Effect of Stepped Care on Sexual Interest and Enjoyment in Distressed Patients with Head and Neck Cancer: A Randomized Controlled Trial.

Laura E.R Schutte,Mirjam A.G Sprangers,Marije R Vergeer,Birgit I Lissenberg-Witte,Femke Jansen,Heleen C Melissant,Ellen T.M Laan,C René Leemans,Irma M Verdonck-De Leeuw

doi:10.1016/j.esxm.2020.100304

Laura E.R Schutte, Mirjam A.G Sprangers + Show 7 more

Open Access

https://doi.org/10.1016/j.esxm.2020.100304

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Abstract

IntroductionA recent randomized controlled trial (RCT) in patients with head and neck cancer (HNC) with psychological distress showed that a stepped care (SC) program targeting psychological distress compared with care as usual (CAU), is (cost)effective in reducing psychological distress.AimThe aim of the present study was to investigate whether SC can coalleviate problems with sexual interest and enjoyment. A secondary aim was to investigate whether the presence of an unmet sexual health need and having a psychiatric disorder (depression or anxiety) at baseline moderated any effect of SC on these sexual variables until 1-year follow-up.MethodsHNC survivors (N = 134), randomized to SC or CAU, were assessed regarding their sexual interest and enjoyment before and after the intervention and at 3, 6, 9, and 12 months follow-up. Linear mixed models were used to evaluate differences in the course of sexual interest and enjoyment between SC and CAU.Main Outcome MeasureThe “sexuality” symptom subscale, part of the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Cancer–specific module.ResultsOf all patients, 76.1% had an unmet sexual need at baseline, 24.6% had a psychiatric disorder (anxiety or depression). SC did not reduce problems with sexual interest and enjoyment at any of the follow-up measurements compared with CAU (P = .85). This was neither moderated by an unmet sexual health need at baseline (P = .64) nor by the presence of a psychiatric disorder at baseline (P = .59).ConclusionA substantial number of patients with HNC have unmet sexual health needs. SC targeting psychological distress does not reduce problems with sexuality in these patients. Interventions specifically targeting sexuality are recommended.Schutte LER, Melissant HC, Jansen F, et al. Effect of Stepped Care on Sexual Interest and Enjoyment in Distressed Patients with Head and Neck Cancer: A Randomized Controlled Trial. Sex Med 2021;9:100304.

Highlights

A recent randomized controlled trial (RCT) in patients with head and neck cancer (HNC) with psychological distress showed that a stepped care (SC) program targeting psychological distress compared with care as usual (CAU), iseffective in reducing psychological distress
These problems can lead to significant distress and are, besides other adverse psychosocial consequences, among the most negative influences of cancer and its treatment on quality of life.1e3 Even though the cancer is located outside the genital organs, patients with head and neck cancer (HNC) are at risk for developing intimacy issues or sexual problems.[4,5]
Treatment of patients with HNC often results in visible facial disfigurement, communication complications and other psychological and functional deficits that may interfere with intimate contact or sexual performance.4e8 sexuality of patients with HNC may be affected in a multidimensional manner

Summary

Introduction

A recent randomized controlled trial (RCT) in patients with head and neck cancer (HNC) with psychological distress showed that a stepped care (SC) program targeting psychological distress compared with care as usual (CAU), is (cost)effective in reducing psychological distress. SC did not reduce problems with sexual interest and enjoyment at any of the follow-up measurements compared with CAU (P 1⁄4 .85) This was neither moderated by an unmet sexual health need at baseline (P 1⁄4 .64) nor by the presence of a psychiatric disorder at baseline (P 1⁄4 .59).

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