Efficacy of Internet-Based Cognitive Behavioral Therapy in Improving Sexual Functioning of Breast Cancer Survivors: Results of a Randomized Controlled Trial

• Published in: Journal of clinical oncology Vol. 35; no. 12; pp. 1328 - 1340
• Main Authors: Hummel, Susanna B, van Lankveld, Jacques J D M, Oldenburg, Hester S A, Hahn, Daniela E E, Kieffer, Jacobien M, Gerritsma, Miranda A, Kuenen, Marianne A, Bijker, Nina, Borgstein, Paul J, Heuff, Gijsbert, Lopes Cardozo, Alexander M F, Plaisier, Peter W, Rijna, Herman, van der Meij, Suzan, van Dulken, Eric J, Vrouenraets, Bart C, Broomans, Eva, Aaronson, Neil K
• Format: Journal Article
• Language: English
• Published: United States 20-04-2017
• Subjects: Breast Neoplasms - physiopathology; Breast Neoplasms - psychology; Breast Neoplasms - therapy; Cognitive Therapy - methods; Female; Humans; Internet; Middle Aged; Self Report; Sexual Behavior - physiology; Sexual Behavior - psychology; Sexual Dysfunction, Physiological - psychology; Sexual Dysfunction, Physiological - therapy; Survivors; Therapy, Computer-Assisted - methods; Waiting Lists
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2016.69.6021

Purpose We evaluated the effect of Internet-based cognitive behavioral therapy (CBT) on sexual functioning and relationship intimacy (primary outcomes) and body image, menopausal symptoms, marital functioning, psychological distress, and health-related quality of life (secondary outcomes) in breast cancer survivors (BCSs) with a DSM-IV diagnosis of a sexual dysfunction. Patients and Methods We randomly assigned 169 BCSs to either Internet-based CBT or a waiting-list control group. The CBT consisted of weekly therapist-guided sessions, with a maximum duration of 24 weeks. Self-report questionnaires were completed by the intervention group at baseline (T0), midtherapy (T1), and post-therapy (T2) and at equivalent times by the control group. We used a mixed-effect modeling approach to compare the groups over time. Results Compared with the control group, the intervention group showed a significant improvement over time in overall sexual functioning (effect size for T2 [ES
] = .43; P = .031), which was reflected in an increase in sexual desire (ES
= .48 and ES
= .72; P < .001), sexual arousal (ES
= .50; P = .008), and vaginal lubrication (ES
= .46; P = .013). The intervention group reported more improvement over time in sexual pleasure (ES
= .32 and ES
= .62; P = .001), less discomfort during sex (ES
= .49 and ES
= .66; P = .001), and less sexual distress (ES
= .59; P = .002) compared with the control group. The intervention group reported greater improvement in body image (ES
= .45; P = .009) and fewer menopausal symptoms (ES
= .39; P = .007) than the control group. No significant effects were observed for orgasmic function, sexual satisfaction, intercourse frequency, relationship intimacy, marital functioning, psychological distress, or health-related quality of life. Conclusion Internet-based CBT has salutary effects on sexual functioning, body image, and menopausal symptoms in BCSs with a sexual dysfunction.