Diminished Sexual Health Should Not Be a Price Paid to Survive Lung Cancer

Findings from a recent survey of more than 240 women with lung cancer highlight a universal issue that is worsened by ignoring underlying problems.

The survey, led by Dr. Narjust Florez (Duma), showed that 77% of the 239 respondents reported experiencing moderate to severe sexual dysfunction after diagnosis and treatment.

“I never expected that we were going to find 77% of patients have sexual dysfunction,” Florez (Duma), a thoracic medical oncologist and associate director of the Cancer Care Equity Program at Dana-Farber Cancer Institute in Boston, said in an interview with CURE®. “Three out of four patients that walk into our thoracic medical oncology clinic (have) moderate to severe sexual dysfunction.

“(Oncologists) do a lot of clinical trials and studies, and to be honest with you, it is very hard to find anything where 77% of the patients have something in common.”

A Growing Issue

Ten years ago, patients with metastatic lung cancer would survive only for approximately six to 12 months, according to Florez (Duma). But as new research has led to several Food and Drug Administration approvals of targeted and immunotherapy treatments, survival for many patients exceeds five years, she said, adding that, unfortunately, sexual health has been perceived as not a priority for patients with lung cancer.

Sexual dysfunction, however, has been linked to depression and is associated with higher symptom burden and a higher need for supportive medications like opiates and antidepressants, according to Florez (Duma), who noted that, traditionally, lung cancer providers have taken data and information from patients with breast cancer who experienced sexual dysfunction and used it to treat their patients.

“Many of these women (with breast cancer) become prematurely menopausal due to the use of antihormonal medications,” she explained. “We’re using data from a (type of) cancer that is very different (in treating) patients with (lung) cancer.”

To gather more accurate information for this patient population, Florez (Duma) and her colleagues set out to identify the rate of sexual dysfunction in women with lung cancer and reasons they reported a lack of sexual desire.

The responses showed that the most common symptoms of sexual dysfunction were vaginal dryness (34%), decreased sexual desire or interest (1%), and vaginal pain or discomfort with sexual activity (13%). The factors most frequently associated with affecting sexual satisfaction were fatigue (40%), feeling sad or unhappy (28%), partner issues (22%) and shortness of breath (15%).

“Shortness of breath is really on the bottom of reasons why patients with breast cancer report decreased desire, but for a patient with lung cancer who had a large lung surgery or high radiation to the chest, shortness of breath is in the top four reasons for sexual dysfunction,” she said. “And it can be easily addressed.

“People think addressing shortness of breath is super hard. I work with physical therapists that work with my patients to show them special sex positions (that) don’t require such a big lung capacity. So sometimes we think the problems are bigger than they are.”

Underlying Issues

Historically, the focus has been to develop new medications that target pain and help with depression, Florez (Duma) explained, but this approach ignores a patient’s underlying issues. For example, patients may be experiencing body image issues following surgery. This creates a trickle-down effect that may cause a patient to become depressed, which may subsequently lead to issues with their sexual health.

She noted that precision medicine is necessary because it addresses the unique needs of a patient with lung cancer. The same is true, she said, for certain side effects such as sexual dysfunction, which should not be addressed in a cookie-cutter manner.

“I’m not a big proponent of just giving people pills without addressing the underlying problem,” she said.

She also wants patients who may be experiencing sexual dysfunction to know that they’re not alone.

“Sexual dysfunction is not a price that patients (with lung cancer) need to pay in order to be alive. ...” she said. “I hear this over and over in my clinic, ‘I thought that was the price I needed to pay.’ And that’s not true.”

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