A Digital Intervention to Address Sexual Health in Hematopoietic Stem Cell Transplant Survivors.

BACKGROUND

Interventions to address sexual health in hematopoietic stem cell transplant (HSCT) survivors are limited.

METHODS

We conducted a pilot randomized trial of a digital app, SHIFT (Sexual Health and Intimacy Following Transplant), to address sexual dysfunction in HSCT survivors who were ≥3 months post autologous or allogeneic HSCT. Patients were randomly assigned to SHIFT or enhanced usual care. All participants first underwent a brief physical examination by a trained HSCT clinician. Participants assigned to the intervention received access to SHIFT for 8 weeks. SHIFT consists of 5 modules addressing the biological, interpersonal, social, and psychological causes of sexual dysfunction. The primary endpoint was feasibility, defined a priori as ≥60% enrollment of eligible patients, and 60% of those assigned to SHIFT completing ≥70% of the modules. We assessed patient satisfaction with sex, interest in sex, orgasm pleasure (using the Patient-Reported Outcomes Measurement Information System [PROMIS]), quality of life (QoL; using the Functional Assessment of Cancer Therapy - Bone Marrow Transplant [FACT-BMT]), and anxiety and depression symptoms (using the Hospital Anxiety and Depression Scale [HADS]) at baseline, 8 weeks, and 12 weeks. The preliminary effects of SHIFT on study outcomes were explored using analysis of covariance (ANCOVA) and estimates of effect size at 8 weeks (Cohen's d).

RESULTS

We enrolled 64.2% (61/95) of eligible patients. Of those assigned to the intervention, 70.0% completed 4 of the 5 SHIFT modules and 66.7% completed all SHIFT modules. At 8 weeks, SHIFT participants reported improved satisfaction with sex (14.6 vs 12.3; d=0.46), interest in sex (6.7 vs 5.7; d=0.59), orgasm pleasure (9.7 vs 8.3; d=0.37), QoL (115.6 vs 108.3; d=0.45), and symptoms of anxiety (4.5 vs 6.4; d=0.47) and depression (3.6 vs 5.4; d=0.62) compared with the control group.

CONCLUSIONS

The SHIFT digital app to address sexual dysfunction demonstrated feasibility and promising preliminary efficacy in improving sexual health outcomes, QoL, and psychological distress for HSCT survivors.