Overcoming Reproductive and Psychological Concerns of Breast Cancer Survivors: A Randomized Controlled Trial
-
Samira Barjasteh
,
Farnaz Farnam
,
Aymen Elsous
,
Saharnaz Nedjat
,
Saeid Razavi Dizaji
,
Zohreh Khakbazan
Abstract
Objective: After developing breast cancer, women experience changes in their sexuality, femininity, and fertility. These changes lead to poor mental health and increased psychological stress. Therefore, this study aimed to investigate the effects of Good Enough Sex (GES)-based, couple-centered group counseling on reproductive and sexual concerns of breast cancer survivors.
Materials and methods: This was a quantitative randomized controlled clinical trial (RCT) conducted at Omid Hospital, West Azerbaijan, Urmia, Iran from March 2018 to October 2020. After completing the informed consent forms, 100 women were assigned to the intervention and control groups (50 individuals per group) using a randomized block design. The intervention included four 90-120-minute sexual counseling sessions with 2 and 3 month follow-ups. The data were collected using the socio-demographic and clinical characteristics, the Persian version of Depression, Anxiety and Stress Scale (DASS-21), Reproductive Concerns after Cancer (RCAC) scale, and Female Sexual Function Index adaptation for Breast Cancer patients (FSFI-BC). Data were collected, from control and intervention groups, at three intervals; before, besides two months and three months post intervention, then were analyzed in SPSS 20 using descriptive and repeated measures analysis of variance (ANOVA) test.
Results: Significant reduction in the mean score of DASS-21, RCAC and improvement of FSFI-BC is reported between the intervention and control groups in favor of intervention group (P<0.001). However, no significant differences are observed within intervention group over two- and three-months post intervention (P > 0.05).
Conclusion: The designed Good Enough Sex (GES)-based, couple-centered group counseling effectively reduced reproductive and sexual concerns of females’ breast cancer survivors. Therefore, these training and counseling programs can be organized by relevant service centers to promote the reproductive health of women with breast cancer.
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J Intern Med 2021; 289: 12-28.
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7. Dolatkhah R, Somi MH, Jafarabadi MA, Hosseinalifam
M, Sepahi S, Belalzadeh M, et al. Breast Cancer Survival and Incidence: 10 Years Cancer Registry
Data in the Northwest, Iran. Int J Breast Cancer 2020; 2020: 1963814.
8. Heinemann J, Atallah S, Rosenbaum T. The impact of culture and ethnicity on sexuality and sexual function. Current Sexual Health Reports 2016; 8: 144-50.
9. Gharibi T, Gharibi T, Ravanipour M. Facilitators and barriers affecting sexual desire in elderly Iranian women: a qualitative study. Sexual and relationship therapy 2019; 34: 228-41.
10. Abdollahzadeh F, Moradi N, Pakpour V, Rahmani A, Zamanzadeh V, Mohammadpoorasl A, et al. Un-met supportive care needs of Iranian breast cancer patients. Asian Pac J Cancer Prev 2014; 15: 3933-8.
11. Wang LY, Pierdomenico A, Lefkowitz A, Brandt R. Female Sexual Health Training for Oncology Providers: New Applications. Sex Med 2015; 3: 189-97.
12. Huang HM, Lai JH, Huang TW. Mediating effects of depression on anxiety and leisure constraints in patients with breast cancer. BMC Women's Health 2019; 19: 141.
13. Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA, et al. Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS One 2017; 12: e0172975.
14. Ruggeri M, Pagan E, Bagnardi V, Bianco N, Gallerani E, Buser K, et al. Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers. Breast 2019; 47: 85-92.
15. Ljungman L, Ahlgren J, Petersson LM, Flynn KE, Weinfurt K, Gorman JR, et al. Sexual dysfunction and reproductive concerns in young women with breast cancer: type, prevalence, and predictors of problems. Psychooncology 2018; 27: 2770-7.
16. Najafi M, Neishaboury M, Ghafari N, Haghighat S, Memari F, Kaviani A. Surgeons' Perspectives on Surgery of Breast Cancer in Iran: The Pattern and Determinants. Archives of Breast Cancer 2015; 2: 58-63.
17. McCarthy B, Wald LM. Couples Therapy and Counseling. Management of Sexual Dysfunction in Men and Women: Springer, 2016: 365-70.
18. Khamse F, Zahrakar K, Mohsenzade F. The effect of practical application of intimate relationship skills (PAIRS) on enhancing sexual satisfaction and marital happiness in married wives. Positive Psychology Research 2015; 1: 52-41.
19. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33: 335-43.
20. Hosini SM, Nazari MA, Rasooli M, Shakarami M, Hosini SM. The relationship of main family health and marital intimacy: Evaluating the mediating role of constructive and non-constructive conflict resolution styles. Thoughts and Behavior in Clinical Psychology 2014; 9: 67-76.
21. Gorman JR, Su HI, Pierce JP, Roberts SC, Dominick SA, Malcarne VL. A multidimensional scale tomeasure the reproductive concerns of young adult female cancer survivors. J Cancer Surviv 2014; 8: 218-28.
22. Bartula I, Sherman KA. The Female Sexual Functioning Index (FSFI): evaluation of acceptability, reliability, and validity in women with breast cancer. Support Care Cancer 2015; 23: 2633-41.
23. Masjoudi M, Keshavarz Z, Nasiri M, Kashani FL. Exploration unmet sexual needs and promoting sexual function in breast cancer patients, Tehran: A mixed study [A dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy (PhD)]: School of Midwifery And Nursing; 2019.
24. McCarthy B, Cohn D, Koman CA. Sexual equity and the good enough sex model. Sexual and Relationship Therapy 2020; 35: 291-303.
25. Ye M, Du K, Zhou J, Zhou Q, Shou M, Hu B, et al. A meta‐analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psychooncology 2018; 27: 1695-703.
26. Shandiz FH, Karimi FZ, Rahimi N, Abdolahi M, Anbaran ZK, Ghasemi M, et al. Investigating sexual function and affecting factors in women with breast cancer in Iran. Asian Pac J Cancer Prev 2016; 17: 3583-6.
27. Khatibian M, Shakerian A. The effectiveness of cognitive behavioral group therapy on decreasing depression, anxiety and stress in breast cancer women admitted to Ahwaz Medical Sciences Hospitals. Scientific Journal of Kurdistan University of Medical Sciences 2014; 19:91-99.
28. Nabipoor Gisi S, Rafieepoor A, Haji Alizadeh K. Effectiveness of mindfulness-based cognitive therapy (MBCT) on psychological symptoms in patients with cancer. Journal of Research in Behavioural Sciences 2019; 16: 333-43.
29. Vu JV, Llarena NC, Estevez SL, Moravek MB, Jeruss JS. Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients.
J Surg Oncol 2017; 115: 116-21.
30. Massarotti C, Scaruffi P, Lambertini M, Sozzi F, Remorgida V, Anserini P. Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients. Hum Reprod 2019; 34: 1462-9.
31. Kufel-Grabowska J, Litwiniuk M, Marszałek S, Górecki M, Malinowska M, Doś J, et al. 192P Strategies and results of oncofertility counselling in young breast cancer patients. Annals of Oncology 2020; 31: S85.
32. Macklon KT, Fauser B. The female post-cancer fertility-counselling clinic: looking beyond the freezer. A much needed addition to oncofertility care. Reprod Biomed Online 2019; 39: 179-81.
33. Deshpande NA, Braun IM, Meyer FL. Impact of fertility preservation counseling and treatment on psychological outcomes among women with cancer: A systematic review. Cancer 2015; 121: 3938-47.
34. Mody SK, Gorman JR, Oakley LP, Layton T, Parker BA, Panelli D. Contraceptive utilization and counseling among breast cancer survivors. J Cancer Surviv 2019; 13: 438-46.
35. Stark SS, Natarajan L, Chingos D, Ehren J, Gorman JR, Krychman M, et al. Design of a randomized controlled trial on the efficacy of a reproductive health survivorship care plan in young breast cancer survivors. Contemp Clin Trials 2019; 77: 27-36.
36. Fatehi S, Maasoumi R, Atashsokhan G, Hamidzadeh A, Janbabaei G, Mirrezaie SM. The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2019; 175: 171-9.
37. Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, et al. Sexual functioning and relationship satisfaction of partners of breast cancer survivors who receive internet-based sex therapy. J Sex Marital Ther 2019; 45: 91-102.
38. Lampic C, Ljungman L, Micaux Obol C, Eriksson LE, Wettergren L. A web-based psycho-educational intervention (Fex-Can) targeting sexual dysfunction and fertility-related distress in young adults with cancer: study protocol of a randomized controlled trial. BMC Cancer 2019; 19: 344.
39. Farah LK, Shahram V, Zeinab H. Sexual skills training, body image and sexual function in breast cancer. Procedia-Social and Behavioral Sciences 2014; 159: 288-92.
40. León‐Pizarro C, Gich I, Barthe E, Rovirosa A, Farrús B, Casas F, et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality‐of‐life indices for gynecologic and breast brachytherapy patients. Psychooncology 2007; 16: 971-9.
41. Reese JB, Smith KC, Handorf E, Sorice K, Bober SL, Bantug ET, et al. A randomized pilot trial of a couple-based intervention addressing sexual concerns for breast cancer survivors. J Psychosoc Oncol. 2019; 37: 242-63.
42. Salonen P, Tarkka MT, Kellokumpu-Lehtinen PL, Åstedt-Kurki P, Luukkaala T, Kaunonen M. Telephone intervention and quality of life in patients with breast cancer. Cancer Nurs 2009; 32: 177-90.
J Intern Med 2021; 289: 12-28.
2. Yazdani-Charati R, Hajian-Tilaki K, Sharbatdaran M. Comparison of pathologic characteristics of breast cancer in younger and older women. Caspian J Intern Med 2019; 10: 42-7.
3. Nafissi N, Khayamzadeh M, Zeinali Z, Pazooki D, Hosseini M, Akbari ME. Epidemiology and histopathology of breast cancer in Iran versus other Middle Eastern countries. Middle East J Cancer 2018; 9: 243-51.
4. Entezar Mahdi R, KHalkhali HR. Estimation burden of breast cancer in West Azarbaijan province in year 2013. Studies in Medical Sciences 2017; 28: 1-7.
5. Zarei M, Bagheri-Saweh MI, Rasolabadi M, Vakili R, Seidi J, Kalhor MM, et al. Breast cancer research in Iran: a scientometric analysis of publications output from 1991 to 2015 in Scopus. Electronic physician 2017; 9: 3816-22.
6. Akbari ME, Sayad S, Sayad S, Khayamzadeh M, Shojaee L, Shormeji Z, et al. Breast cancer status in Iran: Statistical analysis of 3010 cases between 1998 and 2014. Int J Breast Cancer 2017; 2017: 2481021.
7. Dolatkhah R, Somi MH, Jafarabadi MA, Hosseinalifam
M, Sepahi S, Belalzadeh M, et al. Breast Cancer Survival and Incidence: 10 Years Cancer Registry
Data in the Northwest, Iran. Int J Breast Cancer 2020; 2020: 1963814.
8. Heinemann J, Atallah S, Rosenbaum T. The impact of culture and ethnicity on sexuality and sexual function. Current Sexual Health Reports 2016; 8: 144-50.
9. Gharibi T, Gharibi T, Ravanipour M. Facilitators and barriers affecting sexual desire in elderly Iranian women: a qualitative study. Sexual and relationship therapy 2019; 34: 228-41.
10. Abdollahzadeh F, Moradi N, Pakpour V, Rahmani A, Zamanzadeh V, Mohammadpoorasl A, et al. Un-met supportive care needs of Iranian breast cancer patients. Asian Pac J Cancer Prev 2014; 15: 3933-8.
11. Wang LY, Pierdomenico A, Lefkowitz A, Brandt R. Female Sexual Health Training for Oncology Providers: New Applications. Sex Med 2015; 3: 189-97.
12. Huang HM, Lai JH, Huang TW. Mediating effects of depression on anxiety and leisure constraints in patients with breast cancer. BMC Women's Health 2019; 19: 141.
13. Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA, et al. Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS One 2017; 12: e0172975.
14. Ruggeri M, Pagan E, Bagnardi V, Bianco N, Gallerani E, Buser K, et al. Fertility concerns, preservation strategies and quality of life in young women with breast cancer: Baseline results from an ongoing prospective cohort study in selected European Centers. Breast 2019; 47: 85-92.
15. Ljungman L, Ahlgren J, Petersson LM, Flynn KE, Weinfurt K, Gorman JR, et al. Sexual dysfunction and reproductive concerns in young women with breast cancer: type, prevalence, and predictors of problems. Psychooncology 2018; 27: 2770-7.
16. Najafi M, Neishaboury M, Ghafari N, Haghighat S, Memari F, Kaviani A. Surgeons' Perspectives on Surgery of Breast Cancer in Iran: The Pattern and Determinants. Archives of Breast Cancer 2015; 2: 58-63.
17. McCarthy B, Wald LM. Couples Therapy and Counseling. Management of Sexual Dysfunction in Men and Women: Springer, 2016: 365-70.
18. Khamse F, Zahrakar K, Mohsenzade F. The effect of practical application of intimate relationship skills (PAIRS) on enhancing sexual satisfaction and marital happiness in married wives. Positive Psychology Research 2015; 1: 52-41.
19. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33: 335-43.
20. Hosini SM, Nazari MA, Rasooli M, Shakarami M, Hosini SM. The relationship of main family health and marital intimacy: Evaluating the mediating role of constructive and non-constructive conflict resolution styles. Thoughts and Behavior in Clinical Psychology 2014; 9: 67-76.
21. Gorman JR, Su HI, Pierce JP, Roberts SC, Dominick SA, Malcarne VL. A multidimensional scale tomeasure the reproductive concerns of young adult female cancer survivors. J Cancer Surviv 2014; 8: 218-28.
22. Bartula I, Sherman KA. The Female Sexual Functioning Index (FSFI): evaluation of acceptability, reliability, and validity in women with breast cancer. Support Care Cancer 2015; 23: 2633-41.
23. Masjoudi M, Keshavarz Z, Nasiri M, Kashani FL. Exploration unmet sexual needs and promoting sexual function in breast cancer patients, Tehran: A mixed study [A dissertation presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy (PhD)]: School of Midwifery And Nursing; 2019.
24. McCarthy B, Cohn D, Koman CA. Sexual equity and the good enough sex model. Sexual and Relationship Therapy 2020; 35: 291-303.
25. Ye M, Du K, Zhou J, Zhou Q, Shou M, Hu B, et al. A meta‐analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psychooncology 2018; 27: 1695-703.
26. Shandiz FH, Karimi FZ, Rahimi N, Abdolahi M, Anbaran ZK, Ghasemi M, et al. Investigating sexual function and affecting factors in women with breast cancer in Iran. Asian Pac J Cancer Prev 2016; 17: 3583-6.
27. Khatibian M, Shakerian A. The effectiveness of cognitive behavioral group therapy on decreasing depression, anxiety and stress in breast cancer women admitted to Ahwaz Medical Sciences Hospitals. Scientific Journal of Kurdistan University of Medical Sciences 2014; 19:91-99.
28. Nabipoor Gisi S, Rafieepoor A, Haji Alizadeh K. Effectiveness of mindfulness-based cognitive therapy (MBCT) on psychological symptoms in patients with cancer. Journal of Research in Behavioural Sciences 2019; 16: 333-43.
29. Vu JV, Llarena NC, Estevez SL, Moravek MB, Jeruss JS. Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients.
J Surg Oncol 2017; 115: 116-21.
30. Massarotti C, Scaruffi P, Lambertini M, Sozzi F, Remorgida V, Anserini P. Beyond fertility preservation: role of the oncofertility unit in the reproductive and gynecological follow-up of young cancer patients. Hum Reprod 2019; 34: 1462-9.
31. Kufel-Grabowska J, Litwiniuk M, Marszałek S, Górecki M, Malinowska M, Doś J, et al. 192P Strategies and results of oncofertility counselling in young breast cancer patients. Annals of Oncology 2020; 31: S85.
32. Macklon KT, Fauser B. The female post-cancer fertility-counselling clinic: looking beyond the freezer. A much needed addition to oncofertility care. Reprod Biomed Online 2019; 39: 179-81.
33. Deshpande NA, Braun IM, Meyer FL. Impact of fertility preservation counseling and treatment on psychological outcomes among women with cancer: A systematic review. Cancer 2015; 121: 3938-47.
34. Mody SK, Gorman JR, Oakley LP, Layton T, Parker BA, Panelli D. Contraceptive utilization and counseling among breast cancer survivors. J Cancer Surviv 2019; 13: 438-46.
35. Stark SS, Natarajan L, Chingos D, Ehren J, Gorman JR, Krychman M, et al. Design of a randomized controlled trial on the efficacy of a reproductive health survivorship care plan in young breast cancer survivors. Contemp Clin Trials 2019; 77: 27-36.
36. Fatehi S, Maasoumi R, Atashsokhan G, Hamidzadeh A, Janbabaei G, Mirrezaie SM. The effects of psychosexual counseling on sexual quality of life and function in Iranian breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2019; 175: 171-9.
37. Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, et al. Sexual functioning and relationship satisfaction of partners of breast cancer survivors who receive internet-based sex therapy. J Sex Marital Ther 2019; 45: 91-102.
38. Lampic C, Ljungman L, Micaux Obol C, Eriksson LE, Wettergren L. A web-based psycho-educational intervention (Fex-Can) targeting sexual dysfunction and fertility-related distress in young adults with cancer: study protocol of a randomized controlled trial. BMC Cancer 2019; 19: 344.
39. Farah LK, Shahram V, Zeinab H. Sexual skills training, body image and sexual function in breast cancer. Procedia-Social and Behavioral Sciences 2014; 159: 288-92.
40. León‐Pizarro C, Gich I, Barthe E, Rovirosa A, Farrús B, Casas F, et al. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality‐of‐life indices for gynecologic and breast brachytherapy patients. Psychooncology 2007; 16: 971-9.
41. Reese JB, Smith KC, Handorf E, Sorice K, Bober SL, Bantug ET, et al. A randomized pilot trial of a couple-based intervention addressing sexual concerns for breast cancer survivors. J Psychosoc Oncol. 2019; 37: 242-63.
42. Salonen P, Tarkka MT, Kellokumpu-Lehtinen PL, Åstedt-Kurki P, Luukkaala T, Kaunonen M. Telephone intervention and quality of life in patients with breast cancer. Cancer Nurs 2009; 32: 177-90.
| Files | ||
| Issue | Vol 16, No 1 (March 2022) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v16i1.8594 | |
| Keywords | ||
| Breast Cancer Anxiety Depression Reproductive Health Psychology Sexual Function | ||
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How to Cite
1.
Barjasteh S, Farnam F, Elsous A, Nedjat S, Razavi Dizaji S, Khakbazan Z. Overcoming Reproductive and Psychological Concerns of Breast Cancer Survivors: A Randomized Controlled Trial. J Family Reprod Health. 2022;16(1):52-60.
