Improvements in the diagnosis and treatment of cancer mean that more people are living with and surviving cancer, which brings with it a need to identify interventions that can help with any long-term complications. In this podcast, Bridget Candy from Marie Curie Palliative Care Research Department at UCL in London, England describes the findings of a new Cochrane Review from February 2016 which examined the randomised trials of interventions for sexual dysfunction in women.
John: Improvements in the diagnosis and treatment of cancer mean that more people are living with and surviving cancer, which brings with it a need to identify interventions that can help with any long-term complications. In this Evidence Pod, Bridget Candy from Marie Curie Palliative Care Research Department at UCL in London, England describes the findings of a new Cochrane Review from February 2016 which examined the randomised trials of interventions for sexual dysfunction in women.
Bridget: Sexual dysfunction is a potential long-term complication of many types of cancer treatment for women. This includes treatments that have a direct impact on the pelvic area and genitals, as well as treatments that may have a more generalised impact on sexual function such as chemotherapy. Sexual dysfunction poses challenges to a person’s social, mental, emotional and physical wellbeing. In cancer, it’s an important indicator of quality of life both in people undergoing treatments and in those surviving the disease.
We wanted to investigate the effectiveness of interventions, of any type, developed to treat sexual dysfunction following treatments for cancer in women. Such interventions include pharmacological treatments, mechanical, psychotherapeutic and psycho-educational, complementary medicine and exercise. We were also keen to investigate any adverse events associated with these interventions. Overall, we found that the evidence is fairly mixed and many uncertainties remain about how best to help women experiencing sexual dysfunction.
We found eleven randomised trials, involving just over 1500 women. All studies were vulnerable to a number of biases and other potential problems, most because of selection bias and having fewer than 50 participants per trial arm. They all explored interventions following treatment for either gynaecological or breast cancer.
Eight studies evaluated an intervention involving psychotherapeutic techniques, commonly a form of counselling including topics on sexuality and relationships. Another study evaluated exercise and the last two tested a pharmaceutical product, which were a testosterone cream and a pH balanced vaginal gel. Seven of the studies were done in the USA. The others were from Canada, Sweden and South Korea, where there were two trials.
Our ability to do combined analysis of the studies was limited by differences in the content of the interventions and in the outcomes that had been measured. But we are still able to draw some overall impressions of the findings.
The trials evaluating a psychotherapeutic intervention had mixed results for the effect on sexual function. In three studies, significant improvements were found for some measures of sexual function but no benefits were found in the other five studies.
Evidence from the two trials on different pharmaceutical applications and the one on exercise, was limited by small sample sizes. Of these studies, only the trial of a pH-balanced vaginal gel found significant improvements in sexual function.
The studies of pharmaceutical interventions measured harm, as did one of the psychotherapeutic studies, and none of these reported any harms occurring.
In summary, our review does not provide clear information on the impact of interventions for sexual dysfunction following the treatment of women for cancer. Studies to date have only explored effectiveness in women with gynaecological and breast cancers, but there is a risk of sexual problems after treatments for other cancers including, for example, bowel, and head and neck cancers. Few of the studies evaluated harm. This is an important gap, not least because some women may find it distressing to discuss personal sexual problems as part of their treatment for cancer. We’d like to see further evaluations for all interventions, and these new evaluations need to involve larger numbers of participants.”
John: To read more about the interventions that have already been examined in this review, and to watch for future updates as new evidence becomes available, go to the website for all Cochrane Reviews, Cochrane Library dot com, and search 'sexual dysfunction and cancer'.