A Systematic Review Exploring the Effectiveness of Mindfulness for Sexual Functioning in Women with Cancer

Round 1

Reviewer 1 Report

Overall, a very well written manuscript in a topic area that has a demonstrated gap. The body of the paper is clearly articulated - the introduction provides good background information and context, the methods are clear and comprehensive and the results (table) is well presented. The discussion highlights current gaps and utilises high level thinking to develop strategies for moving forward with future research. I have made some minor suggestions for improvement below. Well done.  

Line 66 - outcomes of the mindfulness studies could be better articulated. 

Line 121 - "ther" is misspelled 

Line 170 - "cancer" is included twice as a search term - is this correct?

Some referencing inconsistencies in the reference list

Author Response

Overall, a very well written manuscript in a topic area that has a demonstrated gap. The body of the paper is clearly articulated - the introduction provides good background information and context, the methods are clear and comprehensive and the results (table) is well presented. The discussion highlights current gaps and utilises high level thinking to develop strategies for moving forward with future research. I have made some minor suggestions for improvement below. Well done.  Thank you very much.

Line 66 - outcomes of the mindfulness studies could be better articulated. 

Changed to Outcomes of this study indicated a reduction in distress with overall improvements in quality of life, post-traumatic growth and mindfulness

Line 121 - "ther" is misspelled 

Corrected to the

Line 170 - "cancer" is included twice as a search term - is this correct?

Removed

Some referencing inconsistencies in the reference list

Thank you for pointing this out, these have been checked

Reviewer 2 Report

This reviews summarizes the effectiveness of mindfulness for sexual functioning in women with caners from 8 reports.

Comments:

1. please explain why chose studies from 2008 and 2022?

2. Explains why only 1 report from Asia? and its impact on the conclusion of  this review.

3. Any significant data between the report from China and the rest of reports from western countries?

4. Any supporting data or info from spouses or partners from those 8 reports since this study focuses on sexual functioning in women with cancers?

5. I suggest title, "...... Women with Cancers" since the review covers different cancers.

Author Response

1. please explain why chose studies from 2008 and 2022? There are no studies prior to 2008- this has now been stated
2. Explains why only 1 report from Asia? and its impact on the conclusion of  this review. There are no further studies - there is also only one study based in Iran. And none in the UK. There are only 8 worldwide - nonetheless this raises cultural views on sexual intimacy and cancer and why this topic isn't being discussed more openly.
3. Any significant data between the report from China and the rest of reports from western countries? Not really. Sexual desire was non significant between control and experimental group. When comparing this outcome with other countries similar variations were also reported. The number of studies are still too low to draw any conclusions.       But from a cultural perspective a very interesting question.

4. Any supporting data or info from spouses or partners from those 8 reports since this study focuses on sexual functioning in women with cancers? Interesting question, but sadly not. We have taken this on board and integrated into future research.
5. I suggest title, "...... Women with Cancers" since the review covers different cancers.Thank you, now changed

Reviewer 3 Report

Worthy paper. A few suggestions on clarity and inclusiveness:

Intro

Line 35: Marie Curie have à has (web shows it’s a service for patients, therefor a collective noun)

98-99:  Overall, sexual functioning, including desire, arousal, satisfaction and a reduction of sexual pain, were all reported;  à ? Overall, improved sexual …. ?

105-106: small effect sizes were reported for sexual satisfaction and lubrication post intervention  -> small effect sizes of improvement ?

Given the paucity of research in this field, please consider adding the following 2 papers to the Introduction:

Hucker A, McCabe MP, Incorporating mindfulness and chat groups into an online cognitive behavioral therapy for mixed female sexual problems, J Sex Res 2015;52:627-639

Hucker A, McCabe MP. An online, mindfulness-based, cognitive-behavioral therapy for female sexual difficulties: impact on relationship functioning. J Sex Marital Ther. 2014;40:561-76

 

Materials

Why exclude studies published prior to 2008? Did the teaching of Mindfulness make a major advance since then? If so, the introduction should show that, and it does not. The measurement of sexual function and related distress did not.

Results

Table 1 has several acronymic terms, e.g., RCT, MBSR, FSFI (incorrectly given as FSF1 twice), FSFI, MBCI, FSDS, SB1Q-R, CAU. These should be explained in a footnote.

Discussion

Lines 258-259: Nonetheless, outcome discrepancies in sexual functioning were reported where no changes in sexual function had been identified [26] or levels of orgasm had decreased [36].

The meaning of this is unclear. Do you mean: “Nonetheless, in two studies [of mindfulness for sexual functioning in women post cancer treatment?], sexual function was unchanged (26) or orgasmic function decreased (36) ?

265: “Despite research included within this review had commenced over a decade ago, very little research has centred…” Awkward/confusing – please change to something like “Though research for the prior …. years was included in this review, very little published research has centred…

267-268; “have been developed to support sexual functioning which has possibly left women and their partners with short of [sic] long term difficulties “ awkward/confusing --- please change to something like “…sexual functioning, which may leave affected women and their partners with difficulties…

355-356: “When women are provided with information along with skill-based education applications that can enhance sexual health and quality of life more broadly [25].” This is either an incomplete sentence, or “that” should be replaced with something like “ , such help can enhance…”

358: “including additional RCTs, mindfulness based clinical trials, “  How are additional RCTs different from mindfulness-based clinical trials? Do you mean “mindfulness-based clinical trials, preferably performed with controls,”

367: “as well as wellbeing focused end of life interventions.” -> as well as wellbeing-focused end-of-life interventions

Author Response

Worthy paper. A few suggestions on clarity and inclusiveness:

Thank you very much

Intro

Line 35: Marie Curie have à has (web shows it’s a service for patients, therefor a collective noun)

Changed to has

98-99:  Overall, sexual functioning, including desire, arousal, satisfaction and a reduction of sexual pain, were all reported;  à ? Overall, improved sexual …. ?

Amended thank you

105-106: small effect sizes were reported for sexual satisfaction and lubrication post intervention  -> small effect sizes of improvement ?

Amended - clarity provided

Given the paucity of research in this field, please consider adding the following 2 papers to the Introduction:

Hucker A, McCabe MP, Incorporating mindfulness and chat groups into an online cognitive behavioral therapy for mixed female sexual problems, J Sex Res 2015;52:627-639

Hucker A, McCabe MP. An online, mindfulness-based, cognitive-behavioral therapy for female sexual difficulties: impact on relationship functioning. J Sex Marital Ther. 2014;40:561-76

Both excellent papers are included. However we have placed this in the discussion section when discussing online interventions.

Materials

Why exclude studies published prior to 2008? Did the teaching of Mindfulness make a major advance since then? If so, the introduction should show that, and it does not. The measurement of sexual function and related distress did not.

We were interested in cancer specifically in relation to mindfulness. The search came up with no papers prior to 2008. This has now been clarified.

Results

Table 1 has several acronymic terms, e.g., RCT, MBSR, FSFI (incorrectly given as FSF1 twice), FSFI, MBCI, FSDS, SB1Q-R, CAU. These should be explained in a footnote.

Amended

Discussion

Lines 258-259: Nonetheless, outcome discrepancies in sexual functioning were reported where no changes in sexual function had been identified [26] or levels of orgasm had decreased [36].

The meaning of this is unclear. Do you mean: “Nonetheless, in two studies [of mindfulness for sexual functioning in women post cancer treatment?], sexual function was unchanged (26) or orgasmic function decreased (36) ?

Clarity now provided - sentence broken down and number of studies stated

265: “Despite research included within this review had commenced over a decade ago, very little research has centred…” Awkward/confusing – please change to something like “Though research for the prior …. years was included in this review, very little published research has centred…

267-268; “have been developed to support sexual functioning which has possibly left women and their partners with short of [sic] long term difficulties “ awkward/confusing --- please change to something like “…sexual functioning, which may leave affected women and their partners with difficulties…

Changed thank you

355-356: “When women are provided with information along with skill-based education applications that can enhance sexual health and quality of life more broadly [25].” This is either an incomplete sentence, or “that” should be replaced with something like “ , such help can enhance…”

358: “including additional RCTs, mindfulness based clinical trials, “  How are additional RCTs different from mindfulness-based clinical trials? Do you mean “mindfulness-based clinical trials, preferably performed with controls,”

Amended thank you

367: “as well as wellbeing focused end of life interventions.” -> as well as wellbeing-focused end-of-life interventions

Amended thank you

Reviewer 4 Report

This is a well-written systematic review on the effectiveness of mindfulness for sexual functioning in women with cancer. I believe that this is a timely paper and will have a good contribution to the literature. I only have a few comments to improve the manuscript further:

1. The authors indicated that non-peer-reviewed articles were excluded in the current systematic review. It is unclear why this is necessary as the inclusion of non-peer-reviewed might be important for detecting and correcting for publication bias. There is a need for a strong justification regarding this exclusion criteria

2. There is a need to clarify who are the coders. How did the authors ensure that the data extraction and coding were free from errors?

3. Was there a second coder? What is the inter-rater reliability?

4. The records identified from databases were surprisingly low. Is it possible that the search term is too stringent?

Author Response

This is a well-written systematic review on the effectiveness of mindfulness for sexual functioning in women with cancer. I believe that this is a timely paper and will have a good contribution to the literature. I only have a few comments to improve the manuscript further: Thank you for your comments

1. The authors indicated that non-peer-reviewed articles were excluded in the current systematic review. It is unclear why this is necessary as the inclusion of non-peer-reviewed might be important for detecting and correcting for publication bias. There is a need for a strong justification regarding this exclusion criteria Non-peer reviewed is of course very important but we wanted to include studies that had gone through an initial screening process. This is however highlighted in the limitations section.

2. There is a need to clarify who are the coders. How did the authors ensure that the data extraction and coding were free from errors? This has now been emphasised and we believe it is now clearer

3. Was there a second coder? What is the inter-rater reliability? There were 3 coders. Mention of inter-rater reliability has been made - thank you
4. The records identified from databases were surprisingly low. Is it possible that the search term is too stringent? Despite being stringent even when no inclusion/exclusion criteria were imposed - this area of research is scarce. We did however wish to focus specifically on sex and cancer compared to other domains which might impact pre and post cancer outcomes.

Round 2

Reviewer 2 Report

No more comments

Author Response

Thank you for taking the time to review our manuscript

Reviewer 4 Report

The authors have addressed all my comments well. Congratulations!

 

Author Response

Thank you for taking the time to review our manuscript