Sexual dysfunction in women with lung cancer: Updates from the SHAWL study.
Authors: Florez Narjust , Kiel Lauren , Meza Kelly , Wei Zihan , Mazzola Emanuele , Velazquez Manana Ana I. , Franco Idalid Ivy , Fidler Mary Jo J. , Elkins Ivy Beth , Feldman Jill E. , Seaborne Lori A. , Heisler Christine A , King Jennifer C. , Moore Amy , Kushner David M. 
Published: June 2023

9071 Background: Despite its direct correlation with quality of life, sexual dysfunction is under-discussed and underreported in patients with lung cancer (LC). Sexual dysfunction is highly prevalent in patients with LC, with issues persisting over time; however, most data precede the approval of targeted therapies and immune checkpoint inhibitors. We report updated data from the SHAWL study, focusing on women’s sex life satisfaction. Methods: This cross-sectional, international survey study was administered via the GO2 Foundation Lung Cancer Registry. We utilized the Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function and Satisfaction Measures for data collection. Participants were recruited from June 2020 to June 2021. Eligibility criteria included age > 18 years, self-identification as a woman, and an LC diagnosis within ten years. Participants were asked about sexual health pertaining to 30 days before survey completion, now referred to as “recent.” Results: The survey was administered to 249 women (median age: 61 years). Most (67%) had stage IV LC and 47% were receiving targeted therapy; 66% were undergoing active treatment. Before LC diagnosis, 49% (117) of participants reported having no sexual health issues. Most women (54%, 128) indicated having had recent sexual activity, though 77% (183) reported moderate to severe sexual dysfunction. Indeed, only 7.5% (18) reported being quite or very interested in sexual activity, and only 6.7% (16) felt as if they always or often wanted to be involved in it. Out of the 128 women indicating recent sexual activity, the vast majority (72%, 91) also reported minimal to no satisfaction with their sex life, with 17% (22), 31% (39), and 24% (30) reporting none, a little bit, and some satisfaction, respectively. The most common reasons for lack of recent sexual activity were lack of interest (68%, 76) or vaginal dryness or pain (30%, 33). Most women (69%, 88) also reported rarely becoming sufficiently lubricated during sexual activity, with 54% (68) indicating that it was difficult to impossible to do so. Patients with stage IV diagnosis had a lower interest in and desire for sexual activity than those with non-metastatic LC. Patients not receiving active treatment reported similar rates of lack of interest and desire for sexual activity as those in active cancer therapy. Patients on targeted therapy had similar rates of sexual dysfunction as those receiving other LC treatments. Conclusions: The SHAWL study is the largest study evaluating sexual dysfunction and satisfaction in women with lung cancer in our current clinical environment. Sexual dysfunction, dissatisfaction, and lack of interest in sexual activity were highly prevalent in women with LC regardless of treatment status and type of therapy, suggesting that even after treatment completion, sexual issues persist. Sexual health should be integrated into thoracic oncology care for all patients with lung cancer.