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Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention

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Abstract

While quality of life for most breast cancer survivors (BCS) returns to normal by 1 year post-treatment, problems in sexual function and intimacy often persist. The present study tested the efficacy of a 6-week psycho-educational group intervention in improving BCS’s sexual well-being. We conducted a mailed survey of BCS 1–5 years post-diagnosis to identify a sample of women who reported moderately severe problems in body image, sexual function or partner communication, and were deemed eligible for the randomized intervention trial. Using a pre-randomized design, 70% (n = 284) were assigned to a 6-week psycho-educational group intervention and 30% (n = 127) were assigned to a control condition (print material only); however, only 83 BCS agreed to participate in the intervention. Four months post-intervention, the intervention and control groups were not significantly different on the primary outcome of emotional functioning; however, BCS randomized to the intervention group were more likely to report improvements in relationship adjustment and communication as well as increased satisfaction with sex compared to controls. Members of the intervention group who were the least satisfied with their sexual relationship appeared to improve the most. Although modest in its effects, this intervention can be delivered in standard clinical settings. Having an identified treatment may help reduce physician reluctance to ask BCS about problems in intimacy and as appropriate, refer them for timely help.

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References

  1. Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds) (2008) SEER cancer statistics review, 1975–2005, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2005/, based on Nov 2007 SEER data submission, posted to the SEER web site

  2. Rowland JH, Massie MJ (2009) Psychosocial adaptation during and after breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK (eds) Diseases of the breast, 4th edn. Lippincott Williams and Wilkins, Philadelphia, PA (in press)

    Google Scholar 

  3. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR (2002) Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 94:39–49

    PubMed  Google Scholar 

  4. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 330:702–705. doi:10.1136/bmj.38343.670868.D3

    Article  PubMed  Google Scholar 

  5. Mols F, Vingerhoets AJ, Coebergh JW et al (2005) Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer 411:2613–2619. doi:10.1016/j.ejca.2005.05.017

    Article  Google Scholar 

  6. Alfano CM, Rowland JH (2006) Recovery issues in cancer survivorship: a new challenge for supportive care. Cancer J 12:432–443. doi:10.1097/00130404-200609000-00012

    Article  PubMed  Google Scholar 

  7. Knobf T (2007) Psychosocial responses in breast cancer survivors. Semin Oncol Nurs 23:71–83. doi:10.1016/j.soncn.2006.11.009

    Article  PubMed  Google Scholar 

  8. Wolberg WH, Romsaas EP, Tanner MA, Malec JF (1989) Psychosexual adaptation to breast cancer surgery. Cancer 63:1645–1655. doi:10.1002/1097-0142(19890415)63:8<1645::AID-CNCR2820630835>3.0.CO;2-8

    Article  CAS  PubMed  Google Scholar 

  9. Ganz PA, Schag CAC, Lee JJ, Polinsky ML, Tan SJ (1992) Breast conservation versus mastectomy: is there a difference in psychological adjustment or quality of life in the year after surgery. Cancer 69:1729–1738. doi:10.1002/1097-0142(19920401)69:7<1729::AID-CNCR2820690714>3.0.CO;2-D

    Article  CAS  PubMed  Google Scholar 

  10. Schag CA, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L (1993) Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol 11:783–793

    CAS  PubMed  Google Scholar 

  11. Broeckel JA, Thors CL, Jacobsen PB, Small M, Cox CE (2002) Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy. Breast Cancer Res Treat 75:241–248. doi:10.1023/A:1019953027596

    Article  PubMed  Google Scholar 

  12. Kornblith AB, Herndon JEII, Weiss RB et al (2003) Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer 98:679–689. doi:10.1002/cncr.11531

    Article  PubMed  Google Scholar 

  13. Burwell SR, Case D, Kaelin C, Avis NE (2006) Sexual problems in younger women after breast cancer surgery. J Clin Oncol 24:2815–2821. doi:10.1200/JCO.2005.04.2499

    Article  PubMed  Google Scholar 

  14. Kiebert GM, de Haes JC, Van de Velde CJ (1991) The impact of breast conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. J Clin Oncol 9:1059–1070

    CAS  PubMed  Google Scholar 

  15. Levy SM, Haynes LT, Herberman RB, Lee J, McFeeley S, Kirkwood J (1992) Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up. Health Psychol 11:349–354. doi:10.1037/0278-6133.11.6.349

    Article  CAS  PubMed  Google Scholar 

  16. Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16:501–514

    CAS  PubMed  Google Scholar 

  17. Meyerowitz BE, Desmond KA, Rowland JH, Wyatt GE (1999) Sexuality following breast cancer. J Sex Marital Ther 25:237–250. doi:10.1080/00926239908403998

    Article  CAS  PubMed  Google Scholar 

  18. Taylor KL, Lamdan RM, Siegel JE, Shelby R, Hrywna M, Moran-Klimi K (2002) Treatment regimen, sexual attractiveness concerns and psychological adjustment among African American breast cancer patients. Psychooncology 11:505–517. doi:10.1002/pon.616

    Article  PubMed  Google Scholar 

  19. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA (2000) Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92:1422–1429. doi:10.1093/jnci/92.17.1422

    Article  CAS  PubMed  Google Scholar 

  20. Yurek D, Farrar W, Andersen BL (2000) Comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. J Consult Clin Psychol 68:697–709. doi:10.1037/0022-006X.68.4.697

    Article  CAS  PubMed  Google Scholar 

  21. Beckjord E, Compas BE (2007) Sexual quality of life in women with newly diagnosed breast cancer. J Psychosoc Oncol 25:19–36. doi:10.1300/J077v25n02_02

    Article  PubMed  Google Scholar 

  22. Pelusi J (2006) Sexuality and body image. Am J Nurs 106:32–38

    PubMed  Google Scholar 

  23. Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21:4184–4193. doi:10.1200/JCO.2003.04.196

    Article  PubMed  Google Scholar 

  24. Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks P, Bloom JR (2006) Body image and sexual problems in young women with breast cancer. Psychooncology 15:579–594. doi:10.1002/pon.991

    Article  PubMed  Google Scholar 

  25. Frierson G, Thiel DL, Andersen BL (2006) Body change stress for women with breast cancer: the breast-impact of treatment scale. Ann Behav Med 32:77–81. doi:10.1207/s15324796abm3201_9

    Article  PubMed  Google Scholar 

  26. Manne S, Ostroff J, Rini C, Fox K, Goldstein L, Granna G (2004) The interpersonal model of intimacy: the role of self-disclosure, partner disclosure, and partner responsiveness in interactions between breast cancer patients and their partners. J Fam Psychol 18:589–599. doi:10.1037/0893-3200.18.4.589

    Article  PubMed  Google Scholar 

  27. Wimberly SR, Carver CS, Laurenceau J-P, Harris SD, Antoni MH (2005) Perceived partner reactions to diagnosis and treatment of breast cancer: impact on psychosocial and psychosexual adjustment. J Consult Clin Psychol 73:300–311. doi:10.1037/0022-006X.73.2.300

    Article  PubMed  Google Scholar 

  28. Newell SA, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 94:558–584

    PubMed  Google Scholar 

  29. Shell JA (2002) Evidence-based practice for symptom management in adults with cancer: sexual dysfunction. Oncol Nurs Forum 29:53–66. doi:10.1188/02.ONF.53-69

    Article  PubMed  Google Scholar 

  30. Stanton AL (2006) Psychosocial concerns and interventions for cancer survivors. J Clin Oncol 24:5132–5137. doi:10.1200/JCO.2006.06.8775

    Article  PubMed  Google Scholar 

  31. Ganz PA, Desmond KA, Belin TR, Meyerowitz BE, Rowland JH (1999) Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 17:2371–2380

    CAS  PubMed  Google Scholar 

  32. Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA (1998) Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res 152:396–411

    CAS  PubMed  Google Scholar 

  33. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401. doi:10.1177/014662167700100306

    Article  Google Scholar 

  34. Myers JK, Weissman MM (1980) Use of a self-report symptom scale to detect depression in a community sample. Am J Psychiatry 137:1081–1084

    CAS  PubMed  Google Scholar 

  35. Roberts RE, Vernon SW (1983) The center for epidemiologic studies depression scale: its use in a community sample. Am J Psychiatry 140:41–46

    CAS  PubMed  Google Scholar 

  36. Busby DM, Crane DR, Larson JH, Christensen C (1995) A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales. J Marital Fam Ther 3:289–308. doi:10.1111/j.1752-0606.1995.tb00163.x

    Article  Google Scholar 

  37. Spanier GB (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam 38:15–28. doi:10.2307/350547

    Article  Google Scholar 

  38. Schag CA, Heinrich RL, Aadland RL, Ganz PA (1990) Assessing problems of cancer patients: psychometric properties of the cancer inventory of problem situations. Health Psychol 9:83–102. doi:10.1037/0278-6133.9.1.83

    Article  CAS  PubMed  Google Scholar 

  39. Ganz PA, Schag CA, Lee JJ, Sim MS (1992) The CARES: a generic measure of health-related quality of life for patients with cancer. Qual Life Res 1:19–29. doi:10.1007/BF00435432

    Article  CAS  PubMed  Google Scholar 

  40. Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L (1996) Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat 38:183–199. doi:10.1007/BF01806673

    Article  CAS  PubMed  Google Scholar 

  41. Sherbourne CD (1992) Social functioning: sexual problems measures. In: Stewart AL, Ware JE (eds) Measuring functioning and well-being: the medical outcomes study approach. Duke University Press, London, pp 194–204

    Google Scholar 

  42. Masters JH, Johnson VE (1970) Human sexual inadequacy. Little Brown, Boston

    Google Scholar 

  43. Angrist JD, Imbens GW, Rubin DB (1996) Identification of causal effects using instrumental variables (with discussion). J Am Stat Assoc 91:444–472. doi:10.2307/2291629

    Article  Google Scholar 

  44. Imbens GW, Rubin DB (1997) Bayesian inference for causal effects in randomized experiments with noncompliance. Ann Stat 25:305–327. doi:10.1214/aos/1034276631

    Article  Google Scholar 

  45. Skrondal A, Rabe-Hesketh S (2004) Generalized latent variable modeling. Chapman and Hall/CRC, Boca Raton, FL

    Google Scholar 

  46. Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B 57:289–300

    Google Scholar 

  47. Coyne JC, Lepore SJ, Palmer SC (2006) Efficacy of psychosocial interventions in cancer care: evidence is weaker than it first looks. Ann Behav Med 32:104–110. doi:10.1207/s15324796abm3202_5

    Article  PubMed  Google Scholar 

  48. Andrykowski MA, Manne SL (2006) Are psychological interventions effective and accepted by cancer patients? I. Standards and levels of evidence. Ann Behav Med 32:93–97. doi:10.1207/s15324796abm3202_3

    Article  PubMed  Google Scholar 

  49. Manne SL, Andrykowski MA (2006) Are psychological interventions effective and accepted by cancer patients? II. Using empirically supported therapy guidelines to decide. Ann Behav Med 32:98–103. doi:10.1207/s15324796abm3202_4

    Article  PubMed  Google Scholar 

  50. Huber C, Ramnarace T, McCaffery R (2006) Sexuality and intimacy issues facing women with breast cancer. Oncol Nurs Forum 33:1163–1167. doi:10.1188/06.ONF.1163-1167

    Article  PubMed  Google Scholar 

  51. President’s Cancer Panel (2004) 2003/2004 annual report: living beyond cancer: finding a new balance. National Cancer Institute, Bethesda, MD

    Google Scholar 

  52. Hewitt M, Greenfield S, Stovall E (eds) (2006) From cancer patient to cancer survivor: lost in transition. The National Academies Press, Washington, DC

    Google Scholar 

  53. Goodwin PJ, Leszcz M, Ennis M, Koopmans J, Vincent L, Guther H, Drysdale E, Hundleby M, Chochinov HM, Navarro M, Speca M, Hunter J (2001) The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 345:1719–1726. doi:10.1056/NEJMoa011871

    Article  CAS  PubMed  Google Scholar 

  54. Stanton AL, Ganz PA, Kwan L, Meyerowitz BE, Bower JE, Krupnick JL, Rowland JH, Leedham B, Belin TR (2005) Outcomes from the moving beyond cancer psychoeducational, randomized, controlled trial with breast cancer patients. J Clin Oncol 23:6009–6018. doi:10.1200/JCO.2005.09.101

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by Public Health Service grant R01CA63028 to Dr. Ganz from the National Cancer Institute, National Institutes of Health, Department of Health and Human Services and National Institutes of Health grant CA016042 which supported part of Dr. Crespi’s salary. The authors wish to thank Barbara Bass, Pamela W. Black, Bonnie A. Cesak, Romaine Clifton, Karin M. Johnson, Shirley Otis-Greene, Dominica T. Roth and Deborah S. Kulp for their work as leaders of the intervention groups.

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Authors and Affiliations

  1. Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD, USA

    Julia H. Rowland

  2. Department of Health and Human Services, National Institutes of Health, Bethesda, MD, USA

    Julia H. Rowland

  3. Department of Psychology, University of Southern California, Los Angeles, CA, USA

    Beth E. Meyerowitz

  4. Department of Biostatistics and Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA

    Catherine M. Crespi

  5. Private Practice, Encino, CA, USA

    Beth Leedham

  6. Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, Los Angeles, CA, USA

    Katherine Desmond

  7. Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, USA

    Thomas R. Belin

  8. Psychiatry/Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA

    Thomas R. Belin

  9. Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Drive South, A2-125 CHS, Los Angeles, CA, 90095-6900, USA

    Patricia A. Ganz

Authors
  1. Julia H. Rowland
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  2. Beth E. Meyerowitz
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  3. Catherine M. Crespi
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  4. Beth Leedham
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  5. Katherine Desmond
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  6. Thomas R. Belin
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  7. Patricia A. Ganz
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Correspondence to Patricia A. Ganz.

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Rowland, J.H., Meyerowitz, B.E., Crespi, C.M. et al. Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. Breast Cancer Res Treat 118, 99–111 (2009). https://doi.org/10.1007/s10549-009-0398-x

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  • DOI: https://doi.org/10.1007/s10549-009-0398-x

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