Efficacy of a sexual quality of life intervention for couples facing metastatic breast cancer: Results of a randomized controlled trial

Abstract

Background: Patients with metastatic breast cancer (MBC) often report severe, long-standing concerns with their sexual quality of life (QOL), yet interventions for this population are scarce. This study evaluated the efficacy of a couple-based sexual QOL intervention adapted for MBC couples in a randomized controlled trial.

Methods: Fifty-five female MBC patients reporting sexual concerns and their intimate partners (N = 110 participants) were randomized to Adapted Intimacy Enhancement (AIE), a four-session videoconference intervention providing education and skills training for coping with sexual/intimacy concerns, or Enhanced Care-As-Usual (ECAU; informational booklet). Outcomes (measured at baseline, post-intervention, and 6-month follow-up) included patients' sexual outcomes (sexual function/distress/self-efficacy; primary), patients' psychosocial outcomes (sexual communication, relationship intimacy, and psychological distress; secondary), and similar partner outcomes (secondary). Mixed linear regression models assessed intervention effects on outcomes at follow-ups; psychosocial outcomes were analyzed using dyadic analyses. Effect sizes (Cohen's d) were calculated.

Results: Compared to ECAU, patients in AIE reported greater improvements in overall sexual function (p = .018), desire (p = .007), and sexual distress (p = .046) at 6 months, and in sexual satisfaction at both post-intervention (p = .02) and 6 months (p < .001). Partners in AIE reported greater improvements in sexual distress (p = .006), sexual self-efficacy (p = .008), sexual communication (p = .004), and relationship intimacy (p = .01) at 6 months. Effects were largest for patient sexual satisfaction and partner sexual distress at 6 months.

Conclusions: Compared to a detailed informational booklet on sex/intimacy, the couple-based AIE intervention yielded long-term benefits for MBC patients' sexual outcomes and partners' sexual distress and psychosocial outcomes. Future research should identify intervention mediators and optimal dissemination methods.

Keywords: breast cancer; dyadic coping; intimacy; randomized controlled trial; sexual dysfunction; videoconference intervention.

Figure 1

Study Flow Diagram (CONSORT) Note: A half-completed follow-up survey represents instances where half of a couple completed an assessment (e.g., 0.5 post-intervention survey completed indicates only the patient completed the survey and the partner did not).

Figure 2

Trajectories of Change in Scores on by Role (patient vs. partner) and Study Arm (AIE vs. ECAU) for (a) Self-Efficacy for Coping with Sexual Concerns, (b) Sexual Communication, and (c) Relationship Intimacy Note: Three-way interactions for depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7) were not statistically significant and thus the graphs for these outcomes are not shown.