Sexual dysfunction is a common after-effect for survivors of breast and gynecologic cancers. A recent Oregon State University study found that a mindfulness-based intervention delivered via videoconference by a trained facilitator was a feasible treatment option for survivors.
The study, published in the Journal of Sexual Medicine, was a small pilot designed to test whether participants were able to fulfill the time commitment for the discussion group meetings and at-home practice exercises of the intervention, and how they felt about meeting via Zoom.
Sexual dysfunction is really common, but it's often not discussed as a potential thing that can happen to people in their bodies after their cancer and cancer treatment. And this usually doesn't go away on its own, without intervention. There are a lot of people in my research who are just out there dealing with it, feeling like they're alone."
Jessica Gorman, lead author, associate professor in OSU's College of Public Health and Human Sciences
Cancer and cancer treatments can affect sexual health in a variety of ways, she said. Breast cancer survivors who had a mastectomy may experience a blow to their self-confidence and sexuality; hormonal changes can affect libido and cause vaginal dryness and pain during sex.
"Most health care providers don't talk with patients about it. I think this is true of sexual health in general -; a lot of people are not comfortable talking about it; there's a stigma, a question of 'should I really be talking to my doctor about it?'" Gorman said. "So this is a known problem, and there are efforts underway to try to improve sexual health communication between cancer care providers and patients, but that really isn't happening quickly or consistently."
The pilot study included 22 people total in two cohorts: one before the COVID-19 pandemic and one during the pandemic's early months. Participants went through an eight-week mindfulness-based intervention in a group setting, with a trained facilitator leading discussions on sexuality and factors influencing sexual interest; guided meditations; and practical ways to apply mindfulness exercises in everyday life, including sexuality.
The weekly group sessions occurred via Zoom and lasted 1.5-2 hours each. Participants were also given homework to practice mindfulness exercises and reflect on aspects of sexuality.
In addition to cancer survivors, researchers recruited clinical and community stakeholders who provide medical and supportive care or work in advocacy for cancer survivors. Stakeholders did not attend the Zoom group sessions but were asked to read through the intervention and share their assessment of the general approach.
In general, participants who completed the eight-week program said the time commitment was manageable, and more than 80% attended at least seven of the eight sessions. Roughly three-quarters of participants reported learning and practicing mindfulness exercises; learning about how sexual interest is affected by thoughts and behaviors; and thinking about how their cancer experience relates to their sexual concerns.
Almost three-quarters of participants also said they liked the group nature of the program, especially the knowledge that they weren't alone in their struggle. However, there were some concerns; some participants said the discussions tended to be dominated by an outspoken few; others felt uncomfortable sharing personal details or struggled to feel a connection to the group in the remote video format.
The role of the facilitator proved crucial, Gorman said, and going forward it will be important for facilitators to be more active in moderating group discussions and ensuring each participant feels welcome to speak openly. From the pilot, researchers also learned it will be important to include a second facilitator who can monitor the technical aspect of Zoom meetings.
Researchers now want to test the intervention with a larger group of people to see if the virtual program can affect patient outcomes, Gorman said.
"I don't want to create something and have it just be a research study; I want it to be out in the world," she said. "I want people to be able to use it."
Gorman, J.R., et al. (2022) Feasibility of Mindful After Cancer: Pilot Study of a Virtual Mindfulness-Based Intervention for Sexual Health in Cancer Survivorship. Journal of Sexual Medicine. doi.org/10.1016/j.jsxm.2022.03.618.