Developing a Stepped Approach to Improving Sexual Function aFteR Treatment fOr gyNaecological Cancer

Women affected by gynaecologic cancers are often not aware of sexual consequences of cancer and its treatment. Most do not receive appropriate advice or help to recover sexual function, and the impact on their sexuality may be profound. Despite this several potential therapies can be effective in helping recovery. A major challenge is informing and involving the patients in an appropriate and sensitive manner, and a further issue is the delivery of such therapies in busy and medically driven gynaecologic oncology clinics. It will use and adapt existing evidence based therapies for improving sexual function after cancer treatment and develop a model for delivering these in the NHS (United Kingdom National Health Service) setting. The model of 'stepped care' is adapted from that used nationally and successfully in the Increasing Access to Psychological Therapies (IAPT) programme. Assessment allows for 'stepping up and down', i.e. calibrating the type of help a woman receives according to need and her response to treatment already given.This study will develop and evaluate a 'stepped' system of interventions using elements of best available evidence, adapting existing interventions to help women recover their sexual feelings and activity, starting with simple methods, moving on to new talking treatments for more complex cases. The investigators address all gynaecologic cancers on the principle that sexual difficulty is the problem the investigators are treating, not the cancer of origin. Ongoing clinical assessment will be vital for the success of the stepped care model. The investigators will deliver training and supervision to enhance the skills needed by the Clinical Nursing Specialist (CNS). An important part of this study will be characterising the range of women and their willingness to participate in psychosexual help. One-to-one follow up interviews will inform the level of input required for any subsequent Randomised Control Trial (RCT). The investigators will use internationally recognised rating scales for rating sexual function, assess how illness and treatment affect mood and self esteem. The investigators will also measure the overall cost-effectiveness to the public sector of providing this treatment, compared to costs of subsequent use of health and social services. This pilot study will assess the feasibility of conducting a full scale investigation of a stepped therapy and indicate the potential benefits to the patients, their partners, and to the NHS generally.

Sex

Female

Minimum age

18 Years

Inclusion Criteria:

* Women over 18 (with partners at their choice) treated for any gynaecological malignancy with surgery and/or chemotherapy and/or radiation at UCLH (University College London Hospitals) Gynaecological Cancer Centre or University Hospitals Bristol Gynaecological Cancer Centre
* 3 months minimum post end of treatment
* any sexual orientation
* with sexual function difficulties identified by initial screen (3 clinical questions within clinical interview posed by doctor or nurse)

Exclusion Criteria:

* Poor English
* Current drug or alcohol abuse
* Current sexual therapy or psychotherapy

• DERIVEDGessler S, King M, Lemma A, Barber J, Jones L, Dunning S, Madden V, Pilling S, Hunter R, Fonagy P, Summerville K, MacDonald N, Olaitan A, Lanceley A. Stepped approach to improving sexual function after gynaecological cancer: the SAFFRON feasibility RCT. Health Technol Assess. 2019 Feb;23(6):1-92. doi: 10.3310/hta23060. PMID 30798790