Sexual Health

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

El-Jawahri A, Reese J, et al. • Journal of the National Comprehensive Cancer Network : JNCCN • 2025

PubMed 39938468 DOI 10.6004/jnccn.2024.7076

TL;DR

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.

Key Findings

Results

The SHIFT intervention met the pre-specified feasibility threshold for enrollment of eligible patients.

64.2% (61/95) of eligible patients were enrolled, exceeding the a priori feasibility threshold of ≥60% enrollment.
Patients were ≥3 months post autologous or allogeneic HSCT.
All participants first underwent a brief physical examination by a trained HSCT clinician before randomization.
Participants were randomly assigned to SHIFT or enhanced usual care.

Results

The SHIFT intervention met the pre-specified feasibility threshold for module completion among intervention participants.

70.0% of those assigned to the intervention completed 4 of the 5 SHIFT modules, meeting the a priori threshold of ≥60% completing ≥70% of modules.
66.7% of intervention participants completed all 5 SHIFT modules.
The intervention was delivered over 8 weeks.
SHIFT consists of 5 modules addressing biological, interpersonal, social, and psychological causes of sexual dysfunction.

Results

SHIFT participants reported improved satisfaction with sex compared with the control group at 8 weeks.

SHIFT participants reported a mean satisfaction with sex score of 14.6 versus 12.3 in the control group at 8 weeks.
Effect size was Cohen's d = 0.46.
Satisfaction with sex was measured using the PROMIS (Patient-Reported Outcomes Measurement Information System).
Preliminary effects were explored using analysis of covariance (ANCOVA).

Results

SHIFT participants reported improved interest in sex compared with the control group at 8 weeks.

SHIFT participants reported a mean interest in sex score of 6.7 versus 5.7 in the control group at 8 weeks.
Effect size was Cohen's d = 0.59, representing one of the larger effect sizes observed across outcomes.
Interest in sex was measured using PROMIS.

Results

SHIFT participants reported improved orgasm pleasure compared with the control group at 8 weeks.

SHIFT participants reported a mean orgasm pleasure score of 9.7 versus 8.3 in the control group at 8 weeks.
Effect size was Cohen's d = 0.37.
Orgasm pleasure was measured using PROMIS.

Results

SHIFT participants reported improved quality of life compared with the control group at 8 weeks.

SHIFT participants reported a mean QoL score of 115.6 versus 108.3 in the control group at 8 weeks.
Effect size was Cohen's d = 0.45.
QoL was measured using the Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT).
Outcomes were also assessed at 12 weeks in addition to baseline and 8 weeks.

Results

SHIFT participants reported reduced anxiety symptoms compared with the control group at 8 weeks.

SHIFT participants reported a mean anxiety score of 4.5 versus 6.4 in the control group at 8 weeks.
Effect size was Cohen's d = 0.47.
Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS).
Lower scores on HADS indicate fewer symptoms.

Results

SHIFT participants reported reduced depression symptoms compared with the control group at 8 weeks.

SHIFT participants reported a mean depression score of 3.6 versus 5.4 in the control group at 8 weeks.
Effect size was Cohen's d = 0.62, representing the largest effect size observed across all outcomes.
Depression symptoms were measured using the Hospital Anxiety and Depression Scale (HADS).
Lower scores on HADS indicate fewer symptoms.

What This Means

This research describes a pilot study testing a digital app called SHIFT (Sexual Health and Intimacy Following Transplant) designed to help blood cancer survivors who have undergone stem cell transplants address problems with sexual health. Participants were randomly assigned to either use the SHIFT app for 8 weeks or receive enhanced usual care. The app covered five areas: the biological, interpersonal, social, and psychological causes of sexual difficulties. The study found that the program was feasible — enough eligible patients joined (64.2%) and enough intervention participants completed the app modules (70%) to meet the pre-set thresholds for success. At 8 weeks, patients who used SHIFT reported better outcomes across multiple measures compared to those in the control group. These included greater satisfaction with sex, more interest in sex, improved orgasm pleasure, and better overall quality of life. Notably, SHIFT users also reported lower levels of anxiety and depression, with the largest difference seen in depression symptoms (effect size d=0.62). All of these are considered small-to-medium effect sizes, which is meaningful for a pilot study. This research suggests that a brief, app-based digital intervention can be both practical to deliver and potentially effective in improving sexual health and psychological well-being for stem cell transplant survivors. Sexual health problems are common after this type of treatment but are often not addressed in clinical care. This study provides early evidence that a structured digital tool might help fill that gap, though larger randomized trials are needed to confirm these preliminary findings.

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Citation

El-Jawahri A, Reese J, Traeger L, Dizon D, Cutler C, Bober S, et al.. (2025). A Digital Intervention to Address Sexual Health in Hematopoietic Stem Cell Transplant Survivors.. Journal of the National Comprehensive Cancer Network : JNCCN. https://doi.org/10.6004/jnccn.2024.7076

Key Findings

What This Means

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