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Wu H, Xie L, Chen Q, Xu F, Dai A, Ma X, Xie S, Li H, Zhu F, Jiao C, Sun L, Xu Q, Zhou Y, Shen Y, Chen X. Activation of GABAergic neurons in the dorsal raphe nucleus alleviates hyperalgesia induced by ovarian hormone withdrawal. Pain 2024:00006396-990000000-00678. [PMID: 39106454 DOI: 10.1097/j.pain.0000000000003362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/25/2024] [Indexed: 08/09/2024]
Abstract
ABSTRACT Menopausal and postmenopausal women, characterized by a significant reduction in ovarian hormones, have a high prevalence of chronic pain with great pain intensity. However, the underlying mechanism of hyperalgesia induced by ovarian hormone withdrawal remains poorly understood. Here, we report that decreases in the activity and excitability of GABAergic neurons in the dorsal raphe nucleus (DRN) are associated with hyperalgesia induced by ovariectomy in mice. Supplementation with 17β-estradiol, but not progesterone, is sufficient to increase the mechanical pain threshold in ovariectomized (OVX) mice and the excitability of DRN GABAergic (DRNGABA) neurons. Moreover, activation of the DRNGABA neurons projecting to the lateral parabrachial nucleus was critical for alleviating hyperalgesia in OVX mice. These findings show the essential role of DRNGABA neurons and their modulation by estrogen in regulating hyperalgesia induced by ovarian hormone withdrawal, providing therapeutic basis for the treatment of chronic pain in physiological or surgical menopausal women.
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Affiliation(s)
- Hui Wu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linghua Xie
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ange Dai
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaolin Ma
- School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, China
| | - Shulan Xie
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua Li
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangfang Zhu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cuicui Jiao
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihong Sun
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qi Xu
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yudong Zhou
- School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, China
| | - Yi Shen
- School of Brain Science and Brain Medicine, Zhejiang University School of Medicine, Hangzhou, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, China
| | - Xinzhong Chen
- Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Oxley SG, Wei X, Sideris M, Blyuss O, Kalra A, Sia JJY, Ganesan S, Fierheller CT, Sun L, Sadique Z, Jin H, Manchanda R, Legood R. Utility Scores for Risk-Reducing Mastectomy and Risk-Reducing Salpingo-Oophorectomy: Mapping to EQ-5D. Cancers (Basel) 2024; 16:1358. [PMID: 38611036 PMCID: PMC11010846 DOI: 10.3390/cancers16071358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) are the most effective breast and ovarian cancer preventive interventions. EQ-5D is the recommended tool to assess the quality of life and determine health-related utility scores (HRUSs), yet there are no published EQ-5D HRUSs after these procedures. These are essential for clinicians counselling patients and for health-economic evaluations. METHODS We used aggregate data from our published systematic review and converted SF-36/SF-12 summary scores to EQ-5D HRUSs using a published mapping algorithm. Study control arm or age-matched country-specific reference values provided comparison. Random-effects meta-analysis provided adjusted disutilities and utility scores. Subgroup analyses included long-term vs. short-term follow-up. RESULTS Four studies (209 patients) reported RRM outcomes using SF-36, and five studies (742 patients) reported RRSO outcomes using SF-12/SF-36. RRM is associated with a long-term (>2 years) disutility of -0.08 (95% CI -0.11, -0.04) (I2 31.4%) and a utility of 0.92 (95% CI 0.88, 0.95) (I2 31.4%). RRSO is associated with a long-term (>1 year) disutility of -0.03 (95% CI -0.05, 0.00) (I2 17.2%) and a utility of 0.97 (95% CI 0.94, 0.99) (I2 34.0%). CONCLUSIONS We present the first HRUSs sourced from patients following RRM and RRSO. There is a need for high-quality prospective studies to characterise quality of life at different timepoints.
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Affiliation(s)
- Samuel G. Oxley
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Xia Wei
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Michail Sideris
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child´s Health, Sechenov First Moscow State Medical University, Sechenov University, Moscow 119991, Russia
| | - Ashwin Kalra
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Jacqueline J. Y. Sia
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Subhasheenee Ganesan
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Caitlin T. Fierheller
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Haomiao Jin
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK;
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London WC1V 6LJ, UK
| | - Rosa Legood
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
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Farley D, Kłosowska J, Brączyk J, Buglewicz E, Bąbel P. Treatment of last resort? Psychological therapy seeking in chronic pain patients. Chronic Illn 2024; 20:184-196. [PMID: 37143291 DOI: 10.1177/17423953231172796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Our goal was to assess how many chronic pain patients seek psychological treatment for their condition and what psychological and demographic characteristics are associated with that decision. METHODS The association between pain intensity, quality of life and psychological treatment seeking was tested in two hypothetical models which differed according to beliefs about either external or internal control over pain. RESULTS A minority of patients had experience with psychological treatment of chronic pain. Patients who had that experience were younger, suffered from more intense pain, and applied many more coping strategies than patients who never tried this kind of treatment. Intense pain and low quality of life motivated chronic pain patients to seek psychological treatment only if they believed that doctors could control their pain. DISCUSSION The study results stress the importance of diversifying the methods used to treat chronic pain and educating patients about the benefits of psychological treatment. Low numbers of chronic pain patients who take advantage of psychological treatment indicate that encouragement from medical professionals might be necessary.
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Affiliation(s)
- Dominika Farley
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Joanna Kłosowska
- Clinical Psychology Unit, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Justyna Brączyk
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Ewa Buglewicz
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
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Wei X, Oxley S, Sideris M, Kalra A, Brentnall A, Sun L, Yang L, Legood R, Manchanda R. Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:388-409.e4. [PMID: 37059410 DOI: 10.1016/j.ajog.2023.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE This study aimed to assess the impact of risk-reducing surgery for breast cancer and ovarian cancer prevention on quality of life. We considered risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, and risk-reducing early salpingectomy and delayed oophorectomy. DATA SOURCES We followed a prospective protocol (International Prospective Register of Systematic Reviews: CRD42022319782) and searched MEDLINE, Embase, PubMed, and Cochrane Library from inception to February 2023. STUDY ELIGIBILITY CRITERIA We followed a PICOS (population, intervention, comparison, outcome, and study design) framework. The population included women at increased risk of breast cancer or ovarian cancer. We focused on studies reporting quality of life outcomes (health-related quality of life, sexual function, menopause symptoms, body image, cancer-related distress or worry, anxiety, or depression) after risk-reducing surgery, including risk-reducing mastectomy for breast cancer and risk-reducing salpingo-oophorectomy or risk-reducing early salpingectomy and delayed oophorectomy for ovarian cancer. METHODS We used the Methodological Index for Non-Randomized Studies (MINORS) for study appraisal. Qualitative synthesis and fixed-effects meta-analysis were performed. RESULTS A total of 34 studies were included (risk-reducing mastectomy: 16 studies; risk-reducing salpingo-oophorectomy: 19 studies; risk-reducing early salpingectomy and delayed oophorectomy: 2 studies). Health-related quality of life was unchanged or improved in 13 of 15 studies after risk-reducing mastectomy (N=986) and 10 of 16 studies after risk-reducing salpingo-oophorectomy (N=1617), despite short-term deficits (N=96 after risk-reducing mastectomy and N=459 after risk-reducing salpingo-oophorectomy). Sexual function (using the Sexual Activity Questionnaire) was affected in 13 of 16 studies (N=1400) after risk-reducing salpingo-oophorectomy in terms of decreased sexual pleasure (-1.21 [-1.53 to -0.89]; N=3070) and increased sexual discomfort (1.12 [0.93-1.31]; N=1400). Hormone replacement therapy after premenopausal risk-reducing salpingo-oophorectomy was associated with an increase (1.16 [0.17-2.15]; N=291) in sexual pleasure and a decrease (-1.20 [-1.75 to -0.65]; N=157) in sexual discomfort. Sexual function was affected in 4 of 13 studies (N=147) after risk-reducing mastectomy, but stable in 9 of 13 studies (N=799). Body image was unaffected in 7 of 13 studies (N=605) after risk-reducing mastectomy, whereas 6 of 13 studies (N=391) reported worsening. Increased menopause symptoms were reported in 12 of 13 studies (N=1759) after risk-reducing salpingo-oophorectomy with a reduction (-1.96 [-2.81 to -1.10]; N=1745) in the Functional Assessment of Cancer Therapy - Endocrine Symptoms. Cancer-related distress was unchanged or decreased in 5 of 5 studies after risk-reducing mastectomy (N=365) and 8 of 10 studies after risk-reducing salpingo-oophorectomy (N=1223). Risk-reducing early salpingectomy and delayed oophorectomy (2 studies, N=413) led to better sexual function and menopause-specific quality of life. CONCLUSION Risk-reducing surgery may be associated with quality of life outcomes. Risk-reducing mastectomy and risk-reducing salpingo-oophorectomy reduce cancer-related distress, and do not affect health-related quality of life. Women and clinicians should be aware of body image problems after risk-reducing mastectomy, and of sexual dysfunction and menopause symptoms after risk-reducing salpingo-oophorectomy. Risk-reducing early salpingectomy and delayed oophorectomy may be a promising alternative to mitigate quality of life-related risks of risk-reducing salpingo-oophorectomy.
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Affiliation(s)
- Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - Samuel Oxley
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Michail Sideris
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Ashwin Kalra
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Adam Brentnall
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ranjit Manchanda
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom; Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, London, United Kingdom; Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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Burke W, Barkley J, Barrows E, Brooks R, Gecsi K, Huber-Keener K, Jeudy M, Mei S, O'Hara JS, Chelmow D. Executive Summary of the Ovarian Cancer Evidence Review Conference. Obstet Gynecol 2023; 142:179-195. [PMID: 37348094 PMCID: PMC10278568 DOI: 10.1097/aog.0000000000005211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/29/2022] [Accepted: 01/19/2023] [Indexed: 06/24/2023]
Abstract
The Centers for Disease Control and Prevention awarded funding to the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about ovarian cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in February 2022. This article is the executive summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of ovarian cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.
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Affiliation(s)
- William Burke
- Departments of Obstetrics and Gynecology, Stony Brook University Hospital, New York, New York, Creighton University School of Medicine, Phoenix, Arizona, Virginia Commonwealth University School of Medicine, Richmond, Virginia, the University of California, Davis, Davis, California, the Medical College of Wisconsin, Milwaukee, Wisconsin, the University of Iowa Hospitals and Clinics, Iowa City, Iowa, and New York University Langone School of Medicine, New York; and the American College of Obstetricians and Gynecologists, Washington, DC
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Stuursma A, Lanjouw L, Idema DL, de Bock GH, Mourits MJE. Surgical Menopause and Bilateral Oophorectomy: Effect of Estrogen-Progesterone and Testosterone Replacement Therapy on Psychological Well-being and Sexual Functioning; A Systematic Literature Review. J Sex Med 2022; 19:1778-1789. [PMID: 36175351 DOI: 10.1016/j.jsxm.2022.08.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Besides experiencing vasomotor symptoms, after surgical menopause and bilateral salpingo-oophorectomy (BSO), women experience moderate to severe psychological and sexual symptoms. AIMS To systematically review and meta-analyze the effect of systemic hormone replacement therapy (sHRT) on psychological well-being and sexual functioning in women after surgical menopause and BSO. METHODS Medline/Pubmed, EMBASE and PsychInfo were systematically searched until November 2021. Randomized controlled trials investigating the effect of sHRT on psychological well-being and/or sexual functioning in surgically menopausal women and women after BSO were eligible for inclusion. Two independent authors performed study selection, risk of bias assessment and data extraction. Standardized mean differences (SMDs) were calculated. OUTCOMES Primary outcomes for psychological well-being were defined as overall psychological well-being, depression, and anxiety. Primary outcomes for sexual functioning were defined as overall sexual functioning, sexual desire, and sexual satisfaction. All outcomes were assessed on short (≤12 weeks) or medium term (13-26 weeks). RESULTS Twelve studies were included. Estradiol had a beneficial effect on depressed mood on short term 3-6 years after surgery or 2 years (median) after surgery with high heterogeneity (SMD: -1.37, 95%CI: -2.38 to -0.37, P = .007, I2 79%). Testosterone had a beneficial effect on overall sexual functioning on short to medium term 4.6 years (mean) after surgery (SMD 0.38, 95%CI 0.11-0.65, I2 0%) and on sexual desire on medium term at least 3-12 months after surgery (SMD 0.38, 95%CI 0.19-0.56, I2 54%). For most studies, risk of bias was uncertain. CLINICAL IMPLICATIONS Estradiol may beneficially affect psychological symptoms after surgical menopause or BSO and testosterone might improve sexual desire and overall sexual functioning. STRENGTHS AND LIMITATIONS This review only included patient-reported outcomes, thereby reflected perceived and not simply objective symptoms in surgically menopausal women and women after BSO. The small number of studies highly varied in nature and bias could not be excluded, therefore our results should be interpreted with great caution. CONCLUSION Independent randomized controlled clinical trials investigating the effects of estrogen-progesterone and testosterone on psychological and sexual symptoms after surgical menopause are needed. PROSPERO REGISTRATION NUMBER CRD42019136698. Stuursma A, Lanjouw L, Idema DL, et al. Surgical Menopause and Bilateral Oophorectomy: Effect of Estrogen-Progesterone and Testosterone Replacement Therapy on Psychological Well-being and Sexual Functioning: A Systematic Literature Review. J Sex Med 2022;19:1778-1789.
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Affiliation(s)
- Annechien Stuursma
- Department of Obstetrics & Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Lieke Lanjouw
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Demy L Idema
- Julius Center, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics & Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Zarbo C, Brugnera A, Frigerio L, Celi C, Compare A, Dessì V, Giordano R, Malandrino C, Sina FP, Strepparava MG, Tessitore IV, Ventura M, Fruscio R. Cancer Anxiety Mediates the Association Between Satisfaction With Medical Communication and Psychological Quality of Life After Prophylactic Bilateral Salpingo-Oophorectomy. Front Psychol 2022; 13:840931. [PMID: 35356354 PMCID: PMC8959915 DOI: 10.3389/fpsyg.2022.840931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prophylactic Bilateral Salpingo-Oophorectomy (PBSO) reduces the risk of developing ovarian cancer. However, the psychological mechanisms that may affect post-surgery Quality of Life (QoL) among patients who underwent PBSO are still largely unknown. Thus, this study aimed at exploring the direct and indirect associations of satisfaction with medical communication and cancer anxiety on post-surgery QoL among women at high risk of developing ovarian cancer. Method Fifty-nine women (mean age: 50.64 ± 6.7 years) who underwent PBSO took part in this cross-sectional study, filling out a sociodemographic and clinical questionnaire, a battery of validated psychological measures and an ad hoc developed scale for the assessment of cancer anxiety. We first examined the correlations among all variables of interest, and then tested if cancer anxiety mediated the association between satisfaction with medical communication and post-surgery psychological QoL, controlling both for time from surgery and education. Results Post-surgery psychological QoL was unrelated from any sociodemographic or clinical variable. Cancer anxiety had a significant direct negative effect on psychological QoL, while satisfaction with medical communication had a significant positive direct effect on it. Finally, cancer anxiety significantly mediated the association between satisfaction with medical communication and post-surgery psychological QoL. Discussion Results suggest that post-surgery psychological QoL of patients who underwent PBSO may be increased with interventions, delivered in a genetic counselling setting, targeting quality of medical communication and cancer anxiety.
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Affiliation(s)
- Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Luigi Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Celi
- Clinical Psychology Unit, ASST-Monza, Monza, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Valentina Dessì
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Rosalba Giordano
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Malandrino
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Maria Grazia Strepparava
- Clinical Psychology Unit, ASST-Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | | | | | - Robert Fruscio
- Gynaecologic Surgery Unit, ASST-Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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8
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Kershaw V, Hickey I, Wyld L, Jha S. The impact of risk reducing bilateral salpingo-oophorectomy on sexual function in BRCA1/2 mutation carriers and women with Lynch syndrome: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 265:7-17. [PMID: 34416580 DOI: 10.1016/j.ejogrb.2021.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In the absence of an effective screening test, women with a high genetic predisposition for ovarian cancer are recommended to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) once childbearing is complete. This reduces the risk of ovarian cancer by up to 96%, but can result in undesirable side effects, including menopausal symptoms and sexual dysfunction. We have performed a systematic review and meta-analysis to investigate the effect of RRBSO on sexual function in women at high risk of breast/and or ovarian cancer. METHODS A literature search of the AMED (Allied and complementary medicine), Embase and Medline databases was performed, using search terms including sexual function, risk reducing and oophorectomy. Results were filtered according to the PRISMA protocol. Quality assessment of studies was performed using the Newcastle-Ottawa scale. Data were pooled in meta-analysis. RESULTS There were 21 eligible studies, 10 of which reported sufficient data for meta-analysis. Most studies were retrospective cohort or observational studies. Fifteen of the 21 studies (71%) reported a negative impact of RRBSO on sexual function. Participant numbers ranged from 37 to 1522. Meta-analysis was performed with studies including 3201 patients. This demonstrated that RRBSO has a statistically significant negative impact on sexual function (SMD -0.63, [-0.82, -0.44], p = 0.03). There was a trend towards reduced sexual pleasure and increased discomfort but this did not reach statistical significance. There was minimal change in the frequency of sex. There was a significant increase in vaginal dryness post-RRBSO (SMD 9.25, [3.66, 14.83], p < 0.00001). There was no significant difference in sexual function between pre-menopausal and post-menopausal RRBSO. Hormone replacement therapy (HRT) did not abolish this negative impact. CONCLUSION Sexual function declines post RRBSO, independent of menopausal status. Comprehensive pre-operative counselling regarding anticipated menopausal and sexual symptoms is key to setting realistic patient expectations and minimising post-operative distress. Information and support regarding management of these side effects should be available to all patients.
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Affiliation(s)
- Victoria Kershaw
- Urogynaecology Department, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, United Kingdom.
| | - India Hickey
- Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2SJ, United Kingdom.
| | - Lynda Wyld
- Department of Oncology and Metabolism, Sheffield University, Sheffield S10 2SJ, United Kingdom.
| | - Swati Jha
- Urogynaecology Department, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, United Kingdom.
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9
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Chae S, Kim EK, Jang YR, Lee AS, Kim SK, Suh DH, Kim K, No JH, Kim YB, Kim SW, Kang E. Effect of risk-reducing salpingo-oophorectomy on the quality of life in Korean BRCA mutation carriers. Asian J Surg 2021; 44:1056-1062. [PMID: 33573923 DOI: 10.1016/j.asjsur.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to compare the quality of life (QOL), psychosocial status, sexual function, and menopausal symptoms between the risk-reducing salpingo-oophorectomy (RRSO) and non-RRSO groups comprising BRCA mutation carriers and to evaluate the effect of timing of RRSO on those aspects. METHODS This cross-sectional study recruited BRCA mutation carriers aged ≥35 years between September 2015 and September 2016. Demographic data of carriers were collected. Outcomes were measured using the questionnaires addressing QOL, anxiety, depression, optimism, sexual function, and menopausal symptoms. RESULTS Of 52 participants, 30 (57.7%) underwent RRSO, whereas 22 (42.3%) did not. In the RRSO group, 16 (53.3%) and 14 (46.7%) women underwent RRSO before and after menopause, respectively. The mean age in the RRSO group was higher than that in the non-RRSO group (49.8 vs. 42.1 years, respectively, p = 0.002). The scores for QOL, anxiety, depression, optimism, sexual function, and menopausal symptoms were similar between both groups. In the multivariate analysis, RRSO uptake was associated with worse physical QOL (coefficient, -5.350; 95% confidence interval, -10.593 to -0.108). With respect to the timing of RRSO, only the mental QOL was significantly lower in the postmenopausal RRSO group than in the premenopausal RRSO group (39.2 vs. 43.7, respectively, p = 0.043). CONCLUSION We could not find any difference in mental QOL, psychosocial status, sexual function, and menopausal symptoms between the RRSO and non-RRSO groups. RRSO uptake only affected worse physical QOL. These results will help physicians counsel BRCA mutation carriers about the effect of RRSO on QOL.
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Affiliation(s)
- Sumin Chae
- Department of Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ye Rang Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Angela Soeun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, South Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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10
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Trister R, Jacobson M, Nguyen P, Sobel M, Allen L, Narod SA, Kotsopoulos J. Patient reported experiences following laparoscopic prophylactic bilateral salpingo-oophorectomy or salpingectomy in an ambulatory care hospital. Fam Cancer 2020; 20:103-110. [PMID: 32964297 DOI: 10.1007/s10689-020-00208-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
Women at risk of developing ovarian cancer because of a BRCA1 or BRCA2 pathogenic variant are candidates for prophylactic bilateral salpingo-oophorectomy (BSO). While BSO surgeries are routinely performed, to our knowledge there are no studies that have examined patient-reported experiences following laparoscopic BSO performed in an ambulatory care setting. The objective of this study was to examine whether women undergoing prophylactic laparoscopic BSO felt they were adequately informed about post-operative outcomes. A telephone interview was conducted among 46 women undergoing laparoscopic BSO to collect detailed information regarding surgical outcomes, complications, symptoms, and time to return to daily activities. The average age at surgery was 45.0 years (range 34-66) and 67% of women underwent BSO prior to age 50. The mean reported hospital stay was 7.2 h (range 4-12 h) and at time of discharge, 78% of the women felt well enough to go home. None of the women required a readmission to hospital. Forty-three percent (n = 20) of the women did not feel well informed about what to expect post-operatively. Most of the patient-reported outcomes (including pain, vaginal bleeding, and nausea/vomiting) were expected and patient-reported menopausal symptoms were more common among women who were premenopausal at surgery. In terms of returning to regular activities, premenopausal women (n = 36) resumed sexual activity on average at 43 days (range 2-365), which is later than postmenopausal women (n = 15) at 19 days (range 7-30). On average, women returned to full-time work in 16 days (range 1-56 days). Despite patients receiving pre-surgery counselling, our findings suggest that there is a need to provide supplemental, reinforcing patient materials in preparing patients for what to expect after surgery.
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Affiliation(s)
- Rachel Trister
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Patricia Nguyen
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Room 6423, Toronto, ON, M5S 1B2, Canada
| | - Mara Sobel
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Lisa Allen
- Women's College Hospital, Toronto, ON, Canada.,Mount Sinai Hospital, Toronto, ON, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Room 6423, Toronto, ON, M5S 1B2, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Room 6423, Toronto, ON, M5S 1B2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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11
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Risk factors for sexual dysfunction in BRCA mutation carriers after risk-reducing salpingo-oophorectomy. Menopause 2020; 26:132-139. [PMID: 30020253 DOI: 10.1097/gme.0000000000001176] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the study was to identify risk factors for sexual dysfunction in BRCA mutation carriers who have undergone risk-reducing salpingo-oophorectomy (RRSO). METHODS A cross-sectional study was performed. BRCA1/2 mutation carriers with and without RRSO were surveyed to determine sexual function (Female Sex Function Index [FSFI]), demographics, medical history, sleep quality, depression, and anxiety scores. Characteristics of patients with the lowest quartile of FSFI scores (<14 ± 8.8) were analyzed to identify risk factors for the most severe phenotype. RESULTS In the 804 women surveyed, 764 underwent RRSO. Of the 529 (69%) carriers with completed FSFI questionnaires in the RRSO cohort, sexual dysfunction was reported in 77.3%. Poor sleep (P = 0.002), hot flashes (P = 0.002), lack of current systemic hormone therapy (HT) use (P = 0.002), depression (P < 0.001), and anxiety (P = 0.001) were associated with sexual dysfunction. In adjusted analyses, depression (adjusted odds ratio [aOR] 2.4, 95% CI, 1.4-4.1) and hot flashes (aOR 1.9, 95% CI, 1.2-3.0) remained significantly associated with sexual dysfunction. Depression was also a significant risk factor for the most severe degree of sexual dysfunction (OR 2.1, 95% CI, 1.3-3.5) and had the greatest impact on Arousal and Satisfaction domain scores of the FSFI. Current systemic HT use seemed to decrease the risk for sexual dysfunction (aOR 0.6, 95% CI, 0.4-1.0). CONCLUSIONS Sexual dysfunction is highly prevalent in BRCA mutation carriers after RRSO. Depression seems to be a significant risk factor for sexual dysfunction in this patient population and may be under-recognized and undertreated. Patient and provider education on sexual side effects after surgery and risk factors for sexual dysfunction is necessary to decrease postoperative sexual distress. HT may be associated with improved sexual function after surgery.
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12
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Abildgaard J, Ahlström MG, Nielsen DL, Daugaard G, Lindegaard B, Obel N, Lidegaard Ø. Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study. Psychooncology 2020; 29:655-662. [PMID: 31733110 DOI: 10.1002/pon.5290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/09/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association between prophylactic bilateral oophorectomy and use of antidepressants in women with a family history of cancer. METHODS Nationwide population-based cohort study using Danish National Registries including women oophorectomized due to a family history of cancer (n = 2,002) and an age matched reference group (n = 18,018). Analyses were stratified by age at time of bilateral oophorectomy and use of hormone replacement therapy (HRT). RESULTS Women oophorectomized at age ≤ 45 years were more likely to use antidepressants from the first year after bilateral oophorectomy (OR = 1.34; 95 % CI: 1.08-1.65) compared to the reference group. Women oophorectomized at age 46-55 years and at age >55 years had no significantly increased use of antidepressants (OR = 0.90; 95 % CI: 0.68-1.18 and OR = 1.14; 95 % CI: 0.81-1.61). The increased use of antidepressants in women oophorectomized at age ≤ 45 years was limited to women treated with HRT (OR = 1.51; 95 % CI: 1.18-1.94) whereas women oophorectomized at age ≤ 45 years not treated with HRT had no increased use of antidepressants (OR = 1.03; 95 % CI: 0.70-1.51). CONCLUSIONS Women oophorectomized due to a family history of cancer at age ≤ 45 years were more likely to use antidepressants after bilateral oophorectomy. The increased use of antidepressants was limited to women treated with HRT. The study calls for further large-scale studies to understand how bilateral oophorectomy and concomitant HRT affects risk of depression in women with a family history of cancer.
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Affiliation(s)
- Julie Abildgaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorte Lisbeth Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Gedske Daugaard
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of GynecologyRigshospitalet, University of Copenhagen, Denmark
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13
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Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020; 8:231-241. [PMID: 31928932 DOI: 10.1016/j.sxmr.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/24/2019] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Genetic testing for germline cancer mutations allows individuals to gain specific knowledge of their hereditary cancer risks. Although risk-reducing strategies such as increased screening, prophylactic surgeries, and chemoprevention may be potentially lifesaving, these options can also significantly impact sexual health and function. AIM This study overviews current challenges at the intersection of cancer genetic testing and sexual health and describes a systematic review that summarizes this evidence, identifies methodological limitations, and provides future research directions. METHODS Articles on the intersection of genetic testing and/or family history of cancer, cancer risk, and sexual health were searched in Medline, PsycINFO, and PsycARTICLES databases. MAIN OUTCOME MEASURE The main outcome measure was sexual health in women who pursued risk-reducing surgery. RESULTS On the basis of the inclusion criteria, 32 studies were reviewed. 31 contained empiric data from 3,367 participants; one was a conceptual study. All studies were published between 2000 and 2019. Mean ages ranged from 38 to 51.2. CONCLUSION Given the prevalence of sexual dysfunction after risk-reducing surgery, evidence-based interventions are needed. Furthermore, quality of life that includes sexual health, in at-risk women who pursue preventive surgery, remains an understudied aspect of cancer genetic testing. Yusufov M, Bober SL. Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020;8:231-241.
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14
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Mai PL, Huang HQ, Wenzel LB, Han PK, Moser RP, Rodriguez GC, Boggess J, Rutherford TJ, Cohn DE, Kauff ND, Phillips KA, Wilkinson K, Wenham RM, Hamilton C, Powell MA, Walker JL, Greene MH, Hensley ML. Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study. Gynecol Oncol 2020; 156:131-139. [PMID: 31759774 PMCID: PMC6980744 DOI: 10.1016/j.ygyno.2019.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) and ovarian cancer screening (OCS) are management options for women at increased risk of ovarian cancer. Long-term effects of these interventions on quality of life (QOL) are not well understood. METHODS GOG-0199 is a prospective cohort study of women at increased ovarian cancer risk who chose either RRSO or OCS as their risk management intervention. At study entry, 6, 12, 24 and 60 months of follow-up, participants completed the QOL questionnaire, which included the Medical Outcome Study Short Form-36, the Impact of Events Scales, the Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory, the Functional Assessment of Cancer Therapy - Endocrine Subscale, and the Sexual Activity Questionnaire. QOL measures were compared between the RRSO and OCS cohort at baseline and over time. RESULTS Five-hundred-sixty-two participants in the RRSO cohort and 1,010 in the OCS completed the baseline and at least one follow-up questionnaire. At baseline, participants selecting RRSO reported lower health-related QOL (HRQOL), greater ovarian cancer-related stress, greater anxiety, and more depressive symptomatology, which improved during follow-up, especially for ovarian cancer-related stress. Screening was not found to adversely impact HRQOL. Hormone-related menopausal symptoms worsened and sexual functioning declined during follow-up in both cohorts, but more so among participants who underwent RRSO. CONCLUSIONS HRQOL improved after surgery among women who chose RRSO and remained stable among participants undergoing screening. The adverse effects of RRSO and screening on short-term and long-term sexual activity and sexual functioning warrant consideration in the decision-making process for high-risk women.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850-9772, USA.
| | - Helen Q Huang
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY, 14263-0001, USA.
| | - Lari B Wenzel
- Center for Health Policy Research, University of California, Irvine, Irvine CA, 92697, USA.
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, 04101, USA.
| | - Richard P Moser
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20850-9761, USA.
| | - Gustavo C Rodriguez
- Division of Gynecologic Oncology, North Shore University Health System; Evanston, IL, 60201, USA.
| | - John Boggess
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill; Raleigh NY 27607, USA.
| | | | - David E Cohn
- Ohio State University, Columbus Cancer Council; GYN Oncology; Columbus, OH, 43026, USA.
| | - Noah D Kauff
- Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center; Surgery Department; New York, NY, 10065, USA.
| | - Kelly-Anne Phillips
- Peter MacCallum Cancer Centre, Division of Cancer Medicine, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, 300 AU, Australia.
| | - Kelly Wilkinson
- University of Mississippi Medical Center, Dept. of Hematology/Oncology, Jackson, MS, 39216, USA.
| | - Robert M Wenham
- H. Lee Moffitt Cancer Center & Research Institute, Gynecology Oncology Division; Tampa, FL, 33612-9497, USA.
| | - Chad Hamilton
- Walter Reed Army Medical Center, Bethesda, MD, 20889, USA.
| | - Matthew A Powell
- Washington University School of Medicine, Saint Louis, MO, 63110, USA.
| | - Joan L Walker
- Stephenson Cancer Center, Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850-9772, USA.
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, 10065, USA.
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Stanisz M, Panczyk M, Kurzawa R, Grochans E. The Effect of Prophylactic Adnexectomy on the Quality of Life and Psychosocial Functioning of Women with the BRCA1/BRCA2 Mutations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244995. [PMID: 31818005 PMCID: PMC6950418 DOI: 10.3390/ijerph16244995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
The main purpose of this study was to analyze the effect of risk-reducing salpingo-oophorectomy (RRSO) on the quality of life (QoL) and psychosocial functioning of patients with the BRCA1/BRCA2 mutations. This survey-based study was conducted using the Blatt-Kupperman Index, the Women’s Health Questionnaire, the Perceived Stress Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory-II, and the authors’ questionnaire. All calculations were done using Statistica 13.3. The QoL after RRSO was statistically significantly lower in most domains compared with the state before surgery. The greatest decline in the QoL was observed in the vasomotor symptoms domain (d = 0.953) and the smallest in the memory/concentration domain (d = 0.167). We observed a statistically significant decrease in the level of anxiety as a state (d = 0.381), as well as a statistically significant increase in the severity of climacteric symptoms (d = 0.315) and depressive symptoms (d = 0.125). Prophylactic surgeries of the reproductive organs have a negative effect on the QoL and psychosocial functioning of women with the BRCA1/2 mutations, as they increase the severity of depressive and climacteric symptoms. At the same time, these surgeries reduce anxiety as a state, which may be associated with the elimination of cancerophobia.
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Affiliation(s)
- Marta Stanisz
- Department of Gynecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.S.); (R.K.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Rafał Kurzawa
- Department of Gynecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.S.); (R.K.)
- Center of Gynecology and Treatmemt for Infertility “Vitrolive”, al. Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin; ul. Żołnierska 48, 71-210 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-4800-910
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16
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Powell CB, Alabaster A, Le A, Stoller N, Armstrong MA, Raine‐Bennett T. Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations. Psychooncology 2019; 29:331-338. [DOI: 10.1002/pon.5253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/13/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022]
Affiliation(s)
- C. Bethan Powell
- Kaiser Permanente Northern California Gynecologic Cancer Program California United States of America
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Amy Alabaster
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Amy Le
- Kaiser Permanente Ob/Gyn Residency Program California United States of America
| | - Nicole Stoller
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Mary Anne Armstrong
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Tina Raine‐Bennett
- Division of Research Kaiser Permanente Northern California California United States of America
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA-mutation carriers following risk-reducing surgery. Cochrane Database Syst Rev 2019; 10:CD012894. [PMID: 31595976 PMCID: PMC6784162 DOI: 10.1002/14651858.cd012894.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Women who carry a pathogenic mutation in either a BRCA1 DNA repair associated or BRCA2 DNA repair associated (BRCA1 or BRCA2) gene have a high lifetime risk of developing breast and tubo-ovarian cancer. To manage this risk women may choose to undergo risk-reducing surgery to remove breast tissue, ovaries, and fallopian tubes. Surgery should increase survival, but can impact women's lives adversely at the psychological and psychosexual levels. Interventions to facilitate psychological adjustment and improve quality of life post risk-reducing surgery are needed. OBJECTIVES To examine psychosocial interventions in female BRCA carriers who have undergone risk-reducing surgery and to evaluate the effectiveness of such interventions on psychological adjustment and quality of life. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase via Ovid, CINAHL, PsycINFO, Web of Science up to April 2019 and Scopus up to January 2018. We also handsearched abstracts of scientific meetings and other relevant publications. SELECTION CRITERIA We included randomised controlled trials (RCT), non-randomised studies (NRS), prospective and retrospective cohort studies and interventional studies using baseline and postintervention analyses in female BRCA carriers who have undergone risk-reducing surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility studies for inclusion in the review. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We screened 4956 records from the searches, selecting 34 unique studies for full-text scrutiny, of which two met the inclusion criteria: one RCT and one NRS. The included studies assessed 113 female BRCA carriers who had risk-reducing surgery, but there was attrition, and outcome data were not available for all participants at final study assessments. We assessed the RCT as at a high risk of bias whilst the NRS did not have a control group. Our GRADE assessment of the studies was very low-certainty due to the paucity of data and methodological shortcomings of the studies. The primary outcome of quality of life was only measured in the RCT and that was specific to the menopause. Both studies reported on psychological distress and sexual function. Neither study measured body image, perhaps because this is most often associated with risk-reducing mastectomy rather than oophorectomy.The RCT (66 participants recruited with 48 followed to 12 months) assessed the short- and long-term effects of an eight-week mindfulness-based stress reduction (MBSR) training programme on quality of life, sexual functioning, and sexual distress in female BRCA carriers (n = 34) in a specialised family cancer clinic in the Netherlands compared to female BRCA carriers (n = 32) who received usual care. Measurements on the Menopause-Specific Quality of Life Questionnaire (MENQOL) showed some improvement at 3 and 12 months compared to the usual care group. At 3 months the mean MENQOL scores were 3.5 (95% confidence interval (CI) 3.0 to 3.9) and 3.8 (95% CI 3.3 to 4.2) for the MBSR and usual care groups respectively, whilst at 12 months the corresponding values were 3.6 (95% CI 3.1 to 4.0) and 3.9 (95% CI 3.5 to 4.4) (1 study; 48 participants followed up at 12 months). However, these results should be interpreted with caution due to the very low-certainty of the evidence, where a lower score is better. Other outcome measures on the Female Sexual Function Index and the Female Sexual Distress Scale showed no significant differences between the two groups. Our GRADE assessment of the evidence was very low-certainty due to the lack of blinding of participants and personnel, attrition bias and self-selection (as only one-third of eligible women chose to participate in the study) and serious imprecision due to the small sample size and wide 95% CI.The NRS comprised 37 female BRCA carriers selected from three Boston-area hospitals who had undergone a novel sexual health intervention following risk-reducing salpingo-oophorectomy (RRSO) without a history of tubo-ovarian cancer. The intervention consisted of targeted sexual-health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counselling. This was a single-arm study without a control group. Our GRADE assessment of the evidence was very low-certainty, and as there was no comparison group in the included study, we could not estimate a relative effect. The study reported change in psychosexual adjustment from baseline to postintervention (median 2.3 months) using measures of Female Sexual Function Index (n = 34), which yielded change with a mean of 3.91, standard deviation (SD) 9.12, P = 0.018 (1 study, 34 participants; very low-certainty evidence). The Brief Symptom Inventory, Global Severity Index yielded a mean change of 3.92, SD 5.94, P < 0.001. The Sexual Self-Efficacy Scale yielded change with a mean of 12.14, SD 20.56, P < 0.001. The Sexual Knowledge Scale reported mean change of 1.08, SD 1.50, P < 0.001 (n = 36). Participant satisfaction was measured by questionnaire, and 100% participants reported that they enjoyed taking part in the psychoeducation group and felt "certain" or "very certain" that they had learned new skills to help them cope with the sexual side effects of RRSO. AUTHORS' CONCLUSIONS The effect of psychosocial interventions on quality of life and emotional well-being in female BRCA carriers who undergo risk-reducing surgery is uncertain given the very low methodological quality in the two studies included in the review. The absence of such interventions highlights the need for partnership between researchers and clinicians in this specific area to take forward the patient-reported outcomes and develop interventions to address the psychosocial issues related to risk-reducing surgery in female BRCA carriers, particularly in this new era of genomics, where testing may become more mainstream and many more women are identified as gene carriers.
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Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
| | - Joanne Reid
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Donna Fitzsimons
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
- Queen's University BelfastCentre for Cancer Research and Cell Biology97 Lisburn RoadBelfastUKBT9 7AE
| | - Martin Dempster
- Queen's University BelfastSchool of PsychologyUniversity RoadBelfastNorthern IrelandUKBT7 1NN
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Toss A, Molinaro E, Sammarini M, Del Savio MC, Cortesi L, Facchinetti F, Grandi G. Hereditary ovarian cancers: state of the art. Minerva Med 2019; 110:301-319. [DOI: 10.23736/s0026-4806.19.06091-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Jacobson M, Bernardini M, Sobel ML, Kim RH, McCuaig J, Allen L. No. 366-Gynaecologic Management of Hereditary Breast and Ovarian Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1497-1510. [DOI: 10.1016/j.jogc.2018.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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20
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Jacobson M, Bernardini M, Sobel ML, Kim RH, McCuaig J, Allen L. No 366 - Prise en charge gynécologique du cancer du sein et de l'ovaire héréditaire. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1511-1527. [DOI: 10.1016/j.jogc.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Budiana ING, Angelina M, Pemayun TGA. Ovarian cancer: Pathogenesis and current recommendations for prophylactic surgery. J Turk Ger Gynecol Assoc 2018; 20:47-54. [PMID: 30362670 PMCID: PMC6501866 DOI: 10.4274/jtgga.galenos.2018.2018.0119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ovarian cancer is one of the most common gynecologic cancers, and one of the leading causes of cancer-associated female mortality in the world. Currently, no widely accepted pathogenesis is available, which may explain the entire disease. Early detection and primary prevention of ovarian cancer are difficult, mostly due to its heterogeneous nature. Risk factor modification based on epidemiologic data has not significantly reduced the incidence of ovarian cancer. Currently, prophylactic surgical methods have been proposed as the most effective preventive measures for both the high-risk or low-risk populations. Understanding the existing pathogenesis theories and the surgical options available may alter physician’s perspectives and facilitate better decision making.
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Affiliation(s)
- I Nyoman Gede Budiana
- Department of Obstetrics and Gynecology, Udayana University Sanglah General Hospital Faculty of Medicine, Bali, Indonesia
| | - Michelle Angelina
- Department of Obstetrics and Gynecology, Udayana University Sanglah General Hospital Faculty of Medicine, Bali, Indonesia
| | - Tjokorda Gede Astawa Pemayun
- Department of Obstetrics and Gynecology, Udayana University Sanglah General Hospital Faculty of Medicine, Bali, Indonesia
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Arts-de Jong M, DeJong CAJ, Hermens RP, Kissane DW, Massuger LM, Hoogerbrugge N, Prins JB, deHullu JA. High demoralization in a minority of oophorectomized BRCA1/2 mutation carriers influences quality of life. J Psychosom Obstet Gynaecol 2018; 39:96-104. [PMID: 28279121 DOI: 10.1080/0167482x.2017.1296429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Demoralization is a relatively neglected issue in which low morale and poor coping result from a stressor such as familial cancer risk. Female BRCA1/2 mutation carriers are highly susceptible for developing breast and ovarian cancer. The aim of this study was to evaluate demoralization in oophorectomized BRCA1/2 mutation carriers and its relation to quality of life. METHODS This cross-sectional study examined 288 oophorectomized BRCA1/2 mutation carriers using the following standardized self-report measures: Demoralization Scale, EORTC Quality of Life Questionnaire-C30, State-Trait Anxiety Inventory and the Cancer Worry Scale. RESULTS The mean score on the Demoralization Scale was 17.8 (SD 14.0). A clinically significant level of demoralization, defined as a score ≥30, was found in 45 BRCA1/2 mutation carriers (16%). Being highly demoralized was associated with a significantly lower quality of life, and higher levels of physical problems, anxiety and cancer worries. No demographic or clinical factors could predict higher levels of demoralization. CONCLUSIONS Our findings established that a clear proportion of oophorectomized BRCA1/2 mutation carriers experience demoralization impacting on their well-being. Further research is needed to explore the natural trajectory of demoralization and the resultant need for support in these women.
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Affiliation(s)
- Marieke Arts-de Jong
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cor A J DeJong
- b Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Rosella P Hermens
- c Scientific Institute for Quality of Health Care, Radboud University Medical Center , Nijmegen , The Netherlands
| | - David W Kissane
- d Department of Psychiatry, School of Clinical Sciences at Monash Health , Monash University , Clayton , Victoria , Australia
| | - Leon M Massuger
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nicoline Hoogerbrugge
- e Department of Human Genetics , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Judith B Prins
- f Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Joanne A deHullu
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
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Perspectives and decision-making about menopausal therapies in women who had bilateral oophorectomy. Menopause 2018; 25:795-802. [PMID: 29381661 DOI: 10.1097/gme.0000000000001069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to explore the process of decision-making about menopausal treatments in women who have had surgical menopause as a result of bilateral oophorectomy (≤50 y). METHODS We used a descriptive qualitative research design. Women who had a surgical menopause were purposefully selected from the Edmonton Menopause Clinics. Focus groups were held, each with six to nine participants. All sessions were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULTS We conducted five focus groups from June 30 to July 21, 2016 (N = 37). One-third of the women had the surgery within the last 5 years. Almost all women had a concurrent hysterectomy (97%) and were current users of hormone therapy (70%). Four main themes identified were "perceptions of surgical menopause," "perceptions of received support," "being my own advocate," and "concept of adequate support." Women shared that the experience was worse than their expectations and did not believe they were given adequate support to prepare them to make therapy decisions. Women had to "be their own advocates" and seek support from within the healthcare system and outside to cope with their health issues. To make an informed decision about treatments postsurgery, women expressed a need to learn more about the symptoms of surgical menopause, treatment options, resources, avenues for support, and stories of similar experiences, preferably before the surgery. CONCLUSIONS We identified several modifiable deterrents to decision-making in early surgical menopause which can help inform the development of a patient decision aid for this context.
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Altman AM, Hui JYC, Tuttle TM. Quality-of-life implications of risk-reducing cancer surgery. Br J Surg 2018; 105:e121-e130. [DOI: 10.1002/bjs.10725] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 01/15/2023]
Abstract
Abstract
Background
Modern advances in genetic sequencing techniques have allowed for increased availability of genetic testing for hereditary cancer syndromes. Consequently, more people are being identified as mutation carriers and becoming aware of their increased risk of malignancy. Testing is commonplace for many inheritable cancer syndromes, and with that comes the knowledge of being a gene carrier for some patients. With increased risk of malignancy, many guidelines recommend that gene carriers partake in risk reduction strategies, including risk-reducing surgery for some syndromes. This review explores the quality-of-life consequences of genetic testing and risk-reducing surgery.
Methods
A narrative review of PubMed/MEDLINE was performed, focusing on the health-related quality-of-life implications of surgery for hereditary breast and ovarian cancer, familial adenomatous polyposis and hereditary diffuse gastric cancer.
Results
Risk-reducing surgery almost uniformly decreases cancer anxiety and affects patients' quality of life.
Conclusion
Although the overwhelming quality-of-life implications of surgery are neutral to positive, risk-reducing surgery is irreversible and can be associated with short- and long-term side-effects.
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Affiliation(s)
- A M Altman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - J Y C Hui
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - T M Tuttle
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
INTRODUCTION Women with familial cancer syndromes such as hereditary breast and ovarian cancer syndrome (BRCA1 and BRCA2) and Lynch syndrome are at a significantly increased risk of developing ovarian cancer and are advised to undergo prophylactic removal of their ovaries and fallopian tubes at age 35 to 40 years, after childbearing is complete. METHODS A comprehensive literature search of studies on risk-reducing salpingo-oophorectomy (RRSO), sexuality, and associated issues was conducted in MEDLINE databases. RESULTS Risk-reducing salpingo-oophorectomy can significantly impact on a woman's psychological and sexual well-being, with women wishing they had received more information about this prior to undergoing surgery. The most commonly reported sexual symptoms experienced are vaginal dryness and reduced libido. Women who are premenopausal at the time of surgery may experience a greater decline in sexual function, with menopausal hormone therapy improving but not alleviating sexual symptoms. Pharmacological treatments including testosterone patches and flibanserin are available but have limited safety data in this group. CONCLUSIONS Despite the high rates of sexual difficulties after RRSO, patient satisfaction with the decision to undergo surgery remains high. Preoperative counseling with women who are considering RRSO should include discussion of its potential sexual effects and the limitations of menopausal hormone therapy in managing symptoms of surgical menopause.
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Prusty RK, Choithani C, Gupta SD. Predictors of hysterectomy among married women 15-49 years in India. Reprod Health 2018; 15:3. [PMID: 29304867 PMCID: PMC5756367 DOI: 10.1186/s12978-017-0445-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In India, community based studies and media reports indicate a surge in the number of young women undergoing hysterectomy in the past few years. This has led to suspicion on the misuse of procedure, and intense debates on its potential ill health-effects on young women. However, there are no population-based studies that provide insights into hysterectomy prevalence and its determinants at the national level. DATA AND METHODS This study used data from India's District Level Household Survey that involved a sample of 3, 16,361 married women in the age group of 15-49 years spread across 21 States and Union Territories of India. Bivariate and multivariate regression analysis was performed to estimate hysterectomy prevalence and identify its predictors. RESULTS The study estimated hysterectomy prevalence of 17 per 1000 ever married women. The number of women undergoing hysterectomy ranged from 2 to 63/1000 across different states. A little more than one-third of women who had undergone hysterectomy were under the age of 40 years. The proportion of women below 40 years of age who had had hysterectomy was much higher in southern states of Andhra Pradesh (42%) and Telangana (47%). The likelihood of hysterectomy was higher among women belonging to households with health insurance (OR: 1.88, CI: 1.77-2.00) and women who were sterilized (OR 1.55; CI 1.45-1.67) than uninsured and unsterilized women, and lower among women with education level of matriculation and above (OR 0.47; CI 0.42-0.50) than those with no and/or low education. CONCLUSIONS A sizable proportion of young women undergoing hysterectomy in India may have severe ill-health effects on their physical, reproductive and socio-psycho health. As women with low or no education are also more prone to hysterectomy, providing more information and education to them on the possible after-effects of hysterectomy and alternative options will enable them to make more informed choices.
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Affiliation(s)
- Ranjan Kumar Prusty
- IIHMR University, 1, Prabhu Dayal Marg, Sanganer Airport, Jaipur, 302 029 India
| | - Chetan Choithani
- IIHMR University, 1, Prabhu Dayal Marg, Sanganer Airport, Jaipur, 302 029 India
| | - Shiv Dutt Gupta
- IIHMR University, 1, Prabhu Dayal Marg, Sanganer Airport, Jaipur, 302 029 India
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Howell A, Ashcroft L, Fallowfield L, Eccles DM, Eeles RA, Ward A, Brentnall AR, Dowsett M, Cuzick JM, Greenhalgh R, Boggis C, Motion J, Sergeant JC, Adams J, Evans DG. RAZOR: A Phase II Open Randomized Trial of Screening Plus Goserelin and Raloxifene Versus Screening Alone in Premenopausal Women at Increased Risk of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:58-66. [PMID: 29097444 DOI: 10.1158/1055-9965.epi-17-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/16/2017] [Accepted: 10/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Ovarian suppression in premenopausal women is known to reduce breast cancer risk. This study aimed to assess uptake and compliance with ovarian suppression using the luteinizing hormone releasing hormone (LHRH) analogue, goserelin, with add-back raloxifene, as a potential regimen for breast cancer prevention.Methods: Women at ≥30% lifetime risk breast cancer were approached and randomized to mammographic screening alone (C-Control) or screening in addition to monthly subcutaneous injections of 3.6 mg goserelin and continuous 60 mg raloxifene daily orally (T-Treated) for 2 years. The primary endpoint was therapy adherence. Secondary endpoints were toxicity/quality of life, change in bone density, and mammographic density.Results: A total of 75/950 (7.9%) women approached agreed to randomization. In the T-arm, 20 of 38 (52%) of women completed the 2-year period of study compared with the C-arm (27/37, 73.0%). Dropouts were related to toxicity but also the wish to have established risk-reducing procedures and proven chemoprevention. As relatively few women completed the study, data are limited, but those in the T-arm reported significant increases in toxicity and sexual problems, no change in anxiety, and less cancer worry. Lumbar spine bone density declined by 7.0% and visually assessed mammographic density by 4.7% over the 2-year treatment period.Conclusions: Uptake is somewhat lower than comparable studies with tamoxifen for prevention with higher dropout rates. Raloxifene may preserve bone density, but reduction in mammographic density reversed after treatment was completed.Impact: This study indicates that breast cancer risk reduction may be possible using LHRH agonists, but reducing toxicity and preventing bone changes would make this a more attractive option. Cancer Epidemiol Biomarkers Prev; 27(1); 58-66. ©2017 AACR.
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Affiliation(s)
- Anthony Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Linda Ashcroft
- Trials Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Diana M Eccles
- Faculty of Medicine, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom
| | - Rosalind A Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Ann Ward
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Adam R Brentnall
- Centre for Cancer Prevention, Queen Mary, University of London, London, United Kingdom
| | - Mitchell Dowsett
- Department of Academic Biochemistry, Institute of Cancer Research, London, United Kingdom
| | - Jack M Cuzick
- Centre for Cancer Prevention, Queen Mary, University of London, London, United Kingdom
| | - Rosemary Greenhalgh
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Caroline Boggis
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jamie Motion
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Judith Adams
- Department of Radiology, University of Manchester, Manchester, United Kingdom
| | - D Gareth Evans
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom.
- Division of Evolution and Genomic Science, Department of Genomic Medicine, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, The University of Manchester, St. Mary's Hospital, Manchester, United Kingdom
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Hormone replacement therapy after risk-reducing salpingo-oophorectomy minimises endocrine and sexual problems: A prospective study. Eur J Cancer 2017; 84:159-167. [PMID: 28818705 DOI: 10.1016/j.ejca.2017.07.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND There has been some doubts raised in earlier studies about the efficacy of hormone replacement therapy (HRT) in reducing endocrine and sexual problems in women who have undergone a risk-reducing salpingo-oophorectomy (RRSO). METHODS In this prospective, observational study, we recruited 178 premenopausal women with a high risk for ovarian cancer. Fifty-seven women opted for RRSO and 121 for gynaecological screening (GS). Women completed questionnaires before surgery (T1) and 3 (T2) and 9 (T3) months post surgery, or at equivalent time points for the GS-group. Menopausal symptoms were assessed with the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES) and sexual functioning with the Sexual Activity Questionnaire (SAQ). Groups were compared using repeated measures mixed effect models for continuous variables, and generalised estimating equations for longitudinal ordered categorical data. RESULTS Twenty-seven women who underwent RRSO used HRT after surgery (HRT-users) and 30 did not (HRT-non-users). There were no significant group differences at baseline on the outcome variables. Compared to the HRT-users, the HRT-non-users exhibited a significant increase in overall endocrine symptoms (p = 0.001, effect size (ES) = -0.40 and p < 0.001, ES = -0.59 at T1 and T2, respectively), and in sexual discomfort (p < 0.001, ES = 0.74 and p < 0.001, ES = 1.17). The effect size provides an indication of the magnitude of the observed group differences. An effect size of 0.50 or greater is generally considered to be clinically relevant. No significant differences over time were observed between the HRT-users and the GS-group on any of the outcomes. CONCLUSION Our results suggest that HRT use in the first year after RRSO has beneficial effects in terms of minimising endocrine symptoms and sexual symptoms in premenopausal women who have undergone RRSO.
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Stabile C, Goldfarb S, Baser RE, Goldfrank DJ, Abu-Rustum NR, Barakat RR, Dickler MN, Carter J. Sexual health needs and educational intervention preferences for women with cancer. Breast Cancer Res Treat 2017; 165:77-84. [PMID: 28547655 PMCID: PMC5515493 DOI: 10.1007/s10549-017-4305-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess sexual/vaginal health issues and educational intervention preferences in women with a history of breast or gynecologic cancer. METHODS Patients/survivors completed a cross-sectional survey at their outpatient visits. Main outcome measures were sexual dysfunction prevalence, type of sexual/vaginal issues, awareness of treatments, and preferred intervention modalities. Descriptive frequencies were performed, and results were dichotomized by age, treatment status, and disease site. RESULTS Of 218 eligible participants, 109 (50%) had a history of gynecologic and 109 (50%) a history of breast cancer. Median age was 49 years (range 21-75); 61% were married/cohabitating. Seventy percent (n = 153) were somewhat-to-very concerned about sexual function/vaginal health, 55% (n = 120) reported vaginal dryness, 39% (n = 84) vaginal pain, and 51% (n = 112) libido loss. Many had heard of vaginal lubricants, moisturizers, and pelvic floor exercises (97, 72, and 57%, respectively). Seventy-four percent (n = 161) had used lubricants, 28% moisturizers (n = 61), and 28% pelvic floor exercises (n = 60). Seventy percent (n = 152) preferred the topic to be raised by the medical team; 48% (n = 105) raised the topic themselves. Most preferred written educational material followed by expert discussion (66%, n = 144/218). Compared to women ≥50 years old (41%, n = 43/105), younger women (54%, n = 61/113) preferred to discuss their concerns face-to-face (p = 0.054). Older women were less interested in online interventions (52%, p < 0.001), despite 94% having computer access. CONCLUSION Female cancer patients/survivors have unmet sexual/vaginal health needs. Preferences for receiving sexual health information vary by age. Improved physician-patient communication, awareness, and educational resources using proven sexual health promotion strategies can help women cope with treatment side effects.
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MESH Headings
- Adult
- Aged
- Cross-Sectional Studies
- Female
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/epidemiology
- Genital Neoplasms, Female/psychology
- Genital Neoplasms, Female/therapy
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Humans
- Middle Aged
- Needs Assessment
- Patient Education as Topic/methods
- Patient Preference
- Prevalence
- Sexual Behavior
- Sexual Dysfunction, Physiological/diagnosis
- Sexual Dysfunction, Physiological/epidemiology
- Sexual Dysfunction, Physiological/psychology
- Sexual Dysfunction, Physiological/therapy
- Sexual Dysfunctions, Psychological/diagnosis
- Sexual Dysfunctions, Psychological/epidemiology
- Sexual Dysfunctions, Psychological/psychology
- Sexual Dysfunctions, Psychological/therapy
- Sexual Health
- Treatment Outcome
- Vagina/physiopathology
- Young Adult
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Affiliation(s)
- Cara Stabile
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shari Goldfarb
- Breast Cancer Medicine Service, Department of Medicine - Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah J Goldfrank
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Richard R Barakat
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Maura N Dickler
- Breast Cancer Medicine Service, Department of Medicine - Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jeanne Carter
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
- Female Sexual Medicine and Women's Health, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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The management of sexuality, intimacy, and menopause symptoms (SIMS) after prophylactic bilateral salpingo-oophorectomy: How to maintain sexual health in "previvors". Maturitas 2017; 105:46-51. [PMID: 28602465 DOI: 10.1016/j.maturitas.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 01/23/2023]
Abstract
"Previvors", or "pre-survivors", are individuals who do not have cancer but have a genetic predisposition to cancer. One such example is women with BRCA mutations. As a result of their predisposition to cancer, many will undergo a bilateral salpingo-oophorectomy when they are premenopausal. For premenopausal women, the removal of ovaries results in the depletion of estrogen, immediate menopause, and, in many cases, resultant Sexuality, Intimacy, and Menopausal Symptoms (SIMS). Furthermore, they may undergo changes in body image. SIMS are underreported by patients and underdiagnosed by practitioners. At the time of diagnosis or at preoperative visits, women should be informed of the potential physiologic, hormonal, and psychosocial effects of their risk-reducing surgery. There are many modalities for management of these symptoms. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it.
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Etchegary H, Dicks E, Tamutis L, Dawson L. Quality of life following prophylactic gynecological surgery: experiences of female Lynch mutation carriers. Fam Cancer 2017; 17:53-61. [DOI: 10.1007/s10689-017-9997-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Mai PL, Piedmonte M, Han PK, Moser RP, Walker JL, Rodriguez G, Boggess J, Rutherford TJ, Zivanovic O, Cohn DE, Thigpen JT, Wenham RM, Friedlander ML, Hamilton CA, Bakkum-Gamez J, Olawaiye AB, Hensley ML, Greene MH, Huang HQ, Wenzel L. Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 145:122-129. [PMID: 28190649 PMCID: PMC5359045 DOI: 10.1016/j.ygyno.2017.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. METHODS Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. RESULTS Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p<0.0001), more likely to carry deleterious BRCA1/2 mutations (p<0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as >50%, both higher than objective risk estimates. CONCLUSIONS Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States.
| | - Marion Piedmonte
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME 04101, United States.
| | - Richard P Moser
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States.
| | - Joan L Walker
- Stephenson Cancer Center, Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
| | - Gustavo Rodriguez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL 60201, United States.
| | - John Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC 27514, United States.
| | - Thomas J Rutherford
- Gynecologic Oncology, Yale University School of Medicine, New Haven, CT 06520, United States.
| | - Oliver Zivanovic
- Innovative Surgical Technology, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, United States.
| | - J Tate Thigpen
- Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| | - Robert M Wenham
- Department of Gynecologic Oncology, Program of Chemical Biology and Molecular Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
| | | | - Chad A Hamilton
- Gynecologic Cancer Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States.
| | - Jamie Bakkum-Gamez
- Department of GYN Surgery, Mayo Clinic, Rochester, MN 55905, United States.
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15143, United States.
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, United States.
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States.
| | - Helen Q Huang
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Lari Wenzel
- Center for Health Policy Research, University of California, Irvine, Irvine, CA 92697, United States.
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Vermeulen RFM, Beurden MV, Korse CM, Kenter GG. Impact of risk-reducing salpingo-oophorectomy in premenopausal women. Climacteric 2017; 20:212-221. [PMID: 28509627 DOI: 10.1080/13697137.2017.1285879] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe implications of premenopausal risk-reducing salpingo-oophorectomy (RRSO) on quality of life, endocrine symptoms, sexual function, osteoporosis, cardiovascular health, metabolic syndrome, cognitive impairment and safety of hormone replacement therapy. METHODS We searched the following electronic databases: The Cochrane Library, EMBASE, PsycInfo, and MEDLINE. We selected controlled and uncontrolled trials of premenopausal women undergoing RRSO. Two authors independently assessed studies for inclusion. Reference lists of included reports were searched manually for additional studies. RESULTS Surgical menopause leads to more menopausal complaints and sexual dysfunction than natural menopause. Overall quality of life is not affected by surgery. In the limited literature, there is no evidence that RRSO leads to more osteopenia in comparison with natural menopause at a young age. Cohort studies show a slight impaired cardiovascular health. Cognitive function decreases later in life in premenopausal oophorectomized women. Short-term hormone replacement therapy seems to decline postmenopausal complaints and does not seem to increase the risk for breast carcinoma in mutation carriers without a personal history of breast carcinoma. CONCLUSIONS The conclusions of this systematic review are limited by the absence of randomized, controlled trials. There is growing evidence from observational studies that RRSO may impact negatively on all-cause non-survival endpoints.
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Affiliation(s)
- R F M Vermeulen
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - M van Beurden
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Center for Gynecologic Oncology Amsterdam , Amsterdam , The Netherlands
| | - C M Korse
- b Department of Clinical Chemistry , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - G G Kenter
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Center for Gynecologic Oncology Amsterdam , Amsterdam , The Netherlands
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BRCA mutation genetic testing implications in the United States. Breast 2016; 31:224-232. [PMID: 27931006 DOI: 10.1016/j.breast.2016.11.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 12/14/2022] Open
Abstract
BRCA mutation carriers have a very high risk of breast and ovarian cancer by age 70, in the ranges 47%-66% and 40%-57%, respectively. Additionally, women with BRCA mutation-associated breast cancer also have an elevated risk of other or secondary malignancies. Fortunately, the breast and ovarian cancer outcome for BRCA1/2 mutation carriers is at least as good as for non-carriers with chemoprevention, prophylactic surgeries and appropriate use of therapies. Therefore, identification of those who might have a mutation is important so that genetic counseling, testing, screening and prevention strategies can be applied in a timely manner. This article reviews the impact of genetic testing in general, timing of genetic testing after diagnosis and prior knowledge of mutation status in BRCA carriers with newly diagnosed breast cancer. Additionally, risk-reducing surgeries including the prophylactic contralateral mastectomy, and bilateral salpingo-oophorectomy and the sensitivity of BRCA-defective breast cancer cell lines to differential chemotherapeutic agents will be discussed.
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Discussing Sexuality With Women Considering Risk-Reducing Salpingo-oophorectomy: An International Survey of Current Practice in Gynecologic Oncology. Int J Gynecol Cancer 2016; 26:1338-44. [DOI: 10.1097/igc.0000000000000750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
ObjectiveTo determine how frequently gynecologic oncologists discuss sexuality with women considering risk-reducing salpingo-oophorectomy. Secondary objectives were to assess the availability of resources, and the barriers to discussing sexuality.MethodsMembers of the Australian Society of Gynaecologic Oncologists, International Gynecologic Cancer Society, and Society of Gynecologic Oncology were invited to complete an online survey. Questions addressed frequency of, and barriers to, discussing sexuality, and availability of resources related to sexual issues.ResultsThree hundred eighty-eight physicians in 43 countries responded from 4,006 email invitations (9.7%). Ninety-one percent reported discussing sexuality preoperatively, and 61% discuss it with every patient. Factors associated with higher rates of discussion were female sex (P = 0.020), higher level of training (P = 0.003), time in practice (P = 0.003), and consulting more risk-reducing salpingo-oophorectomy patients per month (P = 0.006). Commonly discussed issues were vasomotor menopausal symptoms (91%) and vaginal dryness (85%). Eighty-eight percent of respondents believed that sexuality should be discussed preoperatively, and most felt that it is their responsibility (82%). Fear of causing distress was the most common barrier to discussing sexuality (49%). Twenty-four percent felt that they did not have adequate training to discuss sexual function.ConclusionsAlthough most respondents believed that discussing sexuality should occur preoperatively, only 61% discuss this with every patient. Resources specifically relating to sexuality are limited. The most common barrier to discussing sexuality was fear of causing distress. Nearly one quarter of gynecologic oncologists felt inadequately trained to discuss sexual function.
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Tran G, Helm M, Litton J. Current Approach to Breast Cancer Risk Reduction for Women with Hereditary Predispositions to Breast Cancer. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Podfigurna-Stopa A, Czyzyk A, Grymowicz M, Smolarczyk R, Katulski K, Czajkowski K, Meczekalski B. Premature ovarian insufficiency: the context of long-term effects. J Endocrinol Invest 2016; 39:983-90. [PMID: 27091671 PMCID: PMC4987394 DOI: 10.1007/s40618-016-0467-z] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 04/04/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Premature ovarian insufficiency (POI) is defined as the cessation of the ovarian function before the age of 40 years. POI aetiology may be related to iatrogenic or endogenous factors and in many cases remains unclear. The aim of this review was to characterize the long-term consequences of POI. METHODS The available literature regarding the long-term consequences of POI from MEDLINE has been reviewed. RESULTS Lack of ovarian steroids synthesis has serious consequences for women's health. The short-term effects are similar to spontaneous menopause and refer mainly to the climacteric syndrome. In a longer perspective, POI affects a variety of aspects. It obviously and drastically reduces the chances for spontaneous pregnancies. Oestrogen loss leads also to urogenital atrophy. The most common urogenital symptoms include vaginal dryness, vaginal irritation and itching. The urogenital atrophy and hypoestrogenism interferes also with sexual functioning. Patients with POI are threatened by a decrease in bone mineral density (BMD). POI women also experience psychological distress and some studies have shown an increased risk of neurodegenerating diseases. Overall, POI women have a shortened life expectancy, mainly due to cardiovascular disease. Some studies have reported a reduced risk of breast cancer in this group of patients. CONCLUSIONS In conclusion there are several well-characterized health risks in POI women. With every patient, an individualized approach is required to properly recognize and prevent these risks.
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Affiliation(s)
- A Podfigurna-Stopa
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - A Czyzyk
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - M Grymowicz
- Department of Gynecological Endocrinology, Warsaw Medical University, Warsaw, Poland
| | - R Smolarczyk
- Department of Gynecological Endocrinology, Warsaw Medical University, Warsaw, Poland
| | - K Katulski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland
| | - K Czajkowski
- II Department of Obstetrics and Gynaecology, Warsaw Medical University, Warsaw, Poland
| | - B Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, ul. Polna 33, Poznan, Poland.
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The effects of pre-operative menopausal status and hormone replacement therapy (HRT) on sexuality and quality of life after risk-reducing salpingo-oophorectomy. Maturitas 2016; 85:42-8. [DOI: 10.1016/j.maturitas.2015.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/06/2023]
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Clinical and Pathological Characteristics of Incidental Diagnostic Early Occult Malignancy After Risk-Reducing Salpingo-Oophorectomy in BRCA Mutation Carriers. Int J Gynecol Cancer 2016; 26:233-9. [DOI: 10.1097/igc.0000000000000624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Hall MJ, Obeid EI, Schwartz SC, Mantia-Smaldone G, Forman AD, Daly MB. Genetic testing for hereditary cancer predisposition: BRCA1/2, Lynch syndrome, and beyond. Gynecol Oncol 2016; 140:565-74. [PMID: 26812021 DOI: 10.1016/j.ygyno.2016.01.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/11/2016] [Accepted: 01/18/2016] [Indexed: 01/07/2023]
Abstract
Obstetrician/gynecologists and gynecologic oncologists serve an integral role in the care of women at increased hereditary risk of cancer. Their contribution includes initial identification of high risk patients, screening procedures like bimanual exam, trans-vaginal ultrasound and endometrial biopsy, prophylaxis via TAH and/or BSO, and chemoprevention. Further, gynecologists also serve a central role in the management of the secondary repercussions of efforts to mitigate increased cancer risks, including vasomotor symptoms, sexual function, bone health, cardiovascular disease, and mental health. The past several years has seen multiple new high and moderate penetrance genes introduced into the clinical care of women at increased risk of gynecologic malignancy. Awareness of these new genes and the availability of new multi-gene panel tests is critical for providers on the front-line of women's health.
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Affiliation(s)
- M J Hall
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States.
| | - E I Obeid
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - S C Schwartz
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States; Department of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - G Mantia-Smaldone
- Department of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - A D Forman
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - M B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA, United States
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Prevalence of sexual dysfunction after risk-reducing salpingo-oophorectomy. Gynecol Oncol 2016; 140:95-100. [DOI: 10.1016/j.ygyno.2015.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 01/23/2023]
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Long-term outcomes of risk-reducing surgery in unaffected women at increased familial risk of breast and/or ovarian cancer. Fam Cancer 2015; 14:105-15. [PMID: 25283514 DOI: 10.1007/s10689-014-9759-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study prospectively investigated long-term psychosocial outcomes for women who opted for risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). Unaffected women from high-risk breast cancer families who had completed baseline questionnaires for an existing study and subsequently underwent RRM and/or RRSO, completed measures of perceived breast and ovarian cancer risk, anxiety, depression, cancer-related anxiety, body image, sexual functioning, menopausal symptoms, use of hormone replacement therapy and decision regret 3 years post-surgery. Outcomes were compared to age- and risk-matched controls. Participants (N = 233) were 17 women who had RRM (39 controls), 38 women who had RRSO (94 controls) and 15 women who had RRM + RRSO (30 controls). Women who underwent RRM and those who underwent RRM + RRSO reported reductions in perceived breast cancer risk and perceived breast and ovarian cancer risk respectively, compared to their respective controls. RRM women reported greater reductions in cancer-related anxiety compared with both controls and RRSO women. RRSO women reported more sexual discomfort than controls and more urogenital menopausal symptoms than controls and RRM only women. No differences in general anxiety, depression or body image were observed. Regret was associated with greater reductions in body image since surgery and more sexual discomfort, although overall regret levels were low. Women who undergo RRM experience psychological benefits associated with reduced breast cancer risk. Although women who undergo RRSO experience some deterioration in sexual and menopausal symptoms, they do not regret their surgery decision. It is vital that women considering these procedures receive detailed information about potential psychosocial consequences.
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Uptake of risk-reducing salpingo-oophorectomy among female BRCA mutation carriers: experience at the National Cancer Center of Korea. J Cancer Res Clin Oncol 2015; 142:333-40. [DOI: 10.1007/s00432-015-2051-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/24/2015] [Indexed: 01/03/2023]
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Abstract
As the testing criteria for BRCA expand, we are identifying a greater number of young women at significant risk for breast and ovarian cancer. Fortunately, there is strong evidence to support risk reduction from mastectomy and oophorectomy. However, these surgeries come with significant psychological and physical health consequences. For breast cancer, screening with mammogram and magnetic resonance imaging may be a reasonable approach for a woman who does not desire surgery. However, there is no evidence to suggest any efficacy in screening for ovarian cancer, and women electing to not undergo surgery must have a detailed discussion with their physician regarding the risks and benefits of different management strategies. As more women are electing to undergo surgical risk reduction, providers must also be able to counsel and care for these women who will face unique health challenges after surgical menopause at a young age. A review of the current evidence behind management of the BRCA woman follows, with a focus on areas of controversy and current research.
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Abstract
In addition to the common symptoms that occur after natural menopause, special considerations apply to women who have had their ovaries removed, particularly when oophorectomy occurs before age 45 years. Women with premenopausal oophorectomy have more severe and prolonged menopausal symptoms. Their risks of adverse mood, heart disease, excessive bone resorption, sexual dysfunction, and cognitive disorders are increased compared with the general population. Retention of the ovaries carries a survival benefit for women at low risk of ovarian malignancy. Women facing oophorectomy should understand the balance of risks and benefits in order to make an informed decision.
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Affiliation(s)
- Maria Rodriguez
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 2622 South Tower, Los Angeles, CA 90048, USA
| | - Donna Shoupe
- Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA.
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Harmsen MG, Hermens RPMG, Prins JB, Hoogerbrugge N, de Hullu JA. How medical choices influence quality of life of women carrying a BRCA mutation. Crit Rev Oncol Hematol 2015; 96:555-68. [PMID: 26299336 DOI: 10.1016/j.critrevonc.2015.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/19/2015] [Accepted: 07/16/2015] [Indexed: 12/24/2022] Open
Abstract
Germline mutations in BRCA1 and BRCA2 genes were discovered twenty years ago. Female BRCA mutation carriers have an increased risk of breast and ovarian cancer at a relatively young age. Several choices have to be made with respect to cancer risk management, and consequences of these choices may affect quality of life. A review of the literature was performed to evaluate quality of life in unaffected BRCA mutation carriers and the influence of these medical choices. Overall, general quality of life appears not to be permanently affected in BRCA mutation carriers or by their choices. Risk-reducing salpingo-oophorectomy and its subsequent premature menopause affect (menopause specific) quality of life most. Hormone replacement therapy does not fully alleviate climacteric symptoms and therefore, there is a strong need for alternative strategies to reduce ovarian cancer risk and/or for improvements in postoperative care. Future research should focus on these needs.
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Affiliation(s)
- Marline G Harmsen
- Department of Obstetrics & Gynaecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics & Gynaecology, Radboud University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Managing symptoms and maximizing quality of life after preventive interventions for cancer risk reduction. Curr Opin Obstet Gynecol 2015; 27:40-4. [DOI: 10.1097/gco.0000000000000146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bober SL, Recklitis CJ, Bakan J, Garber JE, Patenaude AF. Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: effects of a brief, psychosexual intervention. J Sex Med 2014; 12:189-97. [PMID: 25311333 DOI: 10.1111/jsm.12713] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Women at high risk for ovarian cancer due to BRCA1 or BRCA2 mutation or family history are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) after age 35 or completion of childbearing. This potentially life-saving surgery leads to premature menopause, frequently resulting in distressing and unaddressed sexual dysfunction. AIM To pilot a novel sexual health intervention for women with BRCA1/2 mutations who previously underwent RRSO a using a single-arm trial. Feasibility and primary outcomes including sexual dysfunction and psychological distress were assessed. METHODS This single-arm trial included a one-time, half-day educational session comprised of targeted sexual health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counseling. Assessments were completed at baseline and 2 months postintervention. MAIN OUTCOME MEASURE Study end points include feasibility and effectiveness as reported by the participant. RESULTS Thirty-seven women completed baseline and postintervention assessments. At baseline, participants had a mean age of 44.4 (standard deviation [SD] = 3.9) years and mean duration of 3.8 (SD = 2.7) years since RRSO. Overall sexual functioning (P = 0.018), as well as desire (P = 0.003), arousal (P = 0.003), satisfaction (P = 0.028), and pain (P = 0.018), improved significantly. There were significant reductions in somatization (P = 0.029) and anxiety scores (P < 0.001), and, overall, for the Global Severity Index (P < 0.001) of the Brief Symptom Inventory. Sexual self-efficacy and sexual knowledge also improved significantly from baseline to postintervention (both P < 0.001). Women were highly satisfied with the intervention content and reported utilizing new skills to manage sexual dysfunction. CONCLUSIONS This intervention integrates elements of cognitive behavioral therapy with sexual health education to address a much-neglected problem after RRSO. Results from this promising single-arm study provide preliminary data to move toward conducting a randomized, controlled trial.
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Affiliation(s)
- Sharon L Bober
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Yoshimura K, Furuya Y. Changes in ovarian function in premenopausal women with breast cancer undergoing adjuvant TC (docetaxel and cyclophosphamide) chemotherapy during a brief period of amenorrhea around the last chemotherapy cycle. SPRINGERPLUS 2014; 3:352. [PMID: 25077063 PMCID: PMC4112198 DOI: 10.1186/2193-1801-3-352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 11/25/2022]
Abstract
Purpose Docetaxel, a chemotherapeutic agent, induces high rates of transient chemotherapy-induced amenorrhea (CIA) when used as adjuvant chemotherapy for premenopausal women with breast cancer. Clinical laboratory data to assess the hormonal environment implicated in inducing transient CIA was assessed. Methods An observational study was conducted in 35 premenopausal women with hormone-responsive breast cancer who were receiving adjuvant docetaxel/cyclophosphamide (TC) chemotherapy. Serum estradiol and follicular stimulating hormone (FSH) levels were measured at one (n = 6) or two (n = 29) time point(s) around the completion of chemotherapy. Results As early as week 6 after the start of chemotherapy, just before the third TC cycle, serum estradiol levels were invariably suppressed (median of 5.5 pg/ml, n = 15, range <5–18.7 pg/ml) and FSH levels increased (median of 63.9 mIU/ml, range 24.5–127.4 mIU/ml), indicative of ovarian suppression to the menopausal levels. Subsequently, at 9 and 12 weeks, serum estradiol levels were suppressed to a median of 6.6 pg/ml (n = 49, range <5–17.3 pg/ml), while FSH levels were high (median of 66.8 mIU/ml, range 29.2–134.5 mIU/ml). There was a significant Spearman’s correlation (ρ = 0.95, n = 29, p < 0.01) of high serum FSH levels (24.5–134.5 mIU/ml) between two time points of repeated measurements in 29 patients. TC chemotherapy induced rapid ovarian suppression with the formation of a high and stable plateau in serum FSH levels from week 6 to week 12. Conclusions Recovery from transient CIA post-therapy may be partially attributed to high, stable FSH levels that occurred as early as after completion of the second TC chemotherapy cycle.
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Affiliation(s)
- Keiko Yoshimura
- Department of Surgery, Saiseikai Osaka Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012 Japan
| | - Yoshihiko Furuya
- Department of Surgery, Saiseikai Osaka Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012 Japan
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Lorenz T, McGregor B, Swisher E. Relationship satisfaction predicts sexual activity following risk-reducing salpingo-oophorectomy. J Psychosom Obstet Gynaecol 2014; 35:62-8. [PMID: 24693956 PMCID: PMC4117249 DOI: 10.3109/0167482x.2014.899577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Changes in sexual function are a common outcome following risk-reducing salpingo-oophorectomy (RRSO), a prophylactic surgery for women at high risk of ovarian and other gynecologic cancers. Despite the known importance of sexuality in patients' quality of life and satisfaction with surgery, little is known about what predicts sexual activity following RRSO. The present study examined how mental and physical health variables predicted sexual activity before and after RRSO. We conducted a secondary analysis of quality of life measures collected in 85 women at high risk for ovarian cancer. Participants completed validated measures of mental, physical, and relationship health 1-2 weeks before surgery, and 2, 6 and 12 months following surgery. Across analyses, relationship satisfaction emerged as the most significant predictor of change in sexual activity: women with high relationship satisfaction were more likely to continue to have regular sexual activity following RRSO, even in the presence of vaginal menopausal symptoms. The effect of depression, anxiety and overall physical health on sexual activity was non-significant when controlling for relationship satisfaction. When counseling women about RRSO and its impact on sexual activity, clinicians should discuss the effect of the patient's relationship health on this outcome.
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Affiliation(s)
- Tierney Lorenz
- Kinsey Institute, Indiana University, Bloomington, IN, USA
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