Efficacy of a web-based psychoeducational intervention for young adults with fertility-related distress following cancer (Fex-Can): randomized controlled trial
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Abstract
BACKGROUND: Threatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking. OBJECTIVE: This study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer. METHODS: This randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer-Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care. RESULTS: Although 62% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child's health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low. CONCLUSIONS: The Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child's health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer. TRIAL REGISTRATION: ISRCTN Registry 36621459; https://www.isrctn.com/ISRCTN36621459.
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The findings of low adherence are in line with some previous studies.
“Our findings of low adherence are in line with those of some previous studies (Micaux et al., 2022; Schover et al., 2012).”
From Efficacy of a web-based psychoeducational intervention, Fex-can sex, for young adult childhood cancer survivors with sexual dysfunction: A randomized controlled trial (2024) · cites this paper as Micaux et al., 2022
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Strategies to Mitigate Young Cancer Survivors with Depression
Brandon, R., & Zhang, A. (2024) · Springer eBooks · doi:10.1007/978-3-031-32046-0_69-1
O’Donnell, N., Howell, D. A., Morgan, J. E., & Phillips, B. (2025) · Pediatric Blood & Cancer · doi:10.1002/pbc.31787
Strategies to Mitigate Young Cancer Survivors with Depression
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Sexual health and REhabilitation online (SHAREonline): study protocol of an optimisation trial
Miklos, E. M., Recklitis, C. J., Reese, J. B., Medeiros-Nancarrow, C., & Bober, S. L. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-111471
- Authors
- Micaux, C., Wiklander, M., Eriksson, L. E., Wettergren, L., & Lampic, C.
- Affiliations
- Karolinska Institutet (SE)
- University of London (GB)
- Uppsala University (SE)
- Venue
- JMIR Cancer
- Publisher
- JMIR Publications Inc.
- Published
- 2022-03-29
- Volume
- 8
- Issue
- 1
- Pages
- e33239
- ISSN
- 2369-1999 (ISSN-L)
- PMC
- PMC9006131
- OpenAlex
- W4221094794
- Cited by
- 31
- References
- 69
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 9 · 2023: 4 · 2022: 1
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Cancer (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- cancer survivors, young adults, fertility knowledge, health-related quality of life, anxiety and depression, self-help intervention, intervention adherence, dose-response relationship, subgroup analysis, quality of life after cancer
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