Telehealth and e-health interventions could help in promoting sexual health in patients who had or have colorectal cancer (CRC), according to a review published in Healthcare. This result will need to be further researched to assess the efficacy of such interventions.
CRC has the second highest mortality rate in the world, being the fourth most diagnosed cancer globally. Surgery, chemotherapy, and radiation therapy are all potential treatments for CRC but these treatments can all lead to psychological and social impairments that affect the quality of life of the patients. Sexual problems have been found to be a consequence of treatments associated with CRC. Information is lacking in identifying sexual health concerns in patients with CRC. This review aimed to identify interventions that targeted the psychology of patients in improving sexual health.
EBSCO Host, Web of Science, PubMed, and the Cochrane Library were used to search for literature in July 2023. Studies were excluded if they did not specify the cancer type of the patient. Studies were included if they had a sample that was entirely or partially composed of patients and survivors of CRC, included psychological interventions that promoted sexual health in patients and survivors in CRC, if studies contained a control sample, and if the study reported sexual health outcomes. Trials, interventions, and protocols that did not target outcomes for sexual health were excluded. All studies needed to be published in English to be included.
There were 4 studies that were included in the review. The outcomes of the interventions were measured using several different measurements, including the Beck Depression Inventory, the Dyadic Adjustment Scale, the Dyadic Sexual Communication Scale, and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire among others.
The Intimacy Enhancement (IE) Intervention, a telehealth couple’s intervention protocol for patients with CRC, was used in 2 of the studies included in the review. IE uses strategies from both couples and sexual cognitive-behavioral therapy in 4 phone calls lasting 50 minutes held once a week. Large effect sizes were found for male patients’ sexual distress and communication and in female patients’ sexual function in the preliminary findings; dyadic adjustment and spouses’ outcomes had medium effect sizes and intimacy and male sexual function of patients with CRC were small effect sizes. A separate cohort was found to have sexual communication and 2 self-efficacy items presenting with negative effect sizes.
The Psychoeducational Intervention for Sexual Health in Cancer Survivors was used as an e-health self-administered version of an in-person program. This program lasted for 12 weeks and mostly focused on male and female patients who reported sexual distress after gynecologic, colon, and rectal cancer. The mindfulness, psychoeducational intervention focused on a different topic each week that was to be completed in an hour, with homework for all participants each week. Sex-related distress was higher in women than in men at baseline; this decreased after the intervention and was further reduced in a 6-month follow-up. Women reported increases in all dimensions of sexual function whereas men presented improvements in intercourse satisfaction alone. Dyadic consensus decreased in men but did not change significantly in women. Women also presented with a decrease in depressive symptoms at the follow-up assessment.
Cancer Survivorship Intervention-Sexual Health was used for women with rectal or anal cancer who had low to moderate levels of satisfaction. There were 4 sessions for this intervention, all of which had a different theme and homework was assigned for each session. All measured dimensions improved at the 4-month follow-up and remained stable through to the 8-month follow-up. This improvement was notable in women who reported being sexually active; outcomes for sexual function were not significant.
There were some limitations to this study. The score on the Quality Assessment Tool for Quantitative Studies was found to be low in all included studies. A control group was only included in 2 of the studies and effect size analyses were only done in studies that included IE. Patients needing palliative care were also absent from the included studies. High attrition rates were also recorded in the included studies.
Sexual health in patients with CRC could be promoted using these telehealth and e-health interventions, both in patients and survivors. Additional research is required to prove the efficacy of such interventions in larger groups.
Rocha HB, Carneiro BC, Vasconcelos PA, Pereira R, Quinta-Gomes AL, Nobre PJ. Promoting sexual health in colorectal cancer patients and survivors: results from a systematic review. Healthcare. 2024;12:253. doi:10.3390/healthcare12020253