Effects of non-pharmacological interventions on sexual health in patients with breast cancer: A network meta-analysis

Objective: This review systematically identifies and synthesizes evidence to examine the impact of non-pharmacological interventions on the sexual health of patients with breast cancer through a meta-analysis approach. Methods: From establishment to December 2, 2024, eight electronic databases including PubMed, Embase, Web of Science, Cochrane, CNKI, VIP, Wanfang and Biomedical Literature Service System were searched. The inclusion criteria comprised randomized controlled trials (RCTs) of non-drug interventions, controlled clinical trials and quasi-experimental studies. Two researchers independently conducted the literature screening, data extraction, and quality assessment of the included studies by employing the Cochrane quality evaluation manual. The two researchers conducted independent literature screening, data extraction, and quality assessment of the included studies using the Cochrane Manual 5.1.0 recommended RCT risk assessment tool for bias. Meta-analysis was conducted using RevMan5.3 and R studio GEMTC package. The inconsistency test model is employed to evaluate the overall inconsistency. If P > 0.05, the consistency model will be employed for data analysis. Results: A total of 2451 titles and abstracts were retrieved, resulting in the inclusion of 19 articles, covering 19 non-pharmacological intervention methods. The overall risk of bias analysis indicated lower risk in 3 studies and some concerns in 16 studies. The meta-analysis findings indicate that non-pharmacological interventions were associated with improved sexual health outcomes for patients with breast cancer, when compared to standard care practices. The top five non-drug interventions, ranked by effect size, were Stress management consulting [SMD = -2.03, 95% CI (-3.96, -0.05), P < 0.001], Cluster nursing [SMD = -1.44, 95% CI (-3.48, 0.62), P < 0.001], Sexual counseling based on the PLISSIT model [SMD = -1.26, 95% CI (-2.96, 0.40), P < 0.001], sexual psychological counseling [SMD = -0.98, 95% CI (-3.01, 1.03), P < 0.001], and sex education [SMD = -0.91, 95% CI (-2.63, 0.66), P < 0.001]. Cumulative ranking probability analysis indicated that stress management was the most effective non-pharmacological intervention for improving the sexual quality of life in patients with breast cancer. Conclusions: In conclusion, Stress management consulting is recommended as the primary intervention for enhancing the sexual health in patients with breast cancer, emphasizing the need for tailored clinical nursing practices. However, further high-quality randomized controlled trials are necessary to validate these findings.