Dr. Lauren Walker receives funding to study the role of mindfulness-based treatment for sexual difficulties following breast cancer

Women experiencing chemotherapy or endocrine therapy induced menopause are particularly likely to report reduced sexual interest and arousal, and sexual pain. Yet, low sexual interest and arousal is unlikely to resolve on its own and treatment interventions within the cancer population are very limited. 

Prevalence rates of sexual dysfunction after breast cancer (BrCa) treatment are in the order of 45-86%. The most prevalent complaints focus on reduced desire, impaired arousal, and painful sexual experiences (dyspareunia). Women experiencing chemotherapy or endocrine therapy induced menopause are particularly likely to report reduced sexual interest and arousal, and sexual pain. Sexual dysfunction is highly distressing and is unlikely to resolve on its own. It presents challenges to maintaining a satisfying sexual relationship, and ultimately impacts the overall well-being and quality of life of both patients and partners. To date, interventions to treat low sexual interest and arousal within the cancer population are very limited.

Evidence demonstrates that mindfulness-based interventions improve sexual desire, arousal, lubrication, and satisfaction in individuals who do not have cancer. Preliminary data from an 8-session mindfulness-based intervention for otherwise healthy women with Sexual Interest/Arousal Disorder (SIAD) showed significant improvements in participant’s sexual desire, overall sexual function, and sexual distress. The intervention employs Mindfulness-Based Cognitive Therapy for sexuality (MBCT-S) which incorporates several empirically supported therapeutic approaches, integrating elements of education, mindfulness meditation skills, and sex therapy.

The primary aims of Dr. Walker's study are:

1. to test the effects of MBCT-S versus a sex education group on 3 co-primary endpoints: (a) sexual desire, (b) sexual distress, and (c) sexual pain;
2. to test maintenance of effects at 3 and 6 months following treatment;
3. to examine four potential mediators of change following MBCT-S
4. to explore the relationship between baseline patient characteristics and treatment outcomes to determine variables that predict the greatest benefits.

Participants are adult women who are sexually active in the past six months, English-fluent, with a history of BrCa, who exceed the clinical cut-off for sexual distress, and who are not currently receiving cancer treatment. Assessments will occur at 4 time-points: pre-treatment, post-treatment, and 3- and 6-months follow-ups. Assessments will include a clinician administered interview, and validated questionnaires assessing sexual distress, sexual function (including interest and arousal), sexual pain, pain acceptance, pain catastrophizing, mindfulness, and mood.

Descriptive statistics and frequencies will be calculated to report participant characteristics. A 2×4 mixed multivariate analysis of variance (MANOVA) will examine changes in primary outcomes (1) within groups over time, (2) between the two treatment groups, and (3) the interaction of the within and between group factors. Based on a power of .9, alpha of .05, a medium effect size for the primary outcomes (according to the pilot), and 20% attrition, it is estimated that 92 patients are needed (n=46 patients per group).

Low sexual desire and arousal, and sexual pain, are profound issues for BrCa patients that are often unaddressed due to patient-provider communication barriers and lack of treatment options. These findings will position our team to develop KT activities designed to reduce existing barriers preventing women from getting effective sexual health treatments.

Award: This grant is co-led by Dr. Lori Brotto (University of British Columbia) and was awarded by Canadian Cancer Society Research Institute (CCSRI), Innovation Grants 2019 – Prevention and Quality of Life Panel (Grant #706352)

For a complete list of recipients please visit http://www.cancer.ca/en/research/funding-results/recent-competition-results/jan-2019-innov-results/