, limited trained health care providers and privacy concerns), making self-management approaches highly promising. This study assessed the feasibility of the Psychosexual Educational Partners Program (PEPP), a 6-week sexual health self-management intervention for women treated for breast or gynecological cancer and their intimate partners. A mixed methods single-arm, repeated measures design was used for this study. An attrition rate of ≤25% was considered feasible. Intervention experiences were assessed via interviews, and preliminary effects on the Dyadic Sexual Communication Scale, relationship quality measured by the Revised Dyadic Adjustment Scale, and sexual health measured by PROMIS Sexual Function and Satisfaction version 2.0 were explored quantitatively. In total, 7 (77%) of the 9 couples completed the study through week 6 and provided both pre- and poststudy data, resulting in an attrition rate of 22% (2/9), which met the feasibility benchmark for attrition of 25% or less. The following two themes emerged: (1) PEPP helped us start difficult conversations and impacted emotional and physical intimacy. The intervention adherence was 85%. Dyadic Sexual Communication Scale scores improved with a mean change score of 6.64 (SD 9.65) and a Cohen d of 0.69. Revised Dyadic Adjustment Scale scores declined slightly, with a mean change score of -0.93 (SD 3.41) and a Cohen d of 0.27. PROMIS Sexual Function and Satisfaction version 2.0 scores showed small improvements for women on desire, with a mean change score of 2.36 (SD 6.24) and a Cohen d of 0.38. Similarly, for women, the satisfaction mean change score was 2.20 (SD 8.22) and a Cohen d of 0.27. For intimate partners, a small effect was found for desire, but in this instance, desire decreased with a mean change score of -1.57 (SD 6.09) and a Cohen d of 0.26. The findings support PEPP as a feasible intervention for improving sexual communication. If proven effective in a randomized controlled trial, it has the potential to address the critical gap in supportive care among female cancer survivors. ClinicalTrials.gov NCT05070299; https://clinicaltrials.gov/study/NCT05070299.

Background Sexual concerns are distressing for breast cancer survivors and interfere with their intimate relationships. This study evaluates the efficacy of a four-session couple-based intervention delivered via telephone, called Intimacy Enhancement (IE). The IE intervention is grounded in social cognitive theory and integrates evidence-based techniques from cognitive behavioral couple therapy and sex therapy to address survivors’ sexual concerns and enhance their and their partners’ sexual, relationship, and psychological outcomes. Methods This trial is designed to evaluate the efficacy of the IE intervention in improving survivors’ sexual function, the primary study outcome. Secondary outcomes include survivors’ sexual distress, partners’ sexual function, and survivors’ and partners’ relationship intimacy and quality as well as psychological distress (depressive symptoms and anxiety symptoms). Additional aims are to examine whether treatment effects on patient sexual function are mediated by sexual communication and self-efficacy for coping with sexual concerns and to explore whether survivor age and race/ethnicity moderate intervention effects on survivors’ sexual function. Eligible adult female breast cancer survivors reporting sexual concerns and their intimate partners are recruited from two academic sites in the USA and are randomized to either the IE intervention or to a control condition of equal length offering education and support around breast cancer-related health topics (Living Healthy Together). The target sample size is 120 couples. Self-report outcome measures are administered to participants in both conditions at baseline (T1), post-treatment (T2), 3 months post-treatment (T3), and 6 months post-treatment (T4). Discussion Evidence-based interventions are needed to address sexual concerns for breast cancer survivors and to enhance their and their intimate partners’ sexual, relationship, and psychological well-being. This randomized controlled trial will allow us to examine the efficacy of a novel couple-based intervention delivered via telephone for breast cancer survivors experiencing sexual concerns and their intimate partners, in comparison with an attention control. Findings of this study could influence clinical care for women with breast cancer and inform theory guiding cancer-related sexual rehabilitation. Trial registration ClinicalTrials.gov, NCT03930797 . Registered on 24 April 2019.

Purpose Patient-reported outcomes (PROs) are an umbrella term covering a range of outcomes, including symptoms, functioning, health-related quality of life, and supportive care needs. Research regarding the appropriate PRO questionnaires to use is informative. A previously published latent class analysis (LCA) examined patterns of function, symptoms, and supportive care needs in a sample of US cancer patients. The current analysis investigated whether the findings from the original study were replicated in new samples from different countries and whether a larger sample combining all the data would affect the classes identified. Methods This secondary analysis of data from 408 Japanese and 189 Canadian cancer patients replicated the methods used in the original LCA using data from 117 US cancer patients. In all samples, subjects completed the EORTC-QLQ-C30 and Supportive Care Needs Survey Short Form-34 (SCNS-SF34). We first dichotomized individual function, symptom, and need domain scores. We then performed LCA to investigate the patterns of domains for each of the outcomes, both in the individual country samples and then combining the data from all three samples. Results Across all analyses, class assignment was made by level of function, symptoms, or needs. In individual samples, only two-class models (\"high\" vs. \"low\") were generally identifiable while in the combined sample, threeclass models (\"high\" vs. \"moderate\" vs. \"low\") best fit the data for all outcomes. Conclusions In this analysis, the level of burden experienced by patients was the key factor in defining classes.

Recruitment challenges hinder behavioral intervention research in cancer survivors. The purpose was to examine the reasons for declining and intervention preferences of study-eligible breast cancer survivors declining a trial of a four-session couple-based Intimacy Enhancement intervention (refusers) and explore whether refusers differed from participants on key characteristics. Partnered, post-treatment breast cancer survivors reporting sexual concerns who were eligible for but declined participation in the intervention trial were approached to complete a standardized 5-min telephone survey assessing reasons for declining and support preferences. Demographic, clinical, and sexual concerns information were collected during screening. Trial participants and refusers were compared on key variables of age, race, hormone therapy use, time since treatment, level of sexual concerns, and recruitment method using t-tests or chi-square tests. Among the 31 women who declined the trial and completed the survey, the most common reasons for declining were time commitment (74%) and partner noninterest (32%). Most (61%) reported that the telephone format played little to no role in their refusal. Eighty-one percent wanted their partners involved in a program addressing sexual concerns. The two most preferred resources were informational websites (45%) and meeting with a professional (26%). Trial participants and refusers did not differ on any key factors examined. Developing intimacy interventions that are very brief, partner-optional, or that use stepped care may bolster uptake. The methods used to examine study-eligible candidates’ needs and preferences could be employed in other health populations, thus having broader implications for research design.

Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574. PRR1-10.2196/57781.

Purpose Sexual concerns are understudied and undertreated for patients with lung cancer. Objectives were to: (1) assess sexual concerns in lung cancer patients and examine differences by age and gender; (2) examine stability of sexual concerns over time; and (3) evaluate whether sexual concerns in lung cancer patients are significantly related to physical and emotional symptoms. Materials and methods Data were collected from lung cancer patients during four outpatient clinic visits over 6 months. Measures included sexual concerns (reduced sexual enjoyment, interest, or performance), fatigue (FACIT Fatigue Scale), shortness of breath, and emotional distress (acute distress, despair; Patient Care Monitor). Linear mixed model analyses were conducted. Results Sexual concerns were common, with 52% of patients reporting at least mild sexual concerns and were stable. Sexual concerns were significantly associated with physical and emotional symptoms; particularly strong relationships were found between sexual concerns and shortness of breath and emotional distress. Age moderated the relationship between both fatigue and shortness of breath and sexual concerns; gender moderated the relationship between emotional distress and sexual concerns. Conclusions Self-reported sexual concerns are common in people with lung cancer, are stable, and are related significantly to physical and emotional symptoms; age and gender influence the distress associated with sexual symptoms in this population. Better attention to patient concerns, treatment, and more research are clearly needed.