OBJECTIVE Little is known about the effects of lung cancer on intimate and sexual relationships. This study explores health care provider, patient, and partner perspectives on: 1) the effects of lung cancer on physical and emotional intimacy, 2) the ways in which intimacy affects the experience of living with lung cancer, and 3) communication about intimacy and sexuality in the context of lung cancer. METHODS Qualitative, in-depth interviews with 8 cancer care providers and 13 married couples (ages 43–79) affected by lung cancer were conducted and audiotaped in the clinical setting. Interviews were transcribed, iteratively analyzed, and coded according to the above domains. Coding was performed independently by members of an interdisciplinary team; inter-rater reliability was assessed using the kappa statistic; and analyses were summarized by domain. RESULTS Most cancer care providers and couples affected by lung cancer believed intimacy and sexuality issues were salient, yet few reported discussing these. Couples described negative and positive effects of cancer on intimacy. Negative effects were driven by cancer or its treatment, including physical and psychological effects. Positive effects included an increase in non-coital physical closeness and appreciation of the spouse. Age was perceived as an important factor influencing the relationship between lung cancer and intimacy. CONCLUSIONS Emotional intimacy and sexuality are important concerns for couples affected by lung cancer. The findings suggest previously unrecognized positive effects of lung cancer on emotional and physical intimacy. Couples affected by lung cancer and providers believe these issues are relevant for lung cancer care.

BACKGROUND: Brief self-assessment of sexual problems in a clinical context has the potential to improve care for patients through the ability to track trends in sexual problems over time and facilitate patient-provider communication about this important topic. However, instruments designed for research are typically too long to be practical in clinical practice. OBJECTIVE: To develop and validate a single-item selfreport clinical screener that would capture common sexual problems and concerns for men and women. DESIGN: We created three candidate screener items, refined them through cognitive interviews, and administered them to a large sample. We compared the prevalence of responses to each item and explored the discrepancies between items. We evaluated the construct validity of the items by comparing them to scores on the PatientReported Outcomes Measurement Information System® Sexual Function and Satisfaction (PROMIS® SexFS) measure. PARTICIPANTS: Local patients participated in two rounds of cognitive interviews (n=7 and n=11). A probability-based random sample of U.S. adults comprised the item-testing sample (n=3517). MAIN MEASURES: The items were as follows: 1) a yes/no item on any sexual problems or concerns (Bgeneral screener^), 2) a yes/no item on problems experienced for 3 months or more during the past 12 months, with a list of examples (Blong list screener^), and 3) an item identical to the long list screener except that examples appeared individually as response options and respondents could check all that applied (Bchecklist screener^). KEY RESULTS: All of the screeners tested showed evidence for basic validity and had minimal missing data. Percentages of women and men endorsing the screeners were 10 % and 15 % (general); 20 % and 17 % (long list); and 38 % and 30 % (checklist), respectively. Participants who endorsed the screeners had lower function compared to those who did not endorse them. CONCLUSIONS: We recommend the checklist screener for its specificity and ability to identify specific problems associated with decreased sexual function.

Based on this review, the authors address clinical implications, particularly incorporating psychological treatment for sexual problems in comprehensive cancer care, and provide recommendations for further study.

Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision-making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists’ findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns.

Introduction Understanding sexual health issues in cancer patients is integral to care for the continuously growing cancer survivor population. Aim To create a national network of active clinicians and researchers focusing on the prevention and treatment of sexual problems in woman and girls with cancer. Methods Interdisciplinary teams from the University of Chicago and Memorial Sloan-Kettering Cancer Center jointly developed the mission for a national conference to convene clinicians and researchers in the field of cancer and female sexuality. The invitee list was developed by both institutions and further iterated through suggestions from invitees. The conference agenda focused on three high-priority topics under the guidance of a professional facilitator. Breakout groups were led by attendees recognized by collaborators as experts in those topics. Conference costs were shared by both institutions. Main Outcome Measure Development of Scientific Working Groups (SWGs) Results One hundred two clinicians and researchers were invited to attend the 1st National Conference on Cancer and Female Sexuality. Forty-three individuals from 20 different institutions across 14 states attended, including representation from eight NCI-funded cancer centers. Attendees included PhD researchers (n=19), physicians (n=16), and other health care professionals (n=8). Breakout groups included: 1) Defining Key Life Course Sexuality Issues; 2) Building a Registry; and 3) Implementing Sexual Health Assessment. Breakout group summaries incorporated group consensus on key points and priorities. These generated six SWGs with volunteer leaders to accelerate future research and discovery: 1) Technology-Based Interventions; 2) Basic Science; 3) Clinical Trials; 4) Registries; 5) Measurement; and 6) Secondary Data Analysis. Most attendees volunteered for at least one SWG (n=35), and many volunteered for two (n=21). Conclusion This 1st National Conference demonstrated high motivation and broad participation to address research on cancer and female sexuality. Areas of need were identified and SWGs established to help promote research in this field.

Background A systematic review was conducted to identify and characterize self-reported sexual function (SF) measures administered to women with a history of cancer. Methods Using 2009 PRISMA guidelines, we searched electronic bibliographic databases for quantitative studies published January 2008–September 2014 that used a self-reported measure of SF, or a quality of life (QOL) measure that contained at least one item pertaining to SF. Results Of 1,487 articles initially identified, 171 were retained. The studies originated in 36 different countries with 23% from U.S.-based authors. Most studies focused on women treated for breast, gynecologic, or colorectal cancer. About 70% of the articles examined SF as the primary focus; the remaining examined QOL, menopausal symptoms, or compared treatment modalities. We identified 37 measures that assessed at least one domain of SF, eight of which were dedicated SF measures developed with cancer patients. Almost one-third of the studies used EORTC QLQ modules to assess SF, and another third used the Female Sexual Function Inventory. There were few commonalities among studies, though nearly all demonstrated worse SF after cancer treatment or compared to healthy controls. Conclusions QOL measures are better suited to screening while dedicated SF questionnaires provide data for more in depth assessment. This systematic review will assist oncology clinicians and researchers in their selection of measures of SF and encourage integration of this quality of life domain in patient care.

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