E-therapy tied to better body image, intimacy for breast cancer survivors

Internet-based psychotherapy focused on changing behavior may be tied to improved body image and sexual functioning in breast cancer survivors, a recent study suggests.

Researchers randomly selected 169 breast cancer survivors diagnosed with sexual dysfunction to receive either online cognitive behavioral therapy for up to 24 weeks or to join a control group of people on a waiting list for therapy.

After 10 weeks, women in the therapy group reported bigger improvements in sexual desire and pleasure and less discomfort during sex than women on the waitlist, the study found. By the time treatment ended, women who got online therapy also reported greater improvements in desire and overall sexual functioning than women on the waitlist.

"Several studies have demonstrated the efficacy and applicability of internet-based cognitive behavioral therapy for female sexual dysfunctions in the general population," said senior study author Neil Aaronson of the Netherlands Cancer Institute in Amsterdam.

The current study, however, is the first to evaluate and confirm the effectiveness of this type of treatment for sexual dysfunction in female breast cancer survivors, Aaronson added by email.

"This is particularly important because the prevalence of sexual dysfunction in this population is two to three times higher than in the general population," Aaronson said.

For the study, women in the treatment group could participate in up to 24 weekly sessions guided by a therapist. Researchers surveyed all of the participants at the start of the study, after 10 weeks and after therapy sessions concluded, with a similar schedule for women on the waiting list and patients in therapy.

Participants were 51 years old on average and most of them had a romantic partner. Slightly more than half of the women had undergone breast-conserving treatment, with a majority getting chemotherapy, radiation or hormones.

The most common type of sexual dysfunction was low desire, which affected about 83 percent of the women, followed by sexual arousal disorder, which impacted 40 percent of participants.

Overall, the odds of improved sexual functioning were more than tripled with therapy, compared with women on the waiting list.

Researchers didn't find any meaningful differences between groups in orgasmic function, sexual satisfaction, intercourse frequency, relationship intimacy, psychological distress, marital satisfaction or health-related quality of life.

One limitation of the study is that it wasn't designed to show whether web-based treatment might be any better or worse than in-person therapy sessions, the authors note. Another drawback is that only 62 percent of women in therapy completed the treatment cycle.

In addition, researchers didn't have clinicians examine women at the end of the study to see how many participants still had a diagnosis of sexual dysfunction, the researchers note. A goal of treatment would be to help women improve enough to no longer meet the criteria for this diagnosis.

While the internet doesn't allow patients to develop the same personal relationships with therapists that they can establish in the same room together, online treatment may be a more convenient and private option that some women may prefer, Aaronson said.

One potential downside to web therapy could be the lack of a therapist to visit in person when problems arise, said Dr. Christine Rini, a researcher at Hackensack University Medical Center in New Jersey who wasn't involved in the study.

"People using the therapy may be less likely to get help for problems such as distress or relationship conflicts caused by completing the therapy," Rini said by email. "In an emergency, that could be a real problem."

But web-based therapy could make treatment available to far more patients, and be more affordable than in-person visits, Rini said. "Using the web should allow people to get this therapy even if they could not or would not attend in-person therapy," Rini added. "People need to decide whether they prefer in-person versus web-based therapy."