Let’s Talk About Sex: An Acceptable, Appropriate and Feasible Online Sexual Health Educational Video Series for Breast Cancer Patients

Let’s Talk About Sex: An Acceptable, Appropriate and Feasible Online Sexual Health Educational Video Series for Breast Cancer Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Let’s Talk About Sex: An Acceptable, Appropriate and Feasible Online Sexual Health Educational Video Series for Breast Cancer Patients Madeline G. Higgins, Laura Helmkamp, Lauren A. Zimmaro, Sarah E. Leslie, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7023075/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Jan, 2026 Read the published version in Supportive Care in Cancer → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose: Sexual health-related side effects during breast cancer treatment are common and distressing but not always expected by patients. We created an online sexual health educational video series to increase patients’ awareness of these issues. In this exploratory study, we aimed to evaluate the acceptability, appropriateness, and feasibility of the video series among newly diagnosed breast cancer patients. Methods: Eligible and interested patients completed a baseline questionnaire within one month of diagnosis or surgical evaluation. Enrolled participants accessed the online sexual health video series. A follow-up questionnaire evaluating acceptability, appropriateness, and feasibility was administered after 6-months. Descriptive statistics and paired t-tests were utilized. Results: Twenty-eight participants (January-June 2024) with mean age of 48 years (±8 years) comprised the present analysis. Eighty-six percent were White, 4% Hispanic, 89% straight/heterosexual, 86% married/partnered, and 68% were stage I at diagnosis. Eleven participants (39%) completed the 6-month survey, and nine participants reported watching the online videos. Nearly all completely agreed or agreed that the video series was acceptable (mean 4.1 [±1.0]), appropriate (mean 4.3 [± 0.7]), and feasible (mean 4.4 [±0.7]). Qualitative feedback showed strong endorsement for the video series and offered suggested improvements. Conclusion: Breast cancer patients lack access to sexual health resources during treatment, but an online educational video series is acceptable, appropriate, and feasible to utilize. This video series fills a unique gap in patient care, and with further iterations and development has the potential to significantly advance the sexual health resources available to breast cancer patients and survivors. Breast cancer sexual health patient-centered resources quality of life Figures Figure 1 Figure 2 Figure 3 Introduction Advances in breast cancer treatment have led to more than 3.5 million breast cancer survivors in the United States, many of whom will experience short- and long-term sexual health side effects because of their treatment [ 1 – 3 ]. Sexual health symptoms after breast cancer treatment are common with 37–78% of survivors experiencing at least one sexual concern and up to 87% reporting low sexual desire [ 1 – 6 ]. Patients may also experience negative body image, infertility, menopausal symptoms, concerns about intimacy, and struggles with dating [ 5 , 7 ]. These symptoms have meaningful impacts as studies have shown that breast cancer patients with sexual concerns report poorer quality of life [ 3 , 8 ] and greater psychological distress, including greater depression and anxiety, as compared to those without sexual symptoms [ 9 , 10 ]. While treatment-related sexual health symptoms are common during breast cancer, many patients report a lack of sexual health-specific education and resources from their oncology team or other medical providers [ 6 ]. In fact, women with breast cancer report a strong desire for discussions about sexual health to be initiated by their clinician [ 11 – 13 ] and for the topic of sexual health to be brought up early – and often – throughout their breast cancer journey [ 6 ]. Multiple studies demonstrate that patients prefer to receive information through discussions with their providers or from handouts, online websites, and support groups [ 6 , 14 ]. Additionally, focus groups with breast cancer survivors have identified that patients want a broad range of sexual health education from treatment effects to mitigation strategies to navigating dating and partner intimacy [ 6 ]. Unfortunately, studies among breast cancer providers have identified key clinician barriers to discussing sexual health with breast cancer patients including lack of clinic time, inadequate knowledge, and discomfort or embarrassment [ 15 , 16 ]. Clinicians also face conflicting priorities and often focus on cancer outcomes and treatment rather than discussing topics related to intimacy and sexual health [ 12 ]. Overall, sexual health discussions occur in less than half of patient visits [ 17 , 18 ] and when they do, 28% of patients incorrectly self-report whether or not the conversation happened [ 18 ]. While there have been significant scientific and clinical advances in addressing cancer-related sexual issues over the past decade, the need for patient-facing educational programs that are accessible, relevant, and comprehensive remains. Current interventions have features that may limit their ability to provide timely, practical, and appealing sexual health education to breast cancer patients and survivors. For example, many interventions are either clinician-facing and aimed at improving communication [ 19 – 21 ], have a narrow scope and are centered on specific issues such as fertility or menopausal symptoms [ 6 ], are one-time programs [ 22 ] or are only provided post-treatment and after symptoms arise [ 23 – 27 ]. Together, this limits the ability for women to access sexual health information repeatedly or at different timepoints throughout the course of treatment. As such, there remains a continued need for collaborative, patient-centered approaches to develop and implement acceptable, appropriate, and feasible programs to address cancer-related sexual concerns. Therefore, we assembled a multidisciplinary team including sexual health experts and breast cancer survivors to develop an online video educational series to use throughout patients’ breast cancer care. The iterative and rigorous user-centered development process has been described by Adams et. al [ 28 ]. Overall, the video series consisted of 56 separate, brief videos (1–3 minutes long) that provide sexual health education on a range of topics such as 1) medical and biological (i.e., surgical approaches for treatment, expectation setting, possible changes to physical sensation, effects of treatment related to early menopause and estrogen blockades), 2) emotional, behavioral, and cognitive (i.e., coping with anxiety, mindfulness techniques), 3) patient relationships (i.e., accepting support, building relationships with providers), and 4) intimate relationships (i.e., communicating with partners, body image, dating). The videos show short clips from subject matter experts spanning breast surgery, medical oncology, gynecology, psycho-oncology and sexual medicine, plus personal stories and lived-experiences of breast cancer survivors. Preliminary evaluation among prior focus group participants found that the videos were favorable and understandable, however the acceptability, appropriateness, and feasibility among newly diagnosed breast cancer patients was untested [ 28 ]. Exploratory in nature, this pilot study aimed to assess the acceptability, appropriateness, and feasibility of the sexual health video series via validated surveys and open-item feedback responses among a sample of newly diagnosed breast cancer patients. Additionally, we sought to examine preliminary signals of intervention effects by assessing patient-reported sexual function from pre- to post-intervention. Given the proof-of-concept nature of this study [ 29 ], no specific hypotheses were made, but we expected the intervention to be perceived as acceptable, appropriate, and feasible among participants. Methods Study Design and Patient Population This was a pilot study performed as part of an ongoing, prospective clinical trial (NCT06121258) that included Stage I-III adult female breast cancer patients seen in a comprehensive breast cancer center. This study was approved by the Institutional Review Board (COMIRB #23-1734). Eligible women aged 18–100 years old diagnosed with breast cancer provided informed consent and completed study procedures. Patients with Stage 0 or IV breast cancer, prior cancer history, or prior exposure to anti-hormone therapy, chemotherapy or radiotherapy not related to breast cancer were excluded. The online video series was available in English only during this pilot phase, so only patients who could read or speak in English were included. Male breast cancer patients were excluded due to the low prevalence overall [ 30 ]. Eligible patients were identified by a research coordinator and contacted via telephone within one month of their initial multi-disciplinary clinic visit or initial surgical consultation, but prior to initiating treatment, to discuss the study and confirm eligibility. Interested patients were then emailed a consent form and instructions for completing a baseline survey including demographic and recent sexual history. Following informed consent and completion of the baseline survey, participants were emailed a link to access the online video series website, along with a personalized, de-identified username and password. Due to the individualized nature of breast cancer treatment, participants were provided full access to the entire video series without explicit instructions on the order or selection of videos they should watch. Participants then received a monthly email reminder with a link to the videos for five months and a final survey six months after enrollment. All surveys and reminders were administered electronically via the REDCap Database [ 31 , 32 ]. Survey reminders were automatically repeated three times, one week apart. After this, patients received up to three individual emails from a study coordinator with a personal link to their six-month survey. No phone calls or attempts to reach the participants in clinic were made. Participants were considered non-responders if they did not respond to the six-month survey within three months. Participants were provided a $ 25 gift card for completing the baseline survey and an additional $ 25 gift card for completing the six-month follow-up survey. A schematic outlining the study design is demonstrated in Fig. 1 . Outcomes The primary outcomes were acceptability, appropriateness, and feasibility, assessed by the Acceptability of Intervention (AIM), Intervention Appropriateness (IAM), and Feasibility of Intervention Measures (FIM), which are widely used self-reported surveys with good psychometric properties [ 33 ]. Responses are measured on a 5-point Likert scale and higher scores reflect a higher degree of acceptability (i.e., is appealing, satisfactory), appropriateness (i.e., is relevant, fitting), and feasibility (i.e., is easy to use, implementable). Participants who did not endorse watching the videos at the six-month survey were excluded from completing the AIM, IAM, and FIM surveys as the purpose was to capture those who watched at least a portion of the videos. The primary outcomes were assessed 6-months post-intervention and were chosen to improve study participant retention. The secondary outcome was the impact of the online educational resource on sexual health, assessed by the NIH-developed PROMIS Brief Female Sexual Function and Satisfaction (FSFS) v2.0 questionnaire at baseline and six-months. The PROMIS Brief FSFS is a validated patient-reported outcome measure that assesses an individual’s sexual function and satisfaction over the past three months in the following subdomains: 1) interest in sexual activity, 2) vaginal lubrication, 3) vaginal discomfort, 4) labial discomfort, 5) clitoral discomfort, 6) orgasm ability, 7) orgasm pleasure, and 8) satisfaction with sex life [ 34 , 35 ]. This measure was chosen for its greater inclusivity of diverse and varied sexual practices compared to other validated measures of sexual health. In addition to the PROMIS FSFS, a single question was included in the baseline survey assessing sexual activity in the past 6 months prior to the breast cancer diagnosis. Further exploratory outcomes included evaluation of individual patient perceptions of the experience and impact of the online educational resource on their sexual health during breast cancer treatment. This was assessed through free-response questions throughout the study including a question at 6-months post-intervention, “What did you learn from the videos?” Statistical Analysis Survey responses were collected via REDCap, and clinical data was abstracted through chart review. Participant demographic and clinical factors were described using counts and percentages for categorical variables and means and standard deviations for age. Six-month responders were compared to non-responders using chi-square tests or Fisher’s exact tests as appropriate for categorical variables and a t-test for age. The combined means and SD for the AIM, IAM, and FIM scales were described with values ranging from 1 to 5 with higher scores indicating greater acceptability, appropriateness, or feasibility. The PROMIS FSFS was scored according to the instrument’s scoring manual [ 36 ]: Calibrated subdomain scores are expressed in terms of standardized T-scores where a mean score of 50 corresponds with the average response in the reference sample of female respondents (SD = 10). Higher scores indicate greater endorsement of the subdomain assessed (e.g., greater interest in sexual activity, greater vaginal discomfort). Changes in PROMIS scores were calculated by subtracting the baseline score from the 6-month score. Given the exploratory nature of analysis, effects were characterized descriptively via the magnitude of the change score and paired t-tests. Analyses were conducted in SAS version 9.4 with statistical significance set as p -value < .05. Results Study Population From January – June 2024, 117 patients were screened, and 82 (70%) patients were called for potential inclusion (Supplemental Fig. 1). Of those contacted, 57 (70%) expressed an interest in participating and were emailed the electronic consent and baseline survey. Twenty-eight (49%) patients completed both the consent and baseline survey and were given access to the video series. Of these, 11 (39%) patients completed the 6-month follow up survey, while 17 patients did not complete the 6-month survey. The mean age of the 28 participants was 47.9 years (SD 8). Most participants were white (85.7%, n = 24), non-Hispanic/Latina or of Spanish origin (96.4%, n = 27), straight/heterosexual (89.3%, n = 25), were married or partnered (85.7%, n = 24), and with a male sexual partner (75.0%, n = 21) (Table 1 ). The most common sexual activities in the past six months reported by participants were sexual intercourse, oral sex, and masturbation. Clinically, most participants had Stage I disease (67.9%, n = 19) and were diagnosed with invasive ductal carcinoma (82.1%, n = 23) and ER/PR-positive, HER2-negative tumors (75%, n = 21). Additional clinical characteristics are shown in Table 2 . There were no statistically significant differences in baseline demographics and sexual activity among the 6-month responders compared to the non-responders. Table 1 Patient demographic characteristics and sexual activity in the past 6 months. Overall n = 28 6-month non-responder n = 17 6-month responder n = 11 p-value Age, Mean (SD) 47.9 (8.0) 47.8 (7.1) 48.1 (9.7) 0.93 Ethnicity % (N) 0.39 Not Hispanic/Latina or of Spanish origin 96.4% (27) 100.0% (17) 90.9% (10) Hispanic/Latina/Spanish origin 3.6% (1) 0.0% (0) 9.1% (1) Race % (N) > 0.99 American Indian or Alaska 3.6% (1) 5.9% (1) 0.0% (0) Caucasian/White 85.7% (24) 82.4% (14) 90.9% (10) Other (specify) 3.6% (1) 5.9% (1) 0.0% (0) Prefer not to answer 7.1% (2) 5.9% (1) 9.1% (1) Sexual Orientation % (N) 0.34 Heterosexual or straight 89.3% (25) 94.1% (16) 81.8% (9) Lesbian, gay, homosexual, or same-gender loving 3.6% (1) 0.0% (0) 9.1% (1) Bisexual 3.6% (1) 0.0% (0) 9.1% (1) Prefer not to answer 3.6% (1) 5.9% (1) 0.0% (0) Gender Identity % (N) 0.39 Female 96.4% (27) 100.0% (17) 90.9% (10) Unknown 3.6% (1) 0.0% (0) 9.1% (1) Relationship status % (N) > 0.99 Single/ not dating 3.6% (1) 5.9% (1) 0.0% (0) Dating/ boyfriend/ girlfriend 10.7% (3) 11.8% (2) 9.1% (1) Partnered 25.0% (7) 23.5% (4) 27.3% (3) Married 60.7% (17) 58.8% (10) 63.6% (7) Sexual Partner Gender in the Past 6 months % (N) 0.07 Female 7.1% (2) 0.0% (0) 18.2% (2) Male 75.0% (21) 76.5% (13) 72.7% (8) Other 7.1% (2) 11.8% (2) 0.0% (0) Female and Male 7.1% (2) 11.8% (2) 0.0% (0) Unknown 3.6% (1) 0.0% (0) 9.1% (1) Sexual activity in the past 6 months % (N) 0.26 None/ abstinence / prefer not to answer 10.7% (3) 17.6% (3) 0.0% (0) Any sexual activity 89.3% (25) 82.4% (14) 100.0% (11) Table 2 Patient clinical characteristics including breast cancer treatment received over the course of the study. (ER = estrogen receptor, PR = progesterone receptor, AIs = aromatase inhibitors) Overall n = 28 6-month non-responder n = 17 6-month responder n = 11 p-value Breast cancer diagnosis, % (N) 0.47 Invasive lobular carcinoma 7.1% (2) 11.8% (2) 0.0% (0) Invasive ductal carcinoma 82.1% (23) 82.4% (14) 81.8% (9) Other 10.7% (3) 5.9% (1) 18.2% (2) Clinical anatomic stage, % (N) 0.84 Stage I 67.9% (19) 70.6% (12) 63.6% (7) Stage II 21.4% (6) 17.6% (3) 27.3% (3) Stage III 10.7% (3) 11.8% (2) 9.1% (1) Hormone Receptor Status, % (N) > 0.99 ER/PR+, HER2+ 14.3% (4) 11.8% (2) 18.2% (2) ER/PR +, HER2- 75.0% (21) 76.5% (13) 72.7% (8) ER/PR-, HER2- 10.7% (3) 11.8% (2) 9.1% (1) Surgery, % (N) 0.33 Lumpectomy 50.0% (14) 58.8% (10) 36.4% (4) Mastectomy 46.4% (13) 41.2% (7) 54.5% (6) None 3.6% (1) 0.0% (0) 9.1% (1) Chemotherapy, % (N) > 0.99 Neoadjuvant chemotherapy 25.0% (7) 23.5% (4) 27.3% (3) Adjuvant chemotherapy 14.3% (4) 17.6% (3) 9.1% (1) Both 10.7% (3) 11.8% (2) 9.1% (1) None 50.0% (14) 47.1% (8) 54.5% (6) Endocrine therapy (Tamoxifen, AIs), % (N) 57.1% (16) 47.1% (8) 72.7% (8) 0.25 Radiation therapy, % (N) 64.3% (18) 64.7% (11) 63.6% (7) > 0.99 Acceptability, Appropriateness, and Feasibility Of the 6-month survey responders, nine participants reported viewing the online videos and completed the acceptability, appropriateness, and feasibility measures. Overall, the mean acceptability, appropriateness, and feasibility scores were 4.1 (SD 1.0), 4.3 (SD 0.8), and 4.4 (SD 0.7) out of 5, respectfully. Most participants completely agreed or agreed that the online videos were acceptable, appropriate, and feasible (Fig. 2 ). Only one participant disagreed with the acceptability statements that the videos were ‘welcoming’, that they ‘liked’ the videos, that the videos were ‘appealing’, and they ‘approved’ of the videos. Notably, no participant strongly disagreed that the videos were acceptable appropriate, or feasible. PROMIS Sexual Function and Satisfaction Eleven participants completed the PROMIS BRIEF Female Sexual Function and Satisfaction measure at baseline and 6 months. Two participants indicated no sexual activity during the past 30 days, excluding them from answering the remaining domain-specific questions. Changes in sexual function were observed across all symptom domains at 6-months, with mean change scores reflecting possible worsening sexual function from baseline to 6-month follow up (Fig. 3 , Supplemental Table 1). Across sexual function subdomains, decreased vaginal lubrication (T-score change = -8.5, SD = 7.3, p < 0.01) and increased vaginal discomfort (T-score change = + 6.5, SD = 7.2, p-value = 0.03) were the most pronounced with changes in sexual activity, labial discomfort, clitoral discomfort, orgasm ability, orgasm pleasure, and satisfaction with sex life not reaching statistical significance. Free Response Answers All participants shared a range of insights when asked the stand-alone question, “What did you learn from the videos?” (Table 3 ). Five participants reported on content-specific learnings including new knowledge gained about expected physical changes due to cancer and its associated treatment. One participant focused on the structure and delivery of the content and felt they were too “clunky, repetitive, and too short”. Finally, three participants felt the scope was too narrow, ultimately reporting a desire for additional detail or reporting that the content in the videos was similar to their own online research. Table 3 Participant comments regarding what they learned after six months of using the educational video series. The open-ended question asked participants, “What did you learn from the videos?” . Participant Quote Content-specific a) “A better idea of what to expect for bodily changes due to cancer and some upcoming treatment. I never even thought of how cancer could affect sexual health so it was nice hearing from former patients.” (Participant #1) b) “I learned about sexual health during breast cancer. Also, what procedures would be.” (Participant #4) c) “I learned about what to expect with both radiation and tamoxifen.” (Participant #5) d) “Helpful overview of breast cancer before and after surgery.” (Participant #6) e) “I learned about some of the common side effects to treatments as well as what the surgery options were.” (Participant #9) Structure & Delivery a) “I only watched a few videos about mastectomy, but found the videos kind of clunky, repetitive and too short so I didn’t watch more videos.” (Participant #8) Scope a) “Most of the information I learned from my doctor. These videos are nice and short, but didn’t seem to go into very much detail.” (Participant #2) b) “The only one that was helpful was the one on the various mastectomy choices and expectations. The others were too basic and vague.” (Participant #3) c) “Most of the information I already know or did not pertain to me. But that may be because I did a lot of research prior to watching the videos.” (Participant #7) Conclusions In this pilot study, a sample of newly diagnosed breast cancer patients found our online sexual health educational video series to be highly acceptable, appropriate, and feasible as an educational intervention. This study represents an important proof of concept for this novel, patient-centered, video-based intervention. While limited by a small sample size, this exploratory work provides valuable insights into patients’ needs, preferences, and ideas for video optimization. To our knowledge, this is the first study to expand on the use of video-based education, developed in partnership with breast cancer survivors, to provide resources for breast cancer patients inclusive of treatment-related sexual health changes. The online accessibility of the videos supports the feasibility as it allows patients to privately access the videos in a time and place that are most convenient to them. With the growth and accessibility of the internet, many patients turn towards resources they can access through their web browsers and social media. TikTok, a social media platform for creating, sharing, and watching short-form videos, is one such online place where patients may seek information about breast cancer and breast cancer surgery [ 37 , 38 ]. However, studies to characterize the information about breast cancer on TikTok have shown that while videos have high engagement, the videos are not commonly created by healthcare professionals, are fragmented, and have poor content and information quality [ 38 , 39 ]. Conversely, existing video-based education developed by providers has been demonstrated to be feasible [ 40 ], improve breast cancer patient knowledge [ 40 , 41 ], and reduce post-operative anxiety and increase comfort [ 42 ]. However, these video series often focus on general breast cancer content and lack sexual health specific information [ 40 , 42 ]. The online video series in this study mixes the style of TikTok videos (e.g., short in length with real patient stories) with evidence-based information developed by subject matter experts [ 28 ]. The videos were an average length of 1.4 minutes; thus, we hypothesized that this would be welcomed by the patients who are often overwhelmed with the volume of information to learn after a diagnosis. Surprisingly, while nearly all participants felt the videos were acceptable, appropriate, and feasible via Likert responses, when asked what they learned from the videos several participants felt the videos were too short and wanted greater detail. Future semi-structured interviews with study participants aim to qualitatively explore the individual use of the videos and identify specific topics with insufficient detail. Additionally, testing of the videos among a larger patient population is also necessary to identify more perspectives on the content, scope, and delivery of the video series. In the absence of available online information, patients must rely on their healthcare providers, family, and friends for resources and information. Using focus groups, Huynh et al., found that many breast cancer survivors never received sexual health education from their oncology team or other medical providers. When they did, the education focused on reproductive health or menopausal symptoms [ 6 ]. In another study assessing factors affecting willingness to discuss symptoms with providers, researchers found that many patients experience barriers such as discomfort bringing sexual health up, a belief that their symptoms are untreatable, and difficulty finding a provider to take ownership of dealing and assisting with their sexual health concerns [ 43 ]. Clinicians also report significant barriers to discussing sexual health including time, conflicting priorities, and discomfort discussing sexual health [ 12 , 15 ]. To improve sexual health discussions, a multifaceted approach should be taken that addresses both patients and providers. One potential way to better support patients is to teach them how to discuss their sexual health with their providers. For example, a patient-facing multimedia intervention consisting of a 20-minute video slideshow and workbook led to more women raising sexual health topics during their clinic visits [ 20 ]. While the online video series in this study does not directly coach patients in how to communicate with providers about their sexual health, it may have helped to normalize this topic as part of cancer care, which in turn may lead to improved self-efficacy and confidence in broaching it when symptoms arise. Importantly, this normalization of sexual health has been previously shown to support patient comfort in raising the topic [ 43 ]. As such, future studies should investigate specific cognitive (e.g., self-efficacy) and behavioral (e.g., clinical communication) outcomes of the video series. Regarding the impact of the video series on sexual health outcomes, this study was exploratory in nature. Given that more than 70% of the 6-month responders were undergoing treatment with hormone-receptor blockers at the time of their survey, our findings of the wide range of changes across sexual function subdomains is not surprising. Among breast cancer patients, these are the most common sexual health symptoms with vaginal dryness and pain with intercourse occurring in up to 85% and 87% of patients, respectively [ 10 , 25 ]. As many breast cancer patients are undergoing treatment for longer than our six-month study, it’s impossible to directly assess the impact of the video series on these sexual health changes or if access to the videos led patients to obtain treatment resources sooner than patients who may not have had the same education. The next phase of study will examine the impacts of the videos over a longer period, which will allow for further exploration. Additionally, future studies should include a control group to objectively evaluate the effect the video series has on sexual function. Limitations of this study include a small sample size and short timeframe. Participants who completed the six-month survey may have been different than the participants who did not complete the survey in areas we did not measure, such as participants being more interested in sexual health education. However, when comparing the demographic and clinical characteristics of the 6-month responders to the non-responders, we did not find any statistically significant differences. While a small number of participants withdrew from the study due to feeling overburdened (Supplemental Fig. 1), many participants never responded to the 6-month survey despite repeated attempts to engage. It’s possible that more participants decided they did not want to continue in the study after realizing how many videos were on the website. Others may have logged in and watched a few videos and then forgotten about them as their treatment progressed despite monthly emailed reminders. We purposefully did not give participants specific instructions on how to engage with the videos other than to watch the ones they were interested in, but this may be one way to reduce this barrier. For example, perhaps the videos are “prescribed” to the patient during their cancer care. A prescription would personalize the library of content for an individual based on their breast cancer and other health needs while also introducing the possibility of ensuring that patients receive the right information at the right time. It is also possible that participants engaged with the videos but neglected to complete the 6-month survey. In fact, an unpublished group-level analysis of engagement with the video website demonstrated that over 6 months, there was 130 unique sessions with total video watch time of 524 minutes and an average of 8 minutes per session [ 44 ]. Another limitation is the availability of the online videos in English-only which leads to disparities in care for non-English speaking patients who must rely on standard education and cannot utilize this novel resource. The videos are currently being translated into Spanish, but future work should include expanding access across other languages as well. Finally, this study wasn’t powered to detect statistical significance but was intended to identify implementation challenges and inform future study design. Nevertheless, among the women who did watch the video series, responses were overall positive. In conclusion, this pilot study demonstrates the acceptability, appropriateness, and feasibility of a novel sexual health education video series for female breast cancer patients with Stage I-III disease. This video series fills a unique gap in patient care, and with further iterations and development has the potential to significantly advance the sexual health-resources available to breast cancer patients and survivors. Statements and Declarations Acknowledgements: We would like to thank all the other individuals whose contribution to this work made this research possible including Keith Singer and the non-profit organization, Catch It In Time. Additionally, we’d like to thank all the patients who participated in this study and provided their valuable feedback. Author Contributions: Higgins MG: Conceptualization, data curation, funding acquisition, investigation, resources, methodology, project administration, visualization, writing – original draft. Helmkamp L: Methodology, formal analysis, visualization, writing – reviewing & editing. Zimmaro LA: Conceptualization, visualization, writing - reviewing & editing. Leslie SE: Investigation, visualization, writing – reviewing & editing. Adams M: Conceptualization, methodology, writing – reviewing & editing. Vemuru: Conceptualization, writing – reviewing & editing. Baurle E: Conceptualization, writing – reviewing & editing. Rojas KE: Conceptualization, methodology, writing – reviewing & editing. Coons HL: Conceptualization, methodology, writing – reviewing & editing. Tevis S: Conceptualization, funding acquisition, methodology, resources, supervision, validation, visualization, writing – reviewing & editing. Competing Interests: KER: Consulting Fees – Roche Diagnostic Solutions, Merck, Novartis. Speaker Honoraria – Pacira Pharmaceuticals, Research Funding – Robert A. Winn Diversity in Clinical Trials Career Development Award (Bristol Myers Squibb Foundation), NIH/NCI “Early-Stage Surgeon Scientist Program (ESSP) NOT-CA-12-100” (Supplement to 2P30CA240139-06) Funding: This work was supported by the ISSWSH Scholars in Women’s Sexual Health Research Grant awarded to Madeline G. Higgins, MD in 2023, and an American Society of Breast Surgeons Foundation Grant awarded to Sarah Tevis, MD in 2019. Ethics Approval: All procedures performed in this study were reviewed and approved by the institutional review board (COMIRB #23-1789). The study was performed in accordance with the ethical standards as laid down in the 19964 Declaration of Helsinki and its later amendments. Consent: Informed consent was obtained from all individual participants included in the study. References Oberguggenberger, A., et al., Self-reported sexual health: Breast cancer survivors compared to women from the general population - an observational study. 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Vrancken Peeters, N., et al., Sexual quality of life of adolescents and young adult breast cancer survivors. ESMO Open, 2024. 9 (2): p. 102234. Benedict, C., et al., Examining Associations Among Sexual Health, Unmet Care Needs, and Distress in Breast and Gynecologic Cancer Survivors. Semin Oncol Nurs, 2022. 38 (6): p. 151316. Bryl, K., et al., The relationship between anxiety and vaginal-related sexual health in postmenopausal breast cancer survivors on aromatase inhibitors therapies: a cross sectional study. Breast Cancer Res Treat, 2023. 200 (2): p. 257-264. Sporn, N.J., et al., Sexual health communication between cancer survivors and providers: how frequently does it occur and which providers are preferred? Psychooncology, 2015. 24 (9): p. 1167-73. Stead, M.L., et al., Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. Br J Cancer, 2003. 88 (5): p. 666-71. Stabile, C., et al., Sexual health needs and educational intervention preferences for women with cancer. Breast Cancer Res Treat, 2017. 165 (1): p. 77-84. Albers, L.F., et al., Sexual Health Needs: How Do Breast Cancer Patients and Their Partners Want Information? J Sex Marital Ther, 2020. 46 (3): p. 205-226. Zhu, P., et al., Oncology nurses' and oncologists' experience of addressing sexual health concerns in breast cancer patients: A qualitative study. Eur J Oncol Nurs, 2023. 63 : p. 102286. Hordern, A.J. and A.F. Street, Let's talk about sex: risky business for cancer and palliative care clinicians. Contemp Nurse, 2007. 27 (1): p. 49-60. Reese, J.B., et al., Patient-clinician communication about sexual health in breast cancer: A mixed-methods analysis of clinic dialogue. Patient Educ Couns, 2019. 102 (3): p. 436-442. Reese, J.B., et al., Communication about Sexual Health in Breast Cancer: What Can We Learn from Patients' Self-Report and Clinic Dialogue? Patient Educ Couns, 2020. 103 (9): p. 1821-1829. Reese, J.B., et al., A brief intervention to enhance breast cancer clinicians' communication about sexual health: Feasibility, acceptability, and preliminary outcomes. Psychooncology, 2019. 28 (4): p. 872-879. Reese, J.B., et al., Efficacy of a multimedia intervention in facilitating breast cancer patients' clinical communication about sexual health: Results of a randomized controlled trial. Psychooncology, 2021. 30 (5): p. 681-690. Reese, J.B., et al., Mobile Technology-Based (mLearning) Intervention to Enhance Breast Cancer Clinicians' Communication About Sexual Health: A Pilot Trial. J Natl Compr Canc Netw, 2021. 19 (10): p. 1133-1140. Bober, S.L., E. Fine, and C.J. Recklitis, Sexual health and rehabilitation after ovarian suppression treatment (SHARE-OS): a clinical intervention for young breast cancer survivors. J Cancer Surviv, 2020. 14 (1): p. 26-30. Brotto, L.A., M. Yule, and E. Breckon, Psychological interventions for the sexual sequelae of cancer: a review of the literature. J Cancer Surviv, 2010. 4 (4): p. 346-60. Rowland, J.H., et al., Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. Breast Cancer Res Treat, 2009. 118 (1): p. 99-111. Rash, J.K., et al., Patient reported improvement in sexual health outcomes following care in a sexual health clinic for women with cancer. Support Care Cancer, 2023. 31 (3): p. 171. Walker, L.M., et al., Development, implementation, and evaluation of a multidisciplinary oncology sexual health clinic in a Canadian cancer care setting. J Cancer Surviv, 2021. 15 (5): p. 755-766. Reese, J.B., et al., A randomized pilot trial of a couple-based intervention addressing sexual concerns for breast cancer survivors. J Psychosoc Oncol, 2019. 37 (2): p. 242-263. Adams, M., Developing a Patient-Centered Educational Video Series on Sexual Health for Women with Breast Cancer , in American College of Surgeons Quality and Safety Conference . 2024: Denver, CO. Czajkowski, S.M., et al., From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol, 2015. 34 (10): p. 971-82. Konduri, S., et al., Epidemiology of male breast cancer. Breast, 2020. 54 : p. 8-14. Harris, P.A., et al., The REDCap consortium: Building an international community of software platform partners. J Biomed Inform, 2019. 95 : p. 103208. Harris, P.A., et al., Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 2009. 42 (2): p. 377-81. Weiner, B.J., et al., Psychometric assessment of three newly developed implementation outcome measures. Implement Sci, 2017. 12 (1): p. 108. Flynn, K.E., et al., Development of the NIH PROMIS ® Sexual Function and Satisfaction measures in patients with cancer. J Sex Med, 2013. 10 Suppl 1 (0 1): p. 43-52. Weinfurt, K.P., et al., Development and Initial Validation of the PROMIS(®) Sexual Function and Satisfaction Measures Version 2.0. J Sex Med, 2015. 12 (9): p. 1961-74. PROMIS, Sexual Function and Satisfaction Scoring Manual . 2020: NIH. 39. Basch, C.H., et al., How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis. JMIR Cancer, 2022. 8 (4): p. e42245. Xiong, M., et al., Understanding Breast Cancer Surgery Through Tiktok: an Analysis of Video Content and Viewer Engagement. Ann Surg Oncol, 2024. 31 (7): p. 4182-4184. Qu, Y., et al., Assessing the quality of breast cancer-related videos on TikTok: A cross-sectional study. Digit Health, 2024. 10 : p. 20552076241277688. Sulakvelidze, N., et al., Evaluating the Effect of a Video Education Curriculum for First Time Breast Cancer Patients: a Prospective RCT Feasibility Study. J Cancer Educ, 2019. 34 (6): p. 1234-1240. Jimenez, Y.A., et al., Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy. Support Care Cancer, 2018. 26 (8): p. 2879-2888. Güzel, N., A. Yava, and A. Koyuncu, The Effects of Preoperative Video-Assisted Education on Anxiety and Comfort After Breast Cancer Surgery: Nonrandomized Controlled Study. J Perianesth Nurs, 2024. 39 (6): p. 999-1005. Canzona, M.R., et al., Talking about sexual health during survivorship: understanding what shapes breast cancer survivors' willingness to communicate with providers. J Cancer Surviv, 2019. 13 (6): p. 932-942. Higgins, M.G., Feasibility of an online sexual health educational video series for breast cancer patients , in Academic Surgical Congress . 2024: Las Vegas, NV. Additional Declarations Competing interest reported. KER: Consulting Fees – Roche Diagnostic Solutions, Merck, Novartis. Speaker Honoraria – Pacira Pharmaceuticals, Research Funding – Robert A. Winn Diversity in Clinical Trials Career Development Award (Bristol Myers Squibb Foundation), NIH/NCI “Early-Stage Surgeon Scientist Program (ESSP) NOT-CA-12-100” (Supplement to 2P30CA240139-06) Supplementary Files SupplementalFiguresSexualHealthVideoSeriesSCC.docx Cite Share Download PDF Status: Published Journal Publication published 26 Jan, 2026 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 23 Nov, 2025 Reviews received at journal 10 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviewers agreed at journal 20 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviewers invited by journal 10 Aug, 2025 Editor assigned by journal 10 Aug, 2025 Submission checks completed at journal 03 Jul, 2025 First submitted to journal 01 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Coons","email":"","orcid":"","institution":"Women's Mental Health Associates","correspondingAuthor":false,"prefix":"","firstName":"Helen","middleName":"L.","lastName":"Coons","suffix":""},{"id":500233541,"identity":"34da67ba-d2de-48de-80cc-6bfc8fd72929","order_by":11,"name":"Ashley Arkema","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"Ashley","middleName":"","lastName":"Arkema","suffix":""},{"id":500233542,"identity":"c2308246-c604-42c6-916c-6533746f4ccd","order_by":12,"name":"Sarah Tevis","email":"","orcid":"","institution":"University of Colorado Anschutz Medical Campus","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Tevis","suffix":""}],"badges":[],"createdAt":"2025-07-01 19:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7023075/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7023075/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00520-026-10381-y","type":"published","date":"2026-01-26T15:59:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89287329,"identity":"837dda3b-d175-48b6-81f6-40876d34993c","added_by":"auto","created_at":"2025-08-18 11:39:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91820,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic of study design and measures used.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7023075/v1/da7b91319039401e1f59e423.png"},{"id":89287330,"identity":"926d16b7-679a-4172-95b8-ef14e0a7d060","added_by":"auto","created_at":"2025-08-18 11:39:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":75146,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of participant responses on item-level ratings of the video series’ acceptability (Panel A), appropriateness (Panel B), and feasibility (Panel C).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7023075/v1/145225eeb8577635eceedd48.png"},{"id":89287640,"identity":"4a67dd7f-29cd-4ef3-8e56-269f579e797e","added_by":"auto","created_at":"2025-08-18 11:47:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":46013,"visible":true,"origin":"","legend":"\u003cp\u003ePROMIS Brief Female Sexual Function scores at baseline and 6 months (*p\u0026lt;0.05, **p\u0026lt;0.01).\u003cem\u003e Worsening function is indicated by negative (-) change scores in domains of interest in sexual activity, vaginal lubrication, orgasm ability, orgasm pleasure, and satisfaction with sex life; and by positive (+) change scores in subdomains of vaginal discomfort, labial discomfort, and clitoral discomfort.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7023075/v1/f440a082d224625fde0a91c2.png"},{"id":101690965,"identity":"2f5235a3-587f-420b-84d2-bcaa2e5b85b9","added_by":"auto","created_at":"2026-02-02 16:11:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1072214,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7023075/v1/d6831d03-7a82-4a14-a3a7-bf6c29e252a5.pdf"},{"id":89288640,"identity":"fe83f6c4-4db6-4fb1-9022-460179d43d7b","added_by":"auto","created_at":"2025-08-18 11:55:12","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":111634,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFiguresSexualHealthVideoSeriesSCC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7023075/v1/140122fd8f86912baf715686.docx"}],"financialInterests":"Competing interest reported. KER: Consulting Fees – Roche Diagnostic Solutions, Merck, Novartis. Speaker Honoraria – Pacira Pharmaceuticals, Research Funding – Robert A. Winn Diversity in Clinical Trials Career Development Award (Bristol Myers Squibb Foundation), NIH/NCI “Early-Stage Surgeon Scientist Program (ESSP) NOT-CA-12-100” (Supplement to 2P30CA240139-06)","formattedTitle":"Let’s Talk About Sex: An Acceptable, Appropriate and Feasible Online Sexual Health Educational Video Series for Breast Cancer Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdvances in breast cancer treatment have led to more than 3.5\u0026nbsp;million breast cancer survivors in the United States, many of whom will experience short- and long-term sexual health side effects because of their treatment [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Sexual health symptoms after breast cancer treatment are common with 37–78% of survivors experiencing at least one sexual concern and up to 87% reporting low sexual desire [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Patients may also experience negative body image, infertility, menopausal symptoms, concerns about intimacy, and struggles with dating [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These symptoms have meaningful impacts as studies have shown that breast cancer patients with sexual concerns report poorer quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and greater psychological distress, including greater depression and anxiety, as compared to those without sexual symptoms [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile treatment-related sexual health symptoms are common during breast cancer, many patients report a lack of sexual health-specific education and resources from their oncology team or other medical providers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In fact, women with breast cancer report a strong desire for discussions about sexual health to be initiated by their clinician [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and for the topic of sexual health to be brought up early – and often – throughout their breast cancer journey [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Multiple studies demonstrate that patients prefer to receive information through discussions with their providers or from handouts, online websites, and support groups [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, focus groups with breast cancer survivors have identified that patients want a broad range of sexual health education from treatment effects to mitigation strategies to navigating dating and partner intimacy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Unfortunately, studies among breast cancer providers have identified key clinician barriers to discussing sexual health with breast cancer patients including lack of clinic time, inadequate knowledge, and discomfort or embarrassment [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Clinicians also face conflicting priorities and often focus on cancer outcomes and treatment rather than discussing topics related to intimacy and sexual health [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Overall, sexual health discussions occur in less than half of patient visits [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and when they do, 28% of patients incorrectly self-report whether or not the conversation happened [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile there have been significant scientific and clinical advances in addressing cancer-related sexual issues over the past decade, the need for patient-facing educational programs that are accessible, relevant, and comprehensive remains. Current interventions have features that may limit their ability to provide timely, practical, and appealing sexual health education to breast cancer patients and survivors. For example, many interventions are either clinician-facing and aimed at improving communication [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e–\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], have a narrow scope and are centered on specific issues such as fertility or menopausal symptoms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], are one-time programs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] or are only provided post-treatment and after symptoms arise [\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e–\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Together, this limits the ability for women to access sexual health information repeatedly or at different timepoints throughout the course of treatment. As such, there remains a continued need for collaborative, patient-centered approaches to develop and implement acceptable, appropriate, and feasible programs to address cancer-related sexual concerns.\u003c/p\u003e\u003cp\u003eTherefore, we assembled a multidisciplinary team including sexual health experts and breast cancer survivors to develop an online video educational series to use throughout patients’ breast cancer care. The iterative and rigorous user-centered development process has been described by Adams et. al [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Overall, the video series consisted of 56 separate, brief videos (1–3 minutes long) that provide sexual health education on a range of topics such as 1) medical and biological (i.e., surgical approaches for treatment, expectation setting, possible changes to physical sensation, effects of treatment related to early menopause and estrogen blockades), 2) emotional, behavioral, and cognitive (i.e., coping with anxiety, mindfulness techniques), 3) patient relationships (i.e., accepting support, building relationships with providers), and 4) intimate relationships (i.e., communicating with partners, body image, dating). The videos show short clips from subject matter experts spanning breast surgery, medical oncology, gynecology, psycho-oncology and sexual medicine, plus personal stories and lived-experiences of breast cancer survivors. Preliminary evaluation among prior focus group participants found that the videos were favorable and understandable, however the acceptability, appropriateness, and feasibility among newly diagnosed breast cancer patients was untested [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExploratory in nature, this pilot study aimed to assess the acceptability, appropriateness, and feasibility of the sexual health video series via validated surveys and open-item feedback responses among a sample of newly diagnosed breast cancer patients. Additionally, we sought to examine preliminary signals of intervention effects by assessing patient-reported sexual function from pre- to post-intervention. Given the proof-of-concept nature of this study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], no specific hypotheses were made, but we expected the intervention to be perceived as acceptable, appropriate, and feasible among participants.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy Design and Patient Population\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis was a pilot study performed as part of an ongoing, prospective clinical trial (NCT06121258) that included Stage I-III adult female breast cancer patients seen in a comprehensive breast cancer center. This study was approved by the Institutional Review Board (COMIRB #23-1734). Eligible women aged 18–100 years old diagnosed with breast cancer provided informed consent and completed study procedures. Patients with Stage 0 or IV breast cancer, prior cancer history, or prior exposure to anti-hormone therapy, chemotherapy or radiotherapy not related to breast cancer were excluded. The online video series was available in English only during this pilot phase, so only patients who could read or speak in English were included. Male breast cancer patients were excluded due to the low prevalence overall [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Eligible patients were identified by a research coordinator and contacted via telephone within one month of their initial multi-disciplinary clinic visit or initial surgical consultation, but prior to initiating treatment, to discuss the study and confirm eligibility. Interested patients were then emailed a consent form and instructions for completing a baseline survey including demographic and recent sexual history.\u003c/p\u003e\u003cp\u003eFollowing informed consent and completion of the baseline survey, participants were emailed a link to access the online video series website, along with a personalized, de-identified username and password. Due to the individualized nature of breast cancer treatment, participants were provided full access to the entire video series without explicit instructions on the order or selection of videos they should watch. Participants then received a monthly email reminder with a link to the videos for five months and a final survey six months after enrollment. All surveys and reminders were administered electronically via the REDCap Database [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Survey reminders were automatically repeated three times, one week apart. After this, patients received up to three individual emails from a study coordinator with a personal link to their six-month survey. No phone calls or attempts to reach the participants in clinic were made. Participants were considered non-responders if they did not respond to the six-month survey within three months. Participants were provided a \u003cspan\u003e$\u003c/span\u003e25 gift card for completing the baseline survey and an additional \u003cspan\u003e$\u003c/span\u003e25 gift card for completing the six-month follow-up survey. A schematic outlining the study design is demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe primary outcomes were acceptability, appropriateness, and feasibility, assessed by the Acceptability of Intervention (AIM), Intervention Appropriateness (IAM), and Feasibility of Intervention Measures (FIM), which are widely used self-reported surveys with good psychometric properties [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Responses are measured on a 5-point Likert scale and higher scores reflect a higher degree of acceptability (i.e., is appealing, satisfactory), appropriateness (i.e., is relevant, fitting), and feasibility (i.e., is easy to use, implementable). Participants who did not endorse watching the videos at the six-month survey were excluded from completing the AIM, IAM, and FIM surveys as the purpose was to capture those who watched at least a portion of the videos. The primary outcomes were assessed 6-months post-intervention and were chosen to improve study participant retention.\u003c/p\u003e\u003cp\u003eThe secondary outcome was the impact of the online educational resource on sexual health, assessed by the NIH-developed PROMIS Brief Female Sexual Function and Satisfaction (FSFS) v2.0 questionnaire at baseline and six-months. The PROMIS Brief FSFS is a validated patient-reported outcome measure that assesses an individual’s sexual function and satisfaction over the past three months in the following subdomains: 1) interest in sexual activity, 2) vaginal lubrication, 3) vaginal discomfort, 4) labial discomfort, 5) clitoral discomfort, 6) orgasm ability, 7) orgasm pleasure, and 8) satisfaction with sex life [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This measure was chosen for its greater inclusivity of diverse and varied sexual practices compared to other validated measures of sexual health. In addition to the PROMIS FSFS, a single question was included in the baseline survey assessing sexual activity in the past 6 months prior to the breast cancer diagnosis.\u003c/p\u003e\u003cp\u003eFurther exploratory outcomes included evaluation of individual patient perceptions of the experience and impact of the online educational resource on their sexual health during breast cancer treatment. This was assessed through free-response questions throughout the study including a question at 6-months post-intervention, “What did you learn from the videos?”\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eSurvey responses were collected via REDCap, and clinical data was abstracted through chart review. Participant demographic and clinical factors were described using counts and percentages for categorical variables and means and standard deviations for age. Six-month responders were compared to non-responders using chi-square tests or Fisher’s exact tests as appropriate for categorical variables and a t-test for age. The combined means and SD for the AIM, IAM, and FIM scales were described with values ranging from 1 to 5 with higher scores indicating greater acceptability, appropriateness, or feasibility. The PROMIS FSFS was scored according to the instrument’s scoring manual [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]: Calibrated subdomain scores are expressed in terms of standardized T-scores where a mean score of 50 corresponds with the average response in the reference sample of female respondents (SD = 10). Higher scores indicate greater endorsement of the subdomain assessed (e.g., greater interest in sexual activity, greater vaginal discomfort). Changes in PROMIS scores were calculated by subtracting the baseline score from the 6-month score. Given the exploratory nature of analysis, effects were characterized descriptively via the magnitude of the change score and paired t-tests. Analyses were conducted in SAS version 9.4 with statistical significance set as \u003cem\u003ep\u003c/em\u003e-value \u0026lt; .05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eStudy Population\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFrom January \u0026ndash; June 2024, 117 patients were screened, and 82 (70%) patients were called for potential inclusion (Supplemental Fig.\u0026nbsp;1). Of those contacted, 57 (70%) expressed an interest in participating and were emailed the electronic consent and baseline survey. Twenty-eight (49%) patients completed both the consent and baseline survey and were given access to the video series. Of these, 11 (39%) patients completed the 6-month follow up survey, while 17 patients did not complete the 6-month survey.\u003c/p\u003e\u003cp\u003eThe mean age of the 28 participants was 47.9 years (SD 8). Most participants were white (85.7%, n\u0026thinsp;=\u0026thinsp;24), non-Hispanic/Latina or of Spanish origin (96.4%, n\u0026thinsp;=\u0026thinsp;27), straight/heterosexual (89.3%, n\u0026thinsp;=\u0026thinsp;25), were married or partnered (85.7%, n\u0026thinsp;=\u0026thinsp;24), and with a male sexual partner (75.0%, n\u0026thinsp;=\u0026thinsp;21) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The most common sexual activities in the past six months reported by participants were sexual intercourse, oral sex, and masturbation. Clinically, most participants had Stage I disease (67.9%, n\u0026thinsp;=\u0026thinsp;19) and were diagnosed with invasive ductal carcinoma (82.1%, n\u0026thinsp;=\u0026thinsp;23) and ER/PR-positive, HER2-negative tumors (75%, n\u0026thinsp;=\u0026thinsp;21). Additional clinical characteristics are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThere were no statistically significant differences in baseline demographics and sexual activity among the 6-month responders compared to the non-responders.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient demographic characteristics and sexual activity in the past 6 months.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall \u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6-month non-responder\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6-month responder\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, Mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47.9 (8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.8 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.1 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEthnicity % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Hispanic/Latina or of Spanish origin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96.4% (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.0% (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.9% (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic/Latina/Spanish origin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmerican Indian or Alaska\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaucasian/White\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85.7% (24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.4% (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.9% (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (specify)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrefer not to answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.1% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual Orientation % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeterosexual or straight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89.3% (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e94.1% (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.8% (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesbian, gay, homosexual, or same-gender loving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBisexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrefer not to answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender Identity % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96.4% (27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.0% (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e90.9% (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship status % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle/ not dating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDating/ boyfriend/ girlfriend\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.7% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartnered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25.0% (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.5% (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.3% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60.7% (17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.8% (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.6% (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual Partner Gender in the Past 6 months % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.1% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.2% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.0% (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76.5% (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.7% (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.1% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale and Male\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.1% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual activity in the past 6 months % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone/ abstinence / prefer not to answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.7% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.6% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAny sexual activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89.3% (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.4% (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e100.0% (11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient clinical characteristics including breast cancer treatment received over the course of the study. (ER\u0026thinsp;=\u0026thinsp;estrogen receptor, PR\u0026thinsp;=\u0026thinsp;progesterone receptor, AIs\u0026thinsp;=\u0026thinsp;aromatase inhibitors)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;28\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6-month non-responder\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;17\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6-month responder\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBreast cancer diagnosis, % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInvasive lobular carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.1% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInvasive ductal carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82.1% (23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.4% (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.8% (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.7% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.9% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.2% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical anatomic stage, % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67.9% (19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.6% (12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.6% (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21.4% (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.6% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.3% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.7% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHormone Receptor Status, % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eER/PR+, HER2+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.3% (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.2% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eER/PR +, HER2-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.0% (21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76.5% (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.7% (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eER/PR-, HER2-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.7% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgery, % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLumpectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50.0% (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.8% (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36.4% (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMastectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46.4% (13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41.2% (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54.5% (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0% (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChemotherapy, % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeoadjuvant chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25.0% (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.5% (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.3% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdjuvant chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.3% (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.6% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.7% (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8% (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.1% (1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50.0% (14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.1% (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54.5% (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndocrine therapy (Tamoxifen, AIs), % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57.1% (16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.1% (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.7% (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiation therapy, % (N)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64.3% (18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.7% (11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.6% (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eAcceptability, Appropriateness, and Feasibility\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOf the 6-month survey responders, nine participants reported viewing the online videos and completed the acceptability, appropriateness, and feasibility measures. Overall, the mean acceptability, appropriateness, and feasibility scores were 4.1 (SD 1.0), 4.3 (SD 0.8), and 4.4 (SD 0.7) out of 5, respectfully. Most participants completely agreed or agreed that the online videos were acceptable, appropriate, and feasible (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Only one participant disagreed with the acceptability statements that the videos were \u0026lsquo;welcoming\u0026rsquo;, that they \u0026lsquo;liked\u0026rsquo; the videos, that the videos were \u0026lsquo;appealing\u0026rsquo;, and they \u0026lsquo;approved\u0026rsquo; of the videos. Notably, no participant strongly disagreed that the videos were acceptable appropriate, or feasible.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePROMIS Sexual Function and Satisfaction\u003c/em\u003e\u003c/p\u003e\u003cp\u003e Eleven participants completed the PROMIS BRIEF Female Sexual Function and Satisfaction measure at baseline and 6 months. Two participants indicated no sexual activity during the past 30 days, excluding them from answering the remaining domain-specific questions. Changes in sexual function were observed across all symptom domains at 6-months, with mean change scores reflecting possible worsening sexual function from baseline to 6-month follow up (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Supplemental Table\u0026nbsp;1). Across sexual function subdomains, decreased vaginal lubrication (T-score change = -8.5, SD\u0026thinsp;=\u0026thinsp;7.3, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and increased vaginal discomfort (T-score change\u0026thinsp;=\u0026thinsp;+\u0026thinsp;6.5, SD\u0026thinsp;=\u0026thinsp;7.2, p-value\u0026thinsp;=\u0026thinsp;0.03) were the most pronounced with changes in sexual activity, labial discomfort, clitoral discomfort, orgasm ability, orgasm pleasure, and satisfaction with sex life not reaching statistical significance.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFree Response Answers\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAll participants shared a range of insights when asked the stand-alone question, \u0026ldquo;What did you learn from the videos?\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Five participants reported on content-specific learnings including new knowledge gained about expected physical changes due to cancer and its associated treatment. One participant focused on the structure and delivery of the content and felt they were too \u0026ldquo;clunky, repetitive, and too short\u0026rdquo;. Finally, three participants felt the scope was too narrow, ultimately reporting a desire for additional detail or reporting that the content in the videos was similar to their own online research.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant comments regarding what they learned after six months of using the educational video series. The open-ended question asked participants, \u003cb\u003e\u0026ldquo;What did you learn from the videos?\u0026rdquo;\u003c/b\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParticipant Quote\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eContent-specific\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ea) \u0026ldquo;A better idea of what to expect for bodily changes due to cancer and some upcoming treatment. I never even thought of how cancer could affect sexual health so it was nice hearing from former patients.\u0026rdquo; (Participant #1)\u003c/p\u003e\u003cp\u003eb) \u0026ldquo;I learned about sexual health during breast cancer. Also, what procedures would be.\u0026rdquo; (Participant #4)\u003c/p\u003e\u003cp\u003ec) \u0026ldquo;I learned about what to expect with both radiation and tamoxifen.\u0026rdquo; (Participant #5)\u003c/p\u003e\u003cp\u003ed) \u0026ldquo;Helpful overview of breast cancer before and after surgery.\u0026rdquo; (Participant #6)\u003c/p\u003e\u003cp\u003ee) \u0026ldquo;I learned about some of the common side effects to treatments as well as what the surgery options were.\u0026rdquo; (Participant #9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eStructure \u0026amp; Delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ea) \u0026ldquo;I only watched a few videos about mastectomy, but found the videos kind of clunky, repetitive and too short so I didn\u0026rsquo;t watch more videos.\u0026rdquo; (Participant #8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eScope\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ea) \u0026ldquo;Most of the information I learned from my doctor. These videos are nice and short, but didn\u0026rsquo;t seem to go into very much detail.\u0026rdquo; (Participant #2)\u003c/p\u003e\u003cp\u003eb) \u0026ldquo;The only one that was helpful was the one on the various mastectomy choices and expectations. The others were too basic and vague.\u0026rdquo; (Participant #3)\u003c/p\u003e\u003cp\u003ec) \u0026ldquo;Most of the information I already know or did not pertain to me. But that may be because I did a lot of research prior to watching the videos.\u0026rdquo; (Participant #7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this pilot study, a sample of newly diagnosed breast cancer patients found our online sexual health educational video series to be highly acceptable, appropriate, and feasible as an educational intervention. This study represents an important proof of concept for this novel, patient-centered, video-based intervention. While limited by a small sample size, this exploratory work provides valuable insights into patients\u0026rsquo; needs, preferences, and ideas for video optimization.\u003c/p\u003e\u003cp\u003eTo our knowledge, this is the first study to expand on the use of video-based education, developed in partnership with breast cancer survivors, to provide resources for breast cancer patients inclusive of treatment-related sexual health changes. The online accessibility of the videos supports the feasibility as it allows patients to privately access the videos in a time and place that are most convenient to them. With the growth and accessibility of the internet, many patients turn towards resources they can access through their web browsers and social media. TikTok, a social media platform for creating, sharing, and watching short-form videos, is one such online place where patients may seek information about breast cancer and breast cancer surgery [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. However, studies to characterize the information about breast cancer on TikTok have shown that while videos have high engagement, the videos are not commonly created by healthcare professionals, are fragmented, and have poor content and information quality [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Conversely, existing video-based education developed by providers has been demonstrated to be feasible [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], improve breast cancer patient knowledge [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and reduce post-operative anxiety and increase comfort [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. However, these video series often focus on general breast cancer content and lack sexual health specific information [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The online video series in this study mixes the style of TikTok videos (e.g., short in length with real patient stories) with evidence-based information developed by subject matter experts [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The videos were an average length of 1.4 minutes; thus, we hypothesized that this would be welcomed by the patients who are often overwhelmed with the volume of information to learn after a diagnosis. Surprisingly, while nearly all participants felt the videos were acceptable, appropriate, and feasible via Likert responses, when asked what they learned from the videos several participants felt the videos were too short and wanted greater detail. Future semi-structured interviews with study participants aim to qualitatively explore the individual use of the videos and identify specific topics with insufficient detail. Additionally, testing of the videos among a larger patient population is also necessary to identify more perspectives on the content, scope, and delivery of the video series.\u003c/p\u003e\u003cp\u003eIn the absence of available online information, patients must rely on their healthcare providers, family, and friends for resources and information. Using focus groups, Huynh et al., found that many breast cancer survivors never received sexual health education from their oncology team or other medical providers. When they did, the education focused on reproductive health or menopausal symptoms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In another study assessing factors affecting willingness to discuss symptoms with providers, researchers found that many patients experience barriers such as discomfort bringing sexual health up, a belief that their symptoms are untreatable, and difficulty finding a provider to take ownership of dealing and assisting with their sexual health concerns [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Clinicians also report significant barriers to discussing sexual health including time, conflicting priorities, and discomfort discussing sexual health [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To improve sexual health discussions, a multifaceted approach should be taken that addresses both patients and providers. One potential way to better support patients is to teach them how to discuss their sexual health with their providers. For example, a patient-facing multimedia intervention consisting of a 20-minute video slideshow and workbook led to more women raising sexual health topics during their clinic visits [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. While the online video series in this study does not directly coach patients in how to communicate with providers about their sexual health, it may have helped to normalize this topic as part of cancer care, which in turn may lead to improved self-efficacy and confidence in broaching it when symptoms arise. Importantly, this normalization of sexual health has been previously shown to support patient comfort in raising the topic [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. As such, future studies should investigate specific cognitive (e.g., self-efficacy) and behavioral (e.g., clinical communication) outcomes of the video series.\u003c/p\u003e\u003cp\u003eRegarding the impact of the video series on sexual health outcomes, this study was exploratory in nature. Given that more than 70% of the 6-month responders were undergoing treatment with hormone-receptor blockers at the time of their survey, our findings of the wide range of changes across sexual function subdomains is not surprising. Among breast cancer patients, these are the most common sexual health symptoms with vaginal dryness and pain with intercourse occurring in up to 85% and 87% of patients, respectively [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. As many breast cancer patients are undergoing treatment for longer than our six-month study, it\u0026rsquo;s impossible to directly assess the impact of the video series on these sexual health changes or if access to the videos led patients to obtain treatment resources sooner than patients who may not have had the same education. The next phase of study will examine the impacts of the videos over a longer period, which will allow for further exploration. Additionally, future studies should include a control group to objectively evaluate the effect the video series has on sexual function.\u003c/p\u003e\u003cp\u003eLimitations of this study include a small sample size and short timeframe. Participants who completed the six-month survey may have been different than the participants who did not complete the survey in areas we did not measure, such as participants being more interested in sexual health education. However, when comparing the demographic and clinical characteristics of the 6-month responders to the non-responders, we did not find any statistically significant differences. While a small number of participants withdrew from the study due to feeling overburdened (Supplemental Fig.\u0026nbsp;1), many participants never responded to the 6-month survey despite repeated attempts to engage. It\u0026rsquo;s possible that more participants decided they did not want to continue in the study after realizing how many videos were on the website. Others may have logged in and watched a few videos and then forgotten about them as their treatment progressed despite monthly emailed reminders. We purposefully did not give participants specific instructions on how to engage with the videos other than to watch the ones they were interested in, but this may be one way to reduce this barrier. For example, perhaps the videos are \u0026ldquo;prescribed\u0026rdquo; to the patient during their cancer care. A prescription would personalize the library of content for an individual based on their breast cancer and other health needs while also introducing the possibility of ensuring that patients receive the right information at the right time. It is also possible that participants engaged with the videos but neglected to complete the 6-month survey. In fact, an unpublished group-level analysis of engagement with the video website demonstrated that over 6 months, there was 130 unique sessions with total video watch time of 524 minutes and an average of 8 minutes per session [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Another limitation is the availability of the online videos in English-only which leads to disparities in care for non-English speaking patients who must rely on standard education and cannot utilize this novel resource. The videos are currently being translated into Spanish, but future work should include expanding access across other languages as well. Finally, this study wasn\u0026rsquo;t powered to detect statistical significance but was intended to identify implementation challenges and inform future study design. Nevertheless, among the women who did watch the video series, responses were overall positive.\u003c/p\u003e\u003cp\u003eIn conclusion, this pilot study demonstrates the acceptability, appropriateness, and feasibility of a novel sexual health education video series for female breast cancer patients with Stage I-III disease. This video series fills a unique gap in patient care, and with further iterations and development has the potential to significantly advance the sexual health-resources available to breast cancer patients and survivors.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the other individuals whose contribution to this work made this research possible including Keith Singer and the non-profit organization, Catch It In Time. Additionally, we’d like to thank all the patients who participated in this study and provided their valuable feedback.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHiggins MG: Conceptualization, data curation, funding acquisition, investigation, resources, methodology, project administration, visualization, writing – original draft.\u003c/p\u003e\n\u003cp\u003eHelmkamp L: Methodology, formal analysis, visualization, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eZimmaro LA: Conceptualization, visualization, writing - reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eLeslie SE: Investigation, visualization, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eAdams M: Conceptualization, methodology, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eVemuru: Conceptualization, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eBaurle E: Conceptualization, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eRojas KE: Conceptualization, methodology, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eCoons HL: Conceptualization, methodology, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eTevis S: Conceptualization, funding acquisition, methodology, resources, supervision, validation, visualization, writing – reviewing \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKER:\u0026nbsp;\u003c/strong\u003eConsulting Fees – Roche Diagnostic Solutions, Merck, Novartis. Speaker Honoraria – Pacira Pharmaceuticals, Research Funding – Robert A. Winn Diversity in Clinical Trials Career Development Award (Bristol Myers Squibb Foundation), NIH/NCI “Early-Stage Surgeon Scientist Program (ESSP) NOT-CA-12-100” (Supplement to 2P30CA240139-06)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the ISSWSH Scholars in Women’s Sexual Health Research Grant awarded to Madeline G. Higgins, MD in 2023, and an American Society of Breast Surgeons Foundation Grant awarded to Sarah Tevis, MD in 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in this study were reviewed and approved by the institutional review board (COMIRB #23-1789). The study was performed in accordance with the ethical standards as laid down in the 19964 Declaration of Helsinki and its later amendments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOberguggenberger, A., et al., \u003cem\u003eSelf-reported sexual health: Breast cancer survivors compared to women from the general population - an observational study.\u003c/em\u003e BMC Cancer, 2017. \u003cstrong\u003e17\u003c/strong\u003e(1): p. 599.\u003c/li\u003e\n \u003cli\u003eSmedsland, S.K., et al., \u003cem\u003eSexual health in long-term breast cancer survivors: a comparison with female population controls from the HUNT study.\u003c/em\u003e Breast Cancer Res Treat, 2023. \u003cstrong\u003e201\u003c/strong\u003e(3): p. 479-488.\u003c/li\u003e\n \u003cli\u003ePanjari, M., R.J. 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Yava, and A. Koyuncu, \u003cem\u003eThe Effects of Preoperative Video-Assisted Education on Anxiety and Comfort After Breast Cancer Surgery: Nonrandomized Controlled Study.\u003c/em\u003e J Perianesth Nurs, 2024. \u003cstrong\u003e39\u003c/strong\u003e(6): p. 999-1005.\u003c/li\u003e\n \u003cli\u003eCanzona, M.R., et al., \u003cem\u003eTalking about sexual health during survivorship: understanding what shapes breast cancer survivors\u0026apos; willingness to communicate with providers.\u003c/em\u003e J Cancer Surviv, 2019. \u003cstrong\u003e13\u003c/strong\u003e(6): p. 932-942.\u003c/li\u003e\n \u003cli\u003eHiggins, M.G., \u003cem\u003eFeasibility of an online sexual health educational video series for breast cancer patients\u003c/em\u003e, in \u003cem\u003eAcademic Surgical Congress\u003c/em\u003e. 2024: Las Vegas, NV.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Breast cancer, sexual health, patient-centered resources, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-7023075/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7023075/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003ePurpose:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSexual health-related side effects during breast cancer treatment are common and distressing but not always expected by patients. We created an online sexual health educational video series to increase patients’ awareness of these issues. In this exploratory study, we aimed to evaluate the acceptability, appropriateness, and feasibility of the video series among newly diagnosed breast cancer patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMethods:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEligible and interested patients completed a baseline questionnaire within one month of diagnosis or surgical evaluation. Enrolled participants accessed the online sexual health video series. A follow-up questionnaire evaluating acceptability, appropriateness, and feasibility was administered after 6-months. Descriptive statistics and paired t-tests were utilized.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwenty-eight participants (January-June 2024) with mean age of 48 years (±8 years) comprised the present analysis. Eighty-six percent were White, 4% Hispanic, 89% straight/heterosexual, 86% married/partnered, and 68% were stage I at diagnosis. Eleven participants (39%) completed the 6-month survey, and nine participants reported watching the online videos. Nearly all completely agreed or agreed that the video series was acceptable (mean 4.1 [±1.0]), appropriate (mean 4.3 [± 0.7]), and feasible (mean 4.4 [±0.7]). Qualitative feedback showed strong endorsement for the video series and offered suggested improvements.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusion:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBreast cancer patients lack access to sexual health resources during treatment, but an online educational video series is acceptable, appropriate, and feasible to utilize. This video series fills a unique gap in patient care, and with further iterations and development has the potential to significantly advance the sexual health resources available to breast cancer patients and survivors.\u003c/p\u003e","manuscriptTitle":"Let’s Talk About Sex: An Acceptable, Appropriate and Feasible Online Sexual Health Educational Video Series for Breast Cancer Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-18 11:39:07","doi":"10.21203/rs.3.rs-7023075/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-24T03:51:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-11T04:45:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T22:36:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158480052289060856662282027226347336177","date":"2025-10-21T01:42:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272309049707336129523579360678631089081","date":"2025-10-14T13:59:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-10T16:25:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-10T16:24:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-03T07:31:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2025-07-01T19:00:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0cd00439-f001-4a8c-b071-ee2a5d401606","owner":[],"postedDate":"August 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:06:41+00:00","versionOfRecord":{"articleIdentity":"rs-7023075","link":"https://doi.org/10.1007/s00520-026-10381-y","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2026-01-26 15:59:10","publishedOnDateReadable":"January 26th, 2026"},"versionCreatedAt":"2025-08-18 11:39:07","video":"","vorDoi":"10.1007/s00520-026-10381-y","vorDoiUrl":"https://doi.org/10.1007/s00520-026-10381-y","workflowStages":[]},"version":"v1","identity":"rs-7023075","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7023075","identity":"rs-7023075","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}