Evolving Standards of Care
Jun 08, 2020
By Narjust Duma, MD
Posted: July 31, 2020
In the past 10 years, we have seen significant progress in the treatment options for patients with NSCLC and SCLC, improving OS and quality of life. Thanks to those advances, lung cancer survivorship is a reality, and every day, more survivors are living full lives while receiving systemic therapies for lung cancer. Thoracic oncology specialists are learning about the unique challenges faced by lung cancer survivors, from shortness of breath secondary to lung surgeries to the effects of therapy on sexual health. Previous studies have reported that the effects on sexual function is distressing to most patients with lung cancer. Sexual concerns are related to both higher symptom distress and worse functional status.1,2 Unfortunately, most of the data on sexual dysfunction in patients with lung cancer precede the approval of targeted therapy and immune checkpoint inhibitors, which are now the backbone of lung cancer treatments.
Much of the information gathered regarding sexual dysfunction in cancer relates to breast, gynecologic, and prostate cancers, and it is often inappropriately extrapolated to patients with lung cancer, in which the physiology of the disease is not clearly related to hormone changes or surgical interventions to the genital organs. Administration of estrogen or testosterone does not pose the same risk for cancer recurrence in patients with lung cancer as in patients with hormone-positive breast or prostate cancer.
Clinicians involved in the care of patients’ lung cancer often focus most of their time, attention, and effort on the treatment of the primary disease process, associated symptoms, and complications, and little thought may go into sexual health. We often encounter time constraints in the clinic to discuss all aspects of lung cancer survivorship in addition to evaluating restaging scans, treatment logistics, and associated financial toxicity. Sexual health in women with lung cancer is a complex subject that involves social, psychological, physiologic, and environmental factors—all affecting women’s sexual health at different levels.
Much of the information gathered regarding sexual dysfunction in cancer relates to breast, gynecologic, and prostate cancers, and it is often inappropriately extrapolated to patients with lung cancer, in which the physiology of the disease is not clearly related to hormone changes or surgical interventions to the genital organs.
My interest in this subject started when I first noticed an axillary rash in one of my patients. This was initially attributed to her targeted therapy. Later, however, I found the rash was a result of sexual practices with her partner, as vaginal penetration was painful and caused bleeding secondary to the dry mucous membranes induced by her tyrosine kinase inhibitor. Several months later, she was able to have vaginal intercourse with the use of vaginal lubricants and estrogen supplementation and regained satisfaction with her sex life. After this initial encounter, I started asking my patients about their sex life, vaginal lubrication, and beyond, and I noticed that the circumstances experienced by my initial patient were more prevalent than I expected. I learned that sexual dysfunction was common in women receiving all types of therapy, from immunotherapy to tyrosine kinase inhibitors.
To determine the real prevalence of sexual dysfunction in women with lung cancer, we designed the Sexual Health Assessment in Women with Lung Cancer (SHAWL) study in collaboration with the GO2 Foundation for Lung Cancer and two lung cancer activists, Ivy Elkins and Jill Feldman. The SHAWL study is the largest study to date evaluating the sexual health of women with lung cancer. The study is open to all women with a history of lung cancer or who are actively receiving treatment for the disease, regardless of cancer stage or treatment type. The survey is located in the GO2 Foundation Lung Cancer Registry; it is entirely confidential, and on average, it takes between 5 and 15 minutes to complete.
The survey will be available at the GO2 Foundation Lung Cancer Registry. If the patient or potential participant is already part of the registry, it will be in their surveys tab. If they are new to the registry, they will need to create a profile, complete some basic information about their lung cancer, and the survey will become available in the surveys tab on the right corner of the site.
Potential participants can access the survey at https://www.lungcancerregistry.org/. ✦
About the Author: Dr. Duma is an assistant professor at the University of Wisconsin School of Medicine and Public Health. She is an active IASLC volunteer, serving on both the IASLC Communications Committee and the ILCN Editorial Board. You can follow Dr. Duma on Twitter @NarjustDumaMD.
1. Sarna L. Correlates of symptom distress in women with lung cancer. Cancer Pract. 1993;1(1):21-28.
2. Sarna L, Brown JK, Cooley ME, et al. Quality of life and meaning of illness of women with lung cancer. Oncol Nurs Forum. 2005;32(1):E9-19.