Cognitive behavioral therapyand mindfulness-based interventions to address sexual functioning in women with cancer: a systematic review

Abstract Introduction Research suggests that over 60% of women with cancer report sexual functioning difficulties. Cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) have been used to treat sexual functioning difficulties in women with cancer. Objective The purpose of the current systematic review is to examine the state of the science with regard to the clinical efficacy of these interventions and the mechanisms by which they exert their effects. Methods Following PRISMA guidelines, we conducted a systematic review of randomized controlled trials (RCTs), published in English, testing CBT or MBI to improve sexual functioning in women diagnosed with cancer. Articles were identified using PubMed, Scopus, Cochrane, and PsycInfo using keywords and MeSH terms. Two reviewers independently assessed each article for inclusion, with a third to resolve discrepancies. Results Our search resulted in 1,056 articles, nine of which were eligible for inclusion in the review (6 studied CBT, 2 studied MBI, and 1 combined both CBT and MBI techniques). Sample sizes ranged from 21 to 304. One study included an active psychoeducational control group, while the rest were usual care, wait list control, or provided educational materials. Eight focused on breast cancer, and one on gynecologic cancer. All nine studies reported significant improvements in a measure of sexual functioning. Specifically, 8/9 studies found a difference in overall sexual functioning (e.g., Female Sexual Functioning Index (FSFI), PROMIS Sexual Function and Satisfaction Scale, etc.) relative to control. 4/9 studies tested specific domains of the FSFI (arousal, desire, lubrication, orgasm, satisfaction, and pain). Results varied such that relative to controls: 4/4 studies found significant improvement in arousal, 3/4 studies found significant improvement in desire, 3/4 studies found significant improvement in lubrication, 2/4 studies found significant improvement in orgasm, 2/4 studies found significant improvement in satisfaction, and 1/4 studies found significant improvement in pain. The one study that did find improvement in pain employed an MBI for women with breast cancer at any stage. No studies formally tested mechanisms of change. Conclusions Relatively few studies have assessed CBT and MBIs for sexual function in cancer, despite the large body of research on those interventions for cancer supportive care. However, the majority of the 9 CBT/MBI studies demonstrated efficacy for a range of sexual function outcomes. There was little support for improvement in FSFI pain frequency and severity, suggesting more research is needed to develop interventions to target these dimensions of pain. Additionally, given that both CBT and MBIs often work to change pain-related interference, bother, and distress, future studies should take a more in depth approach to pain assessment. Finally, future studies should aim to include active control groups (e.g., attention control) and test for mechanisms of change. Disclosure No