NARRATIVE: There are over 80,000 new gynecologic cancer diagnoses per year. Despite the large numbers, little research has focused on the psychological concerns of these patients, particularly with regard to their significant sexual morbidity. This proposed research advances public mental health by providing an important first step in developing and testing a psychological intervention to decrease sexual dysfunction and improve mental health, thereby reducing burden to patients, their partners, and the healthcare system.
ABSTRACT: Worldwide, gynecologic cancer is a leading cause of death. In the US, it accounts for more than 11% of annual new cancer cases in females. Fortunately, the majority of the 80 thousand women diagnosed each year survive, yet they are forced to cope with significant psychological, behavioral, and health-related morbidities. For the individual patient, diagnosis is accompanied by extreme stress with multimodal therapies to follow. Hundreds of randomized clinical trials (RCTs) of psychological interventions for cancer patients have been conducted; only 21 of these include gynecologic cancer patients. Moreover, few RCTs – only 5 – have included a sexual functioning component, in spite of the high frequency (>50%) of moderate-to-severe morbidity, a circumstance well known among gynecologic oncologists and documented for decades by behavioral scientists. With this application, we propose to test an intervention designed to substantively address this important, unmet need.
A two-phase project is proposed. During Phase I, individual treatment will be offered to gyn survivors (N=8-10) with current sexual complaints. Their clinical responses to treatment will enable a final revision of intervention content and alteration of any procedures to insure treatment acceptability for Phase II. With this and other preparations complete, we will conduct a small RCT in Phase II. Gynecologic cancer survivors (N=60) who are post-surgery will be accrued and randomized to one of two study arms: Intervention (n=30) or Enhanced Standard Care (n=30). The intervention is a novel combination of sex therapy, cognitive-behavioral therapy, and stress management. In Phase II, we will achieve three aims: (1) test the efficacy of the intervention to affect primary (sexual) and secondary (distress, depressive symptoms, fatigue) outcomes; (2) test the acceptability and feasibility of the intervention; and (3) assemble clinical detail, estimate effect sizes, and discover factors producing variability in patient outcomes. Completion of both phases leads an experienced, interdisciplinary, investigator team to their overarching goal, conducting a large-scale RCT testing the efficacy of a psychological intervention tailored to the needs of this underserved cancer patient group. This is a high impact research program that, if successful, will change the trajectory of sexual morbidity and substantively improve gynecologic cancer survivorship.