Multimedia Intervention Starting the Conversation Encouraged Discourse About Sexual Health in Breast Cancer

Contemporary Concepts | <b>Contemporary Concepts in Breast Cancer</b>

Multimedia intervention Starting the Conversation successfully encouraged discourse about sexual health among patients with breast cancer and reduced anxiety.

Patients with breast cancer who were given multimedia intervention to help encourage discourse about sexual and menopausal health, known as Starting the Conversation (STC), increased sexual health communication and reduced anxiety, according to findings from the Sexual Health Communication Trial published in Psycho-Oncology.

Among the 127 clinical encounters that were reported, 59% (n = 75) included conversations regarding sexual health, 55% of which were raised by the clinician and 45% of which were raised by the patient. Notably, in terms of informative encounters, women in the STC arm had a significantly higher chance of bringing up the topic (51%; odds ratio [OR], 2.62; 95% CI, 1.02-6.69; P = .04) vs those in the control arm (30%). Additionally, the topic of sexual health was significantly more likely to be introduced by women in the intervention cohort (40%; OR, 2.85; 95% CI, 1.27-6.38; P = .01) vs those in the control arm (19%). Patients in the STC arm were also reported to have a higher self efficacy post-intervention (P = .02) and after 2 months of follow up (P = .009). However, no significant differences in outcome expectancies were noted between the 2 groups.

“We found that the Starting the Conversation intervention was feasible and

effective at facilitating communication [with patients with breast cancer] about sexual health during clinic encounters. These findings are consistent with prior studies showing that patient-focused interventions can encourage active clinical communication by patients [with cancer] and are notable in light of the intervention’s brevity,” the study authors wrote.

In the unblinded study, women with a breast cancer diagnosis were randomized 1:1 to either STC intervention or the control group. Patients were stratified based on metastatic disease and education level.

Adult patients with any stage of breast cancer who were undergoing active treatment or had completed treatment were eligible to enroll on the study. Patients also needed to have been seen in follow up, as well as agree to have audio from their clinical encounters recorded. Additionally, those who could not speak English, had an ECOG performance status of more than 2, or had overt cognitive dysfunction, psychiatric disturbance, or severe physical or mental illness were not eligible to enroll on the study.

Those in the STC cohort were given a 20-minute video slideshow with accompanying narration, as well as a 5-page workbook with information about communicating sexual concerns to providers and a 2-page resource guide containing resources on menopausal and sexual health. Those in the control arm received the resource guide alone.

Clinical communications about sexual health, which was defined as sexual activity; function such as desire, arousal, orgasm, and pain and discomfort; relationships; general concerns; or body image were analyzed as the proportion of post-training clinic encounters when patients asked a question relating to sexual health or raised the topic of sexual health.

A total of 531 patients were considered for the study from June 2018 to July 2019, 177 of whom were approached to participate. A total of 146 patients consented to participate and 144 were randomized to the intervention arm (n = 73) or control arm (n = 71). Eighty-eight percent of patients provided clinic recordings. Additionally, post-intervention (99%) and 2-month follow up surveys (97%) were obtained from almost all patients. The majority of patients across both cohorts reported using the provided materials, including a high rate of use for video (88%) and workbook (85%).

The majority of patients were White (67%), and most were partnered with a higher education. Additionally, most patients had non-metastatic disease and had been treated through surgery, endocrine therapy, chemotherapy, and radiation, although a few patients underwent immunotherapy or ovarian suppression. The most common current therapies were tamoxifen (Soltamox) or aromatase inhibitors.

Additional findings from the study indicated that more women in the STC cohort were sexually active (70%) compared with the control arm (46%; OR, 8.25; 95% CI, 1.83-37.14; P = .04). The impact of STC was also significant for anxiety. After 2 months of follow-up, those in the STC cohort achieved notable reductions in anxiety vs the control arm (P = .04).


Reese JB, Sorice KA, Pollard W, et al. Efficacy of a multimedia intervention in facilitating breast cancer patients' clinical communication about sexual health: results of a randomized controlled trial. Psycho-Oncol. 2021;30(5):681-690. doi:10.1002/pon.5613