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Efficacy of a web-based psychoeducational intervention targeting young adults with sexual problems 1.5 years after cancer diagnosis—Results from a randomized controlled trial
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden;Department of Surgery and Urology, Danderyd Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-2716-7279
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. (Vårdvetenskap, Caring Sciences)ORCID iD: 0000-0002-4555-1274
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;School of Health and Psychological Sciences, City University of London, London, UK;Medical Unit Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.ORCID iD: 0000-0001-5121-5325
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Department of Psychology, Umeå University, Umeå, Sweden. (Vårdvetenskap, Caring Sciences)ORCID iD: 0000-0002-1739-4486
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2024 (English)In: Digital Health, E-ISSN 2055-2076, Vol. 10Article in journal (Refereed) Published
Abstract [en]

ObjectiveTo test the efficacy of a web-based psychoeducational intervention, Fex-Can Sex, in reducing sexual dysfunction in young adults with cancer.

MethodsThis randomized controlled trial evaluated a 12-week web-based self-help intervention. Young adults aged 19–40 who reported sexual dysfunction 1.5 years after cancer diagnosis were drawn from a population-based cohort. Participants were randomized to an intervention group (IG, n = 72) or a control group (CG, n = 66) that solely received standard care. Primary outcome was assessed by a domain of the Patient Reported Outcome Measures Information Systems® SexFS: “Satisfaction with sex life.” Secondary outcomes included additional SexFS domains, body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), and self-efficacy related to sex. Surveys were completed at baseline, post-intervention, and three months later. Effects of the intervention were tested with t-tests, and linear mixed models (LMMs), including intention-to-treat and subgroup analyses. Additionally, the IG was asked about their experiences of the program with study-specific questions.

ResultsThere were no differences in primary or secondary outcomes between the IG and the CG at post-intervention. Subgroup analyses showed that individuals with greater sexual problems at baseline improved over time, regardless of group allocation. Participants spent a mean time of 20.7 min on the program. The study-specific items showed that the majority of participants in the IG appreciated the program and would recommend it to others.

ConclusionThe Fex-Can Sex intervention did not show effect on primary and secondary outcomes. Adherence to the intervention was low, and future interventions are recommended to include more interactive components to enhance usage.

Clinical trial registrationThe trial was registered on 25 January, 2016 (trial number: 36621459).

Place, publisher, year, edition, pages
Thousand Oaks, California: Sage Publications, 2024. Vol. 10
Keywords [en]
young adults, psychoeducation, sexual dysfunction, web-based intervention, digital health, randomized controlled trial, cancer
National Category
Cancer and Oncology Nursing
Identifiers
URN: urn:nbn:se:uu:diva-546213DOI: 10.1177/20552076241310037ISI: 001383563500001PubMedID: 39741983Scopus ID: 2-s2.0-85213554831OAI: oai:DiVA.org:uu-546213DiVA, id: diva2:1925004
Part of project
Fex-Can Young Adults - Fertility and sexuality following cancer in young adulthood, Forte, Swedish Research Council for Health, Working Life and Welfare
Funder
Swedish Research Council, 2017-01530Vårdal Foundation, 2014-0098Swedish Cancer Society, CAN 2013/886Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4689Swedish Research Council, 2022-00832Swedish Cancer Society, CAN 2016/615Swedish Cancer Society, 190196PjForte, Swedish Research Council for Health, Working Life and Welfare, 2019-00839Available from: 2025-01-07 Created: 2025-01-07 Last updated: 2026-01-18Bibliographically approved
In thesis
1. Internet-delivered interventions for sexual and reproductive health following cancer: The Fex-Can Young Adult project
Open this publication in new window or tab >>Internet-delivered interventions for sexual and reproductive health following cancer: The Fex-Can Young Adult project
2026 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is embedded within the Fex-Can Young Adult research project and consists of five papers. The overall aim was to develop and evaluate internet-delivered interventions targeting sexual problems and fertility-related distress following a cancer diagnosis, with the ultimate goal of improving the quality of survivorship among individuals diagnosed with cancer during young adulthood (18-39 years).

Paper I reported findings from a randomized controlled trial evaluating the efficacy of the Fex-Can Sex program in alleviating sexual dysfunction 1.5 years following a cancer diagnosis during young adulthood. No significant effects of the program were demonstrated, and participant activity in the intervention was limited. 

Paper II explored interactive activity and the content of discussions forum posts within the Fex-Can Sex and Fex-Can fertility programs. A limited proportion of participants met criteria for high level activity. Four themes were constructed through thematic analysis of the discussion forum posts: Fertility fears, Perceptions of the changed body, Missing out on life, and Importance of support and information

Paper III presented the internal pilot trial and randomized controlled trial of the Fex-Can 2.0 intervention, which was designed to alleviate sexual problems and fertility-related distress among individuals diagnosed with cancer during young adulthood. 

Paper IV presented the collaboration between patient research partners and researchers in the refinement and further development of the Fex-Can intervention. Using qualitative content analysis for analysis of multimodal data (impact log information, field notes, individual interviews), three main categories were constructed: Collaborative working process, Group atmosphere and Concrete impact

Paper V investigated changes in perceptions of the body during the first five years following a cancer diagnosis in young adulthood. Over half of female and one-fourth of male participants reported body image disturbance at 1.5 years post-diagnosis, with significant improvements in body image observed over time among males and among females diagnosed with breast cancer or lymphoma. 

The work presented in this thesis contributes to existing research by providing insight into the sexual and reproductive health of young adults diagnosed with cancer, and by informing future research aimed at refining and evaluating internet-delivered interventions. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2026. p. 112
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2227
Keywords
Cancer survivorship, Sexual and reproductive health, Body image, Young adults, Internet-delivered interventions, Patient and public involvement, Complex interventions
National Category
Cancer and Oncology Nursing
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-575649 (URN)978-91-513-2722-8 (ISBN)
Public defence
2026-03-06, Lecture Hall IV, University Main Building, Biskopsgatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2026-02-12 Created: 2026-01-18 Last updated: 2026-02-12

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Skog, RebeccaLampic, ClaudiaWettergren, Lena

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