Intervention May Help Combat Sexual Dysfunction After Ovarian Cancer Care

Many ovarian cancer survivors find sexual problems after treatment to be one of the most distressing long-term side effects of their diagnosis. Researchers at the Dana-Farber Cancer Institute are testing a psychoeducational intervention, with hopes to offer relief to the the 90 percent of survivors facing these challenges.

Early positive findings of a single-arm study evaluating the Sexual Therapy and Rehabilitation after Treatment for Ovarian Cancer (START-OC) intervention among 39 patients were shared by study author Christopher J. Recklitis, at a “Best Abstracts” session at the 8th Biennial Cancer Survivorship Research Conference in Washington, DC. Recklitis, director of research at Dana-Farber’s Perini Family Survivors’ Center, presented the results in behalf of lead investigator Sharon Bober.

“Sexual dysfunction is a serious and common late effect of cancer treatment, particularly for our target population of women who have ovarian cancer, and unfortunately, these women—like many cancer survivors who have sexual dysfunction—don’t receive treatment,” Recklitis noted.

The START-OC intervention involves both group therapy and an individualized treatment plan, Recklitis explained, and it is based on a prior intervention that Bober had developed to address sexual dysfunction in women who had undergone prophylactic oophorectomy.

The single, half-day group session has three parts. The sexual health education component provides women with information about their symptoms and the reasons behind them, along with resources on vaginal health, moisturizers and dilators. The second module involves relaxation training, and participants are taught relaxation exercises they can do at home. The third component focuses on mindfulness-based cognitive therapy to help women become aware of negative thoughts that may be interfering with their sexual satisfaction and sexual function, said Recklitis.

For ongoing support after the workshop, women receive take-home materials that include information about vaginal dilators and moisturizers, pelvic floor exercises and sexual health aids.

At the end of the half-day session, women are asked to reflect on the challenges which brought them to the group to identify specific problems that they want to personally address in the coming weeks, and they each leave with a personalized action plan. One month after the group session, participants receive a follow-up coaching telephone call from a Master’s-level clinician to review progress and help solve any problems that have emerged.

To evaluate the project, participants completed the Female Sexual Function Index (FSFI) twice over an eight-week run-in period. No statistically significant improvements were seen prior to the intervention between these two baseline assessments, said Recklitis. The women were then assessed two and six months after the receiving the START-OC program.

Data from the two-month assessment were presented and based on 39 participants (median age 57), with a median time since their diagnosis of seven years; nearly all (97.4 percent) were white, non-Hispanic, and 84 percent were married. Women who had pelvic radiation as part of their ovarian cancer treatment were not included in this study. Women’s total scores on the FSFI improved significantly after the intervention, as well as their scores on the individual indicators of arousal, lubrication, orgasm, satisfaction and pain. Recklitis said the women also had a significant decrease in depression at the two-month follow-up.

“This brief intervention is very acceptable to women and appears to improve their sexual functioning after ovarian cancer,” said Recklitis. He added that the moderate effect sizes (.45-.63) suggest a meaningful improvement in sexual function, rather than just a statistical change. “We were happy with these effect sizes; I wish all of our interventions had this kind of effect.” Feedback from participants on the group session was also positive, with 97 percent of participants finding the sessions helpful, and all found the content easy to understand. One critique, noted Recklitis, is that participants expressed a desire for more workshops and a way to stay in touch with the women that they met. Recklitis said this will be incorporated in the next phase of the research and facilitated by a moderated, private Facebook group.