Healio Interview

Disclosures: Duma reports consultant/advisory roles with AstraZeneca and Inivata.
July 16, 2020
3 min read

Survey examines effect of lung cancer treatment on women’s sexual health


Healio Interview

Disclosures: Duma reports consultant/advisory roles with AstraZeneca and Inivata.
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An international research effort is underway to assess the effects of lung cancer treatment on women’s sexual health.

Researchers hope the results will serve as the foundation for guidelines that can benefit patients worldwide.

“Sexual health correlates directly with quality of life. Studies in other cancers showed patients with sexual dysfunction have worse pain and worse symptom burden, and it also increases stress in their relationships,” principal investigator Narjust Duma, MD, assistant professor at University of Wisconsin School of Medicine and Public Health and member of the medical oncology and lung cancer clinics at UW Carbone Cancer Center, told Healio.

Narjust Duma, MD
Narjust Duma

“Many women minimize sexual dysfunction, but I have seen patients in my clinic who have encountered these issues for years,” Duma added. “Our goal isn’t just to show that this is a problem. We want to use the information we obtain to develop interventions to help these women improve their quality of life.”

Pulling back the curtain

Data on the impact of lung cancer treatment on women’s sexual health are lacking.

A study conducted in 1998 showed 95% of patients with lung cancer were below the 50th percentile in sexual health, Duma said. However, the analysis included only 89 patients, and the majority were men.

A decade later, Shell and colleagues surveyed 59 patients with small cell or non-small cell lung cancer to examine changes in sexual functioning during treatment. Results of the study — which included men and women — showed most patients reported below-normal sexual function at baseline, and sexual function worsened over time.

The Sexual Health Assessment in Women with Lung Cancer (SHAWL) is designed to “pull back the curtain” in hopes that participants’ responses to blunt and intimate questions will help better define the prevalence and magnitude of these often-unspoken and understudied adverse effects, Duma said.

“Sexual health for women is quite complex, and we do not want them to continue to suffer in silence simply because we haven’t asked them these questions,” Duma, a HemOnc Today Next Gen Innovator, told Healio. “I specialize in treating women with lung cancer and, when I first ask them about their sex life, their faces turn red and they get very uncomfortable. By their next visit, their comfort level with these conversations has increased dramatically. They need to be empowered and understand it is OK to talk with their physicians about this subject, which is as normal as back pain or any other symptom.”


The online survey launched in June through the Lung Cancer Registry, a data-powered platform supported by GO2 Foundation for Lung Cancer, American Lung Association and International Association for the Study of Lung Cancer.

The confidential survey — which takes less than 15 minutes to complete and requires no identifying information — consists of multiple-choice questions developed through the validated Patient-Reported Outcomes Measurement Information System (PROMIS).

The final question is open-ended, allowing women to share additional insights or address subjects not covered in the survey.

Researchers hope to recruit more than 300 participants during the 6-month study period. All women who have been diagnosed with lung cancer are invited to participate.

“We want to include women who are postmenopausal and premenopausal. We hope to include patients receiving active treatment — whether it is chemotherapy, immunotherapy or targeted therapy — and we want to hear about the sequelae after surgery,” Duma said. “We also want to include women who have completed treatment, because sexual dysfunction can persist for years. In most cases, it doesn’t get better unless you do something about it.”

Identifying interventions

Duma and colleagues hope to use the data they collect to develop guidelines that outline interventions for common adverse effects or symptoms.

These may include vaginal dryness, decreased libido or body image issues associated with hair loss due to chemotherapy.

“Some women experience shortness of breath after pneumonectomy, and this can make it difficult to have sexual intercourse,” Duma told Healio. “We can offer sexual therapy to show women positions they can choose that will reduce shortness of breath. Other interventions may be simple, such as using a lubricant to resolve vaginal dryness. In other cases, just having a conversation with her husband can make a big difference.”

Duma and colleagues designed the survey with the help of two patients receiving active treatment for lung cancer. The survey has been modified to include questions about how the COVID-19 pandemic has affected women’s sexual health.

Clinicians who treat women with lung cancer can encourage patients to participate in the survey by signing up for the Lung Cancer Registry at Duma and colleagues also can provide fliers that can be distribute in clinics.

“Lung cancer survivorship is a reality,” Duma told Healio. “Twenty years ago, survival for many patients was measured in months, and their goal was to live for one more birthday or one more Christmas. Now we have patients with no mutations who are living up to 10 years.


“The only group in which lung cancer incidence continues to increase is young women — those 30 to 39 years old,” Duma added. “How can we ask these women not to have any sexual relationships for the rest of their lives? It is extremely important to raise awareness of this subject and help improve quality of life for these patients.”


For more information:

Narjust Duma, MD, can be reached at