Integration of Sexual Health Considerations Into Thoracic Oncology Care Is Critical

Findings from the SHAWL study found that sexual dysfunction rates are high among women with lung cancer.

Results from the Sexual Health Assessment in Women with Lung Cancer (SHAWL) study highlight the need for health interventions in thoracic oncology care, according to Narjust Florez, MD.1

Among 127 participants who had attempted sexual activity within 30 days of completing a survey, 77% reported moderate to severe sexual dysfunction. Of these, 59% (n = 75) had experienced significant issues with vaginal dryness and 26% (n = 63) had experienced vaginal discomfort during sexual activity.

In a direct comparison before and after a diagnosis of lung cancer, there were stark changes in sexual desire and interest (15% vs 31%; P < .001) and vaginal pain and discomfort (13% vs 43%; P < .001).

“The results were sobering,” Florez said in a presentation during the IASLC 2022 World Conference on Lung Cancer. Florez is associate director of the Cancer Care Equity Program and a thoracic medical oncologist at the Lowe Center for Thoracic-Oncology and the Dana-Farber Institute. “This means [that] this is affecting the patient’s quality of life. This is a daily matter for many of these patients.”

Florez said that the study did not limit sexual health to penetrative/vaginal sex, but encompassed all forms of intimacy, such as cuddling, kissing, oral sex, and masturbation. The study results showed that female patients with lung cancer were experiencing moderate to severe changes in various intimate settings.

According to Florez, most patients with lung cancer (up to 95%) receive a sexual dysfunction score below the 50th percentile and, unfortunately, most sexual dysfunction–related issues do not improve over time. Sexual dysfunction has been linked to higher symptom distress and worse functional status.2,3

Despite previous efforts have been undertaken to catalogue the experiences of this patient population, few data exist regarding how patients receiving checkpoint inhibitors and targeted therapies have been affected by changes in sexual health. The effect of newer treatment strategies on patients’ sexual health is largely under-reported, and consequently understudied, Florez said.

The SHAWL study was an observational, cross-sectional, international effort to query patients about their experiences. The study used PROMIS questions in a self-reported online questionnaire and was administered to patients with lung cancer in collaboration with the GO2 Foundation for Lung Cancer and the lung cancer registry.

The survey queried 249 participants. The age range was 29 to 84 years, and the average age of respondents was 59.9 years. Most patients were non-Hispanic Whites (88%) and 81% had a diagnosis of non–small cell lung cancer. Nearly half (45%) were receiving a targeted therapy treatment.

The findings showed that the factors most likely to affect sex life satisfaction included fatigue (40%), feelings of unhappiness (28%), issues with partners (22%), and shortness of breath (15%). Florez noted that shortness of breath is a factor unique to this patient population.

Study authors acknowledged that this study was limited to the US and primarily consisted of non-Hispanic White participants, and that, because sexual health is influenced by cultural beliefs, this represents a limitation. Moving forward, the Florez and other coinvestigators plan to launch the intervention phase of research and seek ways to improve the quality of life for patients who are facing sexual health changes.

References

  1. Florez N, Acharya R, Wei1 Z, et al.Sexual health assessment in women with lung cancer (SHAWL) study. Presented at: IASLC 2022 World Conference on Lung Cancer; August 6-9, 2022; Vienna, Austria. Abstract MA14.04
  2. Sarna L. Correlates of symptom distress in women with lung cancer. Cancer Pract. 1993;1(1):21-28.
  3. Bober SL, Sanchez Varela V. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol. 2012;30(30):3712-3719. doi:10.1200/JCO.2012.41.7915